Emergency Medicine Programs Research Articles

Building the emergency care workforce in a low resource setting; The Seed Global Health experience in Uganda

Introduction: Low- and middle-income countries (LMICs) face a disproportionate burden of diseases requiring emergency care. In Uganda, road traffic trauma in the context of rapid urbanization, particularly motorcycle accidents, accounts for 48% of medical emergencies. The burden of road traffic accidents, obstetric complications, and non-communicable diseases necessitate robust emergency care, yet Uganda faces systemic challenges in this sector. Following the 60th and 72nd sessions of the World Health Assembly that called for strengthened emergency, critical and operative care to achieve universal health coverage, Uganda committed to strengthening emergency medical services through taking key steps such as developing a national Emergency Medical Services (EMS) Policy. The EMS Policy outlined twelve key focus areas including development of human resources for emergency medical services, key among are emergency physicians. To support these efforts, Seed Global Health, the Ugandan Ministry of Health, Makerere University, and Mbarara University of Science and Technology partnered to strengthen the emergency medicine training between 2019 and 2024. Methods: We conducted a desk review to evaluate the collaborative effort between Seed Global Health, Ministry of Health, Makerere University and Mbarara University of Science and Technology. We reviewed policy documents, health records, and program reports to assess initiatives by Seed Global Health that were focused on developing human resources for emergency medical services, including emergency physicians training, emergency nurses and the contributions of local and international faculty. Results: The partnership between Seed Global Health, Ministry of Health, Mbarara University of Science and Technology and Makerere University successfully trained 21 new emergency physicians, with 43 more residents currently in training. It introduced essential clinical resources, enhancing diagnostic and treatment capacities for improved patient care while improving learning environments through skills laboratory support, simulation support and classroom equipment. Additionally, it supported the coordination of emergency services within emergency departments in hospitals as well as enhanced advocacy efforts to improving emergency care in Uganda. However, despite these tremendous milestones, challenges persist including a shortage of specialists relative to the high demand for services, a need for increased investment for emergency medical services and a need for better integration of emergency services within the healthcare system. Conclusion: This article highlights the value of international collaborations, long term partnership and targeted training in addressing emergency care gaps in LMICs. We recommend expanding emergency medicine programs, increasing government investment in facilities and human resources, and strengthening interdisciplinary emergency response teams. These measures are essential for providing sustainable, quality emergency care to address Uganda's growing needs.

Impact of Point of Care Ultrasound Rotation on Single Saudi Emergency Medicine Program, Longitudinal Prospective Study.

Background: Emergency ultrasound (EUS) has become an essential component of patient care and a mandatory skill for emergency medicine (EM) residents. Since 2001, major EM organizations have released guidelines mandating the integration of bedside ultrasonography into EM practice. Objective: This study aims to evaluate the ultrasound knowledge of emergency residents and their progress by conducting a survey before and after their EUS rotation. Method: This longitudinal prospective study was conducted at King Abdulaziz Medical City (KAMC) in Riyadh, Saudi Arabia, to investigate the improvement in knowledge, interpretation accuracy, and clinical decision-making based on ultrasound findings. The study included first-year residents who joined the EM residency program in 2023. The research team collected data by administering a pre-test and post-test. The Wilcoxon signed-rank test was used to compare the participants' scores on pre-tests and post-tests to evaluate individual differences. Results: We analyzed data from 12 residents. Half of them had received ultrasound training, and half of them used ultrasound on a daily basis. Regarding the perceived barriers to ultrasound training, the most commonly reported barriers were a lack of training (75.0%) and a lack of equipment (41.7%). All of the residents under the study anticipated the use of ultrasound in their clinical practice. The mean knowledge score of the pre-rotation period was 13.8 ± 2.6, whereas the mean post-rotation score was 17.3 ± 1.6. There was a significant increase in the knowledge score from the pre- to the post-rotation period (p < 0.0001). Conclusion: Our study has highlighted the significant benefits of the EUS rotation, including increased confidence in using ultrasound as a diagnostic tool and an enriched educational experience. EUS rotation provides residents with the hands-on experience they need to become proficient in image acquisition, interpretation, and the clinical application of these findings.

