1. Introduction References Methods Conclusions Results Emergency Medicine Resident and Medical Student Technology Use During the Care of Critical Patients: A High Fidelity Simulation Study  The use of technology was not related to how quickly the teams completed the simulation.  Pill identification was the only critical action significantly impacted by technology use.  Residents managed the cases more quickly and accurately than students.  Based on these results we suspect that prior knowledge guided learners’ management.  Further studies are need to identify educational modalities that can enhance proper use of electronic resources in simulation.  Emergency medicine resident teams (n=14) and clerkship student teams (n=33) managed two high fidelity simulation cases.  Data collection occurred over one year.  This was a single-blinded experimental study.  Teams of 2-3 were randomized to manage one case with the use of electronic resources and another only with print resources.  Times to successful completion of critical actions were recorded. P. Charlie Inboriboon, MD 1, Emily Hillman, MD 1, Brandon Elder, MD 1, Chirakit Hengrasmee, MD 1, Jennifer Quaintance, PhD 2 1. Department of Emergency Medicine, Truman Medical Center, University of Missouri-Kansas City, Kansas City, MO, USA 2. Office of Medical Education & Research, University of Missouri-Kansas City, Kansas City, MO, USA.  Widespread adoption of electronic resources has increased the amount of information immediately available to physicians; it is unclear what impact this has on patient care. 1  Despite the availability of these resources, there is concern that healthcare providers do not receive adequate training in their use. 2-3  Access to these resources may lead to a false sense of security; information quality is variable. 2-4 Dependent Variable Level of Learner (between-subjects factor) Technology Use (within-subjects factor) Resident Teams (n = 14) Student Teams (n = 33) Used (n = 47) Not Used (n = 47) Percent of Critical Actions Completed M = 69.4% SD = 12.3% M = 48.9% SD = 18.9% M = 64.5% SD = 28.4% M = 44.1% SD = 24.2% p <.001,  p 2 =.245p <.001,  p 2 =.272 Percent of Critical Actions Completed (Pill identification items omitted) M = 82.9% SD = 13.3% M = 60.6% SD = 20.3% M = 69.9% SD = 29.4% M = 61.4% SD = 33.4% p <.001,  p 2 =.255p =.283,  p 2 =.026 Time to Completion (in seconds) M = 1937.64 SD = 409.49 M = 2517.12 SD = 504.64 M = 1209.90 SD = 263.10 M = 1235.95 SD = 285.86 p <.001,  p 2 =.576p =.877,  p 2 =.001 Simulated CaseCritical Action Used Technology (n = 47) Did Not Use Technology (n = 47) Fisher Exact Test p values Isoniazid Overdose Case Administer 1 st line medication 95.2%80.8%.204 Administer 2 nd line medication 71.4%72.0%1.0 Identify unlabeled pill 35%0%.002 Administer pyridoxine 73.7%64.0%.534 Intracranial Hemorrhage Case Medication to manage hypertension 80.8%55.0%.105 Identify unlabeled pill 61.5%0%<.001 Medication to reverse coagulopathy 48.0%50.0%1.0 Table 1. Mixed-methods ANOVA Results Table 2. Percent of Critical Actions Completed Correctly  When teams were allowed to use technology they completed more critical actions correctly (p<.001; Table 1).  The contingency table analysis shows that the difference was due to the critical actions involving identifying an unknown pill (p<.001; Table 2).  Upon removing the pill identification items there was not a significant difference in performance when using technology and when not using technology (Table 1).  Resident teams were significantly more accurate and completed the cases more quickly than the student teams (p<.001).  Click HERE for Table 1 and Table 2 Click HERE for Table 1 and Table 2 Click headings to further view content Note: All interaction effects between level of learner and technology use were not significant (p >.05) Click the red ‘References’ heading for a full list of references. Purpose  The purpose of this study is to determine if the use of electronic resources improved learners’ ability to quickly and accurately manage simulated neurologic emergencies. Questions, contact us:

