Medicine Residency Training Programs Research Articles

Beyond the emergency department: Effects of COVID-19 on emergency medicine resident education.

In December 2019, a novel coronavirus (COVID-19) caused widespread clinical disease, triggering limited in-person gatherings and social-distancing guidelines to minimize transmission. These regulations led most emergency medicine (EM) residency training programs to rapidly transition to virtual didactics. We sought to evaluate EM resident perceptions of the effects of COVID-19 on their didactic and clinical education. We performed a cross-sectional survey study at seven EM residency programs using a mixed-methods approach designed to understand resident perceptions regarding the impact of COVID-19 on their educational experience. Quantitative data were presented as percentages with comparison of subgroups, while open-ended responses were analyzed using qualitative methodology. We achieved a 59% response rate (187/313). The majority of respondents (119/182, 65.4%) reported that the COVID-19 pandemic had a negative impact on their residency education with junior residents disproportionately affected. A total of 81 of 182 (44.5%) participants reported that one or more of their clinical rotations were partially or completely canceled due to the pandemic. Additionally, we identified four themes and 34 subthemes highlighting the contextual effects of the pandemic, which were then divided into positive and negative influences on the residency experience. The four themes include systems experience, clinical experience, didactic experience, and wellness. Our study examined the impact of COVID-19 on residents' educational experiences. We found overall mixed responses with a slightly negative impact on residency education, wellness, and clinical rotations, while satisfaction with EM as a career choice was increased. Factors influencing this included systems, clinical, and didactic experiences as well as overall wellness.

Characterizing the Prevalence and Types of Curricular Tracks in Internal Medicine Residency Training Programs.

Characterizing the Prevalence and Types of Curricular Tracks in Internal Medicine Residency Training Programs.

Emergency medicine matters: epidemiology of medical pathology and changes in patient outcomes after implementation of a post-graduate training program at a Tertiary Teaching Hospital in Kigali, Rwanda

BackgroundEmergency care is a new but growing specialty across Africa where medical conditions have been estimated to account for 92% of all disability-adjusted life years. This study describes the epidemiology of medical emergencies and the impact of formalized emergency care training on patient outcomes for medical conditions in Rwanda.MethodsA retrospective cohort study was performed using a database of randomly sampled patients presenting to the emergency center (EC) at the University Teaching Hospital of Kigali. All patients, > 15 years of age treated for medical emergencies pre- and post-implementation of an Emergency Medicine (EM) residency training program were eligible for inclusion. Patient characteristics and final diagnosis were described by time period (January 2013–September 2013 versus September 2015–June 2016). Univariate chi-squared analysis was performed for diagnoses, EC interventions, and all cause EC and inpatient mortality stratified by time period.ResultsA random sample of 1704 met inclusion with 929 patients in the pre-residency time period and 775 patients in the post-implementation period. Demographics, triage vital signs, and shock index were not different between time periods. Most frequent diagnoses included gastrointestinal, infectious disease, and neurologic pathology. Differences by time period in EC management included antibiotic use (37.2% vs. 42.2%, p = 0.04), vasopressor use (1.9% vs. 0.5%, p = 0.01), IV crystalloid fluid (IVF) use (55.5% vs. 47.6%, p = 0.001) and mean IVF administration (2057 ml vs. 2526 ml, p < 0.001). EC specific mortality fell from 10.0 to 1.4% (p < 0.0001) across time periods.ConclusionsMortality rates fell across top medical diagnoses after implementation of an EM residency program. Changes in resuscitation care may explain, in part, this mortality decrease. This study demonstrates that committing to emergency care can potentially have large effects on reducing mortality.

Development and launch of the first obstetrics and gynaecology master of medicine residency training programme in Botswana

BackgroundSub-Saharan Africa (SSA) faces a severe shortage of Obstetrician Gynaecologists (OBGYNs). While the Lancet Commission for Global Surgery recommends 20 OBGYNs per 100,000 population, Botswana has only 40 OBGYNs for a population of 2.3 million. We describe the development of the first OBGYN Master of Medicine (MMed) training programme in Botswana to address this human resource shortage.MethodsWe developed a 4-year OBGYN MMed programme at the University of Botswana (UB) using the Kern’s approach. In-line with UB MMed standards, the programme includes clinical apprenticeship training complemented by didactic and research requirements. We benchmarked curriculum content, learning outcomes, competencies, assessment strategies and research requirements with regional and international programmes. We engaged relevant local stakeholders and developed international collaborations to support in-country subspecialty training.ResultsThe OBGYN MMed curriculum was completed and approved by all relevant UB bodies within ten months during which time additional staff were recruited and programme financing was assured. The programme was advertised immediately; 26 candidates applied for four positions, and all selected candidates accepted. The programme was launched in January 2020 with government salary support of all residents. The clinical rotations and curricular development have been rolled out successfully. The first round of continuous assessment of residents was performed and internal programme evaluation was conducted. The national accreditation process was initiated.ConclusionTraining OBGYNs in-country has many benefits to health systems in SSA. Curricula can be adjusted to local resource context yet achieve international standards through thoughtful design and purposeful collaborations.

