Medical education is an ever-evolving field, resulting in numerous changes and modifications to curricular structure, learner assessment, feedback, and remediation. To best meet the needs of the individual learners, it is important to design curricula that meet their real needs. Design thinking (DT) first gained popularity in the 1960s and, since then, has been applied to problem solving within business, primary education, and medicine. The process involves five stages: discovery, interpretation, ideation, experimentation, and evolution, which are targeted toward empathizing with end-users to uncover and design for unmet needs. In this paper, we describe the five-stage DT approach with specific application to medical education and discuss future directions within the medical education field.

Non‐exertional heat stroke is a life‐threatening condition characterized by passive exposure to high ambient heat, a core body temperature of 40°C (104°F) or greater, and central nervous system dysfunction. Rapid cooling is imperative to minimize mortality and morbidity. Although evaporative and convective measures are often used for cooling heat stroke patients, cold water immersion produces the fastest cooling. However, logistical difficulties make cold water immersion challenging to implement in the emergency department. To our knowledge, there is no documented case utilizing a body bag (ie, human remains pouch) as a cold water immersion tank for rapid resuscitation of heat stroke. During a regional heat wave an elderly woman was found unconscious in a parking lot with an oral temperature of 40°C (104°F) and altered mental status. She was cooled to 38.4°C (101.1°F) in 10 minutes by immersion in an ice‐ and water‐filled body bag. The patient rapidly regained normal mentation and was discharged home from the ED. This case highlights a novel method for efficient and convenient cold water immersion for heat stroke treatment in the emergency department.

Introduction: With the increasing influence of electronic health records in emergency medicine came concerns of decreasing operational efficiencies. Particularly worrisome was increasing patient length of stay (LOS). Medical scribes were identified to be in a good position to quickly address barriers to treatment delivery and patient flow. The objective of this study was to investigate patient LOS in the midand low-acuity zones of an academic emergency department (ED) with and without medical scribes. Methods: A retrospective cohort study compared patient volume and average LOS between a cohort without scribes and a cohort after the implementation of a scribe-flow coordinator program. Patients were triaged to the mid-acuity Vertical Zone (primarily Emergency Severity Index [ESI] 3) or low-acuity Fast Track (primarily ESI 4 and 5) at a tertiary academic ED. Patients were stratified by treatment zone, acuity level, and disposition. Results: The pre-intervention and post-intervention periods included 8900 patients and 9935 patients, respectively. LOS for patients discharged from the Vertical Zone decreased by 12 minutes from 235 to 223 minutes (p<0.0001, 95% confidence interval [CI],-17,-7) despite a 10% increase in patient volume. For patients admitted from the Vertical Zone, volume increased 13% and LOS remained almost the same, increasing from 225 to 228 minutes (p=0.532, 95% CI,-6,12). For patients discharged from the Fast Track, volume increased 14% and LOS increased six minutes, from 89 to 95 minutes (p<0.0001, 95% CI, 4,9). Predictably, only 1% of Fast Track patients were admitted. Conclusion: Despite substantially increased volume, the use of scribes as patient flow facilitators in the mid-acuity zone was associated with decreased LOS. In the low-acuity zone, scribes were not shown to be as effective, perhaps because rapid patient turnover required them to focus on documentation. [West J Emerg Med. 2020;21(3)653-659.] increasing concerns about physician efficiency and rapid patient throughput 17,18 , as well as the issue of worsening emergency department (ED) crowding 19-23 , the use of medical scribes increased nationwide. 24-26 Importance Strategies that reduce LOS and improve patient flow are critical to the efficient and humane delivery of emergency medical care. 27 Implementation of traditional scribe programs

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