Dream one, do one, teach one: a mental practice script for bougie assisted cricothyrotomy.

Mental practice is an effective method for skill acquisition in medicine. We describe the integration of interview-derived sensory cues with a list of procedural steps into a cohesive script to facilitate mental practice for a High Acuity, Low-Occurrence procedure, the bougie-assisted cricothyrotomy. Data collection occurred through interviews with emergency physicians.

Are we talking about practice? A randomized study comparing simulation-based deliberate practice and mastery learning to self-guided practice.

Objectives: Simulation-based technical skills training is now ubiquitous in medicine, particularly for high acuity, low occurrence (HALO) procedures. Mastery learning and deliberate practice (ML + DP) are potentially valuable educational methods, however, they are resource intensive. We sought to compare the effect of deliberate practice and mastery learning versus self-guided practice on skill performance of the rare, life-saving procedure, a bougie-assisted cricothyroidotomy (BAC).

Defining adverse events during trauma resuscitation: a modified RAND Delphi study.

Background: The majority of preventable adverse event (AEs) in trauma care occur during the initial phase of resuscitation, often within the trauma bay. However, there is significant heterogeneity in reporting these AEs that limits performance comparisons between hospitals and trauma systems. The objective of this study was to create a taxonomy of AEs that occur during trauma resuscitation and a corresponding classification system to assign a degree of harm.

Trauma Resuscitation Using in situ Simulation Team Training (TRUST) study: latent safety threat evaluation using framework analysis and video review.

Introduction: Trauma resuscitation is a complex and time-sensitive endeavour with significant risk for error. These errors can manifest from sequential system, team and knowledge-based failures, defined as latent safety threats (LSTs). In situ simulation (ISS) provides a novel prospective approach to recreate clinical situations that may manifest LSTs.

The Mindset of the Resuscitationist.

Excellent resuscitation requires technical skills and knowledge, but also the right mindset. Expert practitioners must master their internal affective state, and create the environment that leads to optimal team performance. Leaders in resuscitation should use structured approaches to prepare for resuscitation, and psychological skills to enhance their performance including mental rehearsal, positive self-talk, explicit communication strategies, and situational awareness skills.

Pushing boundaries of video review in trauma: using comprehensive data to improve the safety of trauma care.

Adverse events and lapses in safety are identified after the fact and often discussed through postevent review. These rounds rely on personal recollection, information from patient charts and incident reports that are limited by retrospective data collection. This results in recall bias and inaccurate or insufficient detail related to timeline, incidence and nature adverse events.

Mental practice as a novel learning strategy for donning and doffing personal protective equipment during the COVID-19 pandemic.

The coronavirus disease 2019 (COVID-19) pandemic presents challenges to the effective use of personal protective equipment, including equipment shortages, staff unfamiliarity, and physical distancing. Mental practice has been used as an alternative learning strategy in medicine for the development of technical skills. We developed educational materials with the aim of using mental practice to overcome these challenges and increase provider skill and confidence with the use of personal protective equipment.

Pre-arrest and intra-arrest prognostic factors associated with survival following traumatic out-of-hospital cardiac arrest - A systematic review and meta-analysis.

Aim: To summarize the prognostic associations of pre- and intra-arrest factors with return of spontaneous circulation (ROSC) and survival (in-hospital or 30 days) after traumatic out-of-hospital cardiac arrest.

Methods: We conducted this review in accordance with the PRISMA and CHARMS guidelines. We searched Medline, Pubmed, Embase, Scopus, Web of Science and the Cochrane Database of Systematic Reviews from inception through December 1st, 2019.

Just the facts: What drugs are safe and effective for COVID-19?

A 53-year-old male presents with cough, fever, and myalgias for 7 days. Vitals include temperature, 38.0°C; heart rate, 110; blood pressure, 118/70 mm Hg; respiration rate, 28; and oxygen saturation 83% on room air.

Just the Facts: What are the roles of oxygen escalation and noninvasive ventilation in COVID-19?

A 37-year-old female presents with cough, fever, dyspnea, and myalgias for five days after recent contact with a family member with confirmed 2019 coronavirus disease (COVID-19). Her vital signs include T 38.3° C, HR 108, BP 118/70 mm Hg, RR 26 breaths per minute, and oxygen saturation 67% on room air.

Just the Facts: Protected code blue - Cardiopulmonary resuscitation in the emergency department during the coronavirus disease 2019 pandemic.