Impact of COVID-19 Pandemic on Medical Rehabilitation Training and Education in Asia, Eastern Mediterranean, and Oceania

Background: The Coronavirus Disease 2019 (COVID-19) pandemic has adversely impacted the Physical and Rehabilitation Medicine (PRM) residency training program in many countries. Aims and Objectives: To describe and analyse the issues and challenges faced by PRM trainees in Asia, Eastern Mediterranean and Oceania, and to discuss strategies to encounter the training and educational challenges amidst the pandemic. Materials and Methods: A cross-sectional survey was completed by Country Ambassadors of the International Society of Physical and Rehabilitation Medicine (ISPRM) World Youth Forum Task Force, to assess the COVID-19 impact on PRM trainees across Asia, Eastern Mediterranean, and Oceania. Results: Participants reported issues including training program disruption, limited practical skills training, examination postponement, negative psychological consequences, PRM service delivery restructuring, and deployment to acute services. Conclusion: The COVID-19 pandemic has variably impacted PRM residency training programs in the countries. The role of National Societies, training programs, and ISPRM is crucial to support trainees during the pandemic.

Attrition in Podiatric Medicine and Surgery Residency.

The objective of this study was to investigate the rate of attrition within podiatric medicine and surgery residency training programs. Between the academic years 2006-2007 and 2015-2016, the Temple University School of Podiatric Medicine matched 780 graduates into 163 different residency training programs. Program directors from these sites were individually contacted by e-mail and asked whether the specific Temple University School of Podiatric Medicine graduates who originally matched with their program 1) completed the program, 2) transferred to another program, 3) quit the program, or 4) were fired from the program. Results were returned with respect to 614 (78.7%) of the 780 graduates, representing 103 (63.2%) of the 163 training programs. Program directors reported that 573 (93.3%) of the 614 graduates completed the program, 17 (2.8%) transferred from the program, six (1.0%) quit the program, five (0.8%) were fired by the program, and 13 (2.1%) matched but never started the program. This equates to an annual attrition rate of 0.46% for residents who started the podiatric residency training program that they matched with. We conclude that the rate of attrition in podiatric medicine and surgery residency training appears to be relatively low or at least in line with other medical specialties, and hope that this information leads to other investigations examining attrition, specifically as it relates to physician-specific and program-specific risk factors for attrition.

What is the impact of the COVID-19 pandemic on emergency medicine residency training: an observational study

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has engendered difficulties for health systems globally; however, the effect of the pandemic on emergency medicine (EM) residency training programs is unknown. The pandemic has caused reduced volumes of emergency department (ED) patients, except for those with COVID-19 infections, and this may reduce the case exposure of EM residents. The primary objective of this study was to compare the clinical exposure of EM residents between the prepandemic and pandemic periods.MethodsThis was a retrospective study of EM resident physicians’ training in a tertiary teaching hospital with two branch regional hospitals in Taiwan. We retrieved data regarding patients seen by EM residents in the ED between September 1, 2019, and April 30, 2020. The first confirmed COVID-19 case in Taiwan was reported on January 11, so the pandemic period in our study was defined as spanning from February 1, 2020, to April 30, 2020. The number and characteristics of patients seen by residents were recorded. We compared the data between the prepandemic and pandemic periods.ResultsThe mean number of patients per hour (PPH) seen by EM residents in the adult ED decreased in all three hospitals during the pandemic. The average PPH of critical area of medical ED was 1.68 in the pre-epidemic period and decreased to 1.33 in the epidemic period (p value < 0.001). The average number of patients managed by residents decreased from 1.24 to 0.82 in the trauma ED (p value = 0.01) and 1.56 to 0.51 in the pediatric ED (p value = 0.003) during the pandemic, respectively. The severity of patient illness did not change significantly between the periods.ConclusionsThe COVID-19 pandemic engendered a reduced ED volume and decreased EM residents’ clinical exposure. All portion of EM residency training were affected by the pandemic, with pediatric EM being the most affected. The patient volume reduction may persist and in turn reduce patients’ case exposure until the pandemic subsides. Adjustment of the training programs may be necessary and ancillary methods of learning should be used to ensure adequate EM residency training.

