AEM Education and Training最新文献_第5页

Decoding competitiveness: Exploring how emergency medicine faculty interpret standardized letters of evaluation 解码竞争力：探索急诊医学系教师如何解读标准化评价信

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-08-23 DOI: 10.1002/aet2.11019

Caitlin Schrepel MD, Morgan Sehdev MD, Nicole M. Dubosh MD, Benjamin H. Schnapp MD, MEd, Al’ai Alvarez MD, Alexis Pelletier-Bui MD, Cullen Hegarty MD, Sharon Bord MD, Eric Shappell MD, MHPE

Background

Given the importance of the standardized letter of evaluation (SLOE) for application to emergency medicine (EM) residency, it is important that SLOE developers and authors understand how reviewers determine SLOE competitiveness. To inform SLOE design and authorship, the authors set out to build a novel theory to explain how faculty holistically interpret SLOE competitiveness.

Methods

The authors used constructivist grounded theory to explore how EM faculty determine SLOE competitiveness. They used purposive sampling to recruit EM faculty participants with at least 1 year of experience in scoring SLOEs. One author conducted hour-long, semistructured interviews over Zoom between August 2023 and March 2024. Two authors iteratively coded the data to develop the initial codebook, organize codes into categories, and build connections to construct the resulting theory.

Results

The authors interviewed 11 EM faculty from throughout the United States. Participants described a complex process to determine SLOE competitiveness. They began by contextualizing the SLOE to determine its trustworthiness and value before using various components of the SLOE to stratify and refine their understanding of competitiveness. Finally, when participants noted the inconsistency between different aspects of the SLOE, they used various methods to reconcile discordances and determine competitiveness.

Conclusions

This study illuminates the framework used by EM faculty to determine applicant competitiveness based on the SLOE and highlights several factors that SLOE authors should consider to ensure the accurate and efficient transfer of information.

背景鉴于标准化评价书（SLOE）对申请急诊医学（EM）住院实习的重要性，SLOE 的开发者和作者必须了解评审者如何确定 SLOE 的竞争力。为了给 SLOE 的设计和作者提供信息，作者们着手建立一种新的理论来解释教师们是如何从整体上解释 SLOE 竞争力的。方法作者采用建构主义基础理论来探讨少管专业教师如何确定 SLOE 的竞争力。他们采用目的取样法，招募了至少有一年SLOE评分经验的电磁学教师参加。一位作者在2023年8月至2024年3月期间通过Zoom进行了长达一小时的半结构化访谈。两位作者对数据进行了反复编码，以编制初始编码手册，将编码组织成类别，并建立联系以构建由此产生的理论。结果作者采访了 11 位来自美国各地的电磁学教师。参与者描述了确定 SLOE 竞争力的复杂过程。他们首先对 SLOE 进行了背景分析，以确定其可信度和价值，然后使用 SLOE 的各个组成部分对其竞争力进行分层和细化。最后，当参与者注意到 SLOE 不同方面之间的不一致时，他们会使用各种方法来协调不一致之处并确定竞争力。结论本研究揭示了少數族裔教师根据 SLOE 确定申请人竞争力的框架，并强调了 SLOE 作者应考虑的几个因素，以确保准确、高效地传递信息。

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引用次数: 0

Nurse perspectives on the assessment of emergency medicine residents: A qualitative study 护士对急诊科住院医生评估的看法：定性研究

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-08-19 DOI: 10.1002/aet2.11016

Jake Valentine MD, MEd, Julianna Jung MD, MEd

Background

Multisource and 360-degree feedback are emerging methods in the medical education assessment literature. Nursing feedback in particular has been identified as a point of emphasis regarding what medical education leadership would most value for incorporating into their evaluations. There is no currently accepted tool for multisource feedback in the emergency department (ED). To answer this call, we conducted a qualitative study to elucidate nurse perspectives on evaluation of emergency medicine residents.

