Innovation Concept: EM Sim Cases is an innovative, open-access website that was created in 2015 to publish medical simulation resources including standardized, peer-reviewed simulation cases. Herein we describe our interim analysis. Methods: We performed a massive online needs assessment using a methodology previously described by Chan et. al. to determine how we can shape EM Sim Cases to meet the needs of learners and educators who use it. We engaged with simulation experts from the Emergency Medicine Simulation Education Research Collaborative to design a Google Forms survey using best practices in survey design. We distributed the survey to our target community of practice via Twitter, email, and a blog post published on emsimcases.com. Curriculum, Tool, or Material: We received 81 responses from simulation educators representing 8 medical specialties and 13 countries. Most survey respondents identified themselves as staff physicians (n = 44) and specialized in emergency medicine (n = 39). They had 0-21+ years of experience. 37% of respondents (n = 30) stated that material from EM Sim Cases makes up 25% or more of their simulation curriculum. Several respondents noted that using this content made them feel more confident and more current. Respondents praised EM Sim Cases for a well-organized case format, the proper level of detail, consistency between case designs, and the wide variety of cases. Suggested improvements included an opportunity to directly comment on cases and more cases in pediatric, rural, and advanced airway management situations. Suggestions were made to improve the navigability of the website. Respondents wanted to see additional blog content on debriefing strategies and self-made task/skill trainers. Conclusion: EM Sim Cases is a novel, free open-access simulation resource. Using a massive online needs assessment we were able to determine future directions including case topics, website reorganization, and educational material. We were also able to capture how impactful a resource like this can be to clinical and educational practice outside of the simulation setting.

Innovation Concept: Nurses working in corrections facilities are routinely faced with acute care scenarios requiring skilled management. There are also increasing numbers of inmates with chronic health conditions and acute exacerbations. Correctional Service Canada (CSC) has partnered with the Clinical Simulation Lab at Queen's University to develop a simulation-based training program aimed at improving acute care skills of Corrections nurses and staff. This novel quality improvement program encompasses a range of presentations that commonly occur in correctional environments. Methods: The program consisted of two laboratory sessions focused on acute care and trauma followed by an in-situ simulation session. The sessions were organized around the 4-component instructional design that enhances complex learning. Both lab sessions began with scaffolded part-task training (IV insertion, ECG interpretation, airway, circulatory support, etc) and then progressed to six team-based high-fidelity simulations that covered cardiac arrhythmias, hypoglycemia, agitated delirium, drug overdoses, and immediate trauma management. Participants rated the effectiveness of each session. Lastly, an in-situ session was conducted at the Millhaven maximum security facility for nursing and correctional staff. It comprised of five scenarios that incorporated actors, a high-fidelity manikin, and simulated security issues. Participants completed a validated self-assessment before and after the session grading themselves on aspects of acute care. Curriculum, Tool, or Material: Our multi-modal simulation curriculum enhanced self-assessed knowledge of CSC learners. Of 71 attendees in the acute care skills session, 70 agreed or strongly agreed that the exercise enhanced their knowledge, satisfied their expectations, and conveyed information applicable to their practice. All 13 participants in the trauma session agreed or strongly agreed to these sentiments. We used Wilcox signed rank test item by item on the in-situ questionnaire. There was significant improvement in majority of skills sampled: airway management, O2 delivery, team organization and assessment/treatment of cardiac arrest. Conclusion: This initiative is the first time high-fidelity simulation training has been used with Corrections nurses and the first in-situ simulation in a maximum security institution in Canada. The sessions were well-liked by participants and were assessed as very effective, validating the demand for further implementation of clinical simulation in correctional facilities.

Innovation Concept: Video has been proven to be an effective educational tool that is valued by learners and objectively improves knowledge and testing scores. It can simplify complex concepts and is more efficient and effective than audio or reading in tests of 3-day material recall. Our objective in this project was to develop a series of instructional videos geared towards emergency and family physicians on proper application of casts and splints in the emergency department. Methods: We created two procedural videos, each 5-6 minutes long. They each reviewed the process, indications, and precise steps for application for each of two splints: the ulnar gutter and the thumb spica. After finalizing the videos, we created a survey to assess feedback, asking questions about the applicability of the videos to the viewer's clinical practice, how interesting they found the content of the videos, what they liked and disliked, and how willing they would be to access future procedural videos if we were to make them. We also had respondents provide suggestions for topics of future videos. We then sent the videos and accompanying survey to a group of McMaster University medical students, residents, and attending physicians in family medicine and emergency medicine. Upon reviewed the results it seemed that there was a large difference in perceived utility of the videos between attending physicians and trainees, and so we proceeded with subgroup analysis of trainees and staff. Curriculum, Tool, or Material: Orthopedic procedural videos as described above. Conclusion: Using a 5-point Likert scale, we found that overall trainees (4.3, SD 0.76 CI 0.41) found the videos more useful and interesting than did attending physicians (3.4, SD 0.68 CI 0.37), with respondents commenting that they were very clear and easy to follow for junior trainees. Most respondents also indicated that they would access future videos we made (4.2 SD 0.74 CI 0.39 for trainees, 3.2 SD 0.65 SI 0.34) for attendings). Future directions include making the videos more concise and adding more visual summaries to improve viewership, and targeting videos for specific learner level. We are hoping to implement these videos into future curriculum development for our learners and, if successful, other Emergency Medicine residency programs across Canada.