363 A National Survey of Workflow Efficiency Education among Emergency Medicine Residency Training Programs

Patient volumes in United States (U.S.) emergency departments (EDs) have been on the rise. Medical directors and employers seek emergency medicine (EM) physicians who have strong workflow efficiency (WFE) to help address high ED volumes without compromising patient care. Although WFE is a skill that EM residents should learn prior to graduation, it is not an Accreditation Council for Graduate Medical Education (ACGME) core competency, and there is no standard approach to measure and teach this skill during residency. Additionally, no studies have examined whether EM residency program leaders believe efficiency should be formally taught in EM residency programs. We sought to gain further insight into whether explicit teaching of WFE is important to EM residency program leadership, and the manner in which WFE is currently measured and taught to EM residents. We conducted a cross-sectional survey of all allopathic ACGME-accredited EM residency training programs in the U.S. The survey was conducted using SurveyMonkey® in the Fall of 2019. We invited all allopathic EM residency programs to voluntarily participate in the study, primarily by emailing their program directors (PDs). Assistant/associate program directors were invited subsequently if there was no response from the PD. We performed descriptive statistics on all survey data using SurveyMonkey® software. We received a total of 133 responses out of 190 total programs (response rate 70%) with proportionate representation from 3 & 4-year programs and all regions of the U.S. When asked “To what extent teaching efficiency should be a priority compared to other educational goals,” 65% of program leaders responded with “significant” or “moderate” priority. Most EM programs collect WFE data on their residents, either by tracking patients-per-hour (78%) or by written evaluations (59%). The top three methods for providing WFE data to residents were: individual data provided along with de-identified rank (35%), data provided only during private feedback meetings (26%), and no data or rank provided to residents (16%). Regarding targeted WFE teaching to residents, 88% reported utilizing general on-shift teaching, 48% reported teaching WFE during formal didactics, and 45% during dedicated private feedback sessions. WFE-focused simulations (15%), workshops (7%), and one-on-one observation shifts (14%) were uncommon. This national study of allopathic U.S. EM programs suggests that most EM program leaders value WFE teaching. However, we found no consistent approach among programs for tracking or distributing resident WFE data, and many programs lack a formalized way to teach efficiency to their residents. Given the importance of WFE to the clinical practice of EM, programs may benefit from devoting greater resources to teaching and tracking this essential skill set.

Implications of COVID-19 Pandemic on Family Medicine Residency Training Program and ACGME Requirements in Qatar

Implications of COVID-19 Pandemic on Family Medicine Residency Training Program and ACGME Requirements in Qatar

Tips for pandemic response planning for Internal Medicine training programs.

This article was migrated. The article was marked as recommended. The current Coronavirus Disease 2019 (COVID-19) pandemic has strained hospital systems and training programs across the world. As capacity issues mount and trainees are called upon to provide frontline medical care, programs and institutions have had to rapidly evolve to redefine the trainee experience. To that end, there is a paucity of literature regarding how healthcare training programs should operate during a global pandemic. Here, we aim to describe twelve evidence-based recommendations for coordinating a cohesive, systematic approach to pandemic response planning for Internal Medicine residency training programs. These tips encompass inpatient and outpatient practices, provider safety, resuscitation, virtual education programming and resident wellbeing. Though many of these considerations or recommendations were not described during the COVID-19 pandemic, these tips have been described previously in the literature, are applicable to the current pandemic and could be easily extrapolated to future crises.

Medicine Residency Training Program during COVID-19: Qatari Experience.

Family medicine residency training programs should put in place COVID-19 action plan in conjunction with other clinical departments, employee health personnel, and infection control leads. Programs should develop coping strategies that balance resident and patient safety, resident wellbeing, clinical training services, and resident education.

