Emergency Medicine Faculty Research Articles

Multi-disciplinary assessment of the entrustable professional activities of surgery residents.

PurposeMedicine is practiced in a collaborative and interdisciplinary manner. However, medical training and assessment remain largely isolated in traditional departmental silos. Two Entrustable Professional Activities (EPAs) developed by the American Board of Surgery are multidisciplinary in nature and offer a unique opportunity to study interdisciplinary assessment.MethodsEPA microassessments were collected from Surgery and Emergency Medicine (EM) faculty between July 2018 and May 2020. Differences in feedback provided by faculty were assessed using natural language processing (NLP) techniques, (1) automated algorithms; and (2) topic modeling. Summative content analysis was used to identify themes in text feedback. We developed automated coding algorithms for these themes using regular expressions. Topic modeling was performed using latent Dirichlet allocation.Results549 assessments were collected for two EPAs: 198 for GS Consultation and 351 for Trauma. 27 EM and 27 Surgery faculty provided assessments for 71 residents. EM faculty were significantly more likely than Surgery faculty to submit feedback coded as Communication, Demeanor, and Timeliness, (all chi-square test p-values < 0.01). No significant differences were found for Clinical Performance, Skill Level, or Areas for Improvement. Similarly, topic modeling indicated that assessments submitted by EM faculty focused on communication, timeliness, and interpersonal skills, while those submitted by Surgery faculty focused on the residents’ abilities to effectively gather information and correctly diagnose the underlying pathology.ConclusionsFeedback from EM and Surgery faculty differed significantly based on NLP analyses. EPA assessments should stem from multiple sources to avoid assessment gaps and represent a more holistic picture of performance.

An Evaluation of Non-Uniform Grade Distribution with the Emergency Medicine Off-Service Standardized Letters of Evaluation.

Introduction: Standardized Letters of Evaluation (SLOEs) are designed to objectively compare medical students to their peers for completed emergency medicine (EM) rotations to be used in the EM residency match. In an attempt to adapt quickly to the lack of availability of in-person EM rotations due to COVID restrictions, “off-service” SLOEs (OSLOEs) were allowed in place of traditional SLOEs. The purpose of this study was to assess the utility of OSLOEs for candidate selection during the 2020-21 application cycle at a single EM residency.Methods: A retrospective cohort review of all OSLOEs submitted during the 2020-21 academic year to an EM residency program was performed. A total of 270 OSLOES were eligible for review. Summary statistics were calculated for the study variables recorded, including global rank, grade, categorical details, and rank.Results: Of the 270 OSLOEs reviewed, 61.9% ranked candidates in the top 10% of their class, with 95% being ranked in the top two categories. Over 90% of students were graded as honors or high pass and over 75% of students were ranked in the top 1/3 for each specific OSLOE category.Conclusion: Our findings reveal questionable utility of the objective measures in the OSLOE as there are signs it may suffer from non-uniform grade distribution, leading to low utility for candidate selection. Our data shows marked over-ranking within the highest 2 categories. EM program directors and faculty should use caution as the OSLOE may not carry the same weight as a traditional SLOE when objectively evaluating prospective students for a match into EM.

Quality Evaluation of a Checklist for Intubation Preparation in Graduate Medical Education.

BackgroundRapid sequence intubation (RSI) is a multistep process that emergency physicians commonly perform. Unfortunately, there is little published in the graduate medical education literature regarding the use of checklists for RSI education.MethodsWe developed a pre-intubation checklist for RSI preparation and evaluated emergency medicine residents’ use of it. We developed the checklist using a three-round modified Delphi process among a group of emergency medicine faculty physicians within our institution. Over a three-year period, residents were randomized into two groups: a “checklist group” and a “without-checklist group.” Residents were then evaluated for RSI critical step completion in a simulated critically ill patient by two independent study investigators. Inter-rater reliability kappa scores were calculated. Following completion of the scenario, residents in both groups were asked to complete an anonymous survey. Both groups had access to the checklist at the time of the survey. The survey was used to determine if they found the checklist helpful. Odds ratios with p-values, at an alpha of 0.05 for significance, were computed for checklist items comparing the checklist and without-checklist groups. Data analysis was performed using SAS software (SAS, Cary, NC v 9.4). This study was approved by the authors’ Institutional Review Board.ResultsEach assessment was completed by two investigators. Inter-rater reliability was substantial (κ=0.79). Residents having access to the checklist were more likely to verbalize a critical step with a p-value of < 0.0001 and an odds ratio of 2.17 (95% CI: 1.48, 3.19). The checklist group normalized vital signs prior to intubation in 25/28 (89%, 95% CI: 72.81, 96.29) versus only 6/29 (21%, 95% CI: 9.85, 38.39) with a p-value of <0.0001 in the without-checklist group. The checklist group evaluated for difficult laryngoscopy 26/28 (93%, 95% CI: 77.36, 98.02) versus only 21/29 (72%, CI 95% 54.28, 85.30) with p=0.0223 in the without-checklist group. All of the surveyed residents indicated that the checklist would be helpful for future use in the ED.ConclusionThis RSI checklist improved adherence to preparatory steps of RSI. Utilizing a checklist increased evaluation for a difficult airway and normalizing vital signs. Residents found the checklist helpful for ED use.

