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Emergency physicians supervise residents performing rare clinical procedures, but they infrequently perform those procedures independently. Simulation offers a forum to practice procedural skills, but simulation labs often target resident learners, and barriers exist to faculty as learners in simulationbased training. Simulation-based curricula focused on improving emergency medicine (EM) faculty's rare procedure skills were not discovered on review of published literature. Our objective was to create a sustainable, simulation-based faculty education curriculum for rare procedural skills in EM. Between 2012 and 2019, most EM teaching faculty at a single, urban, Level 1 trauma center completed an annual two-hour simulation-based rare procedure lab with small-group learning and guided hands-on instruction, covering 30 different procedural education sessions for faculty learners. A questionnaire administered before and after each session assessed EM faculty physicians' self-perceived ability to perform these rare procedures. Participants' self-reported confidence in their performance improved for all procedures, regardless of prior procedural experience. Faculty participation was initially mandatory, but is now voluntary. Diverse strategies were used to address barriers in this learner group including eliciting learner feedback, offering continuing medical education credits, gradual roll-out of checklist assessments, and welcoming expertise of faculty leaders from EM and other specialties and professions. Participants perceived training to be most helpful for the most rarely-encountered clinical procedures. Similar curricula could be implemented with minimal risk at other institutions. [ABSTRACT FROM AUTHOR]

Remediation of residents is a common problem and requires organized, goal-directed efforts to solve. The Council of Emergency Medicine Residency Directors (CORD) has created a task force to identify best practices for remediation and to develop guidelines for resident remediation. Faculty members of CORD volunteered to participate in periodic meetings, organized discussions and literature reviews to develop overall guidelines for resident remediation and in a collaborative authorship of this article identifying best practices for remediation. The task force recommends that residency programs: 1. Make efforts to understand the challenges of remediation, and recognize that the goal is successful correction of deficits, but that some deficits are not remediable. 2. Make efforts aimed at early identification of residents requiring remediation. 3. Create objective, achievable goals for remediation and maintain strict adherence to the terms of those plans, including planning for resolution when setting goals for remediation. 4. Involve the institution's Graduate Medical Education Committee (GMEC) early in remediation to assist with planning, obtaining resources, and documentation. 5. Involve appropriate faculty and educate those faculty into the role and terms of the specific remediation plan. 6. Ensure appropriate documentation of all stages of remediation. Resident remediation is frequently necessary and specific steps may be taken to justify, document, facilitate, and objectify the remediation process. Best practices for each step are identified and reported by the task force. ACADEMIC EMERGENCY MEDICINE 2010; 17:S95-S103 © 2010 by the Society for Academic Emergency Medicine [ABSTRACT FROM AUTHOR]

Hypotheses: (1) Antibiotic restriction policies result in alteration of microbiologic features of surgical site infections (SSIs) and (2) reported SSI rates are underestimated when postdischarge surveillance is not included in SSI surveillance efforts. Design: Retrospective analysis of prospectively collected SSI surveillance data. Patients and Methods: We compared initial microbial isolates from SSIs between (1) January 1, 1993, and December 31, 1995, and (2) January 1, 1996, and December 31, 1998. Antibiotic restriction policies were implemented at Fairview-University Medical Center, Minneapolis, Minn, on March 1, 1995. For the combined periods (January 1, 1993, to December 31, 1998), we determined SSI rates for 20,007 operations according to the extent of bacterial contamination at surgery (wound class). Then, we analyzed SSI rates for 10,559 of these operations (selected based on availability of Anesthesia Society of America score and type of procedure) using the surgical wound risk index (wound class, Anesthesia Society of America score, and length of operation). We categorized SSI rates by 17 procedures for comparison with SSI rates reported by 286 hospitals that contributed data confidentially and voluntarily to the National Nosocomial Infections Surveillance System in 1998. We compared SSI rates with and without postdischarge surveillance. Results: Coagulase-negative staphylococcus and group D enterococcus were the 2 most frequent isolates before and after antibiotic restriction policies were implemented. Candida albicans isolates decreased from 7.9% (1993-1995) to 6.5% (1996-1998; P=.46). Methicillin–resistant Staphylococcus aureus (1.8% of isolates) and vancomycin-resistant enterococcus (2.4% of isolates) organisms were first identified between 1996 and 1998. Our SSI rates were 2.6% for class I wounds, 3.6% for class II wounds, and 10.5% for class III/IV wounds; 53.9% of SSIs were identified after hospital discharge. Conclusions: Antibioti... [ABSTRACT FROM AUTHOR]

Objective: To examine use of third-generation cephalosporins (3GCs) alone and in association with vancomycin hydrochloride as a risk factor for vancomycin-resistant enterococcus (VRE) infection in surgical patients. Design: Case-control retrospective study analyzing antibiotic use in the 30 days preceding culture of VRE or vancomycin-sensitive enterococcus from an infected site. Setting: A large tertiary care teaching hospital. Patients: Surgical inpatients with VRE infections between September 3, 1993, and January 29, 1997, were matched with patients with vancomycin-sensitive enterococcus infections. Matches were based on surgical procedure, initial infection site, and immunosuppression. Matches were found for 32 of 50 surgical patients with VRE. Twenty matched pairs of patients were recipients of solid organ transplants. Main Outcome Measures: Multivariate logistic regression analysis was done to examine 3GCs and vancomycin as risk factors for VRE infection. Univariate analysis of use of other antibiotic agents and demographic data was also performed. Results: Multivariate analysis showed significant differences in the use of 3GCs both alone and concurrently with vancomycin. Univariate analysis also showed higher use of metronidazole, concurrent vancomycin and metronidazole, concurrent vancomycin and ceftazidime, and all antibiotics combined in patients with VRE infections. Conclusions: This matched control study showed that use of 3GCs, alone (P=.05) or concurrently with vancomycin (P=.05), was a risk factor for VRE infection in surgical patients. Judicious administration of third-generation antibiotics is warranted in surgical patients with other risk factors for VRE. [ABSTRACT FROM AUTHOR]