AEM Early Access

AEM Education and Training 13: Coming in Warm: Qualitative Study and Concept Map to Cultivate Patient‐centered Empathy in Emergency Care

Welcome to the thirteenth episode of AEM Education and Training, a podcast collaboration between the Academic Emergency Medicine E&T Journal and Brown Emergency Medicine. Each quarter, we'll give you digital open access to AEM E&T Articles or Articles in Press, with an author interview podcast and links to curated supportive educational materials for EM learners and medical educators.

Find this podcast series on iTunes here.

DISCUSSING (CLICK ON TITLE TO ACCESS):

Coming in Warm: Qualitative Study and Concept Map to Cultivate Patient‐centered Empathy in Emergency Care. Katie E. Pettit MD Nicholas A. Rattray PhD Hao Wang MD, PhD Shanna Stuckey MS D. Mark Courtney MD, MSCI Anne M. Messman MD Jeffrey A. Kline MD

LISTEN NOW: INTERVIEW WITH FIRST AUTHOR KATIE PETTIT, MD

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Katie Pettit, MD

Assistant Professor of Clinical Emergency Medicine

Associate Program Director, Emergency Medicine Residency Program

Indiana University School of Medicine

ABSTRACT

Background

Increased empathy may improve patient perceptions and outcomes. No training tool has been derived to teach empathy to emergency care providers. Accordingly, we engaged patients to assist in creating a concept map to teach empathy to emergency care providers.

Methods

We recruited patients, patient caretakers and patient advocates with emergency department experience to participate in three separate focus groups (n = 18 participants). Facilitators guided discussion about behaviors that physicians should demonstrate to rapidly create trust; enhance patient perception that the physician understood the patient's point of view, needs, concerns, and fears; and optimize patient/caregiver understanding of their experience. Verbatim transcripts from the three focus groups were read by the authors, and by consensus, five major themes with 10 minor themes were identified. After creating a codebook with thematic definitions, one author reviewed all transcripts to a library of verbatim excerpts coded by theme. To test for inter‐rater reliability, two other authors similarly coded a random sample of 40% of the transcripts. Authors independently chose excerpts that represented consensus and strong emotional responses from participants.

Results

Approximately 90% of opinions and preferences fell within 15 themes, with five central themes: provider transparency, acknowledgment of patient's emotions, provider disposition, trust in physician, and listening. Participants also highlighted the need for authenticity, context, and individuality to enhance empathic communication. For empathy map content, patients offered example behaviors that promote perceptions of physician warmth, respect, physical touch, knowledge of medical history, explanation of tests, transparency, and treating patients as partners. The resulting concept map was named the “Empathy Circle.”

Conclusion

Focus group participants emphasized themes and tangible behaviors to improve empathy in emergency care. These were incorporated into the Empathy Circle, a novel concept map that can serve as the framework to teach empathy to emergency care providers.

AEM Early Access 26: The Yield of Computed Tomography of the Head Among Patients Presenting With Syncope: A Systematic Review

Welcome to the twenty-sixth episode of AEM Early Access, a FOAMed podcast collaboration between the Academic Emergency Medicine Journal and Brown Emergency Medicine. Each month, we'll give you digital open access to an recent AEM Article or Article in Press, with an author interview podcast and suggested supportive educational materials for EM learners.

Find this podcast series on iTunes here.

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DISCUSSING (CLICK ON LINK FOR FULL TEXT, OPEN ACCESS THROUGH MAY 31):

The Yield of Computed Tomography of the Head Among Patients Presenting With Syncope: A Systematic Review. J. Alexander Viau, MA, BMBS, Hina Chaudry, MBBS, EMBA, Ailish Hannigan, PhD, Mish Boutet, MIS, Muhammad Mukarram, MBBS, MPH, and Venkatesh Thiruganasambandamoorthy, MBBS, MSc

LISTEN NOW: AUTHOR INTERVIEW WITH J. Alexander Viau, MA, BMBS and Venkatesh Thiruganasambandamoorthy CCFP-EM, M.Sc

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Venkatesh Thiruganasambandamoorthy CCFP-EM, M.Sc

Associate Professor, Dept. of Emergency Medicine, and School of Epidemiology and Public Health

Scientist, Ottawa Hospital Research Institute

New Investigator, Heart and Stroke Foundation Canada

Staff Attending Physician, The Ottawa Hospital

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J. Alexander Viau, MA, BMBS

Emergency Medicine Resident

University of Ottawa

Abstract

Background: Overuse of head computed tomography (CT) for syncope has been reported. However, there is no literature synthesis on this overuse. We undertook a systematic review to determine the use and yield of head CT and risk factors for serious intracranial conditions among syncope patients.

