Canadian Emergency Medicine Physicians Research Articles

Factors influencing HINTS exam usage by Canadian Emergency Medicine Physicians.

The HINTS examination (head impulse, nystagmus, test of skew) is a bedside physical examination technique that can distinguish between vertigo due to stroke, and more benign peripheral vestibulopathies. Uptake of this examination is low among Emergency Medicine (EM) physicians; therefore, we surveyed Canadian EM physicians to determine when the HINTS exam is employed, and what factors account for its low uptake. We designed and tested a 26-question online survey, and disseminated it via email to EM physicians registered with the Canadian Association of Emergency Physicians (CAEP), with 3 and 5-week reminder emails to increase completion. This anonymous survey had no incentives for participation, and was completed by 185 EM physicians, with post-graduate medical training in either Emergency Medicine or Family Medicine. The primary outcomes were the frequencies of various responses to survey questions, with secondary outcomes being the associations between participant characteristics and given responses. 88 respondents (47.8%) consistently use the HINTS examination in the work-up of vertigo, and 117 (63.7%) employ it in scenarios where its clinical utility is limited. The latter is more common among physicians working in non-academic settings, without 5-year EM residency training, and with greater years of practice (p < 0.01). The most frequent explanations for non-use were a lack of need for the HINTS examination, the lack of validation of the exam among EM physicians, and concerns surrounding the head-impulse test. Though HINTS exam usage is common, there is a need for education on when to apply it, and how to do so, particularly as concerns the head-impulse test. Our attached rubric may assist with this, but quality-improvement initiatives are warranted. Low uptake is partly due to the lack of validation of this examination among EM physicians, so effort should be made to conduct well-designed HINTS trials exclusively involving EM physicians.

Canadian emergency medicine physician burnout: a survey of Canadian emergency physicians during the second wave of the COVID-19 pandemic.

ObjectivesA previous survey of Canadian emergency medicine (EM) physicians during the first wave of the COVID-19 pandemic documented less than 20% experienced high levels of burnout. This study examined the experience of a similar group of physicians during the second pandemic wave. We reported the associations between burnout and physician age, gender, having children at home and training route.MethodsThis study utilized a national survey of Canadian emergency physicians. We collected data on demographics and measured burnout using the Maslach Burnout Inventory (MBI). Multiple logistic regression models identified associations between the emotional exhaustion and depersonalization domains of the MBI and EM physician demographics (age, gender, children living at home, and training route).ResultsBetween November 25, 2020, and February 4, 2021, 416 emergency physicians completed the survey, representing all Provinces or Territories in Canada (except Nunavut). The mean participant age was 44, 53% were male, 64% had children living at home and 41% were FRCPC and 41% CCFP-EM trained. Sixty percent reported high burnout (either high emotional exhaustion and/or high depersonalization). Increasing age was associated with lower emotional exhaustion and depersonalization; female or nonbinary gender was associated with an increase in emotional exhaustion; and having children living at home was associated with lower depersonalization.ConclusionsMost Canadian emergency physicians participating in our study during the COVID-19 pandemic reported high burnout levels. Younger physicians and female physicians were more likely than their coworkers to report high burnout levels. Hospitals should address emergency physician burnout during the pandemic because it is a threat to quality of patient care and retention of the workforce for the future.Supplementary InformationThe online version contains supplementary material available at 10.1007/s43678-021-00259-9.

P.079 Factors influencing HINTS exam usage by Canadian Emergency Medicine Physicians

Background: The HINTS examination is a sensitive and specific tool for determining whether a patient presenting with an acute vestibular syndrome has had a stroke. Despite its efficacy, it is often not used by Emergency Medicine (EM) physicians when assessing patients with vertigo. Methods: To ascertain why, we surveyed, by email, physicians registered with the Canadian Association of Emergency Physicians, to gather information on their practices when assessing patients with vertigo, and their utilization and perspectives concerning the HINTS examination. Results: 185 participants responded to our survey, demographically representative of Canadian EM physicians. The majority regularly use the HINTS exam in the appropriate setting, but significant minorities employ the exam inappropriately, such as in patients without nystagmus, with other neurological findings, or alongside tests for intermittent vertigo. Misapplication was associated with older age, years of practice, non-academic practice settings, and less residency training (p&lt;0.05). The predominant reasons for not using this examination are lack of confidence in recalling and performing component exam techniques, particularly the head-impulse test, and doubts about the necessity, safety, or validity of this examination. Conclusions: HINTS examination use is limited by lack of provider skill, safety concerns, and doubts on its validity in excluding stroke when employed by EM physicians.