2. Introduction Introduction & Purpose Click headings to further view content Emergency Medicine Resident and Medical Student Technology Use During the Care of Critical Patients: A High Fidelity Simulation Study With the rapid growth of medical knowledge and the limits of the human mind to store information, electronic resources have become essential to the practice of medicine. A national survey by the ACGME reports that 85% of providers possess a smartphone and 56% of them utilize apps in their clinical practice. 1 Despite the availability of these resources, there is concern that healthcare providers do not receive adequate training in their use. Studies have demonstrated clinical searches frequently have poor yield and contain low quality information. 2-3 Additionally, internet searches by providers answering clinical questions may lead to a false sense of security and increase the number of incorrect responses to clinical questions. 4 The purpose of this study was to explore how electronic resources affect resident and medical student management of simulated patients suffering from a neurologic emergency. P. Charlie Inboriboon, MD 1, Emily Hillman, MD 1, Brandon Elder, MD 1, Chirakit Hengrasmee, MD 1, Jennifer Quaintance, PhD 2 1. Department of Emergency Medicine, Truman Medical Center, University of Missouri-Kansas City, Kansas City, MO, USA 2. Office of Medical Education & Research, University of Missouri-Kansas City, Kansas City, MO, USA.  Widespread adoption of electronic resources has increased the amount of information immediately available to physicians; it is unclear what impact this has on patient care. 1  Despite the availability of these resources, there is concern that healthcare providers do not receive adequate training in their use. 2-3  Access to these resources may lead to a false sense of security; information quality is variable. 2-4 Purpose  The purpose of this study is to determine if the use of electronic resources improved learners’ ability to quickly and accurately manage simulated neurologic emergencies. Methods  Emergency medicine resident teams (n=14) and clerkship student teams (n=33) managed two high fidelity simulation cases.  Data collection occurred over one year.  This was a single-blinded experimental study.  Teams of 2-3 were randomized to manage one case with the use of electronic resources and another only with print resources.  Times to successful completion of critical actions were recorded. Click the red ‘References’ heading for a full list of references. References Conclusions  The use of technology was not related to how quickly the teams completed the simulation.  Pill identification was the only critical action significantly impacted by technology use.  Residents managed the cases more quickly and accurately than students.  Based on these results we suspect that prior knowledge guided learners’ management.  Further studies are need to identify educational modalities that can enhance proper use of electronic resources in simulation. Results  When teams were allowed to use technology they completed more critical actions correctly (p<.001; Table 1).  The contingency table analysis shows that the difference was due to the critical actions involving identifying an unknown pill (p<.001; Table 2).  Upon removing the pill identification items there was not a significant difference in performance when using technology and when not using technology (Table 1).  Resident teams were significantly more accurate and completed the cases more quickly than the student teams (p<.001).  Click HERE for Table 1 and Table 2 Click HERE for Table 1 and Table 2 Questions, contact us:

3. Introduction Methods Click headings to further view content Emergency Medicine Resident and Medical Student Technology Use During the Care of Critical Patients: A High Fidelity Simulation Study  Emergency medicine resident teams (n=14) and clerkship student teams (n=33), each comprised of 2-3 learners, were randomized to manage one case with the use of electronic resources (internet and personal computing devices). In the other case, teams had access to print resources typically available in the emergency department or on their person.  Times to successful completion of critical actions were recorded.  The authors used mixed-method ANOVAs where the level of the learners (residents vs. students) was a between-groups factor and technology use (used vs. not used) was a within-groups factor to determine if technology use improved performance.  To identify where technology use may have influenced specific critical actions, we used the Fisher’s Exact Test to analyze 2X2 contingency tables. P. Charlie Inboriboon, MD 1, Emily Hillman, MD 1, Brandon Elder, MD 1, Chirakit Hengrasmee, MD 1, Jennifer Quaintance, PhD 2 1. Department of Emergency Medicine, Truman Medical Center, University of Missouri-Kansas City, Kansas City, MO, USA 2. Office of Medical Education & Research, University of Missouri-Kansas City, Kansas City, MO, USA.  Widespread adoption of electronic resources has increased the amount of information immediately available to physicians; it is unclear what impact this has on patient care. 1  Despite the availability of these resources, there is concern that healthcare providers do not receive adequate training in their use. 2-3  Access to these resources may lead to a false sense of security; information quality is variable. 