American Board Of Emergency Medicine Research Articles

Emergency medicine residents' attitudes and opinions of in-training exam preparation.

PurposeEmergency Medicine (EM) residents take the American Board of Emergency Medicine (ABEM) in-training exam, and performance on this exam has been shown to correlate to performance on the ABEM qualifying exam. Though many residencies have in-training exam preparation activities, there is little data on the effectiveness of these efforts. This study aimed to elicit resident perspectives about the exam and exam preparation in order to generate hypotheses and better inform future preparation efforts.MethodsSecond- and third-year EM residents at a single institution were interviewed using a semi-structured format. Qualitative methodology was used to analyze the data.ResultsThirteen EM residents participated in the study. Eight major themes and 18 sub-themes were identified. These were further characterized as relating to the exam itself or to exam preparation. Residents generally value the in-training exam. Sixty-nine percent noted that it provided an assessment of their current knowledge and deficiencies. Thirty-eight percent noted that it improved familiarity with the qualifying exam. Regarding exam preparation, residents stated that a question format was preferred, especially when accompanying explanations were of high quality. Additionally, practical considerations, such as portability, impacted resident selection of study tools.ConclusionResidents value the in-training exam as a marker of their academic progress and for their ability to gain familiarity with the qualifying exam. They prefer question-based preparation over text-based learning, as long as there is a detailed explanation of each answer. Educators creating structured in-training review may want to focus on question-based material with detailed explanations.

The Development of the Emergency Medicine Milestones

The Accreditation Council for Graduate Medical Education (ACGME) has outlined its "Next Accreditation System" (NAS) that will focus on resident and residency outcome measurements. Emergency medicine (EM) is one of seven specialties that will implement the NAS beginning July 2013. All other specialties will follow in July 2014. A key component of the NAS is the development of assessable milestones, which are explicit accomplishments or behaviors that occur during the process of residency education. Milestones describe competencies more specifically and identify specialty-specific knowledge, skills, attitudes, and behaviors (KSABs) that can be used as outcome measures within the general competencies. The ACGME and the American Board of Emergency Medicine (ABEM) convened an EM milestone working group to develop the EM milestones. This article describes the development, use within the NAS, and challenges of the EM milestones.

American Board of Emergency Medicine Report on Residency Training Information (2012-2013), American Board of Emergency Medicine

The American Board of Emergency Medicine (ABEM) gathers extensive background information on emergency medicine residency programs and the residents in those programs. We present the 2013 annual report on the status of US emergency medicine training programs.

Components of the Model of the Clinical Practice of Emergency Medicine: A Survey of American Board of Emergency Medicine Diplomates

BackgroundThe Model of the Clinical Practice of Emergency Medicine is the basis for the content specifications of all American Board of Emergency Medicine (ABEM) examinations. This study describes the frequency with which ABEM diplomates diagnose and manage the conditions and components listed in the Model of the Clinical Practice of Emergency Medicine. ObjectivesThe objectives of this study were to determine the frequency with which ABEM diplomates diagnose and manage the conditions and components described in the Model of the Clinical Practice of Emergency Medicine. MethodsThe listing of conditions and components of the Model of the Clinical Practice of Emergency Medicine were sent to 16,230 randomly selected ABEM diplomates. One of five surveys was sent to each diplomate. Each condition and component was assessed by participants for the frequency that emergency physicians diagnose (D) and manage (M) that condition, as seen in their practice of Emergency Medicine. ResultsOf the 16,230 surveys sent, 5006 were returned (30.8% response rate). The genders of the respondents were 75% male and 24% female. The ages of the respondents were primarily in the age 40–49 years, and 30–39 years age groups. All categories of the listing of conditions and components of the Model of the Clinical Practice of Emergency Medicine were encountered frequently in the practice of Emergency Medicine, as indicated by study participants. ConclusionsA survey of practicing ABEM diplomates was useful in defining the frequency with which specific conditions and components are diagnosed and managed in the practice of Emergency Medicine.

