scholarly journals Stroke Education in Canadian Emergency Medicine Residency Programs

CJEM ◽  
2015 ◽  
Vol 18 (4) ◽  
pp. 283-287 ◽  
Author(s):  
Devin R. Harris ◽  
Philip Teal ◽  
Matthew Turton ◽  
Brian Lahiffe ◽  
Simon Pulfrey
Keyword(s):  
Emergency Medicine ◽  
Emergency Physicians ◽  
Team Leaders ◽  
Residency Programs ◽  
Stroke Team ◽  
Life Threatening ◽  
English Speaking ◽  
Ischemic Attack ◽  
Training Opportunities ◽  
Lecture Time

AbstractObjectivesStroke and transient ischemic attack (TIA) are common disorders treated by Canadian emergency physicians. The diagnosis and management of these conditions is time-sensitive and complex, requiring that emergency physicians have adequate training. This study sought to determine the extent of stroke and TIA training in Canadian emergency medicine residency programs.MethodsA two-page survey was emailed to directors of all English-speaking emergency medicine residency programs in Canada. This included both the Fellow of the Royal College of Physicians of Canada (FRCPC) and the College of Family Physicians Enhanced Training [CCFP(EM)] residency programs. The number of mandatory and elective rotations, lectures, and examinations relevant to stroke and TIA were assessed.ResultsNine FRCPC programs responded (of 11; RR=82%) and 11 CCFP(EM) programs responded (of 18; RR=61%), representing 20 of 29 programs in Canada (RR: 20/29=69%). Mandatory general neurology (3/9) and stroke neurology (2/9) rotations were offered in a minority of FRCPC programs and not at all in CCFP(EM) programs (0/11). Neuroradiology rotations were mandatory in 1/9 FRCPC programs and no CCFP(EM) programs (0/11). Acute ischemic stroke was allocated 3 hours of lecture time per year in all residency programs, regardless of route of training. Despite the fact that 100% of respondents train residents in facilities that administer thrombolysis for stroke, only 1/11 (9%) CCFP(EM) programs and 0/9 FRCPC programs have residents act as stroke team leaders.ConclusionsFormal training in stroke and TIA is limited in Canadian emergency medicine residency programs. Enhanced training opportunities should be developed as this disease is sudden, life-threatening, and can have disabling or fatal consequences, and therapeutic options are time sensitive.

Abstract T P360: Pediatric Acute Stroke Protocol Activation in a Children’s Hospital Emergency Department

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Travis R Ladner ◽  
Jasia Mahdi ◽  
Z L Harris ◽  
Kristen Crossman ◽  
Thomas Abramo ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Stroke ◽  
Pediatric Emergency ◽  
Hospital Emergency ◽  
Neurological Emergencies ◽  
Stroke Team ◽  
Sinovenous Thrombosis ◽  
Life Threatening ◽  
Ischemic Attack ◽  
Pediatric Brain

Introduction: Many children’s hospitals, including ours, have instituted acute stroke protocols, with a pediatric acute stroke team that is alerted and responds urgently for children with acute brain attacks. The purpose of this study was to characterize the final diagnoses of children with brain attacks in the emergency department where the acute stroke protocol was activated. Hypothesis: We hypothesized that less than half of pediatric brain attacks would have a confirmed diagnosis of acute stroke. Methods: Clinical and demographic information were obtained from a quality improvement database and medical records for consecutive patients (age 0-20 y) presenting to a single institution’s pediatric emergency department where the acute stroke protocol was activated between April 2011 and December 2013. Activation of this protocol means that a neurology resident sees the child within 15 minutes and acute MRI is available. All values were assessed with descriptive statistics. Results: There were 100 cases of brain attack (mean age 11.3 y, SD 5.1 y, 55% male); 25 were confirmed strokes (Figure) and 3 children had a transient ischemic attack (TIA). Nine (36%) children with stroke were previously healthy. There were 17 (68%) ischemic strokes, 7 (28%) hemorrhages, and 1 (4%) sinovenous thrombosis. Non-stroke neurological emergencies were found in 13% of patients; the majority were meningitis (n=5) or neoplasm (n=3). Complex migraine was present in 17% and seizure in 12%. All children had urgent neuroimaging. MRI was the first study in 70%. Conclusion: Of pediatric brain attacks, 25% were stroke, 3% were TIA, and 13% were other neurological emergencies. Clinicians evaluating a child for possible acute stroke should consider these frequencies in their differential diagnosis. There are many stroke mimics, some life-threatening, underscoring the need for prompt evaluation and management of children with brain attacks.

