Addressing the educational gap in the role of law enforcement personnel in the resuscitation bay.

BACKGROUND: Health care workers are often uncertain of the role of law enforcement personnel in the resuscitation bay. A cross-sectional, quality improvement project was designed with an educational intervention to address the knowledge gaps. METHODS: There were 2 sessions for trauma surgery and emergency medicine faculty, residents, and staff. The first was a formal presentation by hospital risk management and security focused on answering questions generated by real-life scenarios. After reviewing feedback from the first session, the second session was designed as a panel discussion led by attending physicians who reviewed various clinical scenarios. A pre/postsurvey was administered, including potential clinical scenarios with multiple-choice answers and open feedback. RESULTS: There were 64 presurvey and 31 postsurvey respondents from the first session (48.4%). Significantly more questions were answered correctly from pre to postsurvey (5.5 vs 6.7/16 questions; U = 798.0, P = .048). Of the 14 (45.2%) respondents who provided open-ended feedback, 50% indicated confusion, and 21.4% expressed strong, negative emotions. In the second session, there were 39 presurvey and 18 postsurvey respondents (46.2%). Again, significantly more questions were answered correctly after the second session (2.2 vs 4.5/7 questions; U = 115.0, P ≤ .001). Feedback highlighted that the panel format was considered more helpful than the formal didactic of the first session. CONCLUSION: Confusion about the role of law enforcement personnel in the clinical environment can be partially addressed using multidisciplinary joint conferences that should be led by clinicians to ensure real-life clinical applicability. Further education and law enforcement personnel role clarification for health care workers are critical to protect patient rights.

#WhyIDoIt: A Multidisciplinary Wellness Initiative in an Academic Emergency Department.

INTRODUCTION: Healthcare clinicians in critical care settings such as the emergency department (ED) experience workplace stressors and are at high risk for burnout. This correlates with substance abuse, suicidality, career dissatisfaction, early retirement, and suboptimal patient care. Therefore, recognizing, and mitigating, burnout is critical to a healthcare worker's health and wellbeing. While gratitude and positive psychology are shown to increase resilience and decrease burnout, no prior studies have examined specific ED care team motivators for continued career satisfaction and workplace engagement. To increase the wellness in our ED, we implemented a wellness initiative titled #WhyIDoIt. Our goal was to have all care team members share what motivates them to work in our ED. METHODS: Participants were asked what motivates them in the workplace. We gathered responses each February for three consecutive years, 2017-2019, at our academic Level I trauma center. Emergency department clinicians, nurses, and staff were recruited to participate at grand rounds, nursing huddles, and sign out. Participants self-selected to contribute by writing their response on a sticky note and posting it in the department. After three years of implementing this initiative, we analyzed the collected qualitative data using thematic analysis based on grounded theory. Submissions were subjectively categorized into initial themes and then reconciled into three overarching classifications. RESULTS: In total, we collected 149 responses. Themes included team work (35, 23.5%), pride in a unique skill set (26, 17.4%), helping patients in a time of need (26, 17.4%), teaching/learning opportunities (15,10.1%), humor and levity (14, 9.4%), building relationships with patients (11,7.4%), financial motivation (9, 6.0%), patient gratitude (7, 4.7%), and philosophical and moral motivators (6, 4.0%). These themes were reconciled into three overarching classifications including team-centered motivators (76, 51%), patient-centered motivators (37, 24.8%), and reward-centered motivators (36, 24.2%). CONCLUSION: Responses that showed the greatest motivator for ED clinicians and nurses were team-centered. This highlights the importance of relationship building and a sense of shared purpose and suggests that future workplace well-being initiatives should include strengthening and maintaining professional team relationships.

Using Human-Centered Design to Improve a Surgery Resident Well-Being Program.

INTRODUCTION: Surgery resident mental health, burnout, and overall well-being are constantly scrutinized, and improving surgery resident well-being programs continuously requires refinement. We sought to evaluate the effectiveness of human-centered design (HCD) sprints to enhance our surgery resident well-being program. METHODS: An HCD sprint was conducted with 34 surgery residents in a single session using seven separate domains, including Mental Health/Reflection and Therapy; Mentoring or Faculty Engagement; Physical Well-being; Retreats; Scheduled Breaks or Free Time; Social Connection; and Well-being Lectures, Emails, or Curriculum. Responses were characterized as: "How might we", Suggestions, Useful, and Not Useful. RESULTS: Well-being Lectures, Emails, or Curriculum were overwhelmingly viewed, as Not Useful (77%), as was Mental Health/Reflection and Therapy (42%). Scheduled Breaks or Free Time was viewed as the most Useful (42%). This category also had the most suggestions and "How might we" ideas for improvement (41%). Lastly, Suggestions and "How might we" ideas were also common for improving Mentoring or Faculty Engagement (31% and 29%, respectively). These results were incorporated into multiple strategies to improve surgery resident well-being and also shared in a Department of Surgery Grand Rounds. CONCLUSIONS: Surgery resident well-being and a targeted approach by a well-being program are critical to a residency program, particularly with the arduous nature of surgical training during the pandemic resulting in periods of prolonged social isolation. HCD sprints are an effective means to refine a surgery resident well-being program and to involve the residents themselves in that process.

