Emergency Department Rotation Director

Every rotation offered to pediatric residents must have a rotation director. This individual is a faculty physician who has various administrative and educational responsibilities. As the Emergency Department Rotation Director I am responsible for the residents’  overall education in the ED, as well as our ongoing curriculum and evaluations. I am the administrative faculty contact for over 180 pediatric residents, 50 emergency medicine residents, and 3 dozen outside rotating trainees. I am also part of the Curriculum Competency Committee, a group composed of the individual rotation directors as well as the Pediatric Residency Program leadership.

Rotations

In addition to the ED core rotation our faculty contribute to the education of our trainees in the following elective/selective rotations:

  • Liberty Emergency Department
  • Urgent Care
  • Child Abuse
  • Injury Prevention & Advocacy
  • Emergency Department Procedure Elective
  • Transport Medicine
  • Toxicology
  • Simulation Elective

The ED Rotation Curriculum

Residents consistently rate the quality of the educational content, and the rotation experience in the ED at CCHMC highly. We have won numerous Division Teaching Awards. Our residents receive extensive clinical teaching, often in a one-on-one fashion with attendings and fellows. We are also responsible for a series of Noon Conferences (4-5 per year) that focus on high impact topics (sepsis, traumatic brain injury and respiratory failure for example) presented by national leaders in Pediatric Emergency Medicine.

The highlight of the ED Rotation Curriculum is the bimonthly Friday morning education sessions. One half of these sessions consist of ED faculty and fellows giving traditional didactic lectures (3 per lecture day). Faculty contribute materials for the residents to review prior to the conference, and focus on practical, case-based learning. In this flipped classroom model we are embedding knowledge beforehand, and the residents’ comprehension of background material will enrich discussions with the faculty. The subject matter is determined by reviewing resident feedback, the American Board of Pediatrics content specifications, faculty areas of expertise and seasonal trends (hypothermia in the winter months, orthopedic injuries during the summer).

Once per month we also hold “Sim days” where we divide the residents into small groups and have them rotate through stations in the ED. While one group of residents is participating in an in-situ simulation (sample topics: status asthmaticus, anaphylaxis, hypovolemic shock), the others are afforded the opportunity for deliberate practice in critical skills such as bag mask ventilation, endotracheal intubation, IO placement and use of the defibrillator – all precepted by myself, volunteer faculty and other health care professionals. The simulation scenarios rotate through an 18-month calendar. Below you can view the calendar, along with the associated procedure skills stations as well as two sample sim scenarios.

 

We continue to strive for improvement, and thus each session we acquire written feedback from the residents. Check out a sample evaluation sheet for a lecture based day, and one for a sim day.

During these session we average 13-20 residents in attendance. Over the past 18 months we have had nearly four dozen different presenters and collected over 300 individual feedback forms. Sample topics presented include;

  • Airway and respiratory emergencies
  • Orthopedic and sports injuries
  • Infectious Disease emergencies
  • Child abuse
  • Abdominal pain
  • Toxicology
  • Traumatic brain injuries
  • Seizures
  • Psychiatric emergencies
  • DKA
  • Acute testicular/scrotal pain
  • Ophtho emergencies
  • Jaw injuries
  • Newborn emergencies
  • Pain and sedation
  • Abscess management

Online Asynchronous Learning

PEMBlog

In an effort to offer as comprehensive a curriculum as possible I have introduced an asynchronous online learning program in 2012 that supplements the existing curriculum. Residents can access our online materials at any time, and they serve to supplement and augment their education, even when they aren’t in the ED.

The centerpiece of the online platform is PEMBlog, created using the WordPress platform.

PEMBlog-Banner-Avada-Small

Since 2012 I have been posting every week on a wide array of topics german to the practice of Pediatric Emergency Medicine. In order to connect with readers I utilize my Twitter account @PEMTweets and facebook page – facebook.com/PEMTweets to update followers when new content is available, and as a means to create an ongoing discussion. I have also begun live-tweeting during ED lectures, offering links to articles, reinforcing high impact points, and elaborating on the presented content. I utilize a system of hashtags (#PEMLectures and #FOAMed) to help make my tweets searchable amid the flood of 140 character posts. Each tweet is also posted directly to the facebook page. I have recently mentored several residents in creating content for PEMBlog as a part of the Procedure Elective Rotation.

PEM Currents

My Pediatric Emergency Medicine podcast has been available since early 2013. You can check out the archives on the iTunes page, and subscribe via your favorite podcatcher. All of the episodes are brief and focus on high yield educational topics applicable to patients in the Pediatric Emergency Department. It was recently named best Pediatric Emergency Medicine podcast by Academic Emergency Medicine.

Evaluations

We developed an online evaluation for the more than 250 trainees that rotate through the Emergency Department in order to capture shift based pediatric milestones focused evaluations by their attendings and fellows. It features a customized customized Qualtrics survey optimized for mobile devices and after initial deployment in 2013 has been maintained with an eye towards ongoing improvement initiatives designed to increase and maintain faculty evaluation complete rates. The data we have amassed has helped us identify areas for improvement in dozens of residents in a manner that our previous processes couldn’t achieve. You can see a training tutorial, as well as faculty development resources on the evaluation website.

Emergency Department Rotation Orientation

Given the number of trainees rotating through the ED each month it was imperative that we develop an orientation that met the needs of our trainees and was accessible to them on their own time since it would be highly unlikely that we could get them all together in the same room given the staggered nature of their first shift of the rotation. We employed the full process of curriculum design, including a targeted needs assessment and ultimately developed an online, multimedia rotation orientation that we have adapted to changes in the rotation over time. Residents attest that they viewed the orientation via email. I built the site using WordPress and it is hosted on a secure domain. You can view the current orientation at www.pemcincinnati.com/orientation.