Methods

We conducted individual semistructured interviews of ED nurses with experience working alongside residents via volunteer recruitment. Transcripts were coded independently by each author and then reviewed collaboratively to resolve differences. Codes were created by inductive thematic analysis and subsequently underwent constant comparison and classical content analysis. Recruitment continued until analysis of transcripts showed thematic saturation.

Results

We organized the interview transcript into chunks of information, arranging 407 quotes from the 10 interview transcripts into 17 codes and six themes regarding observable resident behaviors. Representative quotes and exemplar cases added detailed description to the meaning of these codes. The identified themes for observable resident behaviors included “general communication style,” “medical knowledge,” “efficiency,” “patient communication,” “nurse communication,” and “professionalism.” An additional 13 codes addressed the themes of barriers and catalysts for feedback.

Conclusions

The identified themes on observable resident behaviors aligned well with prior literature and with the Accreditation Council for Graduate Medical Education (ACGME) Milestones. The interviews also highlighted nurse perspectives on barriers and catalysts for feedback that would be useful to incorporate into the design of an assessment tool.

背景多源反馈和 360 度反馈是医学教育评估文献中的新兴方法。护理人员的反馈意见尤其被认为是医学教育领导层在评估中最看重的一点。目前，急诊科（ED）还没有公认的多源反馈工具。为了响应这一号召，我们开展了一项定性研究，以阐明护士对急诊科住院医师评估的看法。方法我们通过志愿者招募，对有与住院医师共事经验的急诊科护士进行了个人半结构式访谈。访谈记录由每位作者独立编码，然后共同审阅以解决分歧。通过归纳主题分析创建代码，然后进行不断比较和经典内容分析。招募工作一直持续到对记录誊本的分析显示主题饱和为止。结果我们将访谈记录整理成信息块，将 10 份访谈记录中的 407 句引语归纳为 17 个代码和 6 个主题，这些代码和主题都与可观察到的住院医师行为有关。具有代表性的引语和示例案例对这些代码的含义进行了详细描述。已确定的住院医师可观察行为主题包括 "一般沟通风格"、"医学知识"、"效率"、"患者沟通"、"护士沟通 "和 "专业精神"。另有 13 个代码涉及反馈的障碍和催化剂主题。结论所确定的关于住院医师可观察行为的主题与之前的文献和毕业后医学教育认证委员会（ACGME）的里程碑非常吻合。访谈还强调了护士对反馈障碍和催化剂的看法，这些看法有助于将其纳入评估工具的设计中。

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引用次数: 0

Trends and predictors of unfilled emergency medicine residency positions: A comparative analysis of the 2023 and 2024 Match cycles 未填补急诊医学住院医师职位的趋势和预测因素：对 2023 年和 2024 年匹配周期的比较分析

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-08-11 DOI: 10.1002/aet2.11013

Carl Preiksaitis MD, MEd, Layla Abubshait MD, Kaitlin Bowers DO, Adaira Landry MD, MEd, Kristin Lewis MD, Andrew G. Little DO, Christopher J. Nash MD, EdM, Michael Gottlieb MD

Background

The emergency medicine (EM) landscape has evolved due to the increasing number of programs paired with fewer applicants. This study analyzed the characteristics of EM residency programs associated with unfilled positions during the 2024 Match and compared them with data from the 2023 Match to identify persistent and emerging trends influencing these outcomes.

Methods

In this cross-sectional, observational study, we investigated factors associated with unfilled EM residency positions in the 2024 Match. We used publicly accessible data from the National Resident Matching Program. To identify program-level predictors of unfilled positions, we constructed a Bayesian hierarchical logistic regression model, incorporating data from the 2023 Match season.

Results

In 2024, 54 out of 281 (19.2%) residency programs remained unfilled. Our Bayesian analysis reaffirmed that smaller program size, geographical location, prior osteopathic accreditation, and corporate ownership continue to be significant factors. Programs with vacancies in the previous year were also more likely to remain unfilled. Thus, several factors identified in 2023 remained associated with this year's Match outcomes, with the impact of previous unfilled positions being particularly pronounced.