Attitudes, behaviour, and comfort of Canadian emergency medicine residents and physicians in caring for 2SLGBTQI+ patients.

Physicians working in the emergency department (ED) will interact with two-spirited, lesbian, gay, bisexual, transgender, queer/questioning and intersex (2SLGBTQI+) persons as colleagues and patients. These patients have unique healthcare needs and encounter negative experiences when seeking medical care, leading to poorer health outcomes and inequities. This study aims to explore the attitudes, behaviour, and comfort of Canadian emergency medicine (EM) physicians in caring for 2SLGBTQI+ patients. An anonymous survey was distributed to EM staff physicians and residents through the Canadian Association of Emergency Physicians (CAEP) network and social media channels. Demographic information was collected, and participants were asked about their comfort, current knowledge, and desire to gain new knowledge in caring for 2SLGBTQI+ patients. Personal perceptions and practice patterns in treating cisgender heterosexual (cis-het) and 2SLGBTQI+ patients were analysed using five-point Likert scales. Residents were asked additional questions regarding availability of learning experiences during training. 266 surveys were included in the final analysis consisting of 229 (86%) staff physicians and 37 (14%) residents. 97% (n = 258) of all respondents believed 2SLGBTQI+ patients deserve the same quality care from medical institutions as other patients. Further, 83% (n = 221) respondents agreed that they would like to increase their knowledge in taking care of 2SLGBTQI+ patients, while 34% (n = 91) agreed that performing physical examinations on transgender or intersex patients was more challenging than on cis-het patients. Among resident respondents, 46% indicated a lack of didactic teaching devoted to 2SLGBTQI+ care during residency (n = 17/37), while 38% encountered discrimination towards 2SLGBTQI+ patients, with most comments from senior faculty and nursing staff. This study suggests that Canadian EM physicians feel that 2SLGBTQI+ patients deserve equitable care when compared to cis-het patients. Future work should focus on educational needs and curricular enhancements in residency programs and continuing professional development for physicians to improve care for 2SLGBTQI+ patients in the ED.

How is quality of cardiopulmonary resuscitation being assessed? A national survey of Canadian emergency medicine physicians.

High-quality cardiopulmonary resuscitation (CPR) is a fundamental intervention for cardiac arrest, yet health care providers rarely adhere to recommended guidelines. Real-time feedback improves CPR performance. It is currently unknown how Canadian emergency physicians assess CPR quality during cardiac arrest and if they use feedback devices. Our aim was to describe how emergency physicians assess CPR quality and to describe eventual barriers to implementation of feedback technology. This was a cross-sectional survey that was distributed to attending and resident emergency physicians through the Canadian Association of Emergency Physicians. Responses were summarized and analyzed using descriptive statistics. The response rate was 19% (323/1735). Visual observation was the most common method of assessing CPR quality (41.2%), with leaders standing at the foot of the bed (67.4%). This was followed by real-time pulse check (29.7%) and end-tidal CO2 values (21.7%). Only 12% of physicians utilized CPR feedback technology. The most common perceived barrier to utilization was unavailability, inexperience with devices and lack of guidelines/evidence for their use. Most Canadian emergency physicians that responded to our survey, assess quality of CPR by standing at the foot of the bed and utilize visual observation and palpation methods which are known to be inaccurate. A minority utilize objective measurements such as ETCO2 or feedback devices, with the greatest barrier being lack of availability.

Practice Variation in the Diagnosis of Aneurysmal Subarachnoid Hemorrhage: A Survey of US and Canadian Emergency Medicine Physicians.

