Enhancing clinical competence in postgraduate year (PGY) trainees is crucial for effective patient care, especially in emergency medicine. This study investigated the impact of a well-designed, group-developed, peer-assessed learning approach combined with high-fidelity simulations on clinical skills and teamwork of PGY trainees. PGY trainees participated in a one-month program featuring team development, clinical training, scenario design, simulation, peer-assisted debriefing, and post-course evaluations at one week and three months. Trainees were divided into two groups, engaged in clinical practice, group discussions, and developed critical scenarios under mentor guidance to challenge the other group. Teamwork performance was assessed using the TEAM scale, Ottawa Global Rating Scale, and reflective essays. Follow-up evaluations employed the PGY Clinical Proficiency Evaluation scale. Trainees identified deficiencies in situation monitoring and maintaining composure, noting difficulties in effectively monitoring and reassessing situations. Despite having passed ACLS training, participants recognized their lack of clinical experience in managing critically ill patients, handling dynamic situations, low self-confidence, and limited leadership opportunities in resuscitation teams. However, team morale was high, and performance in communication and leadership was relatively strong due to the similar hierarchical levels of the trainees and initial team dynamics established during their training. Follow-up questionnaires indicated significant improvements in clinical confidence, reasoning abilities, familiarity with ACLS resuscitation guidelines, and team dynamics across various subspecialty training areas. The integration of peer-assisted learning with high-fidelity simulation significantly enhanced clinical competence, teamwork, and confidence in PGY trainees. This innovative approach provides a structured, supportive learning environment that effectively prepares trainees for real-world clinical challenges. Future research should explore long-term outcomes and broader applications of this method.

A record outbreak of community-spread COVID-19 started on 10 May 2021, in Taiwan. In response to the COVID-19 pandemic, care facilities have adopted various protocols using instant communication technology (ICT) to provide remote yet timely healthcare while ensuring staff safety. The challenges of patient evaluation in the emergency department (ED) using ICT are seldom discussed in the literature. The objective of this study was to investigate the factors influencing the utility of ICT for patient assessment in emergency settings during the pandemic. The patient flow protocol and the ED layout were modified and regionalized into different areas according to the patient’s risk of COVID-19 infection. Nine iPads were stationed in different zones to aid in virtual patient assessment and communication between medical personnel. A focus group study was performed to assess and analyze the utility of the ICT module in the ED. Eight emergency physicians participated in the study. Of them, four (50%) had been directly involved in the development of the ICT module in the study hospital. Three main themes that influenced the application of the ICT module were identified: setting, hardware, and software. The setting theme included six factors: patient evaluation, subspecialty consultation, patient privacy and comfortableness, sanitation, cost, and patient acceptability. The hardware theme included six factors: internet connection, power, quality of image and voice, public or personal mode, portable or fixed mode, and maintenance. The software theme included six factors: platform choices, security, ICT accounts, interview modes, video/voice recording, and time limitation. Future studies should focus on quantifying module feasibility, user satisfaction, and protocol adjustment for different settings.

The COVID-19 pandemic has made it necessary for medical personnel to protect themselves from aerosol-producing procedures, especially during airway management. The tracheal intubation process has a significant risk based on the spreading of aerosol, especially when the medical service provider is very close to the airway of the patient. We have developed a novel conservation tent that provides a barrier for healthcare professionals and patients. Through a simulation study, the relationship between the use of the protection tent during intubation and the contamination of medical personnel before and after the movement of the protection tent was explored. A series of experiments in this article provide a theoretical basis for the verification of spray morphology during gas curing and droplet intubation. This inexpensive and simple method for using transparent cloth in the intubation of patients with unknown COVID-19 status can be applied by frontline medical personnel as an additional precautionary measure.

Testicular torsion is a surgical emergency. It obstructs the blood supply to the testes, leading to testicular ischemia and necrosis. It presents with a sudden onset of severe unilateral testicular pain associated with nausea/vomiting, swollen scrotum, and high-riding testicles with an absent cremasteric reflex and negative Prehn sign. Prompt diagnosis of ischemic testicles using ultrasonography is challenging for emergency physicians. Color Doppler ultrasound may reveal a relative decrease or absence of blood flow in the affected testicle. The most specific ultrasonographic feature was the whirlpool sign of the spermatic cord. Manual detorsion should be performed as soon as possible before surgical intervention. However, manual detorsion may fail because of patient discomfort, incomplete torsion, and rotation of the testicle in a less common direction. We report a case demonstrating ultrasound-guided detorsion in a 14-year-old boy with right testicular torsion. The present case highlights the importance of incorporating ultrasound guidance into manual detorsion, which can improve the success rate of the procedure.

Background: Emergency department (ED) overcrowding is a public health crisis that affects patient care quality. Space management in the ED can affect patient flow dynamics and clinical practice. We proposed a novel design of the “emergency procedure zone” (EPZ). The purpose of the EPZ was to provide an isolated area for clinical practice and procedure teaching, to ensure a secure area with adequate equipment and monitors, and safeguard patient privacy and safety. This study aimed to analyze the impact of the EPZ on procedural practice and patient flow dynamics. Methods: This study was conducted at the ED of a tertiary teaching hospital in Taiwan. Data were collected from 1 March 2019 to 31 August 2020 (pre-EPZ period) and from 1 November 2020 to 30 April 2022 (post-EPZ period). Statistical analyses were performed using IBM SPSS Statistics software. This study focused on the number of procedures and length of stay in the emergency department (LOS-ED). Variables were analyzed using the chi-square test and Mann–Whitney U test. Statistical significance was defined as p < 0.05. Results: There were 137,141 (pre-EPZ period) and 118,386 (post-EPZ period) ED visits recorded during this period. The post-EPZ period showed a significant increase in central venous catheter insertion, chest tube or pigtail placement, arthrocentesis, lumbar puncture, and incision and drainage procedures (p < 0.001). For patients who were directly discharged from the ED, the post-EPZ period also had a higher percentage of ultrasound studies performed in the ED and a shorter LOS-ED for patients who were directly discharged from the ED (p < 0.001). Conclusions: The establishment of an EPZ in the ED has a positive impact on procedural efficiency. The EPZ improved diagnosis and disposition efficiency, shortened the length of stay, and provided benefits such as improved management, patient privacy, and teaching opportunities.