AEM Education and Training最新文献

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In Reply to “EM Download: Giving Feedback in the Emergency Department” 回复“电子邮件下载：在急诊科提供意见”。

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2026-01-28 DOI: 10.1002/aet2.70120

Nicholas Maxwell

引用次数: 0

In the Liminal 在阈限。

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2026-01-28 DOI: 10.1002/aet2.70126

Zhaohui Su

引用次数: 0

Simulation-Based Mastery Learning Improves Emergency Medicine Residents' Ability to Perform Emergency Cricothyrotomy 基于模拟的熟练学习提高急诊医学住院医师急诊环甲环切开术的能力。

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2026-01-28 DOI: 10.1002/aet2.70124

Dana E. Loke, Andrew M. Rogers, David H. Salzman

Background

Emergency cricothyrotomy (EC) is a critical procedure for Emergency Medicine (EM) physicians to master. Simulation-based mastery learning (SBML), a form of competency-based education with deliberate practice, has been shown to prepare residents to perform numerous procedures. The objectives of this study were to create a SBML curriculum to teach EM residents EC, to compare pre- and post-training scores for EM residents performing EC, and to assess retention of mastery at 5 months.

Methods

EM residents completed baseline testing, training, post-testing, and retention testing using a commercially available task trainer and completed a post-curriculum satisfaction survey. An expert panel of EM physicians and trauma surgeons reviewed a previously developed 27-item checklist and set a minimum passing standard (MPS) using a Mastery Angoff approach. “Mastery” was defined as a checklist score meeting or exceeding the MPS.

Results

The MPS was set at 26 correctly performed items (96.3%). A cohort of 56 EM residents completed the curriculum. No resident achieved mastery on baseline testing; 33 residents (59.0%) achieved mastery on initial post-testing. Checklist scores significantly improved from baseline to post-testing. All residents that did not initially achieve mastery successfully did after an additional 30-Min of deliberate practice. At 5 months, 40 residents retained mastery (71.4%). Retention performance of various checklist items decayed more than others. Retention performance did not significantly vary based on PGY level or if additional practice was required to achieve mastery. Post-curriculum survey data showed high resident satisfaction and significantly higher confidence in performing emergency cricothyrotomy.

Conclusion

A SBML curriculum improved EM residents' ability to perform EC in a simulated environment. Baseline testing highlighted the gap that traditional training approaches have in teaching this critical skill to a mastery standard. Retention results can inform a timeline for additional deliberate practice to ensure continual mastery.

背景：急诊环甲切开术是急诊医师必须掌握的一门重要手术。以模拟为基础的精通学习（SBML），是一种以能力为基础的教育形式，有针对性的练习，已被证明可以让住院医生准备好执行许多程序。本研究的目的是创建一个SBML课程来教授EM居民EC，比较EM居民执行EC的培训前和培训后的分数，并评估5个月时的掌握情况。方法：EM居民使用市售任务培训师完成基线测试、培训、后测试和保留率测试，并完成课程后满意度调查。由急诊医师和创伤外科医生组成的专家小组审查了先前开发的27项检查清单，并使用Mastery Angoff方法设定了最低通过标准（MPS）。“精通”被定义为检查表得分达到或超过MPS。结果：MPS有26项正确执行，占96.3%。56名新兴市场居民完成了课程。没有住院医师掌握基线测试；33名住院医师（59.0%）掌握了初步后测。检查表得分从基线到测试后显著提高。所有最初没有成功掌握的住院医生都是在额外的30分钟刻意练习后成功掌握的。在5个月时，有40名住院医生仍然掌握（71.4%）。不同项目的保留性能下降幅度较大。在PGY水平的基础上，或者需要额外的练习来达到精通的情况下，记忆力的表现并没有显著的变化。课程后调查数据显示住院医师对急诊环甲环切开术有较高的满意度和信心。结论：SBML课程提高了EM居民在模拟环境中执行EC的能力。基线测试突出了传统培训方法在将这一关键技能教授到掌握标准方面的差距。记忆结果可以为额外的刻意练习提供时间表，以确保持续掌握。

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引用次数: 0

Preparing Physicians to Lead: A Survey of Pediatric Emergency Medicine Fellows and Program Directors on Operations, Administration, and Leadership Education 准备医生领导：儿科急诊医学研究员和项目主任在操作，管理和领导教育的调查。

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2025-12-22 DOI: 10.1002/aet2.70121

Katherine Ryan, Cindy Ganis Roskind, Nazreen Jamal

Background

Operations, administrative, and leadership (OAL) skills are critical for emergency physicians who lead multidisciplinary teams and manage operational tasks daily. Although the ACGME requirements outline key administrative competencies, many pediatric emergency medicine (PEM) fellows do not achieve proficiency, and no standardized curriculum exists.

