AEM Education and Training最新文献_第10页

Identifying the prevalence and characteristics of diversity, equity, and inclusion leaders in academic emergency medicine 确定急诊医学学术界多元化、公平和包容领导者的普遍性和特征

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-03-21 DOI: 10.1002/aet2.10965

Ryan E. Tsuchida MD, Neema Mbele, Zoey Chopra MA, Joel Moll MD, John C. Burkhardt MD, PhD, Daniel J. Hekman MS, Marcia A. Perry MD

Objectives

Our study aims to better understand and describe the current state of diversity, equity, and inclusion (DEI) leadership in emergency medicine (EM) by identifying the prevalence of department DEI leadership positions, their demographics, and their job duty characteristics.

Methods

We disseminated an electronic survey from April to July 2022 to Society for Academic Emergency Medicine (SAEM) Association of Academic Chairs of Emergency Medicine, Academy for Diversity and Inclusion in Emergency Medicine, and the Equity and Inclusion Committee to identify department DEI leads. From July to August 2022, a 45-question survey was sent to all identified DEI leaders on individual characteristics, DEI experience, and DEI lead job description.

Results

We received a response from 79 out of 120 academic EM departments identified (65.8%). Of the responding institutions, 59 (74.7%) reported a DEI leader. A total of 74.6% of these DEI leaders responded at least partially to our survey and 57.6% responded in full. The most common titles were vice/associate chair of DEI (34.4%), director of DEI (28.1%), and DEI committee chair (18.8%). Most respondents (84.4%) were the inaugural DEI lead in their department and 84.4% of respondents did not have a formal DEI role in their department previously. On average, respondents have had their DEI title for 2 years (range 0–7 years) with an average of 7 years (range 0–30 years) of experience performing DEI work. Many (63.4%) do not receive any funded effort for their DEI roles. Most DEI leads were not tenure track (72.2%) and most commonly at the rank of assistant professor (47.2%) followed by associate professor (33.3%), full professor (16.7%), and instructor (2.8%).

Conclusions

This is the first known study to assess the characteristics of DEI department leaders in EM. EM DEI leadership positions are new, common, and led by diverse personal identities and are often not funded. Future directions could gain qualitative insight into this workforce to guide best practices in EM DEI leadership.

目的我们的研究旨在通过确定急诊医学（EM）部门多样性、公平性和包容性（DEI）领导职位的普遍性、其人口统计学特征及其工作职责特征，更好地了解和描述急诊医学（EM）多样性、公平性和包容性（DEI）领导的现状。方法我们于 2022 年 4 月至 7 月向急诊医学学术协会（SAEM）急诊医学学术主席协会、急诊医学多样性与包容性学会以及公平与包容性委员会分发了一份电子调查表，以确定部门的多样性、公平与包容性领导。从 2022 年 7 月到 8 月，我们向所有确定的 DEI 领导者发送了一份包含 45 个问题的调查问卷，内容涉及个人特征、DEI 经验和 DEI 领导者的工作描述。结果在确定的 120 个电磁学术部门中，我们收到了 79 个部门（65.8%）的回复。在回复的机构中，有 59 个（74.7%）机构报告有一名 DEI 领导。其中，74.6%的DEI负责人至少部分回复了我们的调查，57.6%的负责人回复了全部内容。最常见的头衔是发展信息副主席/副主任（34.4%）、发展信息主任（28.1%）和发展信息委员会主席（18.8%）。大多数受访者（84.4%）是其所在系的首任 DEI 领导，84.4%的受访者以前在其所在系没有担任过正式的 DEI 职务。平均而言，受访者担任 DEI 职务已有 2 年（0-7 年不等），平均有 7 年（0-30 年不等）的 DEI 工作经验。许多受访者（63.4%）的 DEI 工作没有得到任何资助。大多数 DEI 负责人不是终身教职（72.2%），最常见的职级是助理教授（47.2%），其次是副教授（33.3%）、正教授（16.7%）和讲师（2.8%）。结论这是已知的第一项评估电磁学系主任特点的研究。EM DEI领导职位是新设的，很常见，由不同的个人身份领导，而且往往没有资金支持。未来的研究方向可以对这支队伍进行定性分析，以指导电磁学DEI领导力的最佳实践。

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引用次数: 0

Clinical duties and compensation for U.S. emergency medicine fellows at academic centers: A descriptive, cross-sectional survey 美国学术中心急诊医学研究员的临床职责和报酬：描述性横断面调查

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-03-21 DOI: 10.1002/aet2.10959

Alexander J. Ulintz MD, Alyssa Tyransky, Gregory M. Archual MBA, Chelsea B. Kadish MD, Ashish R. Panchal MD, PhD

Objective

Fellowship training is increasingly popular among residency graduates and critical to the advancement of academic emergency medicine (EM). Little is known about the clinical hours worked and financial compensation received by fellows during training. We sought to describe the clinical duties and financial compensation of EM fellows at U.S. academic centers.