Spontaneous subarachnoid hemorrhage (SAH) from a brain aneurysm, if untreated in the acute phase, leads to loss of functional independence in about 30% of patients and death in 27-44%. To evaluate for SAH, the American College of Emergency Physicians (ACEP) Clinical Policy recommends obtaining a non-contrast brain computed tomography (CT) scan followed by a lumbar puncture (LP) if the CT is negative. On the other hand, current evidence from prospectively collected data suggests that CT alone may be sufficient to rule out SAH in patients who present within 6h of symptom onset while anecdotal evidence suggests that CT angiogram (CTA) may be used to detect aneurysms, which are the probable cause of SAH. Since many different options are available to emergency physicians, we examinedtheirpractice pattern variation by observing their diagnostic approaches andtheir adherence to the ACEP Clinical Policy. We developed, validated, and distributed a survey to emergency physicians at three practice sites: (1) Stanford Healthcare, California, (2) Intermountain Healthcare (five emergency departments), Utah, and (3) Ottawa General Hospital, Toronto. The survey questions examined physician knowledge on CT and LP's test performance and used case-based scenarios to assess diagnostic approaches, variation in practice, and adherence to guidelines. Results were presented as proportions with 95% CIs. Of the 216 physicians surveyed, we received 168 responses (77.8%). The responses by site were: (1) (n = 38, 23.2%), (2) (n = 70, 42.7%), (3) (n = 56, 34.1%). To the CT and LP test performance question, most physicians indicated that CT alone detects > 90% of SAH in those with a confirmed SAH [n = 150 (89.3%, 95% CI 83.6-93.5]. To the case-based questions, most physicians indicated that they would perform a CTA along with a CT [n = 110 (65.5%, 95% CI 57.8-72.6)], some indicated a LP along with a CT [n = 57, 33.9% 95% CI 26.8-41.6)], and a few indicated both a CTA and a LP [n = 16, 9.5%, 95% CI 5.5-15.0]. We also observed practice site variation in the proportion of physicians who indicated that they would use CTA: (1) (n = 25, 65.8%), (2) (n = 54, 77.1%), and (3) (n = 28, 50.0%) (p = 0.006). Survey responses indicate that physicians use some or all of the imaging tests, with or without LP to diagnose SAH. We observed variation in the use of CTA by site and academic setting and divergence from ACEP Clinical Policy.

Abstract WP124: Practice Variation in the Management of Aneurysmal Subarachnoid Hemorrhage- A Survey of US and Canadian Emergency Medicine Physicians

Introduction: To rule out sub-arachnoid hemorrhage (SAH) national guidelines for emergency physicians recommends obtaining a non-contrast CT scan and, if negative, a lumbar puncture. However, anecdotal evidence suggests recent adoption of CT non-contrast alone in patients presenting within six hours from symptom onset and an increase in the use of a newer imaging modality, CT angiogram (CTA). Our aim was to examine emergency physicians’ diagnostic approach to SAH diagnosis and their adherence to the current guidelines. Method: We developed, validated, and distributed a survey to emergency physicians at three different emergency departments: Site 1) Stanford Healthcare, California, 2) Intermountain Healthcare, Utah, and 3) The Ottawa Hospital, Ottawa, Ontario. We surveyed emergency physicians with questions on test performance for SAH detection and case based scenarios to assess adherence to guidelines. Results were presented as proportions with 95% CIs. Results: Of the 216 physicians surveyed, we received 168 responses (77.8%). The responses by site were: 1) (n= 38, 23.2%), 2) (n=70, 42.7%), 3) (n=56, 34.1%). Most physicians indicated that non-contrast CT imaging within a 6-hour window detects &gt;90% of SAH in those with a confirmed SAH [n=150 ( 89.3%, 95%CI 83.6 - 93.5)]. In response to the case based scenarios, a majority of the physicians indicated that they would use a non-contrast CT with an additional CTA [n=110 ( 65.5%, 95%CI 57.8- 72.6)], some indicated an additional LP [n=57 (33.9%, 95%CI 26.8 - 41.6)], and a few indicated both an additional CTA and LP[n=16 (9.5%, 95%CI 5.5-15.0)]. We also observed practice site variation in the proportion of physicians who indicated that they would use CTA: 1) (n=25/38, 65.8%), 2) (n= 54/70, 77.1%), and 3) (n=28/56, 50.0%) (p= 0.006). Conclusion: Survey responses indicated a significant variation in the emergency physicians’ use of diagnostic imaging for SAH and divergence from current guidelines. In our future studies, we will explore the reasons for the practice variation and increasing use of CTA as a diagnostic modality in SAH evaluation.