Objectives

Our primary aim is to describe existing practices for teaching OAL topics in PEM fellowships. Our secondary aim is to identify content areas for future curricula.

Methods

We conducted a cross-sectional survey targeting PEM fellowship program directors (PDs) and fellows. Using the American Academy of Pediatrics Section on Emergency Medicine's PEM PD listserv, we identified 77 programs, including 400 second- and third-year fellows and 400 recent graduates. Surveys assessed the presence of operations curricula and perceived readiness for post-graduation OAL responsibilities. Data were analyzed using descriptive statistics.

Results

Respondents included 42/77 PDs (55%) and 75/336 fellows (22%). Most PDs (34/42, 81%) and fellows (48/75, 64%) reported no operations curricula. Among PDs without curricula, 22/34 (65%) expressed interest in adopting one, and 30/31 (97%) of current fellows without curricula were interested in participation. The primary barrier to implementation was lack of time (8/12, 67%). PDs reported limited fellow exposure to faculty engagement/development (30/39, 77%), staffing models (28/39, 72%), finance and billing (24/39, 62%), and patient throughput (24/39, 62%). Fellows also reported low confidence in these areas. PDs (24/39, 62%) and fellows (39/70, 56%) identified healthcare disparities as the most important topic for future curricula.

Conclusion

This study highlights significant variability in the presence and content of operations curricula within PEM fellowship programs. Although some programs provide formal training, many fellows report a lack of confidence in OAL skills, underscoring the need for a standardized curriculum to ensure fellows are prepared for post-graduate OAL roles. While focused on PEM, these findings reflect broader opportunities to strengthen OAL education across graduate medical training.

背景：操作、管理和领导（OAL）技能对于领导多学科团队和管理日常操作任务的急诊医生至关重要。尽管ACGME的要求概述了关键的管理能力，但许多儿科急诊医学（PEM）研究员并没有达到熟练程度，也没有标准化的课程。目的：我们的主要目的是描述在PEM奖学金中教授OAL主题的现有实践。我们的第二个目标是确定未来课程的内容领域。方法：我们针对PEM奖学金项目主任（pd）和研究员进行了横断面调查。利用美国儿科学会急诊医学PEM - PD列表服务，我们确定了77个项目，包括400名二年级和三年级的研究员和400名刚毕业的学生。调查评估了业务课程的存在和对毕业后OAL责任的感知准备。数据分析采用描述性统计。结果：受访者包括42/77名pd（55%）和75/336名研究员（22%）。大多数博士（34/ 42,81%）和研究员（48/ 75,64%）报告没有操作课程。在没有课程的博士中，有22/34（65%）表示有兴趣采用一种课程，30/31（97%）的目前没有课程的研究员有兴趣参与。实施的主要障碍是缺乏时间（8/12,67%）。博士们报告说，同事对教师参与/发展（30/ 39,77%）、人员配置模式（28/ 39,72%）、财务和账单（24/ 39,62%）以及患者吞吐量（24/ 39,62%）的接触有限。研究人员还报告说，他们对这些领域的信心很低。博士（24/39,62%）和研究员（39/70,56%）认为医疗保健差距是未来课程中最重要的主题。结论：本研究强调了PEM奖学金项目中操作课程的存在和内容的显著差异。虽然有些项目提供正式的培训，但许多研究员报告说，他们对OAL技能缺乏信心，这强调了需要一个标准化的课程，以确保研究员为研究生的OAL角色做好准备。虽然这些发现侧重于PEM，但也反映了在研究生医学培训中加强OAL教育的更广泛机会。

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引用次数: 0

The Unique Impacts of Implicit Bias on Emergency Medicine 内隐偏见对急诊医学的独特影响

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2025-12-22 DOI: 10.1002/aet2.70118

Amber Cibrario, Rahul Bhat, Bruce M. Lo, Laura Oh, Deborah Diercks, Sarah Greenberger, Joshua Davis, David Carlberg, Christopher Sampson, Elaine Josephson

