AEM Education and Training最新文献

Virtual versus in-person didactic modalities: A national survey of emergency medicine residencies. 虚拟与面对面教学模式：急诊医学住院医师的全国调查。

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-12-26 eCollection Date: 2024-12-01 DOI: 10.1002/aet2.11056

Emily L Jameyfield, Charles W Kropf, Jason J Lewis, Christopher Reisig, Jenna Thomas

Background: Following the widespread shift from in-person to virtual delivery of didactics during the COVID-19 pandemic, some emergency medicine (EM) residency programs have retained virtual didactic time while others have returned exclusively to in-person didactics. In this national survey of EM residency programs, we explored the current national distribution of virtual versus in-person didactic time and the circumstances and motivators for use of each.

Methods: A cross-sectional survey with branched logic was designed via Qualtrics. Distribution was via a Council of Residency Directors in Emergency Medicine (CORD) listserv; nonresponding programs were emailed directly with subsequent reminders. Analysis and descriptive statistics were calculated via Microsoft Excel. All authors performed thematic analysis of narrative comments.

Results: We received responses from 174 of 281 programs (61.9%). "Hybrid" programs utilizing both in-person and virtual time represented 51.7% of respondents, and the remaining 49.3% used in-person didactics only. Among hybrid programs, 77.3% utilized in-person conferences greater than 75% of the time. Simulation (100%) and procedural teaching (99%) were most strongly preferred in person, and oral boards practice (30.2%) was supported virtually. The most common motivations for in-person delivery were perceived impact on resident and/or faculty learning (86.8%), perception of resident engagement (79.3%), community building (74.7%), type of learning sessions (70.1%), and perceived impact on resident and/or faculty wellness (59.8%). Top reasons for choosing virtual didactics were perceived convenience for residents (75.6%) or faculty (60.0%) and perceived impact on resident and/or faculty wellness (43.3%).

Conclusions: Nationwide, EM residency programs spend most didactic time in person. Modality choice is influenced by didactic content as well as sociocultural considerations. Future investigation into the validity of perceptions that participants are more engaged and learn better with in-person didactics is warranted.

背景：在2019冠状病毒病大流行期间，随着教学从面对面授课向虚拟授课的广泛转变，一些急诊医学（EM）住院医师项目保留了虚拟教学时间，而另一些项目则完全恢复了面对面授课。在这项关于新兴市场住院医师计划的全国调查中，我们探讨了目前全国虚拟与面对面教学时间的分布情况，以及使用每种教学时间的情况和动机。方法：采用质谱法设计分支逻辑横断面调查。通过急诊医学住院医师主任理事会（CORD）名单服务进行分发；没有响应的程序直接通过电子邮件发送，并附带后续提醒。通过Microsoft Excel进行分析和描述性统计。所有作者都对叙事评论进行了主题分析。结果：我们收到了281个项目中的174个（61.9%）的回复。51.7%的受访者使用面对面和虚拟时间的“混合”课程，其余49.3%的受访者只使用面对面的教学。在混合项目中，77.3%的人在超过75%的时间里使用了面对面的会议。模拟教学（100%）和程序性教学（99%）最受欢迎，口头教学（30.2%）支持虚拟教学。亲自授课最常见的动机是对住院医生和/或教师学习的感知影响（86.8%），对住院医生参与的感知（79.3%），社区建设（74.7%），学习课程类型（70.1%）以及对住院医生和/或教师健康的感知影响（59.8%）。选择虚拟教学的主要原因是对居民（75.6%）或教师（60.0%）的便利，以及对居民和/或教师健康的影响（43.3%）。结论：在全国范围内，急诊住院医师项目花费了大部分的教学时间。教学形式的选择受到教学内容和社会文化因素的影响。未来的调查有效性的看法，参与者更参与和更好地学习与面对面的教学是必要的。

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引用次数: 0

Unveiling the gaps: Assessing LGBTQIA+ inclusivity on emergency medicine residency websites—An analysis of pronoun usage, diversity pages, and LGBTQIA+ sections 揭示差距：评估急诊医学住院医师网站上LGBTQIA+的包容性——对代词使用、多样性页面和LGBTQIA+部分的分析

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-12-20 DOI: 10.1002/aet2.11054

Eliot H. Blum MD, Michelle D. Lall MD, MHS, Christopher S. Awad MD, MBA, Lauren Jenkins BS, David R. G. Kulp MSc, Khiem H. N. Hoang MD

