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Article ; Online: Bridging the gap: Development of an experiential learning-based health disparities curriculum.

Caretta-Weyer, Holly A / Hess, Jamie M

AEM education and training

2022 Volume 6, Issue 6, Page(s) e10820

Abstract: Background: The increasing number of vulnerable populations served by the emergency department (ED) calls for developing and implementing curricula aimed at training residents to deliver quality care for the most marginalized groups.: Objective: We ... ...

Abstract	Background: The increasing number of vulnerable populations served by the emergency department (ED) calls for developing and implementing curricula aimed at training residents to deliver quality care for the most marginalized groups. Objective: We aimed to address this by developing and piloting a curriculum to introduce the unique challenges and disparities encountered by our diverse ED patient population using an experiential learning approach. Methods: We engaged community partners in designing and implementing a curriculum for incoming interns. This curriculum addresses specific populations encountered within the ED including patients with psychiatric illness, patients with cognitive disabilities, intoxicated patients, violent patients, patients of various cultural backgrounds, non-English-speaking patients, and LGBTQ patients. Experiential and active learning sessions with content experts and site visits to area organizations were arranged. Pre-, post-, and time-delayed surveys were deployed to evaluate the pilot of this curriculum. Results: Thirteen incoming interns participated in the orientation curriculum. Residents' comfort with each of these various patient populations as well as familiarity with community and ED resources was assessed before, after, and 1 year delayed from each session (response 13/13, 100%). Their scores increased significantly from baseline in the postsurvey and were maintained 1 year later (p < 0.05). Residents additionally provided narrative responses regarding what they learned and what was most helpful after completing their intern year. Conclusions: This pilot curriculum demonstrates that implementing an experiential learning curriculum and engaging community leaders and resources is key to training residents to address health disparities within their unique ED patient population. As such, it is imperative that we seek to immersively introduce trainees to the unique needs of the patient population they will serve early in training.
Language	English
Publishing date	2022-12-08
Publishing country	United States
Document type	Journal Article
ISSN	2472-5390
ISSN (online)	2472-5390
DOI	10.1002/aet2.10820
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Validation of Thermal Imaging and the ALT-70 Prediction Model to Differentiate Cellulitis From Pseudocellulitis.

Pulia, Michael S / Schwei, Rebecca J / Alexandridis, Roxana / Lasarev, Michael R / Harwick, Edward / Glinert, Robert / Haleem, Ambar / Hess, Jamie / Keenan, Thomas D / McBride, Joseph A / Redwood, Robert

JAMA dermatology

2024

Abstract: Importance: Cellulitis is misdiagnosed in up to 30% of cases due to mimic conditions termed pseudocellulitis. The resulting overuse of antibiotics is a threat to patient safety and public health. Surface thermal imaging and the ALT-70 (asymmetry, ... ...

Abstract	Importance: Cellulitis is misdiagnosed in up to 30% of cases due to mimic conditions termed pseudocellulitis. The resulting overuse of antibiotics is a threat to patient safety and public health. Surface thermal imaging and the ALT-70 (asymmetry, leukocytosis, tachycardia, and age ≥70 years) prediction model have been proposed as tools to help differentiate cellulitis from pseudocellulitis. Objectives: To validate differences in skin surface temperatures between patients with cellulitis and patients with pseudocellulitis, assess the optimal temperature measure and cut point for differentiating cellulitis from pseudocellulitis, and compare the performance of skin surface temperature and the ALT-70 prediction model in differentiating cellulitis from pseudocellulitis. Design, setting, and participants: This prospective diagnostic validation study was conducted among patients who presented to the emergency department with acute dermatologic lower extremity symptoms from October 11, 2018, through March 11, 2020. Statistical analysis was performed from July 2020 to March 2021 with additional work conducted in September 2023. Main outcomes and measures: Temperature measures for affected and unaffected skin were obtained. Cellulitis vs pseudocellulitis was assessed by a 6-physician, independent consensus review. Differences in temperature measures were compared using the t test. Logistic regression was used to identify the temperature measure and associated cut point with the optimal performance for discriminating between cellulitis and pseudocellulitis. Diagnostic performance characteristics for the ALT-70 prediction model, surface skin temperature, and both combined were also assessed. Results: The final sample included 204 participants (mean [SD] age, 56.6 [16.5] years; 121 men [59.3%]), 92 (45.1%) of whom had a consensus diagnosis of cellulitis. There were statistically significant differences in all skin surface temperature measures (mean temperature, maximum temperature, and gradients) between cellulitis and pseudocellulitis. The maximum temperature of the affected limb for patients with cellulitis was 33.2 °C compared with 31.2 °C for those with pseudocellulitis (difference, 2.0 °C [95% CI, 1.3-2.7 °C]; P < .001). The maximum temperature was the optimal temperature measure with a cut point of 31.2 °C in the affected skin, yielding a mean (SD) negative predictive value of 93.5% (4.7%) and a sensitivity of 96.8% (2.3%). The sensitivity of all 3 measures remained above 90%, while specificity varied considerably (ALT-70, 22.0% [95% CI, 15.8%-28.1%]; maximum temperature of the affected limb, 38.4% [95% CI, 31.7%-45.1%]; combination measure, 53.9% [95% CI, 46.5%-61.2%]). Conclusions and relevance: In this large diagnostic validation study, significant differences in skin surface temperature measures were observed between cases of cellulitis and cases of pseudocellulitis. Thermal imaging and the ALT-70 both demonstrated high sensitivity, but specificity was improved by combining the 2 measures. These findings support the potential of thermal imaging, alone or in combination with the ALT-70 prediction model, as a diagnostic adjunct that may reduce overdiagnosis of cellulitis.
Language	English
Publishing date	2024-03-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	2701761-8
ISSN	2168-6084 ; 2168-6068
ISSN (online)	2168-6084
ISSN	2168-6068
DOI	10.1001/jamadermatol.2024.0091
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Article ; Online: Response to "Misunderstanding the Match: Do Students Create Rank Lists Based on True Preferences?"

