US Emergency Medicine Residency Research Articles

Intern Orientation Rotations in US Emergency Medicine Residency Programs: Statistics and Trends

Intern Orientation Rotations in US Emergency Medicine Residency Programs: Statistics and Trends

Medical Toxicology Rotations in US Emergency Medicine Residency Programs: Trends and Requirements

Medical Toxicology Rotations in US Emergency Medicine Residency Programs: Trends and Requirements

Emergency Medicine Program Directors' Perspectives on Changes to Step 1 Scoring: Does It Help or Hurt Applicants?

IntroductionThe United States Medical Licensing Examination (USMLE) Step 1 score is one of the few standardized metrics used to objectively review applicants for residency. In February 2020 the USMLE program announced that the numerical Step 1 scoring would be changed to a binary (Pass/Fail) system. In this study we sought to characterize how this change in score reporting will impact the application review process for emergency medicine (EM) program directors (PD).MethodsIn March 2020 we electronically distributed a validated anonymous survey to EM PDs at 236 US EM residency programs accredited by the Accreditation Council for Graduate Medical Education.ResultsOf 236 EM PDs, 121 responded (51.3% response rate). Overall, 72.7% believed binary Step 1 scoring would make the process of objectively comparing applicants more difficult. A minority (19.8%) believed it was a good idea, and 33.1% felt it would improve medical student well-being. The majority (88.4%) reported that they will increase their emphasis on Step 2 Clinical Knowledge (CK) for resident selection, and 85% plan to require Step 2 CK scores at application submission time.ConclusionOur study suggests most EM PDs disapprove of the new Step 1 scoring. As more objective data is peeled away from the residency application, EM PDs will be left to rely more heavily on the few remaining measures, including Step 2 CK and standardized letters of evaluation. Further changes are needed to promote equity and improve the overall quality of the application process for students and PDs.

Peek at the glass ceiling: gender distribution of leadership among emergency medicine residency programs

BackgroundA gender gap in faculty rank at academic institutions exists; however, data among graduate medical education (GME) programmes are limited. There is a need to assess gender disparities in GME...

High Prevalence of Burnout Among US Emergency Medicine Residents: Results From the 2017 National Emergency Medicine Wellness Survey

Previous work shows that emergency medicine attending physicians have higher-than-average rates of burnout. Preliminary data suggest that emergency medicine residents are also at risk for burnout. The objective of this study was to conduct the first national survey assessment of US emergency medicine residents to determine the prevalence of burnout. This prospective 2017 National Emergency Medicine Resident Wellness Survey study was conducted through the Wellness Think Tank, whereby emergency medicine residents from 247 residencies across the United States were invited to participate in a national survey. The primary measure of burnout was the Maslach Burnout Inventory-Human Services Survey. Inaccordance with others' work, "burnout" was defined as a dichotomous variable represented by high levels of emotional exhaustion or depersonalization. Because of interpretative variability with the survey tool, we also calculated burnout rates by using a more restrictive definition and a more inclusive definition that have been reported in the literature. Surveys were completed by 1,522 residents (21.1% of all US emergency medicine residents), representing 193 of 247 US emergency medicine residency programs (78.1%). Within this sample, the prevalence of burnout was 76.1% (95% confidence interval 74.0% to 78.3%). With alternative definitions applied, burnout prevalence rates for this same sample were 18.2% (95% confidence interval 16.3% to 20.1%) with the more restrictive definition and 80.9% (95% confidence interval 78.9% to 82.9%) with the more inclusive definition. The majority of US emergency medicine residents responding to this survey reported symptoms consistent with burnout, highlighting that physician burnout in the emergency medicine profession seems to begin as early as residency training. These findings may provide a baseline against which future work can be compared.

How common are cognitive errors in cases presented at emergency medicine resident morbidity and mortality conferences?