Implicit bias refers to unconscious attitudes and associations an individual holds about others, which can impact behavior and decisions. In the emergency department (ED)—a setting characterized by unpredictable patient volumes, overcrowding, high acuity, and significant stress—physicians often face increased cognitive demands, which may heighten susceptibility to implicit bias. This can adversely impact emergency medicine (EM) patient care and outcomes, as well as the well-being of frontline healthcare providers. In this paper, we outline how specific biases can affect both patient care and physician practice. Recognizing that the ED presents unique challenges, we propose targeted solutions to address bias at the individual, institutional, and specialty levels with the ultimate aim of improving the patient care experience and promoting equity in the EM workforce.

内隐偏见是指一个人对他人持有的无意识的态度和联想，它会影响行为和决策。在急诊科（ED）——一个以不可预测的病人数量、过度拥挤、高敏锐度和巨大压力为特征的环境中，医生经常面临着增加的认知需求，这可能会增加对内隐偏见的敏感性。这可能会对急诊医学（EM）患者护理和结果以及一线医疗保健提供者的福祉产生不利影响。在本文中，我们概述了具体的偏见如何影响患者护理和医生实践。认识到急诊科面临着独特的挑战，我们提出了有针对性的解决方案，以解决个人、机构和专业层面的偏见，最终目标是改善患者护理体验，促进急诊科员工的公平。

引用次数: 0

Establishing Minimum Patient Volume Requirements for Emergency Medicine Residencies 建立急诊医学住院医师的最低病人数量要求。

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2025-12-22 DOI: 10.1002/aet2.70122

Tiffany Murano, Douglas McGee, Felicia Davis, David Caro, Linda Regan

Background

The current ACGME EM program requirements (PR) use an annual minimum patient volume of 30,000 at the primary clinical site as a proxy to ensure sufficient clinical exposure for residents. As a part of the major revisions, the PR writing group proposes a modification of this requirement to define a minimum number of patient visits/resident during training using aggregate volumes from all EM rotation sites. Establishing this threshold intends to ensure that individual resident minimum encounter goals can be achieved by the end of residency through verification of adequate resources in the form of patient visits.

Methods

Using minimum values, it was determined that the current patient visits/resident is 3000. We used ACGME program information to calculate the aggregate ED patients/resident for each program by multiplying the weekly ED volume at each site by the number of weeks spent in EM rotations then dividing by the approved complement.

Results

Of the 282 programs (223 3-year and 59 4-year programs), 72.7% (205/282) had less than 5000, 51% (144/282) had under 4000, and 24.1% (68/282) had less than 3000 patient visits/resident (mean 4507.8, median 4219.5). Almost 25% of 4-year programs (14/59) were below 3000. With adjusted calculations to 3-year programs to account for an additional 31 weeks of EM as they transition to the proposed 4-year format, 28.2% (63/223) of programs fell below 5000, 9.4% (21/223) below 4000, and 0.9% (2/223) below 3000 patient visits/resident.

Conclusions

The PRWG determined that 3000 patient visits/resident aggregated across all sites during training should be the minimum resource as this is what most programs are currently providing, and it's consistent with the current PR. Although the ACGME isn't currently tracking patient encounters, the proposed PR will likely support the foundation of patient experiences geared towards an ideal target of 5000 patient encounters/resident.

背景：当前的ACGME EM项目要求（PR）使用主要临床站点的年最低患者量为30,000作为代理，以确保住院医生有足够的临床暴露。作为主要修订的一部分，PR编写小组提出了对这一要求的修改，以使用所有EM轮转站点的总容量来定义培训期间患者就诊/住院的最低次数。建立这一阈值是为了确保每位住院医生在住院结束时，能够通过以患者就诊的形式验证足够的资源来实现最低偶遇目标。方法：采用最小值，确定当前就诊人次/住院人数为3000人次。我们使用ACGME项目信息来计算每个项目的急诊科患者/住院医师总数，方法是将每个地点的每周急诊科数量乘以急诊轮转的周数，然后除以批准的补体。结果：282个项目（223个3年项目和59个4年项目）中，72.7%（205/282）少于5000人次，51%（144/282）少于4000人次，24.1%（68/282）少于3000人次（平均4507.8次，中位数4219.5次）。近25%的四年制课程（14/59）低于3000分。随着3年计划的调整计算，将额外31周的EM转换为拟议的4年格式，28.2%（63/223）的计划低于5000次，9.4%（21/223）低于4000次，0.9%（2/223）低于3000次。结论：PRWG确定，在培训期间，所有站点的3000次患者就诊/住院人数应该是最小的资源，因为这是大多数项目目前提供的，这与当前的PR一致。尽管ACGME目前没有跟踪患者就诊情况，但拟议的PR可能会支持患者就诊/住院人数达到5000人的理想目标。

