Articles: emergency-medicine.
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Questionnaires were sent to 245 North American institutions with pediatric residency programs. There was a 69% response rate. Pediatric emergency care is provided in three types of facilities: emergency departments in pediatric hospitals, separate pediatric emergency departments or combined pediatric and adult emergency departments, in multidisciplinary hospitals. ⋯ There are 27 pediatric emergency medicine programs with 46 fellows in training and 117 full-time positions available for emergency pediatricians throughout North America. Varying qualifications for these positions include board eligibility in pediatrics, certification in Basic Life Support or Advanced Trauma Life Support, and a fellowship in pediatric emergency medicine. The demonstrated need for pediatricians, preferably trained in emergency care, clearly indicates that pediatric emergency medicine is a rapidly developing subspecialty of Pediatrics that will be an attractive career choice for future pediatricians.
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Review
Accuracy of interpretations of emergency department radiographs: effect of confidence levels.
We conducted a prospective study to assess the relationship between the interpretive agreement rate for emergency department radiographs and the degree of interpretive confidence. We hoped to identify a subset of ED radiographs that did not require mandatory review by a radiologist. For each of the 1,872 plain radiographs studied, emergency physicians assigned a confidence level to the interpretation before comparing it with the radiologist's dictated report. ⋯ No subset of radiographs had 100% agreement. Treatment was potentially altered in 38 patients as a result of the interpretive disagreement that occurred in 2% of studied radiographs. We conclude that the interpretive agreement rate increases in relation to interpretive confidence but that confidence levels cannot safely exclude certain radiographs from mandatory review by a radiologist.
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Physician involvement in the provision of both direct and indirect medical control to emergency medical providers is critical to the effective operation of an emergency medical services (EMS) system. We conducted a survey of all accredited emergency medicine residency programs in the United States to determine the content of EMS instruction provided to these physicians-in-training. ⋯ The importance placed on EMS during residency training is variable. EMS is the domain of emergency medicine, and adequate training of residents for these responsibilities is imperative.
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A study of emergency medicine residency training graduates was conducted to determine their perceptions of the quality of their graduate training. A sample of 300 individuals was randomly selected from a population of 1,000 persons graduating from 1982 through 1984. Respondents were asked to use a scale of 1 to 5 (with 1 being highest) to rate the adequacy of their residency training relative to 20 major core content areas. ⋯ Overall, residents were quite positive in their perceptions regarding the quality of their training. They indicated plans to attend continuing medical education programs to reinforce some of their training and to address some of the deficiencies they perceived in residency training. Programs are encouraged to conduct similar surveys with their own graduates to assess particular strengths and weaknesses.