This article reviews the contemporary literature for septic cavernous sinus thrombosis (CST) with a focus on anticoagulation. Modern emphasis is placed on suspecting and treating this condition early, which is aided by recognizing clinical features attributable to sepsis, orbital venous congestion, and involvement of cranial nerves within each cavernous sinus. Established treatments include high dose broad-spectrum parenteral antibiotics, and selective surgery for concurrent suppurations. The role of anticoagulation is contentious because its efficacy is undetermined and it may cause or exacerbate concurrent intracranial haemorrhage in patients with septic CST. Moreover, prospective trials of anticoagulation may never be performed due to the rarity of this condition. Nevertheless, retrospective reviews of published reports indicate that haemorrhage caused by anticoagulation is rare, and that early adjunctive anticoagulation is beneficial in these patients if commenced after excluding the haemorrhagic sequelae of CST radiologically.

Given the discrepancy between men and women's equal rates of medical school matriculation and their rates of academic promotion and leadership role acquisition, the need to provide mentorship and education to women in academic medicine is becoming increasingly recognized. Numerous large-scale programs have been developed to provide support and resources for women's enrichment and retention in academic medicine. Analyses of contributory factors to the aforementioned discrepancy commonly cite insufficient mentoring and role modeling as well as challenges with organizational navigation. Since residency training has been shown to be a critical juncture for making the decision to pursue an academic career, there is a need for innovative and tailored educational and mentorship programs targeting residents. Acknowledging residents' competing demands, we designed a program to provide easily accessible mentorship and contact with role models for our trainees at the departmental and institutional levels. We believe that this is an important step towards encouraging women's pursuit of academic careers. Our model may be useful to other emergency medicine residencies looking to provide such opportunities for their women residents. RÉSUMÉCompte tenu de l'écart qui existe entre les hommes et les femmes en ce qui concerne l'égalité des taux d'inscription dans les écoles de médecine mais l'inégalité des taux de promotion et de nomination à des rôles de direction, la nécessité d'offrir du mentorat et de la formation aux femmes en médecine universitaire s'impose de plus en plus. De nombreux programmes appliqués à grande échelle ont été élaborés afin de fournir du soutien et des ressources aux femmes en vue de leur perfectionnement et de leur maintien en médecine universitaire. Sont souvent invoqués, dans les analyses des facteurs qui jouent un rôle dans cet écart, le manque de mentorat et de modèles de rôle ainsi que les difficultés de s'y retrouver dans les organisations. Des études ayant démontré que la résidence constituait une étape cruciale dans la poursuite d'une carrière universitaire, il est nécessaire d'avoir des programmes novateurs et adaptés de formation et de mentorat, qui ciblent les résidentes. Reconnaissant les demandes concurrentielles des résidentes, les auteurs ont élaboré un programme qui vise à offrir aux stagiaires des possibilités de mentorat et d'établissement de relations avec des modèles de rôle, et ce, tant au niveau du département qu'au niveau de l'établissement. Les auteurs croient qu'il s'agit là d'une étape importante afin d'inciter les femmes à poursuivre une carrière universitaire. Le modèle décrit ici peut se montrer utile dans d'autres programmes de résidence en médecine d'urgence en vue d'offrir aux résidentes ce genre de possibilités.

Resident teaching is a competency that must be recognized, developed, and assessed. The ACGME core competencies include the role of physician as educator to "educate patients and families" and to "facilitate the learning of students and other health care professionals." Residents spend a significant proportion of their time in teaching activities, and students report achieving much of their clinical learning from their interactions with residents. Although many residents enjoy their critical role as teacher, many do not feel well prepared to teach. This article summarizes a preliminary curriculum of modules for a resident teacher-training program for emergency medicine residents. The goal of these modules is to provide learning objectives and an initial structure through which residents could improve basic teaching skills. Many of these skills are adaptable to residents' interactions with each other and with students, other healthcare professionals, and patients. Each module and corresponding teaching exercises can be found at http://www.saem.org.

