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Learning Objectives: 1. Recognize a new format to teach end-of-life care. 2. Review the perception of learners using a serious-game framework to learn rapid discussion about goals of care.Introduction: Emergency departments (ED) care for many patients who are chronically ill and nearing end of life. Establishing goals of care and code status in the ED is an essential skill for Emergency Medicine (EM) residents but is challenging to teach.Educational Objectives: To develop EM residents’ ability to: 1) identify patients in need of a goals-of-care discussion; 2) interpret advance care planning documents; 3) efficiently conduct an informed code status discussion; and 4) manage the actively dying patient.Curricular Design: High-fidelity simulation was utilized to replicate the experience of caring for a critically-ill patient in the high-stress ED environment. The scenario involved a live standardized patient with stage 4 pancreatic cancer presenting with sepsis due to pneumonia and who had the goal of comfort-focused care. The simulation utilized the Live-Die-Repeat format, which is a serious-game scheme in which learners are allowed infinite opportunities (“lives”) to progress through a single patient scenario. If learners complete the predetermined critical actions, the game is paused and there is a debriefing to reinforce knowledge and skills before resident’s progress to the next stage of the simulation. Conversely, if learners do not complete critical actions, the game is over and learners must undergo remedial debriefing before they repeat the scenario they previously failed.Impact/Effectiveness: Eighty percent (16/20) of the residents completed a Simulation Effectiveness Tool-Modified survey and 100% strongly or somewhat agree the simulation improved their skills and confidence at the end of life including: better prepared to respond to changes in condition, more confident in assessment skills, teaching patients, reporting to the medical team, empowered to make clinical decisions, and ability to prioritize care and interventions (Figure). Comments emphasized the impact of simulation on their ability to have a goal of care discussion (Table).

Introduction: Epinephrine is the treatment of choice for anaphylaxis. We surveyed emergency department (ED) health care providers regarding 2 methods of intramuscular (IM) epinephrine administration (autoinjector and manual injection) for the management of anaphylaxis and allergic reactions and identified provider perceptions and preferred method of medication delivery.Methods: This observational study adhered to survey reporting guidelines. It was performed through a Web-based survey completed by health care providers at an academic ED. The participants consisted of all ED providers, including staff physicians, resident physicians, pharmacists, advanced practice providers, and nurses. The primary outcomes were assessment of provider perceptions and identification of the preferred IM epinephrine administration method by ED health care providers.Results: Of 217 ED health care providers invited to participate, 172 (79%) completed the survey. Overall, 82% of respondents preferred the autoinjector method of epinephrine administration. Providers rated the autoinjector method more favorably with regard to time required for training, ease of use, convenience, satisfaction with weight-based dosing, risk of dosing errors, and speed of administration (P

Introduction: Compassion fatigue (CF) is the emotional and physical burden felt by those helping others in distress, leading to a reduced capacity and interest in being empathetic towards future suffering. Emergency care providers are at an increased risk of CF secondary to their first responder roles and exposure to traumatic events. We aimed to investigate the current state of compassion fatigue among emergency medicine (EM) resident physicians, including an assessment of contributing factors.Methods: We distributed a validated electronic questionnaire consisting of the Professional Quality of Life Scale with subscales for the three components of CF (compassion satisfaction, burnout and secondary traumatic stress), with each category scored independently. We collected data pertaining to day- versus night-shift distribution, hourly workload and child dependents. We included residents in EM, neurology, orthopedics, family medicine, pediatrics, obstetrics, and general surgery.Results: We surveyed 255 residents, with a response rate of 75%. Of the 188 resident respondents, 18% worked a majority of their clinical shifts overnight, and 32% had child dependents. Burnout scores for residents who worked greater than 80 hours per week, or primarily worked overnight shifts, were higher than residents who worked less than 80 hours (mean score 25.0 vs 21.5; p=0.013), or did not work overnight (mean score 23.5 vs 21.3; p=0.022).  EM residents had similar scores in all three components of CF when compared to other specialties. Secondary traumatic stress scores for residents who worked greater than 80 hours were higher than residents who worked less than 80 hours (mean score 22.2 vs 19.5; p=0.048), and those with child dependents had higher secondary traumatic stress than those without children (mean score 21.0 vs 19.1; p=0.012).Conclusion: CF scores in EM residents are similar to residents in other surgical and medical specialties. Residents working primarily night shifts and those working more than 80 hours per week appear to be at high risk of developing compassion fatigue. Residents with children are more likely to experience secondary traumatic stress. [West J Emerg Med. 2014;15(6):–0]