Emergency medicine (EM) training programs vary in how residents are exposed to clinical responsibilities. Transitioning to new roles often causes stress and uncertainty. Structured orientation programs may alleviate these challenges.
Methods
We implemented three role-specific orientation sessions targeting post-graduate year (PGY)-2, PGY-3, and PGY-4 EM residents at a 4-year residency program. Pre- and post-surveys measured comfort with clinical, supervisory, and system-based skills. Paired t-tests assessed changes.
Results
All three orientation sessions significantly improved self-reported comfort across various domains. Participating PGY-2 residents (n = 10) showed increased preparedness for managing critical conditions. PGY-3 residents (n = 6) demonstrated improved confidence in procedural supervision and knowledge of rare procedures. PGY-4 residents (n = 11) transitioning to attending roles showed the largest gains, particularly in billing and medico-legal domains.
Conclusion
Structured orientation improves EM resident readiness for role transitions. These findings support the integration of targeted educational interventions to enhance performance and preparedness.
{"title":"Enhancing Emergency Medicine Resident Transitions: The Impact of Structured Orientation Programs on Comfort and Preparedness","authors":"Jessica Baez, Erin McDonough","doi":"10.1002/aet2.70080","DOIUrl":"https://doi.org/10.1002/aet2.70080","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Emergency medicine (EM) training programs vary in how residents are exposed to clinical responsibilities. Transitioning to new roles often causes stress and uncertainty. Structured orientation programs may alleviate these challenges.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We implemented three role-specific orientation sessions targeting post-graduate year (PGY)-2, PGY-3, and PGY-4 EM residents at a 4-year residency program. Pre- and post-surveys measured comfort with clinical, supervisory, and system-based skills. Paired <i>t</i>-tests assessed changes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>All three orientation sessions significantly improved self-reported comfort across various domains. Participating PGY-2 residents (<i>n</i> = 10) showed increased preparedness for managing critical conditions. PGY-3 residents (<i>n</i> = 6) demonstrated improved confidence in procedural supervision and knowledge of rare procedures. PGY-4 residents (<i>n</i> = 11) transitioning to attending roles showed the largest gains, particularly in billing and medico-legal domains.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Structured orientation improves EM resident readiness for role transitions. These findings support the integration of targeted educational interventions to enhance performance and preparedness.</p>\u0000 </section>\u0000 </div>","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 4","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aet2.70080","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144687908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shayan Novin, Tehrim Younas, Jessie Xu, Samuel Graef, Nima Karimi, Maggie Xu, Jo-Anne Petropoulos, Quang Ngo, Elif Bilgic
Background
Medical trainees have limited opportunities to practice certain pediatric emergency medicine (PEM) procedures in the clinical setting. Simulation-based education provides an opportunity for trainees to improve their technical and non-technical skills. This scoping review aimed to explore the ways in which simulation has been used to train and assess medical learners.
Methods
A search was conducted from 2011 to August 2022 using MEDLINE, OVID Embase, OVID Emcare, and Cochrane Trials, among others. The review included empirical studies that used simulation for training medical trainees in four essential pediatric procedures: intubation, lumbar puncture, intraosseous insertion, and chest tube insertion. Six reviewers independently screened titles, abstracts, and full texts. Data were recorded, stored, and summarized in a standardized spreadsheet.
Results
The search retrieved 4073 articles, of which 207 underwent full-text screening. Data were extracted from 107 studies. Among these, 69 studies focused exclusively on intubation skills, 19 studies on lumbar puncture, 10 studies on intraosseous insertion, and two studies on chest tube insertion. The majority of studies (n = 61) involved residents, while 15 studies focused on medical students. Training platforms included mannequins (n = 84), ex-vivo models (n = 6), task trainers (n = 4), and standardized patients (n = 1). Competency was largely assessed using an assessment tool (n = 45) as the sole assessment method.
Conclusions
Simulation-based training and assessment can support medical learners in developing key technical and non-technical skills related to PEM procedures. However, there is a need for diversification of simulation platforms used, expansion of procedures targeted in simulation-based training and assessment programs, and creation of standardized and procedure-specific assessments.