Abstract Background Cognitive errors are a major contributor to medical error. Traditionally, medical errors at teaching hospitals are analyzed in morbidity and mortality (M&M) conferences. We aimed to describe the frequency of cognitive errors in relation to the occurrence of diagnostic and other error types, in cases presented at an emergency medicine (EM) resident M&M conference. Methods We conducted a retrospective study of all cases presented at a suburban US EM residency monthly M&M conference from September 2011 to August 2016. Each case was reviewed using the electronic medical record (EMR) and notes from the M&M case by two EM physicians. Each case was categorized by type of primary medical error that occurred as described by Okafor et al. When a diagnostic error occurred, the case was reviewed for contributing cognitive and non-cognitive factors. Finally, when a cognitive error occurred, the case was classified into faulty knowledge, faulty data gathering or faulty synthesis, as described by Graber et al. Disagreements in error type were mediated by a third EM physician. Results A total of 87 M&M cases were reviewed; the two reviewers agreed on 73 cases, and 14 cases required mediation by a third reviewer. Forty-eight cases involved diagnostic errors, 47 of which were cognitive errors. Of these 47 cases, 38 involved faulty synthesis, 22 involved faulty data gathering and only 11 involved faulty knowledge. Twenty cases contained more than one type of cognitive error. Twenty-nine cases involved both a resident and an attending physician, while 17 cases involved only an attending physician. Twenty-one percent of the resident cases involved all three cognitive errors, while none of the attending cases involved all three. Forty-one percent of the resident cases and only 6% of the attending cases involved faulty knowledge. One hundred percent of the resident cases and 94% of the attending cases involved faulty synthesis. Conclusions Our review of 87 EM M&M cases revealed that cognitive errors are commonly involved in cases presented, and that these errors are less likely due to deficient knowledge and more likely due to faulty synthesis. M&M conferences may therefore provide an excellent forum to discuss cognitive errors and how to reduce their occurrence.

Emergency Physician Risk Estimates and Admission Decisions for Chest Pain: A Web-Based Scenario Study

We conducted this study to better understand how emergency physicians estimate risk and make admission decisions for patients with low-risk chest pain. We created a Web-based survey consisting of 5 chest pain scenarios that included history, physical examination, ECG findings, and basic laboratory studies, including a negative initial troponin-level result. We administered the scenarios in random order to emergency medicine residents and faculty at 11 US emergency medicine residency programs. We randomized respondents to receive questions about 1 of 2 endpoints, acute coronary syndrome or serious complication (death, dysrhythmia, or congestive heart failure within 30 days). For each scenario, the respondent provided a quantitative estimate of the probability of the endpoint, a qualitative estimate of the risk of the endpoint (very low, low, moderate, high, or very high), and an admission decision. Respondents also provided demographic information and completed a 3-item Fear of Malpractice scale. Two hundred eight (65%) of 320 eligible physicians completed the survey, 73% of whom were residents. Ninety-five percent of respondents were wholly consistent (no admitted patient was assigned a lower probability than a discharged patient). For individual scenarios, probability estimates covered at least 4 orders of magnitude; admission rates for scenarios varied from 16% to 99%. The majority of respondents (>72%) had admission thresholds at or below a 1% probability of acute coronary syndrome. Respondents did not fully differentiate the probability of acute coronary syndrome and serious outcome; for each scenario, estimates for the two were quite similar despite a serious outcome being far less likely. Raters used the terms "very low risk" and "low risk" only when their probability estimates were less than 1%. The majority of respondents considered any probability greater than 1% for acute coronary syndrome or serious outcome to be at least moderate risk and warranting admission. Physicians used qualitative terms in ways fundamentally different from how they are used in ordinary conversation, which may lead to miscommunication during shared decisionmaking processes. These data suggest that probability or utility models are inadequate to describe physician decisionmaking for patients with chest pain.

