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Alanna Darling,1 Edward Ullman,2 Victor Novak,3 Melissa Doyle,4 Nicole M Dubosh2 1Department of Emergency Medicine, UMass Chan Medical School – Baystate Medical Center, Springfield, MA, USA; 2Department of Emergency Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA; 3Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel; 4Center for Violence Prevention and Recovery, Beth Israel Deaconess Medical Center, Boston, MA, USACorrespondence: Alanna Darling, UMass Chan Medical School - Baystate Medical Center, Department of Emergency Medicine, 759 Chestnut St., Springfield 5, S5426, Springfield, MA, 01199, USA, Tel +1 508-414-4492, Email ardarling@gmail.com; Alanna.darling@baystatehealth.orgPurpose: Intimate partner violence (IPV) is a widespread public health issue that is relevant to all areas of medicine. Patients who suffer from IPV often contact the health care system via the emergency department, making this a particularly important but too often overlooked issue in this setting. Education on IPV varies in medical schools and emergency medicine (EM) educational programs, and evidence suggests that a barrier to assessing for IPV is a lack of adequate training of clinicians. In this study, we sought to design, implement and evaluate the efficacy of a curriculum on IPV geared towards medical students on an EM clerkship.Methods: We assembled a multi-disciplinary team of EM education faculty, a resident content expert on IPV, and social workers to design a two-part curriculum that was administered to medical students on an EM clerkship. The curriculum involved a 20-minute narrated slide presentation viewed asynchronously, followed by a 1-hour case-based discussion session. The curriculum was evaluated using a 13-item self-assessment survey on knowledge, comfort level and skill in managing victims of IPV, administered electronically before and after the curriculum. Survey results were compared pre- and

Introduction: Despite the extraordinary amount of time physicians spend communicating withpatients, dedicated education strategies on this topic are lacking. The objective of this study was todevelop a multimodal curriculum including direct patient feedback and assess whether it improvescommunication skills as measured by the Communication Assessment Tool (CAT) in fourth-yearmedical students during an emergency medicine (EM) clerkship.Methods: This was a prospective, randomized trial of fourth-year students in an EM clerkship atan academic medical center from 2016-2017. We developed a multimodal curriculum to teachcommunication skills consisting of 1) an asynchronous video on communication skills, and 2)direct patient feedback from the CAT, a 15-question tool with validity evidence in the emergencydepartment setting. The intervention group received the curriculum at the clerkship midpoint. Thecontrol group received the curriculum at the clerkship’s end. We calculated proportions and oddsratios (OR) of students achieving maximum CAT score in the first and second half of the clerkship.Results: A total of 64 students were enrolled: 37 in the control group and 27 in the interventiongroup. The percentage of students achieving the maximum CAT score was similar between groupsduring the first half (OR 0.70, p = 0.15). Following the intervention, students in the intervention groupachieved a maximum score more often than the control group (OR 1.65, p = 0.008).Conclusion: Students exposed to the curriculum early had higher patient ratings on communicationcompared to the control group. A multimodal curriculum involving direct patient feedback may be aneffective means of teaching communication skills.

Introduction: Emergency physicians (EP) experience high rates of workplace violence, the risks of which increase with the presence of weapons. Up to 25% of trauma patients brought to the emergency department (ED) have been found to carry weapons. Given these risks, we conducted an educational needs assessment to characterize EPs’ knowledge of firearms, frequency of encountering firearms in the ED, and level of confidence with safely removing firearms from patient care settings.Methods: This was a survey study of attending and resident EPs at two academic and four community hospitals in the Midwest and Northeast. A 26-item questionnaire was emailed to all EPs at the six institutions. Questions pertained to EPs’ knowledge of firearms, experience with handling firearms, and exposure to firearms while at work. We calculated response proportions and p-values. Results: Of 243 recipients who received the survey, 149 (61.3%) completed it. Thirty-three respondents (22.0%) reported encountering firearms in the workplace, 91 (60.7%) reported never handling firearms, and 25 (16.7%) reported handling firearms at least once per year. Thirty-six respondents (24.0%) reported formal firearms training, and 63 (42.3%) reported no firearms training. There were no significant regional differences regarding firearms training or exposure. Residents from the Northeast were more likely to be moderately confident that they could safely handle a firearm prior to law enforcement involvement (p=0.043), while residents from the Midwest were more likely to be not at all confident (p=0.018). Conclusion: The majority of surveyed attending and resident EPs reported little experience with handling firearms. Among resident EPs, there was a regional difference in confidence in handling firearms prior to law enforcement involvement. Given the realities of workplace violence and the frequency with which firearms are encountered in the ED, further investigation is needed to evaluate provider competence in