Introduction

Despite progress in promoting diversity, equity, and inclusion (DEI) in medical education, lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual, and more (LGBTQIA+) individuals remain underrepresented and often face barriers to equitable advancement. Emergency medicine (EM) residency programs are instrumental in creating inclusive environments that attract diverse applicants and support LGBTQIA+ trainees. Since the COVID-19 pandemic's shift to virtual recruitment, residency websites have become vital tools for communicating DEI initiatives. This study examines LGBTQIA+ inclusivity on EM residency websites, focusing on the visibility of resident pronouns, diversity pages, and LGBTQIA+ subsections.

Methods

We conducted a review of 282 EM residency program websites listed on the Electronic Residency Application Service (ERAS) between August and October 2023. Websites were assessed for the presence of pronouns on resident biographies, dedicated diversity pages, and LGBTQIA+ content. Data were stratified by geographic region and analyzed using descriptive statistics.

Results

Among the websites reviewed, 4.3% displayed resident pronouns, 31.2% had dedicated diversity pages, and 3.9% included LGBTQIA+ subsections. The Midwest region had the highest proportion of programs featuring resident pronouns (5/70), while the West region led in diversity pages (14/32) and LGBTQIA+ content (4/32).

Discussion

The limited visibility of LGBTQIA+ content and pronouns across EM residency websites suggests an underutilization of online platforms to promote inclusivity. With virtual recruitment now standard, these websites are critical for conveying program culture to prospective applicants. Displaying pronouns, DEI pages, and LGBTQIA+-specific content can foster a welcoming environment and signal support to diverse applicants. Programs in regions with stronger DEI representation could serve as models for others, sharing best practices in promoting inclusivity.

Conclusions

Enhancing DEI visibility on EM residency websites may positively influence perceptions and engagement among LGBTQIA+ applicants, fostering more inclusive and equitable training environments that align with the needs of diverse trainees in emergency medicine.

引言尽管在促进医学教育的多样性、公平性和包容性（DEI）方面取得了进展，但男女同性恋、双性恋、变性人、同性恋者/质疑者、双性人、无性人以及更多人（LGBTQIA+）的代表性仍然不足，并经常面临公平晋升的障碍。急诊医学（EM）住院医师培训项目在创造包容性环境以吸引不同申请者和支持 LGBTQIA+ 学员方面发挥着重要作用。自 COVID-19 大流行转向虚拟招聘以来，住院医师培训网站已成为宣传 DEI 计划的重要工具。本研究考察了少管住院医师网站对 LGBTQIA+ 的包容性，重点关注住院医师代词、多样性页面和 LGBTQIA+ 子栏目的可见度。方法我们对2023年8月至10月期间在住院医师电子申请服务（ERAS）上列出的282个急诊科住院医师项目网站进行了审查。我们对网站进行了评估，看其是否在住院医师简历中使用代词、是否有专门的多样性页面以及是否有 LGBTQIA+ 内容。数据按地理区域进行分层，并使用描述性统计进行分析。结果在审查的网站中，4.3%的网站显示了居民代词，31.2%的网站有专门的多样性页面，3.9%的网站包含 LGBTQIA+ 子栏目。中西部地区使用居民代词的项目比例最高（5/70），而西部地区在多样性页面（14/32）和 LGBTQIA+ 内容（4/32）方面领先。讨论 EM住院医师网站中LGBTQIA+内容和代词的能见度有限，这表明没有充分利用网络平台来促进包容性。随着虚拟招聘成为标准，这些网站对于向潜在申请人传达项目文化至关重要。显示代词、DEI页面和LGBTQIA+特定内容可以营造一个欢迎的环境，并向不同的申请者发出支持的信号。一些地区的项目具有更强的 DEI 代表性，可以为其他地区的项目树立榜样，分享促进包容性的最佳实践。结论在急诊科住院医师培训网站上提高 DEI 的能见度可能会对 LGBTQIA+ 申请者的看法和参与度产生积极影响，从而营造出更具包容性和公平性的培训环境，以满足急诊科不同学员的需求。

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引用次数: 0

Square pegs in round holes: How do pediatric emergency medicine fellowship program directors fit graduates of emergency medicine residencies into their programs? 方枘圆凿：儿科急诊医学奖学金项目主任如何将急诊医学住院医生毕业生纳入其项目？

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-12-19 DOI: 10.1002/aet2.11051

Anne P. Runkle MD, Marianela Feliu MD, MS, Charmaine B. Lo PhD, MPH, David P. Way MEd, Jennifer Mitzman MD

Objective

Pediatric emergency medicine (PEM) fellowship directors can interview candidates from either pediatric or EM residency programs. Currently, most candidates are pediatricians; however, because emergency physicians have attributes that could benefit PEM, our goal was to investigate facilitators and barriers to training more of them to become PEM physicians.

