allows the program to monitor a resident’s progress andto identify areas in which the resident may need moreinstruction. This system has potential applications forcompetency assessment.

3 Taking a History from the ChallengingPatient in the Emergency DepartmentBruce BeckerRhode Island Hospital/ Brown University

This exhibit will use DVD footage, written material, andlive real-time interaction to demonstrate an innovativemethodology to teaching residents and medical stu-dents to gain comfort and expertise in communicatingwith and taking a history from challenging patients inthe ED. I teach this course at our institution every year.Professional actors with improvisational experienceplay out unscripted interactions with students based ona character or characters, a set scene, and predefinedgoals and endpoints. Their dialogue and choices evolvefrom the student’s response and the tone, direction,and approach that the student takes. These scenariosare much more realistic and educational than OSCEswhich are often described as artificial and flat. Some ofthe scenarios that I will present include: Daughter try-ing to make End-of-life choices for her mother, type Aman with chest pain trying to sign out, a woman with‘‘dental pain’’ who is seductive and drug-seeking, anintoxicated attending MD brought in from a motorvehicle crash (MVC) who uses power in a manipulativeway. Many of the scenarios contain potential ethical,sexual, gender, racial issues that the student mustaddress along with the medical problems.

4 A Multimedia Web-based InteractiveQuiz Module for the Education ofEmergency Medical PersonnelJames D’Agostino1, J. Woo2, T. Anderton2

1Upstate Medical University2Departments of Emergency Medicine andPathology

A dynamic database-driven website was introduced in2002. This site has served successfully as a learning toolwith its annual update and addition of interactive caseand quiz modules. To extend web-based learning as aneducational tool, we developed a multimedia web-basedmodule for emergency medicine, with video and audioenhancements to simulate patient encounters in theemergency ward setting.Central to the web-moduledevelopment is the creation of a relational database. Weuse FileMaker Pro with search, storage, retrieval, image,video and audio incorporation functions, and a built-ininterface that allows display of database contents in webtemplates. Initially the patient’s history and presentationare presented with a 30–60 second video followed by keyphysical findings. The diagnostic studies and manage-ment of the patient are then available through sequential

interactive quizzes and feedback replies, presented inaudio-, video- and image-oriented formats. The formatof the quizzes themselves simulates medical board ques-tions.Initial feedback has been favorable. The majority ofemergency medicine personnel feel that this modulecomplements and enhances regular lecture sessions. Inaddition, it enables preservation of interesting and/orinfrequently encountered cases for viewing by all resi-dents in Emergency Medicine.

5 The Contraption: A Low-Cost ParticipatoryHemodynamic SimulatorJames RitchieNaval Medical Center

A hemodynamic simulator assembled from readily-available, inexpensive components can be used todemonstrate complex, clinically pertinent physiologicconcepts in a hands-on experiential setting. Our simula-tor is composed of clear plastic tubing, squeeze bulbs,Heimlich valves, simple plastic connectors, balloons, IVtubing, plastic storage containers, a low-pressuregauge, and a child’s water wheel. After a short intro-duction, student participants reproduce cardiac andsystemic vascular function in a coordinated simulation.Normal functional physiology is demonstrated, followedby scripted changes in physiologic conditions. At leastfour students are simultaneously involved in managingthe simulation, including squeezing the bulbs in simu-lating heart chamber contraction, modifying afterload,preload, and heart rate, and assessing output parame-ters such as blood pressure, cerebral blood flow, andcardiac output. Using this model, we are able to dem-onstrate and teach the following concepts: preload,afterload, hypertensive consequences, effects of dys-rhythmias, valve disorders, preload criticality with dis-orders such as tamponade and right ventricular MI,gradual nature of change in physiology, normal com-pensation despite serious malfunction, relationship ofblood pressure with cardiac output, shock state despitenormal BP, neurogenic shock, septic shock, hypovolem-ic shock, cardiogenic shock, cardiac work, maximumblood pressure, vasopressor physiology, diastolic dys-function coupled with decreased preload or atrialdysfunction, and CHF treatment options. Trainee feed-back has been overwhelmingly positive. Trainees at alllevels of training, including EMTs and senior EM resi-dents, have grasped complex hemodynamic physiologyconcepts intuitively after participating with this trainer.

