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Background: GridlockED (The Game Crafter, LLC) is a serious game that was developed to teach challenges that face nursing and medical professionals in the emergency department (ED). However, few studies have explored nurses' perceptions of the utility, fidelity, acceptability, and applicability of the serious game modality. This study examined how ED nurses view GridlockED as a continuing education platform. Method: This single-center observational study explored how nurses engage with and respond to Grid-lockED. The convenience sample included participants recruited from a local continuing nursing education day. Participants completed a presurvey, engaged in a full game play session with the GridlockED game for approximately 45 minutes, and immediately completed a post-game play survey. Results: Of the 48 participants (11 male, 37 female; 44 of 48 were RNs), most (91%) agreed that the workflow reflected in the game was equivalent to the flow in a typical ED. Almost all (96%) found the cases in the game reflective of real ED patients, and most (92%) found the game a useful educational tool to prepare new nurses to transition into the ED environment. Conclusion: The GridlockED game shows potential as a serious game to support nursing education, particularly for new ED nurse orientation and transition to ED practice. [J Contin Educ Nurs. 2024;55(5):231–238.] [ABSTRACT FROM AUTHOR] more...

Objectives Food insecurity (FI) is associated with a number of adverse child health outcomes and increased emergency department (ED) use. The COVID-19 pandemic exacerbated the financial hardship faced by many families. We sought to determine the prevalence of FI among children with ED visits, compare this to pre-pandemic rates, and describe associated risk factors. Methods From September to December 2021, families presenting to a Canadian paediatric ED were asked to complete a survey screening for FI along with health and demographic information. Results were compared to data collected in 2012. Multivariable logistic regression was used to measure associations with FI. Results In 2021, 26% (n = 173/665) of families identified as food insecure compared to 22.7% in 2012 (n = 146/644) a difference of 3.3% (95% CI [−1.4%, 8.1%]). In multivariable analysis, greater number of children in the home (OR 1.19, 95% CI [1.01, 1.41]), financial strain from medical expenses (OR 5.31, 95% CI [3.45, 8.18]), and a lack of primary care access (OR 1.27, 95% CI [1.08, 1.51]) were independent predictors of FI. Less than half of families with FI reported use of food charity, most commonly food banks, while one-quarter received help from family or friends. Families experiencing FI expressed a preference for support through free or low-cost meals and financial assistance with medical expenses. Conclusion More than one in four families attending a paediatric ED screened positive for FI. Future research is needed to examine the effect of support interventions for families assessed in medical care facilities including financial support for those with chronic medical conditions. [ABSTRACT FROM AUTHOR] more...

Background: Funding for educational innovations is increasingly scarce in academic medicine. While there is some funding for medical education research, this is often for discovery or application work, and there are few avenues for those with a heavy innovation focus to fund early work. Objective of the Innovation: The objective was to develop an intrapreneurial unit focused on medical education projects and scholarship. Development Process and Implementation: The GridlockED and TriagED games are educational or serious games that seek to teach health care learners about emergency medicine processes. Both games were cocreated with learners and brought to market in the past 3 years. All of the proceeds from the sales of these games have been accrued over time to create a new innovation fund. This fund seeks to support trainees and early career educators in their medical education projects. Outcomes: Sales for GridlockED began in March 2018 and the TriagED began in November 2019. In the first year, sales for GridlockED yielded a total of $9,534. After 18 months of sales, the fund has accrued a total of $14,530. The fund has helped finance the development of new games. Additionally, the fund awarded two internal $500 Kickstarter grants to assist with evaluating and improving two local education projects. The GridlockED and TriagED games have also spurred multiple academic opportunities for junior educators interested in this domain: five workshops, eight conference abstracts, two peer-reviewed papers, and two research protocols are being developed. Conclusions: The GridlockED and TriagED games represent a new academically oriented, intrapreneurial approach to medical education work. [ABSTRACT FROM AUTHOR] more...

Introduction: Within the Canadian competency‐based medical education system, entrustable professional activities (EPAs) are used to assess residents on performed clinical duties. This study aimed to determine whether implementing a bundle of two interventions (a case‐based discussion intervention and a rotation‐based nudging system) could increase the number of EPA assessments that could occur for our trainees. Methods: The authors designed an intervention bundle with two components: 1) a case‐based workshop where trainees discussed which EPAs could be assessed with multiple cases and 2) a nudging system wherein each trainee was reminded of EPAs that would be useful to them on each rotation in their first year. We conducted a retrospective program evaluation to compare the intervention cohort (2019) to two historical cohorts using similar EPAs (2017, 2018). Results: Data from 22 trainees (seven in 2017, eight in 2018, and seven in 2019) were analyzed. There was a marked increase in the total number of EPA assessments acquired in the 2019 cohort (average per resident = 285.7, 95% confidence interval [CI] = 256.1 to 312.3, range = 195–350) compared to the two other years (2018 [average = 132.4, 95% CI = 107.5 to 157.02, range = 107–167] and 2017 [70.1, 95% CI 45.3 to 91.0, range = 49–95]), yielding an effect size of Cohen's d = 4.02 for our intervention bundle. Conclusions: Within the limitations of a small sample size, there was a strong effect of introducing two interventions (a case‐based orientation and a nudging system) upon EPA assessments with PGY‐1 residents. These strategies may be useful to others seeking to improve EPA assessment numbers in other specialties and clinical environments. [ABSTRACT FROM AUTHOR] more...