Anesthesiologist and Emergency Medicine Physician Attitudes and Knowledge Regarding Etomidate for Intubation.

The use of etomidate as an induction agent for critically ill patients is controversial. While its favorable hemodynamic profile is enviable, etomidate has been shown to cause transient adrenal suppression. The clinical consequences of transient adrenal suppression are poorly understood. Anecdotally, some clinicians advocate strongly for etomidate, while others feel it can cause significant harm. To better understand the current clinical environment with respect to single-dose etomidate use in critically ill patients, Canadian anesthesiologists and Canadian emergency medicine (EM) physicians were questioned regarding their opinions, knowledge, and preferences about etomidate use as an induction agent. Invitations to participate with the electronic survey were sent to 100 Canadian EM physicians and 260 Canadian anesthesiologists. The survey had 4 general parts: demographics, familiarity with the current literature, choice of induction agent given various clinical scenarios, and opinions on the controversy. The Pearson γ2 test was used to detect whether significant differences exist between physician groups. Ninety three anesthesiologists and 42 EM physicians responded for response rates of 36% and 42%. There were no self-reported differences in knowledge about etomidate properties between EM physicians and anesthesiologists. There were significant differences in etomidate use between EM physicians and anesthesiologists in general rapid sequence intubation, noncritically ill patients, and those with undifferentiated hypotension. Both EM physicians and anesthesiologists describe the current etomidate controversy as significant and not adequately resolved. There is no significant difference in self-reported etomidate knowledge between anesthesiologists and EM physicians; however, significant practice pattern differences exist with EM physicians using etomidate more often. Broad agreement supports future research to investigate etomidate's impact in critically ill patients.

Ascertaining top evidence in emergency medicine: A modified Delphi study.

The application of evidence-informed practice in emergency medicine (EM) is critical to improve the quality of patient care. EM is a specialty with a broad knowledge base making it daunting for a junior resident to know where to begin the acquisition of evidence-based knowledge. Our study's objective was to formulate a list of "top papers" in the field of EM using a Delphi approach to achieve an expert consensus. Participants were recruited from all 14 specialty EM programs across Canada by a nomination process by the program directors. The modified Delphi survey consisted of three study rounds, each round sent out via email. The study tool was piloted first with McMaster University's specialty EM residents. During the first round, participants individually listed top papers relevant to EM. During the two subsequent rounds, participants ranked the papers listed in the first round, with a chance to adjust ranking based on group responses. A total of eight EM specialty programs responded with 30 responses across the three rounds. There were 119 studies suggested in the first round, and, by the third round, a consensus of&gt;70% agreement was reached to generate the final list of 29 studies. We produced, via an expert consensus, a list of top studies relevant for Canadian EM physicians in training. It can be used as an educational resource for junior residents as they transition into practice.

Perceived barriers and facilitators to goals of care discussions in the emergency department: A descriptive analysis of the views of emergency medicine physicians and residents.

Few studies have examined the challenges faced by emergency medicine (EM) physicians in conducting goals of care discussions. This study is the first to describe the perceived barriers and facilitators to these discussions as reported by Canadian EM physicians and residents. A team of EM, palliative care, and internal medicine physicians developed a survey comprising multiple choice, Likert-scale and open-ended questions to explore four domains of goals-of-care discussions: training; communication; environment; and patient beliefs. Surveys were sent to 273 EM staff and residents in six sites, and 130 (48%) responded. Staff physicians conducted goals-of-care discussions several times per month or more, 74.1% (80/108) of the time versus 35% (8/23) of residents. Most agreed that goals-of-care discussions are within their scope of practice (92%), they felt comfortable having these discussions (96%), and they are adequately trained (73%). However, 66% reported difficulty initiating goals-of-care discussions, and 54% believed that admitting services should conduct them. Main barriers were time (46%), lack of a relationship with the patient (25%), patient expectations (23%), no prior discussions (21%), and the inability to reach substitute decision-makers (17%). Fifty-four percent of respondents indicated that the availability of 24-hour palliative care consults would facilitate discussions in the emergency department (ED). Important barriers to discussing goals of care in the ED were identified by respondents, including acuity and lack of prior relationship, highlighting the need for system and environmental interventions, including improved availability of palliative care services in the ED.

