dnb em :good academics in emergency training progam

Good academics in Emergency Medicine training program

Dr.Venugopalan P PDA,DNB,MNAMS,MEM[GWU]

Director ,Aster DM Health care Ltd.Deputy Director ,MIMS Academy,

Founder & Executive Director ANGELS –Active Network Group of Emergency Life Savers

India, Kerala

Focus

• DNB Emergency medicine• Strategies to make good teaching schedule • Implementation of program• A good start , strong progression and

excellent exit • Contents and beyond ….. • Students expectations Faculty expectation

Emergency Medicine

Initial evaluation, treatment and disposition of any person at any time for any symptom, event or disorder deemed by the person or someone acting on his or her behalf to require expeditious medical, surgical or psychiatric attention.

ACEM

Emergency Physician

• A specialist who has been trained to engage in the immediate initial recognition, evaluation and disposition of patient with acute illness and injury..

Specialists who doesn’t passionate and spend time in ER will not understand the “issue and challenges” of emergency medicine

MCI

• July 21st 2009 • Primary specialty• Rapid growth • Need of the Nation • Need of health care system

National Board of examination officially declared DNB program in November 2013

Assessment-Diagnosis-Treatment-Management-DispositionTriage

Admit

Discharge

EMS

Patient Presentation

ED Design

Triage Cueing

Over crowding

Information Gap

Lab errors

Report Delay

Authority Gradient

Orphaned Pt

Team work problem

Transition of Care

ResourceConstrain

SenseMaking

Affective state

RadiologyError

Fatigue &Shift work

Cognitive properties of the mind

Violation producing factors

Proceduralfactors

Medication errors

InadequateDischarge Plan

Long waiting time For Bed

Follow upfailures

Sources of Failures and Errors in ED

Acad Emerg Med. 2000 Nov;7(11):1204-22.Promoting patient safety and preventing medical error in emergency departments.Schenkel S.Author information

AbstractAn estimated 108,000 people die each year from potentially preventable iatrogenic injury. One in 50 hospitalized patients experiences a preventable adverse event. Up to 3% of these injuries and events take place in emergency departments. With long and detailed training, morbidity and mortality conferences, and an emphasis on practitioner responsibility, medicine has traditionally faced the challenges of medical error and patient safety through an approach focused almost exclusively on individual practitioners. Yet no matter how well trained and how careful health care providers are, individuals will make mistakes because they are human. In general medicine, the study of adverse drug events has led the way to new methods of error detection and error prevention. A combination of chart reviews, incident logs, observation, and peer solicitation has provided a quantitative tool to demonstrate the effectiveness of interventions such as computer order entry and pharmacist order review. In emergency medicine (EM), error detection has focused on subjects of high liability: missed myocardial infarctions, missed appendicitis, and misreading of radiographs. Some system-level efforts in error prevention have focused on teamwork, on strengthening communication between pharmacists and emergency physicians, on automating drug dosing and distribution, and on rationalizing shifts. This article reviews the definitions, detection, and presentation of error in medicine and EM. Based on review of the current literature, recommendations are offered to enhance the likelihood of reduction of error in EM practice.

PMID:11073469[PubMed - indexed for MEDLINE]

•108000 preventable deaths from iatrogenic injuries per year•1 in 50 hospitalized patients experiences preventable adverse events •3% from ER

Emergency Medicine Make practice more stressful • Decision making

• Dynamic nature• Errors in judgments• Communication • Unknown cases• Unexpected issues • Unlimited numbers • Exposed environment

How can we implement a good academic program in EM?

Selection

Induction

Rotation

Electives

Examination and Exit

CET

Ice break

EM allied specialties

Reputed institutions

Multiple and focused

EMERGNCY

MEDICNE

Induct with warm intro

• Introduction of EM and ER

• Knowing entire hospital • Process and protocol • Team building and

getting along • E Based learning

Induction

• Communication• Presentation skills• Basic sciences • Research methodology • Life support courses

Life support courses

• BLS[Basic life support] • ACLS[Advanced life

support] • PALS[Pediatric advanced

life support] • NALS[Neonatal Advanced

Life support ]• ITLS [International Trauma

life support]• ATLS[Advanced Trauma life

Support] Complete within first six months…….

Focused training Programs

• BDLS[Basic Disaster Life support ]

• ADLS[Advanced Disaster Life Support]

• ATULS[Advanced Trauma Ultrasound Life

Support]• HAZMAT • ECHO and Ultrasound • Wound care management

Daily case discussion

• Daily rounds• Weekly grand rounds • Weekly academic clubs

Early morning 2-4 am is highly potential for errors and wrong judgments

Morning reports

• Focus on minor and major issues • Review codes • Follow up cases

Bedside teaching

• Success of program • Discuss cases• Communication skills• Teaching skills• Equipment orientation• Team work• Paramedic education

Faculty coverage

• 24 hours faculty coverage

• Every case is a chapter • Modulate students• Inculcate extra attitude • Free time – Simulations

Faculty as

Learners

Academic growth

Inculcating Creativity

Professional excellence

Community engagements

Strategic Planning

Procedures

• Essential procedure to be accomplished

• Expected numbers• Supervised • Self • Simulation based

Log book

• Academic • Clinical• Procedure• Seminars• Conferences• Workshop• Special works Must be submitted and

signed monthly basis

Thesis and research

• Search topics• Department thrust

areas• Institutional Research

committee• Institutional ethics

committee • Time bound execution• Presentable and

publishable projects Beneficial for the student ,institution and Community

Evaluation

• Clinical skill• Decision making• Communication skill• Knowledge base • Presentation skill• Attitude and aptitude • Teaching skill• Strength and weakness

Empower students

Monthly Modular system

• Plan to cover entire curriculum in 36 module • Pre planed teaching schedule• Students presentations • Faculty presentations

Rotation

• Define the objective • Interactive • 360 degree feedback• Confidential report

Electives

• Reputed centers• Trauma centers • Burns centers • Pediatric and Obstetric institutions • Palliative care

Faculty and students exchange program

• Regional • National • International

Public education

• Basic life support• Trauma life support • Disaster managements• Public health • Stroke • First response training

Skill lab and simulations

Workshops

• Mechanical Ventilation• ABG• Wound care • Ultrasound • Vascular access • Procedural sedation • Nerve blocks

Conferences and seminars

• Regional • National • International

Motivate students to prepare and submit

abstracts

Mortality , Journals

• Monthly Basis • Journal reviews • Medical News board in the department • E based groups to share recent advances

Medical Records

• Prompt • Regular entry • Electronic records• Police intimation• Wound certificate • Reference letters• Photographs and Videos

Books & Resources

Journals

E Learning

Scope of social media in emergency medicine

Exit exams

• Written • Clinical

Objective Eliminate personal bias Relevant Basic science OSCEOral board style

Monthly Yearly Final

OSCE

Thank you so much …..

www.drvenu.net , www.emergencymedicinemims.com

www.drvenu.net