Interactive virtual cases for emergency medicine physicians during the COVID-19 pandemic.
Ontology highlight
ABSTRACT:
SUBMITTER: Forristal C
PROVIDER: S-EPMC8243042 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:The COVID-19 pandemic has been a significant catalyst for change in medical education and clinical care. The traditional model of bedside clinical teaching in required advanced clerkships was upended on March 17, 2020, when the Association of American Medical Colleges recommended removing medical students from direct patient care to prevent further spread of the disease and also to help conserve scarce personal protective equipment (PPE). This created unique challenges for delivering a robust, advanced emergency medicine (EM) clerkship since the emergency department is ground zero for the undifferentiated and potentially infected patient and has high demand for PPE. Here, we describe the development, application, and program evaluation of an online-based, virtual advanced EM curriculum developed rapidly in response to the COVID-19 pandemic.Starting March 23, 2020, we began rotating fourth-year medical students through a four-week rotation. We completed a total of four virtual clerkship experiences comprised of 56 students through July 27, 2020. Through analysis of the students' performance on a national standardized EM shelf exam, students participating in this virtual clerkship demonstrated a fund of knowledge that was not significantly different from that of their peers who completed a traditional clerkship in the specialty prior to the pandemic interruptions. Additionally, the critical review of the traditional course created the opportunity to make improvements and enrich the medical student educational experience in a virtual environment and upon resumption of the traditional course when students returned to the in-person environment. The resources provided for those interested in adopting our pedagogical approach include a course syllabus, calendar, and learner summative assessment.
| S-EPMC8202996 | biostudies-literature
Project description:ObjectivesA previous survey of Canadian emergency medicine (EM) physicians during the first wave of the COVID-19 pandemic documented less than 20% experienced high levels of burnout. This study examined the experience of a similar group of physicians during the second pandemic wave. We reported the associations between burnout and physician age, gender, having children at home and training route.MethodsThis study utilized a national survey of Canadian emergency physicians. We collected data on demographics and measured burnout using the Maslach Burnout Inventory (MBI). Multiple logistic regression models identified associations between the emotional exhaustion and depersonalization domains of the MBI and EM physician demographics (age, gender, children living at home, and training route).ResultsBetween November 25, 2020, and February 4, 2021, 416 emergency physicians completed the survey, representing all Provinces or Territories in Canada (except Nunavut). The mean participant age was 44, 53% were male, 64% had children living at home and 41% were FRCPC and 41% CCFP-EM trained. Sixty percent reported high burnout (either high emotional exhaustion and/or high depersonalization). Increasing age was associated with lower emotional exhaustion and depersonalization; female or nonbinary gender was associated with an increase in emotional exhaustion; and having children living at home was associated with lower depersonalization.ConclusionsMost Canadian emergency physicians participating in our study during the COVID-19 pandemic reported high burnout levels. Younger physicians and female physicians were more likely than their coworkers to report high burnout levels. Hospitals should address emergency physician burnout during the pandemic because it is a threat to quality of patient care and retention of the workforce for the future.
| S-EPMC8792132 | biostudies-literature
Project description:ObjectiveTo evaluate medical student and attending surgeon experiences with a novel interactive virtual Otolaryngology - Head and Neck Surgery (OHNS) medical student elective during the COVID-19 pandemic.Study designA virtual OHNS elective was created, with three components: (1) interactive virtual operating room (OR) experience using live-stream video-conferencing, (2) telehealth clinic, (3) virtual didactics.SettingOHNS Department at the University of Pennsylvania (May 2020 to June 2020).MethodsSix medical students from the University of Pennsylvania; five attending otolaryngologists. Two surveys were designed and distributed to participating medical students and attending surgeons. Surveys included 5-point Likert scale items, with 1 indicating "not at all" and 5 indicating "very much so".ResultsResponse rate was 100% for both surveys. Students on average rated the educational value of the telehealth experience as 4.2±1.2, and the virtual OR experience as 4.0±0.6. Most students (n=5, 83%) indicated that they had enough exposure to faculty they met on this rotation to ask for a letter of recommendation (LOR) for residency if needed, while attending surgeons had an average response of 3.0±1.0 when asked how comfortable they would feel writing a LOR for a student they met through the rotation. A majority of students (n=4, 67%) felt they connected enough with faculty during the rotation to ask for mentorship. Half the students (n=5, 50%) indicated that the rotation allowed them to evaluate the department's culture either "extremely well" or "somewhat well".ConclusionsOverall, participating students described this innovative virtual surgical rotation as an educationally and professionally valuable experience. With the continued suspension of visiting student rotations due to the COVID-19 pandemic, this virtual model may have continued relevance to medical education.
