Browsing by Author "Turner, Joseph"
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Item Assessment of Gender Bias During Paramedic-Physician Handoffs(Springer Nature, 2023-07-11) Pettit, Katei; Harris, Chelsea; Smeltzer, Kathryn; Sarmiento, Elisa J.; Hall, John T.; Howell, Cody; Liao, Mark; Turner, Joseph; Emergency Medicine, School of MedicineObjective: Gender bias against female physicians has been frequently demonstrated and associated with negative feelings toward their careers. Gender bias has also been demonstrated in prehospital clinical care. However, potential gender bias during paramedic-physician handoffs has not been studied. This study aimed to identify gender bias during interactions between prehospital personnel and emergency physicians at the time of patient handoff. Methods: An observational study was conducted at an urban academic emergency department. Observers were trained to record information from paramedic-physician handoffs but were blind to the nature of the study. The primary outcome was to whom paramedics initially directed the focus of their handoff report based on physician gender, with secondary outcomes of to whom paramedics directed most of their report and whether they asked about further questions based on physician gender. Results: There were 784 observed handoffs. There was no significant association between the gender of the physician and which physician received first attention (χ2 {1, N = 782} = 0.9736, p = 0.3238) or majority attention (χ2 {1, N = 780} = 1.9414, p = 0.1635). Paramedics were more likely to ask questions to male attendings than female attendings (χ2 {1, N = 784} = 4.4319, p = 0.0353). Conclusion: We identified limited differences in communication based on gender between paramedics and physicians during emergency department patient handoffs.Item Congenital leukemia presenting as fever in a neonate(Elsevier, 2015-06) Beard, Bethany; Turner, Joseph; Department of Emergency Medicine, IU School of MedicineBackground Emergency department workup of pediatric fever typically focuses on ruling out serious bacterial infection, but other disease processes can cause fever. Congenital leukemia is a rare but important cause of fever in neonates. We review the presentation, pathophysiology, and potential complications of congenital leukemia presenting to the emergency department as pediatric fever. Case Report We report a case of a 4-week-old infant brought to the emergency department for fever and “not acting normally.” Complete blood count demonstrated hyperleukocytosis. Subsequent bone marrow biopsy and flow cytometry confirmed the diagnosis of congenital leukemia. The extreme elevation of the patient's white blood cell count put her at high risk for complications, necessitating aggressive treatment, close monitoring, and appropriate consultation for comprehensive care. Why Should an Emergency Physician Be Aware of This Congenital leukemia is a rare but serious cause of neonatal fever. While the workup for fever without a source in young pediatric patients primarily focuses on ruling out serious bacterial illness, emergency physicians must be familiar with other potentially life-threatening causes of this complaint.Item Does Colchicine Improve Pain in an Acute Gout Flare?(Elsevier, 2015-09) Turner, Joseph; Cooper, Dylan; Department of Emergency Medicine, IU School of MedicineLow-quality evidence suggests that both high- and low-dose colchicine decreases pain in acute gout flares; however, high-dose regimens are associated with more frequent adverse effects.Item Experience introducing physician assistant students into a medical student emergency medicine clerkship(Elsevier, 2019-03) Turner, Joseph; Corson-Knowles, Daniel; Besinger, Bart; Rebman, Rebecca; Hobgood, Cherri; Palmer, Megan; Emergency Medicine, School of MedicineBackground Physician assistants continue to play an increasingly important role in our healthcare system, including a growing role in the emergency department. Introducing physician assistant students into an existing emergency department learning environment makes efficient use of resources and provides an opportunity for interprofessional education, but the success of such a strategy and the resultant impact on medical student education have not been previously described. The goals of our study were to determine the impact of the introduction of physician assistant students into a learning environment that already serves medical students and residents, and to assess the readiness of physician assistant students to participate in an established medical student emergency medicine clerkship. Methods A survey was completed by emergency medicine faculty and residents shortly after the introduction of physician assistant students into an emergency department learning environment. The survey contained 18 questions in two sections: 11 questions asking about the effect of physician assistant students on the emergency department learning environment and 7 questions comparing