Innovation Concept: Effective communication for ad hoc teams is critical to successful management of multisystem trauma patients, to improve situational awareness and to mitigate risk of error. OBJECTIVES 1. Improve communication of ad hoc teams. 2. Identify system gaps. INNOVATION Team in situ simulations provide a unique opportunity to practice communication and assess systems in the real environment. Our trauma team consists of residents and staff from emergency services, general surgery, orthopedics, anaesthesia, nursing and respiratory therapy. Methods: A team of subject matter experts (SME's) from trauma, nursing, emergency medicine and simulation co-developed curriculum in response to a needs assessment that identified gaps in systems and team communication. The simulation occurred in the actual trauma bay. The on-call trauma team was paged and expected to manage a simulated multisystem trauma patient. Once the team arrived, they participated in a briefing, manikin-based simulation and a communication and system focused debriefing. Curriculum, Tool, or Material: Monthly scenarios consisted of management of a blunt trauma patient, emergency airway and massive hemorrhage protocol. Teams were assessed on communication skills and timeliness of interventions. Debriefing consisted of identification of system gaps and latent safety threats. Feedback was given by each discipline followed by SME's. Information was gathered from participant evaluations (5-point Likert scale and open ended questions) and group debrief. Feedback was themed and actions taken to co-create interventions to communication gaps and latent safety threats. As a result, cricothyroidotomy trays were standardized throughout the hospital to mitigate confusion, time delay and unfamiliarity during difficult airway interventions. Participants felt the exercise was an effective means of practicing interprofessional communication and role clarity, and improved their attitude towards the same. Conclusion: In situ simulation-based education with ad hoc trauma teams can improve interprofessional communication and identify latent safety threats for the management of multisystem trauma patients.

Innovation Concept: Research training programs for students, especially in emergency medicine (EM), may be difficult to initiate due to lack of protected time, resources, and mentors (Chang Y, Ramnanan CJ. Academic Medicine 2015). We developed a ten-week summer program for medical students aimed at cultivating research skills through mentorship, clinical enrichment, and immersion in EM research culture through shadowing and project support. Methods: Five second year Ontario medical students were recruited to participate in the Summer Training and Research in Emergency Medicine (STAR-EM) program at University Health Network, Toronto, from June - Aug, 2019. Program design followed review of existing summer research programs and literature regarding challenges to EM research (McRae, Perry, Brehaut et al. CJEM 2018). The program had broad emergency physician (EP) engagement, with five EP research project mentors, and over ten EPs delivering academic sessions. Curriculum development was collaborative and iterative. All projects were approved by the hospital Research Ethics Board (REB). Curriculum, Tool or Material: Each weekly academic morning comprised small group teaching (topics including research methodology, manuscript preparation, health equity, quality improvement, and wellness), followed by EP-led group progress review of each student's project. Each student spent one half day per week in the emergency department (ED), shadowing an EP and identifying patients for recruitment for ongoing mentor-initiated ED research projects. Remaining time was spent on independent student project work. Presentation to faculty and program evaluation occurred in week 10. Scholarly output included one abstract submitted for publication per student. Program evaluation by students reflected a uniform impression that course material and mentorship were each excellent (100%, n = 5). Interest in pursuing academic EM as a career was identified by all students. Faculty researchers rated the program as very effective (80%, n = 4) or somewhat effective (20%, n = 1) in terms of enhancing productivity and scholarly output. Conclusion: The STAR-EM program provides a transferable model for other academic departments seeking to foster the development of future clinician investigators and enhance ED research culture. Program challenges included delays in REB approval for student projects and engaging recalcitrant staff to participate in research.

