AEM Education and Training最新文献_第3页

Nature Versus Nurture: Resident Career Decisions in Emergency Medicine 先天与后天：急诊医学住院医师的职业决定。

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2025-11-12 DOI: 10.1002/aet2.70103

Jaime Jordan, Samuel O. Clarke, Mark Curato, Adam Frisch, Adam Janicki, Laura R. Hopson, Michael Gottlieb

Objectives

Choosing a post-residency career path in emergency medicine (EM) represents a complex set of decisions involving personal preferences and training program characteristics. It is unclear to what degree the training program environment shapes these choices or if residents select training programs that align with their pre-existing career plans. We sought to evaluate resident career plans over time and assess differences between 3- and 4-year training formats in EM.

Methods

We conducted a prospective, observational, cohort study of EM residents at six ACGME-accredited residencies in the United States from 2020 to 2024. Participants reported demographics and career plans at the onset of their training and at graduation. We used analysis of covariance to determine differences in career choice and change over time between 3-year and 4-year programs. We used univariable regression to assess associations between personal and program factors on change in career choice during residency.

Results

Eighty-one residents completed both the initial and graduation surveys. We did not detect any statistical difference between three- and four-year programs for either initial (p = 0.32) or graduation (p = 0.80) career plans. Thirty participants were undecided about their career plans at the beginning of training. There was no difference between types of changes in career choices between three- and four-year programs when including (p = 0.40) or excluding (p = 0.60) those changes of participants who were initially undecided. We did not detect any significant associations between individual (age, gender) or program (program identity, program format) factors on the change of career plans during residency.

Conclusion

We did not find a significant difference between program format and career plans. A minority of residents changed career plans during residency, and neither program length nor demographic factors were significantly associated with those changes. A proportion of residents begins training undecided about their career path, highlighting a potential role for early, structured career guidance.

目的：选择急诊医学（EM）的住院医师后职业道路是一套复杂的决策，涉及个人偏好和培训计划特点。目前尚不清楚培训项目环境在多大程度上影响了这些选择，也不清楚住院医生选择的培训项目是否符合他们之前的职业规划。我们试图评估住院医师随着时间的推移的职业规划，并评估3年和4年培训形式之间的差异。方法：我们对2020年至2024年美国六个acgme认证的住院医师进行了一项前瞻性、观察性、队列研究。参与者在培训开始时和毕业时报告了人口统计和职业规划。我们使用协方差分析来确定三年制和四年制课程的职业选择和随时间变化的差异。我们使用单变量回归来评估个人因素和项目因素对住院医师职业选择变化的相关性。结果：81名居民完成了初始调查和毕业调查。我们没有发现三年制和四年制课程在初始（p = 0.32）或毕业（p = 0.80）职业规划方面有任何统计学差异。30名参与者在培训开始时还没有确定自己的职业规划。当包括（p = 0.40）或排除（p = 0.60）最初未决定的参与者的职业选择变化时，三年制和四年制课程之间的职业选择变化类型没有差异。我们没有发现个人（年龄、性别）或项目（项目身份、项目形式）因素对住院医师职业规划改变有任何显著的关联。结论：我们没有发现课程形式与职业规划之间的显著差异。少数住院医师在住院期间改变了职业规划，且项目长度和人口因素都与这些变化无关。一部分住院医生在接受培训时还没有确定自己的职业道路，这凸显了早期结构化职业指导的潜在作用。

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引用次数: 0

Recruitment: An Invitation to Remember 招聘：一个值得记住的邀请

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2025-10-24 DOI: 10.1002/aet2.70107

Juhi Varshney

引用次数: 0

Declining Performance on American Board of Emergency Medicine Written Examinations 美国急诊医学委员会笔试成绩下滑

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2025-10-24 DOI: 10.1002/aet2.70105

Earl J. Reisdorff, Samuel M. Keim, Diane L. Gorgas, Suzanne R. White, John L. Kendall, Kathleen C. Ruff, Felix K. Ankel, Susan E. Farrell, Yvette Calderon, Michael Gottlieb, Yachana Bhakta, Melissa A. Barton, Kevin B. Joldersma

Introduction

Emergency medicine (EM) is at a critical juncture with pervasive boarding and overcrowding, a rapid rise in new residency programs, and continuing recovery from the COVID-19 pandemic. These factors could all potentially impact trainees' learning experiences. To explore how this has influenced trainee knowledge acquisition, we analyzed the trends in the American Board of Emergency Medicine (ABEM) In-training Examination (ITE) and the written Qualifying Examination (QE).

