Papers by Stefanie Ellison
Building a Patient-Centered Interprofessional Education Program, 2020
Building effective interprofessional (IP) teams is an important process for healthcare systems ac... more Building effective interprofessional (IP) teams is an important process for healthcare systems across the world. In order to be truly effective, professional degree programs must teach our future health professionals to learn and collaborate on teams during their education. The goal of building effective IP healthcare teams will be achieved when each healthcare system effectively supports IP collaboration, the development of dynamic teams, and the appropriate use of resources. Advancing the effort to build effective IP healthcare teams will take an investment from key stakeholders such as educators, faculty and students, leaders and researchers in academic medicine, hospital and system administrators, policymakers, as well as patients and their families to create a culture of IP collaboration and provide the resources necessary to be sustainable and successful. This chapter will serve to show that effective IP healthcare teams can successfully improve patient outcomes, provide quali...
Advances in Medical Education, Research, and Ethics
This chapter serves to provide medical educators with an overview of competency-based education (... more This chapter serves to provide medical educators with an overview of competency-based education (CBME) and the clinical skills necessary for medical school graduate. Technology that supports the teaching, learning, and assessment of CBME and clinical skills is defined and examples are provided for each of the Accreditation Council for Graduate Medical Education (ACGME) core competencies. The competencies are defined, and clinical skills embedded in each are highlighted. This chapter provides a summary of the useful technological tools and provides examples of medical schools that use technology to teach and assess CBME with these tools. Online teaching or eLearning, simulation, online assessment, virtual humans, the electronic health record, gaming, procedural software, discussion boards, reflective writing, portfolios, and telemedicine programs are covered in detail.
Missouri medicine
Prior research has identified knowledge gaps between the verbalization of procedures and performa... more Prior research has identified knowledge gaps between the verbalization of procedures and performance in simulations. Against this background, we designed a procedural simulation conference to enhance our students' procedural skills development using instruction and deliberate practice. The conference had six procedure stations, each focusing on specific learning objectives. Sixty medical students and 20 instructors from University of Missouri-Kansas City's Emergency Medicine Interest Group participated. A majority rated the conference as helpful in enhancing students' procedural skills.
Journal of Contemporary Medical Education, 2015
Background and Purpose: There is a paucity of empirical-based knowledge upon which medical studen... more Background and Purpose: There is a paucity of empirical-based knowledge upon which medical students and clerkship directors in the US and Canada direct National Board of Medical Examiners (NBME) subject exam preparation. This study investigated NBME subject exam preparation habits and their predictive effects on actual scores. Methods: Sixty medical students from the University of Missouri-Kansas City were surveyed in six clerkships on preparation time, resources utilization, study strategies, and help-seeking trends when relating to NBME subject exam preparation. Multiple regression analyses were conducted to determine predictive effects of the constructs on actual scores. Results: Participants relied on rote-memorization and mock exam rehearsal more than cooperative learning and conceptualization. On average, 3-6 resources/clerkship were utilized with clear preference of question banks and review books over textbooks. Participants spent 11-20 hours/week/clerkship studying for NBME subject exams with a majority starting midway through the rotations. Despite observed positive correlations, none of the study variables significantly predicted actual scores. The full regression model, however, accounted for 32.2% of the variance in NBME subject exam scores. Conclusions: Exam preparation trends unveiled in this study may provide helpful insights to clerkship directors and medical students in making informed decisions on selection of preparatory resources and study strategies to best utilize time and funding.
Primary care, 2015
Adolescent sudden cardiac death is rare. When it occurs, it is devastating to families and commun... more Adolescent sudden cardiac death is rare. When it occurs, it is devastating to families and communities because of the unexpected nature of the death and the age of the victim. It is especially troubling because these patients are seemingly healthy compared with their adult counterparts who die from coronary artery disease. This article reviews the incidence, etiology, prevalence, risk, screening, and prevention strategies for the sudden cardiac death of adolescents.
Missouri medicine
Sexual assault (SA) is unfortunately common and patients most often present to the emergency depa... more Sexual assault (SA) is unfortunately common and patients most often present to the emergency department, if at all. The health care provider should evaluate and manage the SA patient in a stepwise and detail-oriented fashion. This includes medical and forensic evaluation and treatment while providing for the emotional and legal needs of the patient. The health care provider should also understand the importance of medical and forensic documentation and evidence collection unique to the SA patient.
