1.      PEER VII on SpacedEd™ is available for purchase only from the ACEP Bookstore.

2.      As you complete your purchase, make sure that the purchaser name and e-mail address are correct for the person who wants to receive PEER VII on SpacedEd™ and earn the CME credit. PEER VII on SpacedEd™ is a single-user activity; CME credit will be issued only in the name of the purchaser, and the e-mail notifications will be sent only to the e-mail address used for the purchase. Print your receipt from the purchase screen.

3.      Within 3 business days, you will receive an “invitation” e-mail from “The ACEP PEER VII Team.”  Please make sure to look for it in your “junk” folder in case it gets filtered out of your Inbox. Click on the signup link near the bottom of this e-mail. It will take you to the SpacedEd signup page.

4.      If you already have an account with SpacedEd tied to the e-mail address used for your invitation, you will simply be required to log in using your SpacedEd username and password. If you do not have an account with SpacedEd tied to the e-mail address used for your invitation, you will be required to create one. You will need this SpacedEd username and password to log in and answer questions, so make note of it. ACEP will not have a record of your username and password.

5.      As you create your SpacedEd account, make sure to use the same e-mail address that your invitation was sent to. Click on “Create My Account.” Read the CME credit information on the next screen, then click “Enroll now (invitation valid).”

6.      Set up your delivery and spacing preferences. Keep in mind that PEER VII on SpacedEd™ questions will be delivered to you according to your preferences and will be available to you until you “retire” all of them or until PEER VIII is released in mid-2011, whichever comes first – then pace yourself accordingly. The default preferences that appear on the screen are those recommended by the SpacedEd researchers. If you want to receive questions more frequently, or receive more questions per e-mail, or change the number of times questions are repeated in order to cover more of the 410 total questions, follow the “choose your own” link and change your spacing preferences:

o   Number of questions per delivery – a number from 1 to 410

o   Frequency of delivery – in days, how often you want to be notified that you have new questions

o   Repeating of questions – number of times you want to see each question again after answering it once (must be at least “1”)

o   Retiring of questions – number of times you want to answer a question correctly to have it no longer delivered to you (must be at least “1”)

7.      After you set your preferences, your first question will appear on your screen, and then subsequent questions will be delivered to you by e-mail according to your spacing preferences. One question will appear in the body of the e-mail; when you click “Answer Question,” you will be asked to log in using your SpacedEd username and password. You will see the question again after you log in; you will answer it then click “Submit,” and then you will see the correct answer, the reference, and the answer explanation. If you have more unanswered questions, you will be able to access them in the “Continue” section.

8.      Be sure to check the “Progress” section after you read each answer explanation – this will show you when the question will be resent to reinforce what you have learned and how many questions you have answered and retired so far. Read and participate in the “Comments by Learners” section as well.

9.      “What’s the ‘dashboard?’” The “My Dashboard” section is where you control your PEER VII on SpacedEd™ experience – your spacing preferences, your delivery options, your account settings. It is also where you go to check your progress on questions you have been asked so far, see your estimated completion date, review previous questions, and request your CME certificate. When you are on your dashboard, look for the box labeled, “Courses you are taking.” The course title (ACEP PEER VII on SpacedEd) is in blue – click on it, then you’ll have access to most of the features you’ll need to manage your learning experience. Remember, you can change your spacing preferences anytime. An alternative path is to go to the box labeled “Courses you are taking” and click “Update delivery options.” Choose “Adjust settings” to change any or all of your preferences.

10.  “So how am I doing?” In “My Dashboard,” go to the box labeled “Courses you are taking,” and click on the blue course title. Then, in the “Your Progress” box, click “View detailed report.” You will be able to see how many times you have answered each question and how many attempts you made before answering each one correctly. This will give you an indication of how you would perform on a written certification examination.