Methods

This was a retrospective study of multiyear performance trends for the ITE (2018–2024) and QE (2019–2024). Only ITE results from residents in categorical ACGME-accredited EM programs were included. ITE performance was the aggregate mean scaled (equated) scores of all EM training levels. The measures for QE performance were the mean scaled scores (equated) and the pass rates. For each test, descriptive statistics were reported and an omnibus analysis of variance (ANOVA) comparing scores across years was computed. When an ANOVA result was statistically significant (α < 0.01), Tukey's tests were performed.

Results

For the ITE, there were 61,512 test results, of which 59,075 (96.0%) met inclusion criteria. The mean (SD) scaled ITE scores declined from 77.36 (8.85) in 2018 to 72.19 (9.44) in 2024. The ANOVA for the ITE scaled scores was statistically significant (p < 0.01). The QE had 17,040 test results, of which 15,651 (91.8%) met inclusion criteria. The mean (SD) scaled scores declined from 82.8 (4.6) in 2019 to 80.5 (4.5) in 2024, while the pass rate also declined from 92.3% in 2019 to 82.0% in 2024. The ANOVA for the QE scaled scores across years was significant (p < 0.01).

Conclusions

Physician performance on the ABEM ITE has steadily declined since 2018; performance on the QE has declined since 2019. Future research is needed to understand and address the potential causes of these trends.

急诊医学（EM）正处于一个关键时刻：普遍的寄宿和过度拥挤，新的住院医师计划迅速增加，以及COVID-19大流行的持续复苏。这些因素都有可能影响学员的学习经历。为了探讨这对培训生知识获取的影响，我们分析了美国急诊医学委员会（ABEM）培训考试（ITE）和书面资格考试（QE）的趋势。方法回顾性研究ITE（2018-2024）和QE（2019-2024）的多年表现趋势。只有来自acgme认证的EM项目的住院医生的ITE结果被包括在内。ITE表现为所有EM培训水平的总平均缩放（等额）分数。量化宽松表现的衡量标准是平均分（等额）和通过率。对于每个测试，报告描述性统计数据，并计算综合方差分析（ANOVA），比较历年得分。当方差分析结果具有统计学意义（α < 0.01）时，进行Tukey检验。结果ITE共检测结果61512例，其中59075例（96.0%）符合纳入标准。平均（SD）量表ITE得分从2018年的77.36（8.85）下降到2024年的72.19（9.44）。ITE量表得分的方差分析有统计学意义（p < 0.01）。量化宽松共有17,040个测试结果，其中15,651个（91.8%）符合纳入标准。平均（SD）评分从2019年的82.8分（4.6分）下降到2024年的80.5分（4.5分），通过率也从2019年的92.3%下降到2024年的82.0%。各年量化宽松量表得分的方差分析具有显著性（p < 0.01）。自2018年以来，医师在ABEM ITE上的表现稳步下降；自2019年以来，量化宽松的表现一直在下降。未来的研究需要了解和解决这些趋势的潜在原因。

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引用次数: 0

Changes in the Growth Rate for Emergency Medicine Residency Training Positions From 2011 to 2025 2011 - 2025年急诊医学住院医师培训岗位增长率的变化

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2025-10-16 DOI: 10.1002/aet2.70101

Matthew R. Klein, Christian Keenan, Brian Clyne

Objectives

Emergency medicine (EM) has experienced considerable expansion in recent years, prompting concern among potential EM applicants. This study reports the growth rate for training positions in EM and other specialties during three consecutive 5-year periods from 2011 to 2025, with the goal of providing context for medical students and their advisors as they assess EM's growth relative to other fields.

Methods

This study analyzed National Residency Matching Program (NRMP) Main Residency Match data. The growth rate for first-year postgraduate (PGY-1) training positions was calculated for EM and eight other specialties from 2011 to 2015, 2016 to 2020, and 2021 to 2025, which correspond to the 5-year periods before, during, and after the transition to a single graduate medical education accreditation system. The percentage of total NRMP positions offered by each specialty was also calculated.