the skills of physician assistant students with medical students. Data from medical student evaluations of the clerkship were also collected. Results and Discussion: Forty-six physician preceptors (43%) responded to the survey. The majority of preceptors felt that the presence of physician assistant students offered valuable interprofessional education and overall was a positive experience, though some expressed concerns about the effect on the education of other learners. Most preceptors felt that physician assistant students had comparable skills with medical students, though some concerns were expressed regarding knowledge base and variability of skill level. Medical student evaluations of the clerkship were similar before and after the introduction of physician assistant students. These results, however, must be viewed with caution as we were able replace a medical student with a physician assistant student, keeping the total number of students at the study sites constant, which some institutions may not be able to do. Conclusions The impact of introducing physician assistant students to a medical student emergency medicine clerkship is viewed as being positive overall, though more research is needed to understand and optimize the learning involvement for all learners.Item Factors that Contribute to Resident Teaching Effectiveness(Cureus, 2019-03-21) Rutz, Matt; Turner, Joseph; Pettit, Katie; Palmer, Megan M.; Perkins, Anthony; Cooper, Dylan D; Emergency Medicine, School of MedicineBackground One of the key components of residency training is to become an educator. Resident physicians teach students, advanced practice providers, nurses, and even faculty on a daily basis. Objective The goal of this study was to identify the objective characteristics of residents, which correlate with perceived overall teaching effectiveness. Methods We conducted a one-year, retrospective study to identify factors that were associated with higher resident teaching evaluations. Senior emergency medicine (EM) teaching residents are evaluated by medical students following clinical teaching shifts. Eighteen factors pertaining to resident teaching effectiveness were chosen. Two items from the medical students' evaluations were analyzed against each factor: teaching effectiveness was measured on a five-point Likert scale and an overall teaching score (1-75). Results A total of 46 EM residents and 843 medical student evaluations were analyzed. The ACGME milestones for systems-based practice (p = 0.02) and accountability (p = 0.05) showed a statistically significant association with a rating of "five" on the Likert scale for teaching effectiveness. Three other ACGME milestones, systems-based practice (p = 0.01), task switching (p = 0.04), and team management (p = 0.03) also showed a statically significant association of receiving a score of 70 or greater on the overall teaching score. Conclusion Residents with higher performance associated with system management and accountability were perceived as highly effective teachers. USMLE and in-service exams were not predictive of higher teaching evaluations. Our data also suggest that effective teachers are working in both academic and community settings, providing a potential resource to academic departments and institutions.Item Failure of an Educational Intervention to Improve Consultation and Implications for Healthcare Consultation.(Cureus, Inc., 2019-02-20) Turner, Joseph; Litzau, Megan; Morgan, Zachary S.; Pollard, Katherine; Cooper, Dylan; Emergency Medicine, School of MedicineINTRODUCTION: Consultation of another physician for his or her specialized expertise regarding a patient's care is a common occurrence in most physicians' daily practice, especially in the emergency department (ED). Therefore, the ability to communicate effectively with another physician during a patient consultation is an essential skill. However, there has been limited research on a standardized method for a physician to physician consultation with little guidance on teaching consultations to physicians in training. The objective of our study was to measure the effect of a structured consultation intervention on both content standardization and quality of medical student consultations. METHODS: Senior medical students were assessed on a required emergency medicine rotation with a physician phone consultation during a standardized, simulated chest pain case. The intervention groups received a standard consult checklist as part of their orientation to the rotation, followed by a video recording of a good consult call and a bad consult call with commentary from an emergency physician. The intervention was given to students every other month, alternating with a control group who received no additional education. Recordings were reviewed by three second-year internal medicine residents pursuing a fellowship in cardiology. Each recording was evaluated by two of the three reviewers and scored using a standardized checklist. RESULTS: