Evaluating Pharmacy Students' Teamwork Attitudes in Virtual COVID-19 Emergency Department Simulations: A Pilot Study.

OBJECTIVE: This study explores the impact of virtual simulation training on the transformation of teamwork attitudes among pharmacy students in a simulated severe COVID-19 pneumonia scenario in the emergency department. METHODS: From July 2022 to January 2023, 16 pharmacy students, along with other health care students, participated in interprofessional simulation rounds. Each pharmacy student was assigned specific days for participation, using either a 3-dimensional computer or a virtual reality headset to manage a patient with severe COVID-19 pneumonia in the virtual emergency department. The TeamSTEPPS Teamwork Attitudes Questionnaire (T-TAQ) was used for pre- and post-training assessments. RESULTS: The mean baseline T-TAQ score was 119.44 ± 10.63, showing a significant post-training improvement to a mean score of 130.88 ± 8.98 (Hedges' g = 1.52). Stratification by academic year and device type revealed no significant impact on the learning experience. Remarkable enhancements in teamwork attitudes were observed after training, specifically in team structure, situation monitoring, mutual support, and communication domains. CONCLUSION: These findings indicate that virtual simulation training in scenarios such as severe COVID-19 effectively augments teamwork attitudes among pharmacy students, preparing them for collaborative practice in high-stakes emergency medicine settings.

Novel tool for assessing the quality of feedback in the emergency room (FEED-ER).

BACKGROUND: The Accreditation Council for Graduate Medical Education (ACGME) emphasizes constructive feedback as a critical component of residency training. Despite over a decade of using competency-based milestone evaluations, emergency medicine (EM) residency programs lack a standardized method for assessing the quality of feedback. We developed two novel EM-specific feedback surveys to assess the quality of feedback in the ER (FEED-ER) from both the resident and the faculty perspectives. This study aimed to evaluate the surveys' psychometric properties. METHODS: We developed FEED-ER using a Likert scale with faculty and resident versions based on the ACGME framework and a literature review. The preliminary survey consisted of 25 questions involving the feedback domains of timeliness, respect/communication, specificity, action plan, and feedback culture. We conducted two modified Delphi rounds involving 17 content experts to ensure respondent understanding of the items, item coherence to corresponding feedback domains, thematic saturation of domain content, and time duration. A multicenter study was conducted at five university-based EDs in the United States and one in Thailand in 2019. We evaluated the descriptive statistics of the frequency of responses, validity evidence, and reliability of FEED-ER. RESULTS: A total of 147 EM faculty and 126 EM residents completed the survey. Internal consistency was adequate (Cronbach's alpha > 0.70) and test-retest reliability showed adequate temporal stability (ICC > 0.80) for all dimensions. Content validity was deemed acceptable (CVC > 0.80) for all items. From the 25 items of FEED-ER, 23 loaded into the originally theorized dimensions (with factor loadings > 0.50). Additionally, the five feedback domains were found to be statistically distinct, with correlations between 0.40 and 0.60. The final survey has 23 items. CONCLUSIONS: This is the first study to develop and provide validity evidence for an EM-specific feedback tool that has strong psychometric properties, is reproducible and reliable, and provides an objective measure for assessing the quality of feedback in the ED.

Randomized Controlled Trial of Ultrasound-guided Fluid Resuscitation of Sepsis-Induced Hypoperfusion and Septic Shock.