Physical activity prescription by Canadian Emergency Medicine Physicians.

An increase in physical activity has been shown to improve outcomes in many diseases. An estimated 600 000 Canadians receive their primary health care from emergency departments (ED). This study aims to examine physical activity prescription by emergency medicine physicians (EPs) to determine factors that influence decisions to prescribe physical activity. A survey was distributed to EPs via email using the Canadian Association of Emergency Physicians (CAEP) survey distribution protocol. Responses from 20% (n = 332) of emergency physician/residents in Canada were analyzed. Of the EPs, 62.7% often/always counsel patients about preventative medicine (smoking, diet, and alcohol). Only 12.7% (42) often/always prescribe physical activity. The CCFP-trained physicians (College of Family Physicians Canada) were significantly more likely to feel comfortable than CCFP-EM-trained physicians (Family Physicians with Enhanced Skills in Emergency Medicine) prescribing physical activity (p = 0.0001). Both were significantly more likely than the FRCPC-trained EPs (Fellows of the Royal College of Physicians of Canada). Of the EPs, 73.4% (244) believe the ED environment does not allow adequate time for physical activity prescription. Family medicine-trained EPs are more likely to prescribe physical activity; the training they receive may better educate them compared with FRCPC-trained emergency medicine. Further education is required to standardize an approach to ED physical activity prescription.

P085: Dental complaints in the emergency department: a national survey of Canadian EM physicians

Introduction: Dental complaints and emergencies are a common emergency department (ED) issue that has not been extensively studied. This study aimed to provide an evaluation of Canadian practice patterns and clinical training relating to dental emergencies in the ED. Methods: We conducted an electronic survey inviting 1520 Canadian emergency medicine (EM) physicians from CAEP’s physician distribution network. Thirty-three questions were asked regarding ED physician training with dental emergencies, practice patterns and comfort with dental care, current available ED dental resources, and how dental care may be improved in Canadian EDs. Standard descriptive statistics were calculated. Results: Survey response rate was 15.1%. Respondents were predominantly male (62.8%) with a mean 15.3 years (SD: ±9.8) of practice, and were primarily CCFP-EM (50.7%) or FRCP-trained (25.6%) in either tertiary (48.0%) or community (36.3%) teaching hospitals. They received broad training on dental issues, but this was limited in scope to ≤1 day of residency (61.4%). A combined majority (59.6%) felt their residency left them somewhat to very unprepared for treating dental complaints, and &amp;lt;40% of physicians reported feeling comfortable with specific, common dental emergency procedures, with the exception of avulsed tooth storage (61.1%). For pain management and local trauma exploration, 36.9% felt somewhat to very uncomfortable performing oral and facial nerve blocks. Many respondents do not have access to any dental emergency supplies (48.0%), or do not know if they have any access (14.2%). Furthermore, 18.9% have no access to any professional support for help with dental emergencies requiring advanced management. Respondents believe dental emergency consultant support is an issue at their centre (62.5%). EM physicians want more training with dental emergencies (79.5%) and improved access to dental-specific emergency materials in their departments (63.7%). The greatest barriers to providing good ED dental care were cost to patients (72.7%), physician comfort treating complaints (54.7%), and clear follow-up with outpatient dental professionals (54.3%). Conclusion: ED physicians feel relatively unprepared by their residency training to treat dental complaints, and professional dental support is an issue in the majority of EDs. Dental care may be improved with more access to training, to dental ED resources and professional support.