Methods

We surveyed U.S. PEM fellowship program directors (PDs) about their program's recruitment practices: Do they recruit only pediatricians or mostly pediatricians with an occasional emergency physician or do they actively recruit both? We solicited volunteers from each recruitment group for interviews. These were recorded, transcribed, and thematically coded using summative content analysis. Comments were cataloged into themes that were philosophical or logistic in nature and those that might facilitate (drivers) or serve as barriers (restrainers) to the inclusion of emergency physicians in PEM.

Results

We received 50 of 86 (58%) survey responses, 29 (34%) of whom volunteered for interviews. The 17 volunteers we selected for interviews generated 13 themes that fell into the four major theme categories: four philosophical drivers, three logistic drivers, two philosophical restrainers, and four logistic restrainers. Program groups differed with regard to the inclusion of emergency physicians. Most limiting were the impact of variable program length and the implicit belief that pediatricians are best suited to treat children. Most beneficial is the recognized value of EM graduates to the field of PEM.

Conclusions

While PDs acknowledged a growing need for PEM physicians, particularly in community hospitals, and that emergency physicians would contribute to PEM, they also identified the logistical burden of including them in programs primarily designed for pediatricians. This burden involves maintaining separate curricula for EM graduates and finding emergency physician faculty to serve as mentors. PDs also expressed a desire for resources to guide the integration of more emergency physicians into their programs.

目的儿科急诊医学（PEM）奖学金主任可以面试来自儿科或急诊住院医师项目的候选人。目前，大多数候选人是儿科医生；然而，由于急诊医生具有有利于PEM的属性，我们的目标是调查培训更多急诊医生成为PEM医生的促进因素和障碍。方法：我们调查了美国PEM奖学金项目主任（pd）的项目招聘实践：他们是只招聘儿科医生，还是主要招聘儿科医生，偶尔也有急诊医生，还是两者都积极招聘？我们从每个招聘组中征集志愿者进行面试。使用总结性内容分析对这些内容进行记录、转录和主题编码。评论分为哲学或逻辑性主题和可能促进（推动）或阻碍（限制）急诊医生参与PEM的主题。结果我们收到了86份回复中的50份（58%），其中29份（34%）是自愿接受采访的。我们选择的17名志愿者进行访谈，产生了13个主题，这些主题分为四个主要主题类别：四个哲学驱动因素，三个逻辑驱动因素，两个哲学约束因素和四个逻辑约束因素。方案组在纳入急诊医生方面存在差异。最受限制的是项目长度的变化以及认为儿科医生最适合治疗儿童的隐性信念的影响。最有利的是EM毕业生对PEM领域的公认价值。虽然pd承认对PEM医生的需求日益增长，特别是在社区医院，并且急诊医生将为PEM做出贡献，但他们也认识到将他们纳入主要为儿科医生设计的项目的后勤负担。这种负担包括为急诊毕业生开设单独的课程，并寻找急诊医师教师作为导师。医生们也表达了对资源的渴望，以指导更多的急诊医生融入他们的项目。

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引用次数: 0

Deaf culture awareness among physicians and advanced practice providers in the emergency department: A multicenter study 急诊科医生和高级实践提供者的聋人文化意识：一项多中心研究。

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-12-11 DOI: 10.1002/aet2.11050

Luke Johnson MD, Stefani Schmitz MD, Kevin Dillon MD, Emily Mudrick RN, MSEd, Shivram Kumar MBBS, MPH, Courtney Jones PhD, Jason Rotoli MD

