AEM Education and Training最新文献_第7页

SPIKES: Breaking bad news in the emergency department SPIKES：在急诊科发布坏消息

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-04-15 DOI: 10.1002/aet2.10977

Megan Rivera MD, Thomas Yang MD, Tiffany Moadel MD, Samuel Corbo MD, Sreeja Natesan MD

引用次数: 0

Determination, categorization, and hierarchy of content for a pediatric emergency medicine curriculum designed for emergency medicine residents 为急诊科住院医师设计的儿科急诊医学课程内容的确定、分类和分级

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-04-15 DOI: 10.1002/aet2.10978

Sarah C. Cavallaro MD, Sara Schutzman MD, Joyce Li MD, MPH, Martin Pusic MD, PhD

Background

Currently, the Accreditation Council of Graduate Medical Education requires time-based pediatric experiences for emergency medicine (EM) residents in both pediatric emergency medicine (PEM) and critical care settings. The American Board of Emergency Medicine has published the Model of the Clinical Practice of Emergency Medicine, which is a list of content an EM resident should learn. However, this list is large and without prioritization and therefore can be difficult to incorporate into time-limited curricula.

Objectives

The primary objective of this study was to develop comprehensive categorization of PEM content using an EM lens. The second objective was to suggest a prioritization for the EM learner of the enumerated PEM elements.

Methods

We first assembled a comprehensive list of PEM concepts, diagnoses, and procedures that might be taught to EM residents. We then convened focus groups composed of key stakeholders to help formulate content and concept themes important for EM resident training. Once the themes were identified, we divided the list of PEM topics into appropriate themes and then carried out a second round of focus groups expanded to include more diverse expert input for prioritizing the elements of the comprehensive list within each theme.

Results

We prioritized 168 important PEM concepts from previous standards and emerging PEM literature among 10 identified themes: the pediatric normal, the bottom-line boil-it-down approach, common presentations, high-acuity pediatric cases and procedures, differences between children and adults, same between children and adults, red flags, infrequency of caring for a child compared with an adult, keep breadth but promote self-directed depth, and triage and disposition.

Conclusions

Based on input from stakeholders in EM resident education, we identified key themes within PEM education and created a framework for the hierarchical categorization of PEM content for within an EM residency.

背景目前，美国毕业医学教育认证委员会（Accreditation Council of Graduate Medical Education）要求急诊医学（EM）住院医师在儿科急诊医学（PEM）和重症监护环境中进行基于时间的儿科实习。美国急诊医学委员会发布了《急诊医学临床实践模型》，列出了急诊医学住院医师应学习的内容。然而，这份清单内容繁多，而且没有主次之分，因此很难纳入有时间限制的课程中。研究目的本研究的主要目的是以急诊医学的视角对急诊医学教学内容进行综合分类。第二个目标是为电磁学习者建议所列举的电磁学内容的优先次序。方法我们首先收集了一份全面的 PEM 概念、诊断和程序清单，可能会教授给急诊科住院医师。然后，我们召集了由主要相关人员组成的焦点小组，帮助制定对急诊科住院医师培训非常重要的内容和概念主题。确定主题后，我们将 PEM 主题列表划分为适当的主题，然后进行第二轮焦点小组讨论，以纳入更多不同的专家意见，从而在每个主题中对综合列表中的内容进行优先排序。结果我们从以前的标准和新出现的 PEM 文献中选出了 168 个重要的 PEM 概念，并在 10 个已确定的主题中进行了优先排序，这 10 个主题是：儿科正常情况、底线煮沸法、常见表现、高危儿科病例和手术、儿童和成人之间的差异、儿童和成人之间的相同点、红旗、与成人相比护理儿童的频率较低、保持广度但促进自主深度以及分流和处置。结论根据急诊科住院医师教育相关人员的意见，我们确定了急诊科住院医师教育的关键主题，并为急诊科住院医师教育内容的分级分类创建了一个框架。

