CJEM最新文献

{"title":"Simulation training in Canadian College of Family Physicians Emergency Medicine (CCFP-EM) programs.","authors":"Aajab Abdulhussein, Susan Humphrey-Murto, Avik Nath, Warren J Cheung, Andrew K Hall","doi":"10.1007/s43678-026-01268-2","DOIUrl":"https://doi.org/10.1007/s43678-026-01268-2","url":null,"abstract":"<p><strong>Objectives: </strong>The Canadian College of Family Physicians Emergency Medicine (CCFP-EM) program offers 1 year of enhanced emergency training following a 2-year family medicine residency. Due to limited training time and unpredictable exposure to high-acuity scenarios, simulation-based education plays a critical role in developing procedural and crisis resource management competencies. This study aimed to characterize simulation use across Canadian CCFP-EM programs, with objectives to 1) describe the volume and delivery of simulation programs, 2) outline curricular content, and 3) explore how simulation is used for assessment.</p><p><strong>Methods: </strong>From June 2023 to January 2024, we interviewed 16 out of 17 program representatives from Canadian CCFP-EM programs. Data were collected via both a pre-interview survey and a semi-structured interview. Program representatives included program directors, assistant program directors, or simulation directors.</p><p><strong>Results: </strong>All programs reported access to a simulation center, with 25% offering remote or virtual simulation. The median simulation hours provided across programs was 42 h annually, with individual residents participating 40 h on average. Most programs covered core national emergency medicine simulation topics, obtaining cases from their own case bank, or using open-access simulation resources. Most program representatives supported developing a standardized national simulation curriculum, emphasizing the need for flexibility for local adaptation. Only 31% of programs used simulation for assessment, citing concerns over psychological safety, feasibility and standardization. Faculty time and cost were the most cited barriers to simulation in general. Notable innovations included disaster simulations, resident-led peer teaching, and specialist-assisted procedural curriculum.</p><p><strong>Conclusion: </strong>Our results provide a starting point for discussion and collaboration across programs, creating opportunities to optimize curricular development and the use of simulation for assessment, while considering resource availability and learner psychological safety. Simulation-based education has been a key educational tool, and educators and program leaders must understand how we are using simulation to teach our residents.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extended-release subcutaneous buprenorphine vs. daily sublingual buprenorphine for opioid use disorder in the emergency department.","authors":"Matthew Hacker Teper, Ian V Beamish, Hasan Sheikh","doi":"10.1007/s43678-026-01282-4","DOIUrl":"https://doi.org/10.1007/s43678-026-01282-4","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149066339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of faculty development interventions on supervisor narrative feedback quality in competency-based medical education.","authors":"Rob Woods, Max Spadafore, Brent Thoma, Lynsey Martin, Teresa Chan, Venkat Bandi","doi":"10.1007/s43678-026-01267-3","DOIUrl":"https://doi.org/10.1007/s43678-026-01267-3","url":null,"abstract":"<p><strong>Objectives: </strong>Improving the feedback that supervisors provide trainees in medical education is challenging. The development of automated methods of rating the quality of narrative feedback has created an opportunity to quantify the impact of interventions focused on this goal.</p><p><strong>Methods: </strong>We used a previously developed natural language processing model based on the Quality Assessment of Learning (QuAL) score to rate the quality of each comment in our Royal College Emergency Medicine specialty training program from July 2018 to June 2024. We quantified the effectiveness of three faculty development interventions (e-mail feedback, audit and feedback workshops, and assessment form modifications) by comparing pre- and post-intervention QuAL scores.</p><p><strong>Results: </strong>During the study period 9709 narrative comments were scored. The average QuAL score rose from 3.2/5 in 2019 to 4.5/5 in 2024. All interventions resulted in an overall improvement in the mean QuAL score as measured by assessor weighted mean: individual e-mail with suggestions for improvement (35.1%), assessment form template change (24.3%), workshop (19.1%) and individual e-mail thanking them for their high-quality comments (11.0%).</p><p><strong>Conclusions: </strong>By combining a multi-faceted faculty development approach with a scalable measurement of our outcome, we have demonstrated an improvement in supervisor narrative comment quality and quantified the impact of each intervention. While it is likely that the interventions were complementary, individual e-mails to faculty with suggestions for improvement and modifications to the assessment form were associated with largest improvements in quality. These results may guide to other programs seeking to improve the quality of supervisor narrative comments.