Mandating disability education in medicine: A call to action

Health care clinicians frequently treat persons with disabilities, yet disability is often overlooked in medical education. Fewer than half of U.S. medical schools include disability education in their undergraduate medical education curriculum. When included, it is often superficial and insufficient to apply to patient care. Although 98% of students at one institution reported receiving disability education, 80% reported that it was inadequate, and 64% of them felt unprepared to evaluate, diagnose, and treat people with disabilities (PWD). This trend continues in graduate medical education (GME), with only 43% of emergency medicine programs including disability content.

Mandating disability education in medicine: A call to action

Health care clinicians frequently treat persons with disabilities, yet disability is often overlooked in medical education. Fewer than half of U.S. medical schools include disability education in their undergraduate medical education curriculum. When included, it is often superficial and insufficient to apply to patient care. Although 98% of students at one institution reported receiving disability education, 80% reported that it was inadequate, and 64% of them felt unprepared to evaluate, diagnose, and treat people with disabilities (PWD). This trend continues in graduate medical education (GME), with only 43% of emergency medicine programs including disability content.

Deidentifying Narrative Assessments to Facilitate Data Sharing in Medical Education.

Narrative assessments are commonly incorporated into competency-based medical education programs. However, efforts to share competency-based medical education assessment data among programs to support the evaluation and improvement of assessment systems have been limited in part because of security concerns. Deidentifying assessment data mitigates these concerns, but deidentifying narrative assessments is time-consuming, resource intensive, and error prone. The authors developed and tested a tool to automate the deidentification of narrative assessments and facilitate their review. The authors met throughout 2021 and 2022 to iteratively design, test, and refine the deidentification algorithm and data review interface. Preliminary testing of the prototype deidentification algorithm was performed using narrative assessments from the University of Saskatchewan emergency medicine program. The algorithm's accuracy was assessed by the authors using the review interface designed for this purpose. Formal testing included 2 rounds of deidentification and review by members of the authorship team. Both the algorithm and data review interface were refined during the testing process. Authors from 3 institutions, including 3 emergency medicine programs, an anesthesia program, and a surgical program, participated in formal testing. In the final round of review, 99.4% of the narrative assessments were fully deidentified (names, nicknames, and pronouns removed). The results were comparable for each institution and specialty. The data review interface was improved with feedback obtained after each round of review and found to be intuitive. This innovation has demonstrated viability evidence of an algorithmic approach to the deidentification of assessment narratives while reinforcing that a small number of errors are likely to persist. Future steps include the refinement of both the algorithm to improve its accuracy and the data review interface to support additional data set formats.

Fixing the leaky physician-scientist pipeline: Integrated-dedicated research period programs in emergency medicine.

Emergency physicians (EPs) are well positioned to perform medical research. EPs are exposed to a wide range of disease types, medical specialties, and treatment modalities. Furthermore, emergency medicine (EM) serves as the safety net for the U.S. health care system. The diverse exposure provides a vast opportunity for EP to perform many worthwhile research projects. Yet, EM has historically had the lowest amount of funding and a lower number of National Institutes of Health-funded research projects. Many suggest the etiology is a "leaky" educational pipeline with loss of many potential physician-scientists over the training and development course. Current research training options for the EM physician-scientist includes MD-PhD, 4-year EM residency program and postresidency fellowships. While each has its advantages and disadvantages, we describe an additional educational alternative of EM physician-scientists, which we have named the integrated-dedicated research period within an EM residency. We describe the features of these programs and preliminary results from the graduates and current trainees.

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.

Pediatric Emergency Medicine Fellow Training for Bedside Teaching: A National Survey of Pediatric Emergency Medicine Fellows and Program Directors

Pediatric Emergency Medicine Fellow Training for Bedside Teaching: A National Survey of Pediatric Emergency Medicine Fellows and Program Directors

Utilizing Post-Clerkship Surveys to Optimize Emergency Medicine Program Outcomes in the Match

Utilizing Post-Clerkship Surveys to Optimize Emergency Medicine Program Outcomes in the Match

Implementation of an Evidence-Based Medicine Curriculum for Postgraduate Emergency Medicine Physician Assistant and Nurse Practitioner Fellows.

