AEM Education and Training最新文献

英文中文

Differences in language used to describe racial groups in emergency medicine standardized letter of evaluation 急诊医学标准化评估信中描述种族群体的语言差异

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2025-05-19 DOI: 10.1002/aet2.70054

Felisha Gonzalez MD, Laura Welsh MD, Johanna Caicedo MD, Avery Clark MD, Ijeoma M. Okafor MPH, Kerrie P. Nelson PhD, Sula Frausto, Emily C. Cleveland Manchanda MD, MPH

Introduction

According to program directors in emergency medicine (EM), the standardized letter of evaluation (SLOE) is the most important component of the EM residency application. Understanding possible biases in SLOE language is critical for an equitable review process. Past studies have shown differences in the way medical students are described in narrative evaluations by race and gender; however, research on SLOE narratives has been limited to gender. This study seeks to evaluate narrative linguistic differences in applicant SLOEs by race.

Methods

This is a narrative analysis of all U.S. MD and DO SLOEs from applicants to the study institution in the 2022 application cycle. We used Linguistic Inquiry and Word Count (LIWC) to complete two analyses. Analysis 1 used frequency of words within 19 categories to evaluate differences between underrepresented minorities in medicine (URiM) and non-URiM applicants and within racial subgroups. Analysis 2 used LIWC to evaluate dichotomous use of 21 key words in these same groups. Linear mixed models were performed for each of the outcomes to evaluate for associations between URiM/non-URiM status or racial subgroup and each outcome.

Results

Of the 809 unique applicants, 18.3% identified as URiM, 57.5% identified as White, 17.4% identified as Asian, 10% identified as Latinx, and 6.3% identified as Black. The analysis revealed applicants who are Black contained on average 0.537 (SE 0.154, Bonferroni-adjusted p = 0.010) percentage points more communal words when compared to White applicant SLOEs. URiM applicants had 0.322 percentage points more communal words (SE 0.102, Bonferroni-adjusted p = 0.030) compared to non-URiM SLOEs.

Conclusion

Applicants who were URiM or Black were more likely to be described with communal words than their peers. URiM applicants had twice the amount of empathic words in their SLOEs when compared to their non-URiM peers; however, this finding did not meet statistical significance (p = 0.053). Our study demonstrates that students who are URiM or Black are more likely to be described with language that, in STEM literature, has been associated with decreased hireability. This pattern may reflect the use of coded language in evaluations, which could hinder advancement of URiM residents and impact diversity in our field. These findings highlight the need for residency program directors and educators to critically examine evaluation language and implement strategies to ensure equitable assessment practices.

根据急诊医学（EM）项目主任的说法，标准化评估信（swe）是急诊医学住院医师申请中最重要的组成部分。理解SLOE语言中可能存在的偏见对于公平的审查过程至关重要。过去的研究表明，在叙事评价中，种族和性别对医学生的描述存在差异；然而，对SLOE叙事的研究一直局限于性别。本研究旨在评估不同种族申请人的语言叙述差异。方法对2022年申请周期中从申请人到研究机构的所有美国MD和DO sloe进行叙述性分析。我们使用语言调查和字数统计（LIWC）来完成两个分析。分析1使用19个类别中的单词频率来评估医学中未被充分代表的少数民族（URiM）和非URiM申请人之间以及种族子群体之间的差异。分析2采用LIWC对同一组中21个关键词的二分法使用情况进行评价。对每个结果进行线性混合模型，以评估URiM/非URiM状态或种族亚组与每个结果之间的关系。结果在809个独特的申请人中，18.3%被确定为URiM， 57.5%被确定为白人，17.4%被确定为亚洲人，10%被确定为拉丁裔，6.3%被确定为黑人。分析显示，与白人申请者相比，黑人申请者的公共词汇平均多出0.537个百分点（SE 0.154，经bonferroni调整p = 0.010）。与非URiM的sloe相比，URiM申请者的公共词汇多出0.322个百分点（SE 0.102, Bonferroni-adjusted p = 0.030）。结论：与同龄人相比，白人或黑人申请者更容易被描述为有共同语言的人。与非URiM的同龄人相比，URiM的申请者在他们的记忆中有两倍的移情词；然而，这一发现没有统计学意义（p = 0.053）。我们的研究表明，在STEM文献中，白人或黑人学生更有可能被描述为与就业能力下降有关的语言。这种模式可能反映了在评估中使用编码语言，这可能会阻碍URiM居民的进步并影响我们领域的多样性。这些发现强调了住院医师项目主管和教育工作者需要严格审查评估语言并实施策略以确保公平的评估实践。

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引用次数: 0

Comparison of direct laryngoscopy and digital intubation with and without bougie assistance in novice learners: A simulation-based study 直接喉镜检查和数字插管的比较，在新手学习者有和没有帮助：模拟为基础的研究

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2025-05-14 DOI: 10.1002/aet2.70053

Bjarni Dagur Bakkmann Thordarson BS, Nils Danielsson MD, Eric Contant MD, Hjalti Mar Bjornsson MD

Background

Endotracheal (ET) intubation is a common emergency procedure generally done with direct laryngoscopy (DL). Digital intubation (DI), which uses blind finger guidance to manipulate the ET tube, is rarely used but is useful if secretions block the view or a laryngoscope is not available. DI can also be done bougie-assisted. This study aimed to compare three different approaches to intubation in simulation.

