United States Emergency Medicine Research Articles

228 Pediatric Point-of-Care Ultrasound Training in United States Emergency Medicine Residencies: Is Current Training Adequate?

228 Pediatric Point-of-Care Ultrasound Training in United States Emergency Medicine Residencies: Is Current Training Adequate?

Impacts of the COVID-19 Pandemic on United States Emergency Medicine Education: A Council of Residency Directors in Emergency Medicine (CORD) Task Force Survey-Based Analysis.

Introduction The COVID-19 pandemic presented unpredicted challenges to Emergency Medicine (EM) education. The rapid onset of the pandemic created clinical, operational, administrative, and home-life challenges for virtually every member of the medical education community, demanding an educational and professional response at all levels including undergraduate medical education (UME), graduate medical education (GME), and faculty.The Council of Residency Directors in Emergency Medicine (CORD) COVID-19 Educational Impact Task Force was established in 2021 to examine these effects and the response of the EM educational community. Methods The Task Force utilized consensus methodology to develop the survey instruments, which were revised using a modified Delphi process. Both open- and closed-answer questions were included in the survey, which was initially distributed electronically to attendees of the 2021 Virtual Academic Assembly. Results were analyzed quantitatively and qualitatively. Results Sixty-three individuals responded to the first part of the survey (which addressed issues related to UME and GME) and 41 individuals responded to the second part of the survey (which addressed faculty and wellness). The pandemic's influence on EM education was viewed in both a positive and negative light. The transition to virtual platforms had various impacts, including innovation and engagement via technology.Remote technology improved participation in didactics and allowed individuals to more easily participate in departmental meetings.However, this also led to a decreased sense of connection with peers and colleagues resulting in a mixed picture for overall engagement and effectiveness.The Task Force has developed a list of recommendations for best practices for EM programs and for EM organizations. Conclusion The survey results articulated the educational benefits and challenges faced by EM educators during the COVID-19 pandemic. Through the challenging times of the pandemic, many institutional and program-based innovations were developed and implemented to address the new educational environment. These approaches will provide invaluable educational tools for future training.This will also prepare the EM academic community to respond to future educational disruptions.

A National Survey of Wilderness Medicine Curricula in United States Emergency Medicine Residencies.

Wilderness medicine (WM) is a growing subspecialty of emergency medicine. In 2018, we surveyed all 240 emergency medicine residencies in the United States to assess the scope of WM education in emergency medicine training programs in light of the nearly 30% increase in the number of residencies since 2015. A survey was e-mailed to the Council of Residency Directors in Emergency Medicine listserv and individual program directors of each of the 240 residencies. The survey included questions on educational content, format, number of hours taught, availability of conference credit, offering of an elective or fellowship, and several predefined WM curricula. We evaluated differences between 3-y and 4-y residencies using the χ2 test, where P<0.05 was considered significant. We had a response rate of 57% for completed surveys. Analysis showed 63% of respondent programs teach WM material. The majority (86%) partially or completely developed their curriculum, with 33% offering at least 1 of the predefined curricula. Thirteen percent taught with lecture only, 2% taught by hands-on only, and 85% used a combination of the 2. WM electives were significantly more likely to be offered by 4-y than 3-y residencies (P=0.009). Almost two-thirds of respondent residency programs teach WM material. Of these, only one-third teach any of the predefined curricula. Four-year residencies are more likely to offer WM electives but are otherwise comparable to 3-y programs.

Website usability analysis of United States emergency medicine residencies.

The Council of Residency Directors (CORD) in Emergency Medicine (EM) has recommended that all residency programs should conduct virtual interviews for the 2020 to 2021 application cycle due to the COVID-19 pandemic. While factors such as geographical region, city, program size, or hospital affiliation are not modifiable, EM residencies can bridge the information gap created by a lack of face-to-face interaction by representing themselves digitally. Measuring usability provides an objective method for EM residencies to improve their Web presence and effectively represent themselves to applicants. Our sample set included 55 U.S. EM residency program websites. Using methodology replicated from previous literature on health care website usability, we divided usability into four categories for quantifiable analysis: accessibility, marketing, content quality, and technology. Analysis was performed on each website and scored in all four categories. A "general usability" score was calculated for each website using a composite of the key factors within the four categories. Using a weighted percentage across all of the factors, an overall score was calculated. Content quality was the overall highest scoring category (mean± SD= 5.4, SE= 0.33). The overall lowest performing category was technology (mean± SD= 0.8± 0.09, SE= 0.01). Measuring usability can help EM residency programs identify ways to improve their Web presence. To effectively promote their programs, residencies need quality content that communicates their key features. Our recommendation is for all residency programs to periodically perform website audits and apply the usability measures outlined to improve their digital presence, especially during times when face-to-face interactions will be limited.

