Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
-
The state of pediatric emergency medicine (PEM) education within emergency medicine (EM) residency programs is reviewed and discussed in the context of shifting practice environments and new demands for a greater focus on the availability and quality of PEM services. The rapid growth of PEM within pediatrics has altered the EM practice landscape with regard to PEM. ⋯ Innovative educational modalities are discussed, as well as the role of simulation and pediatric-specific patient safety education. Finally, barriers to PEM fellowship training among EM residency graduates are discussed in light of the shortage of practitioners from this training pathway and in recognition of the ongoing importance of the EM voice in PEM.
-
Multicenter Study
Inaccuracy of the global assessment score in the emergency medicine standard letter of recommendation.
The standard letter of recommendation (SLOR) is used by most emergency medicine (EM) faculty to submit evaluations for medical students applying for EM residency programs. In the global assessment score (GAS) section, there is a crucial summative question that asks letter writers to estimate the applicant's rank order list (ROL) position in their own program. The primary aim of the study was to determine if these estimated global assessment tiers agreed with the actual ROL, using the criteria recommended by the Council of Emergency Medicine Residency Directors (CORD). ⋯ Standard letter of recommendation writers are inaccurate in estimating the ROL position of the applicant using the GAS tier criteria. The GAS tiers were accurate only 26% of the time. Because of the valuable role that the SLOR plays in determining an applicant's competitiveness in the National Resident Matching Program (NRMP) in EM, future discussion should focus on improving the consistency and accuracy of the GAS section. Furthermore, there needs to be a national dialogue to reassess the utility of the criterion-based GAS within the SLOR.
-
Written examinations are frequently used to assess medical student performance. Within emergency medicine (EM), a National Board of Medical Examiners (NBME) subject examination for EM clerkships does not exist. As a result, clerkship directors frequently generate examinations within their institution. This article reviews the literature behind the use of standardized examinations in evaluating medical student performance, describes methods for generating well-written test questions, reviews the statistical concepts of reliability and validity that are necessary to evaluate an examination, and proposes future directions for testing EM students.
-
Comparative Study
Feasibility and reliability of the SHOT: A short scale for measuring pretreatment severity of alcohol withdrawal in the emergency department.
Use of a symptom-triggered scale to measure the severity of alcohol withdrawal could reduce the rate of seizures and other complications. The current standard scale, the Clinical Institute of Withdrawal Assessment (CIWA), takes a mean (±SD) of 5 minutes to complete, requiring 30 minutes of nursing time per patient when multiple measures are required. ⋯ The SHOT has potential as a feasible and acceptable tool for measuring pretreatment alcohol withdrawal severity in the ED. Further research is needed to validate the SHOT, to assess the utility of serial measurements of the SHOT, and to demonstrate that its use reduces length of stay and improves clinical outcomes.
-
This study examines the effect of variations in emergency department (ED) volume on physician work efficiency (new patients per hour) and work profile (patient-related activities, including both direct and indirect patient care) and whether these differ between first- (Postgraduate Year [PGY]1) and third- (PGY3) year residents. The authors also determine if changes in volume are associated with changes in teaching interactions between attending and resident physicians. ⋯ Third-year residents see and carry more patients than do their first-year counterparts. They do so primarily by decreasing the amount of time spent with patients and attendings and working more efficiently overall. However, they are not as capable of altering their work profiles in the face of increased volume as their first-year counterparts. While the length of teaching interactions is decreased as volume increases, the number of those interactions resulting in teaching remains constant regardless of volume.