SPIRALS: An Approach to Non-Linear Thinking for Medical Students in the Emergency Department.

Context We lack guidelines to inform the necessary components of an emergency medicine undergraduate rotation. Traditionally, clinical reasoning has been taught using linear thought processes likely not ideal for diagnostic and management decisions made in the emergency department.  Methods We used the Delphi method to obtain consensus on a set of competencies for undergraduate emergency medicine that illustrate the non-linear concepts we believe are necessary for learners. Competencies were informed by a naturalistic observational study of emergency physicians. A survey outlining these competencies was subsequently circulated to emergency physicians who rated their relative importance. Results Eleven competencies were included in Round 1, all rated within the "for consideration" for inclusion range. This was reduced to 10 competencies in Round 2, which was only marginally more definitive with respondents rating one competency in the "definite inclusion range" and the remaining in the "for consideration" range.  Conclusions This study was conducted to address a gap in the current undergraduate emergency medicine curriculum. Consensus on the relative importance of each competency was not achieved, though we believe that the competencies that arose from this study will help medical students develop the non-linear thinking processes necessary to succeed in emergency medicine.

Diagnosis and Management of an Inferior ST-elevation Myocardial Infarction: A Simulation Scenario.

Immediate diagnosis and management of ST-elevation myocardial infarction (STEMI), a condition resulting from the complete occlusion of a coronary artery, is critical to achieving optimal patient outcomes. This report outlines an acute inferior STEMI simulation which can be used for teaching different levels of learner including novice, intermediate and advanced. It focuses on the presentation, diagnosis, and management of inferior myocardial infarctions. Additionally, it incorporates the advanced cardiovascular life support (ACLS) protocol for more advanced learners and uses the CanMEDS collaborator/communicator role as an adjunct objective for all learners.

All-terrain vehicle-related injuries and deaths in Newfoundland and Labrador between 2003 and 2013: a retrospective trauma registry review.

BACKGROUND: Injury and death involving all-terrain vehicles (ATV) has been reported in a number of Canadian provinces. The objective of this study is to describe the frequency, nature, severity, population affected, immediate health costs, efficacy of related legislation, and helmet use in ATV related injuries and deaths in Newfoundland and Labrador (NL). METHODS: A retrospective review of injured or deceased ATV riders of all ages entered in the Newfoundland and Labrador Trauma Registry from 2003 to 2013 was conducted. Variables studied included demographics, injury type and severity, use of helmets, admission/discharge dates, and referring/receiving institution. Data was also obtained from the Newfoundland and Labrador Center for Health Information (NLCHI) and included all in-hospital deaths and hospitalizations due to ATVs between 1995 and 2013. RESULTS: There were a total of 298 patients registered in the trauma registry, resulting in 2759 admission days, nine deaths, and a total estimated immediate healthcare system cost in excess of $1.6 million. More males (N=253, 84.9%) than females (N=45, 15.1%) were injured in ATV related incidents, t(20)=7.12, p<.0001. Head and thorax injuries were the most serious. 38.6% of patients were confirmed to be wearing helmets. Mean injury severity scores are as follows: head injury (M=11, SD=9.51), thorax (M=10, SD=8.3), abdominal/pelvis (M=9, SD=7.62), upper extremity (M=9, SD=8.53), other injuries (M=9, SD=10.56) lower extremity (M=8, SD=8.34), and spine (M=8, SD=6.52). CONCLUSIONS: This study describes ATV related injuries and deaths in NL. Information from this study may guide physician practice, public education, and future legislation.

Can We CanMEDS? Intangible Learning Through Tangible Simulation Case Development.

The Royal College CanMEDS framework has become a guide for medical school curricula. This framework aims to improve patient care by identifying and explaining seven key roles that physicians must fulfill in order to deliver high-quality healthcare to their patients. While medical schools incorporate these roles in their teaching processes, students can also apply them outside the classroom. Here, we describe a unique model developed at Memorial University of Newfoundland's Tuckamore Simulation Research Collaborative (TSRC), where students develop simulation cases with the guidance of expert mentors and apply the Royal College CanMEDS framework to writing clinical simulations.

City mouse, country mouse: a mixed-methods evaluation of perceived communication barriers between rural family physicians and urban consultants in Newfoundland and Labrador, Canada.

OBJECTIVES: To examine perceived communication barriers between urban consultants and rural family physicians practising routine and emergency care in remote subarctic Newfoundland and Labrador (NL). DESIGN: This study used a mixed-methods design. Quantitative and qualitative data were collected through exploratory surveys, comprised of closed and open-ended questions. The quantitative data was analysed using comparative statistical analyses, and a thematic analysis was applied to the qualitative data. PARTICIPANTS: 52 self-identified rural family physicians and 23 urban consultants were recruited via email. Rural participants were also recruited at the Family Medicine Rural Preceptor meetings in St John's, NL. SETTING: Rural family physicians and urban consultants in NL completed a survey assessing perceived barriers to effective communication. RESULTS: Data confirmed that both groups perceived communication difficulties with one another; with 23.1% rural and 27.8% urban, rating the difficulties as frequent (p=0.935); 71.2% rural and 72.2% urban as sometimes (p=0.825); 5.8% rural and 0% urban acknowledged never perceiving difficulties (p=0.714). Overall, 87.1% of participants indicated that perceived communication difficulties impacted patient care. Primary trends that emerged as perceived barriers for rural physicians were time constraints and misunderstanding of site limitations. Urban consultants' perceived barriers were inadequate patient information and lack of native language skills. CONCLUSIONS: Barriers to effective communication are perceived between rural family physicians and urban consultants in NL.