Integration of the preventive medicine specialty in the rural and Tribal public health workforce

The majority of the U.S. American Indian and Alaska Native (AI/AN) population live in rural areas, and are thus disproportionately affected by rural health issues. In addition, the AI/AN population has unique health characteristics resulting from a distinct cultural and sociopolitical history. A public health approach to both rural and Tribal health should include the medical specialty of preventive medicine, a unique physician specialty that combines both direct patient care and public health skills. To best prepare preventive medicine physicians for rural and Tribal practice, medical schools could recruit students from rural and Tribal areas and encourage them to pursue the specialty of preventive medicine. Additionally, preventive medicine residency training programs could establish clinical and public health practicum rotations in rural and Tribal areas, and develop curricula that address rural and Tribal health issues. Currently very few preventive medicine residency programs expressly state a mission to train physicians in rural or Tribal settings.

Gender Disparity in Academic Rank and Productivity Among Public Health Physician Faculty in North America.

BackgroundThe issue of gender disparity is particularly important in the domain of public health where the tone of its leadership is pivotal in bringing about impactful change to research, policies, and the wellbeing of our various populations. Our aim is to explore the gender disparity of author metrics and academic rankings of public health physician faculty through a cross-sectional study.MethodsData collection for this retrospective cross-sectional study took place during June and July of 2017. Public health and preventive medicine residency training programs in the United States and Canada were to compiled and all faculty members that met the inclusion criteria were recorded (n = 973). Variables of interest include gender, h-index, years of active research, and academic appointments. SCOPUS database (Elsevier, Amsterdam, the Netherlands) was used to generate author metrics, and all statistical tests were performed using Statistical Package for the Social Sciences (SPSS) software version 20 (IBM Corp., Armonk, NY).ResultsOverall, 31.14% (n = 303) of faculty members we studied were from Canada, and 68.86% (n = 670) were from the United States. In both countries, males made up the majority of all faculty members. Female faculty comprised most of the early career positions, and their proportions tapered off with higher academic rank, whereas male faculty trended in the opposite direction. Males generally were higher in all academic measures across all appointments. Conclusions Gender disparity exists within the North American public health and preventive medicine discipline. There are underlying factors preventing women from moving beyond early career positions or engaging in academic research.

Assessing the effectiveness of pediatric emergency medicine education in emergency medicine residency training: A national survey

Background: Evaluating the effectiveness of pediatric emergency medicine training is essential to ensure that emergency physicians and emergency medicine residents have sufficient knowledge, skill, and confidence in optimizing care for acute pediatric visits. Although the field of pediatric emergency medicine has experienced phenomenal growth in past decades, it still faces challenges in how to best implement the curriculums in emergency medicine residency training programs. Objectives: Exploring emergency physicians’ and emergency residents’ perspectives on pediatric emergency medicine training in emergency residency training programs in Taiwan through a nationwide survey. Methods: The survey was distributed to 1281 emergency physicians and emergency medicine residents in 43 teaching hospitals. The survey inquired about demographic data, hospital type, rank of proctored trainers and assessors, and the setting of pediatric emergency medicine training. Participants’ confidence in managing acute pediatric visits and their satisfaction and reflections of their pediatric emergency medicine training were explored. Results: In all, 258 responses were received from 117 residents and 141 emergency physicians. Seventy-seven percent reported working in medical centers. Clinical supervision was primarily performed by pediatric attending physicians and emergency physicians. Fifty-eight percent of participants felt satisfied with their pediatric emergency medicine training. However, only 52.3% felt confident managing acute pediatric visits, which was attributed to inadequate exposure to pediatric patients. Residents noted lack of confidence in managing newborns, infants, and clinical procedures. Therefore, simulation training and point-of-care ultrasound learning were considered advantageous. Conclusion: The pediatric emergency medicine training in emergency medicine residency programs is diverse in intensive care training, supervisors, and assessors. Surveys demonstrate that learning experience in pediatric wards and emergency department rotations is associated with overall satisfaction with pediatric emergency medicine training; inadequate exposure to pediatric patients contributed to learners having less confidence. Emergency medicine residency program reform might focus on adequate hands-on pediatric patient care.

