An Educational Program to Train Emergency Medicine Residents in Pre-hospital Direct Medical Direction 公开

Vaidyanathan, Lekshmi (2012)

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An Educational Program to Train Emergency Medicine Residents in Pre-hospital Direct Medical Direction By Lekshmi Vaidyanathan

Emergency Medical Services (EMS) plays a vital role in the country's emergency and trauma care system providing response and transport to over 18 million Americans annually. Since field care is provided largely by paramedics, the clinical practice of emergency medicine extends into the pre-hospital environment through the radio communication between the paramedics and physician for real time medical advice. Direct Medical Direction is care rendered under direct orders over the radio or telephone. Training in base station communication and medical direction has been highlighted as a requirement for physicians training in Emergency Medicine (EM). Given the growing emphasis on the benefits of experiential learning the aim of this project was to design an educational program to provide practical education to the physicians training in Emergency Medicine as well as provide a recorded line for continuous ongoing call quality improvement.

The educational program incorporates longitudinal and practical training in direct medical direction to improve pre-hospital care delivery and enabling physicians to be better equipped to manage these calls following their training period. The project also consists of a monitoring and evaluation component to assess the effectiveness of this program over a 4 year time period from implementation and continued ongoing evaluation thereafter to assess the efficacy of the program. Monitoring of the program will be performed through recorded paramedic calls, documentation on triage nurse call logs, Direct Medical Direction feedback forms and paramedic satisfaction surveys. The evaluation component is geared toward evaluating the benefits rendered to the physicians (resident and attending) and paramedics.

The direct medical direction operational program hopes to standardize patient care while providing the vital hands-on education to 3rd year residents training in Emergency Medicine. It allows future evaluation of these recorded calls and measures the quality and consistency of the physician's advice. These reports allow the ED to develop training courses and materials for physicians to help streamline their responses. It also provides an opportunity to expand the pre-hospital curriculum for resident physicians training in Emergency Medicine.

Table of Contents


Background 1
Education Modalities 6
Emergency Medical Services (EMS) Education 9
Emory Emergency Medicine Resident Direct Medical Direction Education 11
Grady EMS overview 13
Program Description 14
Conceptual Framework and Log Frame 14
EMS Clinical Care Guidelines Access 16
Communication Protocol 16
Physician and Resident Involvement 17
Monitoring and Evaluation 20
Monitoring 20
Performance Indicators 20
Verifying Performance Indicators 20
Means of verification 21
Resources 24
Data Summary 24
Data-Driven Action 25
Evaluation 26
Evaluating Resident Education 27
Evaluating Call Consistency 29
Evaluating EMS satisfaction 30
Validity and Reliability 30
Internal validity 31
Reliability 32
External validity 33
Limitations 34
Conclusion 35
References 36
Figures & Tables 39
Figure 1: Components of the Emergency Medical Services (EMS) System in the United States 39
Table 1: Adult Learning Principles that apply to the Medical Learner 40
Figure 2: Dale's Cone of Experience: an intuitive model of the concreteness of various audiovisual media 40
Figure 3: Cone of experience displaying percentage of information people remember under different learning conditions adapted from the original Dale's cone of experience 41
Table 2: Proposed model Direct Medical Direction training curriculum for the Society of Academic Emergency Medicine (SAEM) Emergency Medical Services Committee 43
Figure 4: Conceptual Framework outlining the key determinants, outcome measures and benefits of the DMD program 44
Figure 5: Log Frame outlining the performance indicators and means of verification for the various goals and outputs 45
Figure 6: Communications Pathway 47
Figure 7: Triage Nurse's Call Log 48
Figure 8: Direct Medical Control Form 48
Figure 9: Gantt Chart 50
Figure 10: Data Summary 51
Figure 11: Sample Resident Survey 53
Figure 12: Sample Post Project Implementation Survey Responses 55

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