{"title":"Simulation Platforms to Train and Assess Pediatric Acute Care Procedural Skills: A Scoping Review","authors":"Shayan Novin, Tehrim Younas, Jessie Xu, Samuel Graef, Nima Karimi, Maggie Xu, Jo-Anne Petropoulos, Quang Ngo, Elif Bilgic","doi":"10.1002/aet2.70083","DOIUrl":"https://doi.org/10.1002/aet2.70083","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Medical trainees have limited opportunities to practice certain pediatric emergency medicine (PEM) procedures in the clinical setting. Simulation-based education provides an opportunity for trainees to improve their technical and non-technical skills. This scoping review aimed to explore the ways in which simulation has been used to train and assess medical learners.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A search was conducted from 2011 to August 2022 using MEDLINE, OVID Embase, OVID Emcare, and Cochrane Trials, among others. The review included empirical studies that used simulation for training medical trainees in four essential pediatric procedures: intubation, lumbar puncture, intraosseous insertion, and chest tube insertion. Six reviewers independently screened titles, abstracts, and full texts. Data were recorded, stored, and summarized in a standardized spreadsheet.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The search retrieved 4073 articles, of which 207 underwent full-text screening. Data were extracted from 107 studies. Among these, 69 studies focused exclusively on intubation skills, 19 studies on lumbar puncture, 10 studies on intraosseous insertion, and two studies on chest tube insertion. The majority of studies (<i>n</i> = 61) involved residents, while 15 studies focused on medical students. Training platforms included mannequins (<i>n</i> = 84), ex-vivo models (<i>n</i> = 6), task trainers (<i>n</i> = 4), and standardized patients (<i>n</i> = 1). Competency was largely assessed using an assessment tool (<i>n</i> = 45) as the sole assessment method.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Simulation-based training and assessment can support medical learners in developing key technical and non-technical skills related to PEM procedures. However, there is a need for diversification of simulation platforms used, expansion of procedures targeted in simulation-based training and assessment programs, and creation of standardized and procedure-specific assessments.</p>\u0000 </section>\u0000 </div>","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 4","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aet2.70083","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nicholas Pokrajac, Kimberly Schertzer, Deborah Hsu, Stefanie S. Sebok-Syer
{"title":"Procedural Skills and Emergency Medicine Common Program Requirements: It's Time to Address Skill Decay","authors":"Nicholas Pokrajac, Kimberly Schertzer, Deborah Hsu, Stefanie S. Sebok-Syer","doi":"10.1002/aet2.70081","DOIUrl":"https://doi.org/10.1002/aet2.70081","url":null,"abstract":"","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 4","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144687909","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}
Sydney Krispin, Eric Kontowicz, Brett Faine, Michael Takacs, Karisa K. Harland, J. Priyanka Vakkalanka, Kelli Wallace, Andrew Nugent, Nicholas M. Mohr
Objectives
Emergency medicine (EM) residency programs require participation in scholarly activity. In 2017, we launched a formal Resident Research Program (RRP) for physician residents in our 3-year accredited residency program. We aimed to measure the association between the implementation of the RRP and resident scholarly productivity.
Methods
This analysis was a before-after study of residents in a Midwestern university-based EM residency program (7–10 per class) graduating between 2013 and 2023. The RRP was implemented in July 2017 and offered resources and requirements; our study compared outcomes before and after the launch of the program. We provided a dedicated training program study coordinator, 24-h in-house research assistants, faculty/research staff mentorship, and research funding. Residents were required to complete a hypothesis-driven research project and submit an abstract to a professional meeting or manuscript for publication. We tracked scholarly productivity per class, including publications, presentations, first-author manuscripts, and faculty publications with a resident. We measured the association between the RRP and scholarly productivity through univariate Poisson regression models to report the unadjusted rate ratio (RR) with 95% confidence intervals (95% CI).
Results
Ninety residents were included (n = 43 after RRP launch). Annual mean resident scholarly productivity increased post-intervention for publications (10.4 vs. 6.2 publications per class, RR 1.68, 95% CI 1.09–2.59), presentations (7.4 vs. 3.7 abstracts per class, RR 2.01, 95% CI 1.19–3.42), and first-author publications (5.8 vs. 2.2 publications per class, RR 2.66, 95% CI 1.40–5.09). No significant change in faculty co-authors was observed (12.8 vs. 9.5, RR 1.35, 95% CI 0.95–1.92).
