AEM Education and Training最新文献

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

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.”

Standardized examinations such as the United States Medical Licensing Examination (USMLE) and American Board of Emergency Medicine Qualifying Examination (ABEM-QE), the written examinations, serve as measures of medical knowledge and application of knowledge to patient care. These are intended to serve as gateways to licensure and practice and thus serve as key outcomes for training in Emergency Medicine (EM).

Flynn observed that over the past decades, there has been an increase in scores on some standardized tests, such as the Intelligence Quotient (IQ) tests [1]. Similarly, USMLE Step 2 scores have been rising [2]. Starting before COVID and amplified during COVID, EM has seen a decrease in scores on EM-specific first-time examinations, which is concerning [3].

The purpose of this Educational Download is to provide a snapshot of examination scores over the continuum of training. Thus, we follow a cohort of trainees from USMLE Steps 1 and 2 (and COMLEX 1 and 2) [4], through In-Training Examination (ITE) scores to board qualification (the written ABEM-QE). We followed the index cohort through their series of examinations (assuming a 3-year residency program).

Since the change of Step 1 to pass/fail, pass rates have decreased while Step 2 pass rates and scores are high. Importantly, there are decreases in EM ITE and ABEM-QE scores and pass rates during and since COVID.

One caveat is that the majority of these examinations are equated, a process by which scores from one test may be weighted so as to have equal meaning with scores from another test. Another limitation is that some examinations report on the calendar year (December–January) while others report on the academic year (July–June); exact alignment of the scores for cohorts is not possible versus scaled scores. Scoring of examinations is imprecise, and the fluctuations in scores could be within the standard error of measurement [6]. Finally, some examinations have equating changes or standard settings related cut score changes that are not reflected here.

Sally A. Santen: conceptualization; writing – original draft; visualization; writing – review and editing. Jessica Baez: conceptualization; writing – original draft. Susan Promes: conceptualization; writing – original draft; writing – review and editing. Anne Messman: writing – original draft; conceptualization; writing – review and editing.

Dr. Sally A. Santen is an ABEM oral board examiner and serves on a NBME committee. Dr. Anne Messman is on the NBME Council.

The authors declare no conflicts of interest.