AEM Education and Training最新文献_第2页

Leadership training in emergency medicine: A national survey 急诊医学领导力培训：全国调查

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-11-21 DOI: 10.1002/aet2.11047

Shea Palmer PhD, Amanda Rodrigues Amorim Adegboye PhD, Gareth Hooper PhD, Aanika Khan MSc, Caroline Leech MD, Amanda Moore PhD, Bhupinder Pawar PhD, Ala Szczepura Dphil(Oxon), Chris Turner MD, Rosie Kneafsey PhD

Background

Emergency medicine (EM) is a uniquely stressful environment in which leadership training could improve individual and team performance, patient outcomes, well-being, and EM career intentions. The primary aim was to evaluate EM-specific leadership training (EMLeaders) compared to no leadership training. A secondary comparison was with other forms of leadership training.

Methods

An online survey was distributed to Royal College of Emergency Medicine (RCEM) members in England. Three groups were recruited: those who reported receiving EMLeaders training, no training, and other training. Information was collected on group demographics, job roles, responses to 14 leadership knowledge and skills items, well-being at work, and EM career intentions.

Results

A total of 417 responders (177 EMLeaders, 148 no training, 92 other training) were largely representative of RCEM members, although the EMLeaders group were at less senior career grades. Although all groups provided generally positive responses, EMLeaders demonstrated more positive ratings for seven of 14 leadership items relative to no training (all p < 0.05): knowledge about clinical leadership, application of clinical leadership, empowerment to make decisions, managing the emergency department environment, ability to influence the EM environment, confidence in leadership, and confidence in facilitating teams. The other training group demonstrated superior ratings for five of seven of the same items, except empowerment to make decisions and ability to influence the EM environment. Direct comparison of EMLeaders with other training identified ability to influence the EM environment as a unique benefit of EMLeaders (p < 0.05), while knowledge about clinical leadership favored other training (p < 0.05).

Conclusions

EMLeaders improved many aspects of perceived leadership knowledge and skills, but there was little evidence of impact on well-being or EM career intentions. EMLeaders particularly appears to enhance perceived ability to influence the EM environment. Considering that the EMLeaders group were generally earlier in their career, the findings are promising and can inform the refinement of future EM-specific training.

背景急诊医学（EM）是一种独特的压力环境，在这种环境中，领导力培训可以改善个人和团队的表现、患者的治疗效果、幸福感和急诊医学职业意向。研究的主要目的是评估针对急诊科的领导力培训（EMLeaders）与无领导力培训的比较。其次是与其他形式的领导力培训进行比较。方法对英国皇家急诊医学院（RCEM）成员进行在线调查。调查对象分为三组：接受过 EMLeaders 培训、未接受过培训以及接受过其他培训。收集的信息包括各组的人口统计学特征、工作角色、对 14 个领导力知识和技能项目的回答、工作中的幸福感以及 EM 职业意向。结果共有 417 人（177 人接受过 EMLeaders 培训，148 人未接受过培训，92 人接受过其他培训）作出了回应，他们在很大程度上代表了 RCEM 成员，尽管 EMLeaders 组的职业级别较低。尽管所有组别都给出了总体上积极的回答，但在 14 个领导力项目中，EMLeaders 在以下 7 个项目上的评价比未接受培训者更积极（所有项目的 p 均为 0.05）：临床领导力知识、临床领导力的应用、决策授权、管理急诊科环境、影响急诊科环境的能力、领导力自信心和促进团队的自信心。除决策能力和影响急诊环境的能力外，其他培训组在七个相同项目中的五个项目上都获得了较高的评分。将 EMLeaders 与其他培训进行直接比较后发现，影响急救环境的能力是 EMLeaders 的独特优势（p <0.05），而临床领导力知识则是其他培训的优势（p <0.05）。结论 EMLeaders 提高了许多方面的领导知识和技能，但几乎没有证据表明它对幸福感或 EM 职业意向产生了影响。EMLeaders尤其提高了影响电磁环境的能力。考虑到 EMLeaders 小组的成员一般都处于职业生涯的早期阶段，这些研究结果很有希望，可以为改进未来针对电磁学的培训提供参考。