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapid development of a dedicated emergency department follow-up clinic during a large pediatric Shiga toxin-producing E. coli outbreak.","authors":"Jennifer Thull-Freedman, Otto G Vanderkooi, Shauna Langenberger, Tania Principi, Mohamed Eltorki, Heather Patterson, Stephen B Freedman","doi":"10.1007/s43678-026-01274-4","DOIUrl":"https://doi.org/10.1007/s43678-026-01274-4","url":null,"abstract":"<p><strong>Objectives: </strong>To describe the rapid development, implementation, and outcomes of a dedicated pediatric Shiga toxin-producing Escherichia coli follow-up clinic during a large outbreak, and to identify operational lessons relevant to future surge events.</p><p><strong>Methods: </strong>During the 2023 Calgary daycare-associated STEC outbreak, the Alberta Children's Hospital activated an emergency command structure and rapidly established a follow-up clinic for the anticipated surge of children requiring daily assessment and laboratory monitoring. New clinic space was developed by repurposing conference rooms into clinical spaces with workflows designed to support patient flow, safety, and infection prevention. Staffing was achieved through multidisciplinary redeployment and voluntary additional shifts and supported by rapid training and standardized clinical care. Processes were refined using Plan-Do-Study-Act cycles informed by frontline feedback, conversations with families, and direct observation. Operational data were collected and staff feedback was obtained through a post-outbreak survey.</p><p><strong>Results: </strong>After 2 days of treating patients in a modified pre-existing clinic space, the dedicated clinic opened in repurposed conference room space. Between September 6 and 21, 133 patients accounted for 328 visits that would have otherwise occurred in the ED. The median daily visit volume was 22 (range 1-44), and the median number of visits per patient was 2 (range 1-7). Laboratory testing occurred in 97.6% of visits, 3.5% involved intravenous fluid administration, and 2.1% of visits led to admission. No significant adverse events occurred among discharged patients. Survey respondents shared insights for future preparedness, and 85% rated clinic effectiveness at 8/10 or higher.</p><p><strong>Conclusion: </strong>Rapid expansion of ambulatory capacity during outbreaks can be achieved through coordinated redesign of space, staffing, systems, and support services. In this model, early command structure activation, repurposing of non-clinical space, standardized protocols, and broad stakeholder engagement enabled safe care while preserving ED capacity. These transferable principles offer a practical approach for managing future outbreaks.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of made-for-purpose ring cutter devices for the removal of modern hard ring materials.","authors":"Jeffrey J Perry, Sara Khaksari, Gabriel Sandino-Gold, Marie-Joe Nemnom, Andy Pan","doi":"10.1007/s43678-026-01257-5","DOIUrl":"10.1007/s43678-026-01257-5","url":null,"abstract":"<p><strong>Objectives: </strong>Ring entrapment is a common problem in emergency departments. With modern durable metals such as tungsten carbide, titanium, and stainless steel, traditional tools may be ineffective. We evaluated the performance of four purpose-designed ring cutter devices on three hardened ring materials.</p><p><strong>Methods: </strong>Medical providers tested four ring cutting devices-the M5118 Stainless Steel Manual Ring Cutter (Acme United Corporation), Dolphin Ring Cutter (Ring Rescue Inc.), GEM-II Ring Cutter (A-Z Tec Medical Ltd.), and Raptor Shears (Leatherman Tools)-on tungsten carbide, titanium, and stainless steel rings (2.5 mm × 6 mm, size 9-10). Outcomes included successful ring removal, time to removal, ease of use, and user confidence. Research assistants timed each cut. Participants rated ease of use and confidence after each cut.</p><p><strong>Results: </strong>Twenty-one participants (mean age 40 ± 10 years; 76% female) included seven physicians, nine registered nurses, two registered practical nurses, and three patient care attendants. Participants combined performed 242 unique ring cut attempts. The Stainless Steel Manually-Operated Ring Cutter failed on all rings. The Raptor Shears succeeded on titanium 25% of the time but failed on others. The GEM-II Ring Cutter succeeded in 62% of tungsten carbide, 65% of titanium, and 83% of stainless steel rings. The Dolphin Ring Cutter successfully removed all rings. Mean (SD) cut times in seconds were 251 (92) for Dolphin, 561 (239) for GEM-II, and 292 (160) for Raptor. Dolphin scored highest for ease of use 4.8 (0.5) and confidence 4.8 (0.4).