{"title":"Determination, categorization, and hierarchy of content for a pediatric emergency medicine curriculum designed for emergency medicine residents","authors":"Sarah C. Cavallaro MD, Sara Schutzman MD, Joyce Li MD, MPH, Martin Pusic MD, PhD","doi":"10.1002/aet2.10978","DOIUrl":"https://doi.org/10.1002/aet2.10978","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Currently, the Accreditation Council of Graduate Medical Education requires time-based pediatric experiences for emergency medicine (EM) residents in both pediatric emergency medicine (PEM) and critical care settings. The American Board of Emergency Medicine has published the Model of the Clinical Practice of Emergency Medicine, which is a list of content an EM resident should learn. However, this list is large and without prioritization and therefore can be difficult to incorporate into time-limited curricula.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The primary objective of this study was to develop comprehensive categorization of PEM content using an EM lens. The second objective was to suggest a prioritization for the EM learner of the enumerated PEM elements.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We first assembled a comprehensive list of PEM concepts, diagnoses, and procedures that might be taught to EM residents. We then convened focus groups composed of key stakeholders to help formulate content and concept themes important for EM resident training. Once the themes were identified, we divided the list of PEM topics into appropriate themes and then carried out a second round of focus groups expanded to include more diverse expert input for prioritizing the elements of the comprehensive list within each theme.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We prioritized 168 important PEM concepts from previous standards and emerging PEM literature among 10 identified themes: the pediatric normal, the bottom-line boil-it-down approach, common presentations, high-acuity pediatric cases and procedures, differences between children and adults, same between children and adults, red flags, infrequency of caring for a child compared with an adult, keep breadth but promote self-directed depth, and triage and disposition.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Based on input from stakeholders in EM resident education, we identified key themes within PEM education and created a framework for the hierarchical categorization of PEM content for within an EM residency.</p>\u0000 </section>\u0000 </div>","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"8 2","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140553135","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}

引用次数: 0

Is boarding compromising our residents' education? A national survey of emergency medicine program directors 寄宿制是否会影响住院医师的教育？一项针对急诊医学项目主任的全国调查

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-04-15 DOI: 10.1002/aet2.10973

Katja Goldflam MD, Cassandra Bradby MD, Ryan F. Coughlin MD, Alexis Cordone MD, Jessica Bod MD, Leah Bright DO, Rebecca Merrill MD, Alina Tsyrulnik MD

Background

Boarding patients in the emergency department (ED) potentially affects resident education. Program director (PD) perceptions of the impact of boarding on their trainees have not been previously described.

Methods

We surveyed a cross-sectional convenience sample of emergency medicine PDs using a mixed-methods approach to explore their perceptions of how boarding has affected their residents' training. Descriptive data were reported as percentages and differences were calculated using Pearson's chi-square test, with p < 0.05 considered significant. A framework model was used to qualitatively analyze free-text responses.

Results

A total of 170 responses were collected, for a response rate of 63%. Most respondents felt that boarding had at least some effect on resident education with 29%, 35%, 18%, and 12% noting “a little,” “a moderate amount,” “a lot,” and “a great deal,” respectively, and 5% noting “no effect at all.” Respondents perceived a negative impact of boarding on resident education and training, with 80% reporting a “somewhat” or “extremely negative” effect, 18% feeling neutral, and 2% noting a “somewhat positive” effect. Most noted a “somewhat” or “extremely negative” effect on resident education in managing ED throughput (70%) and high patient volumes (66%). Fifty-four percent noted a “somewhat” or “extremely negative” impact on being involved in the initial workup of undifferentiated patients. Thirty-two percent saw a “somewhat” or “extremely positive” effect on learning the management of critically ill patients. Qualitative analysis of challenges, mitigation strategies, and resident feedback emphasized the lack of exposure to managing departmental patient flow, impact on bedside teaching, and need for flexibility in resident staffing.

Conclusions

Most PDs agree that boarding negatively affects resident education and identify several strategies to mitigate the impact. These findings can help inform future interventions to optimize resident learning in the complex educational landscape of high ED boarding.

背景在急诊科（ED）寄宿病人可能会影响住院医师的教育。项目主任（PD）对寄宿制对其学员的影响的看法以前还没有描述过。方法我们采用混合方法对急诊科项目主任进行了横向方便抽样调查，以了解他们对寄宿制如何影响住院医师培训的看法。描述性数据以百分比形式报告，差异采用皮尔逊卡方检验（P< 0.05为显著）计算。采用框架模型对自由文本回答进行定性分析。结果共收集到 170 份回复，回复率为 63%。大多数受访者认为寄宿对住院医师教育至少有一些影响，分别有 29%、35%、18% 和 12% 的受访者表示 "有一点"、"适度"、"很多 "和 "很大"，5% 的受访者表示 "完全没有影响"。受访者认为寄宿制对住院医师教育和培训有负面影响，80%的受访者表示 "有点 "或 "非常负面"，18%的受访者表示 "中性"，2%的受访者表示 "有点正面"。大多数人指出，在管理急诊室吞吐量（70%）和高患者量（66%）方面，住院医师教育受到了 "一定程度 "或 "极其负面 "的影响。54%的人认为对参与未分化病人的初步检查有 "一定程度上 "或 "极为不利 "的影响。32%的人认为对学习管理危重病人有 "一些 "或 "极其积极 "的影响。对挑战、缓解策略和住院医师反馈的定性分析强调了住院医师缺乏管理科室患者流程的经验、对床旁教学的影响以及住院医师人员配备需要灵活性。结论大多数住院医师都认为寄宿会对住院医师教育产生负面影响，并提出了几种减轻影响的策略。这些发现有助于为未来的干预措施提供依据，从而在急诊室寄宿率高的复杂教育环境中优化住院医师的学习。