Conclusions

This study identified several factors associated with a greater likelihood of having unfilled EM residency positions, with previous unfilled positions emerging as the most significant predictor. These findings offer critical insights for residency programs and governing bodies, providing a basis for enhancing recruitment strategies, addressing the cyclical nature of unfilled positions, and tackling workforce challenges in EM.

背景急诊医学（EM）的格局已经发生了变化，原因是越来越多的项目与越来越少的申请者配对。本研究分析了与 2024 年比赛中未填补职位相关的急诊科住院医师培训项目的特点，并将其与 2023 年比赛的数据进行比较，以确定影响这些结果的持续和新兴趋势。方法在这项横断面观察性研究中，我们调查了与 2024 年比赛中未填补的急诊科住院医师职位相关的因素。我们使用了国家住院医师配对计划的公开数据。为了确定未填补职位的项目级预测因素，我们建立了一个贝叶斯分层逻辑回归模型，并纳入了 2023 年比赛季的数据。结果 2024 年，281 个住院医师项目中有 54 个（19.2%）仍未完成。我们的贝叶斯分析再次证实，较小的项目规模、地理位置、之前的骨科认证和公司所有权仍然是重要因素。上一年出现空缺的项目也更有可能继续空缺。因此，2023 年发现的几个因素仍然与今年的 Match 结果有关，其中以前未填补职位的影响尤为明显。结论本研究发现了几个与更有可能出现未填补的急诊科住院医师职位相关的因素，其中以前未填补的职位是最重要的预测因素。这些发现为住院医师培训项目和管理机构提供了重要的启示，为加强招聘策略、解决职位空缺的周期性问题以及应对急诊科劳动力挑战提供了依据。

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引用次数: 0

Innovations report: A grading committee for a required fourth-year emergency medicine clerkship 创新报告：四年级急诊医学实习评分委员会。

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-07-22 DOI: 10.1002/aet2.11012

Meredith Thompson MD, Megan Rivera MD, Jeffrey Katz MD, Nicholas Maldonado MD, Caroline Srihari MD, Michael Marchick MD, Rosemarie Fernandez MD

Background

Assessment of medical students in the clinical learning environment is fraught with challenges. Seemingly small variations in clinical clerkship evaluation can significantly impact a student's future. As such, the integrity of the grade selection process must be heavily scrutinized. Group decision making in the form of a clerkship grading committee may be part of a solution to address this complex problem.

Methods

We conducted a retrospective observational study to describe grading committee decisions for a required fourth-year EM clerkship from August 2021 to April 2022. Literature on best practices for group decision making and assessment were reviewed. This informed the development and implementation of the committee process. Each committee meeting was video recorded and coded for discussion time per student, times the committee grade differed from historical-grade cutoffs with reasoning, and the frequency a committee member voiced a first-hand account of student performance.

Results

Data from nine meetings was reviewed (86 students). The mean discussion time per student was 2 min 13 s (range 11 s to 9 min 22 s). The final committee decision differed from historical-grade cutoffs for nine students (10%), six were adjusted above and three below. In 64% (55/86) of student reviews a committee member voiced a first-hand experience of working with the student. Positive grade adjustments were made due to outlier evaluations and negative adjustments were made for professionalism concerns.

Conclusions

Grading committees are a means to conduct a comprehensive review of student performance and offer shared ownership of the grade decision among committee members. More study is needed to directly determine their potential benefit and role in clerkship grading.