Methods

This cross-sectional study surveyed U.S. academic EM department administrators who were members of the Society for Academic Emergency Medicine's Academy of Administrators in Academic Emergency Medicine (AAAEM) regarding their fellowship programs and fellows. We electronically distributed the validated survey instrument to 73 member sites between October 2022 and January 2023. Survey domains included fellow and fellowship demographics, base and total annual clinical hours, and base and total annual compensation. We calculated descriptive statistics and compared fellows by accreditation (Accreditation Council for Graduate Medical Education [ACGME] or non-ACGME) using chi-square and Wilcoxon rank-sum testing. We conducted a secondary analysis of base and total salary by gender and accreditation using Wilcoxon rank-sum testing.

Results

We received 38 institutional responses (response rate 52%), which represented 217 individual fellows. Nearly three-fourths (n = 158, 72.8%) of fellows enrolled in non-ACGME fellowships, worked 33% more base hours annually than ACGME fellows (median 571 h vs. 768 h, p < 0.001), and received base compensation 20% higher than ACGME fellows ($88,540 vs. $70,777, p < 0.001). Accounting for additional compensation, the median total annual compensation for non-ACGME fellows remained 11% higher than ACGME fellows ($105,000 vs. $93,853, p = 0.004). We observed no significant differences salary when stratified by gender.

Conclusions

Most EM fellows at U.S. academic institutions enrolled in non-ACGME fellowships with significantly higher base hours and financial compensation than ACGME fellowships. These results represent the first description of the clinical hours and financial compensation of academic EM fellows and should be considered in ongoing benchmarking efforts by AAAEM.

目的研究员培训在住院医生毕业生中越来越受欢迎，对急诊医学（EM）的学术发展至关重要。人们对研究员在培训期间的临床工作时间和经济报酬知之甚少。我们试图描述美国学术中心急诊科研究员的临床职责和经济报酬。本横断面研究调查了美国学术急诊医学会（Society for Academic Emergency Medicine）的学术急诊医学行政人员学会（AAAEM）成员中的急诊医学学术部门行政人员的研究金项目和研究员情况。我们在 2022 年 10 月至 2023 年 1 月期间以电子方式向 73 个会员站点分发了经过验证的调查工具。调查领域包括研究员和研究员的人口统计学特征、基本和年度总临床时间以及基本和年度总报酬。我们计算了描述性统计数字，并使用秩和检验和 Wilcoxon 秩和检验比较了不同认证（毕业后医学教育认证委员会 [ACGME] 或非 ACGME）的研究员。我们使用 Wilcoxon 秩和检验对不同性别和评审的基本工资和总工资进行了二次分析。结果我们收到了 38 个机构的回复（回复率为 52%），代表了 217 名研究员。近四分之三（n = 158，72.8%）的研究员参加了非 ACGME 研究项目，每年的基本工作时间比 ACGME 研究员多 33%（中位数为 571 小时 vs. 768 小时，p < 0.001），基本报酬比 ACGME 研究员高 20%（88,540 美元 vs. 70,777 美元，p < 0.001）。考虑到额外报酬，非 ACGME 研究员的年总报酬中位数仍比 ACGME 研究员高 11%（105,000 美元对 93,853 美元，p = 0.004）。我们观察到，按性别划分的薪酬差异并不明显。结论美国学术机构的大多数急诊科研究员都参加了非 ACGME 研究项目，其基本工作时间和经济补偿明显高于 ACGME 研究项目。这些结果首次描述了学术急诊科研究员的临床时间和经济补偿，AAAEM在进行基准测试时应加以考虑。

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引用次数: 0

A novel online training program for sexual and gender minority health increases allyship in cisgender, heterosexual paramedics 新颖的性与性别少数群体健康在线培训计划增强了顺性别异性恋辅助医务人员的同盟关系

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-03-20 DOI: 10.1002/aet2.10958

Michael I. Kruse MD, CCFP(EM), Blair L. Bigham MD, MSc, Susan P. Phillips MD, CCFP, MSc (Epid)

Introduction

Sexual and gender minorities (SGM) make up 4% of the Canadian population. Due to existing barriers to care in the community, SGM patients may seek more help and be sicker at presentation to hospital. Paramedics occupy a unique role and can remove or decrease these barriers. There are no existing evaluations of training programs in SGM health for prehospital providers. A training program to develop better allyship in paramedics toward SGM populations was developed and assessed.

Methods

A 70- to 90-min mandatory, asynchronous, online training module in SGM health in the prehospital environment was developed and delivered via the emergency medical service (EMS) system's learning management system. A before-and-after study of cisgender, heterosexual, frontline paramedics was performed to measure the impact of the training module on the care of SGM patients. The validated Ally Identity Measure (AIM) tool was used to identify success of training and includes subscales of knowledge and skills, openness and support, and oppression awareness. Demographics and satisfaction scores were collected in the posttraining survey. Matched and unmatched pairs of surveys and demographic associations were analyzed using nonparametric statistics.

