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Lecture given in a CME KIMS PEER on 27th September 2014 at Trivandrum .
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Good academics in Emergency Medicine training program
Dr.Venugopalan P PDA,DNB,MNAMS,MEM[GWU]
Director ,Aster DM Health care Ltd.Deputy Director ,MIMS Academy,
Founder & Executive Director ANGELS –Active Network Group of Emergency Life Savers
India, Kerala
Focus
• DNB Emergency medicine• Strategies to make good teaching schedule • Implementation of program• A good start , strong progression and
excellent exit • Contents and beyond ….. • Students expectations Faculty expectation
Emergency Medicine
Initial evaluation, treatment and disposition of any person at any time for any symptom, event or disorder deemed by the person or someone acting on his or her behalf to require expeditious medical, surgical or psychiatric attention.
ACEM
Emergency Physician
• A specialist who has been trained to engage in the immediate initial recognition, evaluation and disposition of patient with acute illness and injury..
Specialists who doesn’t passionate and spend time in ER will not understand the “issue and challenges” of emergency medicine
MCI
• July 21st 2009 • Primary specialty• Rapid growth • Need of the Nation • Need of health care system
National Board of examination officially declared DNB program in November 2013
Assessment-Diagnosis-Treatment-Management-DispositionTriage
Admit
Discharge
EMS
Patient Presentation
ED Design
Triage Cueing
Over crowding
Information Gap
Lab errors
Report Delay
Authority Gradient
Orphaned Pt
Team work problem
Transition of Care
ResourceConstrain
SenseMaking
Affective state
RadiologyError
Fatigue &Shift work
Cognitive properties of the mind
Violation producing factors
Proceduralfactors
Medication errors
InadequateDischarge Plan
Long waiting time For Bed
Follow upfailures
Sources of Failures and Errors in ED
Acad Emerg Med. 2000 Nov;7(11):1204-22.Promoting patient safety and preventing medical error in emergency departments.Schenkel S.Author information
AbstractAn estimated 108,000 people die each year from potentially preventable iatrogenic injury. One in 50 hospitalized patients experiences a preventable adverse event. Up to 3% of these injuries and events take place in emergency departments. With long and detailed training, morbidity and mortality conferences, and an emphasis on practitioner responsibility, medicine has traditionally faced the challenges of medical error and patient safety through an approach focused almost exclusively on individual practitioners. Yet no matter how well trained and how careful health care providers are, individuals will make mistakes because they are human. In general medicine, the study of adverse drug events has led the way to new methods of error detection and error prevention. A combination of chart reviews, incident logs, observation, and peer solicitation has provided a quantitative tool to demonstrate the effectiveness of interventions such as computer order entry and pharmacist order review. In emergency medicine (EM), error detection has focused on subjects of high liability: missed myocardial infarctions, missed appendicitis, and misreading of radiographs. Some system-level efforts in error prevention have focused on teamwork, on strengthening communication between pharmacists and emergency physicians, on automating drug dosing and distribution, and on rationalizing shifts. This article reviews the definitions, detection, and presentation of error in medicine and EM. Based on review of the current literature, recommendations are offered to enhance the likelihood of reduction of error in EM practice.
PMID:11073469[PubMed - indexed for MEDLINE]
•108000 preventable deaths from iatrogenic injuries per year•1 in 50 hospitalized patients experiences preventable adverse events •3% from ER
Emergency Medicine Make practice more stressful • Decision making
• Dynamic nature• Errors in judgments• Communication • Unknown cases• Unexpected issues • Unlimited numbers • Exposed environment
How can we implement a good academic program in EM?
Selection
Induction
Rotation
Electives
Examination and Exit
CET
Ice break
EM allied specialties
Reputed institutions
Multiple and focused
EMERGNCY
MEDICNE
Induct with warm intro
• Introduction of EM and ER
• Knowing entire hospital • Process and protocol • Team building and
getting along • E Based learning
Induction
• Communication• Presentation skills• Basic sciences • Research methodology • Life support courses
Life support courses
• BLS[Basic life support] • ACLS[Advanced life
support] • PALS[Pediatric advanced
life support] • NALS[Neonatal Advanced
Life support ]• ITLS [International Trauma
life support]• ATLS[Advanced Trauma life
Support] Complete within first six months…….
Focused training Programs
• BDLS[Basic Disaster Life support ]
• ADLS[Advanced Disaster Life Support]
• ATULS[Advanced Trauma Ultrasound Life
Support]• HAZMAT • ECHO and Ultrasound • Wound care management
Daily case discussion
• Daily rounds• Weekly grand rounds • Weekly academic clubs
Early morning 2-4 am is highly potential for errors and wrong judgments
Morning reports
• Focus on minor and major issues • Review codes • Follow up cases
Bedside teaching
• Success of program • Discuss cases• Communication skills• Teaching skills• Equipment orientation• Team work• Paramedic education
Faculty coverage
• 24 hours faculty coverage
• Every case is a chapter • Modulate students• Inculcate extra attitude • Free time – Simulations
Faculty as
Learners
Academic growth
Inculcating Creativity
Professional excellence
Community engagements
Strategic Planning
Procedures
• Essential procedure to be accomplished
• Expected numbers• Supervised • Self • Simulation based
Log book
• Academic • Clinical• Procedure• Seminars• Conferences• Workshop• Special works Must be submitted and
signed monthly basis
Thesis and research
• Search topics• Department thrust
areas• Institutional Research
committee• Institutional ethics
committee • Time bound execution• Presentable and
publishable projects Beneficial for the student ,institution and Community
Evaluation
• Clinical skill• Decision making• Communication skill• Knowledge base • Presentation skill• Attitude and aptitude • Teaching skill• Strength and weakness
Empower students
Monthly Modular system
• Plan to cover entire curriculum in 36 module • Pre planed teaching schedule• Students presentations • Faculty presentations
Rotation
• Define the objective • Interactive • 360 degree feedback• Confidential report
Electives
• Reputed centers• Trauma centers • Burns centers • Pediatric and Obstetric institutions • Palliative care
Faculty and students exchange program
• Regional • National • International
Public education
• Basic life support• Trauma life support • Disaster managements• Public health • Stroke • First response training
Skill lab and simulations
Workshops
• Mechanical Ventilation• ABG• Wound care • Ultrasound • Vascular access • Procedural sedation • Nerve blocks
Conferences and seminars
• Regional • National • International
Motivate students to prepare and submit
abstracts
Mortality , Journals
• Monthly Basis • Journal reviews • Medical News board in the department • E based groups to share recent advances
Medical Records
• Prompt • Regular entry • Electronic records• Police intimation• Wound certificate • Reference letters• Photographs and Videos
Books & Resources
Journals
E Learning
Scope of social media in emergency medicine
Exit exams
• Written • Clinical
Objective Eliminate personal bias Relevant Basic science OSCEOral board style
Monthly Yearly Final
OSCE
Thank you so much …..
www.drvenu.net , www.emergencymedicinemims.com
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