Clinical Practice Of Emergency Medicine Research Articles

Current gaps in emergency medicine core content education for oncologic emergencies: A targeted needs assessment.

The core content of emergency medicine (EM) residency training includes the management of oncologic emergencies; however, documented knowledge gaps continue to exist in this subtopic. This study represents a targeted needs assessment as indicated by Step 2 of Kern's curriculum design to determine the specific training gaps to be addressed within the oncologic EM curriculum. A multi-institutional cross-sectional survey of oncologists (surgical and medical) and emergency physicians (attendings and residents) was conducted during 2023 at five institutions. The voluntary survey consisted of general and specialty-specific questions exploring gaps in oncologic emergency-specific training/education topics. Descriptive statistics reported responses as frequencies and percentages. Of the 833 surveys sent across the five sites, 302 (36.3%) were accessed by link; of these, 271 (89.7%) surveys were completed. There were no differences in the responses between early and later respondents and no differences in the characteristics of respondents between sites. A vast majority of the oncologist and EM groups (91.2% and 83.0%, respectively) reported a belief that emergency physicians would benefit from additional oncologic emergency training. Our survey identified 16 important topics for inclusion in an oncologic EM curriculum, including five topics not present on the 2022 Model of Clinical Practice of Emergency Medicine. Based on this needs assessment, an oncologic EM curriculum should include the topics listed under oncologic emergencies in the 2022 Model of the Clinical Practice of Emergency Medicine along with our respondent-identified topics of radiation therapy adverse effects, stem cell transplant complications, and the management of cancer-specific postsurgical complications, pain, and common diseases in patients with cancer.

Weighing the gold standard: The breadth of emergency medicine core content covered by textbooks.

Textbooks are often considered the criterion standard in medical education, but there is a growing preference for free open-access medical education (FOAM) content among learners. Despite FOAM's appeal, these resources often fall short in covering core content as comprehensively as the American Board of Emergency Medicine's 2019 Model of the Clinical Practice of Emergency Medicine (MCPEM), thereby sustaining the recommendation for textbook use. However, textbooks have limitations, such as how quickly content can become outdated. Notably, there is no evaluation of the comprehensiveness of emergency medicine (EM) textbooks in the literature. This observational cross-sectional study compared Rosen's Emergency Medicine: Concepts and Clinical Practice 10th Edition (Rosen's) and Tintinalli's Emergency Medicine: A Comprehensive Study Guide 9th Edition (Tintinalli's) with the MCPEM subtopics. Each textbook chapter was reviewed for content alignment with MCPEM subtopics. The primary outcome was the proportion of MCPEM subtopics covered by each textbook. Secondary outcomes included the count of chapters covering each topic and their distribution relative to the core content weighting in the ABEM National Qualifying Examination (NQE). Rosen's covered 95.3% of MCPEM subtopics (837 unique subtopics), and Tintinalli's covered 94.5% (826 unique subtopics). Both textbooks overrepresented topics like toxicology and psychobehavioral disorders compared to their weighting in the NQE. Relatively underrepresented topics included environmental disorders, cardiovascular disorders, renal and urogenital disorders, and traumatic disorders in Rosen's and other core competencies and cardiovascular disorders in Tintinalli's. The textbooks varied significantly in coverage of certain topics. Both Rosen's and Tintinalli's comprehensively cover MCPEM subtopics, with some discrepancies in topic representation compared to the NQE. While textbooks offer depth and breadth, they may not fully align with the NQE content distribution. A diversified approach to EM education, combining traditional textbooks and FOAM resources may be required for comprehensive learning.

Determination, categorization, and hierarchy of content for a pediatric emergency medicine curriculum designed for emergency medicine residents.