scholarly journals Building and strengthening relationships between academic departments/divisions of emergency medicine and rural and regional emergency departments

CJEM ◽  
2019 ◽  
Vol 21 (5) ◽  
pp. 595-599 ◽  
Author(s):  
Aaron Johnston ◽  
Kylie Booth ◽  
Jim Christenson ◽  
David Fu ◽  
Shirley Lee ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Emergency Departments ◽  
Academic Departments ◽  
List Type ◽  
Emergency Physicians ◽  
Common Value ◽  
Rural And Urban ◽  
Canadian Association ◽  
Rural Physicians ◽  
Training Opportunities

ABSTRACTObjectivesMake recommendations on approaches to building and strengthening relationships between academic departments or divisions of Emergency Medicine and rural and regional emergency departments.MethodsA panel of leaders from both rural and urban/academic practice environments met over 8 months. Draft recommendations were developed from panel expertise as well as survey data and presented at the 2018 Canadian Association of Emergency Physicians (CAEP) Academic Symposium. Symposium feedback was incorporated into final recommendations.ResultsSeven recommendations emerged and are summarized below: 1)CAEP should ensure engagement with other rural stakeholder organizations such as the College of Family Physicians of Canada and the Society of Rural Physicians of Canada.2)Engagement efforts require adequate financial and manpower resources.3)Training opportunities should be promoted.4)The current operational interface between the academic department of Emergency Medicine and the emergency departments in the catchment area must be examined and gaps addressed as part of building and strengthening relationships.5)Initial engagement efforts should be around projects with common value.6)Academic Departments should partner with and support rural scholars.7)Academic departments seeking to build or strengthen relationships should consider successful examples from elsewhere in the country as well as considering local culture and challenges.ConclusionThese recommendations serve as guidance for building and strengthening mutually beneficial relationships between academic departments or divisions of Emergency Medicine and rural and regional emergency departments.

Air-Medical Transport Experience in Emergency Medicine Residencies: Then and Now

2009 ◽  
Vol 24 (3) ◽  
pp. 247-252 ◽  
Author(s):  
Nelson Tang ◽  
Kim Fredericksen ◽  
Lauren Sauer ◽  
Buddy Kozen ◽  
Horace Liang ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
The United States ◽  
Resident Training ◽  
Effective Utilization ◽  
Residency Programs ◽  
Medical Transport ◽  
Two Phases ◽  
Training Opportunities ◽  
Geographical Locations

AbstractObjective:The appropriate activation and effective utilization of air-medical transport (AMT) services is an important skill for emergency medicine physicians in the United States.Previous studies have demonstrated variability with regards to emergency medical services (EMS) experience during residency training. This study was designed to evaluate the nature and extent of AMT training of the emergency medicine residency programs in the United States.Methods:An identity-unlinked survey of the program directors of all Accreditation Committee for Graduate Medical Education (ACGME) approved emergency medicine residency programs was conducted.The survey focused on EMS and AMT resident training opportunities and was conducted in two phases (1999 and 2006) using near-identical methodologies.Results:Response rates of 82% and 84% were achieved in 1999 and 2006, respectively. Percentages of programs offering AMT experiences were similar between the two study phases (76% in 1999 and 65% in 2006). The roles of residents during AMT experiences ranged widely between observer-only, active team member, and medical director/team leader in both 1999 and 2006. Compared to those in 1999, programs in 2006 demonstrated a greater frequency of EMS rotations being provided earlier, by year of training during emergency medicine residency. Residencies located in non-metropolitan centers only were slightly more likely to offer AMT training than were those in metropolitan locations.Conclusions:A majority of emergency medicine residency programs offer AMT experience that includes both scene responses and inter-facility transports. The role of residents during AMT training varies widely, as does the timing of their experiences during residency. The geographical locations of programs do not appear to impact the availability of AMT training.

Anglo-American vs. Franco-German Emergency Medical Services System

2003 ◽  
Vol 18 (1) ◽  
pp. 29-37 ◽  
Author(s):  
Wolfgang F. Dick
Keyword(s):  
Emergency Medicine ◽  
Emergency Medical Services ◽  
The United States ◽  
Medical Services ◽  
Care Providers ◽  
Emergency Physicians ◽  
Emergency Patients ◽  
Emergency Medical ◽  
Life Threatening ◽  
Anglo American