{"title":"Is boarding compromising our residents' education? A national survey of emergency medicine program directors","authors":"Katja Goldflam MD, Cassandra Bradby MD, Ryan F. Coughlin MD, Alexis Cordone MD, Jessica Bod MD, Leah Bright DO, Rebecca Merrill MD, Alina Tsyrulnik MD","doi":"10.1002/aet2.10973","DOIUrl":"https://doi.org/10.1002/aet2.10973","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Boarding patients in the emergency department (ED) potentially affects resident education. Program director (PD) perceptions of the impact of boarding on their trainees have not been previously described.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We surveyed a cross-sectional convenience sample of emergency medicine PDs using a mixed-methods approach to explore their perceptions of how boarding has affected their residents' training. Descriptive data were reported as percentages and differences were calculated using Pearson's chi-square test, with <i>p</i> < 0.05 considered significant. A framework model was used to qualitatively analyze free-text responses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 170 responses were collected, for a response rate of 63%. Most respondents felt that boarding had at least some effect on resident education with 29%, 35%, 18%, and 12% noting “a little,” “a moderate amount,” “a lot,” and “a great deal,” respectively, and 5% noting “no effect at all.” Respondents perceived a negative impact of boarding on resident education and training, with 80% reporting a “somewhat” or “extremely negative” effect, 18% feeling neutral, and 2% noting a “somewhat positive” effect. Most noted a “somewhat” or “extremely negative” effect on resident education in managing ED throughput (70%) and high patient volumes (66%). Fifty-four percent noted a “somewhat” or “extremely negative” impact on being involved in the initial workup of undifferentiated patients. Thirty-two percent saw a “somewhat” or “extremely positive” effect on learning the management of critically ill patients. Qualitative analysis of challenges, mitigation strategies, and resident feedback emphasized the lack of exposure to managing departmental patient flow, impact on bedside teaching, and need for flexibility in resident staffing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Most PDs agree that boarding negatively affects resident education and identify several strategies to mitigate the impact. These findings can help inform future interventions to optimize resident learning in the complex educational landscape of high ED boarding.</p>\u0000 </section>\u0000 </div>","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"8 2","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140556245","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}

引用次数: 0

Personal well-being and professional accountability: Cultural challenges for a new residency program 个人福祉与专业责任：新住院医师培训项目面临的文化挑战

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-04-15 DOI: 10.1002/aet2.10975

Daniel B. Frank MD, Andrew Mastanduono MD, Debby Yanes MD, Lauren Cooke-Sporing DO, MS

引用次数: 0

Psychological safety and perceived organizational support in emergency medicine residencies 急诊医学实习生的心理安全和感知到的组织支持

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-04-13 DOI: 10.1002/aet2.10964

Margaret Goodrich MD, Kerry McCabe MD, Jesse Basford MD, Kimberly Bambach MD, Aaron Kraut MD, Jeffrey N. Love MD, MHPE, MSc

Background

The clinical learning environment (CLE) is a key focus of the Accreditation Council of Graduate Medical Education. It impacts knowledge acquisition and professional development. A previous single-center study evaluated the psychological safety and perceived organizational support of the CLE across different specialties. Building on this work, we explored and evaluated psychological safety and perceived organizational support across multiple heterogeneous emergency medicine (EM) residencies to identify trends and factors affecting perceptions of the CLE.

Methods

Using the Psychological Safety Scale (PSS) and Survey of Perceived Organizational Support (SPOS), residents from seven U.S. EM residencies were surveyed using REDCap software from September through November 2021, with 300 potential respondents. As an adjunct to these surveys, three open-ended questions were included regarding features of their learning environments.

Results

A total of 137 out of 300 residents completed the survey. The overall response rate was 45.7%. There was a variable response rate across programs (26.0%–96.7%). Pooled results demonstrate an overall positive perception of CLEs, based on positive mean responses (i.e., “Members of my department are able to bring up problems and tough issue” had a mean of 4.2 on a 5-point Likert scale). Open responses identified teaching, collegiality, and support from program leadership as supportive features of the CLE. Confrontational interdisciplinary communication, a sense of being devalued, and off-service rotations were identified as threats or areas for improvement to the CLE.

