Journal Club

December Journal Club 2017

Summary #1

Kristen Whitworth, PGY-3

Moraros J, Islam A, Yu S, Banow R, Schindelka B. Flipping for success: evaluating the effectiveness of a novel teaching approach in a graduate level setting. BMC Medical Education. 2015;15(1). doi:10.1186/s12909-015-0317-2.

Main Point/Limitations

This was a prospective study evaluating the effectiveness of the Flipped Classroom model in the graduate level setting. Surveys regarding the several aspects of the flipped classroom format were completed by 67 masters students prior to the start of the semester, mid semester, and on the final day of class.

Eighty percent of the students found the Flipped Classroom to be either be somewhat effective or very effective. Students found the most effective aspects of this method were practicing problem-solving questions together in class and class/group discussions. A major limitation of the Flipped Classroom was technical issues. Overall, it was felt that this method was effective in the graduate level setting.

Take Home Point

Flipped Classroom is an educational model that provides in class opportunities for critical thinking and problem solving along with group discussion to solidify subject matter read about prior to class. It can effectively be utilized in the graduate level setting.

Summary #2

Tomasz Przednowek, PGY-1

Cortellaro F, Ferrari L, Molteni F, et al. Accuracy of point of care ultrasound to identify the source of infection in septic patients: a prospective study. Intern Emerg Med. 2017;12(3):371-378.

Main Point/Limitations

A mono-centric, non-randomized Italian study which looked at using point of care ultrasound to identify a potential of sepsis in 200 consecutive patients. The authors looked to see if the clinician’s ability to identify a source of sepsis could be improved with the addition of point of care ultrasound which looked at lung, abdominal, cardiac, joint and soft tissue organs, and whether ultrasound also improved the time to identification of the source.

The authors found that point of care ultrasound improved sensitivity of the initial clinical impression by 25%, and often led to a diagnosis within 10 minutes, compared to standard work-up which only identified a septic source in 21.9% of patients after one hour. Sensitivities varied among the various areas studied by ultrasound, with pneumonia, soft tissue infections, and cholecystitis being most sensitive to ultrasound confirmation.

The study was limited in that it was non-randomized and monocentric, and used the same clinicians for the initial clinical history and work-up as well as bedside ultrasound. Additionally, clinicians had very advanced ultrasound skills, being able to find hydronephrosis, appendicitis and even diverticulitis. The study also lacked the power to investigate the impact of ultrasound on mortality in septic patients due to low numbers.

Take Home Summary

A single-center study out of Italy which showed that ultrasound, when combined with a regular work-up, can significantly improve the time-to-diagnosis of septic patients, especially in disease conditions such as pneumonia, soft tissue infections, or intraabdominal infections such as cholecystitis. The study, however, did not take into account variability of ultrasound skills, had somewhat lower participation numbers with a larger number of pneumonia patients, and occurred only during the months of April to September.

Summary #3

Timothy Scheel DO, PGY-3

Cureton, E., Yeung, L., Kwan, R., Miraflor, E., Sadjadi, J., Price, D. and Victorino, G. (2012). The heart of the matter. Utility of ultrasound of cardiac activity during traumatic arrest. Journal of Trauma and Acute Care Surgery, 73(1), pp.102-110.

Main Point/Limitations

This was a retrospective review of all pulseless traumatic adult patient. Results of POCUS were compared to EKG rhythm and survival. 162 patients were included in the study with a 4.3% rate survival.

Among patients with cardiac motion on US there was increased rates of survival. 23.5% of patients who survived had both cardiac motion and EKG activity vs 1.9% of patient’s who survived had EKG activity alone. And 66.7% of patients who survived had cardiac activity on US without EKG activity vs 0% who had neither cardiac motion or EKG activity.

Sensitivity was 86% and specificity was 91% for predicting survival among all traumatic arrest and this increased to 100% when looking at penetrating trauma alone. 75% for blunt trauma alone. Perhaps most importantly POCUS had a negative predictive value of 100% for survival to hospital admission if the patient had neither cardiac motion or EKG activity.

Take Home Summary

This seem like a well done study although the results are somewhat predictable. Survival in patients who present in cardiac arrest from traumatic causes is very low but survival among those patients who have no cardiac motion on US seems to be exceedingly rare. Therefore this information is helpful and could change the course of certain patients. POCUS seems to have more applicability to medical causes of cardiac arrest, as it helps determine etiology.

Summary #4

Katie Clark, PGY-4

Nickson, Christpher P., Cadogan, Michael D . Free Open Access Medical education (FOAM) for the emergency physician. Emergency Medicine Australasoa.26, 76-83. 2014.

Main Point/Limitations

FOAM is a ‘free open-access medical education’. It is comprised of a dynamic collection of resources and tools for lifelong learning. The resources are predominantly social media based including blogs, podcasts, tweets, Google hangouts, web-based applications, online videos, text documents, photographs, graphics and written documents. Social medial has been a catalyst for developing and disseminating resources fueled by a global community of FOAM users and creators. FOAM allows EM physicians to interact with colleagues from around the world.

FOAM is NOT peer reviewed in a traditional sense, however it is subject to a more pervasive peer review that occurs post-publication. FOAM opinions and arguments ‘live or die by being hammered on ‘the anvil of Truth’ that is free and open debate and discussion.’

FOAM resources are easily accessible and are portable which makes them ideal for asynchronous learning and the ‘flipped classroom’ model. FOAM and medical journals will likely blur as we move forward, however it is still considered separate from our major emergency medicine textbooks which provide a more comprehensive review rather than just focusing on the “sexy topics”

Take Home Summary

FOAM is a free open-access medical education that is fueled by social medial and comprised of multiple mediums in many locations. It is an adjunct to traditional teaching and an aid to knowledge translation, as well as provide accessible and reusable resources that allow meaningful and rapid interaction with the creator.

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