Simulation-based mastery learning using a substantial asynchronous component is an effective way for senior medical students to learn and retain EM clinical skills. This method can be adapted to other skill training necessary for residency readiness.

Background:The transition to residency marks a significant shift in the financial circumstances of medical trainees. Despite existing resources, residents still cite uncertainty in this domain. A personal finance curriculum is needed to close this educational gap and improve the financial well-being of trainees. Methods:The curriculum was developed using Kern's framework. Two needs assessments informed the consensus development of goals and objectives, educational strategies, and assessments. Course material was hosted online for asynchronous review and complemented by two 1-hour webinars. The curriculum was piloted at one institution. Participants completed (1) knowledge assessments before and after the intervention, (2) a survey of reactions to the curriculum, and (3) an assessment of financial behavioral changes after the intervention.Results: Thirty-seven residents (37/49, 76%) enrolled in the curriculum. Among participants, 20 (20/37, 54%) completed the curriculum. Most participants agreed or strongly agreed that the content was relevant (20/20, 100%) and clearly presented (19/20, 95%) and that they would recommend the curriculum to other residents (20/20, 100%). Performance on the knowledge assessment improved 21% after the intervention (mean ± SD = pretest 57% ± 17%, posttest = 78% ± 12%; p < 0.001). Most residents (17/20, 85%) also reported behavioral changes including setting new financial goals (12/20, 60%), taking new action toward financial planning (11/20, 55%), and changing financial habits (6/20, 30%). There were no direct financial costs incurred in the implementation of this pilot.Conclusions: This is a successful pilot of a virtual personal finance curriculum with positive outcomes data. Addressing this problem at scale will require buy-in from educators around the country to deliver this information to residents that may not otherwise seek it out. Future study should assess curricular outcomes in other settings and the durability of acquired knowledge and behavioral changes over time.

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IntroductionEmergency physicians (EP) experience high rates of workplace violence, the risks of which increase with the presence of weapons. Up to 25% of trauma patients brought to the emergency department (ED) have been found to carry weapons. Given these risks, we conducted an educational needs assessment to characterize EPs’ knowledge of firearms, frequency of encountering firearms in the ED, and level of confidence with safely removing firearms from patient care settings.MethodsThis was a survey study of attending and resident EPs at two academic and four community hospitals in the Midwest and Northeast. A 26-item questionnaire was emailed to all EPs at the six institutions. Questions pertained to EPs’ knowledge of firearms, experience with handling firearms, and exposure to firearms while at work. We calculated response proportions and p-values.ResultsOf 243 recipients who received the survey, 149 (61.3%) completed it. Thirty-three respondents (22.0%) reported encountering firearms in the workplace, 91 (60.7%) reported never handling firearms, and 25 (16.7%) reported handling firearms at least once per year. Thirty-six respondents (24.0%) reported formal firearms training, and 63 (42.3%) reported no firearms training. There were no significant regional differences regarding firearms training or exposure. Residents from the Northeast were more likely to be moderately confident that they could safely handle a firearm prior to law enforcement involvement (p=0.043), while residents from the Midwest were more likely to be not at all confident (p=0.018).ConclusionThe majority of surveyed attending and resident EPs reported little experience with handling firearms. Among resident EPs, there was a regional difference in confidence in handling firearms prior to law enforcement involvement. Given the realities of workplace violence and the frequency with which firearms are encountered in the ED, further investigation is needed to evaluate provider competence in safely handling them. EPs may benefit from training on this topic.

Objectives: Emergency department thoracotomy (EDT) is a rare and challenging procedure. Emergency medicine (EM) residents have limited opportunities to perform the procedure in clinical or educational settings. Standardized, reliable, validated checklists do not exist to evaluate procedural competency. The objectives of this project were twofold: 1) to develop a checklist containing the critical actions for performing an EDT that can be used for future procedural skills training and 2) to evaluate the reliability and validity of the checklist for performing EDT.Methods: After a literature review, a preliminary 22-item checklist was developed and disseminated to experts in EM and trauma surgery. A modified Delphi method was used to revise the checklist. To assess usability of the checklist, EM and trauma surgery faculty and residents were evaluated performing an EDT while inter-rater reliability was calculated with Cohen's kappa. A Student's t-test was used to compare the performance of participants who had or had not performed a thoracotomy in clinical practice. Item-total correlation was calculated for each checklist item to determine discriminatory ability.Results: A final 22-item checklist was developed for EDT. The overall inter-rater reliability was strong (j = 0.84) with individual item agreement ranging from moderate to strong (j = 0.61 to 1.00). Experts (attending physicians and senior residents) performed well on the checklist, achieving an average score of 80% on the checklist. Participants who had performed EDT in clinical practice performed significantly better than those that had not, achieving an average of 80.7% items completed versus 52.3% (p < 0.05). Seventeen of 22 items had an itemtotal correlation greater than 0.2. Conclusions:A final 22-item consensus-based checklist was developed for the EDT. Overall inter-rater reliability was strong. This checklist can be used in future studies to serve as a foundation for curriculum development around this important procedure.