Within physician assistant (PA) education, the inclusion of evidence-based medicine (EBM) is mandatory. Despite existing literature on EBM training methodologies for PA students and emergency medicine (EM) physician residents, there exists a dearth of published data concerning EBM instruction within postgraduate PA EM programs. A pilot study is described providing an overview of implementation of an EBM curriculum in a single-institution postgraduate physician assistant and nurse practitioner emergency medicine fellowship. Quantitative data using pre-curriculum and post-curriculum surveys were collected. The curriculum included statistical concept screencasts, required attendance at a journal club with assigned topics for discussion, and used a critical appraisal tool designed to help fellows better analyze and understand the articles being reviewed. Upon graduation, fellows participated in structured interviews to collect qualitative data about the curriculum and application of learned concepts to the clinical setting. There was a statistically significant improvement in fellows' reported confidence in discussing the medical literature with practicing providers ( P = .02). However, there was no difference in prescores and postscores on EBM knowledge questions or on fellows' feelings of importance of EBM to clinical practice. Qualitative data revealed several themes, including helpfulness of tools provided in the curriculum, appreciation of curricular changes made secondary to fellow suggestions, and reports of improvement in reviewing medical literature and comfort in participation in local journal clubs upon graduation from the fellowship program. Limitations, including small sample size and validity concerns, are discussed. Positive changes were made to the curriculum based on qualitative data collected. The authors advocate for subsequent investigations into this subject within a multi-institutional and multispecialty context, thereby enhancing the breadth of the findings. Nevertheless, this study furnishes the initial accessible substantiation of the viability of introducing an EBM curriculum within this specific demographic.

Trends in nursing feedback for emergency medicine residents: A mixed-methods survey analysis of national practices.

Feedback is critical for physician development. Multisource feedback is especially important in a team-based specialty such as emergency medicine (EM) and is required by the Accreditation Council for Graduate Medical Education. Nursing assessments provide a unique perspective, but little is known about the current national patterns of their collection and use in EM. We surveyed EM program directors using a mixed-methods approach to explore the use of nursing assessment of EM residents. Descriptive data were reported as absolute numbers and percentages. An adjunct analysis of free-text responses was done using the framework method. The response rate for our survey was 63% (190 responses), of which 84% currently collect nursing feedback. Respondents from 94% of programs agreed that nursing feedback is useful in assessing professionalism and respondents from 92% of programs agreed that nursing feedback is useful in assessing communication and interpersonal skills, while 44% agreed that it is useful in informing resident medical knowledge. Forty-two percent reported that nursing feedback did not directly influence residents' progression through their training, while 2% indicated that such feedback played a significant role in leading to dismissal or probation. The majority of programs (64%) that do not collect feedback from nurses have done so in the past and hope to do so in the future. Qualitative analysis revealed themes of logistic challenges with data collection, concern regarding quality of feedback, and retributive or gender-disparate feedback. Nursing assessments of EM residents were collected by most responding programs and majority of those who do not collect them presently wish to do so in the future. They were considered particularly useful in the assessment of interpersonal skills, communication, and professionalism. However, lack of uniform methods for collecting assessment that meaningfully informs resident development and progression represents a challenge and direction for future inquiry.

Mandating disability education in medicine: A call to action

Health care clinicians frequently treat persons with disabilities, yet disability is often overlooked in medical education. Fewer than half of U.S. medical schools include disability education in their undergraduate medical education curriculum.1 When included, it is often superficial and insufficient to apply to patient care. Although 98% of students at one institution reported receiving disability education, 80% reported that it was inadequate, and 64% of them felt unprepared to evaluate, diagnose, and treat people with disabilities (PWD).2 This trend continues in graduate medical education (GME), with only 43% of emergency medicine programs including disability content.3

Development and delivery of a higher diploma in emergency medicine and critical care for clinical officers in Kenya

The provision of emergency medicine and critical care in a cost-efficient manner has the potential to address many preventable deaths in low- and middle-income countries. Here, utilising Kern's framework for curriculum development, we describe the origins, development and implementation of the Emergency Medicine and Critical Care Clinical Officer training program; Kenya's first training programme for clinical officers in emergency medicine and critical care. Graduates are scattered across the country in diverse settings, ranging from national referral hospitals in the capital, Nairobi, to rural hospitals in northern Kenya. In these locations, they provide clinical care, leadership, and teaching. Similar programmes could be replicated in other locations to help plug the gap in critical care provision in Sub-Saharan Africa.

