Emergency Medicine Residents Research Articles

Recruiting diverse emergency medicine residents: The influence of community diversity.

There is limited understanding of factors influencing recruitment of emergency medicine (EM) residents identifying as races and ethnicities underrepresented in medicine (URM): Black/African American, Hispanic, American Indian/Alaskan Native, or Native Hawaiian/Pacific Islander. This study explored whether diversity of EM residents at the program level is associated with community diversity at the county level. The proportion of URM residents in each EM residency program was determined using Association of American Medical Colleges academic year 2023-2024 data. We excluded newer programs without a full complement of residents and those not reporting race/ethnicity data. We used U.S. Census data to categorize each program's surrounding county as having lower diversity (<30% URM population), moderate diversity (≥30% to <49% URM population), or higher diversity (≥49% URM population). We used Kruskal-Wallis test with Dunn's procedure to determine whether the proportion of URM residents in a program was associated with the level of diversity in the surrounding county. Among 247 included EM programs, 5% of residents were Black (range 0%-46% per program), 8% Hispanic (range 0%-43%), and 4% another URM race/ethnicity. The proportion of URM EM residents was significantly lower among programs in lower-diversity counties (median [IQR] 10% [6%-16%]) than among programs in moderate-diversity (median [IQR] 14% [8%-20%], p < 0.001) or higher-diversity (median [IQR] 15% [9%-22%], p < 0.001) counties. Similarly, programs in counties with higher Black populations had more Black EM residents, and programs in counties with higher Hispanic populations had more Hispanic EM residents. EM residents at programs in lower-diversity counties are less likely to be URM than those in moderate- or higher-diversity counties. EM programs located in less diverse communities may require unique strategies to increase resident diversity.

Impact of a Hospital-Wide Nursing Strike on an Emergency Medicine Residency: Lessons Learned

Impact of a Hospital-Wide Nursing Strike on an Emergency Medicine Residency: Lessons Learned

Impact and Influence of a Teaching Resident Rotation on Emergency Medicine Resident Physicians.

The Accreditation Council for Graduate Medical Education requires residency programs to train their residents to be teachers. Teaching resident (TR) rotations in emergency medicine (EM) residency programs provide both an opportunity to train residents in teaching skills and a dedicated teaching service for junior learners in the clinical setting. The impact that this experience has on the residents themselves is unknown. We sought to explore the impact of our residency program's TR rotation on our recent graduates. We conducted a qualitative study using semistructured interviews. We recruited our residency program's recent graduates and interviewed participants over a videoconferencing platform. We used a constructivist paradigm to guide our thematic analysis. We interviewed 11 graduates and identified major themes regarding how the TR rotation impacted their comfort and preparedness to teach and supervise learners postgraduation: discovery of their teaching identity, communication skills, development of teaching and supervisory skills, and professional development. EM residents found TR rotations helpful in developing skills that prepared them to educate learners and supervise patient care postgraduation. The findings of this study may inform the use and development of TR rotations in EM and other specialties.

Implementation of regional anesthesia education for emergency medicine residents and faculty.

Using opioids for pain management in emergency departments (ED) poses risks such as respiratory depression and addiction. Ultrasound-guided regional anesthesia (UGRA) offers an alternative to opioids and procedural sedation, yet many emergency medicine (EM) residencies lack formal training for this skill. It is crucial to develop education initiatives aimed at incorporating UGRA techniques into clinical practice for emergency physicians (EPs). A regional anesthesia education program for EM residents and faculty was piloted. The intervention comprised a 25-min video on safe UGRA practices followed by a 4-h hands-on course using cadaveric and live models. Participant knowledge was tested before the course and 6 weeks afterward. Test results were analyzed via paired t-test. The electronic health record was reviewed for UGRA blocks performed in the ED 2 months before and after the intervention. Efficacy was evaluated through patient-reported pain improvement and ultrasound image review. Immediate complications are reported. Twenty-six residents and 11 faculty completed the video review, hands-on course, and the pre/posttests. With a maximum score of 30, median (IQR) pretest scores were 14 (12-17) and increased to 21 (18-23) 6 weeks postcourse, with a median 8 (95% CI 4.1-9.0) points improvement. One-hundred percent of participants found the training helpful. Clinical data were collected from August 26, 2023, to December 25, 2023, and the number of UGRA blocks performed rose from 55 before to 102 after the intervention. Pain improvement was similar before and after the intervention. Review of recorded images indicated proper needle position and anesthetic spread in 91% of blocks precourse and 82% postcourse. This educational intervention increased UGRA blocks with few complications and a high success rate. Provider knowledge significantly improved, but needle positioning and anesthetic spread were inappropriate in 18% of blocks postcourse, emphasizing the need for ongoing education to enhance UGRA competency among EPs.