| S-EPMC8064875 | biostudies-literature
Project description:BackgroundEmergency medicine (EM) physicians have been on the front line of the COVID-19 pandemic. This study aims to determine the impact of COVID-19 pandemic and other related factors such as resource availability and institutional support on well-being, burnout and job-satisfaction of EM physicians in the United States.MethodsA cross-sectional survey study of EM physicians was conducted through the Emergency Medicine Practice Research Network of the ACEP. The survey focused on resource adequacy, institutional support, well-being, and burnout. A total of 890 EM physicians were invited to participate. Both descriptive and risk adjusted, and multivariate regressions were performed with a statistical significance defined as p < 0.05.ResultsEM physicians' response rate was 18.7% (166) from 39 states. Burnout was reported by 74.7% (124) since the start of the pandemic. Factors contributing included work-related emotional strain and anxiety, isolation from family and friends, and increased workload. Those reporting inadequate resources felt ignored by their institutions (p < 0.0001). Physicians who felt there was inadequate institutional support, were also dissatisfied with patient care resources (p = 0.001). Physicians expressing job dissatisfaction were more likely to report feelings of burnout (p = 0.001).ConclusionEM physicians face greater burnout in the COVID-19 pandemic. This may be compounded by resource scarcity, psychological stress, isolation, and job dissatisfaction. Many of the survey respondents reported inadequate mental health services and resources. The findings of this study may help identify solutions to mitigate these issues.
| S-EPMC8016733 | biostudies-literature
Project description:Coronavirus disease 2019 (COVID-19) is an emerging viral disease that has caused a global pandemic. Among emergency department (ED) patients, pediatric patient volume mostly and continuously decreased during the pandemic period. Decreased pediatric patient volume in a prolonged period could results in inadequate pediatric training of Emergency Medicine (EM) residents. We collected data regarding pediatric patients who were first seen by EM resident physicians between 1 February 2019, and 31 January 2021, which was divided into pre-epidemic and epidemic periods by 1 February 2020. A significant reduction in pediatric patients per hour (PPH) of EM residents was noted in the epidemic period (from 1.55 to 0.81, p < 0.001). The average patient number was reduced significantly in the classification of infection (from 9.50 to 4.00, p < 0.001), respiratory system (from 84.00 to 22.00, p < 0.001), gastrointestinal system (from 52.00 to 34.00, p = 0.007), otolaryngology (from 4.00 to 2.00, p = 0.022). Among the diagnoses of infectious disease, the most obvious drop was noted in the diagnosis of influenza and enterovirus infection. Reduced pediatric patient volume affected clinical exposure to pediatric EM training of EM residency. Changes in the proportion of pediatric diseases presented in the ED may induce inadequate experience with common and specific pediatric diseases.