背景：在临床学习环境中对医学生进行评估充满了挑战。临床实习评价中看似微小的差异都会对学生的未来产生重大影响。因此，必须严格审查评分选择过程的完整性。以实习评分委员会为形式的集体决策可能是解决这一复杂问题的方法之一：我们进行了一项回顾性观察研究，以描述评分委员会在 2021 年 8 月至 2022 年 4 月期间对四年级急诊实习的决策。我们回顾了有关小组决策和评估最佳实践的文献。这为委员会流程的制定和实施提供了依据。每次委员会会议都进行了录像，并对每位学生的讨论时间、委员会评分与历史分数线不同的次数（说明理由）以及委员会成员对学生表现发表第一手意见的频率进行了编码：对九次会议（86 名学生）的数据进行了审查。每位学生的平均讨论时间为 2 分 13 秒（11 秒至 9 分 22 秒不等）。委员会的最终决定与 9 名学生（10%）的历史分数线不同，6 名学生的分数线高于历史分数线，3 名学生的分数线低于历史分数线。在 64%（55/86）的学生评语中，委员会成员都表达了与学生合作的第一手经验。积极的成绩调整是由于离群的评价，消极的调整则是出于专业性的考虑：评分委员会是对学生表现进行全面审查的一种手段，也是委员会成员共同决定成绩的一种方式。需要进行更多研究，以直接确定其在实习评分中的潜在益处和作用。

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引用次数: 0

Bereavement scheduling policy for emergency medicine residents: A descriptive pilot study 急诊科住院医生的丧亲调度政策：描述性试点研究

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-07-10 DOI: 10.1002/aet2.11009

Timothy D. Kelly MD, MPH, Bryce T. de Venecia MD, Peter S. Pang MD, Joseph S. Turner MD, Kyra D. Reed MD, Katie E. Pettit MD

Background

The Accreditation Council for Graduate Medical Education has tasked residency programs to prioritize resident wellness, reduce trainee stress, and prevent burnout. Grief and bereavement can significantly impact residents' wellness during difficult clinical training schedules. There are no best practices on how to support residents during this time.

Methods

In a split academic county emergency medicine (EM) residency, this pilot study documents a resident-driven change to scheduling practices for bereavement leave. An advisory group of residents, chief residents, and program directors informally polled peer institutions to develop bereavement leave guidelines. Considerations were made to balance resident wellness, education, and patient care in developing a bereavement scheduling policy.

Results

The bereavement policy was adopted in January 2023, aiming to “support the resident during a difficult time and reduce concerns around shift coverage” following the death of a family member without impacting sick call. The number of covered days depended on the relationship of the resident to the deceased. Residents covering bereavement days for their peers were financially compensated. During the first 7 months following implementation, five residents utilized the policy. These residents noted this to be the most positive impact on the residency during the past year. Based on resident feedback, the scope was expanded to include grave medical illness of a family member as an implementation criterion.

Conclusions

This article outlines the creation, implementation, and benefits of a bereavement scheduling policy within an EM residency. Describing this approach will provide guidance for other residencies to adopt similar wellness-focused strategies.

背景毕业医学教育认证委员会要求住院医师培训项目优先考虑住院医师的健康问题，减轻学员的压力，防止倦怠。在艰难的临床培训期间，悲伤和丧亲之痛会严重影响住院医师的健康。关于如何在此期间为住院医师提供支持，目前尚无最佳实践。方法在一个县级急诊医学（EM）住院医师培训机构中，本试点研究记录了由住院医师主导的丧假安排实践变革。一个由住院医师、住院总医师和项目主任组成的顾问小组非正式地调查了同行机构，以制定丧假指南。在制定丧假安排政策时，考虑到了平衡住院医师的健康、教育和患者护理。结果丧假政策于 2023 年 1 月通过，旨在家庭成员去世后，在不影响病假的情况下，"在困难时期为住院医师提供支持，并减少对轮班工作的担忧"。覆盖天数取决于住院医师与逝者的关系。为同伴代班的住院医师可获得经济补偿。在政策实施后的头 7 个月，有 5 名住院医师使用了这项政策。这些住院医师指出，这是过去一年中对住院医师产生的最积极的影响。根据住院医师的反馈意见，该政策的适用范围扩大到将家庭成员患重病作为一项执行标准。结论本文概述了急诊科住院医生丧亲调度政策的创建、实施和益处。对这一方法的描述将为其他住院医师培训机构采用类似的以健康为重点的策略提供指导。