Results

The number of EM PGY-1 positions grew by 13.3% from 2011 to 2015, 40.6% from 2016 to 2020, and 8.0% from 2021 to 2025. Among the specialties included in this analysis, EM had the sixth highest growth rate from 2011 to 2015, the second highest growth rate from 2016 to 2020, and the seventh highest growth rate from 2021 to 2025. The proportion of EM positions, as a percentage of all NRMP PGY-1 positions, decreased from 2011 to 2015, increased from 2016 to 2020, and then decreased from 2021 to 2025.

Conclusions

The growth rate for EM training positions offered through the NRMP increased during the transition to a single accreditation system, then slowed during the 5 years following the transition. From 2021 to 2025, the growth rate for EM positions was exceeded by anesthesiology, family medicine, general surgery, internal medicine, interventional radiology, and physical medicine and rehabilitation. These results demonstrate that the recent expansion in EM training opportunities is not unique.

近年来，急诊医学（EM）经历了相当大的扩张，引起了潜在EM申请者的关注。本研究报告了从2011年到2025年连续三个5年期间，EM和其他专业培训职位的增长率，目的是为医科学生及其导师评估EM相对于其他领域的增长提供背景。方法对全国户籍匹配计划（NRMP）的主要户籍匹配数据进行分析。计算了2011年至2015年、2016年至2020年和2021年至2025年期间，EM和其他八个专业一年级研究生（PGY-1）培训职位的增长率，对应于过渡到单一研究生医学教育认证制度之前、期间和之后的5年期间。还计算了每个专业提供的NRMP总职位的百分比。结果2011 - 2015年EM PGY-1职位数量增长13.3%，2016 - 2020年增长40.6%，2021 - 2025年增长8.0%。在该分析中包括的专业中，新兴市场在2011年至2015年的增长率排名第六，2016年至2020年的增长率排名第二，2021年至2025年的增长率排名第七。新兴市场职位占所有NRMP PGY-1职位的比例从2011年到2015年下降，从2016年到2020年上升，然后从2021年到2025年下降。通过NRMP提供的EM培训职位的增长率在向单一认证体系过渡期间增加，然后在过渡后的5年内放缓。从2021年到2025年，麻醉学、家庭医学、普外科、内科、介入放射学、物理医学和康复学的增长率超过了EM职位的增长率。这些结果表明，最近新兴市场培训机会的增加并非个例。

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引用次数: 0

Are Escape Rooms an Antidote for Anxiety in Simulation? An Experimental Randomized Study Comparing High-Fidelity Simulation to an Escape Room Format 逃离房间是模拟游戏焦虑的解药吗？一项比较高保真模拟和密室逃生格式的实验随机研究

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2025-10-16 DOI: 10.1002/aet2.70096

Aubrey A. Bethel, Sara P. Dimeo, Vivienne Ng

Introduction

Simulation-based education is well established in graduate medical education and augments medical knowledge acquisition. While a highly effective tool, some potentially negative impacts such as cognitive overload and anxiety have been described. The use of escape rooms to “gamify” simulation has been shown to be an enjoyable way to engage learners. However, it is unknown if the format causes a similar level of anxiety compared to scenario-based simulation. This study compares a traditional scenario-based simulation to an escape room format to demonstrate the effect on self-reported learner anxiety.

Methods

A peer-reviewed pediatric emergency medicine simulation case was modified into an escape room simulation. Emergency medicine (EM) residents were consented and randomized into the scenario-based control group or escape room intervention group. The primary outcome was comparing self-reported anxiety levels of the residents pre- and post-simulation. The secondary outcome was the acquisition of medical knowledge, as measured by improvement on pre- and post-simulation medical knowledge quizzes. Descriptive data and differences of means by two-tailed t-test are reported.

Results

Fifty-two EM residents participated, with 40 available for analysis. Post-simulation self-reported anxiety levels of participants in the scenario-based simulation group were slightly increased (50.71–52.38), whereas the levels for those in the escape room format were significantly decreased (52.05–31.10), p = 0.002. Both groups showed similar improvement on the post-simulation medical knowledge quiz (73%–80%, p = 0.016 and 71%–79%, p = 0.004, scenario-based and escape room, respectively), with no difference between the groups (p = 0.665).

