American Journal of Emergency Medicine xxx (2015) xxx–xxx
Contents lists available at ScienceDirect
American Journal of Emergency Medicine journal homepage: www.elsevier.com/locate/ajem
Correspondence
Freestanding EDs and the Emergency Medicine Resident: A Valuable Part of Resident Education?☆,☆☆,★ To the Editor, The goal of emergency medicine (EM) residency training is to prepare physicians for independent practice. This includes all practice environments from the tertiary care center to rural emergency departments (EDs) with limited resources. The EM resident must be effectively taught the fundamental skills, knowledge, and humanistic qualities that make up the foundation of EM practice [1,2]. Our health system operates 3 freestanding EDs (FEDs) in neighboring communities. They treat all illness and injuries that arrive by private vehicle as well as a large portion of ambulance traffic. In addition, each FED has 2 rooms designated as trauma rooms. The FEDs are staffed by residents as part of their FED rotation month. Our objective was to examine the effect of FEDs on resident education. This includes making timely and appropriate disposition for all patients presenting to the ED as well as the ability to perform procedures necessary for emergency care and stabilization within the ED. This study is an important step in evaluating whether FEDs could present a valuable experience to residency education. In 2014, a voluntary, anonymous, Likert scale survey was sent to all EM residents in their first through third years of training, at a single community-based, university-affiliated EM residency program. Residents who completed at least a 1-month rotation at an FED were included. Questions are based on overall goals of the EM residency. This is a prospective survey-based study using the standardized Likert agreement scale. Two scales were used: a 6-item scale of agreement and a 6-item scale of frequency. Survey questions were grouped into categories addressing procedure competency, critical care, throughput, communication, efficiency, multitasking, value to education, and administration. Frequencies of the core procedures performed by residents at the FEDs were also calculated and correlated with whether there was an increased level of confidence. We examined procedures, which included adult and pediatric incision and drainage, fracture splinting, intubation, central line placement, slit lamp exam, conscious sedation, chest tube placement, and arthrocentesis. Subsequently, frequency questions asking how often a resident performs each of the core procedures were analyzed. Percentages of residents who viewed the FED experience as valuable vs not were also calculated along with frequencies of core EM procedures performed by residents in the FEDs. χ 2 Goodness of fit test was ☆ Informed consent for research involving human subjects: This study was approved by the Akron General Institutional Review Board. ☆☆ Funding sources/disclosures for all authors: None. ★ All authors have no current and foreseeable financial and personal relationships that might inappropriately influence their actions and have no conflict of interest to disclose.
conducted for each question item. A level of significance (P value) for each question addressing the core competencies of residency training was calculated. It was then established whether there was significant level of agreement or disagreement with the FEDs impacting each core area of residency education. A total of 21 residents met inclusion criteria postgraduate year 1 to 3. Of these residents, 95.2% felt that the experience helped them develop better communication strategies, teaching skills, and ability to simultaneously manage multiple patients (P = .000). 90.5% agreed that the FED experience helped them balance quality care with optimal patient throughput and contributed overall to their education (P b .001). There was significant value to education with positive effect on strategies for life-long learning (P = .016), increased ability to treat all conditions presenting to the ED (P = .025), and positive contribution to education (P b .001). There was also significant positive level of agreement in independently directed patient evaluations and increased efficiency in task switching and managing a busy ED with limited resources (P = .001). We found that a significant association exists between resident agreement that their FED experience increased their efficiency in task switching, managing the ED under high volume situations, and working one on one with the attending physician having a positive effect on their educational experience (2-sided P = .014), calculated with Fisher exact test. The most commonly performed procedures at the FEDs were adult and pediatric laceration repair, incision and drainage (adult), and independent evaluation of radiographs. The frequency of procedural performance by residents at the FEDs correlates with perceived level of confidence in performing each procedure by residents. There was a statistically significant level of agreement with 95.2% of residents feeling that the FED rotation increased their confidence with performing adult laceration repair (P b .001). Residents also felt an increased level of confidence with pediatric laceration repair (P = .007) and incision and drainage (P b .001). We found that there was no statistically significant impact of FEDs on performance of critical care procedures and management of critical resuscitation (P N .275). We also found no significant agreement that the FED rotation helped residents better perform administrative tasks (P = .127). The FED rotation provided a statistically significant impact on resident education. It also provided essential core residency skills based on Accreditation Council for Graduate Medical Education program requirements in areas of ED throughput, communication skills, efficiency, procedures, and multitasking. There were a statistically significant number of residents that viewed the rotation as valuable to their overall education. These experiences may otherwise not be available in a large tertiary care center. Further studies are warranted.