2-4  The purpose of this study is to determine if the use of electronic resources improved learners’ ability to quickly and accurately manage simulated neurologic emergencies. Purpose Methods  Emergency medicine resident teams (n=14) and clerkship student teams (n=33) managed two high fidelity simulation cases.  Data collection occurred over one year.  This was a single-blinded experimental study.  Teams of 2-3 were randomized to manage one case with the use of electronic resources and another only with print resources.  Times to successful completion of critical actions were recorded. Results  When teams were allowed to use technology they completed more critical actions correctly (p<.001; Table 1).  The contingency table analysis shows that the difference was due to the critical actions involving identifying an unknown pill (p<.001; Table 2).  Upon removing the pill identification items there was not a significant difference in performance when using technology and when not using technology (Table 1).  Resident teams were significantly more accurate and completed the cases more quickly than the student teams (p<.001).  Click HERE for Table 1 and Table 2 Click HERE for Table 1 and Table 2 Conclusions  The use of technology was not related to how quickly the teams completed the simulation.  Pill identification was the only critical action significantly impacted by technology use.  Residents managed the cases more quickly and accurately than students.  Based on these results we suspect that prior knowledge guided learners’ management.  Further studies are need to identify educational modalities that can enhance proper use of electronic resources in simulation. References Click the red ‘References’ heading for a full list of references. Questions, contact us:

4. Results Click headings to further view content Emergency Medicine Resident and Medical Student Technology Use During the Care of Critical Patients: A High Fidelity Simulation Study P. Charlie Inboriboon, MD 1, Emily Hillman, MD 1, Brandon Elder, MD 1, Chirakit Hengrasmee, MD 1, Jennifer Quaintance, PhD 2 1. Department of Emergency Medicine, Truman Medical Center, University of Missouri-Kansas City, Kansas City, MO, USA 2. Office of Medical Education & Research, University of Missouri-Kansas City, Kansas City, MO, USA. Purpose  The purpose of this study is to determine if the use of electronic resources improved learners’ ability to quickly and accurately manage simulated neurologic emergencies. Introduction  Widespread adoption of electronic resources has increased the amount of information immediately available to physicians; it is unclear what impact this has on patient care. 1  Despite the availability of these resources, there is concern that healthcare providers do not receive adequate training in their use. 2-3  Access to these resources may lead to a false sense of security; information quality is variable. 2-4 Methods  Emergency medicine resident teams (n=14) and clerkship student teams (n=33) managed two high fidelity simulation cases.  Data collection occurred over one year.  This was a single-blinded experimental study.  Teams of 2-3 were randomized to manage one case with the use of electronic resources and another only with print resources.  Times to successful completion of critical actions were recorded. Results  When teams were allowed to use technology they completed more critical actions correctly (p<.001; Table 1).  The contingency table analysis shows that the difference was due to the critical actions involving identifying an unknown pill (p<.001; Table 2).  Upon removing the pill identification items there was not a significant difference in performance when using technology and when not using technology (Table 1).  Resident teams were significantly more accurate and completed the cases more quickly than the student teams (p<.001).  Click HERE for Table 1 and Table 2 Click HERE for Table 1 and Table 2 Conclusions  The use of technology was not related to how quickly the teams completed the simulation.  Pill identification was the only critical action significantly impacted by technology use.  Residents managed the cases more quickly and accurately than students.  Based on these results we suspect that prior knowledge guided learners’ management.  Further studies are need to identify educational modalities that can enhance proper use of electronic resources in simulation. References Click the red ‘References’ heading for a full list of references. Questions, contact us: Technology vs. No Technology  When teams were allowed to use technology (smartphone, tablet device, or internet) they completed more critical actions correctly (p<.001; Table 1).  The use of technology was not related to how quickly teams completed the simulation cases.  The contingency table analysis shows that the difference was due to the critical actions involving identifying an unknown pill (p<.001; Table 2).  Upon removing pill identification items there was not a significant difference in performance (Table 1). Residents vs. Medical Students  Resident teams were significantly more accurate and completed the cases more quickly than the student teams (p<.001; Table 1)  Click HERE for Table 1 and Table 2 Click HERE for Table 1 and Table 2

