Dataset Information

Low Back Pain in the Emergency Medicine Department: A Flipped Classroom Module.

ABSTRACT:

Introduction

Current residency didactic schedules that are built upon hour-long, lecture-based presentations are incongruous with adult learning theory and the needs of millennial generation residents. An alternative to the traditional lecture, the flipped classroom involves viewing a short video lecture at home, followed by an active discussion during class time. This module was developed for emergency medicine residents and rotating medical students without previous training on the subject.

Methods

The at-home portion of the module was designed to be delivered at home, while the in-class discussion was designed to be carried out over 30-45 minutes during a regularly scheduled didactic time. Small-group size may be determined by faculty availability, though groups of five are optimal. There is no requirement for faculty preparation prior to the in-class session. Associated materials include objectives, the at-home video, a discussion guide for faculty facilitators, a case-based handout for students and residents, and assessment questions. We assessed our module with a pretest, immediate posttest, and the posttest again after 90 days.

Results

The mean pretest score was 66%, mean posttest score 76%, and mean retention test score 66%. There was an immediate increase of 10%, which did not remain at 90 days.

Discussion

We developed a flipped classroom module that can be implemented in any emergency medicine residency or clerkship. It addresses the theoretical challenges posed to traditional conference didactics by increasing the focus on problem solving and self-directed learning.

SUBMITTER: Riddell JC

PROVIDER: S-EPMC6464443 | biostudies-literature | 2016 Sep

REPOSITORIES: biostudies-literature

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Publications

Low Back Pain in the Emergency Medicine Department: A Flipped Classroom Module.

Riddell Jeff C JC Sawtelle Stacy S Jhun Paul P Comes James J Tabatabai Ramin R Joseph Daniel D Shoenberger Jan J Chen Esther E Fee Christopher C Swadron Stuart S

MedEdPORTAL : the journal of teaching and learning resources 20160923

<h4>Introduction</h4>Current residency didactic schedules that are built upon hour-long, lecture-based presentations are incongruous with adult learning theory and the needs of millennial generation residents. An alternative to the traditional lecture, the flipped classroom involves viewing a short video lecture at home, followed by an active discussion during class time. This module was developed for emergency medicine residents and rotating medical students without previous training on the sub ...[more]

PMID: 31008236

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Project description:IntroductionLinking educational objectives and clinical learning during clerkships can be difficult. Clinical shifts during emergency medicine (EM) clerkships provide a wide variety of experiences, some of which may not be relevant to recommended educational objectives. Students can be directed to standardize their clinical experiences, and this improves performance on examinations. We hypothesized that applying a "flipped classroom" model to the clinical clerkship would improve performance on multiple-choice testing when compared to standard learning.MethodsStudents at two institutions were randomized to complete two of four selected EM clerkship topics in a "flipped fashion," and two others in a standard fashion. For flipped topics, students were directed to complete chief complaint-based asynchronous modules prior to a shift, during which they were directed to focus on the chief complaint. For the other two topics, modules were to be performed at the students' discretion, and shifts would not have a theme. At the end of the four-week clerkship, a 40-question multiple-choice examination was administered with 10 questions per topic. We compared performance on flipped topics with those performed in standard fashion. Students were surveyed on perceived effectiveness, ability to follow the protocol, and willingness of preceptors to allow a chief-complaint focus.ResultsSixty-nine students participated; examination scores for 56 were available for analysis. For the primary outcome, no difference was seen between the flipped method and standard (p=0.494.) A mixed model approach showed no effect of flipped status, protocol adherence, or site of rotation on the primary outcome of exam scores. Students rated the concept of the flipped clerkship highly (3.48/5). Almost one third (31.1%) of students stated that they were unable to adhere to the protocol.ConclusionPreparation for a clinical shift with pre-assigned, web-based learning modules followed by an attempt at chief-complaint-focused learning during a shift did not result in improvements in performance on a multiple-choice assessment of knowledge; however, one third of participants did not adhere strictly to the protocol. Future investigations should ensure performance of pre-assigned learning as well as clinical experiences, and consider alternate measures of knowledge.