MP018: Exercise prescription by Canadian emergency medicine physicians

Introduction: Health promotion and disease prevention have been increasingly recognized as activities within the scope of emergency medicine. Exercise prescription by physicians has been shown to improve outcomes in obesity, cardiovascular disease, and many other diseases. An estimated 600,000 Canadians receive the majority of their care from emergency departments (ED), representing a substantial opportunity for health promotion. Our study examined the frequency of exercise prescription by emergency physicians (EPs) and determined factors that influence decisions to prescribe exercise. Methods: A national, confidential 22-item survey was distributed to Canadian EPs via email by the CAEP survey distribution protocol in November/December 2015. Demographics, exercise prescription rates and self-reported exercise habits were collected. Results: A total of 332 EPs responded. 92.4% of EPs reported being at least moderately active. 62.7% of EPs often or always council their patients about preventative medicine (smoking cessation, drug and alcohol use, diet and safe sex). However, only 23.8% often or always ask about their exercise habits. Even fewer (12.7%) often or always prescribe exercise. Training background significantly predicted level of comfort prescribing exercise. CCFP trained EPs were 5.1 (p = 0.001) times more likely than trained EPs to respond 'yes' they feel comfortable prescribing exercise, and 3.7 (p = .009) times more likely to respond 'sometimes'. CCFP (EM) trained EPs were 3.5 (p &lt; 0.001) times more likely than trained EPs to respond 'yes' they feel comfortable prescribing exercise, and 2.0 (p = .031) times more likely to respond 'sometimes'. 76.1% of respondents believe that other EPs rarely or never prescribe exercise. Of respondents, only 36% feel comfortable prescribing exercise. The majority of EPs (73.4%) believe that the ED environment did not allow adequate time for exercise prescription. Conclusion: The majority of EPs council their patients regarding other forms of preventative medicine but few prescribe exercise to their patients. Available time in the ED was cited as a significant barrier to exercise prescription. CCFP trained EPs are more comfortable prescribing exercise, suggesting that their training may better educate and prepare them to council patients on exercise compared to trained EPs. Further education may be required to standardize an approach to prescribing exercise in the ED.

P057: Performance of a national simulation-based resuscitation OSCE for emergency medicine trainees

Introduction: The use of high-fidelity simulation is emerging as an effective method for competency-based assessment in postgraduate medical education. We have previously reported the development of the Queen’s Simulation Assessment Tool (QSAT), for use in simulation-based Objective Structured Clinical Examinations (OSCEs) for Emergency Medicine (EM) trainees. We aimed to demonstrate the feasibility and present an argument for the validity of a simulation-based OSCE utilizing the QSAT with EM residents from multiple Canadian training sites. Methods: EM post-graduate trainees (PGY 2-5) from 9 Canadian EM training programs participated in an 8-station simulation-based resuscitation OSCE at Queen’s University in Kingston, ON. Each station was scored by a single trained rater from a group of 9 expert Canadian EM physicians. Raters utilized a station-specific QSAT and provided an Entrustment Score. A post-examination questionnaire was administered to the trainees to quantify perceived realism, comfort and educational impact. Statistical analyses included analysis of variance to measure the discriminatory capabilities and a generalizability study to examine the sources of variability in the scores. Results: EM postgraduate trainees (N=36) participated in the study. Discriminatory validity was strong, with senior trainees (PGY4-5) outperforming junior trainees (PGY2-3) in 6 of 8 scenarios and in aggregated QSAT and Entrustment Scores across all 8 stations (p&lt;0.01). Generalizability studies found the largest sources of random variability was due to the trainee by station interaction and the error term, with a G coefficient of 0.84. Resident trainees reported reasonable comfort being assessed in the simulation environment (3.6/5), indicated significant perceived realism (4.1/5), and found the OSCE valuable to their learning (4.8/5). Conclusion: Overall, this study demonstrates that a large-scale simulation-based EM resuscitation OSCE is feasible, and an argument has been presented for the validity of such an examination. The incorporation of simulation or a simulation-based OSCE in the national certification process in EM may help to satisfy the increased demand for competency-based assessment required by the Royal College of Physicians &amp; Surgeons of Canada’s Competency by Design transition.

A national survey on small research grants and the scholarly productivity of emergency medicine physicians in Canada

Small research grants can provide a funding source for novice physician-scientists during residency or as junior investigators. However, it is unknown if emergency medicine (EM) grant recipients benefit beyond the immediate monetary infusion of these modest awards (<$5,000). To better understand the role of small grants in EM research, we evaluated the scholarly productivity of previous recipients of a Canadian Association of Emergency Physicians (CAEP) research grant and compared the portion of career researchers among the recipients to all certified Canadian EM physicians. A 27-question online survey was developed and distributed to the recipients to ask about their CAEP grant project and research career productivity. Of the 96 grant recipients, 56 completed the survey (58% response rate). Respondents reported a high rate of project completion (95%) and publication success. Many recipients (85%) held an academic appointment, and 47% had formal research positions. In Canada, 2.5% of all certified EM physicians (n = 3,699) and 9.5% of EM specialists (n = 978) are currently involved in research. CAEP grant recipients are 5-fold and nearly 20-fold more likely than the population of certified EM specialists or all certified EM physicians, respectively, to be involved in research. As there are few funding sources in Canada for small EM-related projects, the finding that a considerably great proportion of physicians who are funded by these small grants (versus the entire pool of EM-trained physicians) commit to research as part of their career suggests that the funds may be meaningful beyond both the monetary support and project completion. The results of our evaluation indicate that modest research grants can support physician-researchers early in their careers, and many of these researchers continue with future research success, including research appointments, funding, and scholarly publications.