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引用次数: 0

AI passed the test, but can it make the rounds? 人工智能通过了测试，但它能进行巡演吗？

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-11-20 DOI: 10.1002/aet2.11044

Christian Rose MD, Carl Preiksaitis MD, MEd

引用次数: 0

Effects of opening a vertical care area on emergency medicine resident clinical experience 开设垂直护理区对急诊科住院医师临床经验的影响。

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-11-20 DOI: 10.1002/aet2.11040

Alina Tsyrulnik MD, Craig Rothenberg MPH, Wendy W. Sun MD, Arjun Venkatesh MD, MBA, MHS, Ryan F. Coughlin MD, Katja Goldflam MD, Rohit B. Sangal MD, MBA

Background

Challenging clinical environments faced by emergency departments (EDs) have led to operational changes including implementation of vertical care units and fast-track units. Little is known regarding the impact of such units on resident physician clinical education.

Methods

A retrospective, observational study was performed at an urban quaternary care ED evaluating the effect of opening a vertical care unit with a triage physician directing lower acuity patients to be seen by physician associates (PAs)/advanced practice registered nurses (APRNs) on the following parameters: (1) percentage of patients seen by residents, (2) Emergency Severity Index (ESI) of patients seen by residents, (3) number of procedures performed by residents, (4) number of patients per shift seen by residents, (5) percentage of critical care patients seen by residents, and (6) percentage of behavioral health patients seen by residents.

Results

Comparing the implementation of the vertical care unit to the prior 3 months, postgraduate year (PGY)-1 residents had greater exposure to ESI Levels 1 and 2 (odds ratio [OR] 2.15) and more critical care (OR 2.58). PGY-2 and PGY-3 residents had a lower exposure to ESI 1 and 2 patients (PGY-2 OR 0.63, PGY-3 OR 0.61) and less critical care exposure (OR 0.64 for PGY-2 and OR 0.62 for PGY-3) after implementation. PGY-1 residents saw fewer behavioral health patients (OR 0.65) while the other two classes saw more (PGY-2 OR 1.64, PGY-3 OR 2.74). ESI 4 and 5 exposure decreased for all classes (PGY-1 OR 0.15, PGY-2 OR 0.86, PGY-3 OR 0.72). No significant difference was found in the proportion of patients treated by residents (p = 0.85) or the number of procedures performed by residents (p = 0.25) comparing the implementation of a vertical care unit to the prior 3 months.

Conclusions

This study suggests no detrimental effects of vertical care unit implementation on multiple resident education outcomes including the number and acuity level of patients seen as well as procedure numbers of resident trainees. While the outcomes measured did not show significant negative effect for the resident compliment as a whole, we noted changes to the distribution of patient acuity based on PGY level. Similar assessments are recommended to determine the educational impact of comparable operational changes in other EDs.