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引用次数: 0

Training of Emergency Medicine Residents to Initiate Extracorporeal Membrane Oxygenation Cardiopulmonary Resuscitation (ECPR) 急诊住院医师进行体外膜氧合心肺复苏（ECPR）的培训。

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2025-12-17 DOI: 10.1002/aet2.70116

Arianna R. Moreno, R. Madelaine Paredes, Allyson Araña Mireles, Jae-Hyek Choi, Heang Sundermann, Kaysie Sachs, Dylan Rodriguez, Joseph K. Maddry

Background

The objective of our study was to evaluate the ability of Emergency Medicine (EM) physicians who have completed an accelerated extracorporeal membrane oxygenation (ECMO) course and mannequin training to initiate extracorporeal cardiopulmonary resuscitation (ECPR) in a swine model.

Methods

Twenty teams of two EM residents each were provided with 2 h of training on how to initiate ECPR using prerecorded instructional videos and hands-on training using an ECMO circuit, ECMO cannulas, and a task trainer model of a human pelvis. Following training, EM residents attempted to cannulate and initiate ECMO on anesthetized swine receiving cardiopulmonary resuscitation (CPR) after an electrically induced sudden cardiac arrest (SCA). The ability of and duration of time required for the two-resident teams to initiate veno-arterial ECMO on the swine was recorded. A knowledge assessment and survey were performed before and after course completion.

Results

Forty EM residents participated in this study, for a total of 20 teams. Seventy-five percent (15/20) of the teams successfully initiated ECMO. The average time to successful initiation of ECMO was 22 min and 10 s (95% CI 17:25–26:54). Participants' knowledge assessment scores improved by 21.1%, from a mean of 46.8%–67.9% correct after study completion (95% CI 13.3%–28.8%). Confidence in competency improved across all survey categories. The most frequent reason for unsuccessful ECPR was the inability to obtain appropriate vascular access.

Conclusions

An abbreviated two-hour ECPR training course for EM residents resulted in a 75% success rate of ECPR initiation on a swine SCA model. Training of EM physicians in ECPR may expand the number of hospitals capable of providing this therapy. Advanced engineering solutions or increased experience with ultrasound-guided vascular access during CPR may improve ECMO cannulation success rates.

背景：我们研究的目的是评估急诊医学（EM）医生在完成加速体外膜氧合（ECMO）课程和假人训练后在猪模型中启动体外心肺复苏（ECPR）的能力。方法：20个小组（每组2名急诊住院医师）接受了2小时的培训，学习如何使用预先录制的教学视频启动ECPR，并使用ECMO电路、ECMO套管和人类骨盆任务训练器模型进行实践培训。在培训之后，急诊住院医师尝试对电致心脏骤停（SCA）后接受心肺复苏（CPR）的麻醉猪进行插管和ECMO。记录了两个驻地小组对猪进行静脉-动脉ECMO的能力和所需的时间。课程完成前后分别进行知识评估和调查。结果：共有40名EM住院医师参与了本研究，共20个小组。75%（15/20）的团队成功启动ECMO。成功启动ECMO的平均时间为22分钟10秒（95% CI 17:25-26:54）。研究完成后，参与者的知识评估得分从平均46.8%-67.9%的正确率提高了21.1% （95% CI 13.3%-28.8%）。在所有调查类别中，对能力的信心都有所提高。ECPR失败最常见的原因是无法获得适当的血管通路。结论：在猪SCA模型上，对EM居民进行简短的两小时ECPR培训课程导致75%的ECPR启动成功率。对急诊医生进行ECPR培训可能会增加有能力提供这种治疗的医院的数量。先进的工程解决方案或在心肺复苏术中超声引导血管通路的经验增加可能会提高ECMO插管的成功率。