| S-EPMC8773981 | biostudies-literature
Project description:ObjectiveThe objective was to assess anxiety and burnout levels, home life changes, and measures to relieve stress of U.S. academic emergency medicine (EM) physicians during the COVID-19 pandemic acceleration phase.MethodsWe sent a cross-sectional e-mail survey to all EM physicians at seven academic emergency departments. The survey incorporated items from validated stress scales and assessed perceptions and key elements in the following domains: numbers of suspected COVID-19 patients, availability of diagnostic testing, levels of home and workplace anxiety, severity of work burnout, identification of stressors, changes in home behaviors, and measures to decrease provider anxiety.ResultsA total of 426 (56.7%) EM physicians responded. On a scale of 1 to 7 (1 = not at all, 4 = somewhat, and 7 = extremely), the median (interquartile range) reported effect of the pandemic on both work and home stress levels was 5 (4-6). Reported levels of emotional exhaustion/burnout increased from a prepandemic median (IQR) of 3 (2-4) to since the pandemic started a median of 4 (3-6), with a difference in medians of 1.8 (95% confidence interval = 1.7 to 1.9). Most physicians (90.8%) reported changing their behavior toward family and friends, especially by decreasing signs of affection (76.8%). The most commonly cited measures cited to alleviate stress/anxiety were increasing personal protective equipment (PPE) availability, offering rapid COVID-19 testing at physician discretion, providing clearer communication about COVID-19 protocol changes, and assuring that physicians can take leave for care of family and self.ConclusionsDuring the acceleration phase, the COVID-19 pandemic has induced substantial workplace and home anxiety in academic EM physicians, and their exposure during work has had a major impact on their home lives. Measures cited to decrease stress include enhanced availability of PPE, rapid turnaround testing at provider discretion, and clear communication about COVID-19 protocol changes.
| S-EPMC7361565 | biostudies-literature
Project description:BackgroundThe objective of this study was to explore Canadian emergency physicians' experiences, concerns, and perspectives during the first wave of the coronavirus disease (COVID-19) pandemic.MethodsThis cross-sectional survey of physician members of Pediatric Emergency Research Canada and the Canadian Association of Emergency Physicians explored: personal safety/responsibility to care; patient interactions; ethical issues in pandemic care; institutional dynamics and communication practices. Data analysis was descriptive: categorical data were summarised with frequency distributions, continuous data [100 mm visual analog scales (VAS)] were analysed using measures of central tendency. Short open-ended items were coded to identify frequencies of responses.ResultsFrom June 29 to July 29, 2020, 187 respondents (13% response rate) completed the survey: 39% were from Ontario and 20% from Quebec, trained in general (50%) or pediatric (37%) emergency medicine. Respondents reported a high moral obligation to care for patients (97/100, IQR: 85-100, on 100 mm VAS). Fear of contracting COVID-19 changed how 82% of respondents reported interacting with patients, while 97% reported PPE negatively impacted patient care. Despite reporting a high proportion of negative emotions (84%), respondents (59%) were not/slightly concerned about their mental health. Top concerns included a potential second wave, Canada's financial situation, worldwide solidarity, and youth mental health. Facilitators to provide emergency care included: teamwork, leadership, clear communications strategies.ConclusionCanadian emergency physicians felt a strong sense of responsibility to care, while dealing with several ethical dilemmas. Clear communication strategies, measures to ensure safety, and appropriate emergency department setups facilitate pandemic care. Emergency physicians were not concerned about their own mental health, requiring further exploration.
