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JULY 1

JULY 1. 4%. LOS. $$$. Assessing the effect of previous clinical experience with intubation on medical students’ competency during high fidelity simulation. Terrance McGovern DO MPH, Justin McNamee DO, Matthew Meigh DO, Nilesh Patel DO, Anthony Catapano DO

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JULY 1

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  1. JULY 1

  2. 4% Huckman, et al. "Cohort Turnover and Productivity: The July Phenomenon in Teaching Hospitals." NBER (2005)

  3. LOS Huckman, et al. "Cohort Turnover and Productivity: The July Phenomenon in Teaching Hospitals." NBER (2005)

  4. $$$ Huckman, et al. "Cohort Turnover and Productivity: The July Phenomenon in Teaching Hospitals." NBER (2005)

  5. Issenberg, S., et al. "Features And Uses Of High-fidelity Medical Simulations That Lead To Effective Learning: A BEME Systematic Review*." Medical Teacher: 10-28.

  6. Assessing the effect of previous clinical experience with intubation on medical students’ competency during high fidelity simulation Terrance McGovern DO MPH, Justin McNamee DO, Matthew Meigh DO, Nilesh Patel DO, Anthony Catapano DO St. Joseph’s Regional Medical Center, Department of Emergency Medicine, Paterson, NJ

  7. Methods • July 2013-Dec 2013 • 38 consecutive third and fourth year students voluntarily enrolled during their EM clerkship • All students attempted intubation on 2 mannequins with direct and video laryngoscopy • The students received a 40 minute hands-on didactic session with instruction on proper technique, mechanics and positioning for endotracheal intubation

  8. Results

  9. Results

  10. Results

  11. Results

  12. Discussion Significant Improvement First pass success Time for intubation Comfort level Video Laryngoscopy Longer time to intubate Higher initial success rates Lim, T.J., et al. "Evaluation of Ease of Intubation with the GlideScope or Macintosh Laryngoscope by Anaesthetists in Simulated Easy and Difficult Laryngoscopy." Anaethesia (2005): 180-83. Narang, A., et al. "Comparison of Intubation Success of Video Laryngoscopy Versus Direct Laryngoscopy in the Difficult Airway Using High-Fidelity Simulation." Simulation in Healthcare: J of the Society for Sim in Healthcare: 160-65.

  13. Discussion 47 intubations needed to have a 90% chance of having a “good” intubation High fidelity simulation could help clinicians acquire proficiency in orotracheal intubation rather than training on human subjects Mulcaster, J., et al. "Laryngoscopic Intubation: Learning and Performance." Anaesthesia (2003): 23-27. Hall, R. E. "Human Patient Simulation Is Effective for Teaching Paramedic Students Endotracheal Intubation." AcadEmer Med(2005): 850-55.

  14. Conclusion Clinical exposure alone is not adequate for students’education with intubation and simulation can improve their proficiency and comfort level despite their previous clinical experiences

  15. JULY 1

  16. Member of the Asscoiated Press . Aenean commodo ligula eget dolor. Aenean. Aenean commodo ligula eget dolor. Aenhswse. Cejhciebce fcdcdcd. ILLUSTRATED WEEKLY NEWSPAPER Thursday, July 2, 2015 Price 6d Est. 1869 Incompetent Resident Physician Essentially Murders Co-worker’s Mother the resident physician in question he repeatedly stated that he had seen “a ton” of intubations completed during his previous medical training and figured that would be enough to successfully intubate the patient without the assistance of his supervising physician. A fellow co-worker who overheard our conversation promptly referred him to a recent presentation at ACOEP in Las Vegas which recommended more formal instruction prior to beginning residency. The resident physician allegedly attempted to place an endotracheal tube designed for a 3 year-old child into the poor 89 year-old female who did not survive her trip to the hospital. Upon speaking with one of the experienced nurses at the scene she described a chaotic scene where she even had to intervene and instruct the resident on what type of tube to use when he inadvertently attempted to place a foley catheter into the patients trachea to establish a definitive airway. After an exclusive interview with The preventable death of a fellow co-worker’s mother at St. BeGood Regional Medical Centercould have been prevented. Yesterday morning the patient entered the Emergency Department in respiratory distress and necessitated mechanical ventilation via endotracheal intubation. Per eyewitness accounts the resident physician taking care of the patient had just began his post-graduate training 3 hours prior to her arrival.

