Background/ObjectivesAirway Manikins are commonly used to train physicians in the psychomotor skills associated with intubation; however, manikin anatomy has been shown to be significantly different from patient measurements. While practicing the approach to anatomically difficult airways is of particular value; few commercial products attempt to recreate anatomic variants. For this study, our objective was to use multimodal 3D printing technology to re-create actual patient anatomy in an intubatable airway manikin.MethodsA retrospective chart review of ED patients at a northeast urban community medical center was performed to generate a set of relevant patient anatomy variants. A query revealed 60,142 ED patients with neck imaging presenting to the ED between 2015 to 2020, of which 252 had CT neck imaging and were intubated. Of these, 66 met criteria for inclusion; various measurements were taken from each image and compared to prior published studies regarding airway anatomy measurements. A selected image from this set was used for the initial print. Anatomic structures with distinct houndsfield intensity (via CT) were isolated and volume rendered segmentations were generated utilizing MimicsTM. Anatomic features were adjusted to account for the anticipated changes in airway size that occur when patients are positioned for intubation and to account for the volume occupied by airway secretions. A commercial model from 7-SigmaTM was utilized as a base for the 3D printed airway structures; a commercial model was used to increase the durability of the resulting airway and lessened the amount of 3D printing materials needed. After renderings were created, engineering features were added to the model to allow integration with this commercial manikin and to provide a hinge mechanism for jaw movement. Anatomic features were assigned material properties based roughly on values in the literature and adjusted to optimize for a realistic feel of manikins during intubation. A Polyjet digital material printer (stratasys J826) was used to print these assemblies with multimaterial properties based on the Agilus series of multimaterial resins allowing for a range of materials properties ranging from ∼1 MPa to ∼1 GPa.ResultsThis approach to utilizing multimodal 3D printing to augment a commercial manikin has generated intubatable manikins based on actual patient anatomy that are currently in testing with trained intubators.ConclusionMultimodal 3D printing can be utilized to generate higher fidelity training manikins based on actual patient anatomy. This feasibility study is an example of how this technology can be utilized to enhance training tools for future airway management training.Yes, authors have interests to discloseDisclosureEmergency Medicine FoundationGrant SupportEmergency Medicine FoundationDisclosureMaimonides Research and Development FoundationGrant SupportMaimonides Research and Development Foundation Background/ObjectivesAirway Manikins are commonly used to train physicians in the psychomotor skills associated with intubation; however, manikin anatomy has been shown to be significantly different from patient measurements. While practicing the approach to anatomically difficult airways is of particular value; few commercial products attempt to recreate anatomic variants. For this study, our objective was to use multimodal 3D printing technology to re-create actual patient anatomy in an intubatable airway manikin. Airway Manikins are commonly used to train physicians in the psychomotor skills associated with intubation; however, manikin anatomy has been shown to be significantly different from patient measurements. While practicing the approach to anatomically difficult airways is of particular value; few commercial products attempt to recreate anatomic variants. For this study, our objective was to use multimodal 3D printing technology to re-create actual patient anatomy in an intubatable airway manikin. MethodsA retrospective chart review of ED patients at a northeast urban community medical center was performed to generate a set of relevant patient anatomy variants. A query revealed 60,142 ED patients with neck imaging presenting to the ED between 2015 to 2020, of which 252 had CT neck imaging and were intubated. Of these, 66 met criteria for inclusion; various measurements were taken from each image and compared to prior published studies regarding airway anatomy measurements. A selected image from this set was used for the initial print. Anatomic structures with distinct houndsfield intensity (via CT) were isolated and volume rendered segmentations were generated utilizing MimicsTM. Anatomic features were adjusted to account for the anticipated changes in airway size that occur when patients are positioned for intubation and to account for the volume occupied by airway secretions. A commercial model from 7-SigmaTM was utilized as a base for the 3D printed airway structures; a commercial model was used to increase the durability of the resulting airway and lessened the amount of 3D printing materials needed. After renderings were created, engineering features were added to the model to allow integration with this commercial manikin and to provide a hinge mechanism for jaw movement. Anatomic features were assigned material properties based roughly on values in the literature and adjusted to optimize for a realistic feel of manikins during intubation. A Polyjet digital material printer (stratasys J826) was used to print these assemblies with multimaterial properties based on the Agilus series of multimaterial resins allowing for a range of materials properties ranging from ∼1 MPa to ∼1 GPa. A retrospective chart review of ED patients at a northeast urban community medical center was performed to generate a set of relevant patient anatomy variants. A query revealed 60,142 ED patients with neck imaging presenting to the ED between 2015 to 2020, of which 252 had CT neck imaging and were intubated. Of these, 66 met criteria for inclusion; various measurements were taken from each image and compared to prior published studies regarding airway anatomy measurements. A selected image from this set was used for the initial print. Anatomic structures with distinct houndsfield intensity (via CT) were isolated and volume rendered segmentations were generated utilizing MimicsTM. Anatomic features were adjusted to account for the anticipated changes in airway size that occur when patients are positioned for intubation and to account for the volume occupied by airway secretions. A commercial model from 7-SigmaTM was utilized as a base for the 3D printed airway structures; a commercial model was used to increase the durability of the resulting airway and lessened the amount of 3D printing materials needed. After renderings were created, engineering features were added to the model to allow integration with this commercial manikin and to provide a hinge mechanism for jaw movement. Anatomic features were assigned material properties based roughly on values in the literature and adjusted to optimize for a realistic feel of manikins during intubation. A Polyjet digital material printer (stratasys J826) was used to print these assemblies with multimaterial properties based on the Agilus series of multimaterial resins allowing for a range of materials properties ranging from ∼1 MPa to ∼1 GPa. ResultsThis approach to utilizing multimodal 3D printing to augment a commercial manikin has generated intubatable manikins based on actual patient anatomy that are currently in testing with trained intubators. This approach to utilizing multimodal 3D printing to augment a commercial manikin has generated intubatable manikins based on actual patient anatomy that are currently in testing with trained intubators. ConclusionMultimodal 3D printing can be utilized to generate higher fidelity training manikins based on actual patient anatomy. This feasibility study is an example of how this technology can be utilized to enhance training tools for future airway management training.Yes, authors have interests to disclose Multimodal 3D printing can be utilized to generate higher fidelity training manikins based on actual patient anatomy. This feasibility study is an example of how this technology can be utilized to enhance training tools for future airway management training.