0735-6757/© 2015 Elsevier Inc. All rights reserved.
Please cite this article as: Orlik K, et al, Freestanding EDs and the Emergency Medicine Resident: A Valuable Part of Resident Education? Am J Emerg Med (2015), http://dx.doi.org/10.1016/j.ajem.2015.04.081
2
Correspondence
Kseniya Orlik MD ⁎ Christina M. Campana DO Department of Emergency Medicine, Akron General Medical Center, Akron, OH ⁎Corresponding author at: Department of Emergency Medicine, Akron General Medical Center, 1 Akron General Ave., Akron, OH 44307 Tel.: +1 330 962 9208; fax: +1 330 761 3416 E-mail addresses: [email protected], [email protected] Michael S. Beeson MD Erin L.Simon DO Department of Emergency Medicine, Akron General Medical Center Akron, OH
Northeast Ohio Medical University, Rootstown, OH E-mail addresses: [email protected] [email protected] http://dx.doi.org/10.1016/j.ajem.2015.04.081 References [1] ACGME. ACGME Program Requirements for Graduate Medical Education in Emergency Medicine; 2012 [Available at https://www.acgme.org/acgmeweb/Portals/0/PFAssets/ 2013-PR-FAQ-PIF/110_emergency_medicine_07012013.pdf. Accessed July 12, 2014]. [2] Beeson M. Emergency Medicine Resident Progress and Promotion Department of Emergency Medicine Akron General Medical Center; 2013 [Available].
Please cite this article as: Orlik K, et al, Freestanding EDs and the Emergency Medicine Resident: A Valuable Part of Resident Education? Am J Emerg Med (2015), http://dx.doi.org/10.1016/j.ajem.2015.04.081
Contents lists available at ScienceDirect
American Journal of Emergency Medicine journal homepage: www.elsevier.com/locate/ajem
Correspondence
Freestanding EDs and the Emergency Medicine Resident: A Valuable Part of Resident Education?☆,☆☆,★ To the Editor, The goal of emergency medicine (EM) residency training is to prepare physicians for independent practice. This includes all practice environments from the tertiary care center to rural emergency departments (EDs) with limited resources. The EM resident must be effectively taught the fundamental skills, knowledge, and humanistic qualities that make up the foundation of EM practice [1,2]. Our health system operates 3 freestanding EDs (FEDs) in neighboring communities. They treat all illness and injuries that arrive by private vehicle as well as a large portion of ambulance traffic. In addition, each FED has 2 rooms designated as trauma rooms. The FEDs are staffed by residents as part of their FED rotation month. Our objective was to examine the effect of FEDs on resident education. This includes making timely and appropriate disposition for all patients presenting to the ED as well as the ability to perform procedures necessary for emergency care and stabilization within the ED. This study is an important step in evaluating whether FEDs could present a valuable experience to residency education. In 2014, a voluntary, anonymous, Likert scale survey was sent to all EM residents in their first through third years of training, at a single community-based, university-affiliated EM residency program. Residents who completed at least a 1-month rotation at an FED were included. Questions are based on overall goals of the EM residency. This is a prospective survey-based study using the standardized Likert agreement scale. Two scales were used: a 6-item scale of agreement and a 6-item scale of frequency. Survey questions were grouped into categories addressing procedure competency, critical care, throughput, communication, efficiency, multitasking, value to education, and administration. Frequencies of the core procedures performed by residents at the FEDs were also calculated and correlated with whether there was an increased level of confidence. We examined procedures, which included adult and pediatric incision and drainage, fracture splinting, intubation, central line placement, slit lamp exam, conscious sedation, chest tube placement, and arthrocentesis. Subsequently, frequency questions asking how often a resident performs each of the core procedures were analyzed. Percentages of residents who viewed the FED experience as valuable vs not were also calculated along with frequencies of core EM procedures performed by residents in the FEDs. χ 2 Goodness of fit test was ☆ Informed consent for research involving human subjects: This study was approved by the Akron General Institutional Review Board. ☆☆ Funding sources/disclosures for all authors: None. ★ All authors have no current and foreseeable financial and personal relationships that might inappropriately influence their actions and have no conflict of interest to disclose.