Emergency medical services (EMS) is called for a 65-year-old man with a 1-week history of cough, fever, and mild shortness of breath now reporting chest pain. Vitals on scene were HR 110, BP 135/90, SpO2 88% on room air. EMS arrives at the emergency department (ED).

An Active Shooter in Your Hospital: A Novel Method to Develop a Response Policy Using In Situ Simulation and Video Framework Analysis.

Hospital shootings (Code Silver) are events that pose extreme risk to staff, patients, and visitors. Hospitals are faced with unique challenges to train staff and develop protocols to manage these high-risk events. In situ simulation is an innovative technique that can evaluate institutional responses to emergent situations.

Design Thinking-Informed Simulation: An Innovative Framework to Test, Evaluate, and Modify New Clinical Infrastructure.

Introduction: Designing new healthcare facilities is complex and transitions to new clinical environments carry high risks, as unanticipated problems may arise resulting in inefficient care and patient harm. Design thinking, a human-centered design method, represents a unique framework to support the planning, testing, and evaluation of new clinical spaces throughout all phases of construction. Healthcare simulation has been used to test new clinical spaces, yet most report using simulation only in the late design stages.

Understanding diagnosis through ACTion: evaluation of a point-of-care checklist for junior emergency medical residents.

Background Avoiding or correcting a diagnostic error first requires identification of an error and perhaps deciding to revise a diagnosis, but little is known about the factors that lead to revision. Three aspects of reflective practice, seeking Alternative explanations, exploring the Consequences of missing these alternative diagnoses, identifying Traits that may contradict the provisional diagnosis, were incorporated into a three-point diagnostic checklist (abbreviated to ACT). Methods Seventeen first and second year emergency medicine residents from the University of Toronto participated.

Perfecting practice: a protocol for assessing simulation-based mastery learning and deliberate practice versus self-guided practice for bougie-assisted cricothyroidotomy performance.

Background: Simulation-based medical education (SBME) is a cornerstone for procedural skill training in residency education. Multiple studies have concluded that SBME is highly effective, superior to traditional clinical education, and translates to improved patient outcomes. Additionally it is widely accepted that mastery learning, which comprises deliberate practice, is essential for expert level performance for routine skills; however, given that highly structured practice is more time and resource-intensive, it is important to assess its value for the acquisition of rarely performed technical skills.

Femtosecond dynamics of metal-centered and ligand-to-metal charge-transfer (t-based) electronic excited states in various solvents: A comprehensive study of IrBr .

The photophysical properties of intraconfigurational metal-centered (MC) and ligand-to-metal charge transfer (LMCT) states were studied in a prototype low spin heavy d transition metal complex, IrBr . The femtosecond-to-picosecond dynamics of this complex was investigated in solutions of drastically different polarity (acetonitrile, chloroform, and water) by means of ultrafast broadband transient absorption spectroscopy. We observed that the system, when excited into the third excited [second LMCT, U'(T)] state, undergoes distortion from the Franck-Condon geometry along the t vibrational mode as a result of the Jahn-Teller effect, followed by rapid internal conversion to populate (90 fs) the second excited [first LMCT, U'(T)] state.

Force of Habit: Developing Situation Awareness in Critical Care Transport.

Situation awareness (SA) is a vital cognitive skill for high-stakes, high-hazard occupations, including military, aviation, and health care. The ability to maintain SA can deteriorate in stressful situations, exposing patients to dangerous errors. The literature regarding how to best teach SA techniques is sparse.

Bougie-assisted cricothyroidotomy: Delphi-derived essential steps for the novice learner.

Objective: A cricothyroidotomy is a life-saving procedure, performed as a final option to emergency airway algorithms, and is essential for all clinicians who perform emergency airway management. The bougie-assisted cricothyroidotomy (BAC) is a novel technique that may be performed faster and with fewer complications than other traditional approaches. There is no established standard set of steps to guide the instruction of BAC performance.

Tracking workflow during high-stakes resuscitation: the application of a novel clinician movement tracing tool during in situ trauma simulation.

Introduction: Clinician movement and workflow analysis provides an opportunity to identify inefficiencies during trauma resuscitation care. Inefficient workflows may represent latent safety threats (LSTs), defined as unrecognised system-based elements that can negatively impact patients. In situ simulation (ISS) can be used to model resuscitation workflows without direct impact on patients.