Results

Of 609 paramedics, 571 completed the training, and 239 surveys were completed before and 105 (n = 344) surveys after the training; 60 surveys were paired. Overall AIM scores of matched pairs (n = 60) improved by 12% (p < 0.001), with knowledge and skills accounting for most of the increase (21%, p < 0.001). Unmatched pairs (n = 344) were similar in demographics and scores. Rural paramedics also had significantly lower pretraining oppression awareness scores and had lower posttraining AIM scores compared to suburban paramedics (6% difference). Satisfaction scores rated the training as relevant and applicable (87% and 82%, respectively).

Conclusions

A novel prehospital training program in the care of SGM patients resulted in a statistically significant increase in allyship in cisgender, heterosexual-identified frontline paramedics.

导言性与性别少数群体（SGM）占加拿大人口的 4%。由于目前社区中存在的医疗障碍，SGM 患者可能会寻求更多帮助，并且在入院时病情会加重。辅助医务人员扮演着独特的角色，可以消除或减少这些障碍。目前还没有针对院前医疗人员的 SGM 健康培训计划的评估。我们制定并评估了一项培训计划，旨在培养医护人员对 SGM 群体的友好关系。方法针对院前环境中的 SGM 健康问题开发了一个 70 到 90 分钟的强制性异步在线培训模块，并通过紧急医疗服务 (EMS) 系统的学习管理系统进行交付。为了衡量培训模块对 SGM 患者护理的影响，我们对顺性、异性、一线护理人员进行了一项前后对比研究。经过验证的 "盟友身份测量"（AIM）工具用于确定培训是否成功，该工具包括知识和技能、开放性和支持以及压迫意识等分量表。培训后调查收集了人口统计数据和满意度评分。使用非参数统计法对匹配和非匹配的调查对和人口统计学关联进行了分析。结果在 609 名护理人员中，有 571 人完成了培训，培训前完成了 239 份调查，培训后完成了 105 份（n = 344）调查；有 60 份调查是配对的。配对组合（n = 60）的 AIM 总分提高了 12% (p < 0.001)，其中知识和技能占提高分数的大部分 (21%, p < 0.001)。不匹配的对子（n = 344）在人口统计学和分数方面相似。与郊区护理人员相比，农村护理人员在培训前的压迫意识得分明显较低，培训后的AIM得分也较低（相差6%）。满意度评分认为培训具有相关性和适用性（分别为 87% 和 82%）。结论一项针对 SGM 患者护理的新颖院前培训计划使顺性、异性身份的一线护理人员的同盟关系有了统计学意义上的显著提高。

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引用次数: 0

Simulating empathy: A qualitative experiential study of embedded resident learners in an empathy curriculum 模拟移情：同理心课程中嵌入式常驻学习者的定性体验研究

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-03-20 DOI: 10.1002/aet2.10957

Anna Culhane MD, Jerome Martin MD, Zachary Huston, Sara M. Hock MD

Objectives

Physician empathy and communication skills are crucial parts of a successful emergency department (ED) interaction. This study aimed to evaluate whether these skills can be improved through a novel curriculum where interns act as patients for their senior residents during simulated ED cases.

Methods

Twenty-five residents participated in the curriculum. Prior to the cases, participants filled out the Toronto Empathy Questionnaire (TEQ). They then completed three simulated cases, with the 11 interns portraying the patients and the 14 seniors (postgraduate year [PGY]-2 and PGY-3 residents) in the physician role. Following the cases, the residents participated in a recorded, structured focus group. At the conclusion of the session participants again filled out the TEQ and answered a Likert questionnaire on their thoughts about the curriculum. Qualitative analysis was used to determine themes from the debriefs.

Results

Twenty-two residents completed all components of the study. The mean (±SD) TEQ scores pre- and postcurriculum for all residents were 46.2 (±4.64) pre and 47.9 (±6.03) post (ns). On qualitative analysis, we derived four major themes: empathy, communication, feedback, and physician experience. The most common subthemes discussed were empathy for the patient situation and the importance of communicating visit expectations. On a 5-point Likert survey related to the simulated cases, respondents rated comfort providing feedback to their peers (mean ± SD 4.41 ± 0.95) and gaining insight into the patient experience (mean ± SD 4.27 ± 0.83).

Conclusions

The embedded intern exercise was rated well by resident participants, with no observed change in empathy scores. Qualitative analysis identified empathy and communication as major themes. Residents enjoyed this style of simulation and found it realistic.