Innovation Concept: Emergency physicians (EP) rarely receive timely, iterative feedback on clinical performance that aids their reflective practice. The Calgary zone ED recently implemented a novel email-based alert system wherein an EP is notified when a patient whose ED care they were involved in is admitted to hospital within 72-hours of discharge from an index ED visit. Our study sought to evaluate the general acceptability of this form of audit and feedback and determine whether it encourages practice reflection. Methods: This mixed methods realist evaluation consisted of two sequential phases. An initial quantitative phase used data from our electronic health record and a survey to examine the general features and acceptability of 72-hour readmission alerts sent from May 2017-2018. A subsequent qualitative phase involved semi-structured interviews exploring the alert's role in greater depth. Quantitative data were summarized using descriptive statistics and qualitative data were analyzed using thematic and template analysis techniques. Results of both phases were used to guide construction of context-mechanism-outcome statements to refine our program theory. Curriculum, Tool, or Material: 4024 alerts were sent over a 1-year period, with each physician receiving approximately 17 alerts per year (Q1: 7, Q3: 25, IQR: 18). The top five CEDIS complaints on index presentations were abdominal pain, flank pain, shortness of breath, vomiting and/or nausea, and chest pain (cardiac features). The majority of re-admissions (78.6%) occurred within 48 hours after discharge. Immediate alert survey feedback provided by EP's noted that 52.65% (N = 471) of alerts were helpful. Thematic analysis of 17 semi-structured interviews suggests that the alert was generally acceptable to physicians, However, certain EPs were concerned that the alert impacted hire/fire decisions even when leadership didn't endorse this sentiment. Physicians who didn't believe alerts were involved in hire/fire decisions, described greater engagement in the reflective process. Conversely, physicians, who believed alerts were involved in hire/fire decisions, were more likely to defensively change their practice. Conclusion: Most EPs noted that timely notification of 72-hour readmissions made them more mindful of documenting discharge instructions. Our implementation of a 72- hour readmission alert was an acceptable format for audit and feedback and appeared to facilitate physician reflection under certain conditions.

Innovation Concept: The Orange Book (OB) identifies drugs approved on the basis of safety and effectiveness by the FDA and serves as the gold standard reference for correct pharmacological therapies. It ties in closely with Choosing Wisely Canada (CWC) modelling good stewardship in antimicrobial prescriptions. The book focuses on passive didactic learning instead of active learning, which was shown to have a greater influence on prescribing behaviour. Educational video games, a form of active learning, have been shown to improve clinical skills in medical training. Contagion is a role-playing video game providing an active way of teaching antimicrobial components of the OB and CWC guidelines. Method: Phase I of Contagion was qualitatively tested on students and physicians at McMaster University for teaching effectiveness, applicability to real-life scenarios, and enjoyability. Post-game play 12 participants scored different aspects of the game on a Likert scale. Curriculum, Tool, or Material: The player is a rural physician treating infections in various communities. Each round, the player is given a crate of antibiotics. As communities are infected, the player is provided with clinical symptoms the patients present with. The player must identify the pathology and then correctly treat the communities. The player can treat empirically or order tests to identify the infectious organism. The player strategically navigates which communities to treat as there are limited actions per turn and the player must prevent communities from dying or infecting neighboring regions. Communities tend to build antibiotic resistance over time making first-line treatments unviable, thus careful strategizing and stewardship is essential. Active learning will occur when players are tasked with finding the correct answer to different presentations. After each turn, players will learn about the infecting organism, its phenotypes, and common infectious symptoms. This is considered passive learning. Conclusion: Contagion was well-received by physicians and medical students as an active learning tool to teach the OB and CWC guidelines. On preliminary user testing Contagion scored 5 in effectiveness in teaching treatments and 4.6 in teaching stewardship. An objective of this project is to perform large scale testing across schools to demonstrate the effectiveness of the learning components of the game. We hope to eventually create a tool that can be incorporated in continuing medical education for physicians.

