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Objectives: Coronavirus disease (COVID-19) has been identified as an acute respiratory illness leading to severe acute respiratory distress syndrome. As the disease spread, demands on health care systems increased, specifically the need to expand hospital capacity. Alternative care hospitals (ACHs) have been used to mitigate these issues; however, establishing an ACH has many challenges. The goal of this session was to perform systems testing, using a simulation-based evaluation to identify areas in need of improvement. Methods: Four simulation cases were designed to depict common and high acuity situations encountered in the ACH, using a high technology simulator and standardized patient. A multidisciplinary observer group was given debriefing forms listing the objectives, critical actions, and specific areas to focus their attention. These forms were compiled for data collection. Results: Logistical, operational, and patient safety issues were identified during the simulation and compiled into a simulation event report. Proposed solutions and protocol changes were made in response to the identified issues. Conclusion: Simulation was successfully used for systems testing, supporting efforts to maximize patient care and provider safety in a rapidly developed ACH. The simulation event report identified operational deficiencies and safety concerns directly resulting in equipment modifications and protocol changes. [ABSTRACT FROM AUTHOR]

Background: Postgraduate training programmes rely on faculty to meet core educational needs, including simulation. Time is arguably the most valuable resource for academic physicians, which presents a challenge for recruiting faculty to provide extra‐clinical teaching. To increase faculty engagement in simulation‐based education (SBE), we first identified barriers to participation. Next, we sought to overcome barriers using a self‐determination theory (SDT) framework to increase motivation using strategies that addressed faculty autonomy, competence and relatedness. Methods: Faculty from a single department of emergency medicine were surveyed about factors influencing participation in SBE. Responses were grouped into themes and used to develop the intervention—a faculty support bundle—to overcome common barriers and promote participation. Supports focused on course materials, organisational consistency and peer recognition. Faculty participation in SBE pre‐ and post‐implementation of the support bundle was analysed via chi‐squared analysis. Faculty who delivered SBE were resurveyed after the implementation phase to explore how the support bundle affected their experience. Results: Initial survey response was 41%. Reported barriers to participation in SBE included scheduling issues, preparation time, competing responsibilities, lack of confidence with simulation and lack of interest. Twenty‐four faculty participated in SBE during the pre‐implementation phase, compared to 39 post implementation (p = 0.03). Discussion The faculty support bundle increases faculty participation in SBE. Strategies focused on internal motivators identified using an SDT framework. In contrast to traditional external motivators, these were no cost interventions. Those seeking to increase faculty participation in SBE should consider implementing similar strategies. [ABSTRACT FROM AUTHOR]

Plautus’ theatre proposes the crisis of authority of the pater familias towards his son and towards the servus; on the stage we see the problems produced by the love rivalry between fathers and sons and the defeat of the masters’ intelligence, victims of the slave’s deception. The expression senati columen highlights with farcical irony the inability of unreliable fathers to occupy the role of power; at the same time, the senatorial metaphors for the slave’s intrigue construct an imaginative alternative power. [ABSTRACT FROM AUTHOR]