Conclusions
The implementation of a structured RRP was associated with increased resident scholarly productivity. The targeted research resources served as both a strategy to support resident research and enhance departmental academic engagement. Future research should examine the perceptions, quality, and impact of scholarly activity requirements on residents.
目的急诊医学（EM）住院医师项目需要参与学术活动。2017年，我们为住院医师推出了正式的住院医师研究计划（RRP），该计划为期3年。我们的目的是衡量RRP的实施与居民学术生产力之间的关系。方法对2013年至2023年毕业的中西部大学EM住院医师项目（每班7-10人）的住院医师进行了前后研究。RRP于2017年7月实施，并提供了资源和要求；我们的研究比较了项目启动前后的结果。我们提供了专门的培训项目研究协调员，24小时内部研究助理，教师/研究人员指导和研究资金。居民被要求完成一个假设驱动的研究项目，并向专业会议提交摘要或手稿发表。我们跟踪每堂课的学术生产力，包括出版物、演讲、第一作者手稿和一位住院医师的教员出版物。我们通过单变量泊松回归模型测量RRP与学术生产力之间的关联，以95%置信区间（95% CI）报告未调整率比（RR）。结果RRP启动后共纳入90名居民（n = 43）。干预后，发表文章（每类10.4篇对6.2篇，RR = 1.68, 95% CI = 1.09-2.59）、报告（每类7.4篇对3.7篇摘要，RR = 2.01, 95% CI = 1.19-3.42）和第一作者发表文章（每类5.8篇对2.2篇，RR = 2.66, 95% CI = 1.40-5.09）的年平均学术生产力均有所提高。教职工共同作者未见显著变化（12.8 vs. 9.5, RR 1.35, 95% CI 0.95-1.92）。结论：结构化RRP的实施与住院医师学术生产力的提高有关。有针对性的研究资源既是支持居民研究的战略，也是加强部门学术参与的战略。未来的研究应该考察居民对学术活动要求的看法、质量和影响。
{"title":"Resident Scholarly Activity and Productivity Outcomes Before and After Implementing a Structured Research Program: A Before–After Study","authors":"Sydney Krispin, Eric Kontowicz, Brett Faine, Michael Takacs, Karisa K. Harland, J. Priyanka Vakkalanka, Kelli Wallace, Andrew Nugent, Nicholas M. Mohr","doi":"10.1002/aet2.70082","DOIUrl":"https://doi.org/10.1002/aet2.70082","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Emergency medicine (EM) residency programs require participation in scholarly activity. In 2017, we launched a formal Resident Research Program (RRP) for physician residents in our 3-year accredited residency program. We aimed to measure the association between the implementation of the RRP and resident scholarly productivity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This analysis was a before-after study of residents in a Midwestern university-based EM residency program (7–10 per class) graduating between 2013 and 2023. The RRP was implemented in July 2017 and offered resources and requirements; our study compared outcomes before and after the launch of the program. We provided a dedicated training program study coordinator, 24-h in-house research assistants, faculty/research staff mentorship, and research funding. Residents were required to complete a hypothesis-driven research project and submit an abstract to a professional meeting or manuscript for publication. We tracked scholarly productivity per class, including publications, presentations, first-author manuscripts, and faculty publications with a resident. We measured the association between the RRP and scholarly productivity through univariate Poisson regression models to report the unadjusted rate ratio (RR) with 95% confidence intervals (95% CI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ninety residents were included (<i>n</i> = 43 after RRP launch). Annual mean resident scholarly productivity increased post-intervention for publications (10.4 vs. 6.2 publications per class, RR 1.68, 95% CI 1.09–2.59), presentations (7.4 vs. 3.7 abstracts per class, RR 2.01, 95% CI 1.19–3.42), and first-author publications (5.8 vs. 2.2 publications per class, RR 2.66, 95% CI 1.40–5.09). No significant change in faculty co-authors was observed (12.8 vs. 9.5, RR 1.35, 95% CI 0.95–1.92).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The implementation of a structured RRP was associated with increased resident scholarly productivity. The targeted research resources served as both a strategy to support resident research and enhance departmental academic engagement. Future research should examine the perceptions, quality, and impact of scholarly activity requirements on residents.</p>\u0000 </section>\u0000 </div>","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 4","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aet2.70082","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A Statement of Support for Focused Pediatric Emergency Medicine Training in Emergency Medicine Residency","authors":"Sarah C. Cavallaro, Jennifer M. Mitzman","doi":"10.1002/aet2.70077","DOIUrl":"https://doi.org/10.1002/aet2.70077","url":null,"abstract":"","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 4","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688008","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}
Henry J. Higby, John D. Hoyle Jr., Joshua D. Mastenbrook, Philip A. Pazderka, Sarah Fichuk, Austin Wilkinson, Caleb Porter
Background
Pediatric prehospital dosing errors occur at high rates, up to 60% for epinephrine. Senior emergency medicine residents (EMR) in the Western Michigan University Homer Stryker MD School of Medicine (WMed) residency respond as EMS physicians to cardiac arrests in Kalamazoo County. We sought to determine error rates for weight estimation, epinephrine doses, dose administration mechanics, and esophageal intubation (EI) recognition by EMRs at the end of the PGY-1 year, during EMS physician training summative testing.