Evaluating Nontechnical Skills in US Emergency Departments Using Simulation: Validating and Contextualizing a UK Assessment Tool.

Nontechnical skills (NTS) in medicine are the "cognitive, social, and personal resource skills that complement technical skills contributing to safe and efficient care." We aimed to (1) evaluate the validity and reliability of a 12-element United Kingdom emergency medicine (EM) NTS assessment tool in the context of United States (US) EM practice and (2) identify behaviors unique to US clinical practice. This was a mixed methods study conducted in 2 phases, following Kane's validity framework. The intended use of the NTS tool is to provide formative assessment of US EM physicians (EPs) from a video of simulated clinical encounters. In phase I, a focus group assessed the appropriateness of each aspect of the tool in the context of US EM practice by reviewing and identifying the NTS of an EP in a simulated clinical scenario. In phase II, EPs (N = 208) attending a national EM conference evaluated an EP's behaviors in 1 of 2 video simulations. Reliability in the form of internal consistency was calculated using Cronbach α. All participants suggested exemplar behaviors for the 12 elements in the context of their own clinical practice and generated new assessment elements. Internal consistency was acceptable (α > 0.7) for all categories, except teamwork and cooperation. Participants proposed 4 novel behavioral elements and suggested US exemplar behaviors for all 12 original elements. This tool can be used to assess US EP's NTS for the purpose of formative assessment. Refinement of exemplar behaviors and inclusion of novel US-specific elements may optimize usability.

204 Website Usability Analysis of United States Emergency Medicine Residencies

The Counsel of Residency Directors in Emergency Medicine (CORD) has recommended all emergency medicine (EM) residency programs conduct virtual interviews for the 2020-2021 application cycle due to COVID-19. While residency factors such as geographical region, city, program size or hospital affiliation are not modifiable, EM residencies can still bridge the information gap created by a lack of face-to-face interaction by representing themselves digitally via their Web sites. Whether or not this representation is effective can be measured by evaluating usability, a term meaning ease of user experience on a Web site. Many variables determine a Web site’s usability, and this measure provides an objective method for EM residencies to improve their Web presence and effectively represent themselves to potential applicants. Aim 1: Categorize EM residency programs and their Web sites. Aim 2: Utilize a usability scoring system to objectively and quantitatively analyze their Web sites. Aim 3: Introduce aspects for improvement amongst EM residency Web sites. Our sample set included 53 U.S. EM residency program Web sites. These programs used their own primary domain or subdomain for the program’s respective emergency department. Programs using a subpage of a larger domain (ie, hospital or university) were excluded as the analysis would include non-residency related content (ie, patient care). Using methodology adapted from previous literature on health care Web site usability (Calvano, 2020), we divided usability into four categories for quantifiable analysis: Accessibility (ability of users to access and navigate a Web site), Marketing (search engine optimization, social media), Content Quality (relevance of material, frequency of updates, readability, and grammar), and Technology (Web site infrastructure, quality of program coding, and download speed). Utilizing several content analysis tools, analysis was performed on each Web site and scored in all four categories. An overall “General Usability” score was calculated for each Web site using a composite of the key factors within the four categories. Using a weighted percentage across all of the factors, an overall score was calculated. Content Quality was the overall highest scoring category with a mean score of 5.3 (std +/- 2.50) (SE 0.34). The overall lowest performing category was Technology, with an average of 0.8 (std +/- 0.09) (SE 0.01) (Table 1). On average, Content Quality had the highest score amongst EM residency program Web sites. To effectively promote their programs, residencies need quality content that communicates their key features. The lowest scoring category on average was Technology. Our recommendation is for all residency programs to periodically perform audits on their web pages using usability measures in order to improve their digital presence, especially during times when face-to-face interactions will be limited.Table 1CategoryMeanStandard ErrorStandard DeviationAccessibility1.90.080.61Marketing1.30.070.48Content Quality5.30.342.50Technology0.80.010.09General Usability1.30.050.38 Open table in a new tab

Use of graded responsibility and common entrustment considerations among United States emergency medicine residency programs.

