Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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This paper reports the proceedings of the discussion panel assigned to look at clinical aspects of quality in emergency medicine. One of the seven stated objectives of the Academic Emergency Medicine consensus conference on quality in emergency medicine was to educate emergency physicians regarding quality measures and quality improvement as essential aspects of the practice of emergency medicine. Another topic of interest was a discussion of the value of information technology in facilitating quality care in the clinical practice of emergency medicine. It is important to note that this is not intended to be a comprehensive review of this extensive topic, but instead is designed to report the discussion that occurred at this session of the consensus conference.
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The Outcome Project is a long-term initiative by which the Accreditation Council for Graduate Medical Education (ACGME) is increasing emphasis on educational outcomes in the evaluation of residency programs. The ACGME initiated the Outcome Project to "ensure and improve the quality of graduate medical education." In order to assist program directors in emergency medicine (EM) to begin complying with components of the ACGME Outcome Project, the Council of Residency Directors in Emergency Medicine (CORD-EM) convened a consensus conference in March 2002 in conjunction with several other EM organizations. The working group for the competency of Practice-based Learning and Improvement (PBL) defined the components of PBL as: 1) analyze and assess practice experience and perform practice-based improvement; 2) locate, appraise, and utilize scientific evidence related to the patient's health problems and the larger population from which they are drawn; 3) apply knowledge of study design and statistical methods to critically appraise the medical literature; 4) utilize information technology to enhance personal education and improve patient care; and 5) facilitate the learning of students, colleagues, and other health care professionals in EM principles and practice. ⋯ Checklist evaluation is appropriate for assessing any competency that can be broken down into specific behaviors or actions. 360-degree evaluation may be used to assess teamwork, communication skills, management skills, and clinical decision making. Chart-stimulated recall and record review are additional evaluation methods that can be used to assess resident competency in PBL. Simulations and models, such as computer-based scenarios, may be ideal for low-frequency but critical procedures.
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The Accreditation Council for Graduate Medical Education (ACGME) has challenged all residencies with a new paradigm-to teach and evaluate residents based on six core competencies. One of these core competencies is clinical assessment. Standardized patients and direct observation are the most promising for emergency medicine educators to use to assess this competency. There is much room for research and national standardization of methods.
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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.
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The Accreditation Council for Graduate Medical Education (ACGME) has challenged residency programs to provide documentation via outcomes assessment that all residents have successfully mastered the six core competencies. A variety of assessment "tools" has been identified by the ACGME for outcomes assessment determination. ⋯ This is a significant deviation from both the peer review process and the resident review process that almost exclusively use physicians as raters. Because of its relative lack of development, utilization, and validation as a method of resident assessment in graduate medical education, a great opportunity exists to develop the 360-degree feedback tool for resident assessment.