Building a RAFFT: Impact of a professional development program for women faculty and residents in emergency medicine.

BackgroundWomen comprise 28% of faculty in academic departments of emergency medicine (EM) and 11% of academic chairs. Professional development programs for women are key to career success and to prevent pipeline attrition. Within emergency medicine, there is a paucity of outcomes‐level data for such programs.ObjectivesWe aim to measure the impact of a novel structured professional development curriculum and mentorship group (Resident and Faculty Female Tribe, or RAFFT) within an academic department of EM.MethodsThis prospective single‐center curriculum implementation and evaluation was conducted in the academic year 2020–2021. A planning group identified potential curricular topics using an iterative Delphi process. We developed a 10‐session longitudinal curriculum; a postcurriculum survey was conducted to assess the perceived benefit of the program in four domains.ResultsA total of 76% of 51 eligible women attended at least one session; for this project we analyzed the 24 participants (47%) who attended at least one session and completed both the pre‐ and the postsurvey. The majority of participants reported a positive benefit, which aligned with their expectations in the following areas: professional development (79.2%), job satisfaction (83.3%), professional well‐being (70.8%), and personal well‐being (79.2%). Resident physicians more often reported less benefit than expected compared to fellow/faculty physicians. Median perceived impact on career choice and trajectory was positive for all respondents.ConclusionsSuccess of this professional development program was measured through a perceived benefit aligning with participant expectations, a positive impact on career choice and career trajectory for participants in each career stage, and a high level of engagement in this voluntary program. Recommendations for the successful implementation of professional development programs include early engagement of stakeholders, the application of data from a program‐specific needs assessment, early dissemination of session dates to allow for protected time off, and structured discussions with appropriate identification of presession resources.

How we compare: Society for Academic Emergency Medicine faculty membership demographics.

The Society for Academic Emergency Medicine (SAEM) has a core value to promote a diverse workforce for patients, providers, and learners. Understanding the organization's membership demographics and how that compares to the academic emergency medicine (EM) workforce is prerequisite to the success of this core value. We obtained 2020 faculty membership data sets from the Association of American Medical Colleges (AAMC) and SAEM; data included self-reported sex, race and ethnicity, and academic rank (professor, associate professor, assistant professor, and instructor). We employed standardized mean difference (SMD) to quantify difference in proportions between data sets. We identified 5874 (AAMC) and 2785 (SAEM) faculty. The AAMC (38.3%) and the SAEM (41.3%) had similar proportions of overall female faculty (SMD 0.063) although SAEM (compared to AAMC) had a higher proportion of female full (25.5% vs. 20.5%, SMD 0.121) and assistant (46.5% vs. 41.2%, SMD 0.106) professors. With the exception of Hispanic instructors, SAEM (compared to AAMC) also had higher proportions of Black and Hispanic female faculty at all ranks (SMD ranging from 0.109 to 0.777). SAEM faculty demographics generally reflect that of the academic EM workforce demographics reported in the AAMC database and that overall, the proportions of female, Black, and Hispanic faculty in SAEM are slightly larger than those in the AAMC database. However, faculty who identify as Black or Hispanic in both the AAMC and the SAEM databases (compared to the overall U.S. population) are dramatically underrepresented.

Resident attitudes, experiences, and preferences on initiating buprenorphine in the emergency department: A national survey.