Currently, the Accreditation Council of Graduate Medical Education requires time-based pediatric experiences for emergency medicine (EM) residents in both pediatric emergency medicine (PEM) and critical care settings. The American Board of Emergency Medicine has published the Model of the Clinical Practice of Emergency Medicine, which is a list of content an EM resident should learn. However, this list is large and without prioritization and therefore can be difficult to incorporate into time-limited curricula. The primary objective of this study was to develop comprehensive categorization of PEM content using an EM lens. The second objective was to suggest a prioritization for the EM learner of the enumerated PEM elements. We first assembled a comprehensive list of PEM concepts, diagnoses, and procedures that might be taught to EM residents. We then convened focus groups composed of key stakeholders to help formulate content and concept themes important for EM resident training. Once the themes were identified, we divided the list of PEM topics into appropriate themes and then carried out a second round of focus groups expanded to include more diverse expert input for prioritizing the elements of the comprehensive list within each theme. We prioritized 168 important PEM concepts from previous standards and emerging PEM literature among 10 identified themes: the pediatric normal, the bottom-line boil-it-down approach, common presentations, high-acuity pediatric cases and procedures, differences between children and adults, same between children and adults, red flags, infrequency of caring for a child compared with an adult, keep breadth but promote self-directed depth, and triage and disposition. Based on input from stakeholders in EM resident education, we identified key themes within PEM education and created a framework for the hierarchical categorization of PEM content for within an EM residency.

"I am the doctor": gender-based bias within the clinical practice of emergency medicine in Canada-a thematic analysis of physician and trainee interview data.

While women comprise about half of current Canadian medical students and physicians, only 31% of emergency medicine physicians identify as women and women trainees are less likely to express interest in emergency medicine compared to men. Gender-based bias continues to negatively impact the career choice, progress, and well-being of women physicians/trainees. Although instances of gender-based bias are well documented within other medical specialties, there remains a gap in the literature addressing the role of gender specific to the Canadian emergency medicine clinical environment. Using a qualitative study with a thematic analytical approach, participants were purposively and snowball sampled from a cross-section of centers across Canada and included emergency medicine attending physicians and trainees. A thematic analysis using an inductive and deductive approach was undertaken. All data were double coded to improve study trustworthiness. Descriptive statistics were used to characterize the study population. Thirty-four individuals (17 woman-identifying and 17 man-identifying) from 10 different institutions across 4 provinces in Canada participated in the study. Six themes were identified: (1) women experience gender bias in the form of microaggressions; (2) women experience imposter syndrome and question their role in the clinical setting; (3) more women provide patient care to women patients and vulnerable populations; (4) gender-related challenges with family planning and home responsibilities affect work-life balance; (5) allyship and sponsorship are important for the support and development of women physicians and trainees; and (6) women value discussing shared experiences with other women to debrief situations, find mentorship, and share advice. Gender inequity in emergency medicine affects women-identifying providers at all levels of training across Canada. Described experiences support several avenues to implement change against perceived gender bias that is focused on education, policy, and supportive spaces. We encourage institutions to consider these recommendations to achieve gender-equitable conditions in emergency medicine across Canada.

Integrating Hospice and Palliative Medicine Education Within the American Board of Emergency Medicine Model.

Hospice and palliative medicine (HPM) is a board-certified subspecialty within emergency medicine (EM), but prior studies have shown that EM residents do not receive sufficient training in HPM. Experts in HPM-EM created a consensus list of competencies for HPM training in EM residency. We evaluated how the HPM competencies integrate within the American Board of Emergency Medicine Milestones, which include the Model of the Clinical Practice of Emergency Medicine (EM Model) and the knowledge, skills, and abilities (KSA) list. Three emergency physicians independently mapped the HPM-EM competencies onto the 2019 EM Model items and the 2021 KSAs. Discrepancies were resolved by a fourth independent reviewer, and the final mapping was reviewed by all team members. The EM Model included 78% (18/23) of the HPM competencies as a direct match, and we identified recommended areas for incorporating the other five. The KSAs included 43% (10/23). Most HPM competencies included in the KSAs mapped onto at least one level B (minimal necessary for competency) KSA. Three HPM competencies were not clearly included in the EM Model or in the KSAs (treating end-of-life symptoms, caring for the imminently dying, and caring for patients under hospice care). The majority of HPM-EM competencies are included in the current EM Model and KSAs and correspond to knowledge needed to be competent in EM. Programs relying on the EM Milestones to plan their curriculums may miss training in symptom management and care for patients at the end of life or who are on hospice.

The Development, Implementation, and Evolution of an Emergency Medicine Ultrasound-guided Regional Anesthesia Curriculum.