Conclusions

PSS and SPOS scores were generally positive in this multi-institution study, consistent with the prior single-institution study indicating that EM is often considered psychologically safe and supportive. EM training programs can consider using the PSS/SPOS to audit their own programs to identify areas for improvement and foster supportive features already in place.

背景临床学习环境（CLE）是毕业后医学教育认证委员会（Accreditation Council of Graduate Medical Education）关注的重点。它影响着知识获取和专业发展。之前的一项单中心研究评估了不同专科临床学习环境的心理安全性和组织支持感知。在此基础上，我们对多个不同的急诊医学（EM）住院医师进行了心理安全和组织支持感知的探索和评估，以确定影响CLE感知的趋势和因素。方法使用心理安全量表 (PSS) 和感知组织支持调查 (SPOS)，从 2021 年 9 月到 11 月使用 REDCap 软件对来自美国 7 家急诊医学住院医师培训机构的 300 名潜在受访者进行了调查。作为这些调查的补充，还包括三个有关学习环境特点的开放式问题。结果 300 名住院医师中共有 137 人完成了调查。总回复率为 45.7%。不同项目的回复率各不相同（26.0%-96.7%）。汇总结果表明，根据积极的平均回答（即 "我所在科室的成员能够提出问题和棘手的问题"，在 5 点李克特量表中的平均值为 4.2），住院医师对社区学习中心的总体看法是积极的。开放式回答认为，教学、同事关系和项目领导的支持是 CLE 的支持性特征。对抗性的跨学科交流、被贬低的感觉和脱产轮转被认为是对 CLE 的威胁或需要改进的地方。结论在这项多机构研究中，PSS和SPOS评分总体上是积极的，这与之前的单机构研究一致，表明电磁学通常被认为是心理安全和支持性的。电磁培训计划可以考虑使用PSS/SPOS来审核自己的计划，以确定需要改进的地方，并促进已经到位的支持性特征。

{"title":"Psychological safety and perceived organizational support in emergency medicine residencies","authors":"Margaret Goodrich MD, Kerry McCabe MD, Jesse Basford MD, Kimberly Bambach MD, Aaron Kraut MD, Jeffrey N. Love MD, MHPE, MSc","doi":"10.1002/aet2.10964","DOIUrl":"https://doi.org/10.1002/aet2.10964","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The clinical learning environment (CLE) is a key focus of the Accreditation Council of Graduate Medical Education. It impacts knowledge acquisition and professional development. A previous single-center study evaluated the psychological safety and perceived organizational support of the CLE across different specialties. Building on this work, we explored and evaluated psychological safety and perceived organizational support across multiple heterogeneous emergency medicine (EM) residencies to identify trends and factors affecting perceptions of the CLE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using the Psychological Safety Scale (PSS) and Survey of Perceived Organizational Support (SPOS), residents from seven U.S. EM residencies were surveyed using REDCap software from September through November 2021, with 300 potential respondents. As an adjunct to these surveys, three open-ended questions were included regarding features of their learning environments.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 137 out of 300 residents completed the survey. The overall response rate was 45.7%. There was a variable response rate across programs (26.0%–96.7%). Pooled results demonstrate an overall positive perception of CLEs, based on positive mean responses (i.e., “Members of my department are able to bring up problems and tough issue” had a mean of 4.2 on a 5-point Likert scale). Open responses identified teaching, collegiality, and support from program leadership as supportive features of the CLE. Confrontational interdisciplinary communication, a sense of being devalued, and off-service rotations were identified as threats or areas for improvement to the CLE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>PSS and SPOS scores were generally positive in this multi-institution study, consistent with the prior single-institution study indicating that EM is often considered psychologically safe and supportive. EM training programs can consider using the PSS/SPOS to audit their own programs to identify areas for improvement and foster supportive features already in place.</p>\u0000 </section>\u0000 </div>","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"8 2","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140550089","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}

引用次数: 0

“They were very very nice but just not very good”: The interplay between resident–supervisor relationships and assessment in the emergency setting "他们非常非常好，但就是不太好"：急诊环境中住院医师-主管关系与评估之间的相互作用

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-03-25 DOI: 10.1002/aet2.10976

Suzanne Laurin MD, Véronique Castonguay MD, MA(ed), Valérie Dory MD, MMedEd, PhD(ed), Lise Cusson MD, Luc Côté MSW, PhD(ed)

Purpose

Clinical supervisors hesitate to report learner weaknesses, a widely documented phenomenon referred to as “failure to fail.” They also struggle to discuss weaknesses with learners themselves. Their reluctance to report and discuss learner weaknesses threatens the validity of assessment-of-learning decisions and the effectiveness of assessment for learning. Personal and interpersonal factors have been found to act as barriers to reporting learners’ difficulties, but the precise role of the resident–supervisor relationship remains underexplored, specifically in the emergency setting. This study aims to better understand if and how factors related to the resident–supervisor relationship are involved in assessment of and for learning in the emergency setting.