Methods
Sixteen PGY-1 EMRs were observed during a simulation: 5-year-old with an EMS EI in asystole requiring multiple epinephrine administrations by the EMR. All EMRs had completed Pediatric Advanced Life Support (PALS). Two observers scored performance. Scenarios were recorded. Recordings and scores were reviewed and discussed by observers. Any disagreements were resolved by consensus. Dosing error was defined as > 20% difference from the correct dose.
Results
All EMRs obtained correct weight with 15 (94%; 72.0%, 99.0%) using length-based tape (LBT) and one (6%) guessing. Four near-miss errors occurred with the LBT. Four (25%) and two (12.5%) of the first and second epinephrine doses, respectively, were incorrect. Five (50%) errors occurred using graduations on the preloaded syringe, and five (50%) were due to air bubbles in the administration syringe. There were no ten-fold errors. Three (19%) EMRs took 3 attempts to assemble the preloaded syringe, six (38%) did not screw the preloaded syringe together correctly, seven (44%) had difficulty attaching a stopcock to the preloaded syringe, and 14 (88%) did not prime the stopcock. One (6%) failed to recognize EI.
Conclusions
PALS-certified PGY-1 EMRs, accurately estimated patient weight, had a high rate of epinephrine dosing errors and frequent difficulty assembling preloaded syringes. To address these errors, training will be developed that includes a checklist, LBT use, weight determination hierarchy, assembling epinephrine preloaded syringes, techniques for appropriate dose administration, and recognition of EI.
{"title":"Epinephrine Dosing by Emergency Medicine Residents During a Simulated Prehospital Pediatric Cardiac Arrest","authors":"Henry J. Higby, John D. Hoyle Jr., Joshua D. Mastenbrook, Philip A. Pazderka, Sarah Fichuk, Austin Wilkinson, Caleb Porter","doi":"10.1002/aet2.70073","DOIUrl":"https://doi.org/10.1002/aet2.70073","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pediatric prehospital dosing errors occur at high rates, up to 60% for epinephrine. Senior emergency medicine residents (EMR) in the Western Michigan University Homer Stryker MD School of Medicine (WMed) residency respond as EMS physicians to cardiac arrests in Kalamazoo County. We sought to determine error rates for weight estimation, epinephrine doses, dose administration mechanics, and esophageal intubation (EI) recognition by EMRs at the end of the PGY-1 year, during EMS physician training summative testing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Sixteen PGY-1 EMRs were observed during a simulation: 5-year-old with an EMS EI in asystole requiring multiple epinephrine administrations by the EMR. All EMRs had completed Pediatric Advanced Life Support (PALS). Two observers scored performance. Scenarios were recorded. Recordings and scores were reviewed and discussed by observers. Any disagreements were resolved by consensus. Dosing error was defined as > 20% difference from the correct dose.