This study evaluates a Massive Open Online Course (MOOC) on Emergency Medicine designed by iEM Education Project and Lecturio, using a validated checklist to assess its usability and user experience. The MOOC received a high score for cognitive connection (>4/5), in four components including interactivity, content and resources, media use, and instructional assessment. However, for learner guidance and support, the score was 2.75/5, indicating that the course did not provide clear instructions on how learners can get support or feedback from teachers when encountering problems in the course. For affective and functional connections, all components received a high overall mean score of more than 4/5. The course was impactful to the users who were in their early clinical years, as they were actively engaged and were motivated to complete the course. However, improvements should be made to better stimulate learning by improving learner feedback and providing space for collaborative learning online. Evaluation of MOOC applying the heuristics of usability and user experience identifies specific components of online learning course apart from rating the severity of acceptance or violation of instructional design principles. The information derived from usability and user experience studies can improve design and delivery of online courses.
User-Centered Design ; Educational Technology ; Emergency Medicine

Humans ; United States ; Internship and Residency ; COVID-19 ; Emergency Medicine/education* ; Curriculum

COVID-19 ; Emergency Medicine ; Humans ; Pandemics ; Qualitative Research ; SARS-CoV-2

The use of computed tomography (CT) in emergency departments has increased over several decades, as physicians increasingly depend on imaging for diagnoses. Patients and medical personnel are put at risk due to frequent exposure to and higher levels of radiation, with very little evidence of improvements in outcomes. Here, we explore why CT imaging has a tendency to be overused in emergency departments and the obstacles that medical personnel face in ensuring patient safety. The solution requires cooperation from all emergency care stakeholders as well as the continuous education of doctors on how CT scans help in particular cases.
Diagnosis ; Education ; Emergencies ; Emergency Medical Services ; Emergency Medicine ; Emergency Service, Hospital ; Humans ; Patient Safety ; Private Practice ; Radiation, Ionizing ; Risk Assessment ; Tomography, X-Ray Computed

Damage control resuscitation is a relatively new resuscitative strategy for patients with severe traumatic hemorrhage. This strategy consists of permissive hypotension and early balanced transfusion, and transfers the patients to subsequent surgery. There is growing evidence on harms of excessive fluids. Since 2013, survival benefit of massive transfusion protocol has been proven in adults. Despite insufficient evidence, pediatric massive transfusion protocols are widely used in North American trauma centers. This review focuses on the concept of damage control resuscitation, and summarizes the relevant pediatric evidence.
Adult ; Blood Coagulation Disorders ; Blood Transfusion ; Child ; Emergency Medicine ; Hemorrhage ; Hemostasis ; Humans ; Hypotension ; Hypotension, Controlled ; Resuscitation ; Trauma Centers ; Wounds and Injuries

A 60-year-old woman presented with polymorphic ventricular tachycardia secondary to hypokalemia, which necessitated dozens of DC cardioversions. She was not taking any other medication and denied any vomiting or diarrhea. Further investigation for hypokalemia suggested a hypermineralocorticoid state. Repeated inquiry prompted the patient to admit to taking herbal medicine containing licorice. She was treated with magnesium sulfate, potassium infusion, and intravenous lidocaine. A potassium-sparing diuretic was also prescribed. On the seventh day, the patient was discharged from the hospital with advice to discontinue taking herbal medicines containing licorice. She has been followed up at our outpatient clinic without further symptoms for 3 years. This case highlights the potential for cardiovascular complications associated with consumption of herbal medicines such as licorice. Clinicians should be aware that patients presenting to the emergency department with ventricular arrhythmia and uncertain hypokalemia should be questioned about licorice intake. Obtaining a detailed history from patients admitted to the hospital for electrical storm is essential.
Ambulatory Care Facilities ; Arrhythmias, Cardiac ; Diarrhea ; Electric Countershock ; Emergency Service, Hospital ; Female ; Glycyrrhiza ; Herbal Medicine ; Humans ; Hypokalemia ; Lidocaine ; Magnesium Sulfate ; Middle Aged ; Potassium ; Tachycardia, Ventricular ; Vomiting

OBJECTIVES: Ultrasound has an established role in the diagnostic pathway for children with suspected appendicitis. Relevant clinical information can influence the diagnostic probability and reporting of ultrasound findings. A Bayesian network (BN) is a directed acyclic graph (DAG) representing variables as nodes connected by directional arrows permitting visualisation of their relationships. This research developed a BN model with ultrasonographic and clinical variables to predict acute appendicitis in children. METHODS: A DAG was designed through a hybrid method based on expert opinion and a review of literature to define the model structure; and the discretisation and weighting of identified variables were calculated using principal components analysis, which also informed the conditional probability table of nodes. RESULTS: The acute appendicitis target node was designated as an outcome of interest influenced by four sub-models, including Ultrasound Index, Clinical History, Physical Assessment, and Diagnostic Tests. These sub-models included four sonographic, three blood-test, and six clinical variables. The BN was scenario tested and evaluated for face, predictive, and content validity. A lack of similar networks complicated concurrent and convergent validity evaluation. CONCLUSIONS: To our knowledge, this is the first BN model developed for the identification of acute appendicitis incorporating imaging variables. It has particular benefit for cases in which variables are missing because prior probabilities are built into corresponding nodes. It will be of use to clinicians involved in ultrasound examination of children with suspected appendicitis, as well as their treating clinicians. Prospective evaluation and development of an online tool will permit validation and refinement of the BN.
Appendicitis ; Bayes Theorem ; Child ; Diagnostic Tests, Routine ; Emergency Medicine ; Expert Testimony ; Humans ; Methods ; Pediatrics ; Prospective Studies ; Ultrasonography