Schnapp, Benjamin H / Ulrich, Katie / Hess, Jamie / Kraut, Aaron S / Tillman, David / Westergaard, Mary

The western journal of emergency medicine

2021 Volume 22, Issue 4, Page(s) 1021–1022

Language	English
Publishing date	2021-07-20
Publishing country	United States
Document type	Letter
ZDB-ID	2375700-0
ISSN	1936-9018 ; 1936-9018
ISSN (online)	1936-9018
ISSN	1936-9018
DOI	10.5811/westjem.2021.4.52801
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Article ; Online: Misunderstanding the Match: Do Students Create Rank Lists Based on True Preferences?

Schnapp, Benjamin H / Ulrich, Kathleen / Hess, Jamie / Kraut, Aaron S / Tillman, David / Westergaard, Mary

The western journal of emergency medicine

2020 Volume 21, Issue 1, Page(s) 4–7

Abstract: Introduction: The "stable marriage" algorithm underlying the National Residency Match Program (NRMP) has been shown to create optimal outcomes when students submit true preference lists. Previous research has shown students may allow external ... ...

Abstract	Introduction: The "stable marriage" algorithm underlying the National Residency Match Program (NRMP) has been shown to create optimal outcomes when students submit true preference lists. Previous research has shown students may allow external information to affect their rank lists. The objective of this study was to determine whether medical students consistently make rank lists that reflect their true preferences. Methods: A voluntary online survey was sent to third-year students at a single midwestern medical school. Students were given hypothetical scenarios that either should or should not affect their true residency preferences and rated the importance of six factors to their final rank list. The survey was edited by a group of education scholars and revised based on feedback from a pilot with current postgraduate year 1 residents. Results: Of 175 students surveyed, 140 (80%) responded; 63% (88/140) reported that their "perceived competitiveness" would influence their rank list at least a "moderate amount. Of 135 students, 31 (23%) moved a program lower on their list if they learned they were ranked "low" by that program, while 6% (8/135) of respondents moved a program higher if they learned they were ranked "at the top of the list." Participants responded similarly (κ = 0.71) when presented with scenarios asking what they would do vs what a classmate should do. Conclusion: Students' hypothetical rank lists did not consistently match their true residency preferences. These results may stem from a misunderstanding of the Match algorithm. Medical schools should consider augmenting explicit education related to the NRMP Match algorithm to ensure optimal outcomes for students.
MeSH term(s)	Algorithms ; Choice Behavior ; Cross-Sectional Studies ; Female ; Humans ; Internship and Residency ; Male ; School Admission Criteria ; Schools, Medical ; Students, Medical/psychology ; Students, Medical/statistics & numerical data ; Surveys and Questionnaires ; United States
Language	English
Publishing date	2020-12-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	2375700-0
ISSN	1936-9018 ; 1936-900X
ISSN (online)	1936-9018
ISSN	1936-900X
DOI	10.5811/westjem.2019.10.44308
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Article: Calcium Pill Aspiration: A Case Report.

Brewer, David Clark / Regala, Mark / Hess, Jamie

The Journal of emergency medicine

2017 Volume 52, Issue 5, Page(s) e201–e202

Language	English
Publishing date	2017
Publishing country	United States
Document type	Journal Article
ZDB-ID	605559-x
ISSN	0736-4679
ISSN	0736-4679
DOI	10.1016/j.jemermed.2016.12.014
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Article ; Online: Use of graded responsibility and common entrustment considerations among United States emergency medicine residency programs.

