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Background The Accreditation Council for Graduate Medical Education defines Level 1 as "the resident demonstrates milestones expected of an incoming resident," yet a previous study of emergency medicine (EM) interns showed most were not meeting Level 1 milestones. In addition, previous research indicates that residents often provide more favorable self-assessments when compared to faculty assessments. Our study, performed in July 2022, aims to determine whether incoming EM residents remain behind on Level 1 care-based milestones and if resident self-assessments are consistent with faculty assessments. Methodology This is an observational study involving five distinct EM residency programs. Incoming interns were directly assessed by faculty for behaviors associated with the care-based milestones for EM using a standardized survey. Interns were asked to complete this same survey regarding their own performance. Results Faculty completed a total of 101 assessments on 49 residents. Of the 49 residents, 39 completed self-evaluations (80%). Achievement of Level 1 ranged from 25% to 82%. Residents had significantly higher self-assessments than faculty assessments on PC-1, PC-5a, and PC-6a. Faculty assessments were significantly higher than resident self-assessments on PC-6b. Conclusions Greater than 75% of incoming interns were able to meet Level 1 milestones in three of seven care-based milestones. However, there is a generalized trend toward overall improvement when compared to previous studies. Residents continue to demonstrate higher self-assessments than faculty in three separate care-based milestones and faculty rated residents significantly higher in one care-based milestone. This is consistent with previous studies.
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BACKGROUND: With the advent of variant strains such as Delta and Omicron, there have been renewed concerns regarding transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) (coronavirus disease 2019 (COVID-19)) disease to healthcare professionals, particularly during intubation procedures. Several forms of barrier protection aimed at decreasing the spread of aerosolized droplets were developed during the early onset of the pandemic. OBJECTIVES: Using a simulated airway model, we examined the impact that three separate barrier devices had on intubation time and success using both direct and video laryngoscopy. We hypothesized that the functionally simplistic devices would be preferred and would allow for faster intubations. METHODS: Just-in-time training sessions focusing on COVID-19 intubations were set up between March and June of 2020. Sixty-seven emergency physicians and anesthesiologists participated. For a subset of physicians, exact times to barrier device setup and both direct and indirect intubations using three different barrier devices were recorded. Subsequently, physicians were asked to fill out a survey regarding their experiences. RESULTS: The survey response rate was 60%. In general, this cohort preferred a plain clear plastic drape or clear plastic drape with polyvinyl chloride (PVC) cube for direct laryngoscopy and video laryngoscopy setups. The use of these two devices resulted in significantly faster times to completed intubation when compared with the fiberglass box while using a simulated task trainer. CONCLUSION: In general, a simple, plastic sheet was the preferred barrier device using video laryngoscopy. Although setup times were faster using the fiberglass box, intubation times were significantly faster using the plastic drape or PVC frame.
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N-[1-(2-benzo[b]thiophenyl)cyclohexyl]piperidine (BTCP), a potent dopamine reuptake inhibitor, substitutes for the reinforcing effects of cocaine and meets other criteria for possible agonist pharmacotherapeutic potential. The purpose of this study was to determine (1) whether BTCP modifies reinstatement of cocaine-seeking elicited by cocaine-related environmental stimuli and (2) whether this compound produces priming effects. Male Wistar rats were trained to associate discriminative stimuli (S(D)) with cocaine availability (0.25 mg/infusion) versus non-reward and then were subjected to repeated extinction sessions during which the reinforcer and S(D) were withheld. Subsequent presentation of the cocaine S(D) produced recovery of cocaine-seeking. BTCP (2.5-30 mg/kg; i.p.) did not attenuate the conditioned reinstatement induced by the cocaine S(D) but, rather, potentiated this effect at 10 mg/kg. To test whether BTCP, by itself, exerts priming effects, different groups of rats were trained to self-administer cocaine (0.25 mg/infusion) for 2 weeks. After a 2-week extinction period, BTCP (5, 10 and 20 mg/kg, i.p.) reinstated cocaine-seeking, showing that BTCP not only increases cocaine-seeking induced by cocaine-related stimuli but also produces priming effects following abstinence. The results suggest that, in cocaine abstinent rats, BTCP produces cocaine-like effects.