INTRODUCTION: The ultrasound measurement of inferior vena cava (IVC) diameter change during respiratory phase to guide fluid resuscitation in shock patients is widely performed, but the benefit on reducing the mortality of sepsis patients is questionable. The study objective was to evaluate the 30-day mortality rate of patients with sepsis-induced tissue hypoperfusion (SITH) and septic shock (SS) treated with ultrasound-guided fluid management (UGFM) using ultrasonographic change of the IVC diameter during respiration compared with those treated with the usual-care strategy. METHODS: This was a randomized controlled trial conducted in an urban, university-affiliated tertiary-care hospital. Adult patients with SITH/SS were randomized to receive treatment with UGFM using respiratory change of the IVC (UGFM strategy) or with the usual-care strategy during the first six hours after emergency department (ED) arrival. We compared the 30-day mortality rate and other clinical outcomes between the two groups. RESULTS: A total of 202 patients were enrolled, 101 in each group (UGFM vs usual-care strategy) for intention-to-treat analysis. There was no significant difference in 30-day overall mortality between the two groups (18.8% and 19.8% in the usual-care and UGFM strategy, respectively; p > 0.05 by log rank test). Neither was there a difference in six-hour lactate clearance, a change in the sequential organ failure assessment score, or length of hospital stay. However, the cumulative fluid amount given in 24 hours was significantly lower in the UGFM arm. CONCLUSION: In our ED setting, the use of respiratory change of IVC diameter determined by point-of-care ultrasound to guide initial fluid resuscitation in SITH/SS ED patients did not improve the 30-day survival probability or other clinical parameters compared to the usual-care strategy. However, the IVC ultrasound-guided resuscitation was associated with less amount of fluid used.

Physician professionalism: definition from a generation perspective.

OBJECTIVES: The primary objective of this study was to determine whether consensuses on the definition of emergency physician professionalism exist within and among four different generations. Our secondary objective was to describe the most important characteristic related to emergency physician professionalism that each generation values. METHODS: We performed a cross-sectional survey study, using a card-sorting technique, at the emergency departments of two university-based medical centers in the United States. The study was conducted with 288 participants from February to November 2017. Participants included adult emergency department patients, emergency medicine supervising physicians, emergency medicine residents, emergency department nurses, and fourth- and second-year medical students who independently ranked 39 cards that represent qualities related to emergency physician professionalism. We used descriptive statistics, quantitative cultural consensuses and Spearman's correlation coefficients to analyze the data. RESULTS: We found cultural consensuses on emergency physician professionalism in Millennials and Generation X overall, with respect for patients named the most important quality (eigenratio 5.94, negative competency 0%; eigenratio 3.87, negative competency 1.64%, respectively). There were consensuses on emergency physician professionalism in healthcare providers throughout all generations, but no consensuses were found across generations in the patient groups. CONCLUSIONS: While younger generations and healthcare providers had consensuses on emergency physician professionalism, we found that patients had no consensuses on this matter. Medical professionalism curricula should be designed with an understanding of each generation's values concerning professionalism. Future studies using qualitative methods across specialties, to assess definitions of medical professionalism in each generation, should be pursued.

Effect of predischarge blood pressure on follow-up outcomes in patients with severe hypertension in the ED.

BACKGROUND: Although emergency department (ED) patients with asymptomatic severe hypertension (ASH) generally have no serious short-term hypertension-related adverse events, it is unclear whether persistently high discharge blood pressure (BP) affects the outcome due to the dynamic nature of BP. OBJECTIVES: This study aims to investigate the effect of predischarge BP on short-term follow-up results for ED patients with ASH. METHODS: The prospective observational study was performed in the ED of a tertiary care hospital during a 3-month period. Adult patients who had systolic BP ≥180 mm Hg and diastolic BP ≥100 mm Hg without acute end-organ damage were enrolled and treated at the emergency physicians' discretion. Discharge BP was precategorized into severely high and moderately high groups. We compared the groups using direct telephone contact and medical record reviews of follow-up BP within 1 week and identified their related adverse events. RESULTS: One hundred and forty-six eligible cases were identified in this study; 1 patient (0.7%) had a serious hypertension-related adverse event. One hundred and thirteen patients had follow-up BP information available. There was no difference in mean systolic BP and diastolic BP at follow-up between patients who were discharged from the ED with severely high vs moderately high BP. CONCLUSION: Predischarge BP value is not associated with immediate serious adverse events and does not affect short-term BP control in ED patients with ASH. Further study on the need to lower BP during the ED stay and on antihypertensive prescriptions for these patients is required.