The objective was to describe emergency medicine (EM) resident attitudes, preferences, and experiences around the knowledge and skills around the evidence-based treatment of opioid use disorder (OUD) in the emergency department (ED). We created an online survey that was distributed by the Emergency Medicine Residents' Association research committee listserv to approximately 6600 resident physicians at all levels of EM residency training. Data were collected between June 2020 and October 2020. This 12-question voluntary, anonymous survey included questions exploring EM resident preferences and experiences around the education and exposure to the evidence-based management of patients with OUD in the ED setting. Descriptive statistics were used. A total of 288 of 6600 invited EM residents (response rate 4.4%) from 127 different EM residency programs across 38 states in the United States, District of Columbia, and Puerto Rico completed the survey. Most respondents (165/288; 57.3%) reported that it was "very important" for emergency physicians to have training to initiate buprenorphine treatment for patients with OUD. Just under half (140/288; 48.6%) reported they have or will receive X-waiver training during residency and 46.9% (135/288) reported experience prescribing buprenorphine in the ED. The estimated proportions of EM faculty at responding residents' primary teaching hospital with an X-waiver was "most or all" (48/285; 16.8%), "about half" (23/285; 8.1%), "a handful" (79/285; 27.7%), "one or two" (33/285; 11.6%), "none" (19/285; 6.7%), or "not sure" (83/285; 29.1%). Survey results suggest that resident emergency physicians perceive the evidence-based management of OUD to be relevant to EM residency training and are interested in receiving training on initiating medications for OUD treatment in the ED. Opportunities to improve resident education and clinical use of buprenorphine during ED residency training were identified.

Establishing a Self-sustaining Emergency Medicine Point-of-Care Ultrasound Curriculum in an Academic Teaching Hospital in Ethiopia.

Point-of-care ultrasound (POCUS) training has become a standard component of Canadian emergency medicine (EM) residency programs. In resource-limited contexts, including Ethiopia, there is a critical shortage of local clinicians who can perform and teach POCUS. Our aim was to establish an introductory POCUS rotation within the EM residency program at Addis Ababa University (AAU) through The Toronto Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM). Through stakeholder engagement, the authors completed a quality improvement initiative and conducted a survey of AAU EM faculty and residents to understand which POCUS scans should be included in a core residency POCUS curriculum, "POCUS1". 17 residents completed the POCUS1 program and 16 residents completed the written survey. Focused assessment with sonography for trauma, inferior vena cava, and lung (pneumothorax, pleural effusions, and interstitial syndrome) were identified as core introductory topics. Seventeen residents completed the initial POCUS1 program. Three program graduates were supported to become "POCUS1 Master Instructors" to continue the program during the SARS-CoV-2 global pandemic. The authors identified the highest yield POCUS scans through a written survey, successfully introduced a sustainable core POCUS curriculum at AAU for EM residents, and graduated three master instructors for curriculum continuation. We outline the structure and materials for implementation of POCUS programs for EM trainees and staff in similar low- and middle-income countries.

Drivers of professional fulfillment and burnout among emergency medicine faculty: A national wellness survey by the Society for Academic Emergency Medicine.

Professional fulfillment and the mitigation of burnout can enhance clinician well-being and the resiliency of the health care organization. This study examined the extent to which specific individual and workplace factors are associated with professional fulfillment and burnout among a national sample of academic emergency physicians. This was a cross-sectional survey of faculty members of the Society for Academic Emergency Medicine. Primary outcomes were professional fulfillment and burnout. The survey also examined individual and workplace factors as well as faculty's thoughts of attrition from academic and clinical medicine. Logistic regression was performed to determine the relationships between each outcome and each factor, respectively. A total of 771 of 3130 faculty completed the survey (response rate 24.6%). A total of 38.7% reported professional fulfillment and 39.1% reported burnout. Meaningfulness of work (odds ratio [OR] 2.2, 95% confidence interval [CI] 1.9-2.5), perceived appreciation (OR 1.9, 95% CI 1.7-2.1), and the academic work environment (OR 1.7, 95% CI 1.5-1.9) had the highest odds of being associated with professional fulfillment. In contrast, low score responses for meaningfulness of work (OR 0.6, 95% CI 0.5-0.6), self-compassion (0.6, 95% CI 0.5-0.6), and control over schedule (OR 0.6, 95% CI 0.6-0.7) were most associated with burnout. Faculty with professional fulfillment were less likely to report plans for attrition from academics (OR 0.1, 95% CI 0.1-0.2) and from clinical medicine (OR 0.2, 95% CI 0.1-0.4). Faculty with burnout were more likely to report plans for attrition from academics (OR 7, 95% CI 4.8-10.4) and clinical medicine (OR 5.7, 95% CI 3.9-8.6). Individual and workplace factors that contributed to professional fulfillment and burnout were identified, with meaningfulness of clinical work demonstrating the strongest association with both occupational phenomena. Knowledge of which factors are most impactful in promoting professional fulfillment and mitigating burnout may be useful in guiding efforts to enhance clinician well-being.