Examining racial, ethnic, and gender representation of applicants and matriculants to emergency medicine residency programs from 2005 to 2021.

The emergency medicine (EM) patient population is racially and ethnically diverse, and the presence of racial and gender minority physicians may help overcome health disparities among these patients. The purpose of this study was to examine representation and its trends of racial, ethnic, and gender identities entering the EM workforce. Reports on race, ethnicity, and gender for medical school graduates, EM applicants, and residents were obtained for the years 2005-2021. Racial and ethnic groups included Asian, Black, Hispanic, and White; gender identities included men and women. The proportion of each identity in each cohort was divided by a denominator of their corresponding U.S. medical school graduate proportion, producing representation quotients among applicants and matriculants (RQapp, RQmat) that refer to the group's medical school graduate representation. Mann-Whitney U-tests were used on RQ averages to assess for differences in representation among applicants compared to matriculants. Linear regressions of yearly RQs were used to assess representation trends. Men who self-identified as Black (RQapp 1.50), Hispanic (RQapp 1.84), or White (RQapp 1.15) had the highest EM applicant representation trend relative to other groups while making up 3.5%, 5.4%, and 36.3% of all applicants, respectively. Asian women were the least represented group among applicants (RQapp 0.52), dropping from 10.7% of medical school graduates to 5.7% of EM residency applicants. Among EM matriculants, Hispanic men (RQmat 1.56) and White men (RQmat 1.43) were the only overrepresented groups. Linear regression indicated that nearly all groups had significant increases in applicant representation over time, except for Asian women and Black men. White men and White women were the only two groups to experience increases in matriculant representation compared to their applicant counterparts. Asian men, Asian women, and Black women remain underrepresented in EM residencies. Additional recruitment efforts to ensure their equitable representation are necessary in future application cycles.

Expanding the scope of emergency care: The clinical forensic medicine fellowship at Kings County Hospital.

Most victims of trauma and abuse will seek care in an emergency department (ED) within hours of their violence-related injuries. Medical training has produced well-trained physicians to evaluate, stabilize, and treat these patients in the acute setting. Unfortunately, in an ED without forensic staff, lack of timely forensic care can result in delays in treatment, loss of evidence, and hope of any justice being achieved. Emergency physicians are in a unique position to provide critical medical and forensic care to these patients, especially in health care facilities without 24-h coverage of forensic staff and social workers. In 2022, Kings County Hospital developed a clinical forensics medicine fellowship to provide specialized care to victims of trauma and provide additional training to emergency medicine (EM) residents. A clinical forensic medicine (CFM) curriculum was created to introduce trauma-informed care in adult and pediatric EM training programs. It demonstrated how forensic medicine can play an integral role in the road to recovery for victims, without interfering with the delivery of critical medical care. This article describes the development of a clinical forensics medicine fellowship at Kings County Hospital using Kern's six-step approach to curriculum design. It includes the problem identification, targeted needs assessment, goals and objectives, educational strategies, implementation, and evaluation. This article elaborates on the importance of CFM in EM residency training and provides the framework to replicate the fellowship at any institution.

Virtual Learning in Emergency Medicine Residency Programs.

Virtual Learning in Emergency Medicine Residency Programs.

Navigating Nonlinear Pathways: Challenges and Opportunities for Diversity, Equity, and Inclusion Leaders in Academic Emergency Medicine.

Navigating Nonlinear Pathways: Challenges and Opportunities for Diversity, Equity, and Inclusion Leaders in Academic Emergency Medicine.

Influence of Clinical Context on Emergency Medicine Residents' Interpretation of Gallbladder Ultrasound Images: A Pilot Analysis.