Despite the inclusion of both diagnostic and procedural ultrasound and regional nerve blocks in the original Model of the Clinical Practice of Emergency Medicine (EM), there is no recommended standardized approach to the incorporation of ultrasound-guided regional anesthesia (UGRA) education in EM training. We developed and implemented a structured curriculum for both EM residents and faculty to learn UGRA in a four-hour workshop. Each Regional Anesthesia Anatomy and Ultrasound Workshop was four hours in length and followed the same format. Focusing on common UGRA blocks, each workshop began with an anatomist-led cadaveric review of the relevant neuromusculoskeletal anatomy followed by a hands-on ultrasound scanning practice for the blocks led by an ultrasound fellowship-trained EM faculty member, fellow, or a postgraduate year (PGY)-4 resident who had previously participated in the workshop. Learners identified the relevant anatomy on point-of-care ultrasound and reviewed how to conduct the blocks. Learners were invited to complete an evaluation of the workshop with Likert-scale and open-ended questions. In the 2020 academic year, six regional anesthesia anatomy and ultrasound workshops occurred for EM faculty (two sessions, N = 24) and EM residents (four sessions, N = 40, including a total of five PGY4s, 10 PGY3s, 12 PGY2s, and 13 PGY1s). Workshops were universally well-received by both faculty and residents. Survey results found that 100.0% of all responding participants indicated that they were "very satisfied" with the session. All were likely to recommend this session to a colleague and 95.08% of participants believed the session should become a required component of the EM curriculum. The use of UGRA is increasing, and and it critical in EM. An interdisciplinary approach in collaboration with anatomists on an interactive, nerve block workshop incorporating both gross anatomy review and hands-on scanning was shown to be well-received and desired by both EM faculty and residents.

Integration of Geriatric Education Within the American Board of Emergency Medicine Model.

Emergency medicine (EM) resident training is guided by the American Board of Emergency Medicine Model of the Clinical Practice of Emergency Medicine (EM Model) and the EM Milestones as developed based on the knowledge, skills, and abilities (KSA) list. These are consensus documents developed by a collaborative working group of seven national EM organizations. External experts in geriatric EM also developed competency recommendations for EM residency education in geriatrics, but these are not being taught in many residency programs. Our objective was to evaluate how the geriatric EM competencies integrate/overlap with the EM Model and KSAs to help residency programs include them in their educational curricula. Trained emergency physicians independently mapped the geriatric resident competencies onto the 2019 EM Model items and the 2021 KSAs using Excel spreadsheets. Discrepancies were resolved by an independent reviewer with experience with the EM Model development and resident education, and the final mapping was reviewed by all team members. The EM Model included 77% (20/26) of the geriatric competencies. The KSAs included most of the geriatric competencies (81%, 21/26). All but one of the geriatric competencies mapped onto either the EM Model or the KSAs. Within the KSAs, most of the geriatric competencies mapped onto necessary level skills (ranked B, C, D, or E) with only five (8%) also mapping onto advanced skills (ranked A). All but one of the geriatric EM competencies mapped to the current EM Model and KSAs. The geriatric competencies correspond to knowledge at all levels of training within the KSAs, from beginner to expert in EM. Educators in EM can use this mapping to integrate the geriatric competencies within their curriculums.

A Profile of Orthopedic Education in Emergency Medicine Residency Programs in the United States.

Introduction Emergency medicine (EM) residents throughout the United States are required to become skilled at performing a robust list of select orthopedic procedures, as well as learn how to diagnose and manage patients with musculoskeletal complaints. However, EM residency programs vary significantly in how they teach orthopedics and the content they cover. The purpose of this study was to profile the orthopedic education received by emergency medicine residents in United States residency programs. Methods We developed a survey based on accreditation requirements and The Model of the Clinical Practice of Emergency Medicine. The survey was designed to gather detailed information about the orthopedic education provided to EM residents. The survey was sent to EM program directors or their designees at all 263 accredited EM residency programs across the United States between October 2020 to January 2021. Results We attained a 34.6% (91 of 260) adjusted response rate with adequate representation of relevant program characteristics such as region, accreditation status, program length, size, and setting. Most (63.7%) responding programs required an orthopedics rotation during the intern year. These required orthopedic rotations were primarily four weeks in duration. The most common methods for teaching orthopedic topics included didactics (97.8%), procedures on live patients under supervision (73.3%), and assigned reading materials in textbooks or manuals (68.9%). Conclusion The orthopedic education received by EM residents in the United States is strikingly variable, with residency programs having to develop custom curricula to teach orthopedics content based on the resources available to them. Future efforts should be directed toward creating a universal curriculum that addresses accreditation and EM practice standards.