Success of implementation of a systemwide point-of-care ultrasound privileging program for emergency medicine faculty.

Point-of-care ultrasound (POCUS) is widely used in the emergency department (ED). Not all practicing emergency physicians received POCUS training during residency, leaving a training gap that is reflected in POCUS privileging. The purpose of this study was to evaluate the success of meeting privileging criteria as well as associated factors, following implementation of a basic POCUS training and privileging program within a large emergency medicine department. We implemented a POCUS training and privileging program, based on national guidelines, for faculty physicians who worked at one of the following EDs staffed by the same emergency medicine department: a pediatric tertiary site, two tertiary academic sites, and seven community sites. POCUS examinations included aorta, cardiac, first-trimester obstetrics (OB), and extended focused assessment with sonography in trauma. Pediatric emergency medicine faculty were taught soft tissue and thoracic US instead of aorta and OB. Completion of the program required 16h of didactics, ≥25 quality-assured US examinations by examination type, and passing a series of knowledge-based examinations. Descriptive statistics were calculated. Associations between physician characteristics and successfully becoming privileged in POCUS were modeled using Firth's logistic regression. A total of 176 faculty physicians were eligible. A total of 145 (82.4%) achieved basic POCUS privileging during the study period. Different pathways were used including 86 (48.9%) practice-based, nine (5.1%) fellowship-based, and 82 (46.9%) residency-based. POCUS privileging was lower for those working in a community versus academic setting (odds ratio 0.3, 95% confidence interval 0.1-0.9). A greater number of scans completed prior to the privileging program was associated with greater success. Implementation of a POCUS training and privileging program can be successful in a large emergency medicine department that staffs hospitals in a large-scale health care system composed of both academic and community sites. Faculty physicians with at least some prior exposure to POCUS were more successful.

What Faculty Want: Academic and Community Emergency Physicians' Perceptions of Learner Feedback.

IntroductionFaculty development is often deployed by central medical schools, with little guidance from end-users. How and what faculty members can use to improve their performance requires a deeper understanding from this user group. This study aims to explore how faculty perceive learners’ feedback about their performance as educators.MethodsThis study is an explanatory mixed-method research, wherein community- and academic-based emergency medicine faculty members from nine regional hospitals were surveyed about their perceptions of various outcome measures for faculty development. Selected participants were invited to follow-up interviews. We analyzed the physicians’ perceptions toward teaching and performance feedback data based on faculty’s gender, role as academic or community physician, and work experience.ResultsThe quantitative phase has 104 participants, and 15 of these were followed up with interviews. The gender of faculty does not have statistical or practical differences regarding their perceptions of learner feedback. Type of practice contains meaningful insights about the perception of learner feedback although it does not have a statistical difference. Moreover, an inverse trend exists between the physicians’ years of experience and their perceived value of learner feedback. Kruskal-Wallis test showed a significant difference in the faculty’s experience level and their perceived value for the metric “quantity of feedback commentary compared to their peer group” (H(4) = 12.21, p = 0.02), specifically between junior and senior faculty (p = 0.007). Some faculty stated that experienced faculty may perceive they have a very well-established style.ConclusionsDiversifying feedback sources and delivery may be useful for different groups of faculty members. Junior physicians are more interested in gaining feedback about the quantity of their written feedback to students compared to more senior physicians. Learner feedback holds promise to trigger continuous improvement in community sites for those who fall behind compared to the academic sites.

Meeting expectations: An exploration of academic emergency medicine faculty experiences and preferences in the virtual meeting environment by age, gender and parental status.

