Ginsburg, Alexander

Objectives: To determine the frequency with which emergency medical services (EMS) clinicians recognize patients enrolled in hospice and describe their prehospital management. Methods: Observational cohort study of patients enrolled in hospice who were transported by EMS within a health system between May 5, 2018, and June 4, 2023. Two physicians reviewed each encounter to determine whether interventions were comfort-focused (hospice philosophy) or life-sustaining care. Interrater reliability was 100% (k = 1.0). Descriptive statistics are provided. Results: EMS clinicians identified hospice enrollment in 51% ( n = 46) of 88 encounters. Most patients (90%, n = 79) received comfort-focused care. Life-sustaining care was provided to four patients identified as hospice-enrolled and included cardiopulmonary resuscitation, an advanced airway, and vasopressors ( n = 1, 25%); spinal immobilization ( n = 2, 50%), and naloxone ( n = 1, 25%). Conclusion: Most patients received care consistent with the philosophy of hospice. However, EMS clinicians may have only identified half of patients enrolled in hospice. This demonstrates an opportunity to improve recognition of patients’ care preferences, starting in the out-of-hospital setting.

Introduction The rapidly growing population of older adults (individuals aged 65 years and older) presents a new set of challenges for healthcare providers in the emergency department (ED), given the prevalence of severe and life-threatening conditions among this group, such as chronic cancer, Alzheimer’s disease/dementia and congestive heart failure. ED encounters often represent a critical point in an older patient’s trajectory of care and can thus be an important opportunity for various interventions such as palliative care consultation. Therefore, identifying those who will benefit most from palliative care is of high importance, especially in determining the course of future treatment. Thus, we aim to conduct a systematic review assessing the efficacy of palliative care screening in the ED by assessing inpatient length of stay as the primary outcome and quality of life, percentage of hospitalisation and cost of care as secondary outcomes. Methods This study will use Ovid MEDLINE, Embase, EBSCO CINAHL, Web of Science and Cochrane as databases. The study population comprises adults aged 60 years and older, with no focus on any specific clinical specialty or disease. Patients who have not received palliative care screening will serve as the comparator. Only studies with an applicable comparator will be considered. Studies published from 1 January 2000 to 1 July 2025 will be included. All articles will be reviewed independently and in duplicate, and every author will participate in the review, data abstraction and conflict resolution process. Ethics and dissemination Ethical approval is not required as it is a protocol for a systematic review. Findings will be disseminated through peer-reviewed publications and conference presentations. PROSPERO registration number CRD42024562389.

Radiology is often incorporated into medical school anatomy courses. Radiology education furthers understanding of anatomical relationships and prepares students to apply anatomical knowledge in clinical practice. The aim of this study was to investigate how cognitive performance on the radiology components (RC) of a first‐year medical school anatomy course are related to performance on non‐radiological components (NRC). We hypothesized that there is no correlation between these two performance variables, because they rely on different cognitive skills. Thus, anatomy education alone will not prepare students for the interpretation of normal anatomy on radiological images. Medical students (n=51) enrolled in a first‐year anatomy course at Mayo Clinic School of Medicine were included in this study. Assessment data from three lab practical examinations were collected, and RC and NRC questions were compared. A bivariate linear regression and statistical tests were conducted. A subgroup analysis was used to compare students whose RC performance was greater than their NRC performance (RC>NRC, n=33) to students whose RC performance was less than their NRC performance (RC<NRC, n=18). When considering all three exams, students correctly answered 71.1% of the RC questions and 68.3% of NRC questions (p=0.047). Bivariate linear regression demonstrated a moderate positive correlation between RC and NRC performance (p<0.01, r= 0.51); however, performance on RC questions only accounted for 24% of the variability of NRC scores. Additionally, students in the RC>NRC group had significantly higher scores on RC questions than the students in the RC<NRC group (74% vs 66%, p<0.02). Conversely, students in the RC>NRC group had significantly lower scores on NRC questions than the students in the RC<NRC group (61% vs 74%, p=0.001). These results indicate that while RC performance has some influence on NRC performance it does not account for the majority of the difference observed. Such results suggest that the cognitive skills involved in both radiology and anatomy education are different. Therefore, dedicated radiology education is an important component of an anatomy course as it fosters the development of novel skills that are necessary when interpreting normal anatomy on radiological images in a clinical setting. Support or Funding Information None