Demystifying Maintenance of Certification

Board certification for a medical specialty was first proposed in 1908. Subsequently, the American Board of Medical Specialties (ABMS) was formed in 1933. The ABMS approved emergency medicine as the 23rd medical specialty in 1979. Since its inception, the American Board of Emergency Medicine (ABEM) has always had time-limited certification requiring a recertification examination every 10 years. The notion of recertification has since evolved into maintenance of certification (MOC). I define the various components of the ABEM MOC program. The MOC axioms of continuous professional development and adherence to quality development are discussed. Finally, physician participation in the ABEM MOC is reviewed.

More Boards Reporting on Certification Maintenance

Eleven new medical boards have begun publicly reporting whether physicians are up to date on their maintenance of certification requirements. The trend toward disclosing maintenance of certification (MOC) status started in August 2011 when seven medical specialty boards, including the American Board of Family Medicine, began making the information publicly available at www.certificationmatters.org – the consumer-focused website of the American Board of Medical Specialties (ABMS). Now only six ABMS member boards do not publicly post the MOC status of their diplomates. That list includes the American Board of Internal Medicine. However, all ABMS member boards are expected to publicly report MOC status by early 2014, according to Dr. Lois Nora, ABMS president and CEO. The move to make MOC information readily available to the public is an important part of medical professionalism, Dr. Nora said in an interview. “We have a covenant with the public that we will act in their best interest.” Since the launch of the certificationmatters.org site in February 2011, more than 1.1 million people have visited the site, according to ABMS. The site allows individuals to search for board certification and MOC status by physician name, location, or specialty. If the physician's certifying board is one of the 18 that publicly discloses its members' MOC status, consumers will also see “Yes,” “No,” or “Not Required” displayed next to a doctor's MOC status. The “Not Required” response relates to physicians who have a lifetime certification. The 18 boards now reporting MOC: ▸American Board of Allergy and Immunology▸American Board of Colon and Rectal Surgery▸American Board of Dermatology▸American Board of Emergency Medicine▸American Board of Family Medicine▸American Board of Medical Genetics▸American Board of Neurological Surgery▸American Board of Nuclear Medicine▸American Board of Obstetrics and Gynecology▸American Board of Ophthalmology▸American Board of Otolaryngology▸ American Board of Physical Medicine and Rehabilitation▸American Board of Plastic Surgery▸American Board of Preventive Medicine▸American Board of Psychiatry and Neurology▸American Board of Surgery▸American Board of Thoracic Surgery▸American Board of Urology

Rural Clinical Experiences for Emergency Medicine Residents: A Curriculum Template

Rural emergency departments (EDs) in the United States are less likely to be staffed with emergency medicine (EM) residency-trained and American Board of Emergency Medicine (ABEM)-certified physicians than urban EDs. Rural EM clinical experiences during residency training have been suggested as a strategy to encourage future rural practice, but past Accreditation Council for Graduate Medical Education (ACGME) Residency Review Committee for Emergency Medicine program requirements and a lack of familiarity with rural rotations in the EM graduate medical education (GME) community have limited their availability. To provide a template for the development and implementation of a rural EM clinical experience, Kern's six-step approach was followed.

22 Performance Improvement Curriculum for Emergency Medicine Residents

Continuous performance improvement (PI) is an essential component of the practice of emergency medicine (EM), and physicians must recognize the importance of PI processes in the safe and effective care of patients. The ACGME's Program Requirements indicate that all residents must be involved with PI activities. The American Board of Emergency Medicine requires diplomates to participate in PI activity. In addition, future health care reimbursement models are expected to include significant requirements for quality measurement and improvement.

