47 Comparison of Traditional Advanced Cardiac LifeSupport (ACLS) Course Instruction vs. Scenario-based,Performance–Oriented Team Instruction (SPOTI) Methodto Korean Paramedic Students

Lee CC, Im M, Stapleton ER, Kim T, Singer AJ, Henry MC/Stony BrookUniversity, Stony Brook, NY; Jeju Halla College, Jeju, Republic of Korea

Study Objectives: Current ACLS course instruction involves a two day coursewith traditional lectures and limited team interaction. We wish to explore theadvantages of a scenario-based performance-oriented team instruction (SPOTI)method to implement core ACLS skills for non-English speaking internationalparamedic students. The objective of this study was to determine if a scenario-based,performance-oriented team instruction (SPOTI) improves educational outcomes forthe ACLS instruction of Korean paramedic students.

Methods: Thirty Korean paramedic students were randomly selected into twogroups. One group of fifteen students was taught the traditional two day ACLScourse. The other fifteen students were instructed using a scenario-basedperformance-oriented team instruction (SPOTI) method. Each group was testedusing ACLS megacode examinations endorsed by the American Heart Association.This study will be performed at Cheju Halla College/Stony Brook UniversityEmergency Medicine Center in Cheju Island, South Korea. Evaluation of thesestudents will be performed by blinded ACLS experts at Stony Brook UniversityMedical Center’s Department of Emergency Medicine, in Stony Brook, New Yorkusing video-tape.

Results: In the traditional ACLS study group an average of 85% of the core skillswere met. In the SPOTI study group an average of 93% of the core skills were met.In particular the SPOTI study group excelled at physical exam skills such as airwayopening, assessment of breathing, signs of circulation and compression rates. Inaddition the SPOTI group performed with higher marks on rhythm recognition ascompared to the traditional group. The traditional group performed better on drugdosages as compared to the SPOTI students. The megacode testing sessions for theSPOTI group was shorter than the traditional ACLS study group. The average timefor the SPOTI participants was approximately 5 minutes and 30 seconds as comparedto 7 minutes and 17 seconds in the traditional ACLS study group.

Conclusion: In this comparison study there was no difference in pass rates ofACLS megacode examinations between Korean paramedic students taught usingtraditional ACLS course teaching and students taught using the SPOTI method. Inaddition the students enrolled in the SPOTI method resulted in higher megacodecore compliance scores than compared to students trained in traditional ACLS courseinstruction.

48 Selection of Target Age for School Education inCardiopulmonary Resuscitation

Chung S, Chung H, Lee H/Yongdong Severance Hospital, Yonsei UniversityMedical College, Seoul, Republic of Korea

Study Objectives: The effectiveness of teaching cardiopulmonary resuscitation(CPR) in schools is known to be higher among older students. However, severaleasier programs have been successful even for primary school children. The purposeof this study is to determine the optimal target age for teaching CPR in schools.

Methods: Six classes from the fifth to the tenth grade were randomly selected. Avideo-based self-instructional program was presented by health teachers in each schoolusing the Korean version of CPR Anytime®(Laerdal) during normal school hours.Questionnaires were given after training to determine their degree of confidence inperforming CPR, their willingness to perform CPR on a stranger, and at what age thechildren wanted to learn CPR. Skill tests were administered for several volunteerstudents. One week after the training, the students were asked to what extent theyhad shared their knowledge of CPR technique with other people.

Results: Two hundred one students were given the CPR instruction. Theconfidence in performing CPR was lowest among seventh grade children. Thewillingness expressed by the students to perform CPR on a family member, a friend,and a stranger were 95%, 89% and 59%, respectively, with boys in the tenth grademost willing to perform CPR on a stranger. The students responded that it is mostsuitable to learn CPR at grade 6.4�2.4. The highest average skill score of 9.5/11 wasfor sixth grade. The average number of people with whom the students had sharedinformation was 1.23, and again this was highest in sixth grade at 3.72.

Conclusion: This study suggests that the optimal target school age for CPReducation using video-based self instruction may be at approximately the sixth grade.