Innovation Concept: Global health fieldwork is valuable for Canadian residents, but is often trainee-organized, short-term, unsupervised, and lacking in preparation and debriefing. In contrast, we have developed a Certificate Program which will be offered to University of Toronto (UofT) emergency medicine (EM) trainees in their final year of residency. This 6-month Program will complement the Transition to Practice stage for residents interested in becoming leaders in GHEM. Methods: We completed a multi-phase needs assessment to inform the structure and content of a GHEM Certificate Program. Phase 1 consisted of 9 interviews with Program Directors (PDs), Assistant PDs, and past fellows from existing GH fellowships in Canada and USA to understand program structure, curriculum, fieldwork and funding. In Phase 2 we interviewed 4 PDs and fellows from UofT fellowship programs to understand local administrative structures. In Phase 3 we collected feedback from 5 UofT residents and 7 faculty with experience in global health to assess interest in a local GHEM Program. All interview data was reviewed and best practices and lessons learned from key stakeholders were summarized into a proposed outline for a 6-month GHEM Certificate Program. Curriculum, Tool, or Material: The Program will comprise of 1) 3 months of preparatory work in Toronto followed by 2) 3 months of fieldwork in Addis Ababa, Ethiopia. Fieldwork will coincide with activities under the Toronto-Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM). The GHEM trainee's work will support TAAAC-EM activities. Preparatory months will include training in specific competencies (POCUS, teaching, tropical medicine, QI) and meetings between the trainee and a UofT mentor to design an academic project. During fieldwork, the trainee will do EM teaching (75% of time) and complete their academic project (25% of time). A UofT supervisor will accompany, orient and supervise the trainee for their first 2 weeks in Addis. Throughout fieldwork, the trainee will be required to debrief with their UofT mentor weekly for academic and clinical mentoring. One AAU faculty member will be identified as a local supervisor and will participate in all evaluations of the trainee during fieldwork. Conclusion: This Program will launch with a call for applications in July 2021, expecting the first trainee to complete the Program in 2022-23. We anticipate that this Program will increase the number of Canadian EM trainees committed to global health projects and partnerships throughout their career.

Innovation Concept: The Calgary Audit and Feedback Framework (CAFF) is an innovative tool developed by the Physician Learning Program (PLP). By addressing four key factors –relationships, question choice, data visualization, and facilitation – CAFF addresses common barriers to physicians receiving their practice data. The goal of this study is to assess whether CAFF-facilitated physician performance improvement (PPI) sessions: 1) improve physicians’ receptiveness to their practice data, and 2) encourage physicians to both identify opportunities for practice change and create action plans. Methods: Peer facilitators were trained to facilitate PPI sessions using the CAFF model. In Calgary, 51/180 emergency physicians have attended at least one of the six PPI sessions. The sessions were evaluated using surveys, commitment to change forms, and the Feedback Orientation Scale (FOS). The FOS is a scale developed to measure a participant's orientation to performance feedback across the four domains of utility, accountability, social awareness, and feedback self-efficacy. Curriculum, Tool, or Material: The PLP has developed and implemented CAFF as a framework to help foster socially constructed learning in audit and group feedback sessions. The CAFF model ensures that the aforementioned four key factors are considered for design and implementation of audit and group feedback. The PLP found that establishing the meaning and credibility of the data is a necessary precursor to reflection and action planning. Conclusion: The FOS was completed for 25/32 physicians. The mean FOS score improved by 0.339 (p < 0.001; z=−3.863). While the mean scores all four domains increased, ‘Feedback Self-Efficacy’ increased the most by .0620 (p < 0.001; z=−3.999). Participants reported that examples of changes made by the peer facilitators were particularly helpful. Evaluations from the sessions suggested physicians overwhelmingly agreed or strongly agreed that the peer comparison was valuable, that the reports helped them reflect on their practice, and that the session helped them identify learning opportunities and strategies to change their practice.

Innovation Concept: Advocacy is a key competency of Canadian residency education, yet physicians seldom engage with supra-clinical advocacy efforts upon completion of training. Emergency medicine (EM) residency training may not equip graduates with the knowledge and skills required to engage as physician-advocates in their communities. Focused writing workshops may increase the confidence and ability of EM trainees to engage as health advocates. Methods: Following a literature review, simulated newsroom workshops were developed by two EM physicians with graduate-level journalism training and workplace experience. Participants were invited to participate in an audio-recorded focus-group and to submit their opinion editorial. Twelve participants registered for the workshops and six attended both sessions and the focus group; four submitted written work. Focus group transcripts and written work were qualitatively analysed to understand acceptability, feasibility, and how students might engage as future health advocates. Curriculum, Tool, or Material: The simulated newsroom consisted of participants acting as journalists and the expert facilitator acting as a news editor. The first workshop provided a framework for news judgement in a didactic session, followed by interactive exercises including: prioritization of news pitches, a simulated editorial meeting, and analysis of published news articles. The participants then drafted their own pitches for in situ feedback from peers and facilitators. Two-weeks later, participants brought their completed articles for peer and expert review before submitting their final article. Conclusion: The innovation bolstered resident physician confidence in advocacy through the popular press, and provided demonstrable skills in opinion writing. Participants felt challenged to develop compelling narratives and differentiate this form of advocacy communication from academic writing or prior media training. Participants valued the workshop as a voluntary component of residency education led by peer experts. Through their writing, residents demonstrated an understanding of structural factors that impact patient health and health systems. Future engagement as physician advocates may be tempered by fears of professional repercussions for public engagement; the impact of physician advocacy on population health outcomes is not yet known.

