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Introduction: Resident remediation is a pressing topic in emergency medicine (EM) training programs. Simulation has become a prominent educational tool in EM training and been recommended for identification of learning gaps and resident remediation. Despite the ubiquitous need for formalized remediation, there is a dearth of literature regarding best practices for simulation-based remediation (SBR).Methods: We conducted a literature search on SBR practices using the terms “simulation,” “remediation,” and “simulation based remediation.” We identified relevant themes and used them to develop an open-ended questionnaire that was distributed to EM programs with experience in SBR. Thematic analysis was performed on all subsequent responses and used to develop survey instruments, which were then used in a modified two-round Delphi panel to derive a set of consensus statements on the use of SBR from an aggregate of 41 experts in simulation and remediation in EM.Results: Faculty representing 30 programs across North America composed the consensus group with 66% of participants identifying themselves as simulation faculty, 32% as program directors, and 2% as core faculty. The results from our study highlight a strong agreement across many areas of SBR in EM training. SBR is appropriate for a range of deficits, including procedural, medical knowledge application, clinical reasoning/decision-making, communication, teamwork, and crisis resource management. Simulation can be used both diagnostically and therapeutically in remediation, although SBR should be part of a larger remediation plan constructed by the residency leadership team or a faculty expert in remediation, and not the only component. Although summative assessment can have a role in SBR, it needs to be very clearly delineated and transparent to everyone involved.Conclusion: Simulation may be used for remediation purposes for certain specific kinds of competencies as long as it is carried out in a transparent manner to all those involved.

Introduction: The focused assessment with sonography for trauma (FAST) is a commonly used and life-saving tool in the initial assessment of trauma patients. The recommended emergency medicine (EM) curriculum includes ultrasound and studies show the additional utility of ultrasound training for medical students. EM clerkships vary and often do not contain formal ultrasound instruction. Time constraints for facilitating lectures and hands-on learning of ultrasound are challenging. Limitations on didactics call for development and inclusion of novel educational strategies, such as simulation. The objective of this study was to compare the test, survey, and performance of ultrasound between medical students trained on an ultrasound simulator versus those trained via traditional, hands-on patient format.Methods: This was a prospective, blinded, controlled educational study focused on EM clerkship medical students. After all received a standardized lecture with pictorial demonstration of image acquisition, students were randomized into two groups: control group receiving traditional training method via practice on a human model and intervention group training via practice on an ultrasound simulator. Participants were tested and surveyed on indications and interpretation of FAST and training and confidence with image interpretation and acquisition before and after this educational activity. Evaluation of FAST skills was performed on a human model to emulate patient care and practical skills were scored via objective structured clinical examination (OSCE) with critical action checklist.Results: There was no significant difference between control group (N=54) and intervention group (N=39) on pretest scores, prior ultrasound training/education, or ultrasound comfort level in general or on FAST. All students (N=93) showed significant improvement from pre- to post-test scores and significant improvement in comfort level using ultrasound in general and on FAST (p

Objectives: Patient handoff occurs when responsibility for patient diagnosis, treatment, or ongoing care is transferred from one healthcare professional to another. Patient handoff is an integral component of quality patient care and is increasingly identified as a potential source of medical error. However, evaluation of handoff from field providers to ED personnel is limited. We here present a quantitative analysis of the information transferred from EMS providers to ED physicians during handoff of critically ill and injured patients. Methods: This study was conducted at an urban academic medical center with an emergency department census of greater than 100,000 visits annually. All patients arriving to our institution by EMS and meeting predefined triage criteria are brought immediately to the ED resuscitation area upon EMS arrival. Handoff from EMS to ED providers occurring in the resuscitation area was observed and audio recorded by trained research assistants and subsequently coded for content. The emergency department team as well as EMS were blinded to study design. Results: Ninety patient handoffs were evaluated. In 78% (95%CI = 70.0–86.7) of all handoffs, EMS provided a chief concern. In 58% (95%CI = 47.7–67.7) of handoffs EMS provided a description of the scene and in 57% (95%CI = 46.7–66.7) they provided a complete set of vital signs. In 47% (95%CI = 31.3–57.5) of handoffs pertinent physical exam findings were described. The EMS provider gave an overall assessment of the patient's clinical status in 31% (95%CI = 21.6–40.3) of cases. Significantly more paramedic handoffs included vital signs (70% vs. 37%, χ2 = 9.69, p = 0.002) and physical exam findings (63% vs. 23%, χ2 = 14.11, p < 0.001). Paramedics were more likely to provide an overall assessment (39% vs. 17%, χ2 = 4.71, p < 0.05). Conclusions: While patient handoff is a critical component of safe and effective patient care, our study confirms previous literature demonstrating poor quality handoff from EMS to ED providers in critically ill and injured patients. Our analysis demonstrates the need for further training in the provision of patient handoff. [ABSTRACT FROM AUTHOR]