AbstractIt has been stated that the Franco-German Emergency Medical Services System (FGS) has considerable drawbacks compared to the Anglo-American Emergency Medical Services System (AAS):1. The key differences between the AAS and the FGS are that in the AAS, the patients is brought to the doctor, while in the FGS, the doctor is brought to the patient.2. In the FGS, patients with urgent conditions usually are evaluated and treated by general practitioners in their offices or at the patient`s home; initially, very few approach an emergency department.3. Emergency patients with life-threatening trauma or disease are treated by emergency physicians at the scene and during transport. Paramedics often are first to arrive at the scene, and until the emergency physician arrives at the scene, are allowed to defibrillate, to intubate endotracheal-ly, and to administer life-saving drugs (epinephrine endotracheally, glucose intravenously, etc.).4. Prehospital emergency physicians treat patients at the scene and during transport.5. Emergency patients are guaranteed to be reached by an appropriate emergency vehicle and a respective crew within 10 minutes in 80% of the responses and within 15 minutes in 95% of cases.6. The FGS deploys qualified emergency physicians assisted by qualified paramedics as prehospital intensive care providers; extended immediate care is standard. Total Prehospital Times (TPT) and scene times only are minimally longer than in the AAS.7. Emergency Medicine is recognized as a supra-specialty to the base specialties. Specific training programs exist for emergency physicians, medical directors of emergency medical services systems (EMSS), and chief emergency physicians (CEP).8. Resuscitation attempts are carried out not only by anesthesiologists, but also by internists, surgeons, pediatricians, etc. Emergency medicine encompasses cardiopulmonary resuscitation (CPR) and shock cases, and patients with an acute myocardial infarction, stroke, poly-trauma, status asthmaticus, etc. Emergency patients are admitted directly to emergency departments of the hospitals, which, depending upon the size of the hospital.9. The incidence of life-threatening trauma victims has decreased to <10% in the FGS. Of a total of 830,000 deaths/year, fatal trauma cases ranked the lowest at 4%.10. Survival figures on cardiac arrest (asystole, ventricular fibrillation/ventricular tachycardia (VF/VT), pulseless electrical activity (PEA), etc.) reported in the German EMSS correspond to those in Europe and the United States.11. Paramedic training is characterized by a two-year program followed by a theoretical and a practical examination.12. Paramedics and emergency physicians-in-training are supervised at the scene and during transport. Quality assurance (Q/A) constitutes an integral and legally compulsory part of the EMSS.13. In the majority of cases, the emergency patients are evaluated and treated by the respective specialties without delays caused by patient transfer to other hospitals.14. The FGS does not require a greater number of ambulances and/or personnel than does the AAS.15. The German healthcare system creates less expenses/ capita than the does the U.S. system at a similar level of quality of care.16. Emergency procedures are carried out by anesthesiologists, emergency physicians, surgeons, internists, and other specialists.

scholarly journals Point-of-Care Ultrasound Training and Credentialing for mid-late Career Emergency Physicians: Is it worth it?

POCUS Journal ◽  
2021 ◽  
Vol 6 (2) ◽  
pp. 56-57
Author(s):  
Courtney Smalley ◽  
Erin Simon ◽  
McKinsey Muir ◽  
Fernando Delgado ◽  
Baruch Fertel
Keyword(s):  
United States ◽  
Emergency Medicine ◽  
Quality Assurance ◽  
American Medical Association ◽  
Medical Association ◽  
Emergency Physician ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Emergency Physicians ◽  
Residency Programs

Point-of-care ultrasound (POCUS) is becoming more prevalent in community emergency medicine (EM) practice with the current American College of Emergency Physician guidelines recommending POCUS training for all graduates from United States based residency programs as well as support for POCUS privileging by the American Medical Association. However, in a recent survey of nonacademic EDs, it was found that most providers lack US training, credentialing, and quality assurance (QA) assessments of their POCUS studies. In 2017, our healthcare system embarked on a system-wide credentialing process for POCUS to credential community physicians with little to no POCUS training.

scholarly journals Professionalism Milestones Assessments Used by Emergency Medicine Residency Programs: A Cross-sectional Survey

2019 ◽  
Vol 21 (1) ◽  
pp. 152-159 ◽  
Author(s):  
Christine Stehman ◽  
Steven Hochman ◽  
Madonna Fernández-Frackelton ◽  
Emilio Volz ◽  
Rui Domingues ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Technical Skills ◽  
Summative Evaluation ◽  
Emergency Physicians ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Residency Programs ◽  
Quality Patient Care ◽  
Vital Component ◽  
Clinical Competency Committee