National Needs Assessment of Emergency Medicine Residencies for Musculoskeletal Knowledge.

Introduction Musculoskeletal (MSK) complaints and injuries account for a large percentage of presenting chief complaints to the emergency department in the United States (US). Despite the prevalence and economic impact on the US healthcare system, there is a documented deficiency in MSK education at all training and practicing levels in the US medical system. The purpose of this needs assessment is to better determine the state of MSK education in Emergency Medicine residency programs. Methods An online needs assessment form was sent to Emergency Medicine program directors in the US. Summary statistics were performed followed by an exploratory analysis. Results Data from 43 of 272 Emergency Medicine program directors that responded to this needs assessment were analyzed. Respondents ranked the importance of MSK education in Emergency Medicine on a Likert scale of 1-5 (very unimportant to very important) at a mean of 4.2. Additionally, 97.6% of respondents believe that their MSK curriculum could be improved. Seventy-nine percent of respondents were somewhat likely or highly likely to use a standardized method or tool to assess MSK knowledge.Of the top three barriers to MSK education implementation, 94.9% cited time, 56.4% cited interdepartmental relations, and 46.2% cited funding. Conclusion MSK knowledge is taught and assessed in highly variable methods across Emergency Medicine residency programs. Although efforts are being made to address the known deficiency in MSK knowledge, further research is needed to perform a larger needs assessment, study innovative MSK education modalities, and develop a standardized MSK assessment for Emergency Medicine residency training.

Perspectives on preparedness for pediatric emergencies after residency: A needs assessment.

General emergency physicians provide most pediatric emergency care in the United States yet report more challenges managing emergencies in children than adults. Recommendations for standardized pediatric emergency medicine (PEM) curricula to address educational gaps due to variations in pediatric exposure during emergency medicine (EM) training lack learner input. This study surveyed senior EM residents and recent graduates about their perceived preparedness to manage pediatric emergencies to better inform PEM curricula design. In 2021, senior EM residents and graduates from the classes of 2020 and 2019 across eight EM programs with PEM rotations at the same children's hospital were recruited and surveyed electronically to assess perceived preparedness for 42 pediatric emergencies and procedures by age: infants under 1 year, toddlers, and children over 4 years. Preparedness was reported on a 5-point Likert scale with 1 or 2 defined as "unprepared." A chi-square test of independence compared the proportion of respondents unprepared to manage each condition across age groups, and a p-value < 0.05 demonstrated significance. The response rate was 53% (129/242), with a higher response rate from senior residents (65%). Respondents reported feeling unprepared to manage more emergency conditions in infants compared to other age groups. Respondents felt least prepared to manage inborn errors of metabolism and congenital heart disease, with 45%-68% unprepared for these conditions across ages. A heat map compared senior residents to recent graduates. More graduates reported feeling unprepared for major trauma, impending respiratory failure, and pediatric advanced life support algorithms. This study, describing the perspective of EM senior residents and recent graduates, offers unique insights into PEM curricular needs during EM training. Future PEM curricula should target infant complaints and conditions with lower preparedness scores across ages. Other centers training EM residents could use our findings and methods to bolster PEM curricula.

Skin Tone and Gender of High-Fidelity Simulation Manikins in Emergency Medicine Residency Training and their Use in Cultural Humility Training.