<div> <section> <h3> Background and Objective</h3> <p>In areas with a large Deaf/hard-of-hearing (DHH) population, emergency medicine (EM) providers may benefit from cultural awareness training as this has been shown to foster delivery of more equitable care in other minority populations. Rochester, New York, has been touted to be the home to the largest per-capita DHH population in the United States. Given the large local DHH community and DHH professionals working in Rochester, University of Rochester (UR) providers likely have higher exposure to DHH people than most other EM providers in the United States. All UR providers receive annual institutional cultural sensitivity e-training that includes information about the DHH community. In addition to the e-training, the UR EM residents also receive a workshop during intern year and recurrent DHH culture education throughout their residency. The purpose of this study was to measure impact of preexisting cultural sensitivity training and higher DHH person exposure on DHH cultural awareness in UR providers compared to non-UR EM providers who may have lower DHH person exposure and culture training.</p> </section> <section> <h3> Methods</h3> <p>In this cross-sectional study, a survey on DHH cultural awareness was distributed to UR and Emergency Research Network in the Empire State (ERNIES) emergency departments. As surrogates for cultural awareness, the survey evaluated providers’ exposure, knowledge, comfort, and attitudes to Deaf culture. Descriptive statistics were employed to characterize the sample. Bivariate analysis was performed to compare UR provider responses to others using chi-square and Fisher's exact testing.</p> </section> <section> <h3> Results</h3> <p>Of 83 recruited participants, 75 providers completed the survey, and 53/75 (71%) responders were from UR. While high percentages of UR and non-UR participants reported seeing DHH patients recently (98% vs. 96%, respectively), one-third (24/75) of all participants reported having no experience or training on Deaf culture. Compared to only 10% of other providers, one-third of UR providers were better able to identify cultural nuances within the DHH community (<i>p</i> = 0.01). UR providers were significantly less comfortable communicating with Deaf patients via lipreading, which is typically an unreliable/unsafe mode of communication (11% vs. 69%, <i>p</i> = 0.002). When knowledge was assessed, UR providers better identified Deaf patient rights in a clinical setting (89% vs. 77%, <i>p</i> = 0.002). Also, all trainees had significantly higher scores on questions related to Deaf culture compared to all advance practice providers and attendings (mean scores 6.86 vs. 6.06 and 6, respectively, <i>p</i> = 0.0

背景和目的：在聋人/听力障碍者（DHH）人口众多的地区，急诊医学（EM）服务提供者可能会从文化意识培训中受益，因为这已被证明能促进为其他少数民族人口提供更公平的医疗服务。纽约州罗切斯特市被誉为美国人均 DHH 人口最多的地方。考虑到当地庞大的 DHH 社区和在罗切斯特工作的 DHH 专业人士，罗切斯特大学（UR）的医疗服务提供者与 DHH 的接触机会可能高于美国其他大多数急诊医疗服务提供者。罗切斯特大学的所有医疗服务提供者每年都会接受机构文化敏感性电子培训，其中包括有关 DHH 社区的信息。除电子培训外，市立医院的急诊科住院医师还在实习年期间参加了一个研讨会，并在整个住院期间接受了经常性的 DHH 文化教育。本研究的目的是，与接触 DHH 人群和接受文化培训较少的非 UR EM 医疗服务提供者相比，测量已有的文化敏感性培训和较高的 DHH 人群接触对 UR 医疗服务提供者的 DHH 文化意识的影响：在这项横断面研究中，我们向急诊科和帝国州急诊研究网络（ERNIES）的急诊科发放了一份关于 DHH 文化意识的调查问卷。作为文化意识的替代指标，调查评估了医疗服务提供者对聋人文化的接触、了解、舒适度和态度。采用描述性统计来描述样本的特征。使用卡方检验和费雪精确检验对 UR 提供者的回答与其他提供者的回答进行了双变量分析比较：在 83 位受访者中，75 位医疗服务提供者完成了调查，其中 53/75 （71%）位受访者来自 UR。城市医疗服务机构和非城市医疗服务机构的参与者中都有很高的比例（分别为 98% 和 96%）表示最近曾接诊过聋人患者，但所有参与者中有三分之一（24/75）表示没有聋人文化方面的经验或培训。与只有 10% 的其他医疗服务提供者相比，三分之一的 UR 医疗服务提供者能够更好地识别 DHH 社区中的文化细微差别（p = 0.01）。通过读唇术与聋人患者交流， UR 医疗服务提供者明显不太适应，因为读唇术通常是一种不可靠/不安全的交流方式（11% 对 69%，p = 0.002）。在知识评估方面，UR 医疗服务提供者能更好地识别聋人患者在临床环境中的权利（89% 对 77%，p = 0.002）。此外，在与聋人文化相关的问题上，所有受训者的得分都明显高于所有先行医疗人员和主治医师（平均分分别为 6.86 vs. 6.06 和 6，p = 0.03）：结论：接受过聋人文化培训并与聋人有较多接触的急诊医疗服务提供者对聋人文化的细微差别更容易接受和识别。此外，接受过聋人文化培训的急救医疗人员在与聋人患者进行交流时，不太习惯使用唇读，这表明他们对这一常见但无效且不准确的交流误区的认识有所提高。这项研究表明，在有大量 DHH 人口的地区开展聋人文化教育可能会增强未来医疗人员的文化意识，并使他们在护理聋人病人时更加得心应手。

