Implementing a Fascia Iliaca Compartment Block Curriculum in an Emergency Medicine Residency Program.

With pain being commonly stated as a reason for presentation to the emergency department (ED) and the advent of the opioid crisis in the United States, regional anesthesia has been gaining prominence as an alternative treatment for acute pain in emergency medicine. However, to this date, there is no widely agreed-upon and standardized training regimen for regional anesthesia in emergency medicine residency programs. In this paper, we set out to define elements of competency for a residency program in a large academic tertiary center and to create a protocol for resident training that could be easily replicated, with a secondary goal of increasing the frequency of nerve blocks in the ED. We also aimed to discuss a curriculum that has been shown to improve resident comfortability with the fascia iliaca compartment block (FICB). This led to a substantial increase in nerve blocks performed in the ED. However, we also demonstrate a loss of retention at six months, indicating that further curriculum refinements will be needed to promote longitudinal retention of knowledge.

Developing and testing a comprehensive tool to assess family meetings: Empirical distinctions between high- and low-quality meetings.

BACKGROUND: The heterogeneity with regard to findings on family meetings (or conferences) suggests a need to better understand factors that influence family meetings. While earlier studies have explored frequency or timing of family meetings, little is known about how factors (such as what is said during meetings, how it is said, and by whom) influence family meeting quality. OBJECTIVES: (1) To develop an evaluation tool to assess family meetings (Phase 1); (2) to identify factors that influence meeting quality by evaluating 34 family meetings (Phase 2). MATERIALS AND METHODS: For Phase 1, methods included developing a framework, cognitive testing, and finalizing the evaluation tool. The tool consisted of Facilitator Characteristics (i.e., gender, experience, and specialty of the person leading the meeting), and 22 items across 6 Meeting Elements (i.e., Introductions, Information Exchanges, Decisions, Closings, Communication Styles, and Emotional Support) and sub-elements. For Phase 2, methods included training evaluators, assessing family meetings, and analyzing data. We used Spearman's rank-order correlations to calculate meeting quality. Qualitative techniques were used to analyze free-text. RESULTS: No Facilitator Characteristic had a significant correlation with meeting quality. Sub-elements related to communication style and emotional support most strongly correlated with high-quality family meetings, as well as whether "next steps" were outlined (89.66%) and whether "family understanding" was elicited (86.21%). We also found a significant and strong positive association between overall proportion scores and evaluators' ratings (rs=0.731, p<0.001). CONCLUSIONS: We filled a gap by developing an evaluation tool to assess family meetings, and we identified how what is said during meetings impacts quality.