Building a Program of Expanded Peer Support for the Entire Health Care Team: No One Left Behind.

BACKGROUND: Medical errors can cause second victim syndrome (SVS) in caregivers. Literature describing the development of effective peer support programs is limited. This article describes the implementation of a peer support program for an entire health care system. METHODS: The research team initially trained 52 supporters representing all clinical areas throughout an urban academic quaternary care campus. Each then supported at-risk colleagues, raised awareness of SVS, and recruited others for training. Triggers for peer support expanded to include medical errors, unanticipated patient outcomes, inability to stop the progression of medical conditions, medical emergencies of colleagues, aggressive behavior by a patient/family member, and COVID-19 events. Data reporting supporters' efforts were summarized. After the initial 5-hour session, training was condensed into 2.5 hours. The effectiveness of these training sessions was assessed. The Second Victim Experience and Support Tool (SVEST) was used to assess program effectiveness three and nine months after implementation. RESULTS: By 18 months, a blended program was achieved with 149 supporters: 81 medical college and 68 hospital personnel. Providers received 46.5% of support efforts and hospital personnel 47.9%. The most common event supported was inability to stop the progression of medical conditions (24.5%). Both training sessions improved attendees' knowledge of SVS and improved their comfort with teaching others how to support a second victim. Both SVEST surveys showed that nonwork and supervisor support rated highest, followed by colleague support. Institution support rated lowest. CONCLUSION: The team successfully implemented a peer support program with trained supporters from various clinical disciplines for distressing events beyond medical errors.

Secondary Traumatic Stress in Ob-Gyn: A Mixed Methods Analysis Assessing Physician Impact and Needs.

OBJECTIVE: This study aims to evaluate the incidence of secondary traumatic stress in Obstetrics and Gynecology physicians including symptoms, impact, and programmatic needs for support. DESIGN: This study used a mixed-methods approach comprised of an anonymous online survey and individual interviews/focus groups. IBM SPSS 24.0 generated statistical analysis: descriptive statistics, Fisher's exact test to compare nominal survey data and across groups, phi correlations (ϕ) and interitem reliability (Cronbach alpha). Constant comparative qualitative analysis determined cross-cutting themes. Research was approved by institutional IRB. SETTING: This study was conducted at the Medical College of Wisconsin, Milwaukee, Wisconsin, a large academic medical institution. PARTICIPANTS: Participants were recruited from the Department of Obstetrics & Gynecology via email. Faculty, fellows, and residents participated in an anonymous online survey and were invited to complete individual interviews or focus groups. The online survey was distributed to 67 clinical faculty, residents, and fellows with a total of 27 individuals completing the reliable (alpha = 0.71) anonymous survey (40% response rate). Ten faculty participated in individual interviews or focus groups. RESULTS: Respondents to the quantitative survey identified involvement in adverse medical events (95%) and symptoms of traumatic stress (75%). Anxiety (81%), guilt (62%), and disrupted sleep (58%) were most frequently reported symptoms (mean number of symptoms = (3.4(±2.1)). Individuals reporting anxiety were more likely to seek support from colleagues (ϕ = 0.5, p < 0.006); those reporting guilt would go to friends (ϕ = 0.5, p < 0.007). Disrupted sleep more commonly led to seeking mental health services (ϕ = 0.5, p < 0.007). Desire for support varied. Those reporting anxiety were interested in peer-to-peer responders (ϕ = 0.6, p < 0.001); those reporting guilt would use debriefing sessions (ϕ = 0.4, p < 0.023). Qualitative data from individual interviews and focus groups yielded descriptions of physical and cognitive symptoms associated with second victim experiences included responsibility, guilt/shame, self-doubt, anxiety/rumination and sleep disturbance. Identified resources for coping: just culture, collegial support, peer-to-peer responders, and structured case conferences for emotional debriefing. CONCLUSIONS: Obstetrics and Gynecology providers are likely to experience symptoms of secondary traumatic stress following adverse patient events similar to other medical specialties. Comprehensive programs to address emotional well-being of physicians are important to promote collegiality and reduce symptoms of secondary traumatic stress. Safety and transparency with opportunities for group processing are identified as essentials for positive institutional culture, as well as peer support programs.

The Osteopathic Applicant.

The number of osteopathic students choosing emergency medicine (EM) as a specialty is continuously increasing. However, EM remains a competitive specialty. Accordingly, in this article we guide osteopathic students interested in EM through the Comprehensive Osteopathic Medical Licensing Examination (COMLEX), the United States Medical Licensing Examination (USMLE), third- and fourth-year rotations, and the match process. Additionally, we provide tips on the process of applying to allopathic programs and we discuss the timeline of both the allopathic and osteopathic match. Finally, we discuss the effect of the Single Accreditation System and the Memorandum of Understanding, an agreement to merge the allopathic and osteopathic graduate medical education systems into a single graduate medical education accreditation system. This is expected to be completed as of July 1, 2020. Therefore, we elucidate the expectations for osteopathic applicants (particularly with regards to the USMLE and COMLEX examinations).