During the COVID-19 pandemic, virtual meetings became the norm in academic emergency medicine (EM) departments. This study explores the experiences of academic EM faculty within this environment. In 2021, authors surveyed a cross-sectional convenience sample of EM faculty using a mixed-methods approach to explore perceptions of the virtual meeting environment. Authors reported data on a five-point Likert scale, summarized as percentages, and calculated differences using Pearson's chi-squared test, where p<0.05 was significant. Free text responses were analyzed qualitatively. Two-hundred-fifty-nine responses were collected, (female [55.6%], ≤40years old, [39.8%]) of which 33.2% had children ≤7years old. Most respondents felt the total number of virtual meetings had increased and were more likely to happen outside of regular business hours compared to in-person meetings. Most faculty preferred meetings during regular hours and liked the virtual format overall. Younger faculty respondents were more polarized in their preferences of timing of meetings and reported more pressure to accept meetings outside of regular hours. Female respondents with young children were more likely to dislike meetings outside regular hours and to have declined them. Women faculty, younger faculty, and women faculty with young children were significantly more likely to agree that women had been "more impacted by the new virtual work environment." Qualitative themes highlighting the flexibility provided by the virtual work environment and decreased commuting time, though many felt communication was limited in virtual meetings. Academic EM faculty mostly preferred keeping meetings during regular business hours and in a virtual format. Experiences varied by age but not by gender overall. Women with young children reported greater challenges than women without. Men did not differ by parental status. The virtual format provided increased flexibility but limited communication and engagement. Academic EM departments may use this data to inform future meeting practices.

Institutional solutions addressing disparities in compensation and advancement of emergency medicine physicians: A critical appraisal of gaps and associated recommendations.

Disparities in salary and advancement of emergency medicine (EM) faculty by race and gender have been consistently demonstrated for over three decades. Prior studies have largely focused on individual-level solutions. To identify systems-based interventions, the Society for Academic Emergency Medicine (SAEM) formed the Research Equity Task Force in 2018 with members from multiple academies (the Academy of Academic Chairs in Emergency Medicine [AACEM], the Academy of Academic Administrators in Emergency Medicine [AAAEM], the Academy for Women in Academic Emergency Medicine [AWAEM], and the Academy for Diversity and Inclusion in Emergency Medicine [ADIEM]) and sought recommendations from EM departmental leaders. The task force conducted interviews containing both open-ended narrative and closed-ended questions in multiple phases. Phase 1 included a convenience sample of chairs of EM departments across the United States, and phase 2 included vice-chairs and other faculty who lead promotion and advancement. The task force identified common themes from the interviews and then developed three-tiered sets of recommendations (minimal, target, and aspirational) based on participant responses. In phase 3, iterative feedback was collected and implemented on these recommendations from study participants and chairs participating in a national AACEM webinar. In findings from 53 interviews of chairs, vice-chairs, and faculty leaders from across the United States, we noted heterogeneity in the faculty development and promotion processes across institutions. Four main themes were identified from the interviews: the need for a directed, structured promotion process; provision of structured mentorship; clarity on requirements for promotion within tracks; and transparency in salary structure. Recommendations were developed to address gaps in structured mentorship and equitable promotion and compensation. These recommendations for AEM departments have the potential to increase structured mentorship programs, improve equity in promotion and advancement, and reduce disparities in the AEM workforce. These recommendations have been endorsed by SAEM, AACEM, AWAEM, ADIEM, and AAAEM.

Design and implementation of a basic and global point of care ultrasound (POCUS) certification curriculum for emergency medicine faculty

Point of care ultrasound (POCUS) use in the emergency department is associated with improved patient outcomes and increased patient satisfaction. When used for procedural guidance, it has been shown to increase first pass success and decrease complications. As of 2012, ultrasound has been identified as a core skill required for graduating emergency medicine (EM) residents. Despite this, only a minority of EM faculty who trained prior to 2008 are credentialed in POCUS. Half of all EM training programs in the United States have less than 50% of their faculty credentialed to perform and teach POCUS to learners. As the use of POCUS continues to grow in medicine, it is especially important to have a pathway for faculty to attain competence and become credentialed in POCUS. The goal of this paper was to outline an implementation process of a curriculum designed to credential EM faculty in POCUS.

Hot Off the Press: Addressing gender inequities: Creation of a multi-institutional consortium of women physicians in academic emergency medicine.

Hot Off the Press: Addressing gender inequities: Creation of a multi-institutional consortium of women physicians in academic emergency medicine.

