Live blogging tomorrow

Tomorrow is the beginning of our department's 2nd annual High Risk Emergency Medicine conference in Hawaii. The day's focus is on ultrasonography. I'm going to try to live-blog some of the clinical pearls that I glean from the day.

Article review: New assessment method for medical students - A Script Concordance Test

What different ways can we assess learners?

This fascinating study assesses a new tool - Script Concordance Test (SCT).

Assessing clinical reasoning skills in scenarios of uncertainty: Convergent validity for a Script Concordance Test in an Emergency Medicine clerkship and residency

What are Scripts?

Scripts are organized networks of knowledge. Integrating them improves decision making. Using scripts, experts see associations while novices struggle with causality. In ambiguous cases, experts process multiple scripts with influx of new information.

What is the format of a Script Concordance Test?

The learners are presented with a short clinical vignette with a series of proposed diagnoses and/or plans. The learners are then presented one new piece of information and asked what effect this information has on the proposed diagnoses and/or plans. They score their decisions on a Likert scale, ranging from -2 to +2.

What did this paper study?

An observational study comparing the scores of 4th year med students (n=314) , residents (n=40) and faculty (n=12) on a SCT with scenarios in Emergency Medicine. The student score was compared to USMLE Step 2 score, and resident score with their ABEM in-training exam score.

What were the results?

The SCT scores were able to differentiate students from residents and residents from faculty. 

• Students vs residents: 60% +/- 6.2 vs 70% +/- 5.4
• Residents vs faculty: 70% +/- 5.4 vs 79% +/- 2.9

There was a significant correlation between resident score and ABEM exam score and a modest correlation between student score and USMLE Step 2 score.

What were the limitations?

It is a single centre study. The internal reliability of the assessment tool was suboptimal.

What were the conclusions?

The SCT may be useful in assessing clinical reasoning in uncertain scenarios.

What do I think?

I enjoy the examples given in the paper. While it is different and likely will take some getting used to, it could be a useful assessment tool.

References

Humbert AJ, Besinger B, Miech EJ. Assessing clinical reasoning skills in scenarios of uncertainty: convergent validity for a Script Concordance Test in an emergency medicine clerkship and residency. Acad Emerg Med. 2011;18(6):627-34. .

Paucis Verbis: Pediatric fever without a source (3 mo-3 yr)

In part 3 of this "Pediatric Fever Without a Source" Paucis Verbis cards, we now cover febrile infants 3 months to 3 years old (PV cards for birth-28 days and 29 days-3 months old).

Notes:

• The algorithm below is a guideline for NON-toxic patients. More ill-appearing children require a more broad workup.
• For the under-immunized (<2 PCV immunizations) and temperature ≥39.5C, blood cultures may be falling out of favor in the near future, because the incidence of blood culture contaminants is close to exceeding the true incidence of occult bacteremia.

You can download this PV card: [MS Word] [PDF]

See other Paucis Verbis cards.

Thanks to Dr. Hemal Kanzaria (UCSF-SFGH resident) for helping design this PV card and Dr. Christine Cho, Dr. Andi Marmor, and Dr. Ellen Laves (UCSF Pediatrics) for the content.

Blog incubation project: New 2 winners!

And the winners of the first ever EM Blog Incubator competition are...

Dr. Jim Campagna (Emergency physician at St Joseph's Hospital Health Center in Syracuse, NY) and Dr. Timothy Peck (Beth Israel Deaconess EM resident in Boston, MA)

Both submitted really fascinating concepts for their blogs. I'm really looking forward to reading each of their 3-part introductory series in the upcoming weeks, as they prepare to launch their own blogs.

Dr. Jim Campagna

Jim plans to focus on the all-things-technology in Emergency Medicine. This includes reviewing and aggregating lists of medical apps and hardware which are relevant to the specialty. Furthermore, he will provide up-to-date literature reviews of other technologies, such as electronic medical records and computer physician order entry, and their impact on clinical practice.

Dr. Timothy Peck

Tim isn't a newcomer to the blogging world. He has a fantastic blog "Teach, MD: Rethinking medical education" since July 2011. On his new blog, Web 2.0 Changed My Management, will feature examples of how Web 2.0 influenced the management of specific patient encounters. Also guests will be allowed to contribute mini-case presentations where they will report how a Web 2.0 activity changed how they managed a patient.

I can't wait to see what Jim and Tim come up with!

Paucis Verbis: Fever without a source (29 days-3 months old)

In part 2 of this "Pediatric Fever Without a Source" Paucis Verbis cards, we now cover febrile infants aged 29 days to 3 months (PV card for birth-28 days). Note that there is no single correct answer in how to manage these patients. There can be a wide variation in practices, partly because of the slightly different criteria used by the 3 studies. The overarching principle is that "high risk" infants get admitted with IV ceftriaxone and "low risk" infants get discharged with close follow-up +/- a ceftriaxone IV or IM dose. The line between these two risk categories is the grey area.

Where I practice, we tend to follow a modified version of the Rochester criteria, where a lumbar puncture and antibiotics aren't always required for this age group (unlike the Boston criteria).

You can download this PV card: [MS Word] [PDF]

See other Paucis Verbis cards.

Keep a lookout for future PV cards which will address fevers without a source in pediatric patients aged 3 months-3 years old.

Thanks to Dr. Hemal Kanzaria (UCSF-SFGH resident) for helping design this PV card and Dr. Christine Cho, Dr. Andi Marmor, and Dr. Ellen Laves (UCSF Pediatrics) for the content.