| S-EPMC8127493 | biostudies-literature
Project description:BackgroundThe COVID-19 pandemic has changed the epidemiology of upper respiratory tract infections (URTI) and the disease profile of patients attending the emergency department (ED). Hence, we sought to explore the changes in ED physicians' attitudes and behaviours in four EDs in Singapore.MethodsWe employed a sequential mixed-methods approach (quantitative survey followed by in-depth interviews). Principal component analysis was performed to derive latent factors, followed by multivariable logistic regression to explore the independent factors associated with high antibiotic prescribing. Interviews were analysed using the deductive-inductive-deductive framework. We derive five meta-inferences by integrating the quantitative and qualitative findings with an explanatory bidirectional framework.ResultsWe obtained 560 (65.9%) valid responses from the survey and interviewed 50 physicians from various work experiences. ED physicians were twice as likely to report high antibiotic prescribing rates pre-COVID-19 pandemic than during the pandemic (AOR = 2.12, 95% CI 1.32 to 3.41, p = 0.002). Five meta-inferences were made by integrating the data: (1) Less pressure to prescribe antibiotics due to reduced patient demand and more patient education opportunities; (2) A higher proportion of ED physicians self-reported lower antibiotic prescribing rates during the COVID-19 pandemic but their perception of the overall outlook on antibiotic prescribing rates varied; (3) Physicians who were high antibiotic prescribers during the COVID-19 pandemic made less effort for prudent antibiotic prescribing as they were less concerned about antimicrobial resistance; (4) the COVID-19 pandemic did not change the factors that lowered the threshold for antibiotic prescribing; (5) the COVID-19 pandemic did not change the perception that the public's knowledge of antibiotics is poor.ConclusionsSelf-reported antibiotic prescribing rates decreased in the ED during the COVID-19 pandemic due to less pressure to prescribe antibiotics. The lessons and experiences learnt from the COVID-19 pandemic can be incorporated into public and medical education in the war against antimicrobial resistance going forward. Antibiotic use should also be monitored post-pandemic to assess if the changes are sustained.
| S-EPMC10057674 | biostudies-literature
Project description:IntroductionThe objective of this study was to analyze the messages of influential emergency medicine (EM) Twitter users in the United States (US) during the early stages of the coronavirus disease 2019 (COVID-19) global pandemic by characterizing the themes, emotional tones, temporal viewpoints, and depth of engagement with the tweets.MethodsWe performed a retrospective mixed-methods analysis of publicly available Twitter data derived from the publicly available "Coronavirus Tweet IDs" dataset, March 3, 2020-May 1, 2020. Original tweets and modified retweets in the dataset by 50 influential EM Twitter users in the US were analyzed using linguistic software to report the emotional tone and temporal viewpoint. We qualitatively analyzed a 25% random subsample and report themes.ResultsThere were 1315 tweets available in the dataset from 36/50 influential EM Twitter users in the US. The majority of tweets were either positive (455/1315, 34.6%) or neutral (407/1315, 31%) in tone and focused on the present (1009/1315, 76.7%). Qualitative analysis identified six distinct themes, with users most often sharing news or clinical information.ConclusionsDuring the early weeks of the COVID-19 pandemic, influential EM Twitter users in the US delivered mainly positive or neutral messages, most often pertaining to news stories or information directly relating to patient care. The majority of these messages led to engagement by other users. This study underscores how EM influencers can leverage social media in public health outbreaks to bring attention to topics of importance.
| S-EPMC8203008 | biostudies-literature
Project description:ObjectivesTo assess prevalence and related factors of sleep disturbances among Saudi physicians during COVID-19 pandemic. Data were collected through a questionnaire including items about demographic characters, knowledge about covid-19 and items to assess sleep quality that were extracted from Pittsburgh Sleep Quality Index (PSQI) scale.ResultsPrevalence of sleep disorders was 43.9%, doctors in the age group of 31-40 years, associate consultants had a significant higher prevalence of sleep disorders. Medical interns and laboratory/pathology/microbiology doctors had a significant more difficulty in fall asleep during COVID-19, and internists and surgeons had a significant higher percent of those who used sleeping pills. Resident doctors had a significant higher percent of having trouble in staying awake, and residents and consultants had a significant higher percent of those who suffered decreased sleep duration. Sleep quality during COVID-19 was very good, fair good and very bad in 23.4%, 60% and 3.5% of HCW respectively. The study observed a negative impact of COVID-19 pandemic on HCW sleep quality. Hospitals administrations should provide optimal working hours with enough break and employ more doctors during the pandemic. Doctors experiencing sleep problems should have mandatory leaves.
| S-EPMC7576978 | biostudies-literature