Perceived self‐efficacy influences how one approaches goals, tasks, and challenges, and has been shown to affect motivation and academic behaviors. The ability to accurately assess one's competency and limitations is also a critical skill for physicians. Research has shown that medical students can underestimate their perceived clinical skills compared to observer assessment, but limited research has addressed perceived knowledge specific to anatomy. This study compares student perception and faculty evaluation of academic competency in a gross anatomy course. Additionally, this study revisits whether daily audience response system (ARS) questions is a predictor of academic success, and the impact of near‐peer tutoring on student performance. Data from 51 first year medical students in a 7‐week gross anatomy course were evaluated. At the end of week 3 of the course, students with a cumulate ARS grade below the 70% pass requirement were contacted by faculty with individualized formative feedback on academic performance and presented with opportunities for improvement and formal tutoring. All students irrespective of performance were made aware of opportunities for tutoring. Six near‐peer teaching assistants tutored students who requested help. Mean ARS scores and laboratory practice practical grades were evaluated before and after the students received formative feedback. Students were placed into one of four groups based on two factors: (1) their perceived ability to succeed in the course, and (2) faculty perception of their potential for success. Students in groups 1 and 3 were identified by faculty members as potentially at risk, whereas groups 2 and 4 were viewed as low risk. From the students' perspective, those in groups 1 and 2 self‐identified as needing assistance, whereas groups 3 and 4 felt that they were not at risk of failing the course. Of the 12 students contacted by faculty, 6 (12% of the class) requested a tutor (group 1). Additionally, 11 (21%) students who were not contacted by faculty requested a tutor (group 2). Six (12%) students that were contacted by faculty did not request a tutor (group 3), while 28 (55%) were not contacted by faculty and did not request a tutor (group 4). The averages of daily ARS scores between groups after feedback was significantly greater in group 4 compared to groups 1 and 2 (68% vs 61% and 63%, p=0.04 and 0.04, respectively). In addition, the post faculty feedback practical average scores were significantly higher in group 4 compared to group 1 (67% vs 56%, p=0.04). These data show that in an environment that fosters acceptance of academic support, students are more receptive to receiving and reaching out for help from near‐peer tutors. Formative feedback from ARS scores continue to be a reliable indicator for tracking student performance. Improvement of student performance in final course evaluation may be a positive indicator of success from near‐peer tutoring. Support or Funding Information None

AbstractBackground EM Talk is a communication skills training program designed to improve emergency providers’ serious illness conversational skills. Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, this study aims to assess the reach of EM Talk and its effectiveness. Methods EM Talk is one of the components of Primary Palliative Care for Emergency Medicine (EM) intervention. It consisted of one 4-hour training session during which professional actors used role-plays and active learning to train providers to deliver serious/bad news, express empathy, explore patients’ goals, and formulate care plans. After the training, emergency providers filled out an optional post-intervention survey, which included course reflections. Using a multi-method analytical approach, we analyzed the reach of the intervention quantitatively and the effectiveness of the intervention qualitatively using conceptual content analysis of open-ended responses. Results A total of 879 out of 1,029 (85%) EM providers across 33 emergency departments completed the EM Talk training, with the training rate ranging from 63–100%. From the 326 reflections, we identified meaning units across the thematic domains of improved knowledge, attitude, and practice. The main subthemes across the three domains were the acquisition of discussion tips and tricks, improved attitude toward engaging qualifying patients in serious illness (SI) conversations, and commitment to using these learned skills in clinical practice. Conclusion Effectively engaging qualifying patients in serious illness conversations requires appropriate communication skills. EM Talk has the potential to improve emergency providers’ knowledge, attitude, and practice of SI communication skills.Trial registration:NCT03424109

Background: Palliative care has been identified as an area of low outpatient referral from our emergency department, yet palliative care has been shown to improve the quality of patient’s lives. Aim: This study investigates both provider and patient perspectives on palliative care for the purpose of identifying barriers to increased palliative care utilization within our healthcare system. Design: Two surveys were developed, one for patients/caregivers and one for healthcare providers. Setting/participants: This was a single-center study completed at a quaternary academic emergency department. A survey was sent to emergency medicine providers with 47% response rate. Research staff approached Emergency Department patients who had been identified to be high risk to fill out paper surveys with 76% response rate. Results: Only 28% of patients had already undergone palliative care, with an additional 25% interested in palliative care. Nearly half of the patients felt that they needed more resources to prevent hospital visits. Patients identified low understanding of palliative care and difficulty accessing appointments as barriers to consultation. Among providers, 98% indicated that they had patients who would benefit from palliative care. A majority of providers highlighted patient understanding of palliative care and access to appointments as barriers to palliative care. Notably, 52% of providers reported that emergency medicine provider knowledge was a barrier to palliative care consultation. Conclusions: Despite emergency department patients’ self-identified need for resources and emergency medicine providers’ recognition of patients who would benefit from palliative care, few patients receive palliative care consultation.

A “perineal” branch of the sciatic nerve has been visualized during surgery, but there is currently no description of this nerve branch in the literature. Our study investigates the presence and frequency of occurrence of perineal innervation by the sciatic nerve and characterizes its anatomy in the posterior thigh. Fifteen cadavers were obtained for dissection. Descriptive results were recorded and analyzed statistically. Twenty‐one sciatic nerves were adequately anatomically preserved. Six sciatic nerves contained a perineal branch. Five sciatic nerves had a branch contributing to the perineal branch of the posterior femoral cutaneous (PFC) nerve. In specimens with adequate anatomical preservation, the perineal branch of the sciatic nerve passed posterior to the ischial tuberosity in three specimens and posterior to the conjoint tendon of the long head of biceps femoris and semitendinosus muscles (conjoint tendon) in one. In specimens in which the perineal branch of the PFC nerve received a contribution from the sciatic nerve, the branch passed posterior to the sacrotuberous ligament in one case and posterior to the conjoint tendon in three. Unilateral nerve anatomy was found to be a poor predictor of contralateral anatomy (Cohen's kappa = 0.06). Our study demonstrates for the first time the presence and frequency of occurrence of the perineal branch of the sciatic nerve and a sciatic contribution to the perineal branch of the PFC nerve. Clinicians should be cognizant of this nerve and its varying anatomy so their practice is better informed. Clin. Anat. 31:357–363, 2018. © 2018 Wiley Periodicals, Inc.