A Novel Comprehensive In-Training Examination Course Can Improve Residency-Wide Scores

The annual American Board of Emergency Medicine (ABEM) in-training examination is a tool to assess resident progress and knowledge. We implemented a course at the New York-Presbyterian Emergency Medicine Residency Program to improve ABEM scores and evaluate its effect. Previously, the examination was not emphasized and resident performance was lower than expected. As an adjunct to required weekly residency conferences, an intensive 14-week in-training examination preparation program was developed that included lectures, pre-tests, high-yield study sheets, and a remediation program. We compared each residents in-training examination score to the postgraduate year-matched national mean. Scores before and after course implementation were evaluated by repeat measures regression modeling. Residency performance was evaluated by comparing residency average to the national average each year and by tracking ABEM national written examination pass rates. Following the course's introduction, odds of a resident scoring higher than the national average increased by 3.9 (95% CI 1.9-7.3) and percentage of residents exceeding the national average increased by 37% (95% CI 23%-52%). In the time since the course was started the overall residency mean score has outperformed the national average and the first-time ABEM written examination board pass rate has been 100%. A multifaceted residency-wide examination curriculum focused around an intensive 14-week course was associated with marked improvement on the in-training examination.

Competence and Challenges of Emergency Medicine Training as Reported by Emergency Medicine Residents

BackgroundThe American Board of Emergency Medicine conducts an annual survey of residents in Emergency Medicine, the Longitudinal Study of Residents in Emergency Medicine survey. Objective: This study was undertaken to describe self-reported competence and challenges facing Emergency Medicine (EM) residents. MethodsIn this descriptive, observational analysis of the Longitudinal Study of Residents in Emergency Medicine survey, survey data from 1996–2008 were compared for 70 survey items. Responses were analyzed with means and 95% confidence intervals by post-graduate year (PGY) and over time. ResultsA total of 496 residents were included in this study. Most participated for 3 years, for a total of 1320 total responses. The most serious day-to-day challenges reported by residents (overall median scores of 3 or more) included knowing enough, keeping up with the medical literature, having enough time for personal life, ancillary support, and having enough time for family. Current level of competence in areas deemed weakest by residents included grant writing, contract negotiation, academic writing, disaster planning, research, and financial management. Residents reported improved competence in most (15 out of 16) areas from PGY-1 to PGY-3 year of training. Resident reports of competence did not change significantly over time from 1998–2008 (15 out of 16 items). ConclusionsEmergency Medicine residents identified several important day-to-day problems, including knowing enough, keeping up with the medical literature, and having enough time for a personal life. PGY-3 residents reported improved competence in almost all aspects of EM work and clinical EM as compared to PGY-1 residents. Knowledge of perceived competence and problems among EM residents is crucial to the development of improved educational approaches to address these issues.

Report on Residency Training Information (2011-2012), American Board of Emergency Medicine

The American Board of Emergency Medicine (ABEM) gathers extensive background information on emergency medicine residency training programs and the residents in those programs. We present the 2012 annual report on the status of US emergency medicine training programs.

More Science for the New Subspecialty

More Science for the New Subspecialty

The Core Content of Emergency Medical Services Medicine

On September 23, 2010, the American Board of Medical Specialties (ABMS) approved emergency medical services (EMS) as a subspecialty of emergency medicine. As a result, the American Board of Emergency Medicine (ABEM) is planning to award the first certificates in EMS medicine in the fall of 2013. The purpose of subspecialty certification in EMS, as defined by ABEM, is to standardize physician training and qualifications for EMS practice, to improve patient safety and enhance the quality of emergency medical care provided to patients in the prehospital environment, and to facilitate integration of prehospital patient treatment into the continuum of patient care. In February 2011, ABEM established the EMS Examination Task Force to develop the Core Content of EMS Medicine (Core Content) that would be used to define the subspecialty and from which questions would be written for the examinations, to develop a blueprint for the examinations, and to develop a bank of test questions for use on the examinations. The Core Content defines the training parameters, resources, and knowledge of the treatment of prehospital patients necessary to practice EMS medicine. Additionally, it is intended to inform fellowship directors and candidates for certification of the full range of content that might appear on the examinations. This article describes the development of the Core Content and presents the Core Content in its entirety.