PurposeThe Accreditation Council for Graduate Medical Education (ACGME) requires all residency programs to provide increasing autonomy as residents progress through training, known as graded responsibility. However, there is little guidance on how to implement graded responsibility in practice and a paucity of literature on how it is currently implemented in emergency medicine (EM). We sought to determine how EM residency programs apply graded responsibility across a variety of activities and to identify which considerations are important in affording additional responsibilities to trainees.MethodsWe conducted a cross-sectional study of EM residency programs using a 23-question survey that was distributed by email to 162 ACGME-accredited EM program directors. Seven different domains of practice were queried.ResultsWe received 91 responses (56.2% response rate) to the survey. Among all domains of practice except for managing critically ill medical patients, the use of graded responsibility exceeded 50% of surveyed programs. When graded responsibility was applied, post-graduate year (PGY) level was ranked an “extremely important” or “very important” consideration between 80.9% and 100.0% of the time.ConclusionThe majority of EM residency programs are implementing graded responsibility within most domains of practice. When decisions are made surrounding graded responsibility, programs still rely heavily on the time-based model of PGY level to determine advancement.

Association Between Empathy and Burnout Among Emergency Medicine Physicians.

BackgroundThe association between physician self-reported empathy and burnout has been studied in the past with diverse findings. We aimed to determine the association between empathy and burnout among United States emergency medicine (EM) physicians using a novel combination of tools for validation.MethodsThis was a prospective single-center observational study. Data were collected from EM physicians. From December 1, 2018 to January 31, 2019, we used the Jefferson scale of empathy (JSE) to assess physician empathy and the Copenhagen burnout inventory (CBI) to assess burnout. We divided EM physicians into different groups (residents in each year of training, junior/senior attendings). Empathy, burnout scores and their association were analyzed and compared among these groups.ResultsA total of 33 attending physicians and 35 EM residents participated in this study. Median self-reported empathy scores were 113 (interquartile range (IQR): 105 - 117) in post-graduate year (PGY)-1, 112 (90 - 115) in PGY-2, 106 (93 - 118) in PGY-3 EM residents, 112 (105 - 116) in junior and 114 (101 - 125) in senior attending physicians. Overall burnout scores were 43 (33 - 50) in PGY-1, 51 (29 - 56) in PGY-2, 43 (42 - 53) in PGY-3 EM residents, 33 (24 - 47) in junior attending and 25 (22 - 53) in senior attending physicians separately. The Spearman correlation (ρ) was -0.11 and β-weight was -0.23 between empathy and patient-related burnout scores.ConclusionSelf-reported empathy declines over the course of EM residency training and improves after graduation. Overall high burnout occurs among EM residents and improves after graduation. Our analysis showed a weak negative correlation between self-reported empathy and patient-related burnout among EM physicians.

301 United States Emergency Medicine Providers' Perceptions of Health Care Disparities: A National Survey

301 United States Emergency Medicine Providers' Perceptions of Health Care Disparities: A National Survey

The Impact of the 2008 Council of Emergency Residency Directors (CORD) Panel on Emergency Medicine Resident Diversity

BackgroundIn 2008, the Council of Emergency Medicine Residency Directors (CORD) developed a set of recruitment strategies designed to increase the number of under-represented minorities (URMs) in Emergency Medicine (EM) residency. ObjectivesWe conducted a survey of United States (US) EM residency program directors to: describe the racial and ethnic composition of residents; ascertain whether each program had instituted CORD recruitment strategies; and identify program characteristics associated with recruitment of a high proportion of URM residents. MethodsThe survey was distributed to accredited, nonmilitary US EM residency programs during 2013. Programs were dichotomized into high URM and low URM by the percentage of URM residents. High- and low-URM programs were compared with respect to size, geography, percentage of URM faculty, importance assigned to common applicant selection criteria, and CORD recruitment strategies utilized. Odds ratios and 95% confidence limits were calculated. ResultsOf 154 residency programs, 72% responded. The median percentage of URM residents per program was 9%. Only 46% of EM programs engaged in at least two recruitment strategies. Factors associated with higher resident diversity (high-URM) included: diversity of EM faculty (high-URM) (odds ratio [OR] 5.3; 95% confidence interval [CI] 2.1–13.0); applicant's URM status considered important (OR 4.9; 95% CI 2.1–11.9); engaging in pipeline activities (OR 4.8; 95% CI 1.4–15.7); and extracurricular activities considered important (OR 2.6; 95% CI 1.2–6.0). ConclusionLess than half of EM programs have instituted two or more recruitment strategies from the 2008 CORD diversity panel. EM faculty diversity, active pipeline programs, and attention paid to applicants' URM status and extracurricular activities were associated with higher resident diversity.

