Publications by authors named "Adam J Janicki"

4 Publications

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Emergency Medicine Residents Experience Acute Stress While Working in the Emergency Department.

West J Emerg Med 2020 Dec 11;22(1):94-100. Epub 2020 Dec 11.

University of Pittsburgh, School of Medicine, Department of Emergency Medicine, Pittsburgh, Pennsylvania.

Introduction: Acute stress may impair cognitive performance and multitasking, both vital in the practice of emergency medicine (EM). Previous research has demonstrated that board-certified emergency physicians experience physiologic stress while working clinically. We sought to determine whether EM residents have a similar stress response, and hypothesized that residents experience acute stress while working clinically.

Methods: We performed a prospective observational study of physiologic stress including heart rate (HR), heart rate variability (HRV), and subjective stress in EM residents during clinical shifts in the emergency department. HR and HRV were measured via 3-lead Holter monitors and compared to baseline data obtained during weekly educational didactics. Subjective stress was assessed before and after clinical shifts via a Likert-scale questionnaire and written comments.

Results: We enrolled 21 residents and acquired data from 40 shifts. Residents experienced an increase in mean HR of eight beats per minute (P < 0.001) and decrease in HRV of 53.9 milliseconds (P = 0.005) while working clinically. Subjective stress increased during clinical work (P <0.001). HRV was negatively correlated with subjective stress, but this did not reach statistical significance (P = 0.09).

Conclusion: EM residents experience acute subjective and physiologic stress while working clinically. HR, HRV, and self-reported stress are feasible indicators to assess the acute stress response during residency training. These findings should be studied in a larger, more diverse cohort of residents and efforts made to identify characteristics that contribute to acute stress and to elicit targeted educational interventions to mitigate the acute stress response.
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http://dx.doi.org/10.5811/westjem.2020.10.47641DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7806330PMC
December 2020

Highest reported clearance of valproate by hemodialysis in massive overdose.

Am J Emerg Med 2021 01 16;39:255.e5-255.e6. Epub 2020 Jul 16.

Division of Medical Toxicology, Department of Emergency Medicine, University of Pittsburgh School of Medicine, United States of America.

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http://dx.doi.org/10.1016/j.ajem.2020.06.073DOI Listing
January 2021

Establishing an Elective Rotation Director and Its Effect on Elective Opportunities and Satisfaction.

West J Emerg Med 2019 Dec 9;21(1):8-11. Epub 2019 Dec 9.

University of Pittsburgh School of Medicine, Department of Emergency Medicine, Pittsburgh, Pennsylvania.

Elective rotations are valuable, allowing trainees to personalize their educational experience, focus on areas of weakness, and offer personal and professional development. Emergency medicine (EM) residency program elective rotations may be limited due to the absence of awareness of opportunities and administrative support. We sought to increase the breadth of elective rotation opportunities, improve residents' satisfaction with their elective rotations, and enhance the opportunities for clinical training. To increase the breadth of our elective rotation opportunities, we established an elective rotation director-a dedicated faculty member to aid in elective planning and provide administrative support. This faculty member met with all residents during their second year, coordinated new electives with the graduate medical education office, and assisted with administrative tasks. Ten new rotations (two local, five domestic away, three international away) were established during the position's first two years, increasing available rotations from nine to 19. A survey was sent to graduates of the program two years before and two years after the position was established to inquire about their elective experience. Of 64 graduates, 49 (76.6%) participated in the survey. Graduates exposed to the dedicated faculty member reported increased exposure to novel learning environments (p<0.001), improved wellness (p<0.001), and were more likely than pre-director graduates to choose the same elective rotation (p=0.006). Programs with multiple elective rotations may benefit more from this position, but additional resources may be needed given the associated increase in administrative time.
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http://dx.doi.org/10.5811/westjem.2019.10.44111DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6948683PMC
December 2019

Monitoring universal protocol compliance through real-time clandestine observation by medical students results in performance improvement.

J Surg Educ 2012 Jan-Feb;69(1):41-6. Epub 2011 Aug 27.

Department of Surgery, Tufts University Medical Center, Boston, Massachusetts 02111, USA.

Objective: To measure universal protocol compliance through real-time, clandestine observation by medical students compared with chart audit reviews, and to enable medical students the opportunity to become conscious of the importance of medical errors and safety initiatives.

Design: With endorsement from Tufts Medical Center's (TMC's) Chief Medical Officer and Surgeon-in-Chief, 8 medical students performed clandestine observation audits of 98 cases from April to August 2009. A compliance checklist was based on TMC's presurgical checklist. Our initial results led to interventions to improve our universal protocol procedures, including modifications to the operating room white board and presurgical checklist, and specific feedback to surgical departments. One year later, 6 medical students performed observations of 100 cases from June to August 2010.

Setting: Tufts Medical Center, Boston, Massachusetts, which is an academic medical center and the principal teaching hospital for Tufts University School of Medicine.

Participants: An operating room coordinator placed the medical students into 1 of our 25 operating rooms with students entering under the premise of observing the anesthesiologist for clinical education. The observations were performed Monday to Friday between 7 am and 4 pm. Although observations were not randomized, no single service or type of surgery was targeted for observation.

Results: A broad range of departments was observed. In 8.2% of cases, the surgical site was unmarked. A Time Out occurred in 89.7% of cases. The entire surgical team was attentive during the time out in 82% of cases. The presurgical checklist was incomplete before incision in 13 cases. Images were displayed in 82% of cases. The operating room "white board" was filled out completely in 49% of cases. Team introductions occurred in 13 cases. One year later, compliance increased in all Universal Protocol dimensions.

Conclusions: Direct, real-time observation by medical students provides an accurate and granular assessment of compliance with specific components of the universal protocol and engages medical students in the quality improvement process, raises their awareness of the gravity of medical errors, and ensures appreciation of the importance of quality and safety initiatives.
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http://dx.doi.org/10.1016/j.jsurg.2011.05.015DOI Listing
May 2012