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引用次数: 0

The Difficult-to-Say ER Patient 难以启齿的急诊病人。

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2025-12-17 DOI: 10.1002/aet2.70119

Zhaohui Su

引用次数: 0

AI Is Not a Four-Letter Word: Moving From Resistance to Responsible Integration in Emergency Medicine Education 人工智能不是四个字母的单词：从抵抗到负责任的急诊医学教育整合

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2025-12-09 DOI: 10.1002/aet2.70114

Steven McGaughey, Jordan Wackett, Elizabeth Silbermann

引用次数: 0

Adapting Palliative and End-of-Life Care Training for Emergency Physicians in Japan: A Modified Grounded Theory Study 日本急诊医生适应姑息治疗和临终关怀培训：一项修正的扎根理论研究

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2025-12-09 DOI: 10.1002/aet2.70113

Kenji Numata, Masaya Higuchi, Yasuhiko Hirose, Anita Chary, Tadayuki Hashimoto, Daisuke Kato, Shan W. Liu, Tammie E. Quest, Joshua Hauser, Kirsten G. Engel, Kei Ouchi

Background

In Japan, the aging population has led to an increase in seriously ill patients requiring emergency care. Although palliative care training opportunities are limited in Japan, established programs exist in the United States (U.S.). To inform future adaptation of such programs for use in Japan, this study aims to identify barriers that emergency physicians (EPs) in Japan encounter when providing palliative care.

Methods

This qualitative study explored the end-of-life care decision-making processes of EPs in Japan. Semi-structured interviews were conducted with board-certified EPs using snowball sampling. Data were analyzed using a modified grounded theory approach, which was chosen for its ability to capture culturally nuanced decision-making, emphasizing reflection, theoretical clarity, and practical applicability. Iterative coding was conducted to inductively generate concepts and develop a conceptual framework describing EPs' decision-making processes. Data collection continued until theoretical saturation was achieved. Data were collected through online interviews conducted between January and August 2024.

Results

Thirteen board-certified EPs in Japan completed interviews. Most participants were male (76.9%) and most were 11–15 years after medical school graduation (n = 7). Analysis identified 16 concepts illustrating a three-phase decision-making process: (1) deciding to accept the transfer of end-of-life patients, (2) building trust with patients and families and conducting an assessment, and (3) determining the treatment plan. Common challenges included struggles with stalled interactions amid family distress and the dilemma of making decisions in the setting of clinical uncertainty, reflecting the emotional and ethical complexity of providing end-of-life care in time-pressured emergency settings.

Conclusions

This study highlights the challenges EPs in Japan face when making urgent decisions with limited time and information while building trust with patients and families. These findings clarify the current barriers to integrating palliative and end-of-life care in emergency settings and provide a foundation for developing culturally adapted educational programs.

在日本，人口老龄化导致需要紧急护理的重病患者增加。虽然日本的姑息治疗培训机会有限，但美国已经建立了相关项目。为了为将来在日本使用此类方案提供信息，本研究旨在确定日本急诊医生（EPs）在提供姑息治疗时遇到的障碍。方法采用定性研究方法，探讨日本临终关怀患者的临终关怀决策过程。采用滚雪球抽样方法对董事会认证的董事进行了半结构化访谈。数据分析使用改进的扎根理论方法，选择该方法是因为它能够捕捉文化上细微差别的决策，强调反思、理论清晰度和实际适用性。通过迭代编码来归纳概念，并建立描述EPs决策过程的概念框架。数据收集继续进行，直到达到理论饱和。数据是在2024年1月至8月期间通过在线访谈收集的。结果13名日本董事会认证的EPs完成了访谈。大多数参与者为男性（76.9%），大多数为医学院毕业后11-15岁（n = 7）。分析确定了16个概念，说明了一个三阶段的决策过程：(1)决定接受临终病人的转移；(2)与病人和家属建立信任并进行评估；(3)确定治疗计划。常见的挑战包括在家庭痛苦中与中断的互动的斗争，以及在临床不确定的情况下做出决定的困境，反映了在时间紧迫的紧急情况下提供临终关怀的情感和道德复杂性。本研究突出了日本的EPs在与患者和家属建立信任的同时，在有限的时间和信息下做出紧急决策时所面临的挑战。这些发现澄清了目前在紧急情况下整合姑息治疗和临终关怀的障碍，并为发展适应文化的教育计划提供了基础。

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