LO80: Perfecting practice for rare procedures: a simulation-based, multi-centre randomized trial

Introduction: Mastery learning, which deconstructs a complex task into sequential sub-steps combined with deliberate practice to achieve each step in sequence, represents an important method to enhance simulation-based procedural skills training. However, the evidence to support the effectiveness of this theory to improve learning is lacking. This study compared mastery learning using deliberate practice with self-guided practice on skill performance of a rarely performed, life-saving procedure, a bougie-assisted cricothyroidotomy (BAC). Methods: In this multi-centre, randomized study at five North American emergency medicine (EM) residency training programs, we assigned 166 EM postgraduate trainees to either mastery learning and deliberate practice (ML + DP) or self-guided practice for BAC. Three blinded airway experts independently evaluated BAC skill performance by video review before (pre-test) and after (post-test) each training session. The primary outcome was post-test skill performance using a 5-point global rating score (GRS). A secondary outcome, defined a priori, was performance time to complete the BAC skill (chronometry). Results: There was no significant difference in post-test BAC performance after ML + DP or self-guided practice. Performance scores improved for both groups by 13% from the pre-test to post-test (F (1,138) = 43, p &lt; 0.001). Overall, time to complete the BAC improved significantly from pre-test (87.6 seconds) to posttest (54.1 seconds), (F, 1,149) = 122, p &lt; 0.001). At post-test, the ML + DP group performed the skill 7.4 seconds faster than the self-guided practice group (F (1,150) = 6.77, p &lt; 0.01). Conclusion: Mastery learning coupled with deliberate practice provides systematic and focused feedback during skill acquisition. However, it is resource intensive and its efficacy is not fully defined. In this study, MP + DP did not result in improved global performance; it did result in faster performance times, a relevant finding for time-sensitive procedures. These results are important for educators who seek to optimize technical skills training in a competency-based model of medical education. Our findings suggest that time-sensitive procedures might benefit from ML + DP teaching strategies to enhance time to procedural performance.

Utilizing Analytics to Identify Trends in Residency Program Website Visits.

IntroductionMost medical residency training programs maintain websites to provide content for audiences including current residents, prospective residents, and medical students. This study seeks to characterize when and how a residency program website is being accessed in order to identify the primary audiences to provide appropriate and timely content.MethodsThe authors examined website analytics at a large urban Accreditation Council for Graduate Medical Education (ACGME)-accredited post-graduate year (PGY)1-PGY4 emergency medicine residency training program website. Analytics were performed from July 1, 2016 to June 30, 2018 with daily traffic cataloged along with referral sources, page views, and device type used to access the website. The top five dates by daily traffic were further analyzed with daily traffic trends during the residency interview season.ResultsThere was an average of 45.8 unique visitors daily with 261.5 daily page views. Computer (67.2%), mobile device (29.6%), and tablet (3.1%) were the most common devices used for viewing. The most popular content areas by page-view were “people” (68,987 visits), “home” (38,569), “clinical curriculum” (35,556), and “medical students” (14,461). The five most-visited dates were all related to application processes including the opening of the Visiting Student Application Service (VSAS), the Electronic Residency Application Service (ERAS), and Match Day. During the interview season, peak visits occurred the dates immediately preceding interview dates.ConclusionResidency program websites appear to be accessed most commonly by medical students and prospective residency applicants. Website managers should take the needs of these audiences into account and provide appropriate content to maximally inform prospective residency program candidates.

Digital Healing: People, Information, Healthcare

Digital Healing takes the reader on an evolutionary journey focusing on the deployment of electronic health record systems across the United States from 2000 to 2018. The author, Marc Ringel, M.D., studied at the Abraham Lincoln School of Medicine in Chicago, Illinois followed by postgraduate training in pediatrics at Cook County Hospital (Chicago). He later became a general practitioner in Yuma, Colorado (population 2,000) as part of the National Health Service Corps where he fell in love with rural medicine and became Board Certified as a family physician. He has also practiced in rural Wisconsin and taught at the North Colorado Family Medicine Residency Training Program in Greeley, Colorado. He is an eloquent writer and speaker, and is dedicated to writing about rural health care, telemedicine, and continuing medical education. Dr. Ringel weaves relevant scholarly references and personal stories about his role as a family medicine physician to engage the reader in a thoughtful discussion about ways in which people are better than computers and vice versa in health care.A recurrent theme throughout the book is that no matter how sophisticated or impressive technology is, the determining factor for its successful implementation is the people involved in deploying and using the technology. Personal stories and clever examples of telemedicine applications are interwoven throughout the book in a way that draws the reader in. Dr. Ringel cleverly depicts the improvement offered by electronic health records while describing the importance of the human component of health care, focusing on patients’ stories and relationships, while using clever chapter titles such as “Left-Handed Pregnant Women,” “Everybody Wants Your Data,” and “Financial and Human Costs of EHRs.” The author commands an encyclopedic knowledge of medical history and integrates it well with the rapidly evolving digital revolution that is affecting health systems throughout the world.The central thesis of the book explores the ways in which human beings can utilize digital information and resources to improve health, while also allowing people to be more human. The author intercalates stories describing entire health systems, such as those in rural and urban centers in Colorado, with individual anecdotes that highlight the strengths and limitations of electronic health records. The author’s views, particularly advocating for rural health initiatives and reducing health services disparities, are prevalent throughout the text.As a rural practitioner, Dr. Ringel recognizes the importance of interventions that address disparities in healthcare access, particularly in remote areas of the country. All forms of telemedicine are emphasized, from phone calls to virtual consults with intensivists who offer around-the-clock expertise to clinicians in remote hospitals with limited or no access to specialists.The book is carefully organized into chapters focusing on specific areas ranging from virtual reality to artificial intelligence to clinical decision support. The author avoids jargon and aims for a balanced presentation that is accessible to medical and general readers alike. This book offers a set of perspectives on the evolution of the electronic health record system, but is not a comprehensive overview of the field. The book is available in hardback and eBook formats through a variety of services. Readers of all levels of experience will enjoy this welcome reality check in today’s digitally connected world.

