Transforming remediation for competency-based medical education.

We care about the future experiences of all health professions trainees as competency-based medical education evolves. It is an exciting new era with many possibilities for progress in learning and competency development. Yet we are concerned that remediation remains a troubled and stigmatized detour from routine learning that can persist as a feared off-ramp from competency development rather than a central avenue for improvement and competency achievement.

Facilitating the transition to residency: A resident-as-coach pilot program.

Background: The transition from medical school to residency is a critical developmental phase; coaching may help students prepare for this role transition.

Aims: We explored whether near-peer coaching could improve a specific workplace skill prior to residency.

Methods: A resident-as-coach program was piloted for the medicine sub-internship, an advanced acting internship rotation.

A pilot clinical skills coaching program to reimagine remediation: a cohort study.

Background New approaches are needed to improve and destigmatize remediation in undergraduate medical education (UME).  The COVID-19 pandemic magnified the need to support struggling learners to ensure competency and readiness for graduate medical education (GME).  Clinical skills (CS) coaching is an underutilized approach that may mitigate the stigma of remedial learning.

Twelve tips for practical clinical skills coaching.

Coaching is rapidly evolving in clinical medicine, including for clinical skills (CS) learning. Yet a schema is needed for to coach students in the many CS that are pivotal to the practice of medicine. These twelve tips aim to provide practical strategies for teachers and educators to coach students for CS learning.

Firearm-related injuries in children and adolescents: an emergency and critical care perspective.

Purpose Of Review: Firearms are a leading cause of death and injury in children, especially in the United States. Many of these injuries present to emergency departments and pediatric ICUs, prompting a need for updated prevention, interventions, and trauma-informed care. This review explores the evidence for prevention and screening for access to firearms, types of injuries, and considerations for mass casualty events.

Cannabis-related emergencies in children and teens.

Purpose Of Review: To examine the spectrum of emergency department presentations associated with cannabis use or misuse that are currently seen in the pediatric population.

Recent Findings: There is a growing concern that pediatric emergency department visits related to cannabis are on the rise, especially given rapidly changing legislation on cannabis and its broad availability in certain areas. These concerns are substantiated in the current literature, as the evidence mounts for an array of emergency department presentations of intentional or accidental cannabis use.

A 17-Year-Old Boy With High-Functioning Autism, Gastrointestinal Illness, and Seizures.

A healthy 17-year-old boy with a high-functioning pervasive developmental disorder presented to the emergency department after having a 4-minute episode of seizure-like activity in the setting of presumed viral gastroenteritis. Within an hour of emergency department arrival, he developed a forehead-sparing facial droop, right-sided ptosis, and expressive aphasia, prompting stroke team assessment and urgent neuroimaging. Laboratory results later revealed a serum sodium of 119 mmol/L.

2018 Academic Emergency Medicine Consensus Conference: Advancing Pediatric Emergency Medicine Education Through Research and Scholarship.

To achieve high-quality emergency care for pediatric patients nationwide, it is necessary to define the key elements for pediatric emergency medicine (PEM) education and scholarship that would: 1) close the gaps in fundamental PEM education and 2) promote systems and standards that assure an ongoing communication of best practices between tertiary pediatric institutions, general (nonchildren's) hospital emergency departments, and urgent care centers. A working group of medical educators was formed to review the literature, develop a framework for consensus discussion at the breakout session, and then translate their findings into recommendations for future research and scholarship. The breakout session consensus discussion yielded many recommendations.

New directions in point-of-care ultrasound at the crossroads of paediatric emergency and critical care.

Purpose Of Review: The diagnostic capability, efficiency and versatility of point-of-care ultrasound (POCUS) have enabled its use in paediatric emergency medicine (PEM) and paediatric critical care (PICU). This review highlights the current applications of POCUS for the critically ill child across PEM and PICU to identify areas of progress and standardized practice and to elucidate areas for future research.

Recent Findings: POCUS technology continues to evolve and advance bedside clinical care for critically ill children, with ongoing research extending its use for an array of clinical scenarios, including respiratory distress, trauma and dehydration.

Comparing Statewide and Single-center Data to Predict High-frequency Emergency Department Utilization Among Patients With Asthma Exacerbation.

Background: Previous studies examining high-frequency emergency department (ED) utilization have primarily used single-center data, potentially leading to ascertainment bias if patients visit multiple centers. The goals of this study were 1) to create a predictive model to prospectively identify patients at risk of high-frequency ED utilization for asthma and 2) to examine how that model differed using statewide versus single-center data.

Methods: To track ED visits within a state, we analyzed 2011 to 2013 data from the New York State Healthcare Cost and Utilization Project State Emergency Department Databases.

Feasibility of "rapid" magnetic resonance imaging in pediatric acute head injury.

Objective: The objective was to determine the feasibility of "rapid" magnetic resonance imaging (rMRI) versus noncontrast computed tomography (NCCT) for pediatric patients with possible traumatic brain injury and to compare the populations receiving imaging in an urban tertiary care emergency department ED.

Methods: We retrospectively reviewed the electronic medical records of ED patients younger than 19 years with possible traumatic brain injury over 4 years who received an rMRI and then age-matched with NCCT patients. Data collection and analysis included demographic and clinical variables, ED length of stay (LOS), and follow-up outcomes.

Advances in simulation for pediatric critical care and emergency medicine.

Purpose Of Review: Routine integration of simulation into healthcare education and practice has gained momentum. Simulation is particularly important to acute and critical care pediatrics, as it offers alternative methods of training for high-risk and/or lower-frequency events in children. This review will discuss the recent advances in simulation education for pediatric critical care and emergency medicine and assess its potential for future growth through these subspecialties.

Minor head injury in children.

Purpose Of Review: This review will examine mild closed head injury (CHI) and the current evidence on head computed tomography (CT) imaging risks in children, prediction rules to guide decisions on CT scan use, and issues of concussion after initial evaluation.

Recent Findings: The current literature offers preliminary evidence on the risks of radiation exposure from CT scans in children. A recent study introduces a validated prediction rule for use in mild CHI, to limit the number of CT scans performed.

Ophthalmologic complications of systemic disease.

The human eye, as an organ, can offer critical clues to the presence of systemic disease. This article discusses the various ophthalmologic manifestations of systemic disease that can be evident on examination by an emergency department provider, as well as some findings that can be discerned with specialty consultation. The following topics are reviewed with respect to potential ocular signs and complications: syphilis, herpes zoster, Lyme disease, acquired immunodeficiency syndrome, Reiter's syndrome, Kawasaki's disease, temporal arteritis, endocarditis, hypertension, and diabetes mellitus.

Pediatric office emergencies.

Purpose Of Review: An emergency in the office setting can be problematic without adequate staff, support, tools, and protocols. Though many emergencies are not immediately life-threatening, one risks the 'worst case scenario' occurring if not adequately prepared. Pediatric patients are prone to respiratory distress and compromise in many emergencies, and can rapidly decompensate without adequate support.

Office pediatrics: current perspectives on the outpatient evaluation and management of lower respiratory infections in children.

Purpose Of Review: The outpatient evaluation and management of a child with lower respiratory infection (LRI) remain a challenge to clinicians worldwide. This update will discuss current problems and new developments in the outpatient evaluation and treatment of pediatric LRIs.

Recent Findings: The cause of pediatric LRIs remains partially defined.