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引用次数: 0

Appreciative education to improve teaching interactions in the emergency department 通过赏识教育改善急诊科的教学互动。

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-07-07 DOI: 10.1002/aet2.11010

Nicole E. Schnabel MD, Donna K. Okoli MD, Carrie A. Bailes MD, Mallory G. Davis MD, MPH, Mary R. C. Haas MD, MHPE

<p>Traditionally, bedside teaching in the emergency department (ED) begins with determining the learners’ current skill level and establishing on-shift goals.<span><sup>1-3</sup></span> Faculty commonly begin by asking, “What would you like to work on today?”<span><sup>3, 4</sup></span> This method aids in goal setting and initiating conversations with educators but takes a problem-solving approach and promotes identification of weaknesses.<span><sup>4</sup></span> This negatively frames the learning process and requires a high level of self-reflection and vulnerability. Additionally, high-achieving learners without significant deficits may benefit less.</p><p>Appreciative inquiry (AI) provides an alternative framework frequently described in business literature. This model focuses on strengths to achieve an individual's or organization's full potential.<span><sup>5</sup></span> AI delineates four phases of inquiry, including discovery (What is the best of what is?); dream (What might be?); design (How can it be?); and destination (What will be? How can we empower and enact?).<span><sup>6</sup></span></p><p>Appreciative education (AE) utilizes AI in an educational context to focus on a learner's strengths and potential to accomplish cocreated goals.<span><sup>7</sup></span> Practical tips for applying AE principles to interactions with learners are to identify a clear outcome focus for a situation and to leverage the learner's strengths to achieve the desired outcome.<span><sup>7</sup></span> Use of AE in clinical teaching may enhance targeted feedback, improve learner motivation, and create a more positive learning environment.</p><p>A cohort of faculty at our academic 4-year emergency medicine (EM) residency program reviewed an article on AE during a faculty development session and brainstormed how to apply it during subsequent ED shifts with EM trainees and medical students.<span><sup>5</sup></span> Thereafter, the cohort of faculty began each shift by identifying the learners’ outcomes, asking about their current strengths, and the characteristics of their ideal ED shift. Faculty and learners then collaboratively brainstormed concrete ways to achieve those outcomes. Throughout the shift faculty reflect with the learner on progress with their goals and problem solve barriers. The shift concludes with a reflection and debrief. Figure 1 depicts the technique. After a month of implementation, the faculty cohort met to discuss their experiences.</p><p>Experience utilizing AE in conjunction with informal feedback from learners has provided insight into the benefits and pitfalls of this teaching strategy. Witnessed benefits include improved learner motivation and self-esteem.<span><sup>7</sup></span> Learners self-reported having a positive reaction to the initial prompt encouraging reflection about strengths and they enjoyed envisioning an ideal shift. AE especially benefited high-achieving learners who felt challenged and motivated by the exercise