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引用次数: 0

ChatG-PD? Comparing large language model artificial intelligence and faculty rankings of the competitiveness of standardized letters of evaluation ChatG-PD吗?比较大语言模型人工智能和教师排名的竞争力标准化评价信。

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-12-09 DOI: 10.1002/aet2.11052

Benjamin Schnapp MD, MEd, Morgan Sehdev MD, Caitlin Schrepel MD, Sharon Bord MD, Alexis Pelletier-Bui MD, Al’ai Alvarez MD, Nicole M. Dubosh MD, Yoon Soo Park PhD, Eric Shappell MD, MHPE

Background

While faculty have previously been shown to have high levels of agreement about the competitiveness of emergency medicine (EM) standardized letters of evaluation (SLOEs), reviewing SLOEs remains a highly time-intensive process for faculty. Artificial intelligence large language models (LLMs) have shown promise for effectively analyzing large volumes of data across a variety of contexts, but their ability to interpret SLOEs is unknown.

Objective

The objective was to evaluate the ability of LLMs to rate EM SLOEs on competitiveness compared to faculty consensus and previously developed algorithms.

Methods

Fifty mock SLOE letters were drafted and analyzed seven times by a data-focused LLM with instructions to rank them based on desirability for residency. The LLM was also asked to use its own criteria to decide which characteristics are most important for residency and revise its ranking of the SLOEs. LLM-generated rank lists were compared with faculty consensus rankings.

Results

There was a high degree of correlation (r = 0.96) between the rank list initially generated by LLM consensus and the rank list generated by trained faculty. The correlation between the revised list generated by the LLM and the faculty consensus was lower (r = 0.86).

Conclusions

The LLM generated rankings showed strong correlation with expert faculty consensus rankings with minimal input of faculty time and effort.

背景：虽然以前的研究表明，教师对急诊医学（EM）标准化评价函（SLOEs）的竞争力有很高的共识，但对教师来说，审查SLOEs仍然是一个非常耗时的过程。人工智能大型语言模型（llm）已经显示出在各种上下文中有效分析大量数据的希望，但它们解释sloe的能力尚不清楚。目的：目的是评估法学硕士评估EM SLOEs竞争力的能力，与教师共识和先前开发的算法进行比较。方法：50封模拟的SLOE信件由一位以数据为中心的法学硕士起草并分析了7次，并指示根据居住权的可取性对其进行排名。法学硕士还被要求使用自己的标准来决定哪些特征对住院医师最重要，并修改其对sloe的排名。法学硕士生成的排名与教师一致的排名进行了比较。结果：最初由LLM共识产生的排名与经过培训的教师产生的排名之间存在高度相关（r = 0.96）。法学硕士修订后的榜单与教师共识的相关性较低（r = 0.86）。结论：LLM生成的排名与专家教师共识排名有很强的相关性，教师的时间和精力投入最小。

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引用次数: 0

Generalizability of consensus regarding standardized letters of evaluation competitiveness: A validity study in a national sample of emergency medicine faculty 标准化评价信竞争力共识的可推广性：急诊医学院全国样本的效度研究。

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-12-09 DOI: 10.1002/aet2.11049

Sharon Bord MD, Morgan Sehdev MD, Alexis Pelletier-Bui MD, Al'ai Alvarez MD, Benjamin Schnapp MD, MEd, Nicole Dubosh MD, Caitlin Schrepel MD, Yoon Soo Park PhD, Eric Shappell MD, MHPE

Background

Standardized letters of evaluation (SLOEs) are an important part of residency recruitment, particularly given the limited availability of other discerning factors in residency applications. While consensus regarding SLOE competitiveness has been studied within a small group of academic faculty, it remains unexplored how a more diverse group of letter readers interpret SLOEs in terms of competitiveness.