Formalized Storytelling in Emergency Medicine

Storytelling is an effective tool for medical education. The authors describe a formalized storytelling program for physicians. A conceptual model is proposed for why storytelling events are an effective modality across the domains of reflective practice, professional development, and physician wellness. Formalized storytelling is a novel strategy for professional development in medicine. In this paper, we describe a storytelling program for emergency physicians and propose a conceptual model for why storytelling events are an effective way to address the imperatives of reflective practice, professional identity development and physician wellness. Since 2015, groups such as Airway-Stories have held events for emergency physicians to help them relate and reflect on stories told by colleagues in a relaxed setting. These storytelling events are live forums in which physicians can share stories about experiences of patient care with an audience of their peers. The events were initially held at local venues in order to create physical and emotional distance from the clinical workplace, but have since proliferated to include many academic emergency medicine conferences and, during Covid-19 lockdowns, international videoconferences. Participants have primarily included emergency medicine faculty and residents, though more recently; these events have integrated other disciplines and health professions in medicine. The narrative topics span the breadth of clinical scenarios and have provided a forum for reflection in a group setting. The stories from these events have involved expressions of pride, humor, gratitude, as well as sadness and regret, along with a variety of authentic emotions that are otherwise not given expression in a formal curriculum or during physician meetings or conferences. Given the unscripted nature of these events, it has been somewhat surprising that the narratives have almost without exception manifested professional virtue and evinced the core humanistic values of medicine. There have been few if any stories with cynical or demoralizing themes. This observation has led us to believe that formalized storytelling events are a way to tap into these positive narratives and that they hold promise in supporting medical professionalism.

Investigation of Self-Esteem and Assertiveness Levels among Emergency Healthcare Personnel

Objective: It has been determined that self-esteem and assertiveness level of the individual significantly affect his/her environment. In this study, our goal is to determine the self-esteem and assertiveness levels of healthcare personnel in Emergency Department.Methods: Our study is a prospective analytical observational study. The study population included nurses, emergency medicine residents, specialists and faculty member working in the Emergency Department. The three-part questionnaire form consists of 54 questions. Data were collected using a personal information form containing socio-demographic characteristics (14 questions), the Rosenberg Self-Esteem Scale (RSES) form (10 questions) and the Rathus Assertiveness Schedule (RAS) (30 questions).Results: 217 participants were included. The median of RSES scores of the individuals was found to be 31 (10-40) and the median RAS of 20 (-42-69). Most of the participants did not receive any training on self-esteem or assertiveness (79.3% and 88%, respectively). Majority of participants stated that they did not have difficulty expressing themselves. RSES scores of those who stated they needed self-esteem training were found to be lower (p &amp;lt;0.001). RAS scores of those who needed assertiveness training were found to be lower than those who did not, and this difference was statistically significant (p &amp;lt;0.001).Conclusion: Self-esteem and assertiveness levels of the healthcare professionals working in the emergency department are high. Although individuals' education about self-esteem or assertiveness does not change their self-esteem and assertiveness, those with low self-esteem and assertiveness feel a need for these issues.

Overcoming barriers to promotion for women and underrepresented in medicine faculty in academic emergency medicine.

Equity in the promotion of women and underrepresented minorities (URiM) is essential for the advancement of academic emergency medicine and the specialty as a whole. Forward‐thinking healthcare organizations can best position themselves to optimally care for an increasingly diverse patient population and mentor trainees by championing increased diversity in senior faculty ranks, leadership, and governance roles. This article explores several potential solutions to addressing inequities that hinder the advancement of women and URiM faculty. It is intended to complement the recently approved American College of Emergency Physicians (ACEP) policy statement aimed at overcoming barriers to promotion of women and URiM faculty in academic emergency medicine. This policy statement was jointly released and supported by the Society for Academic Emergency Medicine (SAEM), American Academy of Emergency Medicine (AAEM), and the Association of Academic Chairs of Emergency Medicine (AACEM).

"Friction by Definition": Conflict at Patient Handover Between Emergency and Internal Medicine Physicians at an Academic Medical Center.