OBJECTIVE: Data mining extracts meaningful information from large datasets. In this study, text mining techniques were used to extract keywords from the Journal of the Korean Society of Emergency Medicine, and the change trend was examined. METHODS: The rvest package in R was used to extract all papers published in the Journal of the Korean Society of Emergency Medicine from 2006 to 2016 that could be searched online. Among them, 3,952 keywords were extracted and studied. Using the selected keywords, the corpus was formed by refining keywords that did not correspond to MeSH (Medical Subject Headings) or were misspelled and had similar meanings based on agreement of researchers. Using the refined keywords, the frequencies of the keywords in the first and second halves of the studies were calculated and visualized. RESULTS: Word Cloud revealed that emergency medical service and cardiopulmonary resuscitation (CPR) were most frequently mentioned in both the first and second halves of the studies. In the first half, ultrasonography, stroke, poisoning, injury, and education were frequently mentioned, while in the second half, poisoning, injury, stroke, acute, and tomography were frequently mentioned. A pyramid graph revealed that the frequencies of emergency medical service and CPR were commonly high. CONCLUSION: Core keywords of the Journal of the Korean Society of Emergency Medicine were analyzed for correlations and trends. Changes in study topics according to key topics of interest and period were visually identified.
Cardiopulmonary Resuscitation ; Data Mining ; Dataset ; Education ; Emergencies ; Emergency Medical Services ; Emergency Medicine ; Poisoning ; Stroke ; Ultrasonography

OBJECTIVE: We investigated the opinions of experts to identify problems and prepare an improvement plan when applying the Korean Triage and Acuity Scale (KTAS) to pediatric patients in the emergency department. METHODS: The experts comprised 15 researchers at a pediatric emergency center designated by the Ministry of Health and Welfare and research team members of the Korean Society of Pediatric Emergency Medicine. The first survey was an open-ended question about the problems, application results, and remedies of applying KTAS to children through e-mail. The problems were categorized by topic, and degree of agreement was presented using a 9-point Likert scale. RESULTS: In the first survey, 67% of experts participated and 18 problems were identified. In the second survey, 73% of experts participated and eight problems were identified in four categories, validity, reliability, feasibility and other opinions. All experts pointed out that resources were not considered during pediatric triage in the KTAS. Ninety-one percent of experts said that peak expiratory flow rate measurement and Glasgow Coma Scale evaluation were unlikely to be feasible. Moreover, 91% experts were concerned that the triage level could be distorted if KTAS was interlocked with medical costs. Eighty-two percent of the respondents pointed to the high triage result of febrile children and the difference in pain score between the evaluators, etc. CONCLUSION: Based on the problems pointed out by experts and the reality of Korea's emergency departments, it is necessary to consider revision of KTAS for children.
Child ; Delphi Technique ; Electronic Mail ; Emergencies ; Emergency Medicine ; Emergency Service, Hospital ; Glasgow Coma Scale ; Humans ; Peak Expiratory Flow Rate ; Surveys and Questionnaires ; Triage

OBJECTIVE: This study investigated and compared the perspectives on emergency medicine (EM) professionalism competencies of medical students and EM residents. In addition, how they learned their EM professionalism was also investigated to develop the base of an educational program of professionalism in the field of EM. METHODS: Medical students in four medical colleges/schools and EM residents were recruited for the questionnaire. Regarding the importance and educational need for EM professionalism, 23 items for medical students and 59 items for EM residents were asked. The items were rated on a five point Likert scale. The perspectives of the two groups were compared. The learning methods for professionalism were investigated. RESULTS: A total of 198 medical students and 109 EM residents responded to the questionnaire. The residents responded with mean of 3.0 or more on all items, agreeing on the importance and educational need. On the other hand, the mean scale was less than 4.0 in communication and cooperation with society and social accountability. The students responded with a mean scale of 4.0 or more on all items and agreed on the importance and educational need. Of the 23 common items, there were differences between the two groups in 17 items, showing a higher mean value in the students. The most common methods of learning EM professionalism was bedside teaching during the clinical clerkship for students, and patient handover or board round for residents. CONCLUSION: EM residents tended to place more importance on medical care than social communication, cooperation, and ethical items. The most common learning method of EM professionalism was clinical practice-associated activities. The results of this study could help to develop a systematic and realistic educational program of EM professionalism in EM clerkship and resident training.
Clinical Clerkship ; Emergencies ; Emergency Medicine ; Hand ; Humans ; Learning ; Methods ; Patient Handoff ; Professionalism ; Social Responsibility ; Students, Medical