Methods

We conducted a qualitative study, using semistructured interviews of 15 clinical supervisors in emergency medicine departments affiliated with our institution. Transcripts were independently coded by three members of the team using an iterative mixed deductive–inductive thematic analysis approach. The team then synthesized the coding and discussed analysis following guidelines for thematic analysis.

Results

Participating emergency medicine supervisors valued resident–supervisor relationships built on collaboration and trust and believed that such relationships support learning. They described how these relationships influenced assessment of and for learning and how in turn assessment influenced the relationship. Almost all profiles of resident–supervisor relationships in our study could hinder the disclosing of resident weaknesses, through a variety of mechanisms. To protect residents and themselves from the discomfort of disclosing weaknesses and to avoid deteriorating the resident–supervisor relationship, many downplayed or even masked residents’ difficulties. Supervisors who described themselves as able to provide negative assessment of and for learning often adopted a more distant or professional stance.

Conclusions

This study contributes to a growing literature on failure to fail by confirming the critical impact that the resident–supervisor relationship has on the willingness and ability of emergency medicine supervisors to play their part as assessors.

目的临床督导人员在报告学员的弱点时犹豫不决，这种现象被广泛记录在案，称为 "失败的失败"。他们也很难与学习者本人讨论他们的弱点。他们不愿意报告和讨论学习者的弱点，这威胁到了学习评价决策的有效性和学习评价的有效性。研究发现，个人和人际关系因素是报告学员困难的障碍，但住院医师与督导关系的确切作用仍未得到充分探讨，尤其是在急诊环境中。本研究旨在更好地了解与住院医师-督导关系相关的因素是否以及如何参与急诊环境中的学习评估。方法我们采用半结构式访谈的方式，对本机构下属急诊医学科的 15 名临床督导进行了定性研究。研究小组的三名成员采用演绎-归纳混合主题分析法对访谈记录进行独立编码。然后，团队根据主题分析指南对编码进行综合并讨论分析。结果参与研究的急诊医学督导重视建立在合作与信任基础上的住院医师与督导之间的关系，并认为这种关系有助于学习。他们描述了这种关系如何影响对学习的评估和对学习的评估，以及评估如何反过来影响这种关系。在我们的研究中，几乎所有住院医师与督导关系的概况都可能通过各种机制阻碍住院医师披露缺点。为了保护住院医师和住院医师自己，避免因暴露缺点而产生不适感，同时也为了避免恶化住院医师与督导之间的关系，许多督导会淡化甚至掩盖住院医师的困难。那些认为自己能够对住院医师的学习提供负面评价的督导人员，往往会采取一种较为疏远或专业的态度。结论本研究证实了住院医师与督导的关系对急诊科督导发挥其评估者作用的意愿和能力有着至关重要的影响，从而为越来越多关于失败的文献做出了贡献。

{"title":"“They were very very nice but just not very good”: The interplay between resident–supervisor relationships and assessment in the emergency setting","authors":"Suzanne Laurin MD, Véronique Castonguay MD, MA(ed), Valérie Dory MD, MMedEd, PhD(ed), Lise Cusson MD, Luc Côté MSW, PhD(ed)","doi":"10.1002/aet2.10976","DOIUrl":"https://doi.org/10.1002/aet2.10976","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Clinical supervisors hesitate to report learner weaknesses, a widely documented phenomenon referred to as “failure to fail.” They also struggle to discuss weaknesses with learners themselves. Their reluctance to report and discuss learner weaknesses threatens the validity of assessment-of-learning decisions and the effectiveness of assessment for learning. Personal and interpersonal factors have been found to act as barriers to reporting learners’ difficulties, but the precise role of the resident–supervisor relationship remains underexplored, specifically in the emergency setting. This study aims to better understand if and how factors related to the resident–supervisor relationship are involved in assessment of and for learning in the emergency setting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a qualitative study, using semistructured interviews of 15 clinical supervisors in emergency medicine departments affiliated with our institution. Transcripts were independently coded by three members of the team using an iterative mixed deductive–inductive thematic analysis approach. The team then synthesized the coding and discussed analysis following guidelines for thematic analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Participating emergency medicine supervisors valued resident–supervisor relationships built on collaboration and trust and believed that such relationships support learning. They described how these relationships influenced assessment of and for learning and how in turn assessment influenced the relationship. Almost all profiles of resident–supervisor relationships in our study could hinder the disclosing of resident weaknesses, through a variety of mechanisms. To protect residents and themselves from the discomfort of disclosing weaknesses and to avoid deteriorating the resident–supervisor relationship, many downplayed or even masked residents’ difficulties. Supervisors who described themselves as able to provide negative assessment of and for learning often adopted a more distant or professional stance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study contributes to a growing literature on failure to fail by confirming the critical impact that the resident–supervisor relationship has on the willingness and ability of emergency medicine supervisors to play their part as assessors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"8 2","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aet2.10976","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140209594","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}