Journal of the American College of Cardiology, 2004
The purpose of this study was to examine the relationships among B-type natriuretic peptide (BNP)... more The purpose of this study was to examine the relationships among B-type natriuretic peptide (BNP) levels within the diagnostic range, perceived congestive heart failure (CHF) severity, clinical decision making, and outcomes of the CHF patients presenting to emergency department (ED). BACKGROUND Since BNP correlates with the presence of CHF, disease severity, and prognosis, we hypothesized that BNP levels in the diagnostic range offer value independent of physician decision making with regard to critical outcomes in emergency medicine. METHODS The Rapid Emergency Department Heart failure Outpatient Trial (REDHOT) study was a 10-center trial in which patients seen in the ED with shortness of breath were consented to have BNP levels drawn on arrival. Entrance criteria included a BNP level Ͼ100 pg/ml. Physicians were blinded to the actual BNP level and subsequent BNP measurements. Patients were followed up for 90 days after discharge. RESULTS Of the 464 patients, 90% were hospitalized. Two-thirds of patients were perceived to be New York Heart Association (NYHA) functional class III or IV. The BNP levels did not differ significantly between patients who were discharged home from the ED and those admitted (976 vs. 766, p ϭ 0.6). Using logistic regression analysis, an ED doctor's intention to admit or discharge a patient had no influence on 90-day outcomes, while the BNP level was a strong predictor of 90-day outcome. Of admitted patients, 11% had BNP levels Ͻ200 pg/ml (66% of which were perceived NYHA functional class III or IV). The 90-day combined event rate (CHF visits or admissions and mortality) in the group of patients admitted with BNP Ͻ200 pg/ml and Ͼ200 pg/ml was 9% and 29%, respectively (p ϭ 0.006). CONCLUSIONS In patients presenting to the ED with heart failure, there is a disconnect between the perceived severity of CHF by ED physicians and severity as determined by BNP levels. The BNP levels can predict future outcomes and thus may aid physicians in making triage decisions about whether to admit or discharge patients. Emerging clinical data will help further refine biomarker-guided outpatient therapeutic and monitoring strategies involving BNP.
Journal of Cardiac Failure, 2006
Previous studies have shown that in patients presenting to the emergency department (ED) with hea... more Previous studies have shown that in patients presenting to the emergency department (ED) with heart failure, there is a disconnect between the perceived severity of congestive heart failure (CHF) by physicians and the severity as determined by B-type natriuretic peptide (BNP) levels. Whether ethnicity plays a role in this discrepancy is unknown. The Rapid Emergency Department Heart Failure Outpatient Trial (REDHOT) was a 10-center trial of 464 patients seen in the ED with acute dyspnea and BNP level higher than 100 pg/mL on arrival. Physicians were blinded to BNP levels. Patients were followed for 90 days after discharge. A total of 151 patients identified themselves as white (32.5%) and 294 as black (63.4%). Of these, 90% were hospitalized. African Americans were more likely to be perceived as New York Heart Association class I or II than whites (P = .01). Blacks who were discharged from the ED had higher median BNP levels than whites who were discharged (1293 vs. 533, P = .004). The median BNP of blacks who were discharged was actually higher than the median BNP of blacks who were admitted (1293 vs. 769, P = .04); the same did not hold true for whites. BNP was predictive of 90-day outcome in both blacks and whites; however, perceived severity of CHF, race, and ED disposition did not contribute to the prediction of events. In patients presenting to the ED with heart failure, the disconnect between perceived severity of CHF and severity as determined by BNP levels is most pronounced in African Americans.
