such as lumbar punctures, laceration repairs, nasogastric tube insertions, and arterialblood gas punctures than those students without a faculty preceptor. Having a clinicalpreceptor may provide students with a valuable educational experience, in that theygain significantly more exposure to procedures crucial to the practice of emergencymedicine.

95 Comparison of Automated External Defibrillator TrainingMethods in High School Students: Traditional LiveInstructor Teaching Versus DVD-Based Method

Young LL, Inaba AS, Yamamoto LG/University of Hawaii John A. Burns School ofMedicine, Honolulu, HI

Study Objectives: Automated external defibrillators (AEDs) have becomeincreasingly available in the community and there is a greater need to instruct laypeople in their use. Instructor taught classes have the advantage of being interactive,but can be labor intensive and time-consuming. The advantage of self-directedlearning is that students may learn at their own time and pace, although this methodlacks immediate feedback and clarification from an instructor. The purpose of thisstudy is to compare two methods of teaching suburban high school students to use anAED: a conventional live instructor-taught class versus a DVD instructional video.

Methods: Classrooms from a suburban high school were assigned to AEDtraining by either live instructor teaching (standard script) or an instructional DVD(composed by the study investigators) teaching method. Immediately after thetraining, students were allowed to practice what they had learned with an AEDtrainer and a manikin without critique. Six months after the instruction, studentswere individually tested to determine if they could use an AED correctly. Testingcriteria included: 1) Turned on the AED (power button) 2) Connected the cable tothe AED and attached the pads in the correct positions to the manikin’s chest 3)Stood clear to allow the AED to analyze the rhythm 4) Pressed the shock buttonwhen advised. The time to shock was recorded. CPR was not assessed as part of thisstudy.

Results: The success rate for completing all 4 criteria in AED use was 73.2% (93/127) in the instructor group and 73.0% (84/115) in the DVD instructed group. Themean times to shock were 49.4 seconds (SDev 11.5, n�93) for the instructor groupand 49.9 seconds (SDev 12.0, n�84) for the DVD taught group.

Conclusion: There was no statistically significant difference in instructor versusDVD taught groups for students learning AED use and for mean time to shock. Thisstudy suggests that an instructional DVD is as effective as the more resource and timeintensive instructor method of teaching AED use to high school students.

96 Critical Misinterpretations of Key ElectrocardiographicEntities by Senior Medical Students

Wald DA, Harrigan RA/Temple University School of Medicine, Philadelphia, PA

Study Objectives: Prior research has shown that senior medical students (SMS)and interns (emergency medicine and internal medicine) often fail to identify manykey electrocardiographic findings. Differentiation of ischemic syndromes fromischemia-mimics on the electrocardiogram (ECG) is a critical component of ECGinterpretation. We sought to determine patterns of misrecognition of keymorphologic abnormalities in common electrocardiographic ischemic and non-ischemic entities.

Methods: A testing set of sixteen 12-lead ECGs was developed by 2 boardcertified emergency physicians. The testing set was reviewed by a board certifiedcardiologist to validate the findings. The testing set was administered to all senior MSat 1 U.S. medical school. A subset of the ECG interpretations was reviewed andcategorized for the ECGs representing ischemic syndromes (acute anterior andinferior wall myocardial infarction{AWMI and IWMI, respectively}) and ischemia-mimics (left and right bundle branch block {LBBB and RBBB, respectively}),ventricular paced rhythm (VPR), and left ventricular hypertrophy with strain (LVH).

Results: All 162 SMS completed the ECG testing packet. 2 (1%) SMS correctlyinterpreted all six 12-lead ECGs representing ischemic and ischemia-mimicsyndromes, 15 (9%) misinterpreted all six ECGs. 71 (44%) SMS failed to recognizeIWMI and 50 (31%) did not recognize AWMI. 41 SMS (25%) misinterpreted bothECGs. In the 2 acute MI ECGs, SMS commonly recognized ST segment elevation,but failed to correctly interpret these findings (33/71, 46% IWMI; 18/50, 36%AWMI). SMS also recognized T wave changes, but failed to correctly interpret this aswell (14/71, 20% IWMI; 2/50, 4% AWMI). IWMI was also misinterpreted aspericarditis (4/71, 6%) and hyperkalemia (4/71, 6%). VPR was the most commonly

misinterpreted ischemia-mimic (143/162, 88%). Common misinterpretationsincluded ventricular tachydysrhythmia (60/143, 42%) and BBB/wide QRScomplex(29/143, 20%). Nine (6%) SMS misinterpreted VPR as MI/ischemia. The 2BBB ECGs were frequently misinterpreted (122/162, 75% LBBB; 112/162, 69%RBBB). Confusion as to the type of BBB was common (32/234, 14%), as was onlyrecognizing a wide QRS complex (47/234, 20%). BBBs were also mistaken for MI/ischemia (8/234, 3%) and ventricular dysrhythmia (11/234, 5%). SMS faired betterwith LVH, misinterpreting it less frequently than other ischemia-mimics (56/102,35%), but LVH was misinterpreted as MI/ischemia in 5% (3/56) of cases.