引用次数: 0

Automated abstraction of information from standard letters of evaluation: A resource for file review and research 从标准评估书中自动抽取信息：档案审查和研究资源

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-03-25 DOI: 10.1002/aet2.10972

Eric Shappell MD, MHPE, Sharon Bord MD, Daniel J. Egan MD, Tiffany Murano MD, Cullen Hegarty MD

引用次数: 0

Depression and associated risk factors among emergency medicine interns: Results from a national longitudinal cohort study 急诊科实习生的抑郁症及相关风险因素：全国纵向队列研究的结果

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-03-25 DOI: 10.1002/aet2.10970

Destiny D. Folk MD, Cortlyn Brown MD, Carrie C. Bissell MD, Lauren A. Fowler PhD

Objective

Despite depression being common in residents, there are no published studies on the prevalence and risk factors for depression in emergency medicine (EM) interns. Our objectives were to explore the prevalence of depression among EM interns and to identify risk factors for depression including sleep, work hours, rotation type, race, ethnicity, sex, and age.

Methods

The Intern Health Study is a national longitudinal cohort study on intern mental health in all specialties. Secondary analysis was performed for EM interns only in this study. Data were collected from 2007 to 2021 and study participants completed a pre–intern year baseline survey and quarterly surveys throughout intern year, which included demographics and information on depressive symptoms, work hours, sleep, and rotation specifics. Depression severity was objectified using the Patient Health Questionnaire (PHQ9) with scores of 10 and higher meeting criteria for moderate to severe depression.

Results

A total of 1123 EM interns completed all surveys. The prevalence of moderate to severe depression among EM interns before starting internship was 4.8%. At Months 3, 6, 9, and 12 of intern year, the prevalence of moderate to severe depression was 17.8%, 20.5%, 20.8%, and 18.8%, respectively. PHQ9 scores were significantly higher at Month 3 of intern year compared to pre–intern year, but there were no differences at subsequent time points during intern year (p < 0.001). Females were more likely to have PHQ9 scores of 10 or above at all time points (p < 0.001). Clinical rotation type had a significant effect on PHQ9 scores, with intensive care unit rotations having a significantly higher PHQ9 score than other rotations (p < 0.001). Pearson's correlation revealed significant weak positive correlations between work hours and PHQ9 at each time point (r = 0.195, 0.200, 0.202, 0.243) and significant weak negative correlations between sleep hours and time off with PHQ9 (−0.162, −0.223, −0.180, −0.178; all p < 0.001).

Conclusions

Many EM interns experience moderate to severe depression. Female EM interns are more likely to be depressed than male interns. Numerous factors influence depression scores for interns, many of which are modifiable.

目的尽管抑郁症在住院医生中很常见，但目前还没有关于急诊医学（EM）实习生抑郁症患病率和风险因素的公开研究。我们的目的是探讨抑郁症在急诊科实习生中的发病率，并确定抑郁症的风险因素，包括睡眠、工作时间、轮转类型、种族、民族、性别和年龄。方法实习生健康研究是一项关于所有专业实习生心理健康的全国性纵向队列研究。本研究只对电磁学实习生进行二次分析。数据收集时间为 2007 年至 2021 年，研究参与者完成了实习前的基线调查和整个实习年的季度调查，调查内容包括人口统计学、抑郁症状、工作时间、睡眠和轮转的具体情况。抑郁严重程度通过患者健康问卷（PHQ9）进行客观评估，10 分及以上为中度至重度抑郁标准。结果共有1123名急诊科实习生完成了所有调查。开始实习前，急诊科实习生中度至重度抑郁症的患病率为 4.8%。在实习年的第3、6、9和12个月，中重度抑郁症的患病率分别为17.8%、20.5%、20.8%和18.8%。与实习前相比，实习年第 3 个月的 PHQ9 分数明显更高，但在实习年的后续时间点上没有差异（P < 0.001）。女性更有可能在所有时间点的 PHQ9 分数都达到或超过 10 分（p < 0.001）。临床轮转类型对 PHQ9 分数有显著影响，重症监护室轮转的 PHQ9 分数明显高于其他轮转（p <0.001）。皮尔逊相关性显示，在每个时间点，工作时间与 PHQ9 之间存在显著的弱正相关（r = 0.195、0.200、0.202、0.243），睡眠时间和休息时间与 PHQ9 之间存在显著的弱负相关（-0.162、-0.223、-0.180、-0.178；所有 p 均为 0.001）。结论许多急诊科实习生患有中度至重度抑郁症。女性急诊科实习生比男性实习生更容易患抑郁症。影响实习生抑郁评分的因素很多，其中许多因素是可以改变的。