Innovation Concept: Canadian medical students completing their Emergency Medicine (EM) clerkship rotations must develop approaches to undifferentiated patients. Increasingly used in postgraduate EM education, Open Educational Resources (OERs) are a convenient and flexible solution to meeting medical student educational needs on their EM rotation. We hoped to supplement Canadian medical student EM education through the development of ‘ClerkCast’, a novel OER and podcast-based curriculum on CanadiEM.org. Methods: We utilized the Kern Six Step approach to curriculum development for ‘ClerkCast’. A general needs assessment involved a review of available OERs and identified a lack of effective EM OERs specific for medical students. A specific online needs assessment was used to determine which EM topics required further education for medical students. The survey was shared directly with key Canadian medical student and undergraduate medical educator stakeholder groups, and distributed globally through the CanadiEM social media networks. Results of the needs assessment highlighted shared perceptions of educational needs for medical students, with an emphasis on increased need for education on critical care and common EM presentations. We used the topics determined to be highest priority for the development of our first ten episodes of ‘ClerkCast’. Curriculum, Tool or Material: Podcast episodes are released from CanadiEM biweekly. Episodes are 30 to 45 min in length, and focus on cognitive approaches to a common EM presentation for medical students. Content is anchored on medical student interactions with a staff or resident EM co-host. Podcasts are supplemented by infographics and blog posts highlighting the key points from each episode. Learners are also encouraged to interact with the content through review quizzes on a provided question bank. Quality assurance of the content is provided by physician co-hosts who review episode scripts both prior to recording. Post-production feedback is elicited via comments on the curriculum's host website, CanadiEM.org, and through direct email correspondence to the ClerkCast address. Conclusion: With an ever increasing number of OERs in EM and critical care, the systematic development of new resources is important to avoid redundancies in content and medium while also addressing unmet learner needs. We describe the successful use of the Kern Six Steps for curriculum development for the creation of our novel EM OER for Canadian medical students, ‘ClerkCast’.

Innovation Concept: High-acuity, low-occurrence (HALO) procedures require skilled performance as they treat life-threatening conditions and are associated with significant morbidity when performed incorrectly. Simulation has proven useful for deliberate practice in a low stake setting. Tube thoracostomy is amendable to this approach. Commercially available trainers exist but often have limited realism and are prohibitively expensive particularly to non-academic centers. Three-dimensional (3D) printing produces models suitable for simulation, but no current simulator has been developed and validated for tube thoracostomy. The aim of this study was to develop such, a 3D-printed low-fidelity simulator validated for the simulation-based instruction of tube thoracostomy. Methods: The development of the simulator followed an iterative design cycle with collaboration between a design team and an emergency medicine expert. Its validity (face and content) was tested through hands-on practice and surveys completed by 15 acute-care practitioners. Participants performed the procedure on the simulator and then provided feedback through a mixed quantitative/qualitative product evaluation survey on appearance, realism (face validity) and value in procedural training (content validity). Mean values for overall appearance and content validity as a training tool were 4/5 and 4.3/5 respectively. All respondents felt the model was a useful adjunct. All but one stated it was a good replacement for pre-existing trainers. Curriculum, Tool, or Material: The model was initially printed in three parts using an Ultimaker 3 and Axiom Airwolf Dual 3D-printer. The ribcage was created using polylactic acid with polyvinyl alcohol support material. Printed sections were bonded using glue at interfaces requiring no flexibility. Flexible joints were made of varying amounts of thermoplastic polyurethane and thermoplastic elastomer. Skin overlay for the whole model was created with a cut out area for replaceable sections that subjects would incise to insert the chest tube. Skin was casted using platinum cured silicone in a 3D-printed mold. Total cost of all materials was roughly 80 CAD. Conclusion: The simulator was found to be a useful adjunct for the simulation-based practice of tube thoracostomy. As well, users found the model anatomically realistic and avoided high-cost and ethical issues. Further research will focus on optimization based on feedback and development into a multi-functional simulator for other HALO procedures.