Background: Emergency physicians require competence performing critical and routine procedures. The clinical practice of emergency medicine (EM) alone may be insufficient for the acquisition and maintenance of skills. Prior studies suggest the presence of trainees in academic settings and/or the low frequency of procedures increase the risk of skills attrition among faculty. We sought to develop a valid needs assessment survey to inform a faculty procedural skills (FPS) maintenance curriculum. Methods: A Web‐based FPS survey was designed to assess experiences performing procedures, self‐reported confidence with procedures, and learning preferences for skills maintenance. The survey was administered at a large academic department of EM. Responses were analyzed to determine survey construct validity, faculty attitudes about procedural attrition, and preferred learning methods. Results: Among EM faculty, confidence was significantly higher for common versus uncommon procedures (p < 0.001). EM faculty respondents reported significantly greater confidence than pediatric EM (PEM) faculty for both common adult procedures (EM mean = 3.7 [±0.3], PEM = 3.0 [±0.4], p < 0.001), and uncommon adult procedures (EM = 2.7 [±0.4], PEM = 2.1 [±0.5], p < 0.001). PEM faculty reported significantly greater confidence with pediatric procedures than EM faculty (PEM mean [±SD] = 3.5 [±0.8], EM = 2.2 [±0.8], p < 0.001). Nearly all faculty (93% [52/56]) agreed that procedural attrition is a concerning problem, and 80% (44/56) had personally experienced it. The most preferred learning methods were task trainers and simulation. Faculty preferred learning environments with faculty peers (91%) over mixed groups with trainees (50%). Conclusions: Significant differences in procedural skills confidence between common and uncommon procedures, and between EM and PEM faculty, indicate that the FPS survey displayed appropriate construct validity. The finding that skills attrition is prevalent among EM and PEM faculty highlights the need for skill maintenance programming, preferably in peer groups employing task trainers and simulation. [ABSTRACT FROM AUTHOR]

In 2021, the U.N. Secretary-General said that climate change was a "code red for humanity," the Intergovernmental Panel on Climate Change concluded that unprecedented changes in the Earth's climate due to human influence; the Office of the Director of National Intelligence projected an increased risk of geopolitical tensions such as cross-border migration, strategic competition leading to conflict, and nations resisting clean energy transitions due to climate change; and leaders from almost 200 countries gathered in Glasgow, Scotland, at the U.N. Climate Change Conference of the Parties to build upon the 2015 Paris Climate Agreement. All present agreed that much work is to be done to protect Earth for future generations. In this Special Edition of JSIRE, "Climate Change-The Homeland Adapts," multidisciplinary approaches to teaching climate change and climate security at higher education institutions are examined. The five articles, authored by professors at higher education institutions, detail various andragogical and pedagogical approaches to integrating climate change into courses taught to students across multiple disciplines and provide insights and guidelines for academics from all fields. [ABSTRACT FROM AUTHOR]

In his Troades Seneca brings Andromacha back to her essential place: on the background of Troy's destruction, the dramatic action is suggested by Euripides' Andromache, set in Phthia, and inspired by the episode of her meeting with Aeneas in Butroto in Vergil's Aeneis. The character 'goes back' to Troy: this strategy, displaying the sequences after the Trojan war, perfects the regressive vocation of the character. In agreement with a tradition promoted also by the Cicero's rhetoric, Seneca makes the features of Andromacha absolute and overturns the symbolism of the Aeneis about the Trojan descendants in the funeral scene at the end of the play. [ABSTRACT FROM AUTHOR]

Seneca accentuates Medea's cruelty. The hostility manifested by the chorus is determining for the new construction of this character. In particular, it is very interesting the way in which Medea commits infanticide, through the rejection and disavowal of her children. [ABSTRACT FROM AUTHOR]