Lai, Jason / Schnapp, Benjamin Holden / Tillman, David Simon / Westergaard, Mary / Hess, Jamie / Kraut, Aaron

Journal of educational evaluation for health professions

2020 Volume 17, Page(s) 11

Abstract: Purpose: The Accreditation Council for Graduate Medical Education (ACGME) requires all residency programs to provide increasing autonomy as residents progress through training, known as graded responsibility. However, there is little guidance on how to ... ...

Abstract	Purpose: The Accreditation Council for Graduate Medical Education (ACGME) requires all residency programs to provide increasing autonomy as residents progress through training, known as graded responsibility. However, there is little guidance on how to implement graded responsibility in practice and a paucity of literature on how it is currently implemented in emergency medicine (EM). We sought to determine how emergency medicine (EM) residency programs apply graded responsibility across a variety of activities and to identify which considerations are important in affording additional responsibilities to trainees. Methods: We conducted a cross-sectional study of EM residency programs using a 23-question survey that was distributed by email to 162 ACGME-accredited EM program directors. Seven different domains of practice were queried. Results: We received 91 responses (56.2% response rate) to the survey. Among all domains of practice except for managing critically ill medical patients, the use of graded responsibility exceeded 50% of surveyed programs. When graded responsibility was applied, post-graduate year (PGY) level was ranked an "extremely important" or "very important" consideration between 80.9% and 100.0% of the time. Conclusion: The majority of EM residency programs are implementing graded responsibility within most domains of practice. When decisions are made surrounding graded responsibility, programs still rely heavily on the time-based model of PGY level to determine advancement.
MeSH term(s)	Accreditation ; Certification ; Clinical Competence ; Cross-Sectional Studies ; Education, Medical, Graduate ; Emergency Medicine/education ; Emergency Service, Hospital/standards ; Humans ; Inservice Training/methods ; Internship and Residency ; Physician Executives ; Physicians ; Surveys and Questionnaires ; United States
Language	English
Publishing date	2020-04-20
Publishing country	Korea (South)
Document type	Journal Article
ZDB-ID	2586380-0
ISSN	1975-5937 ; 1975-5937
ISSN (online)	1975-5937
ISSN	1975-5937
DOI	10.3352/jeehp.2020.17.11
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Post-interview Thank-you Communications Influence Both Applicant and Residency Program Rank Lists in Emergency Medicine.

Jewell, Corlin / David, Tillman / Kraut, Aaron / Hess, Jamie / Westergaard, Mary / Schnapp, Benjamin H

The western journal of emergency medicine

2019 Volume 21, Issue 1, Page(s) 96–101

Abstract: Introduction: The National Residency Matching Program (NRMP) allows post-interview contact between residency applicants and residency programs. Thank-you communications represent one of the most common forms, but data on their value to applicants and ... ...

Abstract	Introduction: The National Residency Matching Program (NRMP) allows post-interview contact between residency applicants and residency programs. Thank-you communications represent one of the most common forms, but data on their value to applicants and program directors (PD) are limited. The objective of this study was to assess the effect of thank-you communications on applicant- and residency-program rank lists. Methods: Two anonymous, voluntary surveys were sent after the 2018 NRMP Match, one to applicants who were offered an interview at a single academic site in the 2017-2018 Match cycle, and one to EM PDs nationwide. The surveys were designed in conjunction with a nationally-recognized survey center and piloted and revised based on feedback from residents and faculty. Results: Of 196 residency applicants, 97 (49.5%) responded to the survey. Of these, 73/95 (76.8%) reported sending thank-you communications. Twenty-two of 73 (30%) stated that they sent thank-you communications to improve their spot on a program's rank list; and 16 of 73 (21.9%) reported that they changed their rank list based upon the responses they received to their thank-you communications. Of 163 PDs, 99 (60.7%) responded to the survey. Of those PDs surveyed, 22.6% reported that an applicant could be moved up their program's rank list and 10.8% reported that an applicant could move down a program's rank list based on their thank-you communications (or lack thereof). Conclusion: The majority of applicants to EM are sending thank-you communications. A significant minority of applicants and PDs changed their rank list due to post-interview thank-you communications.
MeSH term(s)	Communication ; Emergency Medicine/education ; Humans ; Internship and Residency ; Job Application ; School Admission Criteria ; Surveys and Questionnaires ; United States
Language	English
Publishing date	2019-12-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	2375700-0
ISSN	1936-9018 ; 1936-900X
ISSN (online)	1936-9018
ISSN	1936-900X
DOI	10.5811/westjem.2019.10.44031
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Article ; Online: Comparing skin surface temperature to clinical documentation of skin warmth in emergency department patients diagnosed with cellulitis.