Innovation Concept: A major barrier to the development of a national simulation case repository and multi-site simulation research is the lack of a standardized national case template. This issue was recently identified as a priority research topic for Canadian simulation based education (SBE) research in emergency medicine (EM). We partnered with the EM Simulation Education Researchers Collaborative (EM-SERC) to develop a national simulation template. Methods: The EM Sim Cases template was chosen as a starting point for the consensus process. We generated feedback on the template using a three-phase modified nominal group technique. Members of the EM-SERC mailing list were consulted, which included 20 EM simulation educators from every Canadian medical school except Northern Ontario School of Medicine and Memorial University. When comments conflicted, the sentiment with more comments in favour was incorporated. Curriculum, Tool or Material: In phase one we sought free-text feedback on the EM Sim Cases template via email. We received 65 comments from 11 respondents. An inductive thematic analysis identified four major themes (formatting, objectives, debriefing, and assessment tools). In phase two we sought free-text feedback on the revised template via email. A second thematic analysis on 40 comments from 12 respondents identified three broad themes (formatting, objectives, and debriefing). In phase three we sought feedback on the penultimate template via focus groups with simulation educators and technologists at multiple Canadian universities. This phase generated 98 specific comments which were grouped according to the section of the template being discussed and used to develop the final template (posted on emsimcases.com). Conclusion: We describe a national consensus-building process which resulted in a simulation case template endorsed by simulation educators from across Canada. This template has the potential to: 1. Reduce the replication of effort across sites by facilitating the sharing of simulation cases. 2. Enable national collaboration on the development of both simulation cases and curricula. 3. Facilitate multi centre simulation-based research by removing confounders related to the local adoption of an unfamiliar case template. This could improve the rigour and validity of these studies by reducing inter-site variability. 4. Increase the validity of any simulation scenarios developed for use in national high-stakes assessment.

Innovation Concept: Dizziness is an increasingly common presenting complaint in the emergency department (ED), accounting for >2% of visits annually or almost 30% of visits in patients aged over 65. Approximately half of all cases of dizziness in older adults are caused by benign paroxysmal positional vertigo (BPPV). The use of computerized tomography (CT) to rule out serious but rare underlying central nervous system (CNS) causes in patients with dizziness in the ED is increasing despite guidelines supporting the use of clinical exam maneuvers such as the Dix-Hallpike test and therapeutic canalith repositioning maneuvers. Evidence indicates that these clinical tools are underutilized due to clinician discomfort or lack of understanding in performing and interpreting the maneuvers, supporting brief and accessible clinical resources that incorporate video examples to address this. Methods: Through an iterative process the authors have developed a smartphone app that is designed to facilitate the clinical diagnosis of BPPV and provide treatment maneuvers where appropriate. The app is being tested by clinicians practicing emergency medicine or primary care in Northern Ontario. Curriculum, Tool, or Material: The BPPV Tool is designed as a step-wise guide to diagnose BPPV. Clinicians will be prompted to perform specific exam maneuvers based on clinical findings, and can follow short example videos or written directions. Potentially precipitated nystagmus is described along with example videos. Provocative tests include the Dix-Hallpike and Supine Roll. If appropriate, the clinician will be prompted to perform therapeutic repositioning maneuvers such as the Epley or Gufoni, with associated sample videos, descriptions, and billing information where available. If at any point a clinician's exam findings are not in keeping with a diagnosis of BPPV, they will be alerted to this and stop progressing through the app. Conclusion: The BPPV Tool is an accessible and easily disseminated smartphone app designed to improve clinician comfort in reliably diagnosing BPPV. Diagnosing this common condition clinically is supported in the literature and can reduce the number of unnecessary CT scans performed, which would reduce healthcare costs and ED length of stay for these visits, and could reduce the number of patient transfers from peripheral sites for imaging.

Innovation Concept: The objective of this research study was to create a flipped classroom, interactive, experiential learning module on how to do a medical record review study. It is designed for medical students, residents, physicians, and researchers to have a remote, online, but interactive experience that expands on textbook concepts. The “flipped classroom” means that learners will guide their own education. This learning module will include a pre-test, interactive video module, and a post-test. These components will ensure each learner reaches previously set learning goals and not only solidify the learning of learners but validate the educational method, proving its value. Methods: A review of the literature indicates that medical record review is a valuable method of research in emergency medicine however researchers may encounter methodological difficulties, and sometimes medical record reviews are performed in a suboptimal manner due to these difficulties. We are creating a learning module that builds off of the chapter in the Royal College Research Guide and elaborates on various elements, including sample size calculation. Previous work indicates that a flipped classroom approach in medicine to learning has been well developed and is backed by evidence as well as learner preference to guide their own learning. Curriculum, Tool, or Material: The learning module was initiated from the Royal College Research Guide chapter on how to conduct medical record review research. The module is a white board drawing style video that combines elements of explanation and elaboration of the chapter information and a step by step, learner-interactive example of a medical record research project creation. Conclusion: Medical record review research is accessible to many researchers due to the availability of data. This innovation would help ensure that with this availability, good research is being conducted. Future steps will involve testing and validating this learning module using the pre and post-tests, and expanding to create other, similar modules for other Royal College Research Guide chapters.