Conclusion: Common patterns of misinterpretation by SMS of acute MI includerecognition of ST segment elevation and/or T wave abnormalities without properinterpretation, as well as mistaking IWMI for pericarditis or hyperkalemia. ECGmimics of ischemia are frequently misinterpreted as ventricular tachydysrhythmia orMI/ischemia. Education of SMS with regard to ECG interpretation should includeattention to these patterns of misinterpretation.

97 Are Emergency Medicine Residents Adrenaline Junkies?A Comparison of Risk Taking Traits and Behaviorsbetween Emergency Medicine and Family PracticeResidents

Bascom E, Nerland M, Corsi D, Huber L, Kangas J, Kangas M, Bascom A/St.John Hospital and Medical Center and St. John Oakland Hospital, Detroit, MI;St. John Oakland Hospital, Madison Heights, MI; St. John Hospital and MedicalCenter, Detroit, MI

Study Objective: To determine if there is a significant difference in risk takingpersonality profiles and behaviors between Emergency Medicine Residents (EMR)and Family Practice residents (FPR). To address the commonly held belief that EMdocs are the “Cowboys” of medicine and “Adrenaline Junkies” and thus, have uniquesensation seeking traits and behaviors that both draw and predispose them to successin their careers.

Methods: A prospective survey based study in which a validated test and surveyregarding risk taking personality traits (Are You a Risk Taker? Marvin ZuckermanPhD) was administered to FPR and EMR. The test included 35 questions which thecovered personality traits relating to risk; Impulsive Sensation Seeking (ImpSS),Neuroticism-Anxiety (N-Anx), Aggression-Hostility (Agg-Host), Sociability (Sy), andActivity (Act). The survey also included 21 questions specifically about risk behavior(that are utilized when underwriting life insurance policies) with questions rangingfrom ski diving to drinking and driving. Survey Tests were administered as aconvenience sample to FPR and EMR at educational meetings in Michigan. Of thosesurveyed 77 FPR and 87 EMR fully completed the tests. Additionally, data wasgathered on age, gender, marriage status and country or state of origin.

Results: Scoring of the “Are You a Risk Taker” test involved categorizing thosewho only scored in the high extremes (as opposed to low and medium). In everysingle category the EMR scored high more frequently the FPR. The Fisher’s exact testwas used for statistical analysis to compare differences between the groups scoringhigh. EMR scored statically significantly higher (p � .05) in the Impulsive SensationSeeking category (EMR 19.3%, FPR 5.1%). This was the only category with a strongstatistical significance, the others follow; N-Anx (EMR 11.4%, FPR 3.8%), Agg-Host(EMR 9.1%, FPR 6.3%), Sy (EMR 39.8%, FPR 39.2%) and Act EMR 50%, FMR40.5%). The 21 additional risk behavior questions taken as whole (21) showed astrong statistical difference between EMR and FPR. EM residents engage in more riskactivities (11.4 �/� 3.0) than do FP residents (9.3 �/� 3.3), p � 0.0005. Subgroups did not show statistical significance; illegal behavior questions (N�4) (EMR2.4%, FPR 2.1%), risky sports questions (EMR 4.2%, FPR 3%), other risk behavior(N�80) (EMR 4.9, FPR 4.3).

Conclusion: Emergency medicine residents scored high more often than familypractice residents in every single category of risk measurement. Nearly 20% of EMresidents scored in the high category of Impulsive Sensation Seeking compared toonly 3.6 % of FP residents. This was a statistically significant difference. There was astrong statistical difference favoring risk behavior in the EMR group for the 21additional questions as well. It may be that those seeking careers in emergencymedicine are truly “Adrenaline Junkies” who thrive in and adapt well to situationsthat are risk laden. Further areas of investigation might include comparing emergencymedicine personality types that are sensation seekers, with job competency andsatisfaction.

Research Forum Abstracts

Volume , . : September Annals of Emergency Medicine S31