Articles: emergency-medicine.
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We report on a process for assessing the communication skills of emergency medicine residents that includes 1) a faculty development initiative; 2) videotaping of actual resident-patient encounters in the emergency department; and 3) creation of an observation instrument for evaluating communication behaviors. We tested this observation instrument for inter-rater reliability, finding moderate-to-high agreement for only 11 of 32 items. ⋯ There was poor or no agreement for behaviors related to establishing rapport, gathering information, and contracting or informing. Challenges of assessing interpersonal skills of emergency medicine residents are discussed.
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Historical Article
Emergency medicine in Singapore: past, present, and future.
What began in 1948 as a "Casualty and Outpatient Service" at the Singapore General Hospital grew into the first 24-hour emergency unit in 1964 and has since expanded to the current emergency departments of the 6 public hospitals providing acute 24-hour accident and emergency services with an annual patient load of up to 540,000. In 1984, emergency medicine was recognized as a distinct medical specialty by the Ministry of Health. ⋯ Seven areas of subspecialization have since been identified and are in various stages of development: emergency cardiac care, emergency trauma care, emergency toxicology, prehospital emergency care, pediatric emergency medicine, disaster medicine, and observation medicine. The achievements in emergency medicine in Singapore can help to provide a model for the future development of emergency medicine in other similar environments.
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A prospective study of Emergency Medicine (EM) residents was conducted over two consecutive 1-month periods at a rural tertiary-care teaching hospital with a residency in EM to evaluate the effect of a 4-h pain management education program on the assessment and management of acute pain in the emergency department (ED). All patients presenting to the ED with an acute, painful condition were eligible to participate in the survey. Patients were excluded if they had taken any pain medication within 4 h of presenting to the ED, or had any condition requiring immediate resuscitation, suspected cardiac pain, or pain from a potential surgical abdomen. ⋯ Only 65% of the patients studied before the EP had significant reduction in their pain scores after 30 min in the ED; after institution of the EP, 92% had a significant reduction in their pain scores at 30 min. Similarly, a significant improvement was seen in the patients' global evaluation of treatment after the educational program was instituted. It appears that the use of a 4-h educational program on pain assessment and management directed toward EM residents in their training can improve their skills at recognizing and treating painful conditions.