Conclusions

When comparing scenario-based simulation to an escape room format, medical knowledge acquisition was achieved equally, while anxiety levels were markedly lower in escape room participants. Escape room simulation shows promise in decreasing anxiety among the participants while teaching equal medical knowledge compared to traditional scenario-based simulation.

以模拟为基础的教育在研究生医学教育中得到了很好的建立，并增加了医学知识的获取。虽然这是一种非常有效的工具，但也有一些潜在的负面影响，如认知超载和焦虑。使用逃生室来“游戏化”模拟已经被证明是吸引学习者的一种愉快的方式。然而，与基于场景的模拟相比，这种格式是否会引起类似程度的焦虑尚不清楚。本研究比较了传统的基于场景的模拟和逃生室形式，以证明对自我报告的学习者焦虑的影响。方法将同行评议的儿科急诊医学模拟案例修改为密室逃生模拟。急诊医学（EM）住院医师同意并随机分为基于场景的对照组和密室逃生干预组。主要结果是比较居民在模拟前和模拟后自我报告的焦虑水平。次要结果是医学知识的获得，通过模拟前和模拟后医学知识测验的改善来衡量。报告了描述性数据和双尾t检验的均值差异。结果52名EM居民参与调查，其中40名可供分析。情景模拟组受试者模拟后自我报告焦虑水平略有升高（50.71 ~ 52.38），而密室逃生组受试者模拟后自我报告焦虑水平显著降低（52.05 ~ 31.10），p = 0.002。两组在模拟后医学知识测验中分别有73% ~ 80% （p = 0.016）和71% ~ 79% （p = 0.004）的改善，两组间差异无统计学意义（p = 0.665）。结论将情境模拟与密室逃生模式进行比较，密室逃生参与者获得的医学知识相同，但焦虑水平明显降低。与传统的基于场景的模拟相比，逃生室模拟在教授同等医学知识的同时，有望减少参与者的焦虑。

{"title":"Are Escape Rooms an Antidote for Anxiety in Simulation? An Experimental Randomized Study Comparing High-Fidelity Simulation to an Escape Room Format","authors":"Aubrey A. Bethel, Sara P. Dimeo, Vivienne Ng","doi":"10.1002/aet2.70096","DOIUrl":"https://doi.org/10.1002/aet2.70096","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Simulation-based education is well established in graduate medical education and augments medical knowledge acquisition. While a highly effective tool, some potentially negative impacts such as cognitive overload and anxiety have been described. The use of escape rooms to “gamify” simulation has been shown to be an enjoyable way to engage learners. However, it is unknown if the format causes a similar level of anxiety compared to scenario-based simulation. This study compares a traditional scenario-based simulation to an escape room format to demonstrate the effect on self-reported learner anxiety.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A peer-reviewed pediatric emergency medicine simulation case was modified into an escape room simulation. Emergency medicine (EM) residents were consented and randomized into the scenario-based control group or escape room intervention group. The primary outcome was comparing self-reported anxiety levels of the residents pre- and post-simulation. The secondary outcome was the acquisition of medical knowledge, as measured by improvement on pre- and post-simulation medical knowledge quizzes. Descriptive data and differences of means by two-tailed <i>t</i>-test are reported.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty-two EM residents participated, with 40 available for analysis. Post-simulation self-reported anxiety levels of participants in the scenario-based simulation group were slightly increased (50.71–52.38), whereas the levels for those in the escape room format were significantly decreased (52.05–31.10), <i>p</i> = 0.002. Both groups showed similar improvement on the post-simulation medical knowledge quiz (73%–80%, <i>p</i> = 0.016 and 71%–79%, <i>p</i> = 0.004, scenario-based and escape room, respectively), with no difference between the groups (<i>p</i> = 0.665).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>When comparing scenario-based simulation to an escape room format, medical knowledge acquisition was achieved equally, while anxiety levels were markedly lower in escape room participants. Escape room simulation shows promise in decreasing anxiety among the participants while teaching equal medical knowledge compared to traditional scenario-based simulation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 5","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145317204","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

From Assistance to Autonomy: Evaluating Procedural Competency in Pediatric Emergency Medicine 从协助到自主：评估儿科急诊医学的程序能力。

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2025-09-28 DOI: 10.1002/aet2.70095

Richard Barber, Marideth Rus, Elizabeth Moran, Esther M. Sampayo, Deborah Hsu, Corrie E. Chumpitazi, Elizabeth A. Camp, Nidhi V. Singh

Objective

Pediatric emergency medicine (PEM) physicians require expertise in numerous procedural skills to manage emergencies in children. Fellows require hands-on experience, expert supervision, and standardized feedback to build procedural competency. Our objective was to develop and gather validity evidence for an evaluation tool to assess PEM fellows' ability to perform procedures.