Therapeutic hypothermia utilization among physicians after resuscitation from cardiac arrest*

We sought to evaluate current physician use of therapeutic hypothermia after cardiac arrest, to ascertain reasons for nonadoption of this treatment, and to determine current cooling techniques employed. Web-based survey. International physician cohort in the United States, UK, and Finland. Physicians (MD or DO) caring for resuscitated cardiac arrest patients. An anonymous Web-based survey was distributed to physicians identified through United States-based critical care, cardiology, and emergency medicine directories and critical care networks in the UK and Finland. Recipients were queried regarding use of postresuscitation therapeutic hypothermia. Of the final 13,272 surveys actually distributed to physicians, 2,248 (17%) were completed. Most respondents were attending physicians (82%) at teaching hospitals (76%) who practiced critical care (35%), cardiology (20%), or emergency medicine (22%). Of all replies, 74% of United States respondents and 64% of non-United States respondents had never used therapeutic hypothermia. United States emergency medicine physician adoption of cooling was significantly less than that of United States intensivists (16% vs. 34%, p < .05). The most often cited reasons for nonuse by respondents were "not enough data," "not part of Advanced Cardiac Life Support guidelines," and "too technically difficult to use." Factors associated with increased use included non-United States residence, critical care specialty, and larger hospital size. Physician utilization of cooling after cardiac arrest remains low. For improved adoption of therapeutic hypothermia, our data suggest that development of better cooling methodology and recent incorporation into resuscitation guidelines may improve use.

A comparison of Australasian and United States emergency medicine training programmes

AbstractTraining in emergency medicine differs from country to country. This article compares the emergency medicine training programmes of Australasia and the United States of America. The perceived advantages of programmes are highlighted, but no attempt is made to determine which is the better programme. The Australasian programme is significantly longer and places greater emphasis on the basic clinical sciences, physical examination skills and academic output. Australasian College for Emergency Medicine regulations are relatively flexible, and allow trainees to design their own programmes. Australasian trainees are encouraged to arrange accredited positions in a variety of hospitals. Overseas and part‐time training may be acceptable. In the US, trainees rotate within and from one parent institution which provides a rigid teaching structure for a ‘critical mass’ of trainees, based upon a core curriculum. Rotations tend to be much shorter than in the Australasian programme but ensure exposure to a broader range of clinical experience. In the US programme, evaluation of trainees and teaching faculty is more frequent and documentation of procedural and resuscitation skills is required. In addition, trainees are under the close supervision of the teaching faculty at all times when working in an emergency department.

Integration of United States Emergency Medicine Concepts Into Emergency Services in the New Independent States