American Heart Journal, 2006
The study purpose was to examine &amp... more The study purpose was to examine "gray zone" B-type natriuretic peptide (BNP) levels (100-500 pg/mL) in terms of associated clinical factors, perceived severity, and outcomes in patients with established congestive heart failure (CHF). Although gray zone BNP levels may have diagnostic ambiguity, the implications of these levels in patients with an established diagnosis of CHF have not been examined. REDHOT was a national prospective study in which 464 patients seen in the emergency department with dyspnea had BNP levels drawn. Entrance criteria included a BNP > 100 pg/mL; however, physicians were blinded to the actual BNP level. Patients were followed up for 90 days. Thirty-three percent had gray zone BNP levels. There was no difference in perceived New York Heart Association class (P = .32) or admission rates (P = .76) between the gray zone and non-gray zone groups; 62% of patients with a gray zone BNP were identified as class III or IV CHF. Despite this perceived severity, the 90-day event rate was lower in the gray zone group (19.2% vs 32.9%, respectively, P = .002). Although patients in the gray zone had more symptoms of concomitant pulmonary disease, multivariate analysis could not demonstrate any variable that worsened the prognosis of patients with a gray zone BNP level. In patients with established CHF, those with gray zone BNP levels have a better prognosis than those with non-gray zone levels despite being perceived by physicians as having New York Heart Association class III or IV CHF.
Missouri medicine
This study is to determine the assessment accuracy for the diagnosis of stroke by EMS dispatchers... more This study is to determine the assessment accuracy for the diagnosis of stroke by EMS dispatchers and paramedics compared to emergency physicians (EPs). Of the 191 patients who met inclusion criteria, dispatchers assessed 133 as having a stroke; EPs agreed in 67 (50%) cases. Paramedics assessed 100 patients as having stroke; EPs agreed in 70 (70%) cases. Dispatcher and paramedic sensitivity for diagnosing stroke was 61% and 64%, respectively; specificity was 20% and 63% respectively. Sensitivity for the detection of acute stroke was nearly identical between EMS dispatchers and on-scene paramedics; overall agreement with emergency physician diagnosis was moderate.
Journal of Emergency Medicine, 2008
Morbid obesity is a serious and widespread disease that has considerable morbidity and mortality.... more Morbid obesity is a serious and widespread disease that has considerable morbidity and mortality. Bariatric surgery has become widely available in both community and academic centers as a weight loss option for the morbidly obese. Although the procedure is offered to patients after a careful screening process, it is highly invasive and is performed in patients with significant pre-existing comorbidities from obesity. Knowledge of possible postoperative complications and their management is important as it will affect Emergency Departments nationwide. A basic understanding of the available procedures, the anatomical changes of each procedure, and the common complications for each is important to the emergency physician who will need to evaluate and manage the postbariatric surgery patient.
Academic Emergency Medicine, 2007
The Accreditation Council for Graduate Medical Education mandated the integration of the core com... more The Accreditation Council for Graduate Medical Education mandated the integration of the core competencies into residency training in 2001. To this end, educators in emergency medicine (EM) have been proactive in their approach, using collaborative efforts to develop methods that teach and assess the competencies. The first steps toward a collaborative approach occurred during the proceedings of the Council of Emergency Medicine Residency Directors (CORD-EM) academic assembly in 2002. Three years later, the competencies were revisited by working groups of EM program directors and educators at the 2005 Academic Assembly. This report provides a summary discussion of the status of integration of the competencies into EM training programs in 2005. ACADEMIC EMERGENCY MEDICINE 2007; 14:80-94 ª 2007 by the Society for Academic Emergency Medicine
Prehospital Emergency Care, 2003
It has been estimated that between 11% and 61% of ambulance transports to emergency departments a... more It has been estimated that between 11% and 61% of ambulance transports to emergency departments are not medically necessary. This study's objective was to analyze paramedic ability to determine the medical necessity of ambulance transport to the emergency department. Paramedics prospectively assessed adult patients transported to an emergency department during a six-week period. The setting was an urban, all advanced life support, public utility model emergency medical services (EMS) system with 58,000 transports per year. Paramedics determined medical necessity of patient transport based on the following five criteria: 1) need for out-of-hospital intervention; 2) need for expedient transport; 3) potential for self-harm; 4) severe pain; or 5) other. On arrival in the emergency department, the emergency physician made a blinded determination based on the same criteria. Kappa statistics were used to assess agreement. Data forms were completed on 825 of 1,420 (58%) patients transported. Emergency physicians determined 248 (30%) transports were not necessary, paramedics 236 (29%), with agreement in 76.2% (K=0.42) of cases. Paramedics undertriaged 92 patients (11%). Rates of agreement on the five criteria were: 1) 71.9% (K=0.43); 2) 77.7% (K=0.22); 3) 89.6% (K=0.40); 4) 89.6 (K=0.32); and 5) 82.2% (K=0.29). Paramedics and emergency physicians agreed that a significant percentage of patients did not require ambulance transport to the emergency department. Despite only moderate agreement regarding which patients needed transport, the undertriage rate was low.