Helicopter Evacuation Following a Rural Trauma: An Emergency Medicine Simulation Scenario Using Innovative Simulation Technology.

The relevance of simulation as a teaching tool for medical professionals working in rural and remote contexts is apparent when low-frequency, high-risk situations are considered. Simulation training has been shown to enhance learning and improve patient outcomes in urban settings. However, there are few simulation scenarios designed to teach rural trauma management during complex medical transportation. In this technical report, we present a scenario using a medevac helicopter (Replica of Sikorsky S-92 designed by Virtual Marine Technology, St. John's, NL) at a rural community. This case can be used for training primary care physicians who are working in a rural or remote setting, or as an innovative addition to emergency medicine and pre-hospital care training programs.

Should I apply to medical school? High school students and barriers to application.

INTRODUCTION: A major goal of the Faculty of Medicine at the Memorial University of Newfoundland is to produce physicians who will return to rural areas that are currently underserviced. Research shows that the strongest indicator of practice in a rural area is a rural background, and thus it is important that rural students apply to medical school. We investigated what high school students believe to be preventing them from pursuing medical education. METHODS: Between September 2013 and June 2014, we administered a paper survey to high school students in Newfoundland and Labrador, New Brunswick and Prince Edward Island. RESULTS: A total of 665 participants completed the survey. We found that fewer rural students (75.6%) than urban students (98.6%) believed that they could gain admission to medical school (p < 0.01) and that medicine was promoted as a career choice in fewer rural schools (55.7%) than urban schools (69.7%). Also, 55.4% of urban students, but only 44.4% of rural students, believed that rural students were disadvantaged when applying to medical school. CONCLUSION: In our study, rural students believed they were less likely to be accepted into medical school than urban students, and fewer rural students felt that medicine was promoted as a potential career choice. Our results may be explained by a lack of role models or perhaps by financial barriers, although further research is needed.

INTRODUCTION: Un des grands objectifs de la Faculté de médecine de l'Université Memorial de Terre-Neuve est de former des médecins qui retourneront exercer dans les zones rurales qui sont actuellement mal desservies. Des études ont démontré que le facteur le plus fortement associé au choix de la pratique en milieu rural est le fait d'y avoir habité; il est donc important que des jeunes ruraux entrent en faculté de médecine. Nous avons demandé à des élèves de niveau secondaire ce qui pourrait les empêcher de poursuivre des études en médecine. MÉTHODES: Entre septembre 2013 et juin 2014, nous avons invité des élèves de Terre- Neuve-et-Labrador, du Nouveau-Brunswick et de l'Île-du-Prince-Édouard à répondre à un sondage papier. RÉSULTATS: Le sondage a été réalisé auprès de 665 répondants. Les élèves en milieu rural (75,6 %) sont moins nombreux que les élèves en milieu urbain (98,6 %) à croire en leurs chances d'être admis en médecine (p < 0,01). De plus, la promotion de la profession médicale à l'école serait moins répandue en milieu rural (55,7 %) qu'en milieu urbain (69,7 %). Finalement, 55,4 % des élèves en milieu urbain et seulement 44,4 % des élèves en milieu rural croient que le milieu représente un frein à l'admission en médecine. CONCLUSION: En résumé, les élèves du milieu rural croient que les citadins sont plus susceptibles d'être admis en médecine, et ils sont moins nombreux à dire que leur école les a encouragés à faire carrière dans ce domaine. Nos résultats pourraient s'expliquer par un manque de modèles ou des contraintes financières; il faudra approfondir la recherche à ce sujet.

Infant Trauma Management in the Emergency Department: An Emergency Medicine Simulation Exercise.

In a trauma situation, it is essential that emergency room physicians are able to think clearly, make decisions quickly and manage patients in a way consistent with their injuries. In order for emergency medicine residents to adequately develop the skills to deal with trauma situations, it is imperative that they have the opportunity to experience such scenarios in a controlled environment with aptly timed feedback. In the case of infant trauma, sensitivities have to be taken that are specific to pediatric medicine. The following describes a simulation session in which trainees were tasked with managing an infantile patient who had experienced a major trauma as a result of a single vehicle accident. The described simulation session utilized human patient simulators and was tailored to junior (year 1 and 2) emergency medicine residents.

Emergency Physicians Think in Spirals.

As adult learners, junior clerks on core rotations in emergency medicine (EM) are expected to "own" their patients and follow them from presentation to disposition in the Emergency Department (ED). Traditionally, we teach clerks to present an exhaustive linear list of symptoms and signs to their preceptors. This does not apply well to the fast-paced ED setting. Mnemonics have been developed to teach clerks how to present succinctly and cohesively. To address the need for continual patient reassessment throughout the patient's journey in the ED, we propose a complimentary approach called SPIRAL.