Harwick, Edward / Schwei, Rebecca J / Glinert, Robert / Haleem, Ambar / Hess, Jamie / Keenan, Thomas / McBride, Joseph A / Redwood, Robert / Pulia, Michael S

Journal of the American College of Emergency Physicians open

2022 Volume 3, Issue 2, Page(s) e12712

Abstract: Objective: To compare clinical documentation of skin warmth to patient report and quantitative skin surface temperatures of patients diagnosed with cellulitis in the emergency department (ED).: Methods: Adult patients (≥18 years) presenting to the ED ...

Abstract	Objective: To compare clinical documentation of skin warmth to patient report and quantitative skin surface temperatures of patients diagnosed with cellulitis in the emergency department (ED). Methods: Adult patients (≥18 years) presenting to the ED with an acute complaint involving visible erythema of the lower extremity were prospectively enrolled. Those diagnosed with cellulitis were included in this analysis. Participant report of skin warmth was recorded and skin surface temperature values were obtained from the affected and corresponding unaffected area of skin using thermal cameras. Average temperature (Tavg) was extracted from each image and the difference in Tavg between the affected and unaffected limb was calculated (Tgradient). Clinical documentation of skin warmth was compared to patient report and measured skin warmth (Tgradient >0°C). Results: Among 126 participants diagnosed with cellulitis, 110 (87%) exhibited objective warmth (Tgradient >0°C) and 58 (53%) of these cases had warmth documented in the physical examination. Of those with objective warmth, 86 (78%) self-reported warmth and 7 (6%) had warmth documented in their history of present illness (HPI) (difference = 72%, 95% confidence interval [CI]: 62%-82%; Conclusions: The majority of ED-diagnosed cellulitis exhibited objective warmth, yet significant discordance was observed between patient-reported, clinician-documented, and measured warmth. This raises concerns over inadequate documentation practices and/or the poor sensitivity of touch as a reliable means to assess skin surface temperature. Introduction of objective temperature measurement tools could reduce subjectivity in the assessment of warmth in patients with suspected cellulitis.
Language	English
Publishing date	2022-04-18
Publishing country	United States
Document type	Journal Article
ISSN	2688-1152
ISSN (online)	2688-1152
DOI	10.1002/emp2.12712
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Article ; Online: Documentation from trained medical students has a low rate of relative downcoding for emergency medicine encounters.

Tillman, David S / Jewell, Corlin M / Hekman, Dann J / Nicholson, Adam M / Schnapp, Benjamin H / Lasarev, Michael R / Alexandridis, Roxana / Hess, Jamie M / Westergaard, Mary C

AEM education and training

2022 Volume 6, Issue 3, Page(s) e10741

Abstract: Background: Since 2018, the Centers for Medicare & Medicaid Services (CMS) guidelines have allowed teaching physicians to bill for evaluation and management services based on medical student documentation. Limited previous data suggest that medical ... ...

Abstract	Background: Since 2018, the Centers for Medicare & Medicaid Services (CMS) guidelines have allowed teaching physicians to bill for evaluation and management services based on medical student documentation. Limited previous data suggest that medical student documentation suffers from a high rate of downcoding relative to faculty documentation. We sought to compare the coding outcomes of documentation performed by medical students, and not edited by faculty, with documentation edited and submitted by faculty. Methods: A total of 104 randomly selected notes from real patient encounters written by senior medical students were compared to the revised notes submitted by faculty. The note pairs were then split and reviewed by blinded professional coders and assigned level of service (LoS) codes 1-5 (corresponding to E&M CPT codes 99281-99285). Results: We found that the LoS agreement between student and faculty note versions was 63%, with 23% of all student notes receiving lower LoS compared to faculty notes (downcoded). This was found to be similar to baseline variability in professional coder LoS designations. Conclusions: Notes from medical students who have completed a focused documentation curriculum have less LoS downcoding than in previous reports.
Language	English
Publishing date	2022-06-01
Publishing country	United States
Document type	Journal Article
ISSN	2472-5390
ISSN (online)	2472-5390
DOI	10.1002/aet2.10741
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Simulation Training to Maintain Neonatal Resuscitation and Pediatric Sedation Skills for Emergency Medicine Faculty.

Ross, Joshua / Rebella, Greg / Westergaard, Mary / Damewood, Sara / Hess, Jamie

WMJ : official publication of the State Medical Society of Wisconsin

2016 Volume 115, Issue 4, Page(s) 180–184

Language	English
Publishing date	2016
Publishing country	United States
Document type	Journal Article
ZDB-ID	441051-8
ISSN	1098-1861 ; 0043-6542
ISSN	1098-1861 ; 0043-6542
Database	MEDical Literature Analysis and Retrieval System OnLINE

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