Few residency curricular interventions have focused on improving well-being and promoting humanism. We describe the implementation of a novel curriculum based on smallgroup reflection rounds-the Emergency Medicine Reflection Rounds (EMRR)-at a 4-year US emergency medicine (EM) residency. During the inaugural year (2010)(2011), nine residents volunteered to take part in 1-hour monthly sessions with faculty facilitators. Residents were provided with a confidential environment to discuss difficult ethical and interpersonal encounters from their clinical experiences. Ongoing feedback from participants was solicited, culminating with a four-question survey in which all respondents remarked that the EMRR contributed to improving their own well-being and agreed that it provided an important forum for residents to discuss difficult issues in a safe environment. In this article, we describe our innovation as an example of a wellness initiative that has promoted reflective practice and fostered cooperative learning around the communication, professional, and ethical challenges inherent in EM practice. Our EMRR model may be useful to other EM residences looking to supplement their wellness curriculum. RÉ SUMÉLes programmes de ré sidence comprennent peu d'interventions portant sur l'amé lioration du bien-ê tre et la promotion du sentiment d'humanité . Nous dé crivons ici la mise en oeuvre d'une initiative novatrice, consistant en des sé ances de ré flexion en petits groupes-appelé es sé ances de ré flexion en mé decine d'urgence (SRMU)-offerte dans un programme de ré sidence en mé decine d'urgence (MU), d'une duré e de 4 ans, aux É tats-Unis. Au cours de la premiè re anné e d'existence (2010-2011), neuf ré sidents ont accepté de participer à des sé ances mensuelles, d'une duré e de 1 heure, dirigé es par des animateurs membres de la faculté . Les ré sidents é taient placé s dans un environnement confidentiel, ce qui leur permettait de discuter de difficulté s d'ordre é thique et interpersonnel, tiré es de leur expé rience clinique. On demandait aux participants de faire de la ré troaction continue, et celle-ci a atteint son point culminant dans une enquê te qui comptait quatre questions, dans laquelle tous les ré pondants ont souligné que les SRMU avaient contribué à l'amé lioration de leur propre bien-ê tre, et ils é taient d'accord pour dire que celles-ci avaient constitué un lieu d'é changes importants, qui leur avait permis de discuter de questions difficiles dans un environnement sû r. Nous pré sentons, dans l'article, notre expé rience novatrice comme un exemple d'initiative de promotion du bien-ê tre, qui a favorisé la pratique ré flexive et l'apprentissage coopé ratif, relativement à des difficulté s d'ordre professionnel et é thique et à des problè mes de communication, inhé rents à la pratique de la MU. Notre modè le de SRMU peut se montrer utile dans d'autres programmes de ré sidence en MU dont les responsables aimeraient enrichir le contenu en matiè re de bien-ê tre.

Resident teaching is a competency that must be recognized, developed, and assessed. The ACGME core competencies include the role of physician as educator to "educate patients and families" and to "facilitate the learning of students and other health care professionals." Residents spend a significant proportion of their time in teaching activities, and students report achieving much of their clinical learning from their interactions with residents. Although many residents enjoy their critical role as teacher, many do not feel well prepared to teach. This article summarizes a preliminary curriculum of modules for a resident teacher-training program for emergency medicine residents. The goal of these modules is to provide learning objectives and an initial structure through which residents could improve basic teaching skills. Many of these skills are adaptable to residents' interactions with each other and with students, other healthcare professionals, and patients. Each module and corresponding teaching exercises can be found at http://www.saem.org.

In this 30-minute talk, the authors take an in-depth look at how to debrief high-fidelity case-based simulation sessions, including discussion on debriefing theory, goals, approaches, and structure, as well as ways to create a supportive and safe learning environment, resulting in successful small group learning and self-reflection. Emphasis is placed on the ''debriefing with good judgment'' approach. Video clips of sample debriefing attempts, highlighting the ''dos and don'ts'' of simulation debriefing, are included. The goal of this talk is to provide you with the necessary tools and information to develop a successful and effective debriefing approach. There is a bibliography and a quick reference guide in Data Supplements S1 and S2 (available as supporting information in the online version of this paper).

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IntroductionMentorship fosters career development and growth. During residency training, mentorship should support clinical development along with intellectual and academic interests. Reported resident mentoring programmes do not typically include clinical components. We designed a programme that combines academic development with clinical feedback and assessment in a four-year emergency medicine residency programme.MethodsIncoming interns were assigned an advisor. At the conclusion of the intern year, residents actively participated in selecting a mentor for the duration of residency. The programme consisted of quarterly meetings, direct clinical observation and specific competency assessment, assistance with lecture preparation, real-time feedback on presentations, simulation coaching sessions, and discussions related to career development. Faculty participation was recognized as a valuable component of the annual review process. Residents were surveyed about the overall programme and individual components.ResultsOver 88 % of the respondents said that the programme was valuable and should be continued. Senior residents most valued the quarterly meetings and presentation help and feedback. Junior residents strongly valued the clinical observation and simulation sessions.ConclusionsA comprehensive mentorship programme integrating clinical, professional and academic development provides residents individualized feedback and coaching and is valued by trainees. Individualized assessment of clinical competencies can be conducted through such a programme.