Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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In this hypothesis-generating study, we observe, identify, and analyze how emergency clinicians seek to manage work pressure to maximize patient flow in an environment characterized by delayed patient admissions (access block) and emergency department (ED) crowding. ⋯ To redress the linearity of most literature on patient flow, this study adopts a systems perspective and ethnographic methods to bring to light the dynamic role that individuals play, interacting with their work contexts, to maintain patient flow. The study provides an empirical foundation, uniquely discernible through qualitative research, about aspects of ED work that previously have been the subject only of discussion or commentary articles. This study provides empirical documentation of the moment-to-moment responses of emergency clinicians to work pressure brought about by factors outside much of their control, establishing the relationship between patient flow and work pressure. We conceptualize the ED as a dynamic system, combining socioprofessional influences to reduce and control work pressure in the ED. Interventions in education, practice, policy, and organizational performance evaluations will be supported by this systematic documentation of the complexity of emergency clinical work. Future research involves testing the five findings using systems dynamic modeling techniques.
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The development of robust Accreditation Council for Graduate Medical Education (ACGME) systems-based practice (SBP) training and validated evaluation tools has been generally challenging for emergency medicine (EM) residency programs. The purpose of this paper is to report the results of a consensus workgroup session of the 2010 Council of Emergency Medicine Residency Directors (CORD) Academic Assembly with the following objectives: 1) to discuss current and preferred local and regional methods for teaching and assessing SBP and 2) to develop consensus within the CORD community using the modified Delphi method with respect to EM-specific SBP domains and link these domains to specific SBP educational and evaluative methods. ⋯ This consensus process resulted in the development of a taxonomy of EM-specific domains for teaching and observable tasks for evaluating SBP. The concept of SBP is interlinked with the other general competencies and difficult to separate. Rather than develop specific SBP evaluation tools to measure the competency directly, SBP competency evaluation should be considered one element of a coordinated effort to teach and evaluate the six ACGME general competencies.
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As medical educators strive to adopt an evidence-based, outcomes-driven approach to teaching, education research in emergency medicine (EM) is burgeoning. Many educational challenges prompt specific research questions that are well suited to investigative study, but educators face numerous barriers to translating exciting ideas into research publications. ⋯ A common approach to curricular development is reviewed, as well as a fundamental overview of qualitative and quantitative methods that can be applied to educational research questions. Finally, suggestions for disseminating results and overcoming common barriers to conducting research are discussed.
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The future of academic emergency medicine (EM) is based on the continued successful recruitment and cultivation of new faculty from EM residents. Little data exist as to the current rate of residents initially choosing an academic career path or which residency programs are best situated to result in new faculty. ⋯ Our data indicate that program region, size, and research productivity were best associated with academic career selection. Program length was not found to be significantly associated with academic career selection by residents, in contrast to previous studies. While many of these factors are not changeable, academic productivity can be cultivated by decision-makers wishing to increase their residents' academic career selection as opposed to changing program length to extend training for an additional year. It is our belief that our model provides a good description of programmatic factors affecting career choice. Additional research is necessary to further validate these findings, as well to provide important context to their general applicability for policy-makers and program directors.
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The objective was to critically appraise and highlight medical education research studies published in 2010 that were methodologically superior and whose outcomes were pertinent to teaching and education in emergency medicine (EM). ⋯ Forty-one EM educational studies published in 2010 were identified. This critical appraisal reviews and highlights five studies that met a priori quality indicators. Current trends and common methodologic pitfalls in the 2010 papers are noted.