Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
-
The authors propose a three-year curriculum for emergency medicine residents using human simulation both to teach and to assess the Accreditation Council for Graduate Medical Education (ACGME) core competencies. Human simulation refers to a variety of technologies that allow residents to work through realistic patient problems so as to allow them to make mistakes, learn, and be evaluated without exposing a real patient to risk. ⋯ Because of the limitations of current assessment tools, the demonstration of resident competence is used only for formative evaluations. Limitations of this proposal and difficulties in implementation are discussed, along with a description of the organization and initiation of the simulation program.
-
"Patient Care" is the first listed core competency of the six new core competencies recently formulated by the Accreditation Council for Graduate Medical Education (ACGME) and, arguably, the most important. To assist emergency medicine (EM) program directors in incorporating and assessing this competency, the Council of Emergency Medicine Residency Directors (CORD-EM) held a consensus conference in March 2002. ⋯ In addition, all of the ACGME assessment tools were examined and prioritized for use in assessing the competency of EM residents in the area of patient care. Suggestions for an implementation process are also described.
-
In emergency medicine, there is an ongoing debate regarding patients who use the emergency department (ED) as their usual source of medical care-an arguably costly and inefficient pattern of utilization. However, there are few accurate national data on the prevalence of such usage. This analysis uses the 1998 National Health Interview Survey to estimate the number of Americans who name the ED as their usual source of care, and compares their characteristics with those who have a usual source of care other than the ED. Poverty, lack of insurance, younger age, male gender, and minority race or ethnicity predicted identifying the ED as the usual source of care.
-
Simulations are exercises designed to mimic real-life situations in which learners are given the opportunity to reason through a clinical problem and make critical decisions without the potential of harming actual patients. Simulation, using a variety of formats, is useful for assessing the core competencies-particularly patient care (decision making, prioritizing, procedural skills), interpersonal skills (team leadership, communication), and systems-based practice (team structure and utilization, resource use). High-fidelity computerized human simulators are a relatively new tool for use in medical simulation. ⋯ The use of human simulators to reproduce life-threatening situations will be especially useful in assessing the clinical competence of emergency medicine physicians. Operational definitions of competence and tools with which to evaluate performance must first be developed. Standardization of scenarios and evaluation tools will permit assessment of the reproducibility of scenarios and the reliability and validity of the tools used to measure competence.