Methods

We conducted a retrospective study of PEM fellows' procedural performance within a children's hospital system. Faculty evaluated fellows using a one-item, five-point entrustment/level of supervision scale. We focused on three frequently performed procedures: laceration repair, intubation, and procedural sedation. To assess changes in supervision scores by training year, we used a mixed-effects binary logistic regression model with scores ≥ 4 as the threshold. Adjusted odds ratios (aOR), 95% confidence intervals (CIs) and p values were reported. We also assessed inter- and intra-rater reliability overall, by procedure, and by semester.

Results

Data from 38 fellows and 137 supervising faculty evaluations were included. Compared to first-year fellows, second-year fellows were significantly more likely to receive higher scores (aOR = 4.95; 95% CI 3.78–6.47) and third-year fellows even more so (aOR = 10.15; 95% CI 6.71–15.35). Intra-rater reliability showed moderate to very strong correlation (ρ = 0.84), and by procedure: intubation (ρ = 0.78), lac repair (ρ = 0.92), and sedation (ρ = 0.85). Inter-rater reliability was poor across all measures. First-year fellows showed significant differences in intubation scores between specialties. No significant differences were found among third-year fellows.

Conclusion

A supervision-based evaluation tool demonstrated strong intra-rater reliability and captured increasing procedural competency among PEM fellows, as evidenced by progressively higher entrustment scores with increasing years in training. This tool may support standardized assessment and meaningful feedback throughout fellowship training.

目的：儿科急诊医学（PEM）医生需要在许多程序技能的专业知识来管理儿童的紧急情况。研究员需要实践经验、专家监督和标准化反馈来建立程序能力。我们的目标是开发和收集有效性证据的评估工具，以评估PEM研究员执行程序的能力。方法：我们进行了一个回顾性研究PEM研究员的程序性能在儿童医院系统。教师使用单项、5分委托/监督等级量表对研究员进行评估。我们重点介绍了三种常用的手术方法：撕裂伤修复、插管和手术镇静。为了评估不同培训年份监督评分的变化，我们采用混合效应二元logistic回归模型，得分≥4为阈值。报告了校正优势比（aOR）、95%置信区间（CIs）和p值。我们还按程序和学期评估了总体上评分者之间和评分者内部的可靠性。结果：纳入了38名研究员和137名指导教师的评估数据。与一年级的研究员相比，二年级的研究员明显更有可能获得更高的分数（aOR = 4.95; 95% CI 3.78-6.47），三年级的研究员更是如此（aOR = 10.15; 95% CI 6.71-15.35）。组内可靠性显示出中等至非常强的相关性（ρ = 0.84），通过手术：插管（ρ = 0.78），裂孔修复（ρ = 0.92）和镇静（ρ = 0.85）。评估者之间的信度在所有测量中都很差。第一年实习医生在不同专业的插管评分上有显著差异。在三年级的研究人员中没有发现显著差异。结论：基于监督的评估工具显示出较强的内部可靠性，并捕获了PEM研究员日益增长的程序能力，随着培训年限的增加，委托分数逐渐提高。这个工具可以在整个奖学金培训过程中支持标准化评估和有意义的反馈。

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引用次数: 0

Implementation of a Longitudinal Ultrasound Training Program for Senior Emergency Medicine Residents: Impact on Scan Volume and Accuracy 急诊住院医师纵向超声培训计划的实施：对扫描量和准确性的影响。

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2025-09-28 DOI: 10.1002/aet2.70100

Jessica Baez, Olivia Urbanowicz, Heidi Sucharew, Laura Syori, Olivia Gobble, Arthur Broadstock, Patrick Minges, Lori Stolz

Background

Point-of-care ultrasound (POCUS) is a critical skill in emergency medicine, yet training methods and assessment vary widely across residency programs. Skill degradation following initial training remains a persistent challenge.