conducted for each question item. A level of significance (P value) for each question addressing the core competencies of residency training was calculated. It was then established whether there was significant level of agreement or disagreement with the FEDs impacting each core area of residency education. A total of 21 residents met inclusion criteria postgraduate year 1 to 3. Of these residents, 95.2% felt that the experience helped them develop better communication strategies, teaching skills, and ability to simultaneously manage multiple patients (P = .000). 90.5% agreed that the FED experience helped them balance quality care with optimal patient throughput and contributed overall to their education (P b .001). There was significant value to education with positive effect on strategies for life-long learning (P = .016), increased ability to treat all conditions presenting to the ED (P = .025), and positive contribution to education (P b .001). There was also significant positive level of agreement in independently directed patient evaluations and increased efficiency in task switching and managing a busy ED with limited resources (P = .001). We found that a significant association exists between resident agreement that their FED experience increased their efficiency in task switching, managing the ED under high volume situations, and working one on one with the attending physician having a positive effect on their educational experience (2-sided P = .014), calculated with Fisher exact test. The most commonly performed procedures at the FEDs were adult and pediatric laceration repair, incision and drainage (adult), and independent evaluation of radiographs. The frequency of procedural performance by residents at the FEDs correlates with perceived level of confidence in performing each procedure by residents. There was a statistically significant level of agreement with 95.2% of residents feeling that the FED rotation increased their confidence with performing adult laceration repair (P b .001). Residents also felt an increased level of confidence with pediatric laceration repair (P = .007) and incision and drainage (P b .001). We found that there was no statistically significant impact of FEDs on performance of critical care procedures and management of critical resuscitation (P N .275). We also found no significant agreement that the FED rotation helped residents better perform administrative tasks (P = .127). The FED rotation provided a statistically significant impact on resident education. It also provided essential core residency skills based on Accreditation Council for Graduate Medical Education program requirements in areas of ED throughput, communication skills, efficiency, procedures, and multitasking. There were a statistically significant number of residents that viewed the rotation as valuable to their overall education. These experiences may otherwise not be available in a large tertiary care center. Further studies are warranted.
0735-6757/© 2015 Elsevier Inc. All rights reserved.
Please cite this article as: Orlik K, et al, Freestanding EDs and the Emergency Medicine Resident: A Valuable Part of Resident Education? Am J Emerg Med (2015), http://dx.doi.org/10.1016/j.ajem.2015.04.081
2
Correspondence
Kseniya Orlik MD ⁎ Christina M. Campana DO Department of Emergency Medicine, Akron General Medical Center, Akron, OH ⁎Corresponding author at: Department of Emergency Medicine, Akron General Medical Center, 1 Akron General Ave., Akron, OH 44307 Tel.: +1 330 962 9208; fax: +1 330 761 3416 E-mail addresses: [email protected], [email protected] Michael S. Beeson MD Erin L.Simon DO Department of Emergency Medicine, Akron General Medical Center Akron, OH
Northeast Ohio Medical University, Rootstown, OH E-mail addresses: [email protected] [email protected] http://dx.doi.org/10.1016/j.ajem.2015.04.081 References [1] ACGME. ACGME Program Requirements for Graduate Medical Education in Emergency Medicine; 2012 [Available at https://www.acgme.org/acgmeweb/Portals/0/PFAssets/ 2013-PR-FAQ-PIF/110_emergency_medicine_07012013.pdf. Accessed July 12, 2014]. [2] Beeson M. Emergency Medicine Resident Progress and Promotion Department of Emergency Medicine Akron General Medical Center; 2013 [Available].
Please cite this article as: Orlik K, et al, Freestanding EDs and the Emergency Medicine Resident: A Valuable Part of Resident Education? Am J Emerg Med (2015), http://dx.doi.org/10.1016/j.ajem.2015.04.081