290 Usability and Acceptability of a Brief Tool to Guide Code Status Conversations in the Emergency Department

Emergency medicine (EM) resident physicians frequently have difficult conversations with patients regarding goals of care, such as choices around code status. However, many surveyed EM residents report feeling uncomfortable having these conversations. The “Best Case / Worst Case” tool was developed in 2015 to help guide surgeons in discussing care options with patients, but its use by EM providers has not been studied. Our goal was to assess the usability and acceptability of this tool for EM providers. EM residents and faculty in one US EM residency were invited to attend a two-hour session held during the weekly residency conference, during which they were introduced to the “Best Case / Worst Case” tool through a video and presentation based on curriculum made by the tool’s creators. Attendees then tried utilizing the tool themselves, under the guidance of EM and palliative medicine providers, through sample cases. Afterwards, attendees had the option to a voluntary and anonymous survey, either in-person or online, and results were summarized and analyzed. Twenty-seven (27) providers attended the interactive session and twenty-three (23) filled out surveys afterwards. The results are summarized in Table 1. Overall, respondents viewed the “Best Case / Worst Case” tool positively, responding that they felt the tool would benefit patients (82.6%, 19 / 23), lead to improved use of resources while helping severely ill patients (73.3%, 11 / 15), and felt it would be a reliable tool (83.3%, 15 / 18). Additionally, most respondents indicated this tool was better than their usual approach (72.2%, 13 / 18), and that they would feel more comfortable having a Code Status conversation using this tool (77.8%, 14 / 18). After a brief educational session, the “Best Case / Worst Case” tool was described by EM providers as both usable and acceptable. Further study of this and other tools to aid EM providers in leading goals of care conversations is indicated.

Implementation of small-group reflection rounds at an emergency medicine residency program

Few residency curricular interventions have focused on improving well-being and promoting humanism. We describe the implementation of a novel curriculum based on small-group reflection rounds--the Emergency Medicine Reflection Rounds (EMRR)--at a 4-year US emergency medicine (EM) residency. During the inaugural year (2010-2011), nine residents volunteered to take part in 1-hour monthly sessions with faculty facilitators. Residents were provided with a confidential environment to discuss difficult ethical and interpersonal encounters from their clinical experiences. Ongoing feedback from participants was solicited, culminating with a four-question survey in which all respondents remarked that the EMRR contributed to improving their own well-being and agreed that it provided an important forum for residents to discuss difficult issues in a safe environment. In this article, we describe our innovation as an example of a wellness initiative that has promoted reflective practice and fostered cooperative learning around the communication, professional, and ethical challenges inherent in EM practice. Our EMRR model may be useful to other EM residences looking to supplement their wellness curriculum.

Report of the Task Force on Residency Training Information (2008-2009), American Board of Emergency Medicine

The American Board of Emergency Medicine (ABEM) gathers extensive background information on emergency medicine residency training programs and the residents in those programs. We present the 2009 annual report on the status of US emergency medicine residency programs.

Report of the Task Force on Residency Training Information (2007-2008), American Board of Emergency Medicine

The American Board of Emergency Medicine (ABEM) gathers extensive background information on emergency medicine residency training programs and the residents training in those programs. We present the eleventh annual report on the status of US emergency medicine residency programs.

The impact of a rural emergency department rotation on applicant ranking of a US emergency medicine residency program

Few US emergency medicine (EM) residency programs have been located in rural states due to program requirements for emergency department (ED) patient volume. Recent revision to the program requirements now permits 'educationally justifiable exceptions' to the patient population requirement, 'such as clinical sites in a rural setting', and some EM residency programs now plan to offer rural ED clinical experiences as a required curricular component. The impact of a required rural EM rotation on the ranking decisions of applicants is important to residency programs seeking to attract the most desirable applicants. To assess the impact of a required rural ED rotation on applicant ranking of an EM residency program in the US National Resident Matching Program (NMRP). All applicants to the study's EM residency program completing the interview portion of the application process received a mailed and emailed survey following the release of the 2004 NMRP results. The survey included questions addressing the rural/non-rural classification of the location of the applicants' childhood home, medical school, and anticipated future practice. Of 46 eligible subjects, 32 (69.6%) completed the survey. Of subjects with a rural childhood, 73.3% reported a positive impact on rank order (95% CI 50.9-95.7%) and 26.7% reported no impact (CI 4.3-49.1%); 81.3% of subjects with non-rural backgrounds reported no impact (CI 62.2-100%), 12.5% higher rank (CI 0-28.7%), and 6.3% lower (CI 0-18.2%). If planning a future practice in a rural community, 83.3% reported positive impact (CI 62.2-100%) and 16.7% no impact (CI 0-37.8%); 78.9% of subjects anticipating future practice in non-rural communities reported no impact (CI 60.6-97.3%), 15.8% higher rank (CI 0-32.2%), and 5.3% lower (CI 0-15.4). Of the subjects attending medical school in rural states, 52.2% reported a positive impact (CI 31.8-72.6%) and 47.8% no impact (CI 27.4-68.2%), while 75% of graduates of medical schools in non-rural states reported no impact (CI 32.6-100%) and 25% (CI 0-67.4%) a negative impact. The presence of a rural ED rotation did not adversely impact EM residency applicants' ranking of the program.

