AEM Education and Training最新文献_第3页

The R.E.S.T. Initiative: A Pilot Program to Enhance Resident Performance by Taking Breaks On-Shift R.E.S.T.倡议：通过轮班休息来提高住院医生表现的试点项目。

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2025-12-02 DOI: 10.1002/aet2.70112

Michael J. Zdradzinski, Steven Lindsey, Rohit Anand, Sumeet Dixit, Tori Ehrhardt, Michelle D. Lall, Timothy P. Moran, Deanna M. Kaplan, James O'Shea

Objectives

This study was designed to assess the impact of a break-taking initiative for resident physicians to encourage nutrition and patient note writing during their shift in the emergency department (ED). The primary objective was to determine if the intervention improved hunger, fatigue, incomplete documentation in the medical record, and post-shift exit time.

Methods

We introduced an intervention titled the R.E.S.T. initiative, which consisted of encouraging residents to take a 15-min break during their shift to eat and write notes, providing food in the resident break room, and encouraging disposition-focused rounds with the attending physician approximately 1 h prior to the end of shift. An ecologic momentary assessment (EMA) tool was used to assess residents' hunger, fatigue, note burden, and participation in the intervention at three timepoints throughout their ED shift. Pre-intervention baseline data were collected as well. Mixed-effects models were used to assess changes pre- and post-intervention. A post-intervention survey collected feedback and opinions on the intervention from both faculty and residents.

Results

A total of 44 residents participated in the intervention. On-shift break frequency improved from 19% to 56% during the intervention (p < 0.001). Post-shift hunger and fatigue scores improved significantly during the intervention (OR 4.10, p < 0.001 and OR 2.53, p = 0.001, respectively), without a significant change in the number of new patients seen nor patients signed out to the oncoming team. All faculty and residents reported that there were no adverse effects on patients as a result of the intervention. Residents felt the breaks improved their efficiency and the quality of care they provided.

Conclusions

An intervention to encourage breaks for eating and charting, along with disposition-focused rounds near the end of shift, improved hunger and fatigue in emergency medicine residents without negatively impacting patient safety or perceived resident efficiency.

目的：本研究旨在评估住院医师在急诊科（ED）轮班期间鼓励营养和患者笔记书写的休息倡议的影响。主要目的是确定干预是否改善了饥饿感、疲劳、医疗记录不完整和下班后出院时间。方法：我们引入了一项名为R.E.S.T.倡议的干预措施，其中包括鼓励住院医生在轮班期间休息15分钟吃东西和写笔记，在住院医生休息室提供食物，并鼓励在轮班结束前约1小时与主治医生进行集中检查。生态瞬时评估（EMA）工具用于评估居民在ED轮班期间三个时间点的饥饿、疲劳、笔记负担和干预参与情况。还收集了干预前的基线数据。混合效应模型用于评估干预前后的变化。干预后的调查收集了教师和住院医生对干预的反馈和意见。结果：共有44名居民参与了干预。在干预期间，轮班中断频率从19%提高到56% (p p p分别= 0.001)，新就诊的患者数量和即将就诊的患者数量没有显著变化。所有的教师和住院医生都报告说，由于干预，没有对患者产生不良影响。居民们觉得这些休息提高了他们的效率和提供的护理质量。结论：鼓励休息进食和作图的干预措施，以及在轮班结束时进行以倾向为重点的轮岗，改善了急诊医学住院医生的饥饿和疲劳，而不会对患者安全或住院医生的效率产生负面影响。

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引用次数: 0

Enhancing Knowledge and Skills in Pediatric Neurologic Emergencies: A Simulation-Based Medical Education Program for Emergency Medicine Trainees India 提高儿童神经急症的知识和技能：印度急诊医学学员的模拟医学教育计划。

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2025-11-12 DOI: 10.1002/aet2.70097

Rea Mittal, Serkan Toy, Susan Owens, Manu Madhok, Katherine Douglass, Tania Ahluwalia

Background

India has one of the largest pediatric populations globally, with one in five children affected by a neurological condition. However, access to specialized pediatric neurology care is limited due to a shortage of trained pediatric neurologists. Most pediatric neurology cases are managed by emergency medicine (EM) physicians, adult neurologists, or pediatricians. Strengthening EM physicians' ability to recognize and manage these conditions is critical. Simulation-based medical education (SBME) offers an effective avenue to enhance knowledge, procedural skills, and self-efficacy.