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>All EMRs obtained correct weight with 15 (94%; 72.0%, 99.0%) using length-based tape (LBT) and one (6%) guessing. Four near-miss errors occurred with the LBT. Four (25%) and two (12.5%) of the first and second epinephrine doses, respectively, were incorrect. Five (50%) errors occurred using graduations on the preloaded syringe, and five (50%) were due to air bubbles in the administration syringe. There were no ten-fold errors. Three (19%) EMRs took 3 attempts to assemble the preloaded syringe, six (38%) did not screw the preloaded syringe together correctly, seven (44%) had difficulty attaching a stopcock to the preloaded syringe, and 14 (88%) did not prime the stopcock. One (6%) failed to recognize EI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>PALS-certified PGY-1 EMRs, accurately estimated patient weight, had a high rate of epinephrine dosing errors and frequent difficulty assembling preloaded syringes. To address these errors, training will be developed that includes a checklist, LBT use, weight determination hierarchy, assembling epinephrine preloaded syringes, techniques for appropriate dose administration, and recognition of EI.</p>\u0000 </section>\u0000 </div>","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 4","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aet2.70073","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144687911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Included in the major revisions recently proposed by the Accreditation Council for Graduate Medical Education (ACGME) to the program requirements for residency training in Emergency Medicine (EM) are recommendations for increased training in pediatric emergency care [1]. Currently, most children seeking emergency care in the United States present to general emergency departments (EDs), where they are cared for by the graduates of residency programs that require only 5 months of pediatric training [2]. Making the case for this attention to pediatric education are needs assessments and case logs, in which graduates report feeling unprepared or are found to lack exposure to pediatric ages or conditions that they might encounter in practice [3, 4]. The ACGME's emphasis on infants and children under 12 years, with a specific aim to achieve exposure to neonatal resuscitation, seems to address reports that younger ages are the most anxiety provoking for EM physicians [5, 6]. Everything proposed by the ACGME is logical and important, but the feasibility of attainment is another matter. The reality is that exposure to specific aspects of pediatric EM is impossible to guarantee, and varied interpretation of the suggestions incites confusion and concern in the medical educators responsible for making these changes. Compliance with the new recommendations poses challenges that we must recognize and address in order to do what is right for future trainees and the young patients they will care for.
The first challenge many programs will encounter is reliable access to both sufficient pediatric patients and sufficient pediatric expertise. While residents will be able to count pediatric patients seen in community ED settings toward the total time required, most EDs care for fewer than 15 children per day and more rural settings see fewer than five children per day [7, 8]. In a proposed edit to the ACGME recommendations, the Emergency Medicine Residents' Association (EMRA), which is supportive of the recommendation for 24 weeks of pediatrics during training, suggests 1000 pediatric encounters and 18 weeks of pediatric ED time [9]. They note that this amounts to 1.23 children per hour over 18 weeks. It remains to be seen if either metric is achievable in a variety of settings, especially if the new focus is on children under 12 years old.