The 2022 Model of the Clinical Practice of Emergency Medicine

The 2022 Model of the Clinical Practice of Emergency Medicine

An Evaluation of Emergency Medicine Core Content Covered by Podcasts

Podcasts are used broadly for learning in emergency medicine (EM); however, there is concern about the potential for knowledge gaps for learners who rely on podcasts for their learning. The extent to which EM podcasts cover the core curriculum of EM is not known; thus, we sought to quantify the extent to which podcasts represent the core content of our specialty. We performed a retrospective review of all EM podcast episodes published in 2019. All podcasts were given credit for the content they covered as it related to the 2016 American Board of Emergency Medicine (ABEM) Model of Clinical Practice in Emergency Medicine (EM Model). The primary outcome was a description of how podcasts represented the ABEM EM Model content topics compared to the topic representation of the ABEM Qualifying Exam. We included 54 unique EM podcast programs and 1,193 podcast episodes. They covered 2,965 total EM Model core content topics. The topics most covered were "other" (which includes interpersonal skills and professionalism), procedures, and signs and symptoms. Musculoskeletal, hematology, and environmental each accounted for less than 1% of all topics covered. Almost three-quarters of podcast episodes covered other core competencies of the practice of EM. Podcasts had a broad yet imbalanced coverage of the ABEM EM Model core content subtopics in 2019, with a notable coverage of other core competencies of the practice of EM. Learners, educators, and scholars should be mindful of these gaps and focus future work on exploring how podcasts should best be used in EM education.

Distribution of core content coverage among three popular emergency medicine podcasts: A 10-year analysis.

Podcasts are increasingly utilized as educational tools within emergency medicine (EM). As EM residency programs seek to incorporate asynchronous educational material, it is important to ensure we are covering the full breadth of EM core content. This study sought to describe the distribution of EM core content among three popular EM podcasts. We performed a retrospective study of the distribution of podcast topics among three popular EM podcasts from July 2011 to June 2021. We evaluated the podcast episode content and alignment with the EM core content, as defined by the Model of the Clinical Practice of Emergency Medicine (MCPEM) and American Board of Emergency Medicine (ABEM) examination distribution. Data are presented descriptively. We identified 2759 podcast episodes, consisting of 7413 total topics and 2498.7 hours of content. The most frequently covered topics were "signs, symptoms, and presentations" (20.1% of total hours vs. 7.9% of MCPEM and 10.0% of ABEM exam) and "procedures and skills integral to the practice of emergency medicine" (14.8% of total hours vs. 8.1% of MCPEM and 8.0% of ABEM exam). The least frequently covered topics was were "immune system disorders"(0.5% of total hours vs. 2.0% of MCPEM and 2.0% of ABEM exam),"environmental disorders"(0.8% of total hours vs. 2.4% of MCPEM and 2.0% of ABEM exam), "obstetrics and gynecology" (1.0% of total hours vs. 5.4% of MCPEM and 3.0% of ABEM exam), and "cutaneous disorders" (0.9% of total hours vs. 4.3% of MCPEM and 3.0% of ABEM exam). Our findings suggest an imbalance of MCPEM core content in three popular EM podcasts.

Antimicrobial resistance control in the emergency department: a need for concrete improvement

BackgroundRational use of antibiotics (AB) and infection prevention and control (IPC) are key measures for reducing antimicrobial resistance (AMR) in healthcare. Nonetheless, transferring evidence into clinical practice in emergency medicine has proven difficult. The extent to which structural requirements for implementing AMR control exist in German emergency departments (ED) was determined in a survey.MethodsAspects of antimicrobial stewardship (AMS) and IPC implementation were surveyed within the German Association for Emergency Medicine (Deutsche Gesellschaft interdisziplinäre Notfall- und Akutmedizin e.V, DGINA) in 2018. Data were collected using an anonymous online questionnaire on ED characteristics, ED-based-link personnel for IPC and AMS, education and training, process monitoring and specific requirements for AMS and IPC as availability of AMR data and alcohol-based hand rub (AHR) consumption data. Data were analysed descriptively.Results66 EDs with in median [interquartile range (IQR)] of 30,900 [23,000; 40,000] patient visits participated in the survey. EDs’ healthcare worker (HCW) received regular training on hand hygiene (HH) in 67% and on AMS in 20% of EDs. Surveillance of AHR consumption was performed by 73% EDs, surveillance of AB consumption by 64%. Regular audits on HH were performed in 39%. Training and audit activities, showed no significant variations according to EDs’ organizational characteristics. HCWs received immediate feedback of HH performance in 29%, in 23% a regular structured feedback of HH was provided. ED-based physicians with (1) specific IPC responsibilities and training were available in 61%, with (2) AMS training and responsibility in 15%. 83% had ED based IPC link nurses with precise IPC responsibilities in place. Essentially resistance data existed at the hospital level (74%) rather than at ED- or regional level (15% and 14% respectively).ConclusionsManagement of AMR varies in German EDs, especially in accordance to hospital size and level of emergency care. IPC seems to receive more attention than AMS. Our data indicate the need for more implementation of regular IPC and AMS training in connection with monitoring and feedback in German EDs.

