Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
-
Review Case Reports
Clinical decision making: an emergency medicine perspective.
Clinical decision making (CDM) describes a form of qualitative inquiry that examines the thought processes involved in making medical decisions. A significant body of literature exists on the orderly "hypothetico-deductive" model of clinical decision making. ⋯ The concept of diagnostic uncertainty and the utility of the diagnosis of unknown etiology in the disposition phase of the emergency patient visit are discussed. Finally, a unique EM perspective on clinical decision-making errors is presented.
-
Editorial Comment Review
Can acutely ill patients consent to research? Resolving an ethical dilemma with facts.
-
Publication is a marker of academic success. In academia, appointments and promotions are in many cases strongly linked to the candidate's bibliography. The "publish or perish" mindset has placed extraordinary pressures on scientists and academic physicians alike. ⋯ Although guidelines are available to help determine how attribution should be acknowledged, anecdotal experiences with disputes associated with authorship continue to exist. This paper addresses several key problems facing authorship. A discussion of who should be given authorship, the responsibilities of an author, and a method for assigning authorship in a multiauthored publication is provided.
-
While the teaching and assessing of technical skills have been an integral part of residency training, the demonstration of ethical and humanistic skills has been more or less left to chance. Only in the last two decades has the formal teaching of bioethics become an accepted component of Western medical education. In spite of the many ethics lectures, discussions, conferences, and courses, the clinical impact of this educational paradigm shift remains unclear. ⋯ The few prospective evaluations of trainees have focused on single-researcher observations or student attitude surveys that are fraught with observer and recall biases, respectively. More reliable and valid methods of identifying clinical ethical competence are needed. This paper reviews a variety of evaluative tools and suggests a three-level approach to monitoring the ethical knowledge, capacity, and real-time performance of emergency medicine residents.
-
To determine whether telephone preauthorization for reimbursement of ED care (medical "gate-keeping") by managed care organizations (MCOs) is associated with adverse outcomes. ⋯ Adverse outcomes occur with MCO gatekeeping, Although the present study cannot ascertain whether this is a frequent event or a rare one, the safety of MCO gatekeeping deserves further study.