Methods: We searched Embase, Medline, and Cochrane databases from inception until June 2017. Studies including adult syncope patients with part or all of patients undergoing CT head were included. We excluded case reports, reviews, letters, and pediatric studies. Two independent reviewers screened the articles and collected data on CT head use, diagnostic yield (proportion with acute hemorrhage, tumors or infarct), and risk of bias. We report pooled percentages, I2, and Cochran’s Q-test.

Results: Seventeen articles with 3,361 syncope patients were included. In eight ED studies (n = 1,669), 54.4% (95% confidence interval [CI] = 34.9%–73.2%) received head CT with a 3.8% (95% CI = 2.6%–5.1%) diagnostic yield and considerable heterogeneity. In six in-hospital studies (n = 1,289), 44.8% (95% CI = 26.4%–64.1%) received head CT with a 1.2% (95% CI = 0.5%–2.2%) yield and no heterogeneity. In two articles, all patients had CT (yield 2.3%) and the third enrolled patients ≥ 65 years old (yield 7.7%). Abnormal neurologic findings, age ≥ 65 years, trauma, warfarin use, and seizure/stroke history were identified as risk factors. The quality of all articles referenced was strong.

Conclusion: More than half of patients with syncope underwent CT head with a diagnostic yield of 1.1% to 3.8%. A future large prospective study is needed to develop a robust risk tool.

AEM Education and Training 12: Attitudes, Behavior, and Comfort of Emergency Medicine Residents in Caring for LGBT Patients: What do we know?

Welcome to the twelfth episode of AEM Education and Training, a podcast collaboration between the Academic Emergency Medicine E&T Journal and Brown Emergency Medicine. Each quarter, we'll give you digital open access to AEM E&T Articles or Articles in Press, with an author interview podcast and links to curated supportive educational materials for EM learners and medical educators.

Find this podcast series on iTunes here.

DISCUSSING (CLICK ON TITLE TO ACCESS):

Attitudes, Behavior, and Comfort of Emergency Medicine Residents in Caring for LGBT Patients: What Do We Know? Joel Moll MD, Paul Krieger MD, Sheryl L. Heron MD MPH, Cara Joyce PhD, Lisa Moreno‐Walton MD

LISTEN NOW: INTERVIEW WITH FIRST AUTHOR Joel Moll, MD, FACEP

Joel Moll, MD, FACEP

Residency Program Director

Associate Professor

Department of Emergency Medicine

Virginia Commonwealth University School of Medicine

Abstract

Background

Although lesbian, gay, bisexual, and transgender (LGBT) patients are ubiquitous in emergency medicine (EM), little education is provided to EM physicians on LGBT health care needs and disparities. There is also limited information on EM physician behavior, comfort, and attitudes toward LGBT patients. The objective of this study was to assess EM residents behavior, comfort, and attitudes in LGBT health.

Methods

An anonymous survey link was sent to EM programs via the Council of Residency Director listserv. The primary outcome of the 24‐item descriptive survey was the self‐reported comfort levels and self‐reported practice in LGBT health care. Secondary outcomes included individual comfort toward LGBT colleagues and patients who are LGBT, and the frequency of colleagues making discriminatory statements toward LGBT patients and staff in the emergency department setting. Associations between personal and program demographics and survey responses were also examined.

Results

There were 319 responses The majority of respondents were male (63.4%), Caucasian (69.1%), and heterosexual (92.4%). A sizeable minority of respondents felt histories and physical examinations were more challenging for lesbian, gay, or bisexual patients (24.6%) and more so for transgender patients (42.6%). Most residents do not ask patients to identify sexual orientation when presenting with abdominal or genital complaints (63%). Discriminatory LGBT comments were reported from both fellow residents (16.6%) and faculty (10%). A total of 2.5% of respondents were uncomfortable with other LGBT physicians, and 6% did not agree that LGBT patients deserve the same quality care as others.

Conclusion

A number of residents find caring for LGBT patients more challenging than heterosexual patients. Even with professed comfort with LGBT health care, most residents report taking incomplete sexual histories that may affect patient care. Attitudes toward LGBT patients are mainly, but not completely, positive in this cohort.