5. Introduction Conclusions Click headings to further view content Emergency Medicine Resident and Medical Student Technology Use During the Care of Critical Patients: A High Fidelity Simulation Study P. Charlie Inboriboon, MD 1, Emily Hillman, MD 1, Brandon Elder, MD 1, Chirakit Hengrasmee, MD 1, Jennifer Quaintance, PhD 2 1. Department of Emergency Medicine, Truman Medical Center, University of Missouri-Kansas City, Kansas City, MO, USA 2. Office of Medical Education & Research, University of Missouri-Kansas City, Kansas City, MO, USA..  The use of technology was not related to how quickly the teams completed the simulation.  Pill identification was the only critical action significantly impacted by technology use.  Residents managed the cases more quickly and accurately than students.  Based on these results we suspect that prior knowledge guided learners’ management.  Further studies are needed to confirm findings and to identify educational modalities that can enhance proper and effective use of electronic resources in simulation and in vivo.  The purpose of this study is to determine if the use of electronic resources improved learners’ ability to quickly and accurately manage simulated neurologic emergencies. Purpose  Widespread adoption of electronic resources has increased the amount of information immediately available to physicians; it is unclear what impact this has on patient care. 1  Despite the availability of these resources, there is concern that healthcare providers do not receive adequate training in their use. 2-3  Access to these resources may lead to a false sense of security; information quality is variable. 2-4 Methods  Emergency medicine resident teams (n=14) and clerkship student teams (n=33) managed two high fidelity simulation cases.  Data collection occurred over one year.  This was a single-blinded experimental study.  Teams of 2-3 were randomized to manage one case with the use of electronic resources and another only with print resources.  Times to successful completion of critical actions were recorded. Results  When teams were allowed to use technology they completed more critical actions correctly (p<.001; Table 1).  The contingency table analysis shows that the difference was due to the critical actions involving identifying an unknown pill (p<.001; Table 2).  Upon removing the pill identification items there was not a significant difference in performance when using technology and when not using technology (Table 1).  Resident teams were significantly more accurate and completed the cases more quickly than the student teams (p<.001).  Click HERE for Table 1 and Table 2 Click HERE for Table 1 and Table 2 Conclusions  The use of technology was not related to how quickly the teams completed the simulation.  Pill identification was the only critical action significantly impacted by technology use.  Residents managed the cases more quickly and accurately than students.  Based on these results we suspect that prior knowledge guided learners’ management.  Further studies are need to identify educational modalities that can enhance proper use of electronic resources in simulation. References Click the red ‘References’ heading for a full list of references. Questions, contact us:

6. References Click headings to further view content Emergency Medicine Resident and Medical Student Technology Use During the Care of Critical Patients: A High Fidelity Simulation Study 1.Franko OI, Tirrell TF. Smartphone app use among medical providers in ACGME training programs. Journal of medical systems. 2012 Oct;36(5):3135–9. 2.Chisholm R, Finnell JT. Emergency department physician internet use during clinical encounters. AMIA Annual Symposium proceedings / AMIA Symposium. AMIA Symposium. 2012 Jan;2012(March 2010):1176–83. 3.Jwayyed S, Park TK, Blanda M, Wilber ST, Gerson LW, Meerbaum SO, et al. Assessment of emergency medicine residents’ computer knowledge and computer skills: time for an upgrade? Academic emergency medicine. 2002 Feb;9(2):138–45. 4.Krause R, Moscati R, Halpern S, Schwartz DG, Abbas J. Can emergency medicine residents reliably use the internet to answer clinical questions? The Western Journal of Emergency Medicine. 