背景：急诊科（ED）面临着严峻的临床环境，这导致其运营发生了变化，包括实施垂直护理单元和快速通道单元。但人们对这类科室对住院医生临床教育的影响知之甚少：在一个城市的四级医疗急诊室开展了一项回顾性观察研究，评估了开设垂直护理单元，由分诊医师引导低危重病人由助理医师（PA）/高级注册护士（APRN）就诊对以下参数的影响：（1）由助理医师（PA）/高级注册护士就诊的病人比例；（2）由助理医师（PA）/高级注册护士就诊的病人比例；（3）由助理医师（PA）/高级注册护士就诊的病人比例：(1) 由住院医师诊治的患者比例；(2) 由住院医师诊治的患者的急诊严重程度指数 (ESI)；(3) 由住院医师实施的手术数量；(4) 由住院医师每班诊治的患者数量；(5) 由住院医师诊治的危重症患者比例；(6) 由住院医师诊治的行为健康患者比例。结果：将垂直护理单元的实施时间与之前的 3 个月进行比较，研究生 1 年级的住院医师接触 ESI 1 级和 2 级的机会更多（几率比 [OR] 2.15），危重症护理的机会更多（几率比 2.58）。实施 ESI 后，PGY-2 和 PGY-3 住院医师接触 ESI 1 级和 2 级病人的机会较少（PGY-2 OR 0.63，PGY-3 OR 0.61），接触危重症护理的机会较少（PGY-2 OR 0.64，PGY-3 OR 0.62）。PGY-1 级住院医师接诊的行为健康患者较少（OR 0.65），而其他两级住院医师接诊的行为健康患者较多（PGY-2 OR 1.64，PGY-3 OR 2.74）。所有班级的 ESI 4 和 5 接触率都有所下降（PGY-1 OR 0.15，PGY-2 OR 0.86，PGY-3 OR 0.72）。与之前 3 个月相比，由住院医师治疗的患者比例（p = 0.85）或住院医师实施的手术数量（p = 0.25）均无明显差异：本研究表明，垂直护理单元的实施对住院医师教育的多种结果（包括就诊患者的数量和急症程度以及住院医师学员的手术数量）没有不利影响。虽然所测量的结果并未显示出对住院医师整体的显著负面影响，但我们注意到根据住院医师年级的不同，患者急性期的分布也发生了变化。建议进行类似的评估，以确定类似的操作变化对其他急诊室教育的影响。

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引用次数: 0

Precision education in medicine: A necessary transformation to better prepare physicians to meet the needs of their patients 精准医学教育：为更好地培养医生以满足患者需求而进行的必要转型。

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-11-11 DOI: 10.1002/aet2.11041

Sally A. Santen MD PhD, Kimberly Lomis MD, Judee Richardson PhD, John S. Andrews MD, David Henderson MD, Sanjay V. Desai MD

<p>Across the continuum of emergency medicine (EM) education, physicians strive to continuously develop their skills while navigating multiple demands. To achieve the aim of learning amidst exponential growth in medical knowledge and increasingly complex medical care, a new system of accessible, personalized, and continuous learning is needed. In this commentary, we describe the model of precision medical education (PME),<span><sup>1</sup></span> which includes using data and technology to transform lifelong learning by improving data inputs, personalization, and efficiency.</p><p>Innovation creates transformation in medical education. In other spheres, the arc of innovation empowers users and builds value.<span><sup>2</sup></span> For example, Amazon shifted purchasing power from local stores to consumers.<span><sup>3</sup></span> Netflix transferred power of choice to viewers, creating an industry for asynchronous content. Google shifted power of information from the few to many.<span><sup>4</sup></span> Generative AI (artificial and augmented intelligence) similarly has shifted the ability to gain and apply knowledge from experts to the people. While it takes time to fully realize their potential, these innovations largely meet the needs of consumers and society by shifting the locus of control to the end users. We believe medical education should create similar transformational shifts for learning to bring the locus of control to individual—student, emergency medicine (EM) resident, and practicing physician in the arc of lifelong learning.</p><p>The goal of training is to produce an EM physician workforce capable of delivering high-quality care to patients and communities. Explosive growth in medical knowledge and remarkable procedural advances have underscored physicians’ need for continuous and effective lifelong learning. The need to make this learning simple and accessible so that it weaves within existing workflows is also an imperative. Yet how do physicians maintain and advance their knowledge?<span><sup>5</sup></span> The gap between the need and process of learning, including resources, time, and methods, can contribute to the challenges of ongoing learning, contributing to burnout and moral distress as physicians struggle to keep up.</p><p>Medical education for medical students, residents, and practicing physicians has not evolved sufficiently with the pace of change in technology and remains encumbered by inflexibility, inefficiency, and inequity. This gap enhances the struggle to meet the current and future needs of physicians.<span><sup>6</sup></span> There is little emphasis on the process of lifelong learning or maintaining competency in the rapidly expanding universe of medical knowledge and new procedures.</p><p>Because of resource constraints and the need to deliver training at scale, structured medical education (undergraduate medical education, graduate medical education, and continuing professional development [CPD]) are

