The sequence of events leading to the implementation of a change in emergency physicians' practice and the learning activities and processes undertaken are examined and described in this study. A qualitative case study design was utilized and semi-structured interviews were employed as the primary means of data collection. Thirty emergency physicians were interviewed in face-to-face or telephone interviews. One change that required learning was selected per physician for an in-depth interview. The following factors were examined: motivation to change a practice behavior, time to implementation of changes, source of awareness, barriers to change, use of learning resources, stages in the change process, and method of learning.

This dissertation examines factors with influence on the organizational cultural competence of Emergency Medical Services (EMS) systems. The purpose of this study was to draw on theories of representative bureaucracy and transformational leadership to assess cultural competence in Emergency Medical Services systems from the perspective of EMS leadership, within careful consideration of the external environment in which EMS systems operate. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2015 / FAU Electronic Theses and Dissertations Collection

As third-year medical students transition from the classroom to the high-stakes, high-stress environment of the emergency department (ED), they confront a unique set of challenges that result in significant personal trauma. The literature offers limited insight into the trauma experienced specifically during the shift to emergency medicine (EM) as medical students’ first clinical rotation. The purpose of this study was to bridge this gap by examining the interplay between students’ perceived psychological safety of their ED teams and their own self-efficacy on the trauma they experienced as learners when working in this unique learning environment. This mixed-methods study included interviews with 17 third-year medical students who immediately completed the EM clerkship at an urban, academic ED. The study addressed four main questions: 1) What types of trauma do students experience in the EM clerkship as they transition from the classroom into the clinical learning environment for the first time in their training? What are the factors of the learning environment that trigger trauma? 2) In what ways, if any, do students’ intersectional demographics affect their experiences of trauma during the EM clerkship? 3) To what extent does general self-efficacy predict medical students’ perceptions of the psychological safety afforded by their clinical team during the EM clerkship? 4) How are students’ experiences of trauma associated, if at all, with perceived psychological safety? What factors in the clinical learning environment contribute to psychological safety or its lack? This study utilized several data collection methods: (a) a pre-interview questionnaire soliciting information on student demographics and responses to items on the General Self-Efficacy Scale, (b) in-depth interviews using the critical incident technique, and (c) responses to items from the Team Psychological Safety Questionnaire. Several key findings emerged. A substantial amount of trauma that students experienced was rooted in a lack of peer support and student empowerment. Various triggers for trauma were identified that transcended different types of trauma. Demographic factors, such as race/ethnicity and gender, influenced the prevalence and nature of these traumatic experiences, with students from underrepresented backgrounds reporting deeper emotional connections with patients. While student self-efficacy was generally high, it did not correlate with the perceived psychological safety provided by their clinical teams. Furthermore, the perception of psychological safety within ED teams correlated with the nature of trauma experienced; those with lower safety scores reported trauma connected to peer support or issues related to cultural, historical, and gender considerations. Lastly, the opportunity for students to safely take risks or learn from mistakes, coupled with their own medical knowledge limitations, emerged as central to their perception of psychological safety within the team dynamic. Deeper insights into the data were revealed through a cross-interview analysis, and several analytical categories were used to further synthesize and interpret the data. Six conclusions were drawn from the study’s findings and analysis: 1) Medical students experience different types of primary trauma when immersed in the ED. 2) Several forces that are intrinsic to the ED workplace influence the trauma students experience. 3) Clerkship leadership must be aware of the unique experiences underrepresented students have in the EM clerkship. 4) The psychological safety provided to students by their teams impacts their experiences of trauma in the ED. 5) Self-efficacy offers a lens to understand students’ experiences of trauma in the ED, but it is insufficient. 6) Clerkship-specific interventions exist to amplify the team psychological safety afforded to medical students.

[Truncated abstract] Objective: To investigate the demographics, success rate of application, nature and frequency of complication and the survival outcome of patients receiving advanced airway management in the pre-hospital setting. Design: Prospective observational cohort study. Participants: Patients who were attended to by St. John Ambulance Paramedics in the Perth Metropolitan area and selected regional areas within Western Australia. The patients were unconscious, unresponsive with no gag reflex and where application of an advanced airway would improve ventilation. Methods: Ambulance Paramedics received mannequin training within the classroom environment on the techniques for the application of the Endo-Tracheal Tube and the Laryngeal Mask Airway. The indication for the application of an advanced airway was any patient whose ventilation may be improved by intubation. These patients would be either deeply unconscious and areflexic, long term transport, severely injured (especially head injured) or cardiac arrest patients. Results: ... Paramedic assessment demonstrated that 14 (7.4%) 3 patients had an improvement in outcome. Of the 14 patients, 5 (2.7%) cardiac arrest patients survived to discharge from hospital compared to a 2.1 % survival rate for all cardiac arrest cases attended by the WAAS in 2002. Conclusion: Ambulance Paramedics can successfully apply an advanced airway apparatus in the pre-hospital environment. There was no statistical significance to demonstrate whether the introduction of advanced airway skills was beneficial or detrimental to patient survival outcome.