Methods

A sample of 50 real SLOEs in the new SLOE format (2022 eSLOE 2.0) were selected to match the national rating distribution and anonymized. These SLOEs were ranked in order of competitiveness by 25 faculty members representing diverse demographics, geographic regions, and practice settings. Consensus levels were assessed using previously defined criteria and compared to prior results using a cutoff of ±10% to define a significant difference in consensus levels. Two models were tested to determine their ability to predict consensus rankings: a point-based system and a linear regression model.

Results

Faculty consensus in this diverse cohort was slightly below the level measured among academic emergency medicine faculty in the prior study, though no differences were greater than the ±10% cutoff. Prediction models also performed similarly to a previous study except at the tight level of agreement, where consensus was stronger in this study compared to previous results. There is greater consensus among faculty at academic institutions than at community institutions, and years of experience was not correlated with higher consensus.

Conclusions

The degree of consensus regarding competitiveness using real SLOEs was similar in this diverse national sample compared to a prior study in a smaller and more homogenous group ranking mock SLOEs. Consensus ranks were predicted with good accuracy using both the point system and the regression model.

背景：标准化评估信（SLOEs）是住院医师招聘的重要组成部分，特别是考虑到住院医师申请中其他识别因素的有限可用性。虽然关于SLOE竞争力的共识已经在一小群学术教师中进行了研究，但仍未探索更多样化的信件读者群体如何从竞争力的角度解读SLOE。方法：选取新SLOE格式（2022 eSLOE 2.0）的50个真实SLOE样本，匹配全国评分分布，并进行匿名化处理。代表不同人口统计、地理区域和实践环境的25名教员对这些sloe的竞争力进行了排名。共识水平使用先前定义的标准进行评估，并使用±10%的截止值与先前的结果进行比较，以确定共识水平的显着差异。测试了两个模型，以确定它们预测共识排名的能力：基于积分的系统和线性回归模型。结果：在这个多样化的队列中，教师的共识略低于先前研究中在学术急诊医学教师中测量的水平，尽管差异不超过±10%的截止值。预测模型的表现也与之前的研究相似，除了在紧密一致的水平上，与之前的结果相比，本研究的共识更强。学术机构的教职员工比社区机构的教职员工有更大的共识，而且多年的经验与更高的共识并不相关。结论：在这个不同的国家样本中，与之前在一个更小、更同质的组中排名模拟SLOEs的研究相比，使用真实SLOEs的竞争力的共识程度是相似的。使用积分系统和回归模型预测共识等级具有良好的准确性。

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引用次数: 0

Adaptive methods for bedside teaching: Integrating cognitive apprenticeship model and social cognitive theory to elevate workplace learning 床边教学的适应性方法：整合认知学徒模式与社会认知理论提升职场学习

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-12-01 DOI: 10.1002/aet2.11046

Christie Lech MD, MHPE, Christopher Reisig MD, MA, Kaushal Shah MD, Sara Zaidi MD, Di Coneybeare MD, MHPE

引用次数: 0

Beyond the requirement: A novel patient follow-up report 超出要求：一份新的患者随访报告

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-12-01 DOI: 10.1002/aet2.11042

Jack A. Allan MD, MBA, Zachary Repanshek MD, Megan E. Healy MD, Michael DeAngelis MD, Wayne A. Satz MD, Jacob W. Ufberg MD, Kraftin E. Schreyer MD, MBA

Background

Residents are required to participate in practice-based learning and improvement. Most commonly, a resident-initiated patient follow-up log is used to meet the requirement. We sought to provide residents with follow-up information in an efficient, value-added manner via a patient follow-up report (PFUR).

Methods

The PFUR is an automated monthly report sent to individual residents via email. It was generated from the electronic medical record and included five categories of cases: patients who were discharged and returned for admission within 72 h, diagnosis-based criteria, patients who expired during the hospital stay, patients who were admitted to or upgraded to the intensive care unit (ICU) within 24 h of admission, and patients independently flagged by the care team for follow-up. The PFURs were analyzed for 6 months after implementation for number and categorization of cases included as well as via survey of the residents.