接下来的行动和干预措施--将这些数据与个人特征和偏好、来自高质量来源（如已发表的研究和指南）的及时教育计划以及基准信息相结合，将有助于指导医生的发展。理想情况下，辅导将有助于解释反馈信息，提高参与度和个性化程度。例如，通过审查住院医师接触病人的情况（差距），可以针对这些差距实施具体的培训。包括学习评估、医师表现、病人结果和干预评估在内的结果将为个人和项目层面的反馈提供结果。然后，所有信息都会反馈到循环中，为更多的见解、学习和改进提供数据作为输入。此外，还可以通过对医生教育的干预来观察和解决医疗差距问题。图 2 构想了一个未来的环境，在这个环境中，继续医学教育系统得到发展，并帮助医生进行终身学习和改善病人护理。虽然其中一些图示还在未来，但 PME 的试点工作已经开始，我们预计生成式人工智能技术将加速这些努力。Schaye 和团队9 正在开发自然语言处理技术，用于评估住院医师的临床推理能力并提供反馈。该系统将审查每位住院医师的病历，并评估其临床推理能力，在住院医师仪表板上提供相关信息，住院医师可通过该仪表板链接到病历中的具体病历，从而了解自己在哪些方面可以改进。仪表板还将提供汇总数据，记录临床推理记录的改进情况，并将其作为进一步改进的成果。一些急诊团队正在使用 EPIC 元数据为住院医师和急诊项目提供信息。EPIC 提供 "信号数据"，即医疗服务提供者如何使用电子病历 (EHR) 的元数据。例如，可以创建报告来记录所花费的时间和地点（笔记、医嘱、追踪、处置和病历审查）。同样，图表可以显示住院患者如何下达他们的大部分医嘱（单个医嘱或医嘱集），以及与科室其他人相比的智能短语/宏使用情况。这些输入可为医疗服务提供者提供数据，帮助他们了解自己的工作流程和效率。从这些洞察中，他们可以调整自己的方法并监控变化。在此基础上，Schauer 正在探索患者疗效指标与 EPIC 元数据（用户使用模式）之间的关系，如效率、收件箱指标和工作流程。虽然这项工作的对象是内科住院医师，但对急诊科住院医师而言，PME 可使住院医师和教师将电子病历的使用效率指标与病人吞吐量联系起来，更重要的是与病人预后联系起来。11 Woodworth 和团队12 正在为麻醉住院医师建立一个平台，将能力发展、核心知识和患者接触与学习资源结合起来，以弥补差距。一些项目使用实时定位服务跟踪器来收集住院医生的位置以及他们在病房或工作间花费的时间。例如，Phadnis 等人14 报道了使用电磁触觉模拟器进行外侧犬齿切开术和胸廓切开术培训的情况。这些项目有意利用数据向医生提供反馈，以调整他们的学习和实践，这些创新利用了 PME 来帮助医生改善病人护理。公共教育部也可以在项目和组织层面开展工作。例如，美国医学专科委员会（American Board of Medical Specialties）刚刚资助了一个项目，将就诊诊断自动映射到专科委员会的临床领域，以加强评估、认证和精准教育，其中包括将临床就诊映射到 EM 护理模式。

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引用次数: 0

Use of in situ simulation to improve team performance and utilization of a rapid sequence intubation checklist 利用现场模拟提高团队绩效，并使用快速顺序插管清单。

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-11-11 DOI: 10.1002/aet2.11039

Kathleen M. Waters MD, Ruth Hwu MD, Mona Kulkarni MD, Jeffrey Okonye MD, Ronine Zamor MD, MPH, Sofia Chaudhary MD, Andrew Jergel MPH, Scott Gillespie MS, MSPH, Abby Lewis MD, Rachel Krieger DO, MS, Vidya Menon MD, Geovonni Bell MD, Jacob Levy DO, Tory Prynn MD, Jacqueline Regan MD, MPH, Claire Mathai BSN, Nandranie Goodwin BSN, Sherita Holmes MD

Background

Intubation checklists have emerged as tools to reduce adverse events and improve efficiency during rapid sequence intubation (RSI) in pediatric emergency departments (PEDs). This study aimed to use multidisciplinary simulation (SIM) training as an educational tool to improve PED team performance during RSI scenarios through utilization of an RSI checklist.