目的医生的同理心和沟通技巧是急诊科（ED）成功互动的关键部分。本研究旨在评估是否可以通过一种新颖的课程来提高这些技能，即实习生在模拟急诊科病例中充当高年级住院医师的病人。方法 25 名住院医师参加了该课程。在病例前，参与者填写了多伦多移情问卷（TEQ）。然后，他们完成了三个模拟病例，其中 11 名实习生扮演患者，14 名高年级住院医师（研究生 2 年级和研究生 3 年级住院医师）扮演医生。病例结束后，住院医师参加了一个录制的结构化焦点小组。会议结束时，与会者再次填写了 TEQ，并回答了关于他们对课程的看法的李克特问卷。定性分析用于确定汇报中的主题。结果 22 名住院医师完成了研究的全部内容。所有住院医师在课程前和课程后的 TEQ 平均得分（±SD）分别为前 46.2（±4.64）分和后 47.9（±6.03）分（ns）。通过定性分析，我们得出了四大主题：移情、沟通、反馈和医生体验。最常见的副主题是对患者情况的同情和沟通就诊期望的重要性。在与模拟病例相关的 5 点李克特调查中，受访者对向同行提供反馈（平均值±标准差 4.41 ± 0.95）和深入了解患者体验（平均值±标准差 4.27 ± 0.83）给予了舒适的评价。结论住院医师参与者对嵌入式实习练习的评价良好，没有观察到移情评分的变化。定性分析发现，移情和沟通是主要主题。住院医师喜欢这种模拟风格，并认为它很逼真。

{"title":"Simulating empathy: A qualitative experiential study of embedded resident learners in an empathy curriculum","authors":"Anna Culhane MD, Jerome Martin MD, Zachary Huston, Sara M. Hock MD","doi":"10.1002/aet2.10957","DOIUrl":"https://doi.org/10.1002/aet2.10957","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Physician empathy and communication skills are crucial parts of a successful emergency department (ED) interaction. This study aimed to evaluate whether these skills can be improved through a novel curriculum where interns act as patients for their senior residents during simulated ED cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Twenty-five residents participated in the curriculum. Prior to the cases, participants filled out the Toronto Empathy Questionnaire (TEQ). They then completed three simulated cases, with the 11 interns portraying the patients and the 14 seniors (postgraduate year [PGY]-2 and PGY-3 residents) in the physician role. Following the cases, the residents participated in a recorded, structured focus group. At the conclusion of the session participants again filled out the TEQ and answered a Likert questionnaire on their thoughts about the curriculum. Qualitative analysis was used to determine themes from the debriefs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-two residents completed all components of the study. The mean (±SD) TEQ scores pre- and postcurriculum for all residents were 46.2 (±4.64) pre and 47.9 (±6.03) post (<i>ns</i>). On qualitative analysis, we derived four major themes: empathy, communication, feedback, and physician experience. The most common subthemes discussed were empathy for the patient situation and the importance of communicating visit expectations. On a 5-point Likert survey related to the simulated cases, respondents rated comfort providing feedback to their peers (mean ± SD 4.41 ± 0.95) and gaining insight into the patient experience (mean ± SD 4.27 ± 0.83).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The embedded intern exercise was rated well by resident participants, with no observed change in empathy scores. Qualitative analysis identified empathy and communication as major themes. Residents enjoyed this style of simulation and found it realistic.</p>\u0000 </section>\u0000 </div>","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"8 2","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140164427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Suicidal ideation, perception of personal safety, and career regret among emergency medicine residents during the COVID-19 pandemic COVID-19 大流行期间急诊医学住院医生的自杀意念、人身安全感和职业遗憾

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-03-20 DOI: 10.1002/aet2.10955

Arvin R. Akhavan MD, MPA, Tiannan Zhan MS, Michelle D. Lall MD, MHS, Melissa A. Barton MD, Earl J. Reisdorff MD, Yue-Yung Hu MD, MPH, Karl Y. Bilimoria MD, MS, Dave W. Lu MD, MS

Objectives

The COVID-19 pandemic was disruptive for trainees and may have affected career decisions for some learners. This study examined the impact of the pandemic on emergency medicine (EM) resident perceptions of their mental health, perceptions of personal safety, and career choice regret.

Methods

This was a cross-sectional survey study administered following the 2021 American Board of Emergency Medicine In-Training Examination (ITE). Survey measures included suicidal ideation (SI), COVID concerns in terms of infection prevention and control (IPC) training, COVID risk to self and/or COVID risk to family, and COVID-related career regret. COVID concerns were compared by gender and race/ethnicity using Pearson's chi-square tests. Multivariable logistic regression models were used to test the association between SI and COVID concerns, resident characteristics, and program characteristics.

Results

A total of 6980 out of 8491 EM residents (82.2%) from 244 programs completed the survey. Only 1.1% of participants reported insufficient training in COVID IPC practices. Participants were concerned about COVID risk to themselves (40.3%) and to their families (63.3%) due to their job roles. These concerns were more common among women or nonbinary (vs. men); all other races/ethnicities (vs. non-Hispanic Whites); senior residents (vs. PGY-1, PGY-2 residents); and residents who were married or in relationships (vs. single or divorced). A total of 6.1% of participants reported that COVID made them reconsider choosing EM as their career. Career regret in this cohort was higher than that in the proportion (3.2%) expressing career regret in the 2020 ITE (p < 0.001). Career regret was more common among women or nonbinary (vs. men); all other races/ethnicities (vs. non-Hispanic Whites); and senior residents (vs. PGY-1, PGY-2 residents). The overall SI rate was 2.6%, which did not differ from that of the 2020 sample of EM residents (2.5%, p = 0.88).