11.  “Help!” You can log in to PEER VII on SpacedEd™ anytime. Go to: http://acep.spaceded.com/user/dashboard and follow the “Log In” link in the uppermost right-hand corner. If you need help, follow the Technical Support link at the bottom of any page or the links in the “Help” box on the sign in page.

12.  “How do I get my CME certificate?” You may request a CME certificate at any point before July 31, 2011. The number of CME credits printed on your certificate will be based on the number of questions you have answered per request (not cumulative) according to “Method of Participation” below, up to a maximum of 50 AMA PRA Category 1™ credits. Look for the “Get CME Certificate” button in “My Dashboard.” You will be required to complete an evaluation online, then your CME certificate will be mailed to you within 2 weeks.

Release date: June 3, 2010

Expiration date: July 31, 2011

Learner Objective

On completion of PEER VII on SpacedEd™, you should be able to:

• Demonstrate cognitive expertise on topics from “The Model of the Clinical Practice of Emergency Medicine” and preparation sufficient to pass an emergency medicine written certification examination.

System Requirements

Internet connection and a computer running one of the following Web browsers:  Internet Explorer 6.0 or greater, Firefox 3 or greater, Safari 3 or greater, or Chrome 3 or greater.

Privacy Policy

http://www.spaceded.com/info/privacy

Target Audience

Emergency physicians, emergency medicine residents in training, all health care professionals who care for patients in emergency settings

Why do emergency physicians need PEER VII?

Emergency care is best provided by trained, experienced, board-certified emergency physicians, those knowledgeable and skilled in the diagnosis and treatment of conditions that range from primary care to life threatening. The standard for this level of knowledge and skill is certification by the American Board of Emergency Medicine (ABEM). To obtain and then maintain this certification, emergency physicians must take written examinations based on “The Model of the Clinical Practice of Emergency Medicine” (the EM Model), the “core content” developed by all of the leading emergency medicine organizations, and make passing grades of 75% or better. PEER VII is designed to allow users to study and prepare to pass an exam on the EM Model categories.

How does PEER VII on SpacedEd™ meet this need?

Using questions and detailed answer explanations, PEER VII on SpacedEd™ reviews and summarizes key topics from the EM Model with supporting study information referenced to emergency medicine textbooks and journal articles. The questions are designed to assess the user’s cognitive expertise related to EM Model topics and then demonstrate the ability to apply that expertise to patient care as would be measured on a written board certification examination. All of the questions are multiple choice and are written in a style similar to that used on board certification examinations to simulate the test-taking experience. The “spaced learning” methodology is designed to present information and then repeat it over spaced intervals to improve retention. It has been proved to improve knowledge acquisition, increase long-term knowledge retention, change behavior, and boost learners’ ability to accurately self-assess their knowledge.

There are two types of questions in PEER VII on SpacedEd™. Level 1 questions are designed to test recall of facts and ability to recognize patterns. Level 2 questions are designed to test application of knowledge to patient care. More than half of the questions in PEER VII on SpacedEd™ are Level 2 questions; they are case based and designed to test the user’s ability to synthesize several types of clinical information (ie, symptoms, signs, history, physical exam findings, diagnostic test results) and then identify not only the diagnosis but also the appropriate treatment and disposition, and possible complications. The case-based questions also reflect different patient “acuity” levels, from non–life-threatening to critical, as well as special considerations of pediatric and geriatric patients. Additionally, PEER VII questions are written with a “positive” construction, ie, correct answers reflect – and thus reinforce – correct information.

The number of PEER VII on SpacedEd™ questions per EM Model category reflects the “weight” each category is assigned within the EM Model. For example, Cardiovascular Disorders, with a weight of 10% within the EM Model, comprises 41 of the 410 questions. A category with a smaller weight, such as Cutaneous Disorders, comprises fewer questions.