Innovation Concept: Upon completion of training, Canadian physicians are expected to respond to patient needs to advocate for change both within and beyond the immediate clinical environment.1 In the current EM curriculum, residents are not explicitly taught skills necessary to engage in clinical care nor policy change that would improve the social determinants of health (SDOH) of patients. In response to this challenge, we have developed and are piloting a 2 year curriculum on “Equity, Diversity, Advocacy, and Cultural Safety (EDACS), to equip EM trainees with the knowledge and skills to advocate and influence policy - to empower residents to act on healthcare inequities rather than simply be aware of them. Methods: We developed the curriculum utilizing the Structural Competency paradigm, a theoretical framework within which clinical and advocacy skills to address the SDOH at a structural level can be taught and practiced. This paradigm includes five intersecting skill-sets, including recognizing the structures that shape clinical interactions, developing an extra-clinical language of structure, and imagining structural interventions. Curriculum, Tool, or Material: The educational intervention will consist of 8 hour-long sessions and one 3-hour long session held over a 2-year period. The 3-hour long session will consist of a walking tour of sites accessed by individuals living in poverty in the Toronto downtown core, including a homeless shelter, a needle exchange program, and others. This session will be facilitated by a physician lead, with input at each site from community organizers. Prior to the walking tour, residents will receive an introductory session outlining themes to reflect on during and after the walking tour. Hour-long sessions will be delivered by invited healthcare providers with specific clinical expertise in the topics of discussion, which will address the care of and advocacy for various marginalized populations. Conclusion: To our knowledge, this is the first curriculum of its kind being implemented in an EM training program in Canada. Upon completion of the curriculum, students will be able to apply the five skillsets outlined in the Structural Competency Framework to address and improve upon inequitable conditions that influence patients treated in the emergency department. We intend to use formal and informal feedback from residents, clinicians, and lecturers to refine future curriculum cycles, and hope to inform similar programs elsewhere.

Innovation Concept: Is there a healthcare provider on board? Healthcare providers may be less confident for in-flight medical emergencies (IFME), as these situations are not part of usual curriculum or practice contexts (e.g. hospitals). For example, the literature reveals that medical students and physicians lack IFME basic knowledge and preparedness. The goal is to pilot a training session for healthcare providers to improve their confidence in navigating IFME. Methods: This training innovation involved: i) a session to crowdsource insights from multidisciplinary healthcare and first aid providers, followed by reviewing considerations of a CMAJ 2018 article on airplane emergencies, and ii) 2 airplane simulations (syncope and cardiac arrest). During crowdsourcing, 7 IFME learning objectives were explored: i) challenges, ii) solutions, iii) equipment, iv) taking vitals, v) general approach, vi) cardiac arrest approach, and vii) human resources / role-delegation. Knowledge and approaches extracted were then applied in simulations. Participants provided scores out of 7.00 for: i) satisfaction of crowdsourcing session and simulation and ii) self-rated confidence on learning objectives at baseline, post-crowdsourcing session, and post-simulation. Results were analyzed with repeated measures ANOVA with post-hoc Tukey. Curriculum, Tool, or Material: The workshop curriculum was a crowdsourcing session and simulation to mentally rehearse and practice clinical skills in airplane settings to improve IFME preparedness. Conclusion: Participants rated the crowdsourcing activity (6.70/7.00, n = 11) and simulation (6.50/7.00, n = 11) positively. Confidence in the 7 topics improved from baseline (2.49/7.00) to post-crowdsourcing (5.23/7.00) to post-simulation (5.94/7.00). Significant differences (p < 0.01) between baseline and post-crowdsourcing, and between baseline and post-simulation were observed. There was no significant difference between post-crowdsourcing and post-simulation. One simulation limitation was not all could be rescuers; therefore, debriefing is important to meet learning objectives. Second, the simulation was not within an airplane; housing simulations inside an airplane with flight attendants is a potential next step. Overall, self-confidence in topics of IFME may improve after just one crowdsourcing session, facilitated through group discussions and mental rehearsal. Added simulations may maintain self-confidence on these topics, by promoting memory retention through active learning and repetition.

