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Jonathan Sherbino

Publications and source records attributed to Jonathan Sherbino.

5 recordsLinked to original sources
PubMed2006

Evaluating "ED STAT!": a novel and effective faculty development program to improve emergency department teaching.

OBJECTIVES: Effective clinical teaching in emergency departments (EDs) presents unique challenges. No validated approaches to enhancing ED teaching have been reported. The authors evaluated the effectiveness of a novel one-day evidence-based, skills-oriented faculty development course tailored to ED teachers (ED STAT!). METHODS: The authors invited all inaugural course registrants to participate in this program evaluation study. The authors assessed participants' knowledge change and perceived change in teaching behavior using a multiple-choice and short-answer question examination, a teaching behaviors questionnaire, and a survey for satisfaction. Data were gathered before, immediately after, and one month after the course. Mean scores were compared using the Wilcoxon signed rank test, and qualitative results were analyzed via a grounded theory approach. RESULTS: Thirty-one individuals from a variety of academic and community EDs completed the May 2005 course; 28 participated in the pre-evaluation and postevaluation, and 22 participated in the one-month postevaluation. Multiple-choice scores increased from pre-evaluation to one-month postcourse by 15.1% (p < 0.001, effect size large: d = 1.53). Short-answer scores increased by 17.2% (p = 0.001, effect size large: d = 0.90). After one month, 55% of participants reported an increased amount of teaching, 86% perceived this teaching to be of a greater quality, and 82% had shared new strategies with colleagues. The course would be recommended to a colleague by 96.3% of respondents. CONCLUSIONS: ED STAT! improves participants' knowledge about ED-specific teaching strategies, and this improvement is maintained at one month. Participants reported high satisfaction and a positive effect on teaching behavior.

Consumer Behavior↗
PubMed2006

Validation of a rule for termination of resuscitation in out-of-hospital cardiac arrest.

BACKGROUND: We prospectively evaluated a clinical prediction rule to be used by emergency medical technicians (EMTs) trained in the use of an automated external defibrillator for the termination of basic life support resuscitative efforts during out-of-hospital cardiac arrest. The rule recommends termination when there is no return of spontaneous circulation, no shocks are administered, and the arrest is not witnessed by emergency medical-services personnel. Otherwise, the rule recommends transportation to the hospital, in accordance with routine practice. METHODS: The study included 24 emergency medical systems in Ontario, Canada. All patients 18 years of age or older who had an arrest of presumed cardiac cause and who were treated by EMTs trained in the use of an automated external defibrillator were included. The patients were treated according to standard guidelines. Characteristics of diagnostic tests for the prediction rule were calculated. These characteristics include sensitivity, specificity, and positive and negative predictive values. RESULTS: Follow-up data were obtained for all 1240 patients. Of 776 patients with cardiac arrest for whom the rule recommended termination, 4 survived (0.5 percent). The rule had a specificity of 90.2 percent for recommending transport of survivors to the emergency department and had a positive predictive value for death of 99.5 percent when termination was recommended. Implementation of this rule would result in a decrease in the rate of transportation from 100 percent of patients to 37.4 percent. The addition of other criteria (a response interval greater than eight minutes or a cardiac arrest not witnessed by a bystander) would further improve both the specificity and positive predictive value of the rule but would result in the transportation of a larger proportion of patients. CONCLUSIONS: The use of a clinical prediction rule for the termination of resuscitation may help clinicians decide whether to terminate basic life support resuscitative efforts in patients having an out-of-hospital cardiac arrest.

Adolescent↗
PubMed2006

Prehospital transcutaneous cardiac pacing for symptomatic bradycardia or bradyasystolic cardiac arrest: a systematic review.

BACKGROUND: Advanced cardiac life support (ACLS) guidelines suggest transcutaneous cardiac pacing (TCP) for the treatment of symptomatic bradycardia (SB) and bradyasystolic cardiac arrest (BACA). Many EMS systems are extrapolating these guidelines and employing TCP in the prehospital setting. Our objective was to conduct a systematic review to determine the efficacy of prehospital TCP in the management of these two conditions. METHODS: MEDLINE (1966-2004), EMBase and Science Citation Index (1980-2004) were searched using: prehospital/emergency medical services; external/transcutaneous; pacing. Two reviewer teams blinded to the source and author conducted a hierarchical selection (title, abstract, article) and quality assessment using a validated scale. Kappa agreement at each level of review was measured. Data abstraction was done by consensus. RESULTS: Thirty-four articles were identified and seven selected (Kappa agreement; title: 0.85, abstract: 0.78, full article: 0.82). Article quality was poor in all trials. There were three case series (BACA, n=215), three unblinded randomised controlled trials (one BACA, two BACA+SB), and one subgroup (SB) analysis. In the case series of paced BACA patients, 0/215 survived to hospital discharge. In the BACA trials 16/509 (paced) versus14/497 (control) survived to discharge. In a subgroup of one SB trial 5/6 (paced) versus 1/7 (control) survived to discharge (p=0.01). When a SB trial subgroup was combined with a case series 4/27 (paced) versus 0/24 (control) survived to discharge (p=0.07). CONCLUSIONS: In the prehospital setting, there is no evidence to support the use of TCP in bradyasystolic cardiac arrest. There is inadequate evidence to determine the efficacy of prehospital TCP in the treatment of symptomatic bradycardia.

Bradycardia↗
PubMed2006

Improving communication skills: feedback from faculty and residents.

OBJECTIVES: To determine common themes in faculty and peer feedback for emergency medicine (EM) resident oral presentations. METHODS: From January to July 2005, all EM residents received written feedback on communication skills from two faculty and two peer reviewers. The feedback forms were analyzed by using formal grounded theory. The two investigators independently reviewed 25% of the forms to generate a code of general categories and specific qualifiers. The independent codes were merged by consensus into a common code. All forms were independently coded by the two investigators using the common code. Coding disagreements were resolved by consensus, yielding a uniform inventory of feedback categories and qualifiers. RESULTS: Twenty-one of 23 residents participated. Three hundred seventy-two data points were coded, with an interrater agreement of 85.7%. The five most common feedback themes were as follows: focus on key and relevant teaching points; increase audience participation; encourage higher level thinking; decrease content per slide; and add missing content relevant to teaching point. Peers differed from faculty, mentioning more frequently encourage higher level thinking and add missing content relevant to teaching point. Faculty differed from peers, mentioning increase clarity of teaching point and be engaging and enthusiastic more frequently. The difference in distribution of themes between faculty and peers was significant (chi2 = 59.692; p = 0.01). CONCLUSIONS: The authors present a model for providing feedback to EM residents on communication skills that is individualized, behavior based, and includes peer comments. Faculty and peers differ in their recommendations. The findings may inform communication skills curricula for EM residents.

Communication↗