Each time the participant answers a question, the correct answer is shown, along with a detailed essay-style explanation. Each explanation reinforces the correct answer and explains why the “foils” are incorrect, and then provides additional information related to the topic. The answer explanations are drawn from major emergency medicine textbooks, key journal articles, and other selected readings. Page numbers are provided so the user can read more about topics that require additional study. Participants can enhance the learning experience by participating in the discussion forum that follows each answer explanation.

Method of Participation

To summarize, PEER VII on SpacedEd™ is designed for users to participate as follows:

·         Receive the question according to preestablished delivery and spacing preferences.

·         Read the question, along with supporting case and visual stimuli if applicable, and consider the five choices in the answer set.

·         Select and submit one best answer.

·         Proceed to the answer screen to check the result, noting the choices made by other participants.

·         Read and study the answer explanation.

·         As needed, read and study information from the sources cited.

·         To enhance the learning experience, read the comments of other users and participate in the discussion.

·         Participants should be able to complete these steps in approximately 5 minutes per question. This is the guideline used to determine the number of CME credits awarded. Questions are repeated to reinforce learning; because the answer explanations cover all five choices in the answer set, each time a question and its detailed answer explanation are presented, the participant’s ability to demonstrate cognitive expertise on that topic is enhanced, as is the ability to retain that knowledge and apply it to patient care.

Accreditation Statement

This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council of Continuing Medical Education through ACEP. The American College of Emergency Physicians is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The American College of Emergency Physicians designates this educational activity for a maximum of 50 AMA PRA Category 1 Credit(s)^TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Approved by ACEP for 50 hours of ACEP Category I credit.

Approved by the American Osteopathic Association for 50 hours of AOA Category 2-B credit.

