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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. This study sought to systematically develop a BAC checklist for novice instruction using a modified Delphi methodology and international airway experts.
A literature review informed the creation of a preliminary BAC checklist. A three round, modified Delphi method was used to establish a BAC checklist intended for novice-level instruction. The consensus level for each step and the final checklist were predefined at 80%. Participants were international airway experts identified by study personnel and snowball sampling.
Fourteen international airway experts across six acute care specialities participated in the study. The checklist was refined using a seven-point rating scale for each item and participant comments. A 17-item checklist was developed with expert consensus achieved after three rounds. Internal consistency, measured with Cronbach’s α, was 0.855 (95% confidence interval 0.73-0.94).
This modified Delphi-derived checklist is the first systematically developed list of essential steps for guiding BAC instruction for novice learners. This tool serves to standardize BAC skill instruction and provide learners with a structured and consistent set of steps for deliberate practice.
Emergency physicians who work in academic settings enjoy an expanding number of roles beyond that of the skilled clinician. Faculty development (FD) encompasses the broad range of activities that institutions use to renew skill-sets and assist faculty members in these multiple roles. This study seeks to define the current FD needs and interests of Canadian academic emergency physicians (AEPs).
An online survey was administered to 943 AEPs in eight centers across Canada to determine their current FD activities, provide a detailed understanding of their FD needs and interests, elucidate the perceived barriers to and motivation for engaging in FD, and identify preferred methods of delivery for FD activities.
This national, cross-sectional survey was completed by 336 respondents. It shows that need for FD is universally high, particularly in traditional domains of scholarship, leadership and education (79%, 80%, 87% overall interest, respectively). However, the study also suggests that there is increasing need for FD in areas where current participation is lowest, namely research and social accountability (12% and 13% more interest, respectively). Senior and junior faculty evince equivalent overall FD interest (p>0.05), whereas female AEPs expressed greater overall FD needs in leadership (1.82 vs 1.44 activities, p=0.003) than males. Continued participation in FD activities is best promoted by offering relevant topics, at convenient times and locations.
This study reports the first comprehensive national FD needs assessment of Canadian academic emergency physicians.
Effective trauma resuscitation requires the coordinated efforts of an interdisciplinary team. Mental practice (MP) is defined as the mental rehearsal of activity in the absence of gross muscular movements and has been demonstrated to enhance acquiring technical and procedural skills. The role of MP to promote nontechnical, team-based skills for trauma has yet to be investigated.
We randomized anaesthesiology, emergency medicine, and surgery residents to two-member teams randomly assigned to either an MP or control group. The MP group engaged in 20 minutes of MP, and the control group received 20 minutes of Advanced Trauma Life Support (ATLS) training. All teams then participated in a high-fidelity simulated adult trauma resuscitation and received debriefing on communication, leadership, and teamwork. Two blinded raters independently scored video recordings of the simulated resuscitations using the Mayo High Performance Teamwork Scale (MHPTS), a validated team-based behavioural rating scale. The Mann-Whitney U-test was used to assess for between-group differences.
Seventy-eight residents provided informed written consent and were recruited. The MP group outperformed the control group with significant effect on teamwork behaviour as assessed using the MHPTS: r=0.67, p<0.01.
MP leads to improvement in team-based skills compared to traditional simulation-based trauma instruction. We feel that MP may be a useful and inexpensive tool for improving nontechnical skills instruction effectiveness for team-based trauma care.
Ethics in post-medieval responses to the Middle Ages form the main focus of this volume. The six opening essays tackle such issues as the legitimacy of reinventing medieval customs and ideas, at what point the production and enjoyment of caricaturizing the Middle Ages become inappropriate, how medievalists treat disadvantaged communities, and the tension between political action and ethics in medievalism. The eight subsequent articles then build on this foundation as they concentrate on capitalist motives for melding superficially incompatible narratives in medievalist video games, Dan Brown's use of Dante's Inferno to promote a positivist, transhumanist agenda, disjunctures from medieval literature to medievalist film in portrayals of human sacrifice, the influence of Beowulf on horror films and vice versa, portrayals of war in Beowulf films, socialism in William Morris's translation of Beowulf, bias in Charles Alfred Stothard's Monumental Effigies of Great Britain, and a medieval source for death in the Harry Potter novels. The volume as a whole invites and informs a much larger discussion on such vital issues as the ethical choices medievalists make, the implications of those choices for their makers, and the impact of those choices on the world around us. Karl Fugelso is Professor of Art History at Towson University in Baltimore, Maryland. Contributors: Mary R. Bowman, Harry Brown, Louise D'Arcens, Alison Gulley, Nickolas Haydock, Lisa Hicks, Lesley E. Jacobs, Michael R. Kightley, Phillip Lindley, Pascal J. Massie, Lauryn S. Mayer, Brent Moberley, Kevin Moberley, Daniel-Raymond Nadon, Jason Pitruzello, Nancy M. Resh, Carol L. Robinson, Christopher Roman, M.J. Toswell.
Emergency department resuscitation requires the coordinated efforts of an interdisciplinary team. Aviationbased crisis resource management (CRM) training can improve safety and performance during complex events. We describe the development, piloting, and multilevel evaluation of “Crisis Resources for Emergency Workers” (CREW), a simulation-based CRM curriculum for emergency medicine (EM) residents.
Curriculum development was informed by an a priori needs assessment survey. We constructed a 1-day course using simulated resuscitation scenarios paired with focused debriefing sessions. Attitudinal shifts regarding team behaviours were assessed using the Human Factors Attitude Survey (HFAS). A subset of 10 residents participated in standardized pre- and postcourse simulated resuscitation scenarios to quantify the effect of CREW training on our primary outcome of CRM performance. Pre/post scenarios were videotaped and scored by two blinded reviewers using a validated behavioural rating scale, the Ottawa CRM Global Rating Scale (GRS).
Postcourse survey responses were highly favourable, with the majority of participants reporting that CREW training can reduce errors and improve patient safety. There was a nonsignificant trend toward improved teambased attitudes as assessed by the HFAS (p = 0.210). Postcourse performance demonstrated a similar trend toward improved scores in all categories on the Ottawa GRS (p = 0.16).
EM residents find simulation-based CRM instruction to be useful, effective, and highly relevant to their practice. Trends toward improved performance and attitudes may have arisen because our study was underpowered to detect a difference. Future efforts should focus on interdisciplinary training and recruiting a larger sample size.
In this second volume of the New South African Review, the New Growth Path adopted by the South African government in 2010 provides the basis for a dialogue about whether ‘decent work’ is the best solution to South Africa’s problems of low economic growth and high unemployment. There are investigations into rising inequality against the backdrop of the failings of Black Economic Empowerment; ‘greening the economy’, with emphasis on biofuels; the crisis of acid mine drainage on the Witwatersrand; possibilities for participatory forms of government; civil society activism; transformation of the print media and the SABC; the crisis in child care in public hospitals; the relationship between the police and a township community; the problems related to the absence of legislation to govern the powers of traditional authorities over land allocation; and assessments of the state of opposition political parties and the ANC Alliance. Asking whether the New Growth Plan reflects a set of new policies or an attempt to re-dress old (com)promises in new clothes, this volume brings together different voices in debate about possibilities for alternatives to neo-liberal and capitalist development in South Africa.