Navigating gaps in practice: consensus recommendations for educational and support structures for emergency physicians returning from gaps in practice.

OBJECTIVE: The purpose of this study was to identify the learning needs of emergency physicians returning to Emergency Medicine (EM) practice after clinical leaves of less than 2 years, summarize existing return to practice programs, and propose recommendations regarding ideal educational and support structures for these physicians both during their practice gaps and upon return to EM. METHODS: A multiple-phased study was conducted to establish recommendations regarding ideal educational and support structures for emergency physicians returning from practice gaps of less than 2 years. The overall design involved an initial environmental scan of existing and exemplar programs and regulatory body positions, followed by interviews with EM Department Heads from across Canada, and then subsequent content analysis and recommendation derivation by EM medical education expert group consensus. These summary recommendations were further revised by consensus at the 2022 CAEP conference academic symposium to derive a final set of consensus recommendations. CONCLUSIONS: We have developed a set of recommendations regarding ideal educational and support structures for physicians experiencing gaps in practice of less than 2 years. This set of recommendations was informed by review of existing and exemplar programs, policies and experience of regulatory bodies, interviews with EM Department Heads across Canada, and a subsequent process of consensus at the 2022 CAEP conference academic symposium. It is hoped that this set of recommendations will inform discussions and potential strategies employed by departments to facilitate the smooth and effective return to EM practice for individuals experiencing gaps.

ABSTRAIT: OBJECTIFS: Le but de cette étude était de déterminer les besoins d'apprentissage des médecins d'urgence qui retournent à la pratique de la médecine d'urgence (ME) après des congés cliniques de moins de deux ans, de résumer les programmes de retour à la pratique existants. et de proposer des recommandations concernant les structures de formation et de soutien idéales pour ces médecins, à la fois pendant leurs lacunes dans la pratique et à leur retour à la GU. MéTHODES: Une étude en plusieurs phases a été menée afin d'établir des recommandations concernant les structures de formation et de soutien idéales pour les médecins d'urgence qui reviennent de lacunes de moins de deux ans. La conception globale comprenait une première analyse de l'environnement des programmes existants et exemplaires et des postes d'organismes de réglementation, suivie d'entrevues avec les chefs des services de GU de partout au Canada. et ensuite l'analyse du contenu et la formulation de recommandations par consensus du groupe d'experts en éducation médicale de la SE. Ces recommandations résumées ont été révisées par consensus lors du symposium universitaire de la conférence 2022 de l'ACMU afin d'en arriver à une série finale de recommandations consensuelles. CONCLUSION: Nous avons élaboré une série de recommandations concernant les structures de formation et de soutien idéales pour les médecins qui connaissent des lacunes dans la pratique depuis moins de deux ans. Cette série de recommandations a été éclairée par l'examen des programmes, des politiques et de l'expérience des organismes de réglementation existants et exemplaires, des entrevues avec les chefs des services de GU partout au Canada et un processus subséquent de consensus au symposium universitaire de la conférence 2022 de la CAEP. On espère que cette série de recommandations éclairera les discussions et les stratégies potentielles employées par les ministères pour faciliter le retour en douceur et efficace à la pratique de GU pour les personnes qui connaissent des lacunes.

Emergency Medicine Oral Case Presentations: Evaluation of a Novel Curriculum.

OBJECTIVES: Oral case presentation (OCP) is recognized as a central educational and patient care activity, yet has not been well studied in the emergency medicine (EM) setting. The purpose of this study was to evaluate the effect of a novel curriculum on medical students' EM-OCP skills. METHODS: An EM-OCP assessment tool and novel blended curriculum were developed based on results from a Canadian survey of emergency physicians and focus groups with key stakeholders. We conducted a randomized controlled trial of 96 clerkship students between 2017 and 2018. Students were randomly assigned into an intervention group where they completed a novel EM-OCP curriculum or a control group without the curriculum. A pretest baseline assessment of students' OCP skills was performed using a standardized patient case at the beginning of their EM rotation. Similarly, all students completed a posttest assessment with a different standardized patient case at the end of their 6-week EM rotation. Audio recordings of pre- and posttests were assessed using the EM-OCP assessment tool by two blinded assessors. RESULTS: Using the Kruskal-Wallis test, all students demonstrated improvement in EM-OCP skills between their pretest and posttest; however, those who received the curriculum (intervention group) showed significantly greater improvement in "synthesis of information," "management," and "overall entrustment decision" scores. CONCLUSIONS: Implementation of a novel EM-OCP curriculum resulted in improved clinical reasoning and higher entrustment scores. This curriculum could improve OCP performance not only in EM settings but also across specialties where medical students and residents manage critically ill patients.

Do clinical variables predict an abnormal EEG in patients with complex febrile seizures?

PURPOSE: Febrile seizures are the commonest convulsive event in children younger than 5 years of age (incidence of 2-5%). Electroencephalography (EEG) is not indicated in the work up of simple febrile seizures. Information about its role in the assessment of complex febrile seizures (CFSs) is unclear and EEGs are frequently ordered. This study was designed to assess utility of clinical variables at presentation in predicting the likelihood of an abnormal EEG. METHODS: EEG requisitions, EEG reports, clinic charts and medical records over an 11-year period (1990--2001) were retrospectively reviewed. The relationship between clinical variables like age, timing of the EEG since CFS, family history of seizures, neurological assessment and EEG abnormalities was statistically analyzed. RESULTS: One hundred and seventy-five children were included in the study. Of these 39.43% had EEG abnormalities. Children with a normal EEG were younger than those with an abnormal EEG (mean age 15.72 months versus 19.75 months, p<0.05). Using multivariate analysis, factors predictive of abnormal EEGs in children with CFS were; age >3 years (p=0.010; 95% CI: 1.5--18.8), EEGs performed within 7 days (p=0.00; 95% CI: 1.78--7.12) and an abnormal neurological exam (p=0.053; 95% CI: 0.98--16.9). A family history of febrile seizures was more likely to be associated with a normal EEG (p=0.01; 95% CI: 0.04--0.60). CONCLUSIONS: Clinical variables at presentation can be used to screen children with CFS for whom an EEG is considered. This may lead to better use of resources. Whether abnormal EEG translates to future recurrences or epilepsy needs a prospective study.

Differences in the average single molecule activities of E. coli beta-galactosidase: effect of source, enzyme molecule age and temperature of induction.

Using a capillary electrophoresis-based method, single enzyme molecule assays were performed on E. coli beta-galactosidase from three different sets of samples. The first set consisted of lysates of induced cells from five different strains of the bacteria, as well as two different commercial preparations of the enzyme. These samples were found to have substantially different distributions of single molecule activities. For the second set of samples, beta-galactosidase expression was induced for 1.5 hr, followed by further incubation where expression was repressed. Assays were performed on the lysates of the preinduction and on the lysates from aliquots taken set times postinduction. The recently induced enzyme had a 25% higher average single molecule activity than the basally expressed enzyme. This average activity returned to the basal value 3.5 hr postinduction and remained unchanged thereafter. Finally, beta-galactosidase was induced at 26 and 42 degrees C. The enzyme was assayed before and after partial thermal denaturation. The samples were found to be indistinguishable with respect to their average single molecule activities.