Conclusions

Many EM residents reported concerns about COVID risks to themselves and their families. Although the rate of SI remained unchanged, more EM residents reported career regret during the COVID pandemic.

目的 COVID-19 大流行对学员造成了破坏，可能影响了一些学员的职业决定。本研究探讨了大流行对急诊医学（EM）住院医师心理健康、人身安全和职业选择后悔感的影响。方法这是一项横断面调查研究，在 2021 年美国急诊医学委员会在岗培训考试 (ITE) 之后进行。调查措施包括自杀意念（SI）、感染预防与控制（IPC）培训方面的 COVID 问题、COVID 对自身和/或 COVID 对家人的风险，以及 COVID 相关的职业遗憾。使用皮尔逊卡方检验比较了不同性别和种族/族裔对 COVID 的关注程度。多变量逻辑回归模型用于检验 SI 与 COVID 问题、住院医师特征和项目特征之间的关联。结果来自244个项目的8491名住院医师中，共有6980人（82.2%）完成了调查。仅有 1.1% 的参与者表示 COVID IPC 实践培训不足。由于工作角色的原因，参与者担心 COVID 会给自己（40.3%）和家人（63.3%）带来风险。这些担忧在以下人群中更为常见：女性或非二元性别（与男性相比）；所有其他种族/族裔（与非西班牙裔白人相比）；高年资住院医师（与 PGY-1 和 PGY-2 住院医师相比）；已婚或有伴侣的住院医师（与单身或离异者相比）。共有 6.1% 的参与者表示 COVID 使他们重新考虑选择 EM 作为自己的职业。与2020年ITE中表示职业后悔的比例（3.2%）相比，该人群的职业后悔率更高（p <0.001）。职业遗憾在女性或非二元性别（与男性相比）、所有其他种族/族裔（与非西班牙裔白人相比）和高年资住院医师（与 PGY-1 和 PGY-2 住院医师相比）中更为常见。总体 SI 率为 2.6%，与 2020 年抽样调查的急诊科住院医师（2.5%，P = 0.88）没有差异。结论许多急诊科住院医师表示担心 COVID 会给自己和家人带来风险。虽然SI率保持不变，但更多的少医学居民表示在COVID大流行期间对职业感到遗憾。

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引用次数: 0

Oh, the places you'll go! A qualitative study of resident career decisions in emergency medicine 哦，你要去的地方急诊医学住院医师职业决定的定性研究

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-03-20 DOI: 10.1002/aet2.10956

Jaime Jordan MD, MAEd, Jack Buckanavage BS, Jonathan Ilgen MD, PhD, Michael Gottlieb MD, Laura R. Hopson MD, MEd, Adam Janicki MD, MS, Mark Curato DO, Anne K. Chipman MD, MS, Samuel O. Clarke MD, MAS

Objectives

Postresidency career choices are complex decisions that involve personal, professional, and financial preferences and may be influenced by training programs. It is unknown how residents navigate these decisions during emergency medicine (EM) residency. We explored EM residents’ perspectives on career decision making and how residency programs can support career planning.

Methods

We conducted semistructured interviews at seven accredited EM residency programs from diverse locations and training formats. We used purposive sampling to reflect the diversity of trainees with regard to gender, level of training, and career plans. Two researchers independently coded the transcripts. We used a constructivist–interpretivist paradigm to guide our thematic analysis.

Results

We interviewed 11 residents and identified major themes in three categories. Residents described being exposed to career options through formalized curricula such as required rotations, career fairs, and subspeciality tracks, highlighting the importance of access to faculty with diverse areas of clinical and academic expertise. Many noted that exposure was often self-driven. We identified three major themes regarding career decisions: instrumental factors, people involved, and processes of decision making. Instrumental factors included personal interests, goals, and values as well as practice characteristics, financial considerations, timing, and opportunity costs. Mentors and family were highly involved in resident career decisions. Residents often utilized reflection and conversations with mentors and peers in their decision-making process. Participants recommended that programs provide exposure to diverse career options early in training, protect time for career education, and ensure adequate mentorship and a supportive community. Participants suggested specific curricular content and strategies to support career decisions.

Conclusions

This study illuminates important factors involved in resident career decision making and how programs can support their trainees. Essential components include diverse experiences and building a reflective mentorship environment.