At this writing, a collaborative partnership has been in place for 30 months between the Boston University Medical Center, the University of Massachusetts Medical Center, the Armenian Ministry of Health, and the Emergency Hospital of Yerevan, Armenia, to improve emergency and trauma care in that city. Fifty-five individuals have traveled to and from the Emergency Hospital, the partner hospital. The collaboration has led to the creation of the Emergency Medical Services Institute (EMSI) at Emergency Hospital, an 800-bed facility that serves as a trauma center and as base for the Yerevan ambulance system. A curriculum (text and slides) has been developed and translated into Armenian and Russian. To date, the Armenian EMSI has trained nearly 300 emergency medical personnel: physicians, nurses, drivers, and first responders. The Armenian EMSI faculty have received training in directing instruction of emergency care providers. Plans are in place to begin training in Armenian cities outside of Yerevan and in neighboring republics. An emergency medicine residency program received ministry approval and was begun with six resident physicians in January 1995. To date, 45 nurses have graduated from a 400-hour training program. This partnership program chose an education initiative as the vehicle for interaction between the United States and the formerly Soviet-directed Armenian health care system. Officials of the partner hospital requested assistance in upgrading the skills of its abundant emergency care workforce, citing cardiovascular disease, trauma, and accidents as leading causes of death and disability in Armenia. Because the Armenian partners' needs in emergency medicine and trauma coincided with the US partners' areas of greatest expertise, it was clear that meaningful progress was possible. The centralized emergency medical system designed by the former Soviet Union produced nearly identical systems in the republics (including Armenia) that now form the New Independent States (NIS). The opportunity of reaching a broad base by means of development of a standardized curriculum was presented and acted on. In this report we describe and discuss our experience and provide an interim report of the effort. This project has demonstrated the feasibility of out-of-hospital emergency medicine training efforts in the NIS. The transfer of clinical knowledge, skills, systems approaches, and pedagogic techniques between unlike health care settings is possible if ministerial, municipal, and provider institutions themselves participate in the effort. The EMSI provides a model for EMS advancement and training that can be extended to other areas in the NIS.[Aghababian RV, Levy K, Moyer P, Mottley L, Ciottone G, Freitas R, Minasian A: Integration of United States emergency medicine concepts into emergency services in the New Independent States. Ann Emerg Med September 1995;26:368-375.]

United States emergency medicine block rotation curricula for the 1986–87 academic year

Because emergency medicine is a broad-based specialty, there is much leeway in the structure of resident education. The monthly block curriculum is a major determinant of the overall residency training experience. The purpose of our study was to define the block curricula of the accredited emergency medicine residencies in the 1986-87 academic year. In a mail-confirmed telephone survey of residency directors, monthly block rotation data were obtained for 187 postgraduate years in 66 (98%) of 67 approved residencies; identified were 51 individual rotations in nine areas. The PG1 year, present in 47 (71%) of 66 residencies, resembled the flexible internship. Rotations in obstetrics-gynecology, medicine, pediatrics, and surgery accounted for 50% of PG1 year training time. Adult emergency department experience was 21% of PG1 year. In the PG2-4 (PG2+) years, 56% of clinical time was spent in the adult or pediatric ED (mean, 6.6 months per year). Electives and surgery rotations each accounted for 11% of PG2+ years training time. Emergency medicine-related areas and critical care rotations each accounted for 7% of the PG2+ years training time. Besides time spent in the ED and on electives, the most highly weighted individual rotations in the PG2+ years were orthopedic surgery, trauma surgery, and emergency medical services. Nearly all programs offered rotations in the adult ED, a surgical subspecialty, critical care, and an elective during residency training. The percentage of rotations requiring direct supervision by emergency physicians increased threefold by the PG4 year. Off-service rotations dropped 15-fold during the PG4 year relative to the PG1 year.(ABSTRACT TRUNCATED AT 250 WORDS)

United states emergency medicine residency length in 1986–87 and 1987–88

To determine current trends in emergency medicine residency length, US emergency medicine residency directors were asked to describe their 1986-87 and 1987-88 year configurations. In January 1986, 66 of 67 residencies (98%) were contacted by phone, and 62 (94%) completed a validation form. Of the 67, 19 (28%) changed their length of training in 1987-88. Of the 19 programs that changed, 17 (90%) increased residency length by adding a fourth postgraduate (PGY-4) year of training. Two have moved to PGY-1,2,3 configurations. Two new programs are starting in 1987-88; one a PGY-1,2,3, the other a PGY-2,3,4. One program has lost accreditation for emergency medicine training. In 1986-87, 44 of 67 (66%) programs were 36 months long; for 1987-88 the number is 60 of 68 (88%). The number of four-year programs is increased from six (9%) to eight (12%). Both the average length of emergency medicine residency training and the average length of postgraduate training are increased in 1987-88. The number of programs whose graduates train for a minimum of four years prior to sitting for the boards has increased from eight (12%) to 26 (38%). The number of programs that begin at the PGY-I level increased from 48 (72%) to 50 (74%). The Midwest region has the greatest number of residencies and the most programs of the PGY-1,2,3 configuration. The implications of this change, including new curriculum development, differing training patterns, and budget concerns, are discussed.