It is important for physicians to learn how to provide culturally sensitive care. Cultural humility is defined as a lifelong process with a goal of fixing power imbalances and creating institutional accountability through learning about another's culture as well as performing self-exploration about one's own beliefs, identities, and biases. One way to teach cultural humility in medicine is simulation. However, there are no peer-reviewed published studies that examine whether the skin tone or gender of the high-fidelity simulation manikins (HFSM) used by emergency medicine (EM) residency programs reflects the US population nor whether high-fidelity simulation is used to teach cultural humility. We aimed to address that gap in the literature. Our primary objective was to evaluate what proportion of EM residency programs use HFS to teach cultural humility. Our secondary objective was to evaluate whether the skin tone and gender breakdown of the EM residency program HFSM is representative of the US population. We conducted a simple random sample of 80 EM residency programs to characterize HFSM and cultural humility training. Selected programs were emailed a questionnaire. Key outcomes included HFSM skin tone and gender and whether cultural humility was taught via HFSM. We calculated point and interval estimates for the proportion of dark-, medium-, and light-toned skin and the proportion of female and male manikins. Confidence intervals were employed to test the null hypothesis that dark/medium/light skin tone was 20/20/60 and that the female/male ratio was 50/50. Both ratios were extrapolated from the US Census data. Our response rate was 74% (59/80). Fifty-five of 59 EM residency programs that had manikins (0.93, 95% confidence interval [CI] 0.88-0.99) reported data on a total of 348 manikins. Thirty-nine of the 55 programs with manikins reported using HFS to teach cultural humility (0.71, 95% CI 0.60-0.82). Proportions of light-, medium-, and dark-toned manikins were 0.52 (0.43-0.62), 0.38 (0.29-0.47), and 0.10 (0.07-0.14), respectively. Proportions of male and female HFSM were 0.69 (0.64-0.76) and 0.31 (0.24-0.36), respectively. The null hypotheses that skin tone follows a 60/20/20 split and gender follows a 50/50 split were rejected, as not all confidence intervals contained these hypothesized values. While most EM residency programs surveyed use high-fidelity simulation to teach cultural humility, the manikins do not reflect either the skin tone or gender of the US population.

Do emergency medicine residents have access to healthy food options during work hours?

Relatively little data describe how diet and food choices impact trainee well-being despite evidence that diet impacts both physical and mental health. The objective was to describe food options available to emergency medicine (EM) residents when on duty. A survey utilizing closed-ended, binary, rank-order responses was developed by experts in graduate medical education and wellness; it was piloted, revised, and then electronically distributed to 211 EM residency programs over 2 weeks in 2021. The program director (PD) or associate PD was invited to participate. A total of 114 EM programs participated (54%). The primary teaching site included 43 community hospitals, 23 county hospitals, and 48 university hospitals. Resident access to an onsite hospital cafeteria was most common (97%); other onsite options were vending machines (87%), fresh food fridges (34%), national chains (32%), local restaurants (25%), food trucks (30%), and farmer's markets (11%). More than one-third (38%) reported that onsite options did not include healthy food, 26% reported being dissatisfied with onsite food, and 35% rarely or never purchased food onsite. Most programs (89%) do not have a dedicated "meal break" for residents while on duty. Few residency programs include diet or nutrition classes or counseling. When programs sponsor meals during residency events, nutritional value and dietary considerations were ranked less important than cost of food and convenience. Access to healthy food options is not always available during scheduled resident work hours, and dedicated meal breaks are infrequent. These data should inform institutional initiatives to improve the health and well-being of resident physicians.

Characteristics of Emergency Medicine Residency Programs With Unfilled Positions in the 2023 Match