Medicine Residency Training Program during COVID-19: Qatari Experience

Family medicine residency training programs should put in place COVID-19 action plan in conjunction with other clinical departments, employee health personnel, and infection control leads. Programs should develop coping strategies that balance resident and patient safety, resident wellbeing, clinical training services, and resident education.

Necessary but not sufficient: identifying conditions for effective feedback during internal medicine residents' clinical education.

Competency-based medical education and programmatic assessment intend to increase the opportunities for meaningful feedback, yet these conversations remain elusive. By comparing resident and faculty perceptions of feedback opportunities within one internal medicine residency training program, we sought to understand whether and how principles underlying meaningful feedback could be supported or constrained across a variety of feedback opportunities. Using case-study qualitative methodology, interviews and focus groups were conducted to explore 19 internal medicine residents' and 7 faculty members' perceptions of feedback across a variety of feedback opportunities: coaching, mini-CEXs, in-training evaluation reports and routine clinical supervision. Our data analysis moved iteratively between developing conceptual understandings and fine-grained analyses, while attending to both deductive and inductive analysis. Our results suggest that all feedback opportunities, including those created through formalized assessments, can foster meaningful feedback if faculty establish a trusting relationship with the resident, base their feedback on direct observation and support resident learning. However, formalized assessments were often perceived as inhibiting the conditions for meaningful feedback. A coaching program provided a context in which meaningful feedback could arise, in part because faculty were supported in shifting their focus from patient to resident. Meaningful feedback in clinical education may be fostered across a variety of feedback opportunities, however, it is often constrained by assessment. We must consider whether increasing the frequency of formative assessments may inhibit efforts to improve our feedback cultures while, in contrast, freeing up faculty to focus on supporting resident learning could improve these cultures.

The Impact of Selecting Specific Cohorts for Benchmarking and Interpretation of Emergency Department Patient Satisfaction Scores.

Emergency departments (EDs) patient satisfaction metrics are highly valued by hospitals, health systems, and payers, yet these metrics are challenging to analyze and interpret. Accurate interpretation involves selection of the most appropriate peer group for benchmark comparisons. We hypothesized that the selection of different benchmark peer groups would yield different interpretations of Press Ganey (PG) patient satisfaction scores. Emergency department PG summary ratings of "doctors section" and "likelihood-to-recommend" raw scores and corresponding percentiles were derived for three benchmark peer groups from three academic years (2016, 2017, and 2018). The three benchmarks are: 1) the PG Large database; 2) the PG University HealthSystem Consortium (UHC) database; and 3) the Academy of Administrators in Academic Emergency Medicine (AAAEM) database, which is composed only of EDs from academic health centers with emergency medicine residency training programs. Raw scores were converted to percentile ranks for each distribution and then compared using Welch's ANOVA and Games-Howell pairwise comparisons. For both patient satisfaction raw scores evaluated, the AAAEM database was noted to have significantly higher percentile ranks when compared to the PG Large and PG UHC databases. These results were consistent for all three time frames assessed. Benchmarking with different peer groups provides different results, with similar patient satisfaction raw scores resulting in higher percentile ranks using the AAAEM database compared to the two PG databases. The AAAEM database should be considered the most appropriate peer group for benchmarking academic EDs.