Management of Poisoned Patients: Implementing a Blended Toxicology Curriculum for Emergency Medicine Residents.

Management of Poisoned Patients: Implementing a Blended Toxicology Curriculum for Emergency Medicine Residents.

Emergency medicine resident clinical experience vs. in-training examination content: A national database study.

Emergency medicine (EM) residents take the In-Training Examination (ITE) annually to assess medical knowledge. Question content is derived from the Model of Clinical Practice of Emergency Medicine (EM Model), but it is unknown how well clinical encounters reflect the EM Model. The objective of this study was to compare the content of resident patient encounters from 2016-2018 to the content of the EM Model represented by the ITE Blueprint. This was a retrospective cross-sectional study utilizing the National Hospital Ambulatory Medical Care Survey (NHAMCS). Reason for visit (RFV) codes were matched to the 20 categories of the American Board of Emergency Medicine (ABEM) ITE Blueprint. All analyses were done with weighted methodology. The proportion of visits in each of the 20 content categories and 5 acuity levels were compared to the proportion in the ITE Blueprint using 95% confidence intervals (CIs). Both resident and nonresident patient visits demonstrated content differences from the ITE Blueprint. The most common EM Model category were visits with only RFV codes related to signs, symptoms, and presentations regardless of resident involvement. Musculoskeletal disorders (nontraumatic), psychobehavioral disorders, and traumatic disorders categories were overrepresented in resident encounters. Cardiovascular disorders and systemic infectious diseases were underrepresented. When residents were involved with patient care, visits had a higher proportion of RFV codes in the emergent and urgent acuity categories compared to those without a resident. Resident physicians see higher acuity patients with varied patient presentations, but the distribution of encounters differ in content category than those represented by the ITE Blueprint.

Development of a veterinary emergency open standard competency framework using a competency-based model of medical education.

To address the shortage of emergency veterinarians, the profession is exploring accelerated training pathways. We sought to contribute to the solution by developing the foundation for an open standard, competency-based veterinary emergency training curriculum for use by any program. We also developed a curricular delivery, tracking, and assessment system to demonstrate how the framework can be integrated into training programs. DESIGN: Hybrid Delphi method. SETTING: Academia and referral practice. ANIMALS: None. None. An emergency veterinary competency framework was developed by adapting the human Model of the Clinical Practice of Emergency Medicine, which aligns with the Competency-Based Veterinary Education framework, to produce 4 areas of core competency: Patient Care, Interpersonal/Communication, Professionalism, and Practice-based Learning/Improvement. A comprehensive list of veterinary emergency skills was generated and organized within the framework utilizing the hybrid Delphi method. An initial survey completed by 133 emergency and critical care specialists and emergency room clinicians produced data regarding the value of specific skills. An 11-member focus group consisting of survey participants iterated upon the survey results to produce a master library of skills and cases, including 56 Patient Care, 43 Interpersonal/Communication, 11 Practice-based Learning/Improvement, and 20 Professionalism skills, as well as 155 case types. The curricular delivery system tracks and assesses case management proficiency and development of knowledge and professional skills using a patient care eLearning program and simulation training environment. CONCLUSIONS: The increasing need for emergency veterinarians is a shared industry-wide challenge. To contribute toward a collective solution, we have undergone an evidence-based process to create the foundation for an open standard competency framework composed of a library of skills and cases. We offer this open standard framework to the veterinary profession and hope it continues to grow and evolve as we drive toward developing competency-based training programs that address the shortage of emergency veterinarians.

Maintaining procedural skills for academic emergency medicine faculty: A needs assessment.