Clinical ultrasound is an essential tool for emergency medicine practitioners. It is particularly useful for evaluating abdominal pain to detect the presence of gallstones or to identify other signs compatible with the diagnosis of biliary colic or cholecystitis. Although these signs are well-defined in the literature, the influence of clinical context on ultrasound interpretation has not yet been studied. The primary objective of this study is to evaluate the impact of clinical context on emergency medicine residents' interpretation of clinical ultrasound images of normal and pathological gallbladders. This prospective observational pilot study was conducted from May to September 2023 with emergency medicine residents from three Belgian universities. Participants watched a 45-min tutorial video on clinical gallbladder ultrasound and then completed a multiple-choice questionnaire consisting of 40 dynamic ultrasound loop images, 20 without clinical context and the same 20 images with written descriptions of the clinical context. Paired Student's t-test was performed to compare diagnostic performances with and without clinical context. Overall, 23 participants completed the study, with 920 ultrasound loops being analyzed. The inclusion of clinical context significantly improved the overall diagnostic performance and especially the diagnosis of acute cholecystitis (p = 0.0309 and p = 0.0164, respectively). The overall sensitivity and specificity without clinical context were 0.74 (95% CI, 0.69-0.79) and 0.82 (95% CI, 0.76-0.87) respectively, and 0.79 (95% CI, 0.74-0.84) and 0.84 (95% CI, 0.79-0.90) with clinical context. In the subgroup of acute cholecystitis, sensitivity and specificity without clinical context were 0.56 (95% CI, 0.44-0.67) and 0.97 (95% CI, 0.95-0.99) respectively, and 0.78 (95% CI, 0.68-0.88) and 0.97 (95% CI, 0.95-0.99) with clinical context. The integration of clinical context appears to positively influence the interpretation of gallbladder ultrasound images, thereby enhancing diagnostic performance, especially sensitivity and particularly in the case of acute cholecystitis.

Design and implementation of an automated patient-care dashboard to provide individualized patient care data and quality metrics to emergency medicine residents.

The emergency department (ED) is a high-stakes training environment for emergency medicine (EM) residents and residents' ability to reflect and self-evaluate patient care is of critical importance. Patient care dashboards have been shown to increase adherence to quality guidelines and improve patient outcomes. The objectives of this study were: (1) to create a comprehensive list of evidence-based, psychologically safe patient care and quality metrics to include in a patient care dashboard for EM residents; (2) to design an EM patient care residency dashboard in a secure, cloud-based environment integrated with the electronic health record (EHR); and (3) to pilot the usability and acceptability of the dashboard among EM residents. We created a list of potential EM resident patient care metrics using ACGME Emergency Medicine Defined Key Index Procedure Minimums, leading EM quality indicators, and current EM dashboard literature. We surveyed PGY-1 to -4 EM residents at a single residency program for their recommendations about inclusion, exclusion, and the psychological safety of each metric. We then developed a dashboard utilizing Power BI software integrated with Epic EHR. After development, we conducted a 2-month pilot evaluation for usability and acceptability among EM residents utilizing a mixed-methods approach. We identified 41 metrics within five domains (productivity metrics, patient safety and leading quality indicators, key procedures, complex/high-acuity cases, and uncertain diagnosis) to consider for inclusion in the dashboard. Residents (n = 32/68; 47% survey completion rate) recommended inclusion of 33 metrics; among these, three were identified as moderate-high psychological risk (ED length of stay, patients per hour, death within 24 h) whereas the rest were considered low psychological risk. Based on these survey results, we created an EM resident patient dashboard using Microsoft Power BI. Over a 2-month pilot period with 16 residents, user data showed a change between each resident's prior patient care review practices and review practices when using a dashboard; specifically, there were notable variations in frequency of use, time spent per review session, number of patients reviewed per session, and data categories reviewed. Eleven of 16 residents completed the technology usability and acceptability survey, with general acceptability and few concerns on usability. Our dashboard provides individualized patient care data to EM residents related to productivity, patient safety and quality, key procedures, complex/high-acuity cases, and uncertain diagnoses. A pilot group of EM residents found the dashboard acceptable and useable. Continued research is needed to explore ideal implementation and integration of patient care dashboards in residency training.

The Road to Gold: An Emergency Medicine Residents Testimonial

The Road to Gold: An Emergency Medicine Residents Testimonial

Evaluation of the Effectiveness of Ultrasound Training for Emergency Medicine Residents

Evaluation of the Effectiveness of Ultrasound Training for Emergency Medicine Residents

Concussion Knowledge Among Neurosurgery, Neurology, and Emergency Medicine Residents: A Multi-institutional Study in the Western Region of Saudi Arabia.