49 Morbidity and Mortality Conference Use in EmergencyMedicine

McGillicuddy DC, Seigel TA, Barkin AZ, Rosen CL/Beth Israel DeaconessMedical Center, Boston, MA; Rose Medical Center, Denver, CO

Study Objective: Morbidity and Mortality (M&M) conferences fulfill theACGME requirement for practice-based learning and hold large educational potentialrelating to quality improvement and patient safety initiatives. The conferenceprovides a forum for residents and faculty to analyze unforeseen complications ofpatient care, address unexpected mortality, and the opportunity to address bothsystems and medical errors. However, specific guidelines for content, frequency andformat of this conference have not been standardized. This study seeks to describe andquantify the different types M&M conferences in emergency medicine training programs.

Methods: A confidential survey was electronically mailed to the ProgramDirectors of all 124 Emergency Medicine (EM) training programs with functioningelectronic mail addresses listed in the Society of Academic Emergency Medicineresidency catalog in April 2006. 95% Confidence intervals are reported whenappropriate.

Results: 89 of 124 (72%, 95% CI 63-79%) completed surveys were returned. 88programs (99%, 95% CI 93-100%) hold an M & M conference. Conferences areheld monthly at the majority of programs (67%) with 22% meeting more frequently.Cases are most frequently identified by an emergency medicine attending (70%), EMquality assurance (QA) committee (57%), or EM senior residents (48.3%), butprepared most often by an EM senior or chief resident (52%), or the residentinvolved in the case (34%). All of the institutions surveyed require residentattendance at the M&M conference; only 80% require attending attendance, andeven fewer (41%) require medical student attendance. 20% of programs specificallyinvite radiologists to the conference; involved consultants are invited to theconference in 44% of respondents. Pediatric cases account for less than 40% ofpresented cases at 98% of programs, and greater than 40% of cases at 2% ofprograms. Trauma cases are more common, representing up to 60% of presentedcases. All of the programs surveyed present cases of medical and systems errors; casesrelated to medical error accounts for the majority of cases in 28% of respondents. If amedical error is identified via a conference, 79% (95% CI 70-86%) of programs havea protocol for addressing the error. The QA Director was responsible for this processin 30% of respondents, the Department Chair was directly responsible for thisprocess in 20% of respondents, and the Program Director was responsible for thisprocess in 20% of respondents.

Conclusion: Emergency medicine training programs almost uniformly have anM&M conference, but these conferences vary in frequency, content and attendance.The M&M conference offers large potential for interdisciplinary investigation of errorand implementation of ACMGE core competencies. Future studies are needed toinvestigate resident and faculty perception of M&M, its educational impact, and itseffect on quality improvement and patient safety initiatives.

50 Patient Perceptions of Medical Students Involved inTheir Health Care: How Much Do First ImpressionsCount?

Wald DA, Yeh K, Ander DS, Fisher J, Kruus LK, Manthey DE, Richardson B,Emergency Medicine Medical Student Educators Research Group (EMMSERG),On behalf of the Emergency Medicine Medical Student Educators ResearchGroup (EMMSERG)/Temple University School of Medicine, Philadelphia, PA;Emory University School of Medicine, Atlanta, GA; Beth Israel DeaconessMedical Center, Boston, MA; Wake Forest University School of Medicine,Winston Salem, NC; Mount Sinai School of Medicine, New York, NY

Study Objectives: A number of studies have been published focusing on patients’attitudes toward the involvement of medical students in their health care. However,these studies do not address the impact of prior student-patient encounters on howthey affect future perceptions of medical students. In our study, we sought to reportany associations between prior student-patient encounters and how they may affectfuture perceptions of emergency department (ED) patients regarding medical studentinvolvement in their health care.

Methods: Multicenter prospective observational study involving 11 ED’s. Adultpatients � 18 years of age completed self-administered surveys. The surveys weredeveloped by consensus opinion after review of surveys used in other health caresettings. Descriptive statistics were generated and comparisons made using �2 analysis.

Results: 1,428 patients were enrolled. Mean age was 42 �17 years, 45%male, 44% White, 38% Black, 12 % Hispanic, and 2% Asian/Pacific Islander.

Research Forum Abstracts

S16 Annals of Emergency Medicine Volume , . : September