PEER VII Editorial Board

Mary Jo Wagner, MD, FACEP, Editor-in-Chief

Program Director

Synergy Medical Education Alliance

Emergency Medicine Residency Program

Saginaw, Michigan

Professor

Division of Emergency Medicine

Michigan State University College of Human Medicine

East Lansing, Michigan

Fredrick M. Abrahamian, DO, FACEP

Assistant Professor of Medicine

UCLA School of Medicine

Los Angeles, California

Director of Education

Department of Emergency Medicine

Olive View-UCLA Medical Center

Sylmar, California

Robert B. Blankenship, MD, FACEP

MAJ, US Army

Transitional Program Director

Madigan Army Medical Center

Fort Lewis, Washington

Clinical Instructor of Medicine

University of Washington

Seattle, Washington

Lance Brown, MD, MPH, FACEP

Chief, Division of Pediatric Emergency Medicine

Associate Professor of Emergency Medicine and Pediatrics

Loma Linda University Medical Center and Children’s Hospital

Loma Linda, California

Lynda Daniel-Underwood, MD, MS, FACEP

Assistant Professor of Emergency Medicine

Loma Linda University School of Medicine

Loma Linda, California

Michele L. Dorfsman, MD, FACEP

Assistant Professor of Emergency Medicine

University of Pittsburgh School of Medicine

Assistant Program Director

University of Pittsburgh Affiliated Residency in Emergency Medicine

Pittsburgh, Pennsylvania

David Effron, MD, FACEP

Assistant Professor

Case Western Reserve University

Staff Physician, Department of Emergency Medicine

MetroHealth Medical Center

Consultant, Department of Emergency Medicine

Cleveland Clinic

Cleveland, Ohio

Hans House, MD, FACEP, DTMH

Director

The Iowa Emergency Medicine Residency Program

Assistant Professor of Emergency Medicine

University of Iowa Carver College of Medicine

Iowa City, Iowa

Edward A. Michelson, MD FACEP

Associate Professor and Chair

Department of Emergency Medicine

Case Western Reserve University School of Medicine

University Hospitals of Cleveland

Cleveland, Ohio

Robert C. Satonik, MD, FACEP

Associate Residency Program Director

Synergy Medical Education Alliance

Saginaw, Michigan

Assistant Clinical Professor of Emergency Medicine

Michigan State University College of Human Medicine

East Lansing, Michigan

Aaron B. Schneir, MD, FACEP

Assistant Professor

Division of Medical Toxicology

Department of Emergency Medicine

University of California, San Diego Medical Center

San Diego Division

California Poison Control System

San Diego, California

Peter E. Sokolove, MD, FACEP

Associate Professor

Vice Chair for Education

Residency Program Director

Department of Emergency Medicine

University of California, Davis Health System

Sacramento, California

Katren R. Tyler, BMBS, FACEM

Assistant Professor of Emergency Medicine

University of California, Davis

Sacramento, California

Contributors

Sally Henin Awad, MD, FACEP

Justin Barrett, MD

Michael A. Baumann, MD, FACEP

Kip R. Benko, MD, FACEP

Susan Bodtke, MD

Jorge L. Falcon-Chevere, MD, FACEP

Robinson M. Ferre, MD

Christopher P. Johnson, MD

Taylor J. Kallas, MD

Bryan G. Kane, MD, FACEP

Christopher S. Kang, MD, FACEP

Chad Kessler, MD

Christine A. Kletti, MD, FACEP

Sara Laskey, MD

Aisha T. Liferidge, MD

Michelle M. McLean, MD

Susan R. Promes, MD, FACEP

Gillian Schmitz, MD

Matthew Tews, DO

Michael J. Tocci, MD

Christian A. Tomaszewski, MD, FACEP

UCLA/Olive View-UCLA Emergency Medicine Residency Program

Samuel G. Wilson, MD, FACEP

Sone-Seeré A. Wilson, MD, FACEP

Allan B. Wolfson, MD, FACEP

Additional Reviewers

Karlis Austrins, DO

Robert Brandt, MD

Timothy Brown, MD

Tony Cauchi, MD

Cathy Champagne, MD

Thomas Dancoes, DO

Greg Geers, MD

Matthew Griggs, MD

Lisa Haley, MD

Marc Hyde, MD

Jason Johnson, MD

David Kuylen, MD

Timothy Lancaster, MD

Laura Millemon, MD

Hooshmond Nightingale, MD

Sam Paczkowski, MD

Julia Pasquale, MD

Drew Paulson, MD

Duane Penshorn, MD

Christa Persyn, MD

Wendy Regal, MD

Mark Sandoval, MD

Tracie Shea, MD

Aaron Smith, MD

Stephen Stewart, MD

ACEP Staff

Marta Foster

Lilly Friend

Mike C. Goodwin

Jessica Hamilton

Mary Hines

Emma Kiewice

Mary Anne Mitchell

Thomas S. Werlinich

Disclosures

The names and affiliations of the editor-in-chief, all editorial board members, contributors, and staff are listed at the top of this document. Please note that, in accordance with ACCME Standards and ACEP policy, all persons who are in a position to control the content of this educational activity must disclose to participants the existence of significant financial interests in or relationships with manufacturers of commercial products that might have a direct interest in the subject matter. Dr. Brown discloses that he is a co-editor of a pediatric emergency medicine textbook for Elsevier, Inc. Dr. Abrahamian, Dr. Blankenship, Dr. Daniel-Underwood, Dr. Dorfsman, Dr. Effron, Ms. Foster, Dr. House, Dr. Michelson, Ms. Mitchell, Dr. Satonik, Dr. Schneir, Dr. Sokolove, Dr. Tyler, and Dr. Wagner have no significant financial interests or relationships to disclose.

ACEP expects all authors and editors to present information in an objective, unbiased manner without endorsement or criticism of specific products or services. ACEP also expects that the relationships contributors disclose will not influence their contributions.

In PEER VII, in most cases, drugs and devices are referred to by their generic names, in accordance with ACCME and ACEP policy. In a few cases, however, brand names do appear for the sole purpose of clarification or easier recognition or more realistic description of a scenario. In no instance is a drug or device listed by a brand name for a commercial purpose. No person who was in a position to control the content of PEER VII disclosed a relationship with a manufacturer of any drug or device referred to by its brand name.