BACKGROUND: Point-of-care ultrasound (POCUS) is a pivotal diagnostic tool for emergent conditions, yet the variable proficiency of emergency physicians (EPs) poses challenges. Inadequate skills may lead to care delays and suboptimal patient evaluation. This manuscript explores an innovative educational intervention deploying a Registered Diagnostic Medical Sonographer (RDMS) credentialed sonographer educator (SE) in a large academic Emergency Department (ED). We sought to evaluate the feasibility of using a SE to address POCUS skills deficiencies and attrition. METHODS: The study involved 26 EPs voluntarily participating in hands-on training with the SE between July 2021–June 2022. The educational sessions addressed machine operation, image acquisition, image interpretation, and electronic medical record documentation of POCUS results. Subjects who consented completed a survey on their comfort level with POCUS before and after the intervention. RESULTS: Survey data indicated increased comfort and competence among participants with basic machine operation, resident POCUS supervision, and ordering and documenting POCUS exams. Post-training, 44% of providers reported performing more POCUS exams, 44% reported documenting their POCUS in the EMR more often clinically, 57% were more likely to encourage residents to perform scans, and 14% were more likely to perform a POCUS before ordering a comprehensive ultrasound. The study also observed an increase in the number of scans performed post-intervention (more than double). The SE intervention addressed challenges such as resource limitations, and feedback from participants highlighted the program’s positive impact, particularly in reducing intimidation and fostering a desire for further training. While self-reported data and limited survey completion pose limitations, the increase in POCUS scans and positive feedback underscore the intervention’s potential. CONCLUSIONS: This pilot study demonstrates the feasibility and initial impact of integrating a SE into an academic ED setting. Further research is warranted to assess the specific effects on provider comfort and clinical decision-making with POCUS. The findings support the value of a dedicated SE in enhancing EPs’ POCUS proficiency, promoting ongoing education, and ultimately improving patient care. [ABSTRACT FROM AUTHOR]

INTRODUCTION: We simulated an on-site, multi-hospital mass casualty incident (MCI) to educate emergency medicine providers in the principles of trauma resuscitation and collaboration with administration and staff during an MCI. METHODS: We implemented high-fidelity manikins, inflatable manikins, and actors to simulate a sarin gas bombing. Learners triaged patients at a decontamination tent using the simple triage and rapid treatment (START) tool, or they participated in a simulation in a resuscitation bay. RESULTS: Forty participants anonymously rated the learning impact of the exercise, the clinical relevance to emergency medicine, and the effectiveness of the faculty facilitation and debriefing on a 1-5 Likert scale. The average responses to all questions were 4.45 or greater, and 98% of respondents recommended adding the scenario to the standard curriculum. DISCUSSION: We successfully executed a novel, multihospital, MCI drill that was rated to be a better alternative to sequential simulation in a simulation center. [ABSTRACT FROM AUTHOR]

Field hospitals have long been used to extend health care capabilities in times of crisis. In response to the pandemic and an anticipated surge in patients, Rhode Island Gov. Gina Raimondo announced a plan to create three field hospitals, or "alternate hospital sites" (AHS), totaling 1,000 beds, in order to expand the state's hospital capacity. Following China's Fangcang shelter hospital model, the Lifespan AHS (LAHS) planning group attempted to identify existing public venues that could support rapid conversion to a site for large numbers of patients at a reasonable cost. After discussions with many stakeholders - pharmacy, laboratory, healthcare providers, security, emergency medical services, and infection control - design and equipment recommendations were given to the architects during daily teleconferencing and site visits. Specific patient criteria for the LAHS were established, staffing was prioritized, and clinical protocols were designed to facilitate care. Simulations using 4 different scenarios were practiced in order to assure proper patient care and flow, pharmacy utilization, and staffing. [ABSTRACT FROM AUTHOR]

Background: Simulation in medical education is a well-accepted educational modality that allows for practice of high risk, low frequency events. The Obstetric Emergencies for Emergency Medicine course was developed to prepare trainees for challenging scenarios. Methods: Six clinical scenarios were chosen: spontaneous vaginal delivery, neonatal resuscitation, preeclampsia, neonatal resuscitation with cardiopulmonary resuscitation (CPR), shoulder dystocia and postpartum hemorrhage. Development and facilitation was an interdepartmental effort with contributions from Emergency Medicine, Obstetrics and Gynecology, and Pediatric Emergency Medicine. Each case was allotted 35 minutes, including debriefing. Participants completed an evaluation survey for each scenario. Results: All participants responded yes to the question "Would you recommend this simulation become part of the standard curriculum." The means of ratings for "scenario overall" and "relevance to training/duties" ranged from 4.95-5 out of 5 across all simulation groups. Conclusion: An interdepartmental and collaborative approach can optimize the success of a simulation educational program. [ABSTRACT FROM AUTHOR]