Furthermore, many communities lack access to inpatient pediatric care, leaving EM residencies in these areas a dearth of learning opportunities [10]. As a result, both travel to and volume of trainees at certain pediatric sites will increase, which creates its own set of challenges. The ACGME is aware that being away from home during training is a burden: there is language in the program requirements advising that accredited rotation sites over 60 miles, or 30 min, from the home institution must be approved by the Residency R
最近，研究生医学教育认证委员会（ACGME）对急诊医学（EM）住院医师培训的项目要求进行了重大修订，其中包括增加儿科急诊护理培训的建议。目前，在美国，大多数寻求急诊治疗的儿童都到普通急诊科（ed）就诊，在那里，他们由住院医师项目的毕业生照顾，只需要5个月的儿科培训。需求评估和病例记录证明了这种对儿科教育的关注，在这些报告中，毕业生报告感觉没有准备好，或者发现他们缺乏对儿科年龄或他们在实践中可能遇到的条件的了解[3,4]。ACGME强调12岁以下的婴儿和儿童，其具体目标是实现新生儿复苏，这似乎解决了关于更年轻的年龄是最能引起急诊医生焦虑的报道[5,6]。ACGME提出的所有建议都是合乎逻辑且重要的，但实现的可行性是另一回事。现实情况是，接触儿科急诊的特定方面是不可能保证的，对这些建议的不同解释会引起负责做出这些改变的医学教育者的困惑和担忧。遵守新建议带来了挑战，我们必须认识到并解决这些挑战，以便为未来的实习生和他们将照顾的年轻患者做正确的事情。许多项目将遇到的第一个挑战是可靠地获得足够的儿科患者和足够的儿科专业知识。虽然住院医师可以将在社区急诊科就诊的儿科患者计入所需的总时间，但大多数急诊科每天治疗的儿童少于15名，而更多的农村急诊科每天治疗的儿童少于5名[7,8]。在ACGME建议的拟议编辑中，急诊医学居民协会（EMRA）支持在培训期间进行24周儿科培训的建议，建议1000次儿科就诊和18周儿科ED时间。他们指出，在18周的时间里，这相当于每小时生育1.23个孩子。这两项指标是否在各种情况下都能实现还有待观察，特别是如果新的重点是12岁以下的儿童。此外，许多社区缺乏儿科住院治疗，使这些地区的急诊住院医师缺乏学习机会。因此，某些儿科医院的出诊人次和受训者人数都将增加，这也带来了一系列挑战。ACGME意识到，在培训期间远离家乡是一种负担：项目要求中有语言建议，距离家乡院校60英里（或30分钟）以上的经认证的轮岗地点必须得到住院医师审查委员会的批准，以限制任何不必要的旅行。另一个值得讨论的问题是儿科急诊教育的理想年龄范围，包括对新生儿复苏的关注。虽然ACGME没有强制要求急诊住院医师在分娩后立即进行新生儿复苏，但他们也没有建议教育工作者如何解释这一建议。根据美国儿科学会（American Academy of Pediatrics）的说法，新生儿是指出生后28天内的婴儿，“这是人类生命中生理变化最剧烈的时期”。出于这个原因，学术急诊医学协会的儿科特殊兴趣小组建议在产科轮转期间充分利用对新生儿的接触，并将新生儿的概念扩大到包括所有符合该年龄组真正定义的婴儿。有一些住院医师项目为急诊住院医师精心设计了广受好评的新生儿重症监护病房（NICU）轮转，这可能会增强实习生对未来急诊科分娩的准备意识，但在整个新生儿时间框架内还有许多其他紧急问题值得关注和准备。急诊住院医师可能会感谢任何关于这些年轻年龄的教育，因为他们希望更多与新生儿有关的培训，但也对大一点的婴儿感到措手不及，他们承认害怕生病的婴儿出现在他们的急诊室[3,5]。新的建议强调让受训者接触12岁以下的儿童，因为“12至21岁的青少年患者在解剖学和生理学上与成年人相似”，但住院医生“将继续治疗青少年”。这第二条评论很重要：当人们考虑到需要达到某些目标时，年龄的真正限制肯定会阻碍成功。 如果受训者被送到儿科中心进行这些轮转，建议儿科医生照顾所有的青少年似乎是不合理的；事实上，这可能会在某种程度上阻碍与该附属公司的关系。此外，青少年与成年人有很大的不同。例如，儿科创伤外科医生提醒急诊医生，青少年创伤患者有强烈的热量需求，必须满足，以支持伤口愈合，他们应该相应管理。重要的是，在这个国家，青少年经历的行为健康危机是不同的，因为这一人群的发育迟缓和心理社会因素导致他们缺乏适当的处置计划，导致发病率和死亡率的风险增加。强调在生理上与成人不同的儿童的复苏似乎是公平的；完全取消与12岁以上儿童的接触可能会造成长期影响的培训差距，也不太可能符合ACGME的意图。如果ACGME对EM住院医师的建议被采纳，那么这个国家的住院医师计划将需要适应。仅儿童接触是不够的。虽然增加时间或案例数量以增加实现学习目标的潜力是有意义的，但不能保证任何ED都能提供固定的数量或年龄的孩子。创造力和课程建设至关重要。在2019冠状病毒病大流行期间，儿科在急诊科的演讲，甚至主要是儿科急诊科的演讲，在急剧反弹之前急剧下降，教育工作者被迫以任何可能的方式补充培训。虽然急诊医生报告说，经验和接触是建立舒适照顾儿童的关键，但他们也认识到模拟和其他教育辅助手段的价值，例如通过新生儿复苏计划（NRP）进行培训，作为加强儿科人口bb10准备的方法。如果模拟能够满足ACGME的要求，他们就可以专注于特定的年龄或病理，从而有助于降低EM的不可预测性。远程模拟可能对农村地区或其他偏远地区的项目有一定的好处，因为这些地区的儿童中心或专业知识有限。此外，必须强调的是，这些变化将要求ACGME和解释新要求的人具有灵活性。仅仅依赖实足年龄可能过于严格，也太具有挑战性。对3天大的婴儿或青春期前和生长受限的14岁儿童进行复苏应分别有助于满足新生儿和儿科复苏经验的需要。如果项目的目的是记录儿童的暴露情况，那么按年龄跟踪患者所带来的挑战是值得考虑的。目前，项目可以提取18岁以下患者的数据，因此，真正关注12岁以下患者意味着在数据分析方面实施变革，这可能是一个重大负担。有些项目可能有技术和支持，可以轻松地运行这些数据，但即使是那些资源充足的住院医生，也无法计算出那些可能有助于获得知识的病例，尽管这些病例超出了严格的年龄范围。一些程序将把计算任务留给以前没有做过这种工作的受训人员或程序工作人员，因此值得考虑这种努力是否值得在时间或金钱上付出代价。在一篇关于2025年生效的ACGME对儿科住院医师培训要求的变化的深思熟虑的观点文章中，儿科教育者指出，建议的变化将带来财政和后勤方面的挑战，但他们得出结论，这些变化将有利于这个国家未来儿科医生的教育。建议增加儿科接触和对新兴市场居民的教育可能会带来同样的挑战。通过深思熟虑地处理这里提出的问题，急诊专业也可以而且应该做出改变，以支持我们国家的儿童和照顾他们的急诊医生。作者声明无利益冲突。
{"title":"The Challenges of a Necessary Increase in Pediatric Training During Emergency Medicine Residency","authors":"Eva M. Delgado, Regina L. Toto","doi":"10.1002/aet2.70079","DOIUrl":"https://doi.org/10.1002/aet2.70079","url":null,"abstract":"<p>Included in the major revisions recently proposed by the Accreditation Council for Graduate Medical Education (ACGME) to the program requirements for residency training in Emergency Medicine (EM) are recommendations for increased training in pediatric emergency care [<span>1</span>]. Currently, most children seeking