Methods

We created a checklist modeled after previously published PED checklists. PED multidisciplinary teams participated in video-recorded SIM training sessions involving a scenario requiring intubation three times, first without interruption then while receiving our intervention of rapid-cycle deliberate practice (RCDP) debriefing focusing on checklist utilization and team dynamics. Learners went through the scenario once more uninterrupted to apply learned skills. Team performance was evaluated via video review using the Simulation Team Assessment Tool (STAT) focusing on airway management and human factors sections. Scores were compared before and after intervention along with pre- and postintervention surveys.

Results

A total of 483 learners participated in 64 SIM training sessions, 44 of whom met inclusion criteria and were included for data analysis. Scores increased postintervention for airway management, human factors and in total. Least-squares mean differences for total, airway, and human factors scores were 9.55 (95% confidence interval [CI] 7.24–11.85), 4.22 (95% CI 2.91–5.52), and 5.33 (95% CI 3.86–6.8), respectively, which was statistically significant with p-value of <0.001 across all categories. Surveys demonstrated improved role understanding and checklist utilization comfort postintervention.

Conclusions

This study supports the benefit of multidisciplinary SIM training with RCDP-style methodology as an educational method for improving airway management, teamwork skills, and RSI checklist utilization for PED staff. Incorporation of additional maintenance SIM sessions for ongoing education is likely to be further beneficial and would allow evaluation of degradation of skills over time following initial training.

背景：插管核对表已成为儿科急诊室（PED）在快速顺序插管（RSI）过程中减少不良事件和提高效率的工具。本研究旨在利用多学科模拟（SIM）培训作为教育工具，通过使用 RSI 核对表来提高儿科急诊科团队在 RSI 场景中的表现：方法：我们仿照之前发布的 PED 核对表制作了一份核对表。PED 多学科团队参加了视频录制的 SIM 培训课程，其中涉及需要插管的情景三次，首先是不间断的，然后接受我们的快速循环刻意练习（RCDP）干预汇报，重点是核对表的使用和团队动态。学员在不间断的情况下再进行一次情景模拟，以应用所学技能。通过使用模拟团队评估工具（STAT）进行视频审查，对团队表现进行评估，重点是气道管理和人为因素部分。对干预前后的得分进行比较，并进行干预前后的调查：共有 483 名学员参加了 64 次 SIM 培训课程，其中 44 人符合纳入标准并被纳入数据分析。干预后，学员在气道管理、人为因素和总分方面的得分均有所提高。总分、气道和人为因素得分的最小二乘法平均差异分别为 9.55（95% 置信区间 [CI] 7.24-11.85）、4.22（95% CI 2.91-5.52）和 5.33（95% CI 3.86-6.8），具有统计学意义，P 值为结论：本研究支持采用 RCDP 式方法进行多学科 SIM 培训，并将其作为一种教育方法，用于提高 PED 员工的气道管理、团队协作技能和 RSI 核对表使用率。纳入额外的维持性 SIM 课程以进行持续教育可能会带来更多益处，并可评估初始培训后随着时间推移出现的技能退化情况。

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引用次数: 0

Paths to learning: How residents navigate transience in supervisory relationships in the emergency department 学习之路：急诊科住院医师如何应对急诊科督导关系中的短暂性

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-10-31 DOI: 10.1002/aet2.11037

Kelsey A. Miller MD, EdM, Sarah C. Cavallaro MD, Kate Dorney MD, MHPEd, Alexander Hirsch MD, Michael Monuteaux ScD, Joshua Nagler MD, MHPEd

Background

Strong relationships between trainees and physician supervisors can positively influence how trainees navigate workplace learning. How trainees act and learn in clinical workplaces characterized by rapidly developing and dissolving supervisory pairings is less well understood. This study uses the emergency department (ED) to examine the impact of transient supervisory relationships on how residents approach clinical learning opportunities.

