Integrating emergency medicine principles and experience throughout the medical school curriculum: why and how.

The management of acutely ill and injured patients is an essential component of medical student education, yet the formal integration of emergency medicine (EM) into the medical school curriculum has progressed slowly since the inception of the specialty. Medical student interest and the number of resident positions in the National Resident Matching Program are higher than any time in the past, yet students often find access to EM faculty and clinical experience limited to a fourth-year rotation. Incorporating EM into all years of the undergraduate medical student curriculum can offer unique educational experiences and enhance exposure to the necessary and recommended knowledge and skills students must attain prior to graduation. Academic emergency physicians (EPs) should advocate our specialty's importance in their medical school curricula using a proactive approach and actively involve themselves in medical student education at all stages of training. The goals of this article are to describe several approaches for EM faculty to expand medical student exposure to the specialty and enhance student experiences in the core principles of EM throughout the undergraduate medical curriculum.

The academic chair in emergency medicine: current demographics and survey results identifying the skills and characteristics desired for the role.

OBJECTIVES: Due to the rapid growth in academic emergency departments over the past 20 years, recent significant changes in leadership have occurred. To prepare for future transitions, leaders in academic emergency medicine (EM) should identify those skills and characteristics desired in future academic chairs. The authors sought to determine which skills and characteristics are more important than others to help guide the development of EM-specific leadership courses. METHODS: A survey of the current academic chairs in EM included questions pertaining to demographics, career time course, expected career longevity, and ratings of skills and characteristics deemed necessary for academic chairs. Chairs were asked to rate the qualities twice, to identify qualities that must be obtained prior to becoming chair, and those that may be obtained during chair tenure. RESULTS: Ninety-seven percent of the membership of the Association of Academic Chairs in Emergency Medicine (AACEM) completed the survey. Most chairs have been in practice for over 15 years, and a minority, for less than 10 years. One-third predict less than 6 more years in their current position, and almost 50% predict their careers as chair will continue an additional 6-10 years. The highest-rated formal training was an administrative or leadership training course or certification. Chairs noted that academic experience (including scholarly productivity, peer-reviewed publication, faculty development, and graduate medical education) was the most important skill set to obtain prior to becoming a chair, while hospital governance and cross-departmental collaboration skills can be obtained once in the role. Managerial skills were also felt to be of importance. Personal characteristics were overall rated highly. No differences were found between responses from early chairs and those later in their careers. CONCLUSIONS: Leadership courses for aspiring chairs in EM should foster the development of academic experience and managerial skills. Advanced degrees in leadership or administration are highly desirable in future chairs.

Improved fourth-year medical student clinical decision-making performance as a resuscitation team leader after a simulation-based curriculum.

OBJECTIVE: To determine the impact of simulation-based instruction on student performance in the role of emergency department resuscitation team leader. METHODS: A randomized, single-blinded, controlled study using an intention to treat analysis. Eighty-three fourth-year medical students enrolled in an emergency medicine clerkship were randomly allocated to two groups differing only by instructional format. Each student individually completed an initial simulation case, followed by a standardized curriculum of eight cases in either group simulation or case-based group discussion format before a second individual simulation case. A remote coinvestigator measured eight objective performance end points using digital recordings of all individual simulation cases. McNemar chi2, Pearson correlation, repeated measures multivariate analysis of variance, and follow-up analysis of variance were used for statistical evaluation. RESULTS: Sixty-eight students (82%) completed both initial and follow-up individual simulations. Eight students were lost from the simulation group and seven from the discussion group. The mean postintervention case performance was significantly better for the students allocated to simulation instruction compared with the group discussion students for four outcomes including a decrease in mean time to (1) order an intravenous line; (2) initiate cardiac monitoring; (3) order initial laboratory tests; and (4) initiate blood pressure monitoring. Paired comparisons of each student's initial and follow-up simulations demonstrated significant improvement in the same four areas, in mean time to order an abdominal radiograph and in obtaining an allergy history. CONCLUSIONS: A single simulation-based teaching session significantly improved student performance as a team leader. Additional simulation sessions provided further improvement compared with instruction provided in case-based group discussion format.

Physiologic effects of simulated + Gx orbital reentry in primate models of hemorrhagic shock.

INTRODUCTION: While the physiologic effects of space travel are documented in healthy individuals, little is known about its impact on medically ill or injured persons. In this study, hemorrhagic shock in primates was used to model a potentially common pathophysiologic condition during exposure to gravitational forces simulating return from Earth orbit. This experiment did not model the effects of cardiovascular deconditioning that normally occur during spaceflight. METHODS: Using invasive hemodynamic monitoring, serial cardiovascular and laboratory parameters in baboons (Papio papio) were studied. Subjects were centrifuged at either a low +Gx (3.3 G maximum) or high +Gx (7.8 G maximum) acceleration reentry profile before and after being subjected to either class II (20% volume loss) or class IV (40% volume loss) hemorrhagic shock. RESULTS: Significant alterations in cardiovascular and laboratory parameters occurred during shock and exposure to high and low +Gx acceleration. Shock classification was the primary determinant of change in cardiovascular function. During the experimental protocol, 31 of 32 animals survived (97% survival). After a 1-wk post-protocol observation period, 28 of 32 subjects survived (88% survival). CONCLUSIONS: This preliminary study presents data that suggest that the emergent return of a medically compromised individual without resuscitation may be potentially survivable. However, medical stabilization with volume resuscitation, supplemental oxygen, and noninvasive monitoring would likely optimize clinical outcomes in the event of significant hemorrhagic shock states necessitating emergent deorbit.

Report of the Task Force on National Fourth Year Medical Student Emergency Medicine Curriculum Guide.

This manuscript reports recommendations of the National Fourth Year Medical Student Emergency Medicine Curriculum Guide Task Force. This task force was convened by 6 major emergency medicine organizations to develop a standardized curriculum for fourth year medical students. The structure of the curriculum is based on clerkship curricula from other specialties such as internal medicine and pediatrics. The report contains a historical context, global and targeted needs assessment, goals and objectives, recommended educational strategies, implementation guidelines, and suggestions on feedback and evaluation.

Political issues in emergency medicine: The United States.

The format of the paper is to allow three authors to discuss what they believe are the most significant political issues facing emergency medicine (EM) in their country or region. Each author writes independently and does not see any other contributing author's work, therefore potential overlap of subject matter is inevitable. However, we were soliciting their individual opinions about the serious issues confronting us today, rather than a consensus. An additional author, well familiar with the topics being discussed, wrote the Commentary from an overview perspective on the writings of the other authors. This supplemental opinion was offered as a method for enhanced cohesiveness in describing the political situations impacting the specialty of emergency medicine. The three authors for the United States are James Hoekstra, Professor and Chair, Wake Forest University Health Sciences; Robert McNamara, Professor and Chair, Temple University School of Medicine, and Robert Schafermeyer, Associate Chair, Department of Emergency Medicine, North Carolina School of Medicine. Between them, they represent more than 50 years experience in clinical and academic emergency medicine. They write from a personal perspective. Their views are their own, and do not represent any organization(s) with which they may have or had affiliations.

Faculty development: what is faculty development?

Faculty development is an organized, goal-directed process to achieve career progression and growth. Inherent in this process is the acquisition of skills that enable one to contribute in a meaningful way to the advancement of a field of interest, whether educational, operational, or scientific. The process requires attention to technical skills, personal attributes, and explicit goals. Supportive mentorship is optimal. This document outlines important concepts and identifies helpful resources for academic faculty members. Additional resources are available at http://www.saem.org/facdev/index.htm.