目的实习后的职业选择是一项复杂的决定，涉及个人、专业和经济偏好，并可能受到培训计划的影响。目前尚不清楚住院医师在急诊医学（EM）住院医师培训期间是如何做出这些决定的。我们探讨了急诊科住院医师对职业决策的看法，以及住院医师培训项目如何支持职业规划。方法我们对来自不同地区和培训形式的七个经认证的急诊科住院医师培训项目进行了半结构式访谈。我们采用了有目的的抽样，以反映受训者在性别、培训水平和职业规划方面的多样性。两名研究人员独立对记录誊本进行编码。我们采用了建构主义-解释主义范式来指导我们的主题分析。结果我们对 11 名住院医师进行了访谈，确定了三个类别的主要主题。住院医师描述了通过正规课程（如必修轮转、职业招聘会和亚专科方向）接触职业选择的情况，强调了接触具有不同临床和学术领域专业知识的教师的重要性。许多人指出，接触职业往往是自我驱动的。我们确定了有关职业决策的三大主题：工具性因素、相关人员和决策过程。工具性因素包括个人兴趣、目标和价值观，以及实践特点、财务考虑、时机和机会成本。导师和家人高度参与住院医师的职业决策。住院医师在决策过程中通常会进行反思，并与导师和同行进行交流。与会者建议，课程应在培训初期提供多样化的职业选择，为职业教育留出时间，并确保有足够的导师和支持性社区。参与者还提出了支持职业决策的具体课程内容和策略。结论本研究揭示了住院医师职业决策中的重要因素，以及项目如何为学员提供支持。基本要素包括多样化的经验和建立反思性的指导环境。

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引用次数: 0

Proximity to vulnerability 接近脆弱性

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-02-27 DOI: 10.1002/aet2.10949

Mitra Sadigh

<p>With every shift in the emergency department (ED), I am reminded that each of us is only one or two steps from being extremely vulnerable.</p><p>My difficult moments have not been as colored by patient stories as by their stories being lost and misconstrued; spun and respun to maintain distance between staff for whom it's another “day on the job” and patient for whom it may be the worst day or era of their life. The protective barrier transforming an individual in need of help into a problem to be dealt with.</p><p><i>My difficult moments have not been as colored by patient stories as by the ways that another “day on the job” for health care workers can easily become either the worst day or worst era of their life. Sometimes that protective barrier can make us feel more safe</i>.</p><p>It wasn't the woman who arrived obtunded after ingesting an unknown substance in an attempt to end her life, but the disgruntled complaints that she not only needed resuscitation, but had also “sh*t herself.” The sighs of exasperation when she soiled herself again.</p><p><i>It wasn't the process of uncovering what medication had been overingested, but watching the nurse meticulously wipe the dried, pressed fecal matter from the completely unconscious patient who hours ago had decided this life was not worth living</i>.</p><p>It wasn't the survivor of gun violence who repeatedly screamed in pain when the leg the bullet had lodged in was poked and prodded. It was staff rolling their eyes as she continued to vocalize and emote. The disbelief that she could be in so much pain against the belief that she shouldn't have been “out in the streets.”</p><p><i>It wasn't seeing a leg swell up with such tension that it might burst, but watching a resident rush out of the room in tears with the patient's scratch marks across her abdomen</i>.</p><p>It wasn't the teenage survivor of sex trafficking who was brought to the ED against her will because she lacked a safe place to sleep. It was hearing the passing of her story from EMS to nursing to residents about how “difficult” she was and “good luck dealing with her.” That she had “probably spent every night with a new man, ‘getting some.’”</p><p><i>It wasn't the physician returning disappointed after being unable to appease a teenage survivor of sex trafficking. It was hearing her say that the patient had called her a “bitch” and watching her remove herself from the care team</i>.</p><p>I ask you to reflect with me. What is more frightening?</p><p>The “agitated” patient who might raise their voice and threaten or losing the ability to recognize a desperately frightened human staring back?</p><p><i>Losing compassion for a desperately scared human staring back or being another survivor of workplace violence</i>?<span><sup>1</sup></span></p><p>Resuscitating someone who has attempted to end their life or being comfortable publicly humiliating them in their most vulnerable moment as they are being pulled back from the brink of death?