Emergency physicians require competence performing critical and routine procedures. The clinical practice of emergency medicine (EM) alone may be insufficient for the acquisition and maintenance of skills. Prior studies suggest the presence of trainees in academic settings and/or the low frequency of procedures increase the risk of skills attrition among faculty. We sought to develop a valid needs assessment survey to inform a faculty procedural skills (FPS) maintenance curriculum. A Web-based FPS survey was designed to assess experiences performing procedures, self-reported confidence with procedures, and learning preferences for skills maintenance. The survey was administered at a large academic department of EM. Responses were analyzed to determine survey construct validity, faculty attitudes about procedural attrition, and preferred learning methods. Among EM faculty, confidence was significantly higher for common versus uncommon procedures (p<0.001). EM faculty respondents reported significantly greater confidence than pediatric EM (PEM) faculty for both common adult procedures (EM mean=3.7 [±0.3], PEM=3.0 [±0.4], p<0.001), and uncommon adult procedures (EM=2.7 [±0.4], PEM=2.1 [±0.5], p<0.001). PEM faculty reported significantly greater confidence with pediatric procedures than EM faculty (PEM mean[±SD] =3.5 [±0.8], EM=2.2 [±0.8], p<0.001). Nearly all faculty (93% [52/56]) agreed that procedural attrition is a concerning problem, and 80% (44/56) had personally experienced it. The most preferred learning methods were task trainers and simulation. Faculty preferred learning environments with faculty peers (91%) over mixed groups with trainees (50%). Significant differences in procedural skills confidence between common and uncommon procedures, and between EM and PEM faculty, indicate that the FPS survey displayed appropriate construct validity. The finding that skills attrition is prevalent among EM and PEM faculty highlights the need for skill maintenance programming, preferably in peer groups employing task trainers and simulation.

Systematic online academic resource (SOAR) review: Endocrine, metabolic, and nutritional disorders.

Free open-access medical education (FOAM) has become an integral resource for medical school and residency education. However, questions of quality and inconsistent coverage of core topics remain. In this second entry of the SAEM Systematic Online Academic Resource (SOAR) series, we describe the application of a systematic methodology to identify, curate, and describe FOAM topics specific to endocrine, metabolic, and nutritional disorders as defined by the 2016Model of the Clinical Practice of Emergency Medicine (MCPEM). We developed an automated algorithm to search 264keywords derived from ninesubtopics within the MCPEM category in the FOAM Search (a customized FOAM search tool) and the Social Media index. The top 100 results were extracted for each keyword. Resources underwent a manual iterative screening process, and those relevant to endocrine, metabolic, or nutritional disorders and EM were evaluated with the revised Medical Education Translational Resources: Impact and Quality (rMETRIQ) tool. The search yielded 36,346 resources, of which 756met the criteria for quality assessment. After rMETRIQ tool training, four raters demonstrated an average measured intraclass correlation coefficient of 0.94 (95% confidence interval= 0.88 to 0.97, p<0.001). A total of 121 posts (16% of posts) covering 25subtopics were identified as high quality (rMETRIQ ≥16). The most covered subtopic was potassium disorders, representing 15% of all posts. Subtopics that did not have a high-quality resource identified include metabolic alkalosis, respiratory alkalosis, fluid overload, phosphorus metabolism, hyperglycemia, malabsorption, malnutrition, and thyroiditis. From most to least common, the overall target audience was junior resident (91%), PGY-1 resident (88%), senior resident (81%), clerk (64%), attending (50%), and preclerkship (9%). We systematically identified, described, and curated FOAM resources for EM learners on the topic of endocrine, metabolic, and nutritional disorders. A final list of high-quality resources can guide trainees, educator recommendations, and FOAM authors.

Images of dark skin in top emergency medicine journals: A cross-sectional analysis of images of emergent cutaneous disorders.