  17. References • Huckman, Robert, and Jason Barro. "Cohort Turnover and Productivity: The July Phenomenon in Teaching Hospitals." NBER (2005). • Vanderbilt, AA, and Julie Mayglothling. "A Review of the Literature: Direct and Video Laryngoscopy with Simulation as Educational Intervention." Advances in Medical Education and Practice 5 (2014): 15-23. • Johnston, Bradford D., S. Robert Seitz, and Henry E. Wang. "Limited Opportunities for Paramedic Student Endotracheal Intubation Training in the Operating Room." Acad Emer Med: 1051-055. • Barry Issenberg, S., William C. Mcgaghie, Emil R. Petrusa, David Lee Gordon, and Ross J. Scalese. "Features And Uses Of High-fidelity Medical Simulations That Lead To Effective Learning: A BEME Systematic Review*." Med Teach: 10-28. • Hall, R. E."Human Patient Simulation Is Effective for Teaching Paramedic Students Endotracheal Intubation." Acad EmerMed (2005):850-55. • Batchelder, A. J., A. Steel, R. Mackenzie, A. P. Hormis, T. S. Daniels, and N. Holding. "Simulation as a Tool to Improve the Safety of Pre-hospital Anaesthesia - a Pilot Study." Anaesthesia: 978-83. • Pastis, Nicholas J., Peter Doelken, Allison A. Vanderbilt, John Walker, and John J. Schaefer. "Validation of Simulated Difficult Bag-Mask Ventilation as a Training and Evaluation Method for First-Year Internal Medicine House Staff." Simulation in Healthcare: J of the Soc Sim in Healthcare: 20-24. • Mulcaster, Julian, Joanna Mills, Orlando Hung, Kirk MacQuarrie, Adam Law, Saul Pytka, David Imrie, and Chris Field. "Laryngoscopic Intubation: Learning and Performance." Anaesthesia (2003): 23-27. • Harrison, M. J. "Tracking the Early Acquisition of Skills by Trainees." Anaesthesia: 995-98. • Lim, T.J., Y. Lim, and E.H. Liu. "Evaluation of Ease of Intubation with the GlideScope or Macintosh Laryngoscope by Anaesthetists in Simulated Easy and Difficult Laryngoscopy." Anaethesia (2005): 180-83. • Narang, Aneesh T., Paula F. Oldeg, Ron Medzon, Ahmed R. Mahmood, Jordan A. Spector, and Derek A. Robinett. "Comparison of Intubation Success of Video Laryngoscopy Versus Direct Laryngoscopy in the Difficult Airway Using High-Fidelity Simulation." Sim in Healthcare: J of Soc Sim in Hcare: 160-65. • Aziz, Michael, Dawn Dillman, Jeffrey R. Kirsch, and Ansgar Brambrink. "Video Laryngoscopy with the Macintosh Video Laryngoscope in Simulated Prehospital Scenarios by Paramedic Students." Prehospital Emergency Care: 251-55. • Donoghue, Aaron J., Anne M. Ades, Akira Nishisaki, and Ellen S. Deutsch. "Videolaryngoscopy Versus Direct Laryngoscopy in Simulated Pediatric Intubation." Annals of Emergency Medicine: 271-77. • Bair, Aaron E., Kalani Olmsted, Calvin A. Brown, Tobias Barker, Daniel Pallin, and Ron M. Walls. "Assessment of the Storz Video Macintosh Laryngoscope for Use in Difficult Airways: A Human Simulator Study." Academic Emergency Medicine: 1134-137.

  18. Image Credit • iStockPhoto. U.S.News Health. July 21, 2014. http://health.usnews.com/health-news/patient-advice/articles/2014/07/21/headed-to-the-hospital-beware-the-july-effect • Moore, John. Vox Healthcare. Sept 14, 2014. http://www.vox.com/2014/7/13/5893653/the-july-effect-is-real-new-doctors-really-do-make-hospitals-more • iStockPhoto. NPR. Feb 26, 2013. http://www.npr.org/blogs/health/2013/02/26/172993777/ should-you-fear-the-july-effect-of-first-time-doctors-at-hospitals • Fox News. July 17, 2012. http://nation.foxnews.com/july-effect/2012/07/17/beware-july-effect-hospitals • Associated Press. March 31, 2013 http://i.dailymail.co.uk/i/pix/2013/03/31/article-0-18EC705C000005DC-616_634x422.jpg • Tomar, G., et al. “Central Venous catheter rotation malposition: An Unusual Presentation.” IJA. (2012): 415. http://www.ijaweb.org/showBackIssue.asp?issn=0019 5049. • Ghana EM Collaborative. April 8, 2014. http://www.slideshare.net/shimelisassefa/trauma-33283907 • Viernes D., et al. “Evaluation of the Glidescope Direct: A New Video Laryngoscope for Teaching Direct Laryngoscopy.” Anesth Res and Prac. (2012): 1-5. http://www.hindawi.com/journals/ arp/ 2012/820961/fig5/ • Berry, Steve. EMS Airway Clinic. April 5, 2011. http://airway.jems.com/2011/04/arghh/ • FOAM EM RSS. September 11, 2014. http://www.foamem.com/author/pharm/page/93/ • Presentation Magazine. January 24, 2011. http://www.presentationmagazine.com/ editable -old-newspaper-template-4520.htm

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