An exploration of Canadian emergency physicians' and residents' knowledge of computed tomography radiation dosing and risk.

The objective of this study was to measure the current knowledge of Canadian emergency physicians and emergency medicine residents regarding computed tomography (CT) radiation dosing and its associated risks. Three focus groups were conducted as the qualitative element of this study. Cognitive debriefing was carried out to ensure the validity and reliability of the focus group findings and to aid with survey development. A 26-item electronic survey was developed and pilot tested for distribution to the membership of the Canadian Association of Emergency Physicians. Eighteen emergency medicine physicians and three emergency medicine residents participated in the focus groups. Four major themes emerged: 1) physician knowledge of risks associated with CT, 2) risk management strategies, 3) communication, and 4) knowledge translation. The survey response rate was 49.8% (638 of 1,281). The mean respondent age was 40.9±9.9 years, and 70.7% were male. Of all respondents, 82.5% were actively practicing attending physicians, 56.4% of all respondents practiced in urban academic emergency departments, and the average time practicing was 10.7±9.6 years. Radiography and CT were correctly identified by 92.2% and 95.1% of respondents, respectively, as sources of ionizing radiation, whereas magnetic resonance imaging and ultrasonography were selected by 1.0% and 0.5%, respectively. With respect to the lifetime attributable risk (LAR) of malignancy due to CT, 82.2% of participants correctly identified that abdominal CT increases the risk of cancer by 0.2 to 2%, whereas 51.3% correctly identified that the LAR increases twofold in a 7- year-old boy. When asked to identify populations at risk for potential harm due to ionizing radiation, 92.2% of respondents identified children, 80.3% identified pregnant women, and 71.4% identified women of reproductive age. A minority (37.2%) reported communicating the potential risks of CT to a majority of their patients. Electronic platforms were identified by 74.8% of respondents as their preferred method of knowledge translation on this topic. Canadian emergency medicine physicians and emergency medicine residents demonstrated identifiable gaps in knowledge surrounding CT radiation dose and risk.

Rates of elastic compression stockings prescription following the diagnosis of deep venous thrombosis among Canadian emergency physicians and trainees.

Introduction Postthrombotic syndrome (PTS) is a complication of deep vein thrombosis (DVT) characterized by chronic pain, swelling, and heaviness, and may result in ulceration. Elastic compression stockings (ECS) worn daily after DVT have been shown to reduce the incidence and severity of PTS. The aim of our study was to investigate practices and perceptions of physicians regarding adjunct therapies to anticoagulation in patients diagnosed with lower extremity DVT. A national online survey was conducted of Canadian emergency medicine staff physicians and residents (n=471) to investigate their attitudes toward the prescription of ECS post-diagnosis of DVT. A paper survey of patients in a thrombosis clinic (n=58) was also administered to better understand the patient experiences with ECS. The majority of staff physician (62%) and resident (69%) respondents were unsure of whether ECS were effective in preventing PTS and managing venous symptoms. Only 6% of staff physicians and 7% of residents routinely prescribed ECS for above-knee DVTs. More than 78% of respondents were unsure about the optimal timing of initiation of ECS and duration of therapy. Although all patients noted symptomatic relief with ECS, only 50% were prescribed stockings by an emergency or family doctor, and 69% of those patients wore the stockings on a daily basis. Staff physicians most frequently identified poor fit as the reason for lack of patient compliance, whereas patients most frequently cited cost. Our findings suggest that there is variability in practice among Canadian emergency medicine physicians and trainees and a need for widespread education regarding the latest evidence of the benefit of ECS after DVT.