Thai Journal of Emergency Medicine

Retention of Advanced Cardiac Life Support (ACLS) Skills Following Simulation‑Integrated Flipped Learning in Final‑Year Medical Students

Panitnan Jindamanee — 2026-06-16

Introduction
Retention of Advanced Cardiac Life Support (ACLS) skills is a common challenge in undergraduate medical education. Although ACLS is a critical competency for final-year medical students, there is limited research on how flipped-classroom methods combined with simulation-based training influence knowledge and skill retention beyond immediate post-training. This study evaluates the effectiveness of a brief ACLS course integrating these strategies to enhance knowledge, skills, and self-reported confidence in advanced resuscitation.
Objectives
To assess changes in knowledge, skills, and confidence among final-year medical students following a brief ACLS training using a flipped-classroom model integrated with simulation.
Methods
This cross-sectional study was conducted at Trang Hospital from September to December 2024. Twenty-four sixth-year medical students completed a 30-question knowledge test and a skills assessment before training. After the brief ACLS course, students were re-assessed on both knowledge and skills immediately after the training and again at three months. Confidence in applying ACLS was assessed before the training and at the three-month follow-up. Data were analyzed using repeated measures ANOVA and paired t-tests.
Results
Mean knowledge scores increased from 18.15 ± 5.19 (pre-test) to 21.35 ± 4.52 (post-test), and slightly increased to 21.75 ± 3.26 at three months (p < 0.001). Skills scores rose from 7.95 ± 2.11 to 12.48 ± 1.78, and further improved 14.38 ± 1.21 at follow-up (p < 0.001). Confidence scores rose from 2.05 to 4.40 (p < 0.001).
Conclusion
A brief ACLS training program integrating flipped learning and simulation effectively enhanced and sustained knowledge, clinical skills, and learner confidence among final-year medical students. This model provides a practical and scalable solution for ACLS education in resource-limited settings.

Emergency Department Expected and Actual Waiting Time at University Hospital Emergency Department Among Young Adult Patients

Sukanya Khemtong — 2026-06-16

Introduction
Emergency department (ED) overcrowding is a growing challenge, especially due to non-emergency cases. Patient satisfaction is often shaped by their expectations regarding wait times.
Objectives
This study examined the relationship between expected and actual waiting times in a tertiary hospital ED among young adult patients with non-emergency conditions.
Method
A cross-sectional study was conducted at Srinagarind Hospital’s ED in Thailand. Young adults aged 18–35 years who visited between 5:00 PM and 10:00 PM were enrolled. Forty-two participants completed paper-based questionnaires assessing demographics, prior ED experience, perceived and expected waiting times. Actual waiting time-from registration to physician assessment—was obtained from hospital logs. Associations between expected and actual wait times were analyzed, stratified by age, education, and other factors.
Results
Of the 42 participants, the median age was 22 years; 57.1% were female. Most were triaged as level 3 (31%) or 4 (64%). The median expected wait time was 30 minutes, and the actual was 23 minutes (p = 0.069). In the 21–25 age group, the actual wait time (14.5 minutes) was significantly shorter than expected (30 minutes, p = 0.001). Participants with a bachelor’s degree also showed a significant gap between expected and actual times (p = 0.044). Overall, 38% expected shorter wait times than they experienced; no gender differences were found.
Conclusion
Most expectations did not show a statistically significant difference from actual ED wait times. However, younger adults and those with higher education tended to overestimate. Targeted communication strategies may help align expectations and improve satisfaction.

Effect of Stylet Bend Angle on Endotracheal Intubation Time via Direct Laryngoscopy: A Randomized Crossover Simulation Study

Poorich Jiradetpitaksa — 2026-06-16

Introduction
Proper preparation of stylet angulation is a critical factor for rapid endotracheal intubation. However, clinical guidelines regarding the optimal stylet angulation for this procedure remain undefined.
Objectives
To study the effect of different endotracheal tube stylet bend angles on intubation time, first-attempt success rate, and intubation failure rate.
Method
A randomized crossover simulation study was conducted to compare the effect of various stylet angles on intubation time. Seventy medical personnel with varying levels of experience at Saraburi Hospital participated between January 1st and December 31st, 2025. Participants performed intubations using a randomized sequence of predetermined stylet angles. The primary outcome was intubation duration, while secondary outcomes included the number of attempts and intubation failure rates.
Results
The adjusted mean time (aMT) for the 15° angle was 18.2 seconds (95% CI, 15.9–20.4). Intubation durations with 30° and 45° stylet bend angles were significantly shorter than with a 15° stylet bend angle (aMT = 15.4 s; 95% CI, 13.1–17.6 and aMT = 15.5 s; 95% CI, 13.2–17.8, respectively), with no intubation failures. In contrast, 75° and 90° angles required significantly longer durations (aMT = 21.1 s; 95% CI, 18.8–23.3 and aMT = 26.0 s; 95% CI, 23.7–28.2, respectively), with a failure rate of 1.4%. First-attempt success rates did not differ significantly across all angles.
Conclusion
A stylet bend angle of 30°–45° requires the least amount of intubation time in a simulation model when compared to other angles. Stylet angulation does not significantly impact the first-attempt success rate.

Comparison of Screening Tools among Supportive and Palliative Care Indicators Tool (SPICT), Modified Surprise Question and Palliative Care and Rapid Emergency Screening (P-CaRES) to Identify Palliative Care Needs in Emergency Department

Dhayabhorn Likitdhammakul — 2026-06-16

Introduction
The emergency department (ED) serves as a critical entry point for identifying patients with end-of-life needs. However, time and resource constraints make selecting appropriate screening tools challenging.
Objectives
To compare the prognostic accuracy of the Supportive and Palliative Care Indicators Tool (SPICT), Modified Surprise Question (MSQ), and Palliative Care and Rapid Emergency Screening (P-CaRES) in predicting 3-month mortality and to evaluate the agreement between these three screening tools.
Method
This prospective cohort study included 281 participants. Predictive accuracy was analyzed using C-statistics and Adjusted Hazard Ratios (aHR), and survival rates were compared using Kaplan-Meier analysis.
Results
The 3-month mortality rate was 56.23% (158 patients) . All three tools significantly predicted 3-month mortality (p<0.001). P-CaRES demonstrated the highest accuracy (C-statistic 0.666; 95% CI: 0.60–0.73) and identified the highest-risk group with the shortest median survival of 17 days (95% CI: 11.92–22.08). Meanwhile, MSQ yielded the highest aHR of 2.59 (95% CI: 1.78–3.76; p<0.001). The level of agreement among the three tools was fair, with the highest concordance found between SPICT and P-CaRES (kappa = 0.374; p<0.001). Conclusion The three screening tools demonstrated significant prognostic accuracy in predicting 3‑month mortality, with P-CaRES showing the highest overall accuracy, while MSQ yielded the highest adjusted hazard ratio for identifying high‑risk patients. The level of agreement among the three tools was fair.