Introduction: Emergency physicians (EP) experience high rates of workplace violence, the risks of which increase with the presence of weapons. Up to 25% of trauma patients brought to the emergency department (ED) have been found to carry weapons. Given these risks, we conducted an educational needs assessment to characterize EPs’ knowledge of firearms, frequency of encountering firearms in the ED, and level of confidence with safely removing firearms from patient care settings.Methods: This was a survey study of attending and resident EPs at two academic and four community hospitals in the Midwest and Northeast. A 26-item questionnaire was emailed to all EPs at the six institutions. Questions pertained to EPs’ knowledge of firearms, experience with handling firearms, and exposure to firearms while at work. We calculated response proportions and p-values. Results: Of 243 recipients who received the survey, 149 (61.3%) completed it. Thirty-three respondents (22.0%) reported encountering firearms in the workplace, 91 (60.7%) reported never handling firearms, and 25 (16.7%) reported handling firearms at least once per year. Thirty-six respondents (24.0%) reported formal firearms training, and 63 (42.3%) reported no firearms training. There were no significant regional differences regarding firearms training or exposure. Residents from the Northeast were more likely to be moderately confident that they could safely handle a firearm prior to law enforcement involvement (p=0.043), while residents from the Midwest were more likely to be not at all confident (p=0.018). Conclusion: The majority of surveyed attending and resident EPs reported little experience with handling firearms. Among resident EPs, there was a regional difference in confidence in handling firearms prior to law enforcement involvement. Given the realities of workplace violence and the frequency with which firearms are encountered in the ED, further investigation is needed to evaluate provider competence in

Introduction: Despite the extraordinary amount of time physicians spend communicating withpatients, dedicated education strategies on this topic are lacking. The objective of this study was todevelop a multimodal curriculum including direct patient feedback and assess whether it improvescommunication skills as measured by the Communication Assessment Tool (CAT) in fourth-yearmedical students during an emergency medicine (EM) clerkship.Methods: This was a prospective, randomized trial of fourth-year students in an EM clerkship atan academic medical center from 2016-2017. We developed a multimodal curriculum to teachcommunication skills consisting of 1) an asynchronous video on communication skills, and 2)direct patient feedback from the CAT, a 15-question tool with validity evidence in the emergencydepartment setting. The intervention group received the curriculum at the clerkship midpoint. Thecontrol group received the curriculum at the clerkship’s end. We calculated proportions and oddsratios (OR) of students achieving maximum CAT score in the first and second half of the clerkship.Results: A total of 64 students were enrolled: 37 in the control group and 27 in the interventiongroup. The percentage of students achieving the maximum CAT score was similar between groupsduring the first half (OR 0.70, p = 0.15). Following the intervention, students in the intervention groupachieved a maximum score more often than the control group (OR 1.65, p = 0.008).Conclusion: Students exposed to the curriculum early had higher patient ratings on communicationcompared to the control group. A multimodal curriculum involving direct patient feedback may be aneffective means of teaching communication skills.