Despite the major prevalence of concussion, it is the most misdiagnosed and undertreated form of traumatic brain injury. This multi-institutional questionnaire-based cross-sectional study aimed to assess concussion knowledge, exposure, and learning among neurosurgery, neurology, and emergency medicine residents in the western region of Saudi Arabia. The data collection of the responses was conducted between January and March 2024. The questionnairecontained 30 structured questions in three sections: Demographic data, knowledge of concussion definitions and management, and learning experiences on the topic. A total of 105 residents participated, with a mean age of 28.32±2.62years. Fifty-two (49.52%) were males. Neurosurgery residents scored significantly higher, 4±0.85out of 9, in concussion knowledge in comparison to residents in neurology, 3 ± 1.32out of 9, and emergency medicine, 3.32±1.06out of 9 residents. These differences were statistically significant(p=<0.005). Linear regression analysis indicated that residents who received lower scores on the concussion knowledge tended to rate themselves lower than those who received higher scores (B=0.461, p=0.0107). Fifty-six (53.33%) residents have not been clinically exposed to patients with concussions. The residents scored a median of 8 (2-10) out of 10 regarding their desire to involve concussion-related knowledge in their curricula. Fifty-seven (54.29%) residents chose textbooks as their most preferred source of learning about concussion, and 37 (35.24%) chose textbooks as their most preferred format. Residents of three specialties exhibited notable gaps in their knowledge of concussion; however, neurosurgery residents demonstrated better knowledge than their counterparts. These findings necessitate further education and training according to residents' preferred sources and formats to improve medical care and reduce unfavorable outcomes.

Harder, Better, Faster, Stronger? Residents Seeing More Patients Per Hour See Lower Complexity.

Patients seen per hour (PPH) is a popular metric for emergency medicine (EM) resident efficiency, although it is likely insufficient for encapsulating overall efficiency. In this study we explored the relationship between higher patient complexity, acuity on shift, and markers of clinical efficiency. We performed a retrospective analysis using electronic health record data of the patients seen by EM residents during their final year of training who graduated between 2017-2020 at a single, urban, academic hospital. We compared the number of PPH seen during the third (final) year to patient acuity (Emergency Severity Index), complexity (Current Procedural Terminology codes [CPT]), propensity for admissions, and generated relative value units (RVU). A total of 46 residents were included in the analysis, representing 178,037 total cases. The number of PPH increased from first to second year of residency and fell slightly during the third year of residency. Overall, for each 50% increase in the odds of treating a patient requiring high-level evaluation and management (CPT code 99215), there was a 7.4% decrease in mean PPH. Each 50% increase in odds of treating a case requiring hospital admission was associated with a 6.7% reduction (95% confidence interval [CI] 0.73-12%; P = 0.03) in mean PPH. Each 0.1-point increase in PPH was associated with a 262 (95% CI 157-367; P < 0.001) unit increase in average RVUs generated. Seeing a greater number of patients per hour was associated with a lower volume of complex patients and patients requiring admission among EM residents.

Protecting Frontline Workers: Strategies for Preventing and Mitigating Violence in the Emergency Department

Protecting Frontline Workers: Strategies for Preventing and Mitigating Violence in the Emergency Department

Diagnosis and management of bispecific T cell-engaging antibody toxicity: A primer for emergency physicians.

Diagnosis and management of bispecific T cell-engaging antibody toxicity: A primer for emergency physicians.

Validity of MACOCHA Score in Predicting First-pass Success of Endotracheal Intubation in Emergency Department: An Observational Study.

In the emergency department (ED), endotracheal intubation (ETI) is a critical, life-saving procedure. The MACOCHA score predicts difficult intubations in intensive care units (ICUs), but it has not been validated in the ED setting. This study aimed to validate the MACOCHA score for predicting first-pass success of ETI performed in the ED. This prospective observational study was performed in the ED of a tertiary care institute, over a period of 18 months (September 2020 to February 2022). The study included 74 adult patients who underwent emergency ETI performed by emergency medicine residents. Number of ETI attempts, first-pass success rate, and complications were noted. The MACOCHA score was calculated, and its predictive performance was evaluated. The first-pass success rate was 54.1%, and 54.1% of patients experienced complications, with hypoxia (18.9%) and hypotension (17.6%) being the most common. Four ETI attempts (p = 0.009) as well as presence of arrhythmia (p = 0.004) and cardiac arrest followed by death (p = 0.001) were significantly associated with a higher MACOCHA score, while MACOCHA score was not significantly associated with first-pass success, aspiration, hypotension, hypoxia, and local injury (p > 0.05). The number of ETI attempts and the number of complications were significantly correlated (r = 0.258, p = 0.026). At a cut-off score of 2.50, the MACOCHA score had a sensitivity and specificity of 50.0% and 35.3%, respectively, for the prediction of first-pass success rate [area under the curve: 0.593; 95% confidence interval (CI): 0.463-0.723]. MACOCHA score demonstrated limited performance in predicting the first-pass success rate of ETI in the ED. Shukla K, Bhardwaj BB, Kabi A, Galagali S, Manchanda H, Joshi S, et al. Validity of MACOCHA Score in Predicting First-pass Success of Endotracheal Intubation in Emergency Department: An Observational Study. Indian J Crit Care Med 2025;29(3):215-222.