Introduction: Professionalism is a vital component of quality patient care. While competency in professionalism is Accreditation Council for Graduate Medical Education (ACGME)-mandated, the methods used to evaluate professionalism are not standardized, calling into question the validity of reported measurements. We aimed to determine the type and frequency of methods used by United States (US) -based emergency medicine (EM) residencies to assess accountability (Acc) and professional values (PV), as well as how often graduating residents achieve competency in these areas. Methods: We created a cross-sectional survey exploring assessment and perceived competency in Acc and PV, and then modified the survey for content and clarity through feedback from emergency physicians not involved in the study. The final survey was sent to the clinical competency committee (CCC) chair or program director (PD) of the 185 US-based ACGME-accredited EM residencies. We summarized results using descriptive statistics and Fisher’s exact testing. Results: A total of 121 programs (65.4%) completed the survey. The most frequently used methods of assessment were faculty shift evaluation (89.7%), CCC opinion (86.8%), and faculty summative evaluation (76.4%). Overall, 37% and 42% of residency programs stated that nearly all (greater than 95%) of their graduating residents achieve mastery of Acc and PV non-technical skills, respectively. Only 11.2% of respondents felt their programs were very effective at determining mastery of non-technical skills. Conclusion: EM residency programs relied heavily on faculty shift evaluations and summative opinions to determine resident competency in professionalism, with feedback from peers, administrators, and other staff less frequently incorporated. Few residency programs felt their current methods of evaluating professionalism were very effective.

Pediatric Hematologic And Oncologic Emergencies

2018 ◽  
Author(s):  
Rebecca Milligan ◽  
Jenny Mendelson
Keyword(s):  
Emergency Medicine ◽  
Immune Thrombocytopenia ◽  
Pediatric Patients ◽  
Tumor Lysis Syndrome ◽  
Von Willebrand Disease ◽  
Emergency Physicians ◽  
Tumor Lysis ◽  
Oncologic Emergencies ◽  
Life Threatening ◽  
Von Willebrand

Hematologic and oncologic emergencies that afflict children and adolescents are important for emergency medicine physicians to recognize. Pediatric patients can present with a previous formal diagnosis and have a complication related to their disease or with new symptoms that suggest a hematologic or oncologic process. Oncologic treatments can also lead to life-threatening complications. Recognizing these emergencies is very important for emergency physicians to prevent further morbidity. This review covers common patient presentations, diagnosis, and treatments for hematologic and oncologic emergencies.  This review contains 6 figures, 7 tables and 48 references Key words: hematology, hemophilia, immune thrombocytopenia, neutropenic fever, oncology, pediatric, sickle cell anemia, tumor lysis syndrome, von Willebrand disease

Pediatric Hematologic And Oncologic Emergencies

2018 ◽  
Author(s):  
Rebecca Milligan ◽  
Jenny Mendelson
Keyword(s):  
Emergency Medicine ◽  
Children And Adolescents ◽  
Pediatric Patients ◽  
Emergency Physicians ◽  
Oncologic Emergencies ◽  
Life Threatening

Hematologic and oncologic emergencies that afflict children and adolescents are important for emergency medicine physicians to recognize. Pediatric patients can present with a previous formal diagnosis and have a complication related to their disease or with new symptoms that suggest a hematologic or oncologic process. Oncologic treatments can also lead to life-threatening complications. Recognizing these emergencies is very important for emergency physicians to prevent further morbidity. This review covers common patient presentations, diagnosis, and treatments for hematologic and oncologic emergencies.  This review contains 6 figures, 6 tables and 57 references

Pediatric Hematologic And Oncologic Emergencies

2018 ◽  
Author(s):  
Rebecca Milligan ◽  
Jenny Mendelson
Keyword(s):  
Emergency Medicine ◽  
Immune Thrombocytopenia ◽  
Pediatric Patients ◽  
Tumor Lysis Syndrome ◽  
Von Willebrand Disease ◽  
Emergency Physicians ◽  
Tumor Lysis ◽  
Oncologic Emergencies ◽  
Life Threatening ◽  
Von Willebrand

Hematologic and oncologic emergencies that afflict children and adolescents are important for emergency medicine physicians to recognize. Pediatric patients can present with a previous formal diagnosis and have a complication related to their disease or with new symptoms that suggest a hematologic or oncologic process. Oncologic treatments can also lead to life-threatening complications. Recognizing these emergencies is very important for emergency physicians to prevent further morbidity. This review covers common patient presentations, diagnosis, and treatments for hematologic and oncologic emergencies.  This review contains 6 figures, 7 tables and 48 references Key words: hematology, hemophilia, immune thrombocytopenia, neutropenic fever, oncology, pediatric, sickle cell anemia, tumor lysis syndrome, von Willebrand disease

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