</p><p><strong>Conclusion: </strong>For cutting modern hard ring metals, the Dolphin Ring Cutter was the optimal tool of the four assessed, being able to cut through all three materials. The manual ring cutter and trauma shears could not cut through these hardened metals. The Dolphin Ring Cutter was found to be easy to use, and participants had a high degree of confidence in this tool.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149019126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Just the Facts: Resuscitative point-of-care ultrasound in adults with undifferentiated shock.","authors":"Ghaida ALSuhaibani, Chris Doiron, Margo Wilson, Paul Atkinson","doi":"10.1007/s43678-026-01251-x","DOIUrl":"https://doi.org/10.1007/s43678-026-01251-x","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149019155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Operational scholarship in emergency medicine: aligning purpose, evaluation, and dissemination.","authors":"Shelley L McLeod, Jennifer M Hulme, Megan Landes","doi":"10.1007/s43678-026-01264-6","DOIUrl":"https://doi.org/10.1007/s43678-026-01264-6","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148946331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From benchmark success to clinical utility: interpreting large language model performance in emergency department triage.","authors":"Güney Sarıoğlu","doi":"10.1007/s43678-026-01284-2","DOIUrl":"https://doi.org/10.1007/s43678-026-01284-2","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148946382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interhospital transfers from the emergency department: a mixed-methods study on their characteristics and contextual factors influencing their quality.","authors":"Fabian Severino, Maria-Cécilia Gallani, Éric Mercier, Jean-Sébastien Tremblay-Roy, Simon Ouellet, Louis Félix Poulin-Moore, Laurence Bourque, Alexandra Lapierre, Christian Malo, Mélanie Bérubé","doi":"10.1007/s43678-026-01128-z","DOIUrl":"10.1007/s43678-026-01128-z","url":null,"abstract":"<p><strong>Objectives: </strong>Despite an increase in interhospital transfers and the safety risks they represent for patients, little is known about the quality of clinical practices in this field. This study aimed to characterize interhospital transfers by ambulance from the Emergency Departments (ED) of a university hospital and clinicians' perceptions on barriers and facilitators to quality interhospital transfers.</p><p><strong>Methods: </strong>This single-center, prospective descriptive study used a convergent mixed-methods design and was conducted in two phases between May and December 2023. The study was informed by the Donabedian Model for quality improvement and its structure, process and outcomes domains. Quantitative data were collected from the medical records of transferred ED patients and qualitative data from semi-structured interviews with multidisciplinary clinicians involved in interhospital transfers. Descriptive statistics (quantitative) and content analysis (qualitative) were conducted.</p><p><strong>Results: </strong>Characteristics: a total of 72 interhospital transfers were evaluated, with 86.1% carried out for specialized treatment. A nurse accompanied 68.1% of the transfers and respiratory and intravenous equipment was used in about 40% of them. Mean total transfer time was 64.8 (± 20.4) minutes and medication adjustments were performed in 20% of transports supervised by nurses. Among the 57 transfers with complete data, 37 (64.9%) adverse events were observed; 49.1% clinical, 12.3% logistical and 3.5% technical. The 11 interviewed clinicians identified several barriers impacting the quality of interhospital transfers including: equipment issues, insufficient organizational resources, insufficiently prepared patients, and the overall complexity of the transfer process. To address these challenges, they proposed developing specialized expertise, enhancing standardization, establishing multidisciplinary transfer teams dedicated to transfers and integrating paramedics more effectively into the process.</p><p><strong>Conclusions: </strong>This study characterized ED interhospital transfers and the key barriers and facilitators to quality care as perceived by clinicians. Logistical and organizational challenges were highlighted. These findings can inform future quality improvement initiatives targeting interhospital transfer practices.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"856-869"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147438351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Ovens et al. on Beyond bed block: emergency department crowding as an equilibrium outcome.","authors":"Stephenson Strobel","doi":"10.1007/s43678-026-01237-9","DOIUrl":"10.1007/s43678-026-01237-9","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"884-885"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148407358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}