{"title":"Depression and associated risk factors among emergency medicine interns: Results from a national longitudinal cohort study","authors":"Destiny D. Folk MD, Cortlyn Brown MD, Carrie C. Bissell MD, Lauren A. Fowler PhD","doi":"10.1002/aet2.10970","DOIUrl":"https://doi.org/10.1002/aet2.10970","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Despite depression being common in residents, there are no published studies on the prevalence and risk factors for depression in emergency medicine (EM) interns. Our objectives were to explore the prevalence of depression among EM interns and to identify risk factors for depression including sleep, work hours, rotation type, race, ethnicity, sex, and age.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The Intern Health Study is a national longitudinal cohort study on intern mental health in all specialties. Secondary analysis was performed for EM interns only in this study. Data were collected from 2007 to 2021 and study participants completed a pre–intern year baseline survey and quarterly surveys throughout intern year, which included demographics and information on depressive symptoms, work hours, sleep, and rotation specifics. Depression severity was objectified using the Patient Health Questionnaire (PHQ9) with scores of 10 and higher meeting criteria for moderate to severe depression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1123 EM interns completed all surveys. The prevalence of moderate to severe depression among EM interns before starting internship was 4.8%. At Months 3, 6, 9, and 12 of intern year, the prevalence of moderate to severe depression was 17.8%, 20.5%, 20.8%, and 18.8%, respectively. PHQ9 scores were significantly higher at Month 3 of intern year compared to pre–intern year, but there were no differences at subsequent time points during intern year (<i>p</i> < 0.001). Females were more likely to have PHQ9 scores of 10 or above at all time points (<i>p</i> < 0.001). Clinical rotation type had a significant effect on PHQ9 scores, with intensive care unit rotations having a significantly higher PHQ9 score than other rotations (<i>p</i> < 0.001). Pearson's correlation revealed significant weak positive correlations between work hours and PHQ9 at each time point (<i>r</i> = 0.195, 0.200, 0.202, 0.243) and significant weak negative correlations between sleep hours and time off with PHQ9 (−0.162, −0.223, −0.180, −0.178; all <i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Many EM interns experience moderate to severe depression. Female EM interns are more likely to be depressed than male interns. Numerous factors influence depression scores for interns, many of which are modifiable.</p>\u0000 </section>\u0000 </div>","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"8 2","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140209593","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}

引用次数: 0

Better together: A multistakeholder approach to developing specialty-wide entrustable professional activities in emergency medicine 更好地合作：以多方参与的方式开展急诊医学专业范围内的可委托专业活动

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-03-25 DOI: 10.1002/aet2.10974

Holly A. Caretta-Weyer MD, MHPE, Stefanie S. Sebok-Syer PhD, Amanda M. Morris MA, Benjamin H. Schnapp MD, MEd, Abra L. Fant MD, MS, Kevin R. Scott MD, MSEd, Matthew Pirotte MD, Michael A. Gisondi MD, Lalena M. Yarris MD, MCR

Purpose

Entrustable professional activities (EPAs) are a widely used framework for curriculum and assessment, yet the variability in emergency medicine (EM) training programs mandates the development of EPAs that meet the needs of the specialty as a whole. This requires eliciting and incorporating the perspectives of multiple stakeholders (i.e., faculty, residents, and patients) in the development of EPAs. Without a shared understanding of what a resident must be able to do upon graduation, we run the risk of advancing ill-prepared residents that may provide inconsistent care.

Methods

In an effort to address these challenges, beginning in February 2020, the authors assembled an advisory board of 25 EM faculty to draft and reach consensus on a final list of EPAs that can be used across all training programs within the specialty of EM. Using modified Delphi methodology, the authors came to consensus on an initial list of 22 EPAs. The authors presented these EPAs to faculty supervisors, residents, and patients for refinement. The authors collated and analyzed feedback from focus groups of residents and patients using thematic analysis. The EPAs were subsequently refined based on this feedback.

Results

Stakeholders in EM residency training endorsed a final revised list of 22 EPAs. Stakeholder focus groups highlighted two main thematic considerations that helped shape the finalized list of EM EPAs: attention to the meaningful nuances of EPA language and contextualizing the EPAs and viewing them developmentally.