Objective

To evaluate the impact of a longitudinal ultrasound curriculum implemented during the third year of residency (R3) on scan volume and competency.

Methods

A retrospective cohort study was conducted at a single academic emergency medicine residency program. Residents from six graduating classes were analyzed, comparing ultrasound examination volume and quality between those exposed to the longitudinal curriculum (intervention group) and those trained under the prior model (control group). The intervention included 2–8 faculty-supervised scanning shifts during the R3 year.

Results

A total of 84 residents performed 33,278 scans during the 6-year study period. Intervention group residents completed significantly more POCUS exams during their R3 year (mean 156.6 vs. 95.8; p < 0.01). Examination quality and diagnostic accuracy remained high, with no significant difference in advanced scan use.

Conclusion

A structured longitudinal ultrasound curriculum during senior residency meaningfully increases scan volume without compromising examination accuracy, supporting its adoption as a feasible strategy to reinforce POCUS competence.

背景：即时超声（POCUS）是急诊医学的一项关键技能，但培训方法和评估在住院医师项目中差异很大。初始训练后的技能退化仍然是一个持续的挑战。目的：评价住院医师第三年（R3）实施的纵向超声课程对扫描量和能力的影响。方法：回顾性队列研究在一个单一的学术急诊医学住院医师项目中进行。对6个毕业班住院医师进行分析，比较纵向课程组（干预组）和先验模式组（对照组）超声检查量和质量。干预措施包括在3年中2-8次教师监督的扫描班次。结果：在6年的研究期间，共有84名居民进行了33,278次扫描。干预组住院医师在第三年完成了更多的POCUS检查（平均156.6比95.8）。结论：在老年住院医师期间，结构化的纵向超声课程在不影响检查准确性的情况下显著增加了扫描体积，支持将其作为加强POCUS能力的可行策略。

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引用次数: 0

Development, Integration, and Evaluation of Street Medicine Into Emergency Medicine Resident Education 街头医学融入急诊医学住院医师教育的发展、整合与评价。

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2025-09-28 DOI: 10.1002/aet2.70099

John Spartz, Sarah Axelrath, April Krall, Barbara Blok, W. Gannon Sungar, Bonnie Kaplan, Lara Rappaport, Jason Haukoos, Evangelia Murray, Kathleen Joseph

Background

People experiencing homelessness (PEH) utilize the emergency department (ED) at higher rates than the general population. Emergency medicine (EM) physicians would benefit from increased exposure to homeless healthcare, including street medicine, which provides mobile care to PEH. Thus, leveraging a relationship with a local healthcare organization for the homeless, this project aimed to implement a street medicine experience for first-year EM residents and evaluate resident perceptions of the experience.

Methods

By partnering with an existing street medicine program, we piloted an elective one-day experience for first-year EM residents. Residents were invited to complete pre- and post-experience surveys using the Health Professionals' Attitude Toward the Homeless Inventory (HPATHI), augmented with additional Likert scale and qualitative questions. We calculated descriptive statistics and performed analysis of free-text answers using inductive and in vivo codes.

Results

We successfully piloted and integrated a street medicine experience into the curriculum of an EM residency program. 17/17 (100%) residents of the first-year class participated in the elective. 13/17 (76%) of residents completed the pre-survey and 9/17 (53%) of residents completed the post-survey. Although there were no statistical differences between pre- and post-surveys, major themes from free text responses included (1) practice-changing insights into systems- and community-based challenges within the lived experiences of PEH, and (2) interest in additional education dedicated to street medicine. On average, residents found the experience to be useful (mean 4.0, standard deviation [SD] 1.40) and valuable (mean 4.4, SD 1.01), felt more comfortable caring for PEH (mean 4.6, SD 0.73), and had a better understanding of community resources (mean 4.6, SD 0.73) after the experience.

Conclusion

We demonstrated the feasibility of incorporating a street medicine pilot experience into EM resident education, and, on average, residents perceived this experience as a valuable and useful addition to their education.