emergency care in the United States present to general emergency departments (EDs), where they are cared for by the graduates of residency programs that require only 5 months of pediatric training [<span>2</span>]. Making the case for this attention to pediatric education are needs assessments and case logs, in which graduates report feeling unprepared or are found to lack exposure to pediatric ages or conditions that they might encounter in practice [<span>3, 4</span>]. The ACGME's emphasis on infants and children under 12 years, with a specific aim to achieve exposure to neonatal resuscitation, seems to address reports that younger ages are the most anxiety provoking for EM physicians [<span>5, 6</span>]. Everything proposed by the ACGME is logical and important, but the feasibility of attainment is another matter. The reality is that exposure to specific aspects of pediatric EM is impossible to guarantee, and varied interpretation of the suggestions incites confusion and concern in the medical educators responsible for making these changes. Compliance with the new recommendations poses challenges that we must recognize and address in order to do what is right for future trainees and the young patients they will care for.</p><p>The first challenge many programs will encounter is reliable access to both sufficient pediatric patients and sufficient pediatric expertise. While residents will be able to count pediatric patients seen in community ED settings toward the total time required, most EDs care for fewer than 15 children per day and more rural settings see fewer than five children per day [<span>7, 8</span>]. In a proposed edit to the ACGME recommendations, the Emergency Medicine Residents' Association (EMRA), which is supportive of the recommendation for 24 weeks of pediatrics during training, suggests 1000 pediatric encounters and 18 weeks of pediatric ED time [<span>9</span>]. They note that this amounts to 1.23 children per hour over 18 weeks. It remains to be seen if either metric is achievable in a variety of settings, especially if the new focus is on children under 12 years old.</p><p>Furthermore, many communities lack access to inpatient pediatric care, leaving EM residencies in these areas a dearth of learning opportunities [<span>10</span>]. As a result, both travel to and volume of trainees at certain pediatric sites will increase, which creates its own set of challenges. The ACGME is aware that being away from home during training is a burden: there is language in the program requirements advising that accredited rotation sites over 60 miles, or 30 min, from the home institution must be approved by the Residency R","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 4","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aet2.70079","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144687976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Assessor stringency/leniency (ASL), the tendency for an assessor to consistently provide low or high scores, has been shown to have educationally important effects on learner assessment scores in multiple settings. To date, there is no clear understanding of the underlying drivers of ASL in the context of medical education. Some authors have hypothesized a link between personality traits and ASL, but there is currently insufficient data to reach any conclusions. This study seeks to determine whether there is a significant association between physician assessors' personality traits and ASL.