6 The AERIS Course: a Focused Abdominal CTInterpretation Course for AbdominalEmergencies Requiring Immediate SurgeryEric SchultzStony Brook University

Emergency physicians rely heavily on CT scanning toguide their clinical decisions. A significant number ofEDs do not have radiology coverage, especially at

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night, so the EM physician may be called on to inter-pret their own CT scans to guide patient management.Many EM physicians look at their CT scans but havenever had any formal training. Especially in the settingof acute surgical emergencies such as expandingabdominal aortic aneurysms (AAAs), ruptured spleenor perforated viscus, delay for a radiologist interpreta-tion may result in significant morbidity and mortality.In a collaboration between emergency medicine andradiology, our team created a systematic approach toabdominal CT interpretation designed to help EM phy-sicians perform wet reads on CT scans in the setting ofacute surgical emergencies. First, a general survey isdone covering all of the important organs such as theaorta, liver, spleen, kidneys, pancreas, stomach andbowel, then a focused scan into the suspected pathol-ogy. We put this system onto a Power Point presenta-tion. The two hour presentation covered basic CTanatomic pathology then taught the presentations ofcommon surgical emergencies such as appendicitis,nephrolithiasis and surgical catastrophes such as rup-tured AAAs and mesenteric ischemia. The AbdominalEmergencies Requiring Immediate Surgery (AERIS)scan is only intended to be a focused scan for acutesurgical pathology, and not to replace the diagnosticscan of a radiologist. This course was given at a singleUniversity program, and will be given at residency pro-grams throughout the New York metro area. Eventuallywe hope that focused CT interpretation will becomepart of the standardized EM curriculum.

7 Layered Simulation: A Novel Approach toMedical Malpractice EducationNathaniel SchlicherWright State University

Overview: We present a novel approach to the use ofsimulation in medical education with a two-event lay-ered simulation. A patient care simulation with anadverse outcome was followed by a delayed simulateddeposition.Process: Senior residents in an academic emergencymedicine program were solicited as simulation researchvolunteers. Other than stating that the researchinvolved adverse outcomes, no identifying informationwas given. Seven volunteers participated in a simula-tion involving a forced error (nurse confederate gavean incorrect medication dose). Based on the initial sim-ulation, one physician completed a simulated depositionin a teaching conference six weeks later conducted by alicensed attorney with malpractice experience. Theaudience, consisting of residents, attendings, and stu-dents, watched a recording of the patient care, wit-nessed the deposition, and evaluated the experienceusing a 13 question survey with five-point Likert scales.Outcome: Participants felt that, overall, the trainingprogram was a useful educational tool (average Likertscore of 4.63) that would change aspects of their prac-tice (3.31). Participants stated that they would be morecareful in their documentation (3.88), review high risk

situations with staff (4.00), and monitor more carefullyfor errors (3.95). Overall, there was a degree ofincreased fear of the litigation process (3.95), but partic-ipants felt they would improve the risk profile of theirpractices (3.70).Conclusion: A novel approach to medical educationwas successful in changing attitudes and provided anexpanded educational experience for participants.Layered simulation can be successfully incorporatedinto educational programs for numerous issues includ-ing medical malpractice.

8 The Observed Teaching Encounter: ProvidingResidents Feedback on Their Teaching SkillsAnkur DoshiAllegheny General Hospital / Drexel

Introduction: Emergency medicine residents spend asignificant portion of their time teaching junior resi-dents and medical students in the clinical setting. Feed-back is an integral component of any teachingcurriculum, and therefore, feedback on residents’ skillin teaching abilities is an essential part of their learningto teach. We have developed a structured method ofproviding feedback to senior residents on their teachingcompetence.Methods: Upcoming senior residents receive an 8-hourcourse on clinical teaching during their useful confer-ence time. In our ED, attending faculty and senior‘‘teaching’’ residents are matched with medical studentlearners. The Observed Teaching Encounter (OTE) isused during usual clinical ED shifts to reinforce con-cepts in teaching. During the OTE, the teaching resi-dent is directly observed by a faculty physician whileteaching a student learner. A checklist is completed byboth the faculty member and the student learner inorder to provide feedback to the teaching resident.Assessed skills correlate with teaching theory providedto residents in their didactic curriculum. Written forma-tive comments are provided to the resident from fac-ulty, as well.Results: Attending faculty, senior residents, and stu-dent learners have all provided positive feedback on theOTE. Assessment of residents’ retention of knowledgeon methodology of teaching is presently in progress asa tool to evaluate the efficacy of the OTE.

9 A Communication Tool for EmergencyMedicine Residents to Improve Patient Careand Professional DevelopmentJacqueline MahalNew York-Presbyterian Weill Cornell

For every patient in the ED, a web of communication iscreated. A resident is at the center of this web – con-necting team members in and outside the ED. Carefulcommunication, a required ACGME competency, helps

S228 2008 SAEM ANNUAL MEETING ABSTRACTS