Results

In 6 months, 1078 patients, generating 1155 follow-ups, were included on the PFUR. ICU upgrades were the most represented category (41%), followed by diagnosis-based criteria (30%). Patients who were discharged and admitted within 72 h were least commonly represented on the PFUR (2%). Seventy-eight percent of residents felt that patient follow-ups were valuable to their education and 82% felt that the PFUR impacted the clinical care they provided. The PFUR was preferred by 90% of resident respondents and had an average value rating of 4.38 out of 5.

Conclusions

Overall numbers of patient follow-ups significantly increased after implementation of the PFUR. Certain categories were more represented overall and within each class, which has implications for future educational initiatives. After a pilot period, the novel PFUR appears to be more efficient, accessible, and highly valued than the log used previously. Programs looking to maximize the educational benefits of patient follow-ups may consider a similar initiative.

住院医师需要参与基于实践的学习和改进。最常见的是，住院医师发起的患者随访记录被用来满足要求。我们试图通过患者随访报告（PFUR）以一种高效、增值的方式为住院患者提供随访信息。方法PFUR是一种自动的月度报告，通过电子邮件发送给每个居民。它是从电子病历中生成的，包括五类病例：72小时内出院并返回入院的患者、基于诊断的标准、住院期间过期的患者、入院后24小时内入住或升级到重症监护病房（ICU）的患者，以及由护理团队独立标记为随访的患者。对实施后6个月的病例数和分类进行分析，并对居民进行调查。结果在6个月的时间里，共有1078例患者接受了PFUR治疗，随访1155例。ICU升级是最具代表性的类别（41%），其次是基于诊断的标准（30%）。出院并在72小时内入院的患者在PFUR上最不常见（2%）。78%的住院医生认为患者随访对他们的教育有价值，82%的住院医生认为PFUR影响了他们提供的临床护理。90%的居民受访者更喜欢PFUR，平均价值评分为4.38分（满分5分）。结论实施PFUR后，患者随访总人数显著增加。某些类别在整体上和每个班级中都有更多的代表，这对未来的教育活动有影响。经过一段时间的试验，新型的PFUR似乎比以前使用的日志更有效、更容易获取、更有价值。希望最大限度地提高患者随访教育效益的项目可以考虑采取类似的举措。

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引用次数: 0

Development and Initial Validity Evidence for a Pregnancy Disclosure and Options Counseling Checklist in Emergency Medicine 急诊医学妊娠披露和选择咨询清单的发展和初步有效性证据

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-11-27 DOI: 10.1002/aet2.11043

Carl Preiksaitis MD, MEd, Isabel Beshar MD, MPhil, Valerie Dobiesz MD, MPH, Stacey Frisch MD, MHPE, Andrea Henkel MD, MS, Ashley Rider MD, MEHP, Monica Saxena MD, JD, Michael A. Gisondi MD

Background

Many patients first learn of a pregnancy in the emergency department (ED). However, limited ED physician knowledge in pregnancy disclosure and options counseling may contribute to challenges in patient care and potential missed opportunities for timely access to reproductive care. No standardized instruments exist to teach or assess this important communication skill for the ED physicians. This study aimed to develop and collect validity evidence for a checklist for effective pregnancy disclosure and options counseling by ED physicians in an environment with unrestricted access to comprehensive reproductive care.

Methods

A prospective checklist creation and validity evidence collection study was conducted, involving literature review, expert input through a modified Delphi process, and pilot testing with ED faculty and residents at an urban academic medical center. We structured the validity evidence collection process using Messick's criteria for construct validity, addressing content, response process, internal structure, and relations to other variables. Data analysis focused on collecting validity evidence, including inter-rater reliability and participant performance assessment based on faculty or resident status.

Results

The study resulted in a final 17-item checklist for pregnancy disclosure and options counseling in the ED. Pilot testing with 20 participants (eight faculty members and 12 residents) revealed high overall inter-rater reliability with almost perfect agreement (kappa = 0.81) and acceptable internal consistency (Cronbach's alpha = 0.88). Checklist scores showed no significant difference across standardized patients, indicating consistency. Faculty members outperformed residents, suggesting concurrent validity based on levels of clinical experience.

Conclusions

Preliminary validity evidence supports the use of this novel checklist to assess physician competency in pregnancy disclosure and options counseling in the ED. Given the frequency of new pregnancy encounters in the ED and the dynamic changes to pregnant patients’ reproductive rights, enhancing physician education in these areas is critical for optimizing patient care and autonomy.