传统上，急诊科（ED）的床旁教学从确定学习者当前的技能水平和制定当班目标开始。1-3 教员通常会首先询问："你今天想学什么？"3, 4 这种方法有助于制定目标和启动与教育者的对话，但采取的是一种解决问题的方法，并提倡找出弱点。此外，成绩优秀但没有明显缺陷的学习者可能受益较少。"赏识式探究"（AI）提供了另一种框架，在商业文献中经常被提及。5 赏识式探究划分了四个探究阶段，包括发现（什么是现有事物中最好的？将赏识教育原则应用于与学习者的互动中的实用技巧是，为某一情境确定一个明确的成果重点，并利用学习者的优势来实现预期成果。在临床教学中使用AE可以增强针对性反馈，提高学习者的积极性，并创造一个更积极的学习环境。我们四年制急诊医学（EM）住院医师培训项目的教师团队在一次教师发展会议上回顾了一篇关于AE的文章，并集思广益，讨论了如何在随后的急诊科轮班中与急诊科学员和医学生一起应用AE。然后，教师和学员共同集思广益，找出实现这些成果的具体方法。在整个转变过程中，教师与学习者一起反思他们在实现目标方面的进展，并解决障碍问题。轮班结束时进行反思和汇报。图 1 描述了这一技巧。在实施一个月后，教师团队开会讨论了他们的经验。结合学习者的非正式反馈，使用 AE 的经验让我们深入了解了这种教学策略的益处和缺陷。7 学习者自我报告说，他们对最初鼓励反思优势的提示反应积极，并乐于设想理想的转变。AE 对成绩优秀的学习者尤其有益，他们在练习中感受到了挑战和动力。AE 的缺陷包括：教员有责任让学习者对自己的目标负责。ED 环境的不可预测性可能会使这一技术复杂化，因为我们无法控制使之成为 "理想 "班次的各个方面；然而，尽管存在共同的固有挑战（即登机、频繁中断、顾问互动具有挑战性），但远景规划和关注可修改因素的行为可以使双方感到有能力和有控制感。未来的步骤包括对这一技术进行正式的多机构研究。

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引用次数: 0

Impact of an automated patient outcome feedback system on emergency medicine resident patient follow-up: An interrupted time series analysis 病人结果自动反馈系统对急诊科住院医生病人随访的影响：间断时间序列分析。

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-07-04 DOI: 10.1002/aet2.11011

Frances Rudolf MD, Leslie C. Oyama MD, Robert El-Kareh MD, MPH

Objectives

Emergency medicine (EM) residents desire, but often lack, reliable feedback of patient outcomes following handoffs to other providers. This gap is a substantial barrier to calibrating their diagnostic decision making and learning. To address this educational priority, we developed and evaluated the Post-Handoff Reports of Outcomes (PHAROS) system—an automated system within our electronic health record (EHR) to deliver provider-specific patient outcome feedback.

Methods

PHAROS includes: (1) individualized lists of patients seen and brief summaries of each case, (2) flags for important posthandoff events, and (3) links to charts to facilitate review. Starting June 2020, we coupled PHAROS with a resident educational session and individualized emails every 2 weeks outlining patients seen, number of posthandoff events, and instructions on how to access the PHAROS system.

Results

From July 2017 through April 2022, we measured the proportion of handoffs followed by reaccessing patients’ charts between 2 and 14 days posthandoff—a proxy for following up on the patient's outcomes. We performed an interrupted time series analysis on this outcome to determine if PHAROS was associated with a significant change in the trend of our outcome over time. Our secondary outcome was the number of times PHAROS was viewed each month. Our primary outcome had a significant increase in the slope over time (+0.13%/month, p = 0.03) after the introduction of the personalized reports and a nonsignificant change (−1.6%, p = 0.07) at the time of the intervention. The median (IQR) number of views of PHAROS per month was 33.2 (23.75–38.75).

Conclusions

The PHAROS system was associated with a significant increase in the rate of posthandoff chart reaccess among EM residents over time. The PHAROS project demonstrated the feasibility of harnessing the capabilities of the EHR to create an automated system to support EM trainee feedback of patient outcomes—a key component of diagnostic calibration and learning.