IntroductionPatient handoffs from emergency physicians (EP) to internal medicine (IM) physicians may be complicated by conflict with the potential for adverse outcomes. The objective of this study was to identify the specific types of, and contributors to, conflict between EPs and IM physicians in this context.MethodsWe performed a qualitative focus group study using a constructivist grounded theory approach involving emergency medicine (EM) and IM residents and faculty at a large academic medical center. Focus groups assessed perspectives and experiences of EP/IM physician interactions related to patient handoffs. We interpreted data with the matrix analytic method.ResultsFrom May to December 2019, 24 residents (IM = 11, EM = 13) and 11 faculty (IM = 6, EM = 5) from the two departments participated in eight focus groups and two interviews. Two key themes emerged: 1) disagreements about disposition (ie, whether a patient needed to be admitted, should go to an intensive care unit, or required additional testing before transfer to the floor); and 2) contextual factors (ie, the request to discuss an admission being a primer for conflict; lack of knowledge of the other person and their workflow; high clinical workload and volume; and different interdepartmental perspectives on the benefits of a rapid emergency department workflow).ConclusionsCauses of conflict at patient handover between EPs and IM physicians are related primarily to disposition concerns and contextual factors. Using theoretical models of task, process, and relationship conflict, we suggest recommendations to improve the EM/IM interaction to potentially reduce conflict and advance patient care.

Gender differences in publication in emergency medicine journals

Some studies have suggested gender disparities in both pay and academic promotion which may adversely affect salary and career progression for female physicians. The areas of research output, funding, and authorship have not been fully and systematically examined in the emergency medicine literature. We hypothesize that gender differences may exist in research output, impact, authorship, and funding. We conducted a cross-sectional study examining all published articles in the top three emergency medicine journals as determined by Impact Factor between February 2015 and February 2018. We compared the authorship, number of citations of each article, funding, and h-index of each author by gender. Of the 10,118 authors representing 4166 original articles in our sample, 7562 (74.7%) were male and 2556 (25.3%) were female, with females underrepresented relative to the known proportion of female emergency medicine faculty. Males were proportionally more likely to be last authors (OR 1.65, 95% CI, 1.47-1.86) and less likely to be first authors than females (OR 0.85, 95% CI, 0.77-0.94). No difference in proportions of males and females in terms of being named as having funding was found (OR 1.02, 95% CI, 0.78-1.35). Males had higher h-indexes than females (5 vs. 3, p < .001) as well as a higher average number of citations (OR 1.068, 95% CI, 1.018-1.119). Males outnumber females in terms of numbers of publications, but also in number of citations, h-index, and last authorship. Future studies on physician gender disparities in emergency medicine need to account for these population differences.

Characteristics and Experiences of Women Physicians and Professionals in NAEMSP

Introduction: One of the six guiding principles of the EMS Agenda 2050 is to foster a socially equitable care delivery system. A specific recommendation within this principle is that “local EMS leadership, educators and clinicians [should] reflect the diversity of their communities.” Research has shown that women comprise a minority of emergency medicine services (EMS) field clinicians. In academic settings, women are represented at lower rates among experienced EMS faculty than within Emergency Medicine clinicians or faculty at large. The reasons for these differences are also unknown. Little data exist describing the number or experience of female physicians and professionals in EMS. Purpose: Our objective was to describe the composition and experiences of EMS physicians, researchers and professionals who participate in the Women in EMS group of the National Association of EMS Physicians (NAEMSP). Methods: We performed a cross-sectional, mixed-methods descriptive study of women belonging to the Women in EMS Committee of NAEMSP. A survey was sent to the 143 members of this group using a list-serve, and the data was collected in Redcap. Results: Seventy-four people completed the survey. Respondents were 96% female, 82% Caucasian, 11% underrepresented minorities (URM), and 7% LGBTQI. Of the 88% that are physicians, 78% are board certified in Emergency Medicine, compared to 55% in EMS. Forty-eight percent reported they received some form of mentorship. Among these respondents, a minority reported female mentorship, which was usually from a remote rather than local mentor (41% vs. 15%). Eighty-three percent of respondents had experienced some form of discrimination or harassment in their career, but only 68% reported their workplace culture discourages such behavior. Thirty-three percent of respondents report receiving unequal recognition because of gender. Thematic evaluation of the qualitative responses showed that respondents felt there were fewer barriers to mentorship and professional advancement opportunities in local work versus national engagement. Conclusions: In a survey evaluating representation of female professionals in EMS, participants reported on their career representations, and experiences of gender-based inequity within their EMS career settings. Several opportunities exist to improve diversity, equity, and inclusion for women in EMS based on our findings.