California American College of Emergency Physicians Research Forum Abstracts

Objective: To determine whether it is the direction of the needle bevel, J-tip guidewire, or both that influences the direction of the guidewire in subclavian central line placement. Methods: A total of 1,200 trials were performed using a plastic tubular model simulating the subclavian, IJV, and SCV junction. The trials were divided into six groups: needle bevel pointed upwards with J-tip directed upwards (n=200) or J-tip directed downwards (n=200), needle bevel pointed downwards with J-tip directed upwards (n=200), or J-tip directed downwards (n=200), and needle bevel position blinded to experimenter with J-tip directed upwards (n=200), or J-tip directed downwards (n=200). Twenty-eight textbooks were also referenced to see what is instructed regarding needle bevel and J-tip positioning in central line placement. results: The ultimate direction of the guidewire (up towards the IJV versus down towards the SVC) was entirely dependent on the direction of the J-tip guidewire regardless of needle bevel position in 100% of the trials. The guidewire was directed upwards when the J-tip was oriented upwards and directed downwards when the J-tip was oriented downwards. Ten (36%) of the textbooks we referenced commented on needle bevel orientation whereas only one (3.6%) mentioned J-tip direction. Eighteen (64%) of the textbooks did not mention any recommendations regarding needle bevel or J-tip direction. conclusions: Current educational resources that teach subclavian line placement overemphasize the importance of needle bevel direction and fail to mention the much more influential issue of the direction of the guidewire J-tip. Objectives: Evaluating and providing quality feedback to medical students who rotate through the emergency department (ED) can often prove difficult. Unlike many medical school rotations, where students work with a set team of residents and faculty for a month or longer, in the ED students tend to have sporadic exposure to a broad range of physicians. This makes obtaining consistent and meaningful feedback challenging. We hypothesized that by implementing daily written evaluations and utilizing these to give formal mid-and end-rotation feedback, rotating students would have better interaction and evaluation from faculty and receive more useful and timely feedback. Methods: Starting in the 2006 academic year, we implemented written evaluations of medical students each shift. Formal constructive feedback sessions were arranged mid-and end-clerkship. Surveys evaluating students satisfaction with feedback were compared to 2005. Additionally, surveys of evaluation and feedback satisfaction from medical students and clerkship directors were collected nationwide. results: A significant portion of the 60 students and …