Development and implementation of just-in-time curricula for on-shift teaching during times of boarding.

Background: Overcrowded emergency departments (EDs) due to boarding of inpatients can lead to fewer patients seen by residents and may negatively impact their education. The existing literature recommends providing educational resource banks to augment teaching during overcrowding. We aimed to develop and evaluate the use of an educational curriculum during times of boarding. Methods: Using Kern's model of curriculum development, we conducted local and national needs assessments to identify existing curricula. The final curriculum consisted of electrocardiogram (ECG) cases, procedural resources, journal articles, and oral boards style cases. The derived curriculum was implemented at the study site, where content was released weekly via email or Slack and via our departmental educational blog. Residents were asked to fill out a survey assessing their satisfaction with the resource, their current patient load, and current National Emergency Department Overcrowding Study score (NEDOCS). We compared clinician educator satisfaction with teaching before implementation and at 3 months after implementation using Wilcoxon rank-sum test. Results: The national needs assessment was sent to the Council of Residency Directors (CORD) listserv. There were 36 unique program responses with only one program with resources for teaching during overcrowding. The derived curriculum was used seven times during the study period. The mean (±SD) NEDOCS at the time of resource use was 238.7 (±23.6). The median (range) number of active patients while using the resource was 4 (0-7). ECG cases were the most used resource. Mean (±SD) satisfaction with teaching before implementation was 2.8 (±0.9; Likert-type item scale 1 to 6 from not at all to a great deal satisfied). Satisfaction with teaching improved after implementation of the curriculum, with the mean (±SD) increasing to 3.5 (±1.0; p = 0.01). Conclusions: We report the development and implementation of a local educational curriculum for use during times of boarding. The curriculum was lightly used during the study period, but the availability of a curriculum may have increased satisfaction with teaching during boarding.

A Case of Human Trafficking in Appalachia and What Emergency Physicians Can Learn from It.

Human trafficking is an ongoing, global human rights crisis and one of the largest illicit industries worldwide. Although there are thousands of victims identified each year within the United States, the true extent of this problem remains unknown due to the paucity of data. Many victims seek care in the emergency department (ED) while being trafficked but are often not identified by clinicians due to lack of knowledge or misconceptions about trafficking. We present a case of an ED patient being trafficked in Appalachia as an educational stimulus and discuss several unique aspects of trafficking in rural communities, including lack of awareness, prevalence of familial trafficking, high rates of poverty and substance use, cultural differences, and a complex highway network system. The lack of data, appropriate resources, and training for healthcare professionals also poses distinct issues. We propose an approach to identify and treat victims of human trafficking in the ED, with a focus on rural EDs. This approach includes improving data collection and availability on local patterns of trafficking, improving clinician training in identification, and care of victims using trauma-informed techniques. While this case illustrates unique features of human trafficking in the Appalachian region, many of these themes are common to rural areas across the US. Our recommendations emphasize strategies to adapt evidence-based protocols, largely designed in and for urban EDs, to rural settings where clinicians may be less familiar with human trafficking.

Lateral Canthotomy Task Trainer in an Educational Small Group for Flight Providers.

OBJECTIVE: Lateral canthotomy is a rare, emergent, vision-preserving procedure to treat orbital compartment syndrome. Using Ericsson's deliberate practice model, we aimed to develop a multimodal small group intervention including a modified low-fidelity task trainer to improve flight physician knowledge and technical competency for lateral canthotomy in the prehospital context. METHODS: Two cohorts of resident (postgraduate year 1) flight physicians received small group training during an all-day competency-based flight physician orientation. The first cohort completed self-report pre- and postintervention assessments. In the second cohort, examiners assessed pre- and postintervention performance. RESULTS: Comparing pre- and postintervention responses (N = 27), the mean agreement with the knowledge of indications increased from 3.7 to 4.8. The mean agreement regarding confidence in skills increased from 2.2 to 4.2 (P < .001). The majority of participants (20/27) indicated the trainer "definitely helped," whereas 7 of 27 residents indicated the trainer "somewhat helped" them to learn skills. Examiners assessed holistic learner performance (n = 13) as improved from a mean of 3.2 preintervention to 4.7 postintervention, with 11 of 13 learners demonstrating improvement (P < .005). CONCLUSION: We demonstrate the feasibility of a brief small group training combining multimodal didactics with a modified low-fidelity task trainer. Resident self-assessment and examiner assessment demonstrated improved procedural skill with lateral canthotomy.