Trauma-Informed Care for Intimate Partner Violence and Sexual Assault: Simulated Participant Cases for Emergency Medicine Learners.

Emergency medicine (EM) providers often care for patients who present with concerns related to sexual assault (SA) or intimate partner violence (IPV). However, many providers feel uncomfortable discussing SA and IPV with patients. We aimed to design a curriculum using trauma-informed care principles to improve self-assessed competency in caring for this patient population. EM learners, including residents, EM physician assistant fellows, and medical students, attended a 25-minute didactic session introducing the concept of trauma-informed care and important questions to ask in IPV and SA cases. Learners then participated in a 15-minute simulated single-patient encounter during which they practiced collecting a trauma-informed history identifying features of IPV or SA and appropriately responding to such disclosures. The encounters were observed by a trained SA medical forensic examiner or a victim advocate. The learners next participated in a 10-minute individual and 15-minute group debrief. Sixteen pre- and 17 postcurriculum self-assessments were completed. There was a statistically significant increase in self-perceived confidence in the learners' ability to collect information (p < .01), use strategies to help patients feel physically and psychologically safe (p < .001), recognize how bias influences patient encounters (p < .05), and provide counseling (p < .05). Learners overall found the learning exercise valuable. The exercise introduced learners to trauma-informed care, improved learner confidence, and was well received. Many EM residency programs incorporate simulation into their curriculum; this simulation exercise can be adapted to other programs' educational needs.

The stressed heart: Validity evidence supporting mobile heart rate variability applications to detect psychological stress in healthcare learners.

The stress experienced by healthcare learners and practitioners can impact learning, delivery of care, and mental health. Heightened awareness regarding this impact of stress has sparked the growing use of mobile health technologies for real-time tracking of stress in health professions education. The purpose of this study was to evaluate what can accurately be interpreted by the scores generated by mobile technology, regarding psychological stress levels in medical learners. In a quasi-experimental within-subjects design, 10 Emergency Medicine residents experienced two rest periods and two stress-inducing simulation scenarios. Heart rate variability (HRV) parameters produced by a mobile HRV application were compared to a reference standard analysis software, and with traditional stress measures (salivary cortisol and self-report measures) using Pearson correlation coefficients. To determine whether HRV parameters from the mobile application differentiate between rest & psychological stress conditions, a Multivariate Analysis of Variance (MANOVA), with condition (rest, stress) as the independent variable, was calculated for the HRV, cortisol and self-report measures. The mobile application's time-domain HRV parameters correlate strongly with the reference software (r values: 0.93 to 0.99, all p < 0.01), salivary cortisol levels (r = -0.54 to -63, all p <. 0.01) and self-reported stress (r = -0.46 to -0.49, all p < 0.01). These time-domain HRV parameters also accurately differentiated between rest and stress periods (eta2 = 0.43-0.70, all p < 0.01). In contrast, the frequency-domain parameter (LF/HF) of the mobile application showed weaker associations with the reference software (r = 0.10, p = 0.58) and other measures of stress (r = 0.11 to -0.16, NS), and did not differentiate between rest and stress periods (eta2 = 0.07, p = 0.25). This study provides some validity evidence for the use of a subset of time-domain HRV metrics, captured through a mobile application, for the detection of psychological stress responses in simulated clinical settings. The results also highlight the heterogeneity in HRV metrics produced by various programs. Despite the promise of mobile technologies for the detection of stress in learners and health professionals, further validity research is needed to support their use to detect stress in the health professions.

Diversity Among EMS Fellows

Diversity Among EMS Fellows