Academic Emergency Medicine, 2007
The Accreditation Council for Graduate Medical Education mandated the integration of the core com... more The Accreditation Council for Graduate Medical Education mandated the integration of the core competencies into residency training in 2001. To this end, educators in emergency medicine (EM) have been proactive in their approach, using collaborative efforts to develop methods that teach and assess the competencies. The first steps toward a collaborative approach occurred during the proceedings of the Council of Emergency Medicine Residency Directors (CORD-EM) academic assembly in 2002. Three years later, the competencies were revisited by working groups of EM program directors and educators at the 2005 Academic Assembly. This report provides a summary discussion of the status of integration of the competencies into EM training programs in 2005.
Teaching and Learning in Medicine, 2009
Background: The Accreditation Council for Graduate Medical Education requires residency training ... more Background: The Accreditation Council for Graduate Medical Education requires residency training programs to develop methods to teach and assess communication skills in residents to ensure competence as a practitioner. In response, we piloted a communication curriculum for emergency medicine residents. We describe the curriculum and suggest future directions for development based on the strengths and weaknesses of residents' performance and their reactions to the curriculum. Description: Twenty-six residents in a 3-year program at a university-affiliated county hospital participated. Curriculum components were an introductory session, a single standardized patient encounter using a locally written, unvalidated checklist assessing residents' communication skills, a videotape-facilitated self-assessment, and a private feedback session. Evaluation: Residents demonstrated greatest strengths in basic interpersonal skills and efficient information gathering and greatest weakness in empathy. Residents rated the curriculum favorably. Conclusion: The curriculum as implemented offers an initial foundation for teaching and learning critical care communication. Instruction in empathy requires improvement.
Medical Teacher, 2008
Medical students need to learn how to recognize and manage critically ill patients; to communicat... more Medical students need to learn how to recognize and manage critically ill patients; to communicate in critical situations with patients, families, and the healthcare team; and finally, to integrate technical knowledge with communication skills in caring for these patients. Meeting their needs will help prepare them to demonstrate, as physicians, the ability to synthesize information while simultaneously caring for patients, that the American Medical Association recently characterized as vital. Responding to these needs, we developed and implemented a curriculum to enable students in a required emergency medicine clerkship to recognize, manage, and simultaneously communicate with critically ill patients. The curriculum consisted of lectures and exercises on caring for the critically ill including: an introduction to the systematic approach; an interactive lecture on comprehensive communication; observation and discussion of real patients in the emergency department; participation in a single standardized patient encounter while peers and a faculty member observed them; assessment of students' own videotaped performance of the examination by using critical care and communication/interpersonal skills checklists; and receipt of private feedback based on the checklists from the faculty and the standardized patient. Students evaluated the curriculum at the end of the clerkship. Complete performance data for 46 students and curriculum evaluation data from 42 students were available. According to faculty assessment, students as a group performed 79.6% (SD 0.15) of the critical care and 70.9% (SD 11.5%) of the communication skills. Students most often demonstrated Basic Interpersonal Skills (97.9%, SD 0.056) and least often demonstrated Empathy skills (41.7%, SD 0.235). Students rated the curriculum positively. It is feasible to integrate the teaching of communication skills with the recognition and management of critically ill patients. The next step will be to revise the curriculum to address student deficiencies and to evaluate its effectiveness more rigorously.