ObjectivesThe objectives were to critically appraise the emergency medicine (EM) medical education literature published in 2016 and review the highest-quality quantitative and qualitative studies.MethodsA search of the English language literature in 2016 querying MEDLINE, Scopus, Education Resources Information Center (ERIC), and PsychInfo identified 510 papers related to medical education in EM. Two reviewers independently screened all of the publications using previously established exclusion criteria. The 25 top-scoring quantitative studies based on methodology and all six qualitative studies were scored by all reviewers using selected scoring criteria that have been adapted from previous installments. The top-scoring articles were highlighted and trends in medical education research were described.ResultsSeventy-five manuscripts met inclusion criteria and were scored. Eleven quantitative and one qualitative papers were the highest scoring and are summarized in this article.ConclusionThis annual critical appraisal series highlights the best EM education research articles published in 2016.

Leslie A Bilello,1 Nicole M Dubosh,1 Jason J Lewis,1 Matthew M Hall,1 Jonathan Fisher,2 Edward A Ullman1 1Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; 2Department of Emergency Medicine, Maricopa Medical Center, Phoenix, AZ, USA Background: The art of physical examination is one of the most valuable diagnostic tools bestowed upon new generations of medical students. Despite traditional educational techniques and significant attention on a national level, both trainees and educators have noticed a decrease in physical examination proficiency. Simulation has been identified as a potential way to improve physical examination techniques within undergraduate medical education. We sought to determine the utility of a cardiac case-based simulation scenario to assess physical examination performance of fourth-year medical students during an emergency medicine (EM) clerkship.Materials and methods: Fourth-year medical students enrolled in a 4-week EM clerkship were prospectively evaluated during a case-based scenario using a simulation mannequin (Laerdal SimMan®). The case involved a patient presenting with chest pain that evolved into cardiac arrest. All simulations were video recorded and two emergency physicians reviewed each video. The reviewers recorded whether or not each student completed the essential components of a focused physical examination.Results: Twenty-seven students participated in the simulation. The percentage of students completing each of the four components of the physical examination was as follows: cardiac auscultation 33.3% (95% CI 18.5–52.3), lung auscultation 29.6% (95% CI 15.7–48.7), pulse and extremity examination 55.6% (95% CI 37.3–72.4), and abdominal examination 3.70% (95% CI 0–19.8). None of the students completed all four of these components.Conclusion: Our study showed that fourth-year medical students did not uniformly perform components of a focused

Introduction: Chest pain is a common emergency department (ED) presentation accounting for 8-10million visits per year in the United States. Physician-level factors such as risk tolerance are predictive ofadmission rates. The recent advent of accelerated diagnostic pathways and ED observation units mayhave an impact in reducing variation in admission rates on the individual physician level.Methods: We conducted a single-institution retrospective observational study of ED patients with adiagnosis of chest pain as determined by diagnostic code from our hospital administrative database.We included ED visits from 2012 and 2013. Patients with an elevated troponin or an electrocardiogram(ECG) demonstrating an ST elevation myocardial infarction were excluded. Patients were divided into twogroups: “admission” (this included observation and inpatients) and “discharged.” We stratified physiciansby age, gender, residency location, and years since medical school. We controlled for patient- andhospital-related factors including age, gender, race, insurance status, daily ED volume, and lab values.Results: Of 4,577 patients with documented dispositions, 3,252 (70.9%) were either admitted to thehospital or into observation (in an ED observation unit or in the hospital), while 1,333 (29.1%) weredischarged. Median number of patients per physician was 132 (interquartile range 89-172). Averageadmission rate was 73.7±9.5% ranging from 54% to 96%. Of the 3,252 admissions, 2,638 (81.1%) wereto observation. There was significant variation in the admission rate at the individual physician level withadjusted odds ratio ranging from 0.42 to 5.8 as compared to the average admission. Among physicians’characteristics, years elapsed since finishing medical school demonstrated a trend towards associationwith a higher admission probability.Conclusion: There is substantial variation among physicians in the management of patients presentingwith chest pain, with physician experience playing a role.