Innovation Concept: In Sudbury, ON 44% of out-of-hospital cardiac arrest (OHCA) patients receive bystander CPR (bCPR), and only 4.7% survive cardiac arrest. The Northern City of Heroes (NCH) community initiative was launched in April 2019 with a goal of improving survival from OHCA through hands-only bCPR in the municipality. One NCH initiative is an interactive exhibit at Science North, a science centre in Sudbury that hosts 250,000 visitors annually. The exhibit employs simulation trainers for CPR, accompanying signage and interactive elements. The goals of the exhibit are to activate bCPR, change and measure behaviours through exhibit interactions on how to deliver excellent CPR, and improve survival rates in OHCA patients. Methods: Data is being collected from 3000 visitors using self-reported surveying via SurveyGizmo to assess likelihood of performing bCPR, pre and post interacting with the exhibit. Visitor behaviour will be examined at the exhibit using video-recorded interactions and coding those behaviours using BORIS software. Behavioural data will be analyzed using the Visitor Engagement Framework (VEF) where initiation, transition and breakthrough learning-behaviours are coded and an exhibit Visitor Engagement Profile (VEP) is created. The VEF and VEP are tools used in informal learning settings to assess exhibit impacts on learning. Curriculum, Tool, or Material: The use of an easily-apprehendable, hands-on exhibit tool located in a public setting, such as a science centre, creates a platform for engaging large and diverse public audiences. This type of bCPR exhibitry has not been implemented in other similar environments. The informal learning setting allows the science centre staff to engage in personalized interactions that can solidify the quality of learning and confidence in employing the new skills developed. Conclusion: The NCH exhibit and new strategies for embedding informal curriculum are powerful tools to reach diverse audiences, build knowledge and skills, and have a measurable impact on bCPR and OHCA survival rates. Data is being captured and tracked by Health Sciences North around the City of Greater Sudbury's bCPR and OHCA survival rates to monitor long-term impacts of the NCH community initiatives. Limitations of the study may be found in the focused demographics as well as the nature of self-reported learning. Future research directions include broader geographical surveying to assess improvements in community response to OHCA as a direct result of an interactive bCPR exhibitry.

Introduction: Point-of-care ultrasonography (PoCUS) is being incorporated into Canadian undergraduate medical school curricula. The purpose of this study was to evaluate novel PoCUS education sessions to determine what aspects of the sessions benefitted from hands-on training and which PoCUS skills were retained over time. Methods: Second year medical students voluntarily received three different PoCUS training sessions, each lasting three hours. Prior to the sessions, participants prepared independently with pre-circulated online learning materials. After a 15-minute lecture, experienced PoCUS providers led small group (1 instructor: 5 students), live scanning sessions. Evaluations were conducted before and after each session using expert validated multiple choice questions testing general and procedural knowledge, image recognition and interpretation. Volunteer students were evaluated via direct observation of live scanning using an objective structured assessment of technical skills (OSAT) based on the O-score and then re-evaluated at 2 months post-training to assess PoCUS skills retention. Results: 40 second year medical students participated in extended Focused Assessment with Sonography for Trauma (eFAST), cardiac, and gallbladder PoCUS sessions. The live-training sessions significantly improved student PoCUS knowledge beyond what they learned independently for eFAST (p < 0.001), cardiac (p < 0.001), and gallbladder (p = 0.02). The largest improvement was noted in procedural knowledge test scores improving from 44.0% to 84.0% (n = 38). 16 students were evaluated after each session with a mean O-score of 2.37. 8 students returned two months later to be re-evaluated demonstrating a change in O-scores for eFAST (2.00 to 2.38, p = 0.15), cardiac (2.28 to 2.00, p = 0.32), and gallbladder (2.91 to 1.88, p < 0.001). Conclusion: Procedural PoCUS knowledge benefited the most with hands-on training. eFAST and cardiac PoCUS competency was maintained over time while gallbladder PoCUS competency degraded suggesting that targeted PoCUS skills training may be possible. Further study is required to determine the best use of PoCUS resources in undergraduate medical education.

Innovation Concept: Emergency Medicine (EM) residency programs in Canada have transitioned to competency based medical education and the first stage of the curriculum focuses on standardizing learner competency. Pre-internship boot camps provide a focused opportunity to assist with this standardization prior to residency training. The objective of this descriptive review was to describe our institution's EM pre-internship boot camp in the context of current literature and to summarize the state of EM boot camp curricula across all reported EM residency programs. Methods: The description of our two-day boot camp included its curriculum design, required preparation and resources, and a detailed timeline of each day's events. To compare our boot camp to current literature, a comprehensive search of both primary and gray literature was performed. Curriculum, Tool or Material: Our institution's boot camp is two days of teaching focused on clinical knowledge and procedural competency, with a large component centered on simulation. Day one consisted of an introduction to the boot camp, a review of crisis resource management principles and advanced cardiac life support (ACLS) algorithms, ACLS simulation sessions, and small group skill sessions on common emergency department procedures. Day two contained a point of care ultra sound lecture, an ultrasound guided central venous catheterization session, pigtail and chest tube insertion sessions, and high-fidelity simulation cases. In comparison to the other pre-internship boot camps that were identified in the literature, our boot camp offers a unique focus and format. Conclusion: This review is the first to report on an EM-specific boot camp at a non-American institution, and it provides a framework for the development and refinement of pre-internship EM boot camps at other universities.