许多患者是在急诊科（ED）才得知怀孕的。然而，有限的急诊科医生在妊娠信息披露和选择咨询方面的知识可能会给患者护理带来挑战，并可能错过及时获得生殖保健的机会。目前还没有标准化的工具来教授或评估急诊科医生这一重要的沟通技巧。本研究旨在为急诊科医生在不受限制的全面生殖保健环境中有效的妊娠信息披露和选择咨询制定和收集有效性证据。方法采用前瞻性检查表编制和效度证据收集研究，包括文献综述、采用改进的德尔菲法进行专家输入，以及在某城市学术医疗中心的急诊科教师和住院医师中进行试点测试。我们使用Messick的结构效度标准来构建效度证据收集过程，处理内容、反应过程、内部结构以及与其他变量的关系。数据分析侧重于收集效度证据，包括评分者之间的信度和基于教员或居民身份的参与者绩效评估。结果：本研究最终得出了一份包含17个项目的ED妊娠披露和选择咨询清单。对20名参与者（8名教员和12名住院医生）进行的初步测试显示，评分者之间的总体信度很高，几乎完全一致（kappa = 0.81），内部一致性也可以接受（Cronbach's alpha = 0.88）。标准化患者的检查表得分无显著差异，表明一致性。教师的表现优于住院医生，这表明基于临床经验水平的并行有效性。结论初步的有效性证据支持使用这一新的检查表来评估急诊科医生在妊娠披露和选择咨询方面的能力。考虑到急诊科新妊娠的发生频率和怀孕患者生殖权利的动态变化，加强医生在这些方面的教育对于优化患者护理和自主至关重要。

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引用次数: 0

Changing behavior and promoting clinical empathy through a patient experience curriculum for health profession students 通过为卫生专业学生开设病人体验课程，改变行为并促进临床同理心

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-11-24 DOI: 10.1002/aet2.11048

Sara W. Nelson MD, MHPE, Carl Germann MD, MHPE, Rachel Yudkowsky MD, MHPE, Benjamin Pare DO, Lauren Wendell MD, Michael Blackie PhD, Tania Strout PhD, RN, MS, Laura E. Hirshfield PhD

Objectives

The authors sought to explore how a curriculum that uses a patient experience simulation followed by reflection can lead to clinical empathy in learners and whether this experience leads to behavioral change. Further, in response to critiques of common pragmatic approaches to clinical empathy teaching in which empathy is operationalized and taught through formal trainings and checklists, the study aimed to contribute insights regarding how clinical empathy may best be taught to health profession students.

Methods

Twenty-six senior medical students participated in an in situ patient experience simulation during a 4-month period in 2021–2022 in an academic emergency department. The simulation was followed by a written reflection and a structured debrief. A thematic analysis was performed on transcripts of the group debriefs.

Results

In the group debriefs, learners described several empathetic behavioral changes they made after this intervention. First, learners discussed performing more small acts of kindness to improve patient care and humanize the patient experience. Second, learners discussed seeking to improve their communication through acknowledgment and validation of the patient experience. Finally, learners described actions to keep patients informed through frequent check-ins and setting expectations on time.

Conclusions

The findings suggest that empathy may not be simply transactional for health profession students and that an understanding of the patient experience leads to actions that improve the patient experience and alleviate suffering.

研究目的作者试图探究使用模拟患者体验并随后进行反思的课程如何能让学习者产生临床同理心，以及这种体验是否会导致行为改变。此外，针对临床移情教学中常见的实用主义方法（即通过正式培训和检查表来操作和教授移情）的批评，本研究旨在就如何最好地向卫生专业学生教授临床移情提出见解。方法 26 名高年级医科学生在 2021-2022 年的 4 个月期间，在一个学术急诊科参加了一次现场患者体验模拟。模拟后进行了书面反思和结构化汇报。对小组汇报记录进行了主题分析。结果在小组汇报中，学员们描述了他们在干预后的几种移情行为变化。首先，学员们讨论了如何做出更多善意的小举动，以改善病人护理并使病人体验人性化。其次，学员们讨论了如何通过对患者体验的认可和确认来改善他们之间的沟通。最后，学习者介绍了通过经常检查和按时设定期望值来让患者了解情况的行动。结论研究结果表明，对于卫生专业的学生来说，移情可能不仅仅是事务性的，对病人体验的理解会带来改善病人体验和减轻痛苦的行动。

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引用次数: 0