Methods

We retrospectively analyzed pediatric and emergency medicine resident rotations in an urban, tertiary, academic pediatric ED between July 2018 and June 2022. Using social network analysis (SNA), we identified resident–attending dyads and patients seen by each dyad. This informed semistructured interviews to understand how transience in supervisory relationships influences how residents approach and interpret clinical experiences. With self-determination theory as an organizing framework, the investigators performed line-by-line coding with constant comparative analysis which supported subsequent theoretical coding.

Results

During the study, 526 residents completed 1013 rotations with 87 attendings. A mean (±SD) of 25 (±7) attendings supervised a resident per rotation, with dyads caring for a mean (±SD) of 4 (±4) patients. Twelve residents were interviewed and described different paths to learning depending on the transience of their relationships with clinical supervisors. More sustained contact presented an opportunity to build competence by fostering autonomy and feedback, while briefer contact advanced residents’ competence by exposing them to variable practice patterns.

Conclusions

Combining SNA with qualitative analysis revealed that residents in the ED experience a spectrum of contact with attendings and perceive different paths to learning depending on the transience of this relationship. The results suggest different educational strategies may be necessary to maximize learning depending on the length or resident–attending interactions.

背景受训人员与医生主管之间的密切关系可以对受训人员如何在工作场所学习产生积极影响。在临床工作环境中，督导配对关系会迅速发展和解体，学员如何在这种环境中行动和学习，目前还不太清楚。本研究利用急诊科（ED）来探讨短暂的指导关系对住院医师如何把握临床学习机会的影响。方法我们回顾性地分析了 2018 年 7 月至 2022 年 6 月期间在一个城市三级学术儿科急诊科轮转的儿科和急诊科住院医师。通过社会网络分析（SNA），我们确定了住院医师与住院医师之间的关系，以及每个关系所诊治的患者。在此基础上，我们进行了半结构式访谈，以了解督导关系的短暂性如何影响住院医师如何对待和解释临床经验。以自我决定理论为组织框架，研究人员进行了逐行编码和持续比较分析，这为随后的理论编码提供了支持。结果在研究期间，526 名住院医师与 87 名主治医师一起完成了 1013 次轮转。每次轮转时，平均（±SD）有 25 名（±SD）主治医师指导一名住院医师，每组平均（±SD）护理 4 名（±SD）患者。12 名住院医师接受了采访，他们根据与临床督导关系的短暂性描述了不同的学习途径。较持久的接触可通过培养自主性和反馈来提高能力，而较短暂的接触则可让住院医师接触不同的实践模式，从而提高他们的能力。结论将 SNA 与定性分析相结合后发现，急诊科住院医师与主治医师的接触是多种多样的，而且根据这种关系的短暂性，住院医师的学习途径也有所不同。结果表明，根据住院医师与主治医师互动时间的长短，可能需要采取不同的教育策略，以最大限度地提高学习效果。

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引用次数: 0

General emergency physician perceptions of caring for children: A qualitative interview study 普通急诊医生对儿童护理的看法：定性访谈研究

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-10-29 DOI: 10.1002/aet2.11038

Regina L. Toto MD, MSEd, Eva M. Delgado MD, Tara Ketterer MPH, Emily Berner MD, Sarah I. Landau MD, Molly Crowe MD, Angeliz Caro Monroig MD, Gillian Sedigh Haghighat MD, MSEd, Cynthia J. Mollen MD, MSCE

Background

Emergency physicians care for most children presenting to U.S. emergency departments (EDs). Pediatric exposure during emergency medicine (EM) residency can be variable and critically ill children are rarely encountered. A recent needs assessment revealed that emergency physicians feel less prepared to manage various conditions in children and that infants, regardless of presenting complaint, pose particular challenges. Emergency physician perceptions of the experience of caring for pediatric patients have not been widely examined through a qualitative lens.

