Educational Research Impacts EM Residents

December 23, 2014

Jessica Svendsen

Jump has a growing research profile right now that includes important work in educational research. One of our projects is the sedation study, led by Dr. Gregory Tudor, Associate Program Director, Clinical Assistant Professor Department of Emergency Medicine as principal investigator.

Standard debriefing with expert physicians is common practice in medical training, including the training of resident physicians. Often physician experts are limited by the amount of dedicated time available and program financial support.

Through this cohort study involving program years 1-3 emergency residents, self-assessment encourages the individual learner to recognize errors in a similar way with the use of video replay of their performance.

The main objective of the study is to demonstrate that self-assessment can be just as beneficial a tool as instructor debriefing and key non-technical skills are similar: Task management; team working; situation awareness and decision making.

Simulation and Debriefing

The typical case in the study represents a pediatric patient who would appear at the emergency room and require sedation in order to repair, or otherwise treat, their condition. After every simulation, participants are randomized to either standard debriefing or self-assessment.

Standard debriefing involves everyone that would be in the room at the time that a procedure takes place. It can involve the physician, nurse, a medical student, or any participant that may be in on that patient's care.

The debriefing process is a time intensive and faculty intensive endeavor to appropriately debrief learners. In a center like Jump, there's a fixed operating cost. If we are able to lower the faculty cost, without sacrificing the learning experience, it's a tremendous saving.

To preserve resources, we're trying to analyze whether video self-assessment is just as good as standard debriefing. Video self-assessment is essentially watching yourself on camera as you performed the procedure, and assessing yourself according to a checklist. That checklist covers every various stage of the procedure.

Interim Analysis

The sedation study has been going on well over a year now. We have had multiple sessions, where we have the resident physicians run through two different case scenarios.

We have about 31 residents who have completed the study. We have about 9 or 10 who have gone through the first half, and they'll finish up the rest of it in the next couple months.

Currently in our interim analysis however, we have discovered a few different things. For one, we discovered that faculty and resident self-evaluations and the debriefing evaluations are similar.

What we don't know yet, is if they are similar enough - can we say without a doubt that video self assessment is just as good as the standard debriefing? We're not there yet but the results are promising.

Unexpected Results

One of the things you don't anticipate with research is what the other outcomes are, unexpected results from the journey and impacts.

Clinically, our residents now report they have more confidence performing sedation in real patients. We see residents that are more engaged and involved than we did before, and they're saying it's because they've gone through this session.

"I felt the debriefing was useful in identifying what to improve on," said Lawrence Jiang, a first year intern in the emergency medicine department, and a volunteer in the study. "I got to discuss my view point and try to explain some of the steps that I took. It helped to identify some corrective actions."

Research is a great mechanism for us to identify information that we can take back into the clinic, identify some of the gaps that may occur, and fix those gaps through simulation.

The value of Emergency Department Procedural Sedation (EDPS) in simulation may improve performance in real-case clinic scenarios which, in turn, could decrease errors, demonstrate value to resources required for simulated scenarios and improve patient outcomes.

We are thrilled to be working with Dr. Tudor and his team of experts, and can't wait to determine the final results.

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Jessica Svendsen