Providing a standardized consultation intervention did not improve students' ability to communicate with consultants. In addition, there was variability between evaluators in regards to how they received the same information and how they perceived the quality of the same recorded consultation calls. Evaluator inter-rater reliability (IRR) was poor on the questions of 1) would you have any other questions of the student calling the consult and 2) did the student calling the consult provide an accurate account of information and case detail. The IRR was also poor on objective data such as whether the student stated their name. CONCLUSIONS: A brief intervention may not be enough to change complex behavior such as a physician to physician consultant communication. Importantly, despite consultants listening to the same audio recordings, the information was processed differently. Future investigations should focus on both those delivering as well as those receiving a consultation.Item Multi-Institutional Survey of Fourth Year Students’ Self Assessed Milestone Based Skill Proficiency and Faculty Expectation During an Emergency Medicine Clerk-ship: Implications For Curriculum Development(Taylor & Francis, 2018-09-13) Pettit, Katie; Turner, Joseph; Hogan, Kathryn; Poznanski, Stacey; Pfennig-Bass, Camiron; Kouyoumjian, Sarkis; Hexom, Braden; Perkins, Anthony; Pitre, Cory; Humbert, Aloysius; Emergency Medicine, School of MedicineIntroduction: Emergency medicine milestones suggest skill performance expectations for graduating medical students. The objective of this study is to examine differences between student’s perceived proficiency and faculty expectations relative to Level 1 EM milestones, identifying opportunities for curriculum development. Methods: Using ACGME milestone language, the authors developed a survey that measures student perceived skill proficiency with 22 skills, which was administered to fourth year medical students at 6 institutions. Similar surveys were sent to faculty to determine their expectations of students’ skill proficiency. Differences between student and faculty responses were calculated. Results: There were 608 student and 114 faculty responses. There was a statistically significant difference between mean student and faculty responses for 13 of the 22 skills. For 10 of these skills, students rated their own skill proficiency higher than faculty expectations. For 3 of the skills, faculty rated their expectations higher than students’ perceived proficiency. Conclusions: For pharmacology skills, student ratings were low, indicating an area to focus curriculum development. Items where student ratings are higher than faculty may be a result of overconfidence or a lack of understanding by faculty of students’ abilities. Formal assessment of skills in these areas would help clarify the reason and direct faculty and curriculum development.Item Obtaining History with a Language Barrier in the Emergency Department: Perhaps not a Barrier After All(eScholarship Publishing, 2018-11) Litzau, Megan; Turner, Joseph; Pettit, Katie; Morgan, Zachary; Cooper, Dylan; Emergency Medicine, School of MedicineItem Qualities Important in the Selection of Chief Residents(Cureus, Inc., 2020-04-07) Turner, Joseph; Litzau, Megan; Mugele, Josh; Pettit, Katie; Sarmiento, Elisa J.; Humbert, Aloysius; Emergency Medicine, School of MedicineBackground Chief resident selection occurs by numerous methods. Chief residents also fulfill multiple roles, requiring a broad skill set. However, there is little literature on which qualities various stakeholders value in chief resident selection. The objective of this study was to identify the qualities that residents and faculty believe are important for chief residents. Methods Following a literature review, educational experts conducted a multi-institutional survey that asked participants to name the qualities they felt were most important in chief residents and to rank-order a predefined list of 10 qualities. Associations were calculated between rank-order and participant age, gender, institutional position, and history of serving as a chief resident. Results The response rate for the survey was 43.9% (385/877). Leadership, organization, and communication skills were named by all participants among the most common responses. Residents additionally named approachability, advocacy, and listening skills among their most valued qualities, whereas faculty named strong clinical skills and integrity. Dependability and trustworthiness were the most valued qualities in the rank-order list, whereas strong clinical skills and self-reflection were the least valued. Females valued the ability to manage multiple demands more whereas males valued dependability more. The faculty valued strong clinical skills more than residents. Conclusion A variety of qualities are seen as being valuable in chief residents. Additional research is needed to understand what qualities are associated with effective chief resident performance.