背景：无家可归者（PEH）使用急诊科（ED）的比率高于一般人群。急诊医生将受益于更多地接触无家可归者的医疗服务，包括为PEH提供流动护理的街头医疗。因此，利用与当地无家可归者医疗保健组织的关系，该项目旨在为第一年的EM居民实施街头医疗体验，并评估居民对体验的看法。方法：通过与现有的街头医疗项目合作，我们为第一年急诊住院医师试行了为期一天的选修课。邀请居民使用卫生专业人员对无家可归者的态度量表（HPATHI）完成体验前和体验后的调查，并辅以额外的李克特量表和定性问题。我们计算了描述性统计数据，并使用归纳和体内编码对自由文本答案进行了分析。结果：我们成功地试点并将街头医疗经验整合到EM住院医师项目的课程中。17/17（100%）的一年级学生参加了选修课。13/17（76%）的居民完成了预调查，9/17（53%）的居民完成了后调查。尽管调查前后没有统计学差异，但来自免费文本回复的主要主题包括(1)对PEH生活经验中系统和社区挑战的实践改变见解，以及(2)对专门针对街头医学的额外教育的兴趣。平均而言，居民认为该体验是有用的（平均值4.0，标准差[SD] 1.40）和有价值的（平均值4.4,SD 1.01），在体验后对PEH的照顾感到更舒适（平均值4.6,SD 0.73），并且对社区资源有更好的了解（平均值4.6,SD 0.73）。结论：我们证明了将街头医疗试点经验纳入新兴市场居民教育的可行性，并且，平均而言，居民认为这种经验是他们教育的宝贵和有用的补充。

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引用次数: 0

Simulation Resources in Emergency Medicine Residencies: A National Survey 急诊医学住院医师的模拟资源：一项全国性调查。

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2025-09-28 DOI: 10.1002/aet2.70098

Max Berger, Arlene S. Chung, Daniel J. Ackil, Ryan Clark, William E. Soares III, Jaime Jordan

Objectives

The American Board of Emergency Medicine's new Certifying Exam features simulation-based assessment. The current resources available to prepare residents to pass this high-stakes exam are unknown. We sought to assess the current state of simulation resources and utilization in EM residency programs.

Methods

This was a cross-sectional survey study of residency or simulation leadership at ACGME-accredited EM programs. We developed an online survey consisting of multiple-choice items, which was piloted before use. We collected data from August to December 2024. We calculated descriptive statistics, used chi-squared testing for categorical data comparisons, and Kruskal–Wallis for ordinal variables. Univariate logistic regression was used to examine associations between EM residency and simulation resource factors with annual simulation training hours.

Results

We identified contact information for 287 programs, and 194 completed the survey (67.6%). Most EM Residency programs had a simulation center (94.8%, 184/194). Fewer programs had simulation fellowship-trained physician faculty (44.3%, 86/194) or a division of simulation (40.7%, 79/194). Approximately 83% (161/194) of respondents felt that accessing simulation resources was easy or very easy. The median number of hours residents were engaged in simulation training per year was 40 (IQR 25–59). Univariate logistic regression found no association between EM program demographics and the annual number of hours of simulation training. The presence of simulation-trained faculty was associated with increased hours of simulation (OR 1.82, 95% CI 1.1–3.0, p = 0.05).

Conclusions

While most participating EM residency programs have access to simulation resources, variability exists in resources and implementation across programs, which may lead to inequities in preparing trainees for the new ABEM Certifying Exam.

目的：美国急诊医学委员会新认证考试的特点是基于模拟的评估。目前还不知道有哪些资源可以帮助住院医生准备通过这项高风险的考试。我们试图评估EM住院医师计划中模拟资源和利用的现状。方法：这是一项关于acgme认证的EM项目住院医师或模拟领导的横断面调查研究。我们开发了一个包含多项选择题的在线调查，在使用前进行了试点。我们收集了2024年8月至12月的数据。我们计算描述性统计，使用卡方检验进行分类数据比较，使用Kruskal-Wallis检验进行有序变量比较。使用单变量逻辑回归来检验EM驻留和模拟资源因素与年度模拟培训时数之间的关系。结果：我们确定了287个项目的联系方式，其中194个（67.6%）完成了调查。大多数急诊住院医师项目都有一个模拟中心（94.8%,184/194）。较少的项目有模拟研究员培训的医师教师（44.3%,86/194）或模拟部门（40.7%,79/194）。大约83%（161/194）的受访者认为访问模拟资源很容易或非常容易。住院医师每年参与模拟培训的中位数小时数为40 （IQR 25-59）。单变量逻辑回归发现，EM计划人口统计数据与每年模拟培训小时数之间没有关联。接受过模拟训练的教员的存在与模拟时间的增加有关（OR 1.82, 95% CI 1.1-3.0, p = 0.05）。结论：虽然大多数参与的EM住院医师项目都可以访问模拟资源，但不同项目之间的资源和实施存在可变性，这可能导致学员在准备新的ABEM认证考试方面存在不平等。