Conclusions

To foreground all key stakeholders within the EPA process for EM, the authors chose within the development process to draft; come to consensus; and refine EPAs for EM in collaboration with relevant faculty, patient, and resident stakeholders. Each stakeholder group contributed meaningfully to the content and intended implementation of the EPAs. This process may serve as a model for others in developing stakeholder-responsive EPAs.

目的可委托专业活动（EPAs）是一种广泛使用的课程和评估框架，但急诊医学（EM）培训项目的差异性要求制定的 EPAs 必须满足整个专业的需求。这就要求在制定 EPAs 时征求并采纳多方利益相关者（即教师、住院医师和患者）的观点。如果对住院医师毕业时必须具备的能力缺乏共识，我们就有可能培养出准备不足的住院医师，从而提供不一致的医疗服务。方法为了应对这些挑战，从 2020 年 2 月开始，作者组建了一个由 25 名急诊科教师组成的顾问委员会，以起草一份可用于急诊科专业内所有培训项目的 EPAs 最终清单并达成共识。作者使用修改过的德尔菲方法，就一份包含 22 项 EPA 的初步清单达成了共识。作者将这些 EPA 介绍给教师督导、住院医师和患者，以便对其进行完善。作者采用主题分析法整理并分析了住院医师和患者焦点小组的反馈意见。随后根据这些反馈意见对 EPA 进行了改进。结果急诊科住院医师培训的利益相关者认可了最终修订的 22 项 EPA。利益相关者焦点小组强调了两个主要的专题考虑因素，这有助于形成最终的EM EPAs清单：关注EPA语言的有意义的细微差别，以及EPAs的上下文和从发展的角度看待它们。结论为了使EPA过程中的所有关键利益相关者都能参与其中，作者选择在开发过程中与相关教师、患者和住院医师利益相关者合作起草、达成共识并完善EPA。每个利益相关群体都为 EPAs 的内容和预期实施做出了有意义的贡献。这一过程可作为其他方面制定利益相关者响应型 EPA 的范例。

{"title":"Better together: A multistakeholder approach to developing specialty-wide entrustable professional activities in emergency medicine","authors":"Holly A. Caretta-Weyer MD, MHPE, Stefanie S. Sebok-Syer PhD, Amanda M. Morris MA, Benjamin H. Schnapp MD, MEd, Abra L. Fant MD, MS, Kevin R. Scott MD, MSEd, Matthew Pirotte MD, Michael A. Gisondi MD, Lalena M. Yarris MD, MCR","doi":"10.1002/aet2.10974","DOIUrl":"https://doi.org/10.1002/aet2.10974","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Entrustable professional activities (EPAs) are a widely used framework for curriculum and assessment, yet the variability in emergency medicine (EM) training programs mandates the development of EPAs that meet the needs of the specialty as a whole. This requires eliciting and incorporating the perspectives of multiple stakeholders (i.e., faculty, residents, and patients) in the development of EPAs. Without a shared understanding of what a resident must be able to do upon graduation, we run the risk of advancing ill-prepared residents that may provide inconsistent care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In an effort to address these challenges, beginning in February 2020, the authors assembled an advisory board of 25 EM faculty to draft and reach consensus on a final list of EPAs that can be used across all training programs within the specialty of EM. Using modified Delphi methodology, the authors came to consensus on an initial list of 22 EPAs. The authors presented these EPAs to faculty supervisors, residents, and patients for refinement. The authors collated and analyzed feedback from focus groups of residents and patients using thematic analysis. The EPAs were subsequently refined based on this feedback.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Stakeholders in EM residency training endorsed a final revised list of 22 EPAs. Stakeholder focus groups highlighted two main thematic considerations that helped shape the finalized list of EM EPAs: attention to the meaningful nuances of EPA language and contextualizing the EPAs and viewing them developmentally.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>To foreground all key stakeholders within the EPA process for EM, the authors chose within the development process to draft; come to consensus; and refine EPAs for EM in collaboration with relevant faculty, patient, and resident stakeholders. Each stakeholder group contributed meaningfully to the content and intended implementation of the EPAs. This process may serve as a model for others in developing stakeholder-responsive EPAs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"8 2","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140209592","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}

引用次数: 0

Using the Self-Assessment Feedback Encouragement Direction (SFED) model of feedback/coaching model in academic emergency medicine 在急诊医学学术中使用自我评估反馈鼓励指导（SFED）反馈/指导模式

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-03-22 DOI: 10.1002/aet2.10968

Abbas Husain MD, Christine R. Stehman MD, Meredith Thompson MD, FACEP, Samuel Corbo MD, Sreeja Natesan MD, FACEP

引用次数: 0