Sports Medicine for Emergency Medicine Physicians, Too Few to Maintain the Fellowship in Emergency Medicine

Sports medicine (SM) is a clinical subspecialty concerned with the diagnosis and treatment of injuries and illnesses sustained both in and out of the athletic arena. Historically, orthopedic surgeons provided the bulk of care for the athlete. Since the majority of issues with athletes are nonoperative musculoskeletal injuries, traumatic brain injuries, or general medical conditions, primary care providers have developed an important role in SM. The primary care sports medicine (PCSM) physician has become increasingly popular with amateur and professional teams, as growth of sports participation has created medical demands that far exceed the ability of a single medical specialty to provide care.1 Orthopedic surgery practices have also realized the benefits of utilizing PCSM physicians to assist in patient care. The PCSM fellowship started in 1992 when the American Board of Emergency Medicine, the American Board of Pediatrics, the American Board of Family Practice, and the American Board of Internal Medicine made an application to the American Board of Medical Specialties (ABMS) to offer subspecialty certification in SM and received approval. Family medicine (FM) is the administering board and has offered written exams since 1993. Today, SM is 1 of only 6 fellowships recognized by the ABMS for emergency medicine (EM) physicians. SM should be appealing to emergency physicians, as patients with acute athletic injuries present to the emergency department on a fairly routine basis. Although there is no reliable sports injury tracking system, recent reports estimate over 4 million emergency department visits occur annually for injuries related to participation in sports and recreation.2 One could imagine that the demand for sports medicine fellowships would be high. The reality is that there is minimal participation in SM among EM clinicians, and in general there is very little participation in PCSM among any specialty other than FM. The sparse participation is not due to a lack of training opportunities. The majority (62%) of the 97 PCSM fellowship programs allow EM residents to apply. However, only 6 (6.2%) of these fellowships are run by EM, while 83 (85%) are run by FM departments. Currently, 0.5% (n = 101) of all board-certified EM attending physicians and 2.3% (n = 1,486) of all board-certified FM attending physicians are PCSM board certified.3 In our recent survey of 2008 to 2009 EM residency program directors with 89% (116/130) response rate, we found that 51% of program directors reported no SM practitioners.3 Seven percent of departments have 4 or more fellowship-trained attending physicians, while 66% of programs have no one who is fellowship-trained working in their department. In comparison, a mean 1.7 (95% confidence interval: 0.2–3.2) residents per program surveyed were reported to be interested in a career in SM. However, during the last 10 years, 60 EM residents in total have completed a PCSM fellowship following EM residency training. This number is surprisingly small and is inconsistent with the reported interest. There is no readily apparent answer as to why EM residents fail to pursue SM fellowships. Given the lack of prior penetration by EM physicians into SM, current residents with potential interest in SM have EM mentors to look to for guidance, teaching, and exposure to the field. While there are many SM fellowship positions available to EM residents, most of these fellowships are run by FM departments and, thus, may not appeal as much to EM applicants. In order to make a significant presence in SM, we must continue to encourage our residents to do SM electives, be involved in sports coverage, and apply to fellowships. For these opportunities to present themselves, programs must continue to hire fellowship graduates in order to mentor residents and train fellows of their own. If more EM based SM fellowships become available, there will be more EM mentors in the field and more EM resident exposure to SM. This would, in turn, likely lead to more resident participation in fellowship training. A letter to the editor in Academic Emergency Medicine in 20034 discussed the EM ultrasound fellowship and said that these fellowships are needed to advance the field and to provide EM physicians the expertise in ultrasound. Similarly, SM fellowship training is also needed in the field of EM to advance research and to develop EM leaders within the subspecialty. Without this type of growth, SM will continue to be dominated by FM, and EM will never gain a presence in a subspecialty that seems to best suit the EM physician.

Palliative care in the emergency department: An oxymoron or just good medicine?

In 2006, the American Board of Emergency Medicine co-sponsored hospice and palliative medicine as a recognized medical subspecialty. There is recognition of the need for these skills to be available in EDs in the USA. This article discusses the rationale for integrating a palliative approach in the ED. We need to engage our palliative care colleagues to increase clinical support to meet the needs of these vulnerable patients and to foster collaborative educational opportunities.