Methods

The Ronald Reagan Institute of Emergency Medicine at George Washington University has partner programs across India to deliver postgraduate EM training programs. In October 2024, a 2-week, in-person pediatric neurology SBME training was conducted across eight partner sites. Faculty included three visiting specialists in pediatric EM and EM, one pediatric neurology resident, and local EM faculty. Training included a didactic session on pediatric neurological emergencies, a procedural workshop, and simulation cases in pediatric neurology emergencies. The structured procedural workshops used pre-existing checklists to achieve mastery learning in pediatric skills: Intravenous access, intraosseous access, bag-valve-mask ventilation, intubation, and lumbar puncture. Trainees completed three pediatric neurology simulation clinical cases, including procedural skills. Pre- and posttests, including a 3-month follow-up knowledge test and survey, were used to evaluate the effectiveness of the educational intervention.

Results

A total of 106 EM trainees from eight sites across India participated in the study with matched pre- and postintervention data. Statistically significant improvements were observed across all domains: Medical knowledge, self-efficacy in procedural skills, and managing pediatric neurologic emergencies.

Conclusions

The findings of this study suggest that SBME can enhance EM trainees' self-efficacy, knowledge, and procedural skills in managing pediatric neurological emergencies. The training model is scalable, adaptable, and effective in resource-variable environments.

背景：印度是全球儿科人口最多的国家之一，每五个儿童中就有一个患有神经系统疾病。然而，由于缺乏训练有素的儿科神经科医生，获得专门的儿科神经病学护理是有限的。大多数儿童神经病学病例是由急诊医学（EM）医生、成人神经科医生或儿科医生管理的。加强急诊医生识别和管理这些疾病的能力至关重要。基于模拟的医学教育（SBME）为提高知识、程序技能和自我效能提供了有效途径。方法：乔治华盛顿大学罗纳德·里根急诊医学研究所在印度各地有合作项目，提供研究生急诊培训项目。2024年10月，在八个合作伙伴地点进行了为期两周的儿科神经病学SBME现场培训。教师包括三名儿科EM和EM的访问专家，一名儿科神经内科住院医师和当地EM教师。培训包括儿科神经急症的教学会议、程序研讨会和儿科神经急症的模拟案例。结构化的程序研讨会使用预先存在的检查表来掌握儿科技能的学习：静脉注射、骨内注射、气囊-瓣膜-面罩通气、插管和腰椎穿刺。学员完成三个小儿神经病学模拟临床案例，包括程序技能。采用前后测试，包括3个月的随访知识测试和问卷调查，评估教育干预的有效性。结果：来自印度8个地点的106名EM学员参与了这项研究，并提供了相匹配的干预前后数据。在所有领域都观察到统计学上显著的改善：医学知识、程序性技能的自我效能和处理儿科神经急症。结论：本研究结果提示，中小企业培训可提高急诊学员的自我效能感、知识和处理儿科神经急症的程序技能。该培训模型在资源可变的环境中具有可扩展性、适应性和有效性。

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引用次数: 0

Top 10 Medical Education Articles of 2024 2024年医学教育类文章十佳。

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2025-11-12 DOI: 10.1002/aet2.70108

Ivan Zvonar, Neelou Tabatabai, Michael Gottlieb, Jaime Jordan, Susan B. Promes, Esther H. Chen

引用次数: 0

Harnessing Emotions to Enhance Feedback in the Emergency Department 利用情绪来增强急诊科的反馈。

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2025-11-12 DOI: 10.1002/aet2.70102

Alessandra Karam, Morgan O'Neill, Katie Lorenz, Linda Regan, Jeremy Branzetti, Michael Gisondi, Laura R. Hopson

Feedback in graduate medical education is often felt to be inadequate, particularly in the Emergency Department where limited time and continuity hinder meaningful reflections. We introduced an emotion-linked debriefing model at three emergency medicine residencies, using structured prompts to explore both positive and negative emotions experienced during shifts. This approach encouraged richer feedback conversations, deeper trainee engagement, and generation of specific, actionable learning goals. Emotion-linked debriefing offers a practical strategy to enhance real-time feedback and warrants further evaluation of its educational impact.

研究生医学教育中的反馈常常被认为是不充分的，特别是在急诊科，有限的时间和连续性阻碍了有意义的思考。我们在三个急诊医学住院医师中引入了一个与情绪相关的汇报模型，使用结构化的提示来探索轮班期间经历的积极和消极情绪。这种方法鼓励更丰富的反馈对话，更深入的学员参与，并产生具体的，可操作的学习目标。与情感相关的汇报提供了一种切实可行的策略，以加强实时反馈，并有必要进一步评估其教育影响。

引用次数: 0

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。

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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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