目的：急诊医学（EM）住院医师希望在与其他医疗服务提供者交接后获得可靠的患者结果反馈，但往往缺乏这种反馈。这一缺陷严重阻碍了他们的诊断决策和学习。为了解决这一教育重点问题，我们开发并评估了交接后结果报告（PHAROS）系统--这是我们电子健康记录（EHR）中的一个自动化系统，用于提供特定于提供者的患者结果反馈：PHAROS 包括(方法：PHAROS 包括：（1）就诊患者的个性化列表和每个病例的简短摘要；（2）重要离职后事件的标记；以及（3）图表链接以方便查看。自 2020 年 6 月起，我们将 PHAROS 与住院医师教育课程和每两周一次的个性化电子邮件相结合，概述就诊患者、离职后事件数量以及如何访问 PHAROS 系统的说明：从 2017 年 7 月到 2022 年 4 月，我们测量了交接后 2 到 14 天内重新访问患者病历的交接比例，这代表了对患者治疗结果的跟进。我们对这一结果进行了间断时间序列分析，以确定 PHAROS 是否与我们的结果随时间推移的趋势发生显著变化有关。我们的次要结果是每月查看 PHAROS 的次数。在引入个性化报告后，我们的主要结果随时间推移的斜率有了明显增加（+0.13%/月，p = 0.03），而在干预期间则没有明显变化（-1.6%，p = 0.07）。PHAROS每月浏览次数的中位数（IQR）为33.2（23.75-38.75）：结论：随着时间的推移，PHAROS 系统显著提高了急诊科住院医师离职后重新访问病历的比率。PHAROS 项目证明了利用电子病历的功能创建自动化系统以支持急诊科学员对患者结果进行反馈的可行性--这是诊断校准和学习的关键组成部分。

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引用次数: 0

Gamification of emergency medicine cost awareness education 急诊医学成本意识教育游戏化

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-06-20 DOI: 10.1002/aet2.11008

Joseph Ray MD

Background

Despite rising costs of health care, physician awareness of costs remains poor. Educational initiatives to remedy this have shown promise, with gamification specifically having success, but actual improvements in physician estimation capabilities have yet to be evaluated.

Objectives

The objective of the study was to assess a gamified educational session for emergency medicine residents that improved their ability to estimate the costs of tests or services commonly performed in their department.

Methods

Participants completed an anonymous presession survey consisting of demographic data, self-analysis on cost awareness, and a 10-item cost estimation list. This was followed by a 1-h interactive gamified education session utilizing rules from the television show The Price is Right. During this session, only three of the survey items had their cost directly discussed such that the remaining seven were able to be assessed solely on estimation improvement instead of short-term knowledge retention. Participants then completed the same survey to assess for improvement in cost awareness.

Results

Sixteen residents at the PGY-2 or PGY-3 level completed the surveys and education session. All self-analysis questions showed significant improvement in the postsession survey. Eight out of the 10 items had significant differences in cost estimation.

Conclusions

A gamified teaching session using The Price is Right rules can improve a resident's estimation capabilities, even on items not directly taught during the session.

背景尽管医疗成本不断上涨，但医生对成本的认识仍然不足。为弥补这一不足而开展的教育活动已取得了一定成效，其中游戏化教育尤其成功，但医生估算能力的实际提高情况仍有待评估。研究目的该研究旨在评估针对急诊科住院医生的游戏化教育课程，以提高他们估算科室常见检查或服务成本的能力。方法参与者在课前完成一份匿名调查，调查内容包括人口统计学数据、成本意识自我分析以及一份包含 10 个项目的成本估算清单。随后，利用电视节目 "价格是对的"（The Price is Right）中的规则进行了 1 小时的游戏化互动教育。在这一环节中，只有三个调查项目直接讨论了其成本，因此其余七个调查项目的评估只针对估算的改进，而不是短期知识的保留。然后，参与者完成同样的调查，以评估成本意识的提高情况。结果 16 名 PGY-2 或 PGY-3 级别的住院医师完成了调查和教育课程。在课后调查中，所有自我分析问题都有明显改善。在 10 个项目中，有 8 个项目在成本估算方面有显著差异。结论采用 "The Price is Right "规则的游戏化教学课程可以提高住院医师的估算能力，即使是课程中没有直接教授的项目。

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引用次数: 0

Individualized throughput metric reports for emergency medicine residents: Impact on time to disposition and resident perceptions 为急诊科住院医师提供个性化的吞吐量指标报告：对处置时间和住院医师看法的影响

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-06-18 DOI: 10.1002/aet2.11007

Brent A. Becker MD, Andrew J. Bleinberger MD, Brandon J. Golden MD, Amber S. Billet MD

Background

Research suggests that quantitative metric reports can improve the clinical performance of emergency physicians; however, few studies have examined their effects on physicians in training. The primary study objective was to assess the effects of providing emergency medicine (EM) residents with individualized throughput metrics with regard to emergency department (ED) disposition times.