Introduction The structure of the interview day affects applicant interactions with faculty and residents, which can influence the applicant's rank list decision. We aim to determine if there was a difference in matched residents between those interviewing on a day on which didactics were held and had increased resident and faculty presence (Didactic Day) versus an interview day with less availability for applicant interactions with residents and faculty (Non-Didactic Day).Methods Retrospective study reviewing interview dates of matched residents from 2009-2015.Results 42 (61.8%) matched residents interviewed on a Didactic Day with increased faculty and resident presence versus 26 (38.2%) on a Non-Didactic interview day with less availability for applicant interactions (p=0.04).Conclusion There is an association between interviewing on a Didactic Day with increased faculty and resident presence and matching in our program.

Introduction: Chest pain is a common emergency department (ED) presentation accounting for 8-10million visits per year in the United States. Physician-level factors such as risk tolerance are predictive ofadmission rates. The recent advent of accelerated diagnostic pathways and ED observation units mayhave an impact in reducing variation in admission rates on the individual physician level.Methods: We conducted a single-institution retrospective observational study of ED patients with adiagnosis of chest pain as determined by diagnostic code from our hospital administrative database.We included ED visits from 2012 and 2013. Patients with an elevated troponin or an electrocardiogram(ECG) demonstrating an ST elevation myocardial infarction were excluded. Patients were divided into twogroups: “admission” (this included observation and inpatients) and “discharged.” We stratified physiciansby age, gender, residency location, and years since medical school. We controlled for patient- andhospital-related factors including age, gender, race, insurance status, daily ED volume, and lab values.Results: Of 4,577 patients with documented dispositions, 3,252 (70.9%) were either admitted to thehospital or into observation (in an ED observation unit or in the hospital), while 1,333 (29.1%) weredischarged. Median number of patients per physician was 132 (interquartile range 89-172). Averageadmission rate was 73.7±9.5% ranging from 54% to 96%. Of the 3,252 admissions, 2,638 (81.1%) wereto observation. There was significant variation in the admission rate at the individual physician level withadjusted odds ratio ranging from 0.42 to 5.8 as compared to the average admission. Among physicians’characteristics, years elapsed since finishing medical school demonstrated a trend towards associationwith a higher admission probability.Conclusion: There is substantial variation among physicians in the management of patients presentingwith chest pain, with physician experience playing a role.

Introduction The structure of the interview day affects applicant interactions with faculty and residents, which can influence the applicant's rank list decision. We aim to determine if there was a difference in matched residents between those interviewing on a day on which didactics were held and had increased resident and faculty presence (Didactic Day) versus an interview day with less availability for applicant interactions with residents and faculty (Non-Didactic Day).Methods Retrospective study reviewing interview dates of matched residents from 2009-2015.Results 42 (61.8%) matched residents interviewed on a Didactic Day with increased faculty and resident presence versus 26 (38.2%) on a Non-Didactic interview day with less availability for applicant interactions (p=0.04).Conclusion There is an association between interviewing on a Didactic Day with increased faculty and resident presence and matching in our program.

Contents: Water needs and problems; Method of economic analysis; Flood damage reduction; Municipal and industrial water supply; Waste disposal and water quality; and Recreation., Original contains color plates: All DDC reproductions will be in black and white. See also Volume 4, AD-A036 827.

Contents: Economy and character of the Basin; Location, population and development; Agriculture; Forestry; Recreational and scenic resources; Mining; and Towns, industry, and trade., Original contains color plates: All DDC reproductions will be in black and white. See also Volume 3, AD-A036 826.

Contents: Flow maps arranged in following order: US Foreign trade; Dry cargo, 1948, Tanker traffic, 1947; US Domestic trade, 1950; Dry cargo; Tanker (petroleum and products); Total. Origin and destination maps of American domestic shipping, 1950, arranged in the following order of coastal region with separate maps for dry cargo, petroleum and products, and the total: North Atlantic, South Atlantic, Gulf, South Pacific, North Pacific.