The unprecedented number of unfilled emergency medicine post-graduate year 1 (PGY-1) residency positions in the 2023 National Resident Matching Program shocked the emergency medicine community. This study investigates the association between emergency medicine program characteristics and the likelihood of unfilled positions in the 2023 Match. This cross-sectional, observational study examined 2023 National Residency Matching Program data, focusing on program type, length, location, size, proximity to other programs, previous American Osteopathic Association (AOA) accreditation, first accreditation year, and emergency department ownership structure. We constructed a generalized linear mixed model with a logistic linking function to determine predictors of unfilled positions. A total of 554 of 3,010 (18.4%) PGY-1 positions at 131 of 276 (47%) emergency medicine programs went unfilled in the 2023 Match. In our model, predictors included having unfilled positions in the 2022 Match (odds ratio [OR] 48.14, 95% confidence interval [CI] 21.04 to 110.15), smaller program size (less than 8 residents, OR 18.39, 95% CI 3.90 to 86.66; 8 to 10 residents, OR 6.29, 95% CI 1.50 to 26.28; 11 to 13 residents, OR 5.88, 95% CI 1.55 to 22.32), located in the Mid Atlantic (OR 14.03, 95% CI 2.56 to 77.04) area, prior AOA accreditation (OR 10.13, 95% CI 2.82 to 36.36), located in the East North Central (OR 6.94, 95% CI 1.25 to 38.47) area, and corporate ownership structure (OR 3.21, 95% CI 1.06 to 9.72). Our study identified 6 characteristics associated with unfilled emergency medicine residency positions in the 2023 Match. These findings may be used to guide student advising and inform decisions by residency programs, hospitals, and national organizations to address the complexities of residency recruitment and implications for the emergency medicine workforce.

A Collaborative Emergency Medicine and Radiology Pulmonary Nodule Program: Identification of Associated Efficacy and Outcomes

PurposeIncidental radiologic findings are commonplace, but the episodic nature of emergency department (ED) care makes it challenging to ensure that patients obtain appropriate follow-up. Rates of follow-up range from 30% to 77%, with some studies demonstrating that more than 30% have no follow-up at all. The aim of this study is to describe and analyze the outcomes of a collaborative emergency medicine and radiology initiative to establish a formal workflow for the follow-up of pulmonary nodules identified during ED care. MethodsA retrospective analysis was performed of patients referred to the pulmonary nodule program (PNP). Patients were divided into two categories: those with follow-up and those who do not have post-ED follow-up. The primary outcome was determining follow-up rates and outcomes, including patients referred for biopsy. The characteristics of patients who completed follow-up compared with those lost to follow-up were also examined. ResultsA total of 574 patients were referred to the PNP. Initial follow-up was established in 390 (69.1%); 30.8% were considered lost to follow-up, and more than half of these patients did not respond to initial contact. There were minimal differences in characteristics between patients in these two categories. Of the 259 patients who completed PNP follow-up, 26 were referred for biopsy (13%). ConclusionsThe PNP provided effective transitions of care and potentially improved patient health care. Strategies to further enhance follow-up adherence will provide iterative improvement of the program. The PNP provides an implementation framework for post-ED pulmonary nodule follow-up in other health care systems and can be modified for use with other incidental diagnostic findings.

A Comparison of Resident Procedure Logs to Data Generated from an Electronic Health Record

Abstract Background Emergency medicine (EM) residents are required to report procedural competency, often in a database separate from the electronic health record (EHR), in a redundant and time-consuming manner. We hypothesize that, if documented in an appropriate manner, procedural reports generated from an EHR reliably exceed those required by the Accreditation Council for Graduate Medical Education (ACGME) as well as those self-reported by EM residents. Objectives (1) To compare the number of medical resuscitations recorded in the EHR to the number documented by residents in a separate database. (2) To compare the number of medical resuscitations recorded in the EHR to the ACGME requirement for graduation. Methods Self-reported numbers of adult medical resuscitation by each resident of the previous three graduating classes of one EM program were compared with those generated from the EHR (Epic Systems, Verona, Wisconsin). There is no discrete documentation of medical resuscitations in the EHR. The ACGME describes a resuscitation as “…patient care for which prolonged physician attention is needed,” and thus, a surrogate was determined to be any patient for which the attending physician documented critical care time. Results Data generated from the EHR reliably exceeded reported (mean [M] = 165.78, standard deviation [SD] = 45.97) and required (M = 188.09, SD = 30.93) numbers for adult medical resuscitations for 100% of the residents of the past three graduating classes (n = 32). Conclusion In an accredited EM residency program that utilizes a modern EHR with a validated reporting functionality, residents should not need to redundantly log the number of adult medical resuscitations performed. Each resident in this study performed significantly more adult medical resuscitations than they logged and more than required by the ACGME, and thus, the time spent documenting these in a separate database was superfluous. Furthermore, this process increases resident awareness of proper documentation and data stewardship, two skills certain to prevail throughout their careers as modern EM physicians.