在急诊科（ED）的每一次轮班中，我都会被提醒，我们每个人都离极度脆弱只有一到两步之遥。我的困难时刻并不是因为病人的故事而增添色彩，而是因为他们的故事被遗忘和曲解；被扭曲和重演，以保持医护人员与病人之间的距离，对医护人员来说，这又是 "工作的一天"，而对病人来说，这可能是他们生命中最糟糕的一天或一个时代。保护性障碍将需要帮助的人变成了需要处理的问题。我的困难时刻并不是因为病人的故事，而是因为对医护人员来说，"工作中的另一天 "很容易变成他们生命中最糟糕的一天或最糟糕的时代。有时，这道保护屏障会让我们更有安全感。不是那个摄入不明物质后昏迷不醒、试图结束自己生命的女人，而是那些不满地抱怨她不仅需要人工呼吸，而且还 "拉屎了 "的人。当她再次弄脏自己时，护士们发出了气愤的叹息声。这不是揭露她摄入过量药物的过程，而是看着护士一丝不苟地擦拭完全失去知觉的病人身上干涸、压扁的排泄物。当她不断发出声音和表情时，工作人员都在翻白眼。不是看到她的腿肿胀得可能爆裂，而是看着一名住院医师带着病人腹部的抓痕流着泪冲出病房。不是因为没有安全的地方睡觉而被强行带到急诊室的性贩卖少女幸存者。她的故事从急救到护理再到住院医生都在讲述，她是多么 "难缠"，"祝你好运"。她 "可能每晚都和一个新男人在一起，'找点乐子'。"这并不是医生在无法安抚一名性贩卖少女幸存者后失望而归。而是听到她说病人叫她 "婊子"，看着她从护理团队中消失。什么更可怕？是 "激动 "的病人可能会提高嗓门进行威胁，还是失去辨别一个极度恐惧的人的能力？是对一个极度恐惧的人失去同情心，还是成为另一个工作场所暴力的幸存者？对企图结束自己生命的人进行抢救，或者在他们最脆弱的时刻将他们从死亡边缘拉回来时，心安理得地公开羞辱他们？在自杀未遂后反复清理昏迷病人的粪便后表示一时的沮丧，或者在内心深处坚持无休止的抢救，以至于成为又一个医护人员自杀的统计数字？3目睹他人忍受枪伤的痛苦，还是假定他人遭受暴力是罪有应得？假定他人遭受暴力是罪有应得，从而与患者保持距离，还是接受无谓悲剧的现实，与创伤后应激障碍作斗争，因为在急诊室大厅听到无数枪支暴力受害者的尖叫？我们无法阻止生命的悲痛窒息一个人的求生意志，就像我们无法阻止子弹的落点或对孩子难以言喻的伤害一样。我们无法阻止悲剧让我们的日子变得沉重，就像无法阻止看到又一个枪伤或从未有过童年机会的青少年一样。但我们可以做得更多，以保护我们自己、我们的病人和我们对这项工作的热情。我们认识到，仅靠医疗培训不足以应对急诊室环境的挑战，因此我们必须扩大我们的工具包。我们可以深入了解自己的内心世界，学习如何建立抗压能力6；更好地管理自己的偏见7-9；为自己配备更有意识的应对策略10；并向心理健康专家求助，帮助我们改革支持系统。我们可以采用非暴力沟通、自我意识和自我调节的方法，这些方法是在情绪紧张环境中工作的其他人所使用的。我们可以通过建立以患者为中心的护理的标准化定义11 来更新我们的观点，并采取措施保护患者在急诊室内免受进一步伤害。 12-16 我们可以通过定期小组汇报17 和在工作场所提供更有力的支持18 来改善集体支持。我们可以致力于培养对患者的初学者心态，以好奇心而非假设或封闭的态度对待患者。在对尖叫的病人做出反应之前，我们可以停顿一下，问问病人尖叫的原因是什么？痛苦？恐惧？肾上腺素？不堪重负？他们需要止痛药吗？肩膀上的一只手？我们可以致力于培养自己的初学者心态，在做出反应之前暂停片刻，问一个相关的问题：我们此时此刻需要什么？一份点心？三次深呼吸？积极的肯定？我们可以借助跨学科团队的力量，从牧师到社工，他们都是守住情感空间、驾驭温情时刻的典范，他们是将病人与相关资源联系起来的倡导者。我们可以就急诊室目前人满为患、人手不足的状况大声疾呼，呼吁设立患者代言人这样的新角色。与其对我们所提供的医疗服务中存在的障碍感到失望，我们可以更广泛地为患者代言。我们可以共同致力于发展我们自己、我们的工作以及急诊室环境，使其更好地为我们和我们的患者服务。

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引用次数: 0

“If I don't, who will?” "如果我不做，谁做呢？"

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-02-23 DOI: 10.1002/aet2.10952

Frosso Adamakos MD

引用次数: 0

Program director longevity in emergency medicine residencies: A 40-year analysis 急诊医学住院医生项目主任的寿命：40 年分析

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-02-23 DOI: 10.1002/aet2.10951

Arlene S. Chung MD, MACM, Katherine L. Pattee MD, Rachel Bass MD, MPH, Adam N. Frisch MD, MS, Jaime Jordan MD, MAEd

Objective

We sought to assess trends in emergency medicine residency program director (PD) length of service over the past 40 years and evaluate relationships between duration of service and important factors such as PD start year, geographic region, and year of program initial accreditation.

Methods

We retrospectively analyzed program data from the American Medical Association Graduate Medical Education Directory and Emergency Medicine Residents’ Association Match database. We calculated descriptive statistics and used linear regression to assess the impact of PD start year, region, and year of program initial accreditation on PD duration of service.

Results

We gathered data on 783 unique PDs between 1983 and 2023. The overall mean ± SD PD duration of service was 6.19 ± 4.72 years (range 1–29 years). The mean duration of service by decade of start date was 6.49 years in the 1980s, 7.39 years in the 1990s, 5.92 years in the 2000s, 4.08 years in the 2010s, and 2 years in the 2020s. Both PD start year (p = 0.002) and program initial accreditation year (p = 0.001) significantly predicted duration of PD service. Region did not significantly predict duration of PD service (p = 0.225).

Conclusions

Duration of service as a PD is decreasing in recent decades. Both PD start year and year of initial program accreditation significantly predict duration of service as PD. Future research must be done to better understand this phenomenon and uncover strategies to promote PD longevity.