Methods
This prospective cohort study was conducted at an academic emergency department in Ottawa, Canada. Participating assessors volunteered to complete the IPIP-Neo 120, a personality questionnaire based on the five-factor model. All end-of-shift assessments completed between July 1, 2021, and June 30, 2022, were collected, and ASL was quantified for each assessor using the mean delta method. Linear regression was used to assess the correlation between personality scores and ASL.
Results
A total of 2127 assessments, representing 184 learners, were analyzed. Twenty-five assessors were enrolled, with a wide distribution of assessor personality scores for each trait. While there was a trend toward leniency with increasing assessor extraversion, this did not reach statistical significance (p = 0.07, R2 = 0.13). There was no significant link between other personality traits and ASL.
Conclusion
Integrating our findings with the existing literature, we conclude that personality traits are likely not educationally important drivers of ASL in medicine. Future research should examine other possible contributors to ASL in medical education.
{"title":"Assessor Personality Traits Are Not Educationally Important Drivers of Assessor Stringency/Leniency","authors":"Sebastian Dewhirst, Nora D. Szabo, Jason R. Frank","doi":"10.1002/aet2.70074","DOIUrl":"https://doi.org/10.1002/aet2.70074","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Assessor stringency/leniency (ASL), the tendency for an assessor to consistently provide low or high scores, has been shown to have educationally important effects on learner assessment scores in multiple settings. To date, there is no clear understanding of the underlying drivers of ASL in the context of medical education. Some authors have hypothesized a link between personality traits and ASL, but there is currently insufficient data to reach any conclusions. This study seeks to determine whether there is a significant association between physician assessors' personality traits and ASL.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This prospective cohort study was conducted at an academic emergency department in Ottawa, Canada. Participating assessors volunteered to complete the IPIP-Neo 120, a personality questionnaire based on the five-factor model. All end-of-shift assessments completed between July 1, 2021, and June 30, 2022, were collected, and ASL was quantified for each assessor using the mean delta method. Linear regression was used to assess the correlation between personality scores and ASL.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 2127 assessments, representing 184 learners, were analyzed. Twenty-five assessors were enrolled, with a wide distribution of assessor personality scores for each trait. While there was a trend toward leniency with increasing assessor extraversion, this did not reach statistical significance (<i>p</i> = 0.07, <i>R</i><sup>2</sup> = 0.13). There was no significant link between other personality traits and ASL.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Integrating our findings with the existing literature, we conclude that personality traits are likely not educationally important drivers of ASL in medicine. Future research should examine other possible contributors to ASL in medical education.</p>\u0000 </section>\u0000 </div>","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 4","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144687974","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}
Broadstock A, Kalantari A, Dessie AS, et al. Evaluating the role of traditional and nontraditional educational resources in point-of-care ultrasound training: A cross-sectional survey of educator preferences and practices. AEM Educ Train. 2025; 9:e70039. doi:10.1002/aet2.70039
In the article cited above, the affiliation for Dr. Resa Lewiss is incorrectly listed as “Departments of Emergency Medicine and Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.”
The correct affiliation should be “Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.”
{"title":"Correction to “Evaluating the Role of Traditional and Nontraditional Educational Resources in Point-of-Care Ultrasound Training: A Cross-Sectional Survey of Educator Preferences and Practices”","authors":"","doi":"10.1002/aet2.70075","DOIUrl":"https://doi.org/10.1002/aet2.70075","url":null,"abstract":"<p>Broadstock A, Kalantari A, Dessie AS, et al. Evaluating the role of traditional and nontraditional educational resources in point-of-care ultrasound training: A cross-sectional survey of educator preferences and practices. <i>AEM Educ Train</i>. 2025; 9:e70039. doi:10.1002/aet2.70039</p><p>In the article cited above, the affiliation for Dr. Resa Lewiss is incorrectly listed as “Departments of Emergency Medicine and Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.”</p><p>The correct affiliation should be “Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.”</p>","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aet2.70075","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144503258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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