To assess the learning curve of non-ultrasound fellowship-trained emergency physicians (EPs) on the performance of transesophageal echocardiography on a simulator and to determine the number of scans needed for proficiency. This was a prospective observational study of non-ultrasound fellowship-trained EPs. The EPs attended a one-hour TEE workshop and practiced TEE views on a 3D Systems TEE Training Simulator. All participants were asked to return for repeat sessions several months after the module to perform the TEE Standardized Direct Observational Assessment Tools (SDOTs). During each evaluation session a participant could complete up to three SDOTs. EPs were scored on a previously constructed SDOT scoring system. The passing cutoff score was determined using the Angoff method. The study analysis was descriptive of the distributions of SDOT over time. Competency was achieved when a participant reached two consecutive passing scores on two separate evaluation sessions. SDOT Scores for each session and time until a participant reaches two consecutive passing scores on two separate sessions were summarized using medians and IQR. A total of 33 non-ultrasound fellowship trained EPs participated in the study. 33 EPs completed SDOT #1, 30 completed SDOT #2, and 27 completed SDOT #3. 90% of EPs (27 out of 30) required a refresher and could not perform SDOT #1. A passing score of 80 or above was reached by 31% (10 out of 32) of participants on SDOT #2. A passing score was reached by 30% (8 out of 27) of participants who performed SDOT #3. The median time for performing all TEE views decreased over time from a median [IQR] of 259 [180-453] sec on SDOT #1, to 81 [64-126] sec on SDOT #2, and 67 [51-95] sec on SDOT #3. After a TEE workshop, 30% of participants were able to pass the 2nd or 3rd TEE SDOT. Time to completion of TEE views decreases over time as participants continue testing on the transesophageal simulator.

Simulation is a fully immersive modality of education tailor-made for adult learners. After performing in simulated clinical scenarios, formal debriefing allows learners to engage in deep reflection which provides the framework to change dangerous practice patterns and improve future clinical performance. Clarifying the role of learning goals after simulation sessions has the potential to further improve the impact of simulation-based education. The objective of this study was to determine if providing formalized instruction on the creation of Specific, Measurable, Achievable, Realistic, Time-bound learning goals (SMART LG) in the context of debriefing after simulation would result in more self-directed learning compared to standard debriefing techniques.

Attending physician presence is desirable during planned resident and faculty educational development activities. However, because of competing interests and responsibilities, ensuring optimal participation is challenging.

Maintenance of Certification (MOC) is required for ongoing board certification. Airway management is critical to EM practice. New proven rescue devices such as video laryngoscopy have become the standard first-line techniques to manage the most difficult airways; however, many physicians were trained in an era preceding the advent of this lifesaving technology.