Introduction: Within the Canadian competency-based medical education system, entrustable professional activities (EPAs) are used to assess residents on performed clinical duties. This study aimed to determine whether implementing a bundle of two interventions (a case-based discussion intervention and a rotation-based nudging system) could increase the number of EPA assessments that could occur for our trainees. Methods: The authors designed an intervention bundle with two components: 1) a case-based workshop where trainees discussed which EPAs could be assessed with multiple cases and 2) a nudging system wherein each trainee was reminded of EPAs that would be useful to them on each rotation in their first year. We conducted a retrospective program evaluation to compare the intervention cohort (2019) to two historical cohorts using similar EPAs (2017, 2018). Results: Data from 22 trainees (seven in 2017, eight in 2018, and seven in 2019) were analyzed. There was a marked increase in the total number of EPA assessments acquired in the 2019 cohort (average per resident = 285.7, 95% confidence interval [CI] = 256.1 to 312.3, range = 195–350) compared to the two other years (2018 [average = 132.4, 95% CI = 107.5 to 157.02, range = 107–167] and 2017 [70.1, 95% CI 45.3 to 91.0, range = 49–95]), yielding an effect size of Cohen's d = 4.02 for our intervention bundle. Conclusions: Within the limitations of a small sample size, there was a strong effect of introducing two interventions (a case-based orientation and a nudging system) upon EPA assessments with PGY-1 residents. These strategies may be useful to others seeking to improve EPA assessment numbers in other specialties and clinical environments. [ABSTRACT FROM AUTHOR] more...

In recent decades, the gender makeup of Canadian medical residents has approached parity. As residency training years coincide closely with childbearing years and paid parental leave is associated with numerous benefits for both parents and children, it is important for there to be clarity about parental leave benefits. We aimed to conduct a comprehensive review of maternity and parental leave policies in all residency education programs in Canada, to highlight gaps that might be improved or areas in which Canadian programs excel. We searched websites of the 8 provincial housestaff organizations (PHOs) for information regarding pregnancy workload accommodations, maternity leave, and parental leave policies in each province in effect as of January 2020. We summarized the policies and analyzed their readability using the Flesch Reading Ease. All Canadian PHOs provide specific accommodations around maternity and parental leave for medical residents. All organizations offer at least 35 weeks of total leave, while only 3 PHOs offer extended leave of about 63 weeks, in line with federal regulations. All but 2 PHOs offer supplemental income to their residents, although not for the full duration of offered leave. All PHOs offer workplace accommodations for pregnant residents in their second and/or third trimester. Although all provinces had some form of leave, significant variability was found in the accommodations, duration of leave, and financial benefits provided to medical residents on maternity and parental leave across Canada. There is a lack of clarity in policy documents, which may be a barrier to optimal uptake. [ABSTRACT FROM AUTHOR] more...

Objectives: Patient volumes are increasing in emergency departments (ED), causing issues with long wait times and overcrowding. One strategy to cope with this phenomenon is to focus on improving patient flow through the ED. Building on earlier work that identified how staff physicians manage flow and what techniques they employ to teach managerial skills to residents, we aimed to determine when it was most appropriate to implement these teaching strategies in a resident's training. Methods: We employed a Canada‐wide cross‐sectional survey of experienced emergency medicine (EM) teaching faculty to determine when they felt our previously identified teaching strategies would be appropriate to implement. The survey was piloted with local educational experts. Results: A total of 21 EM (38% female, 62% male) educators from 11 programs responded to the survey. The respondents provided an average of 42.5 endorsements per participant for specific teaching techniques across the stages of training. The core of discipline (35.9%) and transition to practice (39.7%) were the stages of training that received the most endorsement. The top two teaching techniques included the observational teaching technique "attitudinal role modeling (i.e. a strong work ethic)" and the conversational teaching technique "teacher provides clinical pearls, tips, pointers." The participants showed fairly high agreement, with the advanced in situ techniques showing fairly high reliability as measured by intraclass correlation coefficients ranging from 0.88 to 0.90. Conclusions: Our results show a trend toward faculty utilizing more didactic and observational teaching techniques early in residency and then progressing toward more experiential techniques in the senior stages of training. This is consistent with a graduated increase in responsibility as residents demonstrate competency and progress through their training. The results of this study will help inform faculty development around teaching managerial skills in the area of competency‐based medical education. [ABSTRACT FROM AUTHOR] more...

Introduction. As serious games are a relatively new phenomenon in medical education, there is little data on end user demographics or usage. In this study our goal was to describe the demographics and usage for purchasers of the GridlockED board game, a serious board game for teaching about a systems approach to managing care in the emergency department. Methods. We conducted a two-phase survey of individuals interested in purchasing GridlockED. Users were asked to complete a brief demographic survey before accessing the purchasing site. A follow-up survey was performed 3-6 months after the initial survey. That survey was to assess participants' usage, play patterns, and what changes to GridlockED they would like to see. Individuals who did not purchase the board game were asked about their barriers to purchase. Results. After one year of sales, 213 games were purchased, 560 individuals had completed the intake survey with 408 consented to follow-up. Responding purchasers were from 16 different roles in healthcare in 11 countries. Our follow-up survey collated 53 responses (out of 408 individuals, 14% response rate). The majority (63%) of respondents reported having played the game, with the most common use cases being for fun (40%), teaching trainees (21%) or training with colleagues (13%). Price of the game unit was cited as the largest barrier to purchase (60%). Conclusion. GridlockED attracted interest from a wide range of medical professionals around the world. Users reported using the game for fun and for teaching/training purposes. The main barrier to purchase was the game's price. [ABSTRACT FROM AUTHOR] more...

A letter to the editor is presented in response to the article "A national survey of troponin testing and recommendations for improved practice" by G.C. McKeeman and P.W. Auld in a 2015 issue.