Emergency medicine (EM) physicians must recognize emergent cutaneous disorders (CDs) in patients of all skin tones. In other medical specialties, images of CDs in light-skinned individuals (LSI) are published more frequently than images of CDs in dark-skinned individuals (DSI). This study aims to determine the representation of LSI versus DSI in images of emergent CDs published in top EM journals. This is a cross-sectional analysis of CD images published from 2015 to 2020 in the six most influential EM journals as determined by Eigenfactor. The 2016Model of the Clinical Practice of Emergency Medicine (EM Model) by the American Board of Emergency Medicine was used to classify CDs as "emergent," "nonemergent," or "not listed." The Fitzpatrick skin tone scale was used to classify skin tone as light, dark, or indeterminate. Two blinded reviewers classified each image; for disagreements, a third blinded reviewer determined the final classification. Descriptive statistics and chi-square were used to analyze the data. A kappa coefficient was used to determine reviewer agreement (LSI vs. DSI), and a weighted kappa coefficient was used for agreement between individual Fitzpatrick categories. There were 314 images of CDs. Forty images were indeterminate, and one image was excluded, leaving 273. Of the 273 images analyzed, 44.0% were emergent, 8.0% were nonemergent, and 48.0% were not listed in the EM Model. DSI comprised 13.6% of images. For emergent CDs, 85.0% were LSI versus 15.0% DSI. For nonemergent CDs, 27.3% were DSI, and for CDs not listed in the EM Model, 9.9% were DSI. The kappa coefficient for reviewer agreement between LSI and DSI was 0.76 (95% confidence interval [CI]=0.65 to 0.87) and the weighted kappa coefficient for agreement between Fitzpatrick categories was 0.70 (95% CI=0.64 to 0.76), showing substantial agreement. For emergent and nonemergent CDs, images of LSI were published more than those of DSI in top EM journals.

Evaluation of spin in the abstracts of emergency medicine systematic reviews and meta-analyses.

The objective of this study was to assess for spin - a form of reporting that overemphasizes benefits or downplay harms - within abstracts of systematic reviews and meta-analyses related to the clinical practice of emergency medicine (EM). PubMed was searched for systematic reviews and meta-analyses published since 2015 in either EM or general medical journals that examined an aspect of emergency medical care. In a duplicate, masked fashion, article titles and abstracts were screened to determine eligibility based on predetermined inclusion criteria. The included full-text studies were read and evaluated for spin using a previously determined search strategy. Two authors further evaluated study quality using the AMSTAR-2 tool. Our PubMed search identified 478 systematic reviews and meta-analyses, of which a random sample of 200 was selected for data extraction. Spin within the abstract of the manuscript was identified in 34.5% (69/200) of the included reviews. We identified seven of the nine spin types, with two types being most common: (1) conclusion claiming a benefit despite high risk of bias among studies reviewed (19.5% of abstracts), and (2) conclusion claiming a benefit despite reporting bias (14.5%). No significant associations were found between the presence of spin and any of the evaluated study characteristics, the AMSTAR-2 appraisal, or the journal of publication. Spin is commonly present in abstracts of EM systematic reviews. The reporting quality for EM systematic reviews requires improvement. Measures should be taken to improve the overall review process and way information is conveyed through abstracts.

Holes in the FOAM: An Analysis of Curricular Comprehensiveness in Online Educational Resources.

We sought to evaluate Free Open Access Medical Education (FOAM), defined as online educational content available free to anyone, anywhere, at any time, by classifying the most impactful FOAM content per the Social Media Index into the topics and subtopics of the American Board of Emergency Medicine's Model of the Clinical Practice of Emergency Medicine. We then analyzed FOAM's comprehensiveness by describing over- and underrepresentation among these topics and subtopics. First, we searched for FOAM resources based on the most recent 12months of relevant content for each organ system from the top 50 Social Media Index sites. Next, we classified all 898 posts into its related topics or subtopics per the American Board of Emergency Medicine's Model of the Clinical Practice of Emergency Medicine. Finally, we analyzed how comprehensively FOAM covered each organ system and the frequency of posts that covered each organ system subtopic as well as identified the subtopics with the most frequent coverage. The search yielded 898 FOAM posts, of which cardiology and neurology were significantly overrepresented and psychobehavioral; obstetrics and gynecology; and head, ears, eyes, nose, and throat were significantly underrepresented. Among subtopics, acute coronary syndrome had the highest subtopic coverage consisting of 55.5% of all cardiology content. Other highly represented subtopics include renal colic; diabetic ketoacidosis; sepsis; and stroke with 39, 40, 40, and 71% of each of their topic's content, respectively. Although residents and programs are frequently incorporating FOAM into the educational curriculum, these materials seem to lack comprehensiveness. Educators and learners must be aware of these deficits in creating comprehensive emergency medicine curricula.