Academic Medicine, 2010
The University of Missouri-Kansas City (UMKC) School of Medicine is a public medical school that ... more The University of Missouri-Kansas City (UMKC) School of Medicine is a public medical school that opened in 1971 in response to a need to train more physicians in Missouri. As a six-year, integrated, combined-degree program leading to the baccalaureate and medical degrees, the school offers an innovative, nontraditional approach to medical education. In the past 35 years, UMKC has graduated over 2,400 physicians who are successful according to outcomes measures used at other medical schools. With recent interest in reforming medical education to prepare physicians for a changing world, a review of alternative models may be especially instructive.UMKC's academic plan offers a blueprint for the curriculum plan and governance of the school. The plan is built on four hallmarks: (1) a combined baccalaureate/MD program, (2) early exposure to clinical medicine, (3) small-group learning through the docent system, and (4) a continuing ambulatory care clinic experience for four years. This article catalogs the results of this plan including student, faculty, and graduates' perceptions of and satisfaction with the school's educational approach, students' achievement on licensing examinations and in the residency match, graduates' performance in residency programs, and their subsequent career patterns. The authors also discuss lessons learned and adjustments made in response to local needs in the context of a changing environment in education, health care, and health care delivery while continually improving the school's nontraditional approach to medical education. These include changes in basic and clinical science instruction, student assessment, faculty development, and funding and governance.
Medical Teacher, 2008
Medical students need to learn how to recognize and manage critically ill patients; to communicat... more Medical students need to learn how to recognize and manage critically ill patients; to communicate in critical situations with patients, families, and the healthcare team; and finally, to integrate technical knowledge with communication skills in caring for these patients. Meeting their needs will help prepare them to demonstrate, as physicians, the ability to synthesize information while simultaneously caring for patients, that the American Medical Association recently characterized as vital. Responding to these needs, we developed and implemented a curriculum to enable students in a required emergency medicine clerkship to recognize, manage, and simultaneously communicate with critically ill patients. The curriculum consisted of lectures and exercises on caring for the critically ill including: an introduction to the systematic approach; an interactive lecture on comprehensive communication; observation and discussion of real patients in the emergency department; participation in a single standardized patient encounter while peers and a faculty member observed them; assessment of students' own videotaped performance of the examination by using critical care and communication/interpersonal skills checklists; and receipt of private feedback based on the checklists from the faculty and the standardized patient. Students evaluated the curriculum at the end of the clerkship. Complete performance data for 46 students and curriculum evaluation data from 42 students were available. According to faculty assessment, students as a group performed 79.6% (SD 0.15) of the critical care and 70.9% (SD 11.5%) of the communication skills. Students most often demonstrated Basic Interpersonal Skills (97.9%, SD 0.056) and least often demonstrated Empathy skills (41.7%, SD 0.235). Students rated the curriculum positively. It is feasible to integrate the teaching of communication skills with the recognition and management of critically ill patients. The next step will be to revise the curriculum to address student deficiencies and to evaluate its effectiveness more rigorously.
Academic Medicine, 2010
The University of Missouri-Kansas City (UMKC) School of Medicine is a public medical school that ... more The University of Missouri-Kansas City (UMKC) School of Medicine is a public medical school that opened in 1971 in response to a need to train more physicians in Missouri. As a six-year, integrated, combined-degree program leading to the baccalaureate and medical degrees, the school offers an innovative, nontraditional approach to medical education. In the past 35 years, UMKC has graduated over 2,400 physicians who are successful according to outcomes measures used at other medical schools. With recent interest in reforming medical education to prepare physicians for a changing world, a review of alternative models may be especially instructive.UMKC's academic plan offers a blueprint for the curriculum plan and governance of the school. The plan is built on four hallmarks: (1) a combined baccalaureate/MD program, (2) early exposure to clinical medicine, (3) small-group learning through the docent system, and (4) a continuing ambulatory care clinic experience for four years. This article catalogs the results of this plan including student, faculty, and graduates' perceptions of and satisfaction with the school's educational approach, students' achievement on licensing examinations and in the residency match, graduates' performance in residency programs, and their subsequent career patterns. The authors also discuss lessons learned and adjustments made in response to local needs in the context of a changing environment in education, health care, and health care delivery while continually improving the school's nontraditional approach to medical education. These include changes in basic and clinical science instruction, student assessment, faculty development, and funding and governance.
American Journal of Emergency Medicine
Uploads
Papers by Stefanie Ellison