ACEP received no commercial support for PEER VII on SpacedEd.™

Finally, no member of the PEER VII Editorial Board or any person who was in a position to control the content of PEER VII was affiliated with ABEM as an item writer or examiner or in any other capacity related to the development of an ABEM exam. Any similarities between questions and answers in PEER VII and those that appear on an ABEM exam are purely coincidental.

The American College of Emergency Physicians makes every effort to ensure that contributors to College-sponsored publications are knowledgeable authorities in their fields. Readers are nevertheless advised that the statements and opinions are provided as guidelines and should not be construed as College policy. The College disclaims any liability or responsibility for the consequences of any actions taken in reliance on these statements or opinions. The materials contained herein are not intended to establish policy, procedure, or a standard of care.

Publisher’s Notice

The American College of Emergency Physicians makes every effort to ensure that contributors to College-sponsored publications are knowledgeable authorities in their fields. Readers are nevertheless advised that the statements and opinions are provided as guidelines and should not be construed as College policy unless specifically referred to as such. The College disclaims any liability or responsibility for the consequences of any actions taken in reliance on these statements or opinions. The materials contained herein are not intended to establish policy, procedure, or a standard of care.

Copyright 2009, American College of Emergency Physicians, Dallas, Texas. All rights reserved. Printed in the United States of America. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means or stored in a database or retrieval system without prior written permission of the publisher.

Questions?

·         For technical support, click on the link at the bottom of any SpacedEd page.

·         For information about content or CME credit, contact the ACEP Bookstore, 800-798-1822, ext. 4, or 972-550-0911; or by e-mail, ACEPBookstore@acep.org; or by mail, PO Box 619911, Dallas TX 75261-9911.

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PEER VII Image Credits

The images used for visual stimuli in PEER VII were provided by members of the editorial board, ACEP faculty members, and other educators and educational resources, as listed below. Reproduction of these images without permission of their owners is strictly prohibited. To request permission to use an image from PEER VII, send an e-mail to ACEPBookstore@acep.org.

Figure 1, Courtesy of Samuel G. Wilson, MD, FACEP

Figures 2, 4, 8, 11, 17, 18, 20, 23, 24, 27, 28, 29, 30, 33, 35, 36, 39, 48, 50, 52, Courtesy of David Effron, MD, FACEP

Figures 3, 7, 9, 10, 12, 13, 15, 21, 26, 32, 37, 37, 38, 41, 45, Courtesy of Mary Jo Wagner, MD, FACEP

Figures 5, 16, 19, 31, 44, Courtesy of Robert B. Blankenship, MD, FACEP

Figure 6, From the Public Health Image Library, http://phil.cdc.gov, #3720, CDC/M. Rein

Figure 14, From the Public Health Image Library, http://phil.cdc.gov, #7824, CDC/Bruno Coignard, MD; Jeff Hageman, MHS

Figure 22, From Dermatlas (http://www.dermatlas.org), © Bernard Cohen, MD. Reprinted with permission.

Figure 25, Courtesy of Joshua S. Broder, MD, FACEP

Figure 34, From the Public Health Image Library, http://phil.cdc.gov, #3055, CDC/Dr. Stuart Brown

Figure 40, Courtesy of MedPixÔ Medical Image Database, http://rad.usuhs.mil/medpix/medpix.html?mode=default#top

Figure 42, Courtesy of Kip R. Benko, MD, FACEP. This image is for educational use only. It is not authorized for any other use. All rights reserved. Distributed by request and authorization of Kip R. Benko, MD. Unauthorized reproduction is prohibited.

Figure 43, From the Public Health Image Library, http://phil.cdc.gov, #2879, CDC/J.D. Millar

Figures 46, 47, Courtesy of Lance A. Brown, MD, MPH, FACEP

Figures 49, 51, Courtesy of Michele Dorfsman, MD, FACEP