Methods

We designed an interview-based qualitative study to explore emergency physician perspectives on pediatric patient care. We recruited emergency physicians who graduated from residency in 2015–2019 and all rotated through the same large tertiary children's hospital. Four trained interviewers conducted in-depth, one-on-one virtual interviews. An interdisciplinary team transcribed and then coded the interviews. The team performed a conventional content analysis for themes. Recruitment continued until thematic saturation was achieved.

Results

Twelve participants completed interviews. These participants trained in five diverse residency programs. Likewise, the participants now practice in a variety of settings. Three major themes emerged from the data: (1) experience and exposure are key to establishing comfort caring for children; (2) simulation, pathways, and the pediatric anesthesia rotation are educationally useful; and (3) caring for children poses unique emotional challenges. Participants shared many recommendations for future pediatric education for EM trainees, including increasing autonomy and exposure to neonates and considering how care might differ in a community setting.

Conclusions

This interview-based qualitative study elucidates key themes in recently graduated emergency physicians’ perceived experience of caring for children. Our findings have important educational implications for this group of emergency physicians and those who share similar experiences in training and practice.

背景美国急诊科（ED）收治的大多数儿童都是由急诊科医生诊治的。在急诊医学（EM）住院医师培训期间，他们接触到的儿科病人并不固定，而且很少遇到重症患儿。最近的一项需求评估显示，急诊医生在处理儿童的各种病症时感到准备不足，而婴儿无论主诉如何，都会带来特殊的挑战。急诊医生对儿科患者护理经验的看法尚未通过定性视角进行广泛研究。方法我们设计了一项基于访谈的定性研究，以探讨急诊医生对儿科患者护理的看法。我们招募了 2015-2019 年毕业的急诊科医生，他们都在同一家大型三级儿童医院轮转。四名训练有素的访谈者进行了一对一的深度虚拟访谈。一个跨学科团队对访谈进行了转录和编码。团队对主题进行了常规内容分析。招募工作一直持续到主题饱和为止。结果 12 名参与者完成了访谈。这些参与者曾在五个不同的住院医师培训项目中接受培训。同样，这些参与者现在也在不同的环境中执业。数据中出现了三大主题：(1) 经验和接触是建立舒适儿童护理的关键；(2) 模拟、路径和儿科麻醉轮转在教育上是有用的；(3) 儿童护理带来了独特的情感挑战。学员们就未来针对急诊科学员的儿科教育提出了许多建议，包括增加自主权和接触新生儿的机会，以及考虑在社区环境下护理工作可能会有哪些不同。结论这项以访谈为基础的定性研究阐明了新近毕业的急诊科医生所感知的儿童护理经验中的关键主题。我们的研究结果对这群急诊医生以及那些在培训和实践中有类似经历的医生具有重要的教育意义。

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引用次数: 0

5, 4, 3, 2, 1, 0: An evidence-based mnemonic to aid recall and interpretation of heart rate values for pediatric patients presenting for acute care 5、4、3、2、1、0：以证据为基础的记忆法，用于帮助回忆和解释急诊儿科病人的心率值。

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-10-23 DOI: 10.1002/aet2.11034

Robert A. Dudas MD, Joel K. Berezow MD

引用次数: 0

“Ardor and diligence”: Quantifying the faculty effort needed in emergency medicine graduate medical education "热心和勤奋"：量化急诊医学研究生医学教育中所需的师资力量。

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-10-22 DOI: 10.1002/aet2.11035

John C. Burkhardt MD, PhD, Jaime Jordan MD, MAEd, James A. Cranford PhD, Fiona E. Gallahue MD, Keith E. Kocher MD, MPH, Tiffany Murano MD, Moshe Weizberg MD, MBA, Laura R. Hopson MD, MEd

Objectives

Regulatory requirements around protected faculty effort to support graduate medical education (GME) programs have changed. The amount of labor required to run a GME program is unknown. We sought to describe the work performed by program leadership and core faculty in emergency medicine (EM).

