Emergency medicine Australasia : EMA
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Emerg Med Australas · Feb 2017
What is the chance all your trainees will pass the next Fellowship exam: A statistician's view.
Your department has had a good track record over many years for preparing trainees to successfully sit for the ACEM Fellowship exam. On average the pass rate for your trainees is over 80%. Then, to your dismay, suddenly only two of five of your trainees pass the latest Fellowship exam. ⋯ Thus despite an 80% pass rate historically, the probability that only two of five candidates will pass is not negligible at 5.1%. It is an anomaly, which we may choose not to act on unless it is recurrent, noting it will be expected to occur naturally about one time out of 20. The real challenge is to maintain or increase that individual probability at 80% or higher.
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Ramping is the practice of requiring paramedics to continue to care for patients rather than hand over clinical responsibility to the ED. It arose as an alternative to admitting patients to EDs that are deemed to be already operating at or beyond capacity. This paper analyses the ethics of ramping. ⋯ However, this perspective fails to adequately consider the implications, especially the opportunity cost of requiring paramedics to remain at the hospital rather than make themselves available for other patients. From this perspective, ramping negatively impacts the wider provision of emergency medical services, with potentially serious consequences for people's health. Advocates of ramping must consider people in the community who require a medical emergency response.