Report of the Task Force on Residency Training Information (2006-2007), American Board of Emergency Medicine

The American Board of Emergency Medicine (ABEM) gathers extensive background information on emergency medicine residency training programs and the residents training in those programs. We present the tenth annual report on the status of US emergency medicine residency programs.

A National Survey of Terrorism Preparedness Training Among Pediatric, Family Practice, and Emergency Medicine Programs

Domestic terrorism is a real threat focusing on a need to engage in effective emergency preparedness planning and training. Front-line physicians are an important component of any emergency preparedness plan. Potential victims of an attack include children who have unique physiologic and psychological vulnerabilities in disasters. Front-line providers need to have adequate training to effectively participate in local planning initiatives and to recognize and treat casualties including children. The goal of the survey was to assess the current state of terrorism preparedness training, including child victims, by emergency medicine, family practice, and pediatric residency programs in the United States and to assess methods of training and barriers to establishing effective training. A survey was e-mailed to a comprehensive list of all US pediatric, family practice, and emergency medicine residency programs 3 times between September 2003 and January 2004. The survey measured the perceived risk of terrorist attack, level of training by type of attack, level of training regarding children, method of training, and barriers to training. Overall, 21% of programs responded (46 of 182 pediatric, 75 of 400 family practice, and 29 of 125 emergency medicine programs). Across all of the event types, emergency medicine programs were more likely to report adequate/comprehensive training. However, < 50% of emergency medicine programs report adequate training for children. Didactic classroom-based lectures were the most commonly used method of training. Emergency medicine programs were more likely to use scenario-based exercises. Among programs that use scenario exercises, 93% report that they never (40%) or only sometimes (53%) incorporate child victims into the scenarios. Time, funding, access to subject matter experts, and availability of training material are the most important barriers to effective training. Children are a precious national resource and a vulnerable population in disasters. Despite the availability of terrorism preparedness funding, these data suggest that we are failing to provide adequate training to front-line providers who may care for children in a catastrophic domestic terrorist event.

Report of the Task Force on Residency Training Information (2005-2006), American Board of Emergency Medicine

The American Board of Emergency Medicine gathers extensive background information on emergency medicine residency training programs and the residents training in those programs. We present the ninth annual report on the status of US emergency medicine residency programs.

Report of the Task Force on Residency Training Information (2004-2005), American Board of Emergency Medicine

The American Board of Emergency Medicine gathers extensive background information on emergency medicine residency training programs and the residents training in those programs. We present the eighth annual report on the status of US emergency medicine residency programs.

Report of the task force on residency training information (2003-2004), American Board of Emergency Medicine

The American Board of Emergency Medicine gathers extensive background information on emergency medicine residents and the programs in which they train. We present the seventh annual report on the status of US emergency medicine residency programs.

Report of the task force on residency training information (2002-2003), american board of emergency medicine

The American Board of Emergency Medicine gathers extensive background information on emergency medicine residents and the programs in which they train. We present the sixth annual report on the status of US emergency medicine residency programs. [Ann Emerg Med. 2003;41:714-732.]

Report of the task force on residency training information (2001-2002), American Board of Emergency Medicine

The American Board of Emergency Medicine gathers extensive background information on emergency medicine residents and the programs in which they train. We present the fifth annual report on the status of US emergency medicine residency programs. [American Board of Emergency Medicine. Report of the Task Force on Residency Training Information (2001-2002), American Board of Emergency Medicine. Ann Emerg Med. May 2002;39:510-527.]

Report of the task force on residency training information (2000-2001), American Board of Emergency Medicine

The American Board of Emergency Medicine gathers extensive background information on emergency medicine residents and the programs in which they train. We present the fourth annual report on the status of US emergency medicine residency programs. [American Board of Emergency Medicine. Report of the Task Force on Residency Training Information (2000-2001), American Board of Emergency Medicine. Ann Emerg Med. May 2001;37:515-532.]