Outcome Measures for Emergency Medicine Residency Graduates: Do Measures of Academic and Clinical Performance During Residency Training Correlate With American Board of Emergency Medicine Test Performance?

Emergency medicine (EM) residency programs are increasingly asked to have measurable outcomes of residents' performance. Successful completion of the written and oral American Board of Emergency Medicine (ABEM) examinations is one key outcome. In the clinical practice of EM, emergency physicians (EPs) are often measured by their clinical productivity (patients per hour). This study explored the correlation between these measures of academic and clinical performance and hypothesized that clinical productivity would have a positive association with ABEM performance. A prospective written survey was sent to all EPs completing training at an established Midwest 3-year EM residency program between 1994 and 2005 (53,000 annual visits in 1994 to 65,000 annual visits in 2005). Physicians self-reported their national ABEM written and oral board scores in a blinded fashion. Simulated oral board scores and senior written in-training examination scores were also recorded. Postgraduate Year 3 (PGY3) clinical productivity was calculated as annual patient encounters divided by hours worked. Correlations among these variables were assessed by Pearson's correlation coefficient, with p < 0.05 being considered statistically significant. Multiple regression analysis was performed for ABEM oral and written examination scores. Fifty-six of 85 residents responded to the initial survey. There was no significant correlation between clinical productivity and ABEM scores, either written (r = -0.021, p = 0.881) or oral (r = -0.02, p = 0.879). There was also no significant correlation between productivity and simulated oral board scores (r = 0.065, p = 0.639) of PGY3 in-training scores (r = 0.078, p = 0.57). As previously reported, there were positive and significant correlations between PGY3 in-service scores and ABEM written examination scores (r = 0.60, p < 0.0001), as well as ABEM oral and written examination scores (r = 0.51, p < 0.0001). Multiple regression analysis revealed only the PGY3 in-training examination was a significant predictor of the ABEM oral and written scores (p < 0.001). PGY3 resident clinical productivity, when measured as patients per hour, correlated poorly with academic performance when measured by written and oral ABEM scores. The PGY3 in-training examination was predictive of the ABEM written and oral examination scores.

Report of the Task Force on Residency Training Information (2010-2011), American Board of Emergency Medicine

The American Board of Emergency Medicine (ABEM) gathers extensive background information on emergency medicine residency training programs and the residents in those programs. We present the 2011 annual report on the status of US emergency medicine training programs.

Investigating Rare Events and a Discussion on Waiting Room Chest Pain Evaluations: Answers to the November 2010 Journal Club Questions

Editor’s Note: You are reading the 18th installment of Annals of Emergency Medicine Journal Club. The questions and the article they are about (Scheuermeyer et al. Ann Emerg Med. 2010;56:455-462) were published in the November 2010 issue. Information about journal club can be found at http://www.annemergmed.com/content/journalclub. Readers should recognize that these are suggested answers. We hope they are accurate; we know that they are not comprehensive. There are many other points that could be made about these questions or about the article in general. Questions are rated “novice,” ( ) “intermediate,” ( ) and “advanced” ( ) so that individuals planning a journal club can assign the right question to the right student. The “novice” rating does not imply that a novice should be able to spontaneously answer the question. “Novice” means we expect that someone with little background should be able to do a bit of reading, formulate an answer, and teach the material to others. Intermediate and advanced questions also will likely require some reading and research, and that reading will be sufficiently difficult that some background in clinical epidemiology will be helpful in understanding the reading and concepts. We are interested in receiving feedback about this feature. Please e-mail journalclub@acep.org with your comments.

Commentary: Making a Difference in Emergency Medical Services

Commentary: Making a Difference in Emergency Medical Services

Viewpoint: Canʼt Get No Satisfaction? The Real Truth Behind Patient Satisfaction Surveys

Viewpoint: Canʼt Get No Satisfaction? The Real Truth Behind Patient Satisfaction Surveys