Project description:Low back pain accounts for nearly 4 million emergency department (ED) visits annually and is a significant source of disability. Physical therapy has been suggested as a potentially effective nonopioid treatment for low back pain; however, no studies to our knowledge have yet evaluated the emerging resource of ED-initiated physical therapy. The study objective was to compare patient-reported outcomes in patients receiving ED-initiated physical therapy and patients receiving usual care for acute low back pain. This was a prospective observational study of ED patients receiving either physical therapy or usual care for acute low back pain from May 1, 2018, to May 24, 2019, at a single academic ED (>91,000 annual visits). The primary outcome was pain-related functioning, assessed with Oswestry Disability Index (ODI) and Patient-Reported Outcomes Measurement Information System pain interference (PROMIS-PI) scores. The secondary outcome was use of high-risk medications (opioids, benzodiazepines, and skeletal muscle relaxants). Outcomes were compared over 3 months using adjusted linear mixed and generalized estimating equation models. For 101 participants (43 receiving ED-initiated physical therapy and 58 receiving usual care), the median age was 40.5 years and 59% were women. Baseline outcome scores in the ED-initiated physical therapy group were higher than those in the usual care group (ODI = 51.1 vs 36.0; PROMIS-PI = 67.6 vs 62.7). Patients receiving ED-initiated physical therapy had greater improvements in both ODI and PROMIS-PI scores at the 3-month follow-up (ODI = -14.4 [95% CI = -23.0 to -5.7]; PROMIS-PI = -5.1 [95% CI = -9.9 to -0.4]) and lower use of high-risk medications (odds ratio = 0.05 [95% CI = 0.01 to 0.58]). In this single-center observational study, ED-initiated physical therapy for acute low back pain was associated with improvements in functioning and lower use of high-risk medications compared with usual care; the causality of these relationships remains to be explored. ED-initiated physical therapy is a promising therapy for acute low back pain that may reduce reliance on high-risk medications while improving patient-reported outcomes. Emergency department-initiated physical therapy for low back pain was associated with greater improvement in functioning and lower use of high-risk medications over 3 months.

Project description:BackgroundLow back pain is the leading cause of disability worldwide and a common presentation to emergency departments, often resulting in subsequent admissions to hospital. There have been several studies investigating the cost of low back pain to society, but few specific to the emergency department and inpatient setting, especially in Australia. The aim was to describe the cost of low back pain in Australian public hospital emergency departments, and inpatient settings, and explore healthcare costs associated with different care pathways.MethodsIn this retrospective observational study, we explored the costs associated with an episode of care for low back pain in adults that attended three emergency departments in Sydney between 1 July 2014 and 30 June 2019. Systematised Nomenclature of Medicine-Clinical Terms (SNOMED) diagnosis codes were used to identify episodes of care where the patients had been diagnosed with non-specific low back pain or lumbosacral radicular syndromes. Serious spinal pathologies were excluded. We determined the costs for different treatment pathways involving the ambulance service, emergency department and inpatient ward care. Hospital costs were adjusted for inflation to 2019 Australian dollars (AUD).FindingsThere were 12,399 non-serious low back pain episodes of care during the study period. 4006 (32%) arrived by ambulance and 2067 (17%) were admitted for inpatient care. The total costs of inpatient and emergency department care across the 5-year period were AUD$36.7 million, with a mean of AUD$2959 per episode of care. The mean cost for a patient who had a non-ambulance presentation to the emergency department and was discharged was AUD$584. Patients presenting to the emergency department via ambulance and were discharged had a mean cost of AUD$1022. Patients who presented without the need of an ambulance and were admitted had a mean cost of $13,137. The most expensive care pathway was for patients arriving by ambulance with subsequent admission, with a mean cost of AUD$14,949.InterpretationThe common practice of admitting patients with non-serious low back pain for inpatient care comes at great cost to the healthcare system. In a resource constrained environment, our data highlights the economic need to implement innovative, evidence-based strategies to reduce the inpatient management of these patients.FundingNil.

Project description:INTRODUCTION:Patients with low back pain often seek care in emergency departments, but the problem is that many patients receive unnecessary or ineffective interventions and at the same time miss out on the basics of care, such as advice on self-management. This pattern of care has important consequences for the healthcare system (expensive and inefficient) and for patients (poor health outcomes). We hypothesised that the implementation of an evidence-based model of care for low back pain will improve emergency care by reducing inappropriate overuse of tests and treatments and improving patient outcomes. METHODS AND ANALYSIS:A stepped-wedge cluster randomised controlled trial will be conducted to implement and evaluate the use of the Agency for Clinical Innovation (ACI) model of care for acute low back pain at four emergency departments in New South Wales, Australia. Clinician participants will be emergency physicians, nurses and physiotherapists. Codes from the Systematised Nomenclature of Medicine-Clinical Terms-Australian version will be used to identify low back pain presentations. The intervention, targeting emergency clinicians, will comprise educational materials and seminars and an audit and feedback approach. Health service delivery outcomes are routinely collected measures of imaging (primary outcome), opioid use and inpatient admission. A random subsample of 200 patient participants from each trial period will be included to measure patient outcomes (pain intensity, physical function, quality of life and experience with emergency service). The effectiveness of the intervention will be assessed by comparing the postintervention period with the retrospective baseline control period. ETHICS AND DISSEMINATION:The study received ethical approval from the Sydney Local Health District (Royal Prince Alfred Hospital zone) Ethics Committee (X17-0043). The results of this study will be published in peer-reviewed journals and presented at international conferences. TRIAL REGISTRATION NUMBER:Australia New Zealand Clinical Trials Registry: ACTRN 12617001160325.

Dataset Information

Low Back Pain in the Emergency Medicine Department: A Flipped Classroom Module.

Introduction

Methods

Results

Discussion

Publications

Low Back Pain in the Emergency Medicine Department: A Flipped Classroom Module.

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