Methods

We performed a prospective survey study of core faculty in EM. Participants completed a demographic questionnaire followed by quarterly time surveys, covering activities in eight domains: evaluation, teaching and education, scholarly activity, service, interview/recruitment, clinical supervision, student responsibilities, and wellness and administration. We collected data from April 2022 to March 2023. We calculated descriptive statistics and used analyses of variance (ANOVA) to assess differences by faculty role and quarter.

Results

A total of 596 physicians completed the demographic questionnaire and 347 (58.2%) completed at least one quarterly time survey including 142 (41%) females, 48 (14%) program directors (PDs), 84 (24%) assistant/associate program directors (APDs), and 215 (62%) general core faculty (GCF). The mean number of hours per week spent on nonclinical education work was 60 h for PDs, 47 h for APDs, and 44 h for GCF. ANOVA found significant differences in mean hours per week and faculty role in domains of evaluation (p < 0.001), service (p = 0.007), and interview/recruitment (p < 0.001). We detected differences in mean hours per week and quarter in domains of evaluation (p < 0.001), teaching and education (p < 0.001), interview and recruitment (p < 0.001), and clinical supervision (p < 0.001).

Conclusions

Running a residency program requires many hours of faculty work, which can vary based on faculty role and time of year. These results can inform decisions regarding faculty support.

目的：有关支持研究生医学教育（GME）项目的受保护教师工作的法规要求已经发生了变化。运行一个 GME 项目所需的工作量尚不清楚。我们试图描述急诊医学（EM）项目领导和核心教师的工作：我们对急诊医学专业的核心教师进行了一项前瞻性调查研究。参与者填写了一份人口统计学调查问卷，随后每季度进行一次时间调查，调查内容包括八个方面的活动：评估、教学和教育、学术活动、服务、面试/招聘、临床监督、学生责任以及健康和管理。我们收集了 2022 年 4 月至 2023 年 3 月期间的数据。我们计算了描述性统计数字，并使用方差分析（ANOVA）来评估不同教师角色和不同季度的差异：共有 596 名医生完成了人口统计学问卷调查，其中 347 人（58.2%）至少完成了一次季度时间调查，包括 142 名女性（41%）、48 名项目主任（14%）、84 名助理/副项目主任（24%）和 215 名普通核心教员（62%）。项目主任每周用于非临床教育工作的平均时间为 60 小时，助理项目主任为 47 小时，普通骨干教师为 44 小时。方差分析发现，在评估（P P = 0.007）和面试/招聘（P P P P P 结论）领域，每周平均时数与教员角色存在显著差异：运行住院医师培训项目需要教师投入大量的工作时间，这些工作时间会因教师的角色和每年的时间而有所不同。这些结果可以为教师支持决策提供参考。

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引用次数: 0

Directed image review technique (DIRT): A framework for ultrasound image assessment and interpretation 定向图像审查技术（DIRT）：超声图像评估和解读框架。

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-10-22 DOI: 10.1002/aet2.11036

Arthur T. Broadstock MD, Jessica Baez MD, Patrick G. Minges MD, Meaghan Frederick MD, Lori A. Stolz MD

Use of point-of-care ultrasound (POCUS) is integral to the practice of emergency medicine, and POCUS education is a required component of emergency medicine training. Developing POCUS skills requires iterative deliberate practice of image acquisition and interpretation. Providing feedback to learners regarding ultrasound image interpretation can be challenging for emergency medicine clinician educators. We present a framework called the directed image review technique. This framework guides learner ultrasound image interpretation and provides educators with a similar structured approach to evaluate a learner's ultrasound competency and provide targeted feedback regarding image acquisition and interpretation.

使用床旁超声（POCUS）是急诊医学实践中不可或缺的一部分，而 POCUS 教育也是急诊医学培训的必修课。培养 POCUS 技能需要反复练习图像采集和判读。对于急诊医学临床教育工作者来说，向学员提供超声图像判读方面的反馈具有挑战性。我们提出了一个名为定向图像审查技术的框架。该框架可指导学习者进行超声图像解读，并为教育者提供类似的结构化方法来评估学习者的超声能力，并就图像采集和解读提供有针对性的反馈。

引用次数: 0