2011 12(4):442–7. P. Charlie Inboriboon, MD 1, Emily Hillman, MD 1, Brandon Elder, MD 1, Chirakit Hengrasmee, MD 1, Jennifer Quaintance, PhD 2 1. Department of Emergency Medicine, Truman Medical Center, University of Missouri-Kansas City, Kansas City, MO, USA 2. Office of Medical Education & Research, University of Missouri-Kansas City, Kansas City, MO, USA. We would like to thank Nicole Fearing, M.D., past Medical Director of the UMKC Clinical Training Facility, Paul Ganss, UMKC EMS Program Director and Manager of the UMKC Clinical Training Facility, Research Assistants: Medical Students Katelyn Harris, Jacob Arnold, Chandra Stockdall and Brian Weber, and the UMKC Department of Emergency Medicine for an internal research grant that supported this study. Acknowledgements Purpose  The purpose of this study is to determine if the use of electronic resources improved learners’ ability to quickly and accurately manage simulated neurologic emergencies. Introduction  Widespread adoption of electronic resources has increased the amount of information immediately available to physicians; it is unclear what impact this has on patient care. 1  Despite the availability of these resources, there is concern that healthcare providers do not receive adequate training in their use. 2-3  Access to these resources may lead to a false sense of security; information quality is variable. 2-4 Methods  Emergency medicine resident teams (n=14) and clerkship student teams (n=33) managed two high fidelity simulation cases.  Data collection occurred over one year.  This was a single-blinded experimental study.  Teams of 2-3 were randomized to manage one case with the use of electronic resources and another only with print resources.  Times to successful completion of critical actions were recorded. Results  When teams were allowed to use technology they completed more critical actions correctly (p<.001; Table 1).  The contingency table analysis shows that the difference was due to the critical actions involving identifying an unknown pill (p<.001; Table 2).  Upon removing the pill identification items there was not a significant difference in performance when using technology and when not using technology (Table 1).  Resident teams were significantly more accurate and completed the cases more quickly than the student teams (p<.001).  Click HERE for Table 1 and Table 2 Click HERE for Table 1 and Table 2 Conclusions  The use of technology was not related to how quickly the teams completed the simulation.  Pill identification was the only critical action significantly impacted by technology use.  Residents managed the cases more quickly and accurately than students.  Based on these results we suspect that prior knowledge guided learners’ management.  Further studies are need to identify educational modalities that can enhance proper use of electronic resources in simulation. References Click the red ‘References’ heading for a full list of references. Questions, contact us:

7. Emergency Medicine Resident and Medical Student Technology Use During the Care of Critical Patients: A High Fidelity Simulation Study P. Charlie Inboriboon, MD 1, Emily Hillman, MD 1, Brandon Elder, MD 1, Chirakit Hengrasmee, MD 1, Jennifer Quaintance, PhD 2 1. Department of Emergency Medicine, Truman Medical Center, University of Missouri-Kansas City, Kansas City, MO, USA 2. Office of Medical Education & Research, University of Missouri-Kansas City, Kansas City, MO, USA. Dependent Variable Level of Learner (between-subjects factor) Technology Use (within-subjects factor) Resident Teams (n = 14) Student Teams (n = 33) Used (n = 47) Not Used (n = 47) Percent of Critical Actions Completed M = 69.4% SD = 12.3% M = 48.9% SD = 18.9% M = 64.5% SD = 28.4% M = 44.1% SD = 24.2% p <.001,  p 2 =.245p <.001,  p 2 =.272 Percent of Critical Actions Completed (Pill identification items omitted) M = 82.9% SD = 13.3% M = 60.6% SD = 20.3% M = 69.9% SD = 29.4% M = 61.4% SD = 33.4% p <.001,  p 2 =.255p =.283,  p 2 =.026 Time to Completion (in seconds) M = 1937.64 SD = 409.49 M = 2517.12 SD = 504.64 M = 1209.90 SD = 263.10 M = 1235.95 SD = 285.86 p <.001,  p 2 =.576p =.877,  p 2 =.001 Simulated CaseCritical Action Used Technology (n = 47) Did Not Use Technology (n = 47) Fisher Exact Test p values Isoniazid Overdose Case Administer 1 st line medication 95.2%80.8%.204 Administer 2 nd line medication 71.4%72.0%1.0 Identify unlabeled pill 35%0%.002 Administer pyridoxine 73.7%64.0%.534 Intracranial Hemorrhage Case Medication to manage hypertension 80.8%55.0%.105 Identify unlabeled pill 61.5%0%<.001 Medication to reverse coagulopathy 48.0%50.0%1.0 Table 1. Mixed-methods ANOVA Results Table 2. Percent of Critical Actions Completed Correctly Note: All interaction effects between level of learner and technology use were not significant (p >.05) Click HERE to return to Results