Study Objectives: One of the greatest challenges in medical education lies in the provision of valuable feedback that motivates residents to improve. Educators often focus on enhancing the quality of feedback, but rarely consider the influence of residents' own self-assessment.This study evaluates the generation of learning goals by emergency medicine residents after participating in an oral board scenario, performing a self-assessment, and receiving feedback. We hypothesize that their learning goals are based more on the resident's own self assessment than on the specific feedback given, and that the greatest impact will be provided when the self-assessment and the feedback are in agreement.Methods: This multicenter prospective educational study at 4 academic programs involved senior emergency medicine residents during a 6-month period. Volunteers were asked to participate in a standard oral board scenario. After the scenario, the resident completed a standardized self-assessment form. Next, the 4 examiners provided specific feedback with both positive and negative points. The feedback was standardized with a checklist, which was validated on a representative sample of the target population. The resident was then asked to generate “SMART” learning goals (Specific, Measurable, Attainable, Realistic, and Timely) (Chang 2011). The primary outcome was the source of the learning goals and whether the learning goals came from the resident's self-assessment, feedback or both.Descriptive statistics (frequency tables, confidence intervals) were used to summarize the data. Quantitative data were expressed as the mean +/− SEM, while nominal data were expressed as a percentage (frequency tables).Results: Of a total of 76 senior emergency medicine residents eligible for study participation, 75 volunteered to participate. Three residents could not complete the study because of time constraints. Overall, 72 residents (95%) were enrolled in the study. Sixty-one (82%) of the residents achieved greater than minimum competence in overall scores. After completing the scenario, these volunteers generated 226 learning goals (mean 3.1 +/− 1.3). Residents' perceptions of their own performance were more likely to result in the generation of learning goals than was examiner feedback (47% versus 27%) (Table) . When there was disagreement between resident and examiner, learning goals favored self-assessment over feedback (4% versus 1%).Tabled 1Conclusions: The findings highlight the perceived strengths and weaknesses in clinical competence and self-assessment skills and provide direction for program training needs. While self-assessments may not realistically indicate ability, it is still critical to determine how students perceive their ability because their opinions drive their learning goals. The interactive examination appeared to be a convenient tool for providing deeper insight into students' ability to prioritize, self-assess and steer their own learning. Study Objectives: One of the greatest challenges in medical education lies in the provision of valuable feedback that motivates residents to improve. Educators often focus on enhancing the quality of feedback, but rarely consider the influence of residents' own self-assessment. This study evaluates the generation of learning goals by emergency medicine residents after participating in an oral board scenario, performing a self-assessment, and receiving feedback. We hypothesize that their learning goals are based more on the resident's own self assessment than on the specific feedback given, and that the greatest impact will be provided when the self-assessment and the feedback are in agreement. Methods: This multicenter prospective educational study at 4 academic programs involved senior emergency medicine residents during a 6-month period. Volunteers were asked to participate in a standard oral board scenario. After the scenario, the resident completed a standardized self-assessment form. Next, the 4 examiners provided specific feedback with both positive and negative points. The feedback was standardized with a checklist, which was validated on a representative sample of the target population. The resident was then asked to generate “SMART” learning goals (Specific, Measurable, Attainable, Realistic, and Timely) (Chang 2011). The primary outcome was the source of the learning goals and whether the learning goals came from the resident's self-assessment, feedback or both. Descriptive statistics (frequency tables, confidence intervals) were used to summarize the data. Quantitative data were expressed as the mean +/− SEM, while nominal data were expressed as a percentage (frequency tables). Results: Of a total of 76 senior emergency medicine residents eligible for study participation, 75 volunteered to participate. Three residents could not complete the study because of time constraints. Overall, 72 residents (95%) were enrolled in the study. Sixty-one (82%) of the residents achieved greater than minimum competence in overall scores. After completing the scenario, these volunteers generated 226 learning goals (mean 3.1 +/− 1.3). Residents' perceptions of their own performance were more likely to result in the generation of learning goals than was examiner feedback (47% versus 27%) (Table) . When there was disagreement between resident and examiner, learning goals favored self-assessment over feedback (4% versus 1%). Conclusions: The findings highlight the perceived strengths and weaknesses in clinical competence and self-assessment skills and provide direction for program training needs. While self-assessments may not realistically indicate ability, it is still critical to determine how students perceive their ability because their opinions drive their learning goals. The interactive examination appeared to be a convenient tool for providing deeper insight into students' ability to prioritize, self-assess and steer their own learning.