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引用次数: 0

Pre- and Post-Pandemic Trends in Emergency Medicine Resident Attrition 大流行前和大流行后急诊医学住院医师流失的趋势。

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2025-09-28 DOI: 10.1002/aet2.70089

Andrew R. Ketterer, Anne V. Grossestreuer, Jason J. Lewis

Introduction

Completion of EM residency is essential for the growth of the specialty and the strength of each residency program. Understanding resident attrition is paramount for program leadership and recruitment. We aimed to determine if there was a change in EM resident attrition rates after the COVID-19 pandemic. We also sought to determine whether residency attrition rates correlated to attending attrition rates or EM residency application numbers.

Methods

This was a retrospective cross-sectional study of publicly available data from the ACGME Data Resource Book from 2013 to 2023, NRMP Results and Data from 2014 to 2024, and the Medicare Physician and Other Practitioners database. When comparing the proportions of attrition between residents and attendings by year, the attending rate from 2 years prior was used, as we hypothesized a lag between attending and resident attrition based on structural factors in residency application and employment. To test whether attrition rates followed a similar pattern over time, slopes between residents and attendings were compared by year using a linear regression. A similar method was used to compare yearly resident attrition rate to annual application rates.

Results

Between 2014 and 2021, there was a general decline in EM resident attrition, followed by an increase in attrition in 2021–22. This pattern mirrored attending attrition rates with a two-year delay. Attending and resident attrition persisted at a higher-than-baseline rate in 2021 and the 2022–23 academic years, respectively. Lower-than-baseline application rates by these students persisted in the 2022–23 academic year, as did higher-than-baseline resident attrition rates.

Discussion

We found a spike in EM resident attrition for the 2021–22 academic year after a period of decline, mirroring trends in EM attending attrition, and an inverse correlation between EM residency application and attrition rates after 2021–22. Further studies are needed to elucidate the underlying factors determining resident attrition, attending attrition, and EM residency application.

简介：完成EM住院医师培训对专业的发展和每个住院医师项目的实力至关重要。了解住院医生的流失对项目领导和招聘是至关重要的。我们的目的是确定COVID-19大流行后新兴市场居民流失率是否发生变化。我们还试图确定住院医师流失率是否与住院医师流失率或EM住院医师申请数量相关。方法：这是一项回顾性横断面研究，收集了2013年至2023年ACGME数据资源书、2014年至2024年NRMP结果和数据以及医疗保险医师和其他从业者数据库中的公开数据。当按年比较住院医师和主治医师之间的流失率时，我们使用了2年前的住院率，因为我们假设住院医师和住院医师之间的流失率存在滞后，这是基于住院医师申请和就业的结构性因素。为了测试流失率是否随着时间的推移遵循类似的模式，使用线性回归按年比较了住院医生和主治医生之间的斜率。一个类似的方法被用来比较年度居民流失率和年度申请率。结果：2014年至2021年间，新兴市场居民的流失率普遍下降，随后在2021年至2022年期间流失率上升。这种模式反映了两年后的流失率。在2021年和2022-23学年，参加和住院人员的流失率分别高于基线率。在2022-23学年，这些学生低于基线的申请率持续存在，居民流失率也高于基线。讨论：我们发现，在经历了一段时间的下降之后，新兴市场住院医师的流失率在2021-22学年出现了飙升，反映了新兴市场住院医师的流失率趋势，并且在2021-22学年之后，新兴市场住院医师申请与流失率之间呈负相关关系。需要进一步的研究来阐明决定住院人员流失、主治人员流失和EM住院申请的潜在因素。

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引用次数: 0