目的我们试图评估过去 40 年中急诊医学住院医师项目主任（PD）服务年限的变化趋势，并评估服务年限与 PD 开始年份、地理区域和项目初始认证年份等重要因素之间的关系。方法我们回顾性地分析了美国医学会毕业后医学教育目录和急诊医学住院医师协会匹配数据库中的项目数据。我们计算了描述性统计数字，并使用线性回归评估了住院医师培训开始年份、地区和项目初始认证年份对住院医师培训服务时间的影响。结果我们收集了 1983 年至 2023 年间 783 个独特 PD 的数据。初级专业人员的总体平均服务年限为 6.19 ± 4.72 年（± 标准差）（1-29 年不等）。按开始日期的十年划分，80 年代的平均服务年限为 6.49 年，90 年代为 7.39 年，2000 年代为 5.92 年，2010 年代为 4.08 年，2020 年代为 2 年。项目开始年份（p = 0.002）和项目初始认证年份（p = 0.001）都能显著预测项目服务的持续时间。地区并不能明显预测 PD 的服务期限 (p = 0.225)。结论近几十年来，初级专业人员的服务期限正在缩短。初级专业人员的起始年份和初始项目认证年份都能显著预测初级专业人员的服务期限。未来的研究必须更好地理解这一现象，并找出促进初级专业人员寿命的策略。

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引用次数: 0

Comparison of nurse and resident physician paging frequency by sex in the emergency department 急诊科护士和住院医生按性别传呼频率的比较

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-02-23 DOI: 10.1002/aet2.10948

Deesha Sarma MD, Bryan Stenson MD, Gordon MacDougall MD, Alyssa Mangino MD, Leon D. Sanchez MD, MPH, David T. Chiu MD, MPH

Objectives

The role of biological sex in interprofessional relationships is an important factor in collaborative health care settings such as the emergency department (ED) but one that has been sparsely studied. While there is anecdotal evidence on gender-based differences in communication, little research has focused on this topic. The goal of this study was to determine whether there are differences in paging frequency between nurses and male and female residents.

Methods

We conducted a retrospective review of patient visits to our urban, tertiary care academic ED between January 1 and April 1, 2021. Only pages from nurses to emergency medicine (EM) residents were included. Outcome variables included number of pages received by sex, number of unique ED visits, and mean number of pages per unique visit. Pearson's chi-square tests were used to analyze differences between observed and expected results.

Results

A total of 15,617 pages from nurses to residents over 6843 unique patient visits to the ED were analyzed. This included 187 nurses, 162 (87%) of whom were female and 25 (13%) were male. Of the 39 residents, 12 (31%) were female and 27 (69%) were male. Female residents received 4500 pages over 2228 unique patient ED visits, or a mean of two pages per patient with a mean of 186 unique ED visits per female resident. Male residents received 11,117 pages over 4615 unique patient ED visits, or a mean of 2.4 pages per patient, with a mean of 171 unique ED visits per male resident. This difference in pages per patient was statistically significant (χ²(1) = 369, p < 0.001).

Conclusions

We found that male residents received significantly more pages per patient than their female colleagues. Overall, further research is required to understand the factors, such as characteristics of patients or preferred communication methods of providers, that drive this disparity and what the implications are for patient outcomes.

目的生理性别在跨专业关系中的作用是急诊科（ED）等合作医疗环境中的一个重要因素，但对这一因素的研究却很少。虽然有轶事证据表明沟通中存在性别差异，但很少有研究关注这一主题。本研究旨在确定护士与男性和女性住院医师之间的传呼频率是否存在差异。方法我们对 2021 年 1 月 1 日至 4 月 1 日期间到我们城市三级医疗学术急诊室就诊的患者进行了回顾性审查。其中只包括护士向急诊医学（EM）住院医师发出的呼叫。结果变量包括按性别分列的收到的页面数、独特的急诊室就诊人数以及每次独特就诊的平均页面数。采用皮尔逊卡方检验分析观察结果与预期结果之间的差异。结果分析了护士向住院医生发送的 15,617 页信息，涉及 6843 次急诊访问。其中包括 187 名护士，162 人（87%）为女性，25 人（13%）为男性。在 39 名住院医师中，12 名（31%）为女性，27 名（69%）为男性。女性住院医师在 2228 次病人急诊访问中收到了 4500 页资料，即平均每位病人收到两页资料，平均每位女性住院医师收到 186 次病人急诊访问。男性住院医师在 4615 次急诊就诊中收到了 11117 页资料，即每位患者平均收到 2.4 页资料，每位男性住院医师平均收到 171 次急诊就诊。每位患者的阅读页数差异具有统计学意义（χ2(1) = 369, p < 0.001）。结论我们发现，男性住院医师为每位患者提供的诊疗页数明显多于女性住院医师。总体而言，需要进一步研究以了解造成这种差异的因素，如患者的特征或医疗服务提供者偏好的沟通方式，以及对患者预后的影响。

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引用次数: 0