Methods

We performed a single-center, retrospective, observational study from January 2021 to December 2022 examining ED disposition times before and after providing upper-level EM residents individualized throughput metrics. Residents received monthly reports of three specific metrics averaged over the preceding 6 months: (1) median time from room to discharge order (Rm2Dc), (2) median time from return of all results to discharge order (Rlts2Dc), and (3) median time from room and to consult order for hospitalization (Rm2Hosp). Overall mean values of the three metrics before and during metric sharing were compared via independent t-test and stratified by level of training and time of year. Adjusted analysis was performed to control for temporal differences between study periods. Testing was conducted at α = 0.05 level of significance.

Results

A total of 35 unique residents were included in the analysis. Overall, mean disposition times were not significantly different before and during reporting of metrics: Rm2Dc (154.8 min vs. 148.9 min, p = 0.109), Rslt2Dc (46.5 min vs. 45.1 min, p = 0.522), and Rm2Hosp (141.7 min vs. 135.7 min, p = 0.257). Subgroup analysis yielded similar results, aside from a significant decrease in mean Rm2Hosp in the postgraduate year-3 (PGY-3) group (145.8 min vs. 124.1 min, p = 0.004). Analysis with adjusted means yielded results similar to those observed with unadjusted data.

Conclusions

Overall, individualized throughput metrics were not correlated with decreased average times to ED disposition for upper-level EM residents; however, in the subset of hospitalized patients seen by PGY-3 residents, we observed a mean decrease of 21.7 min to consultation.

研究背景研究表明，定量指标报告可以提高急诊医生的临床表现；但是，很少有研究对培训中的医生的效果进行检查。研究的主要目的是评估为急诊医学（EM）住院医生提供个性化吞吐量指标对急诊科（ED）处置时间的影响。方法我们在 2021 年 1 月至 2022 年 12 月期间进行了一项单中心、回顾性、观察性研究，检查了为高年级急诊科住院医师提供个性化吞吐量指标前后的急诊科处置时间。住院医师每月都会收到前 6 个月平均的三个特定指标报告：（1）从病房到出院单的中位时间（Rm2Dc）；（2）从返回所有结果到出院单的中位时间（Rlts2Dc）；（3）从病房到住院会诊单的中位时间（Rm2Hosp）。通过独立 t 检验比较了指标共享前和共享期间三个指标的总体平均值，并按培训水平和时间进行了分层。为控制研究期间的时间差异，进行了调整分析。检验的显著性水平为 α = 0.05。结果共有 35 位居民参与了分析。总体而言，报告指标之前和期间的平均处置时间没有明显差异：Rm2Dc（154.8 分钟 vs. 148.9 分钟，p = 0.109）、Rslt2Dc（46.5 分钟 vs. 45.1 分钟，p = 0.522）和 Rm2Hosp（141.7 分钟 vs. 135.7 分钟，p = 0.257）。分组分析结果相似，但研究生三年级（PGY-3）组的平均 Rm2Hosp 显著下降（145.8 分钟对 124.1 分钟，p = 0.004）。调整后的平均值分析结果与未调整数据的结果相似。结论总体而言，个性化吞吐量指标与高年级急诊科住院医师急诊室处置平均时间的缩短无关；但是，在由 PGY-3 级住院医师诊治的住院患者子集中，我们观察到会诊平均时间缩短了 21.7 分钟。

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引用次数: 0

Losses and wins 输赢

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-06-18 DOI: 10.1002/aet2.11005

Elizabeth L. Chang MD

The authors declare no conflicts of interest.

作者声明没有利益冲突。

引用次数: 0