Methods

Medical students without prior airway training were invited to participate in this simulation study on an airway manikin. Participants viewed brief instructional videos on three different methods—DL, DI, and bougie-assisted DI—and performed three attempts with each method in a randomized order. Data were collected for the rate of successful intubations, the timing to intubation, and dental trauma.

Results

Fifty-one medical students performed 459 attempts at intubation on a manikin. On the third attempt, the trachea was successfully intubated in 65% of the attempts using DL, 53% with DI, and 90% with bougie-assisted DI. At the last attempt, the time to intubation was 35 (±16) s for DL, 28 (±10) s with DI, and 44 (±30) s with bougie-guided DI. Dental trauma was less frequent with DI.

Conclusion

Ninety percent of medical students successfully intubated a manikin on the third attempt when using a bougie to guide DI. A bougie-guided DI could be more likely to result in successful ET intubation than DL for those without sufficient training.

背景气管内插管是一种常见的急诊手术，通常通过直接喉镜检查（DL）完成。数字插管（DI），使用盲人手指引导操作ET管，很少使用，但在分泌物阻塞视野或喉镜不可用时是有用的。DI也可以在bougie辅助下完成。本研究旨在比较模拟中三种不同的插管方法。方法邀请未受过气道训练的医学生参与气道人体模型的模拟研究。参与者观看了三种不同方法的简短教学视频——dl、DI和bougie辅助DI，并按随机顺序对每种方法进行了三次尝试。收集了插管成功率、插管时间和牙外伤的数据。结果51名医学生对人体进行了459次插管。第三次插管时，65%的插管成功率为DL， 53%为DI， 90%为bougie辅助DI。最后一次插管时，DL组插管时间为35（±16）s， DI组为28（±10）s， bougge引导DI组插管时间为44（±30）s。牙外伤发生率较低。结论：90%的医学生在第三次尝试时成功地插管了假人。对于那些没有充分训练的患者，bougge引导下的DI比DL更有可能导致ET插管成功。

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引用次数: 0

A nationwide survey of point-of-care ultrasound utilization in academic versus nonacademic general emergency departments 一项全国范围内学术与非学术普通急诊科即时超声使用的调查

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2025-05-14 DOI: 10.1002/aet2.70051

Catriana R. Thorne, Colin Shaughnessy, Lindsay Adelson MD, David Cannata, Emily Orosco, Katie Rong MD, Regina Kostyun PhD, Meghan Kelly Herbst MD

Objective

Despite mandatory point-of-care ultrasound (PoCUS) training in residency, utilization varies across emergency departments (EDs). We sought to characterize PoCUS utilization patterns in the United States, specifically comparing academic to nonacademic settings.

Methods

A nationwide cross-sectional survey was conducted from March to November 2024, targeting general EDs open 24/7. Site directors completed a 15-question survey on PoCUS use, workflow, and billing. Academic EDs (those with emergency medicine residents or ultrasound fellows) were compared to nonacademic EDs. Regular PoCUS use for a physician was defined as using two or more applications at least once per week; regular PoCUS use for an application was defined as at least one scan per week. A strong workflow required image storage to Picture Archiving and Communication System/Middleware and physician review. Differences in PoCUS utilization, workflow, and billing were analyzed using chi-square, Mann–Whitney U, and unpaired t-tests. Correlations between study variables and ED academic status were assessed using Pearson's and Spearman's coefficients. Odds ratios (ORs) measured the strength of associations.

Results

Of 664 invited EDs (15.3% of all U.S. EDs), 423 completed surveys (63.8% response rate) from all 50 states and Washington, DC. Academic EDs (n = 220) were more likely to own four or more ultrasound machines (54.1%) compared to nonacademic EDs (54.2% owned ≤1, p < 0.001). More physicians performed ultrasound regularly at academic sites (58.7% ± 28.1%) versus nonacademic sites (46.7% ± 27.2%, p < 0.001), but there was no association between recent residency training and ultrasound utilization (r = −0.008, p = 0.875). Academic EDs had stronger workflow integration (OR 3.9, 95% confidence interval [CI] 2.6–5.9, p < 0.001) and were more likely to bill for PoCUS (OR 3.8, 95% CI 2.4–6.0, p < 0.001).

Conclusion

PoCUS utilization is lower in nonacademic EDs, with suboptimal workflows and fewer billing practices. Addressing these disparities may enhance PoCUS implementation and improve patient care.

目的：尽管住院医师对超声（PoCUS）进行了强制性培训，但急诊部门（ed）对其的使用情况各不相同。我们试图描述PoCUS在美国的使用模式，特别是比较学术和非学术环境。方法于2024年3月至11月，在全国范围内对24小时开放的普通急诊科进行横断面调查。站点主管完成了一项关于PoCUS使用、工作流程和计费的15个问题的调查。学术性急诊科（急诊住院医师或超声研究员）与非学术性急诊科进行比较。医师的常规PoCUS使用定义为每周至少使用两次或两次以上；应用程序的常规PoCUS使用定义为每周至少一次扫描。一个强大的工作流需要图像存储到图像存档和通信系统/中间件和医生审查。使用卡方检验、Mann-Whitney U检验和非配对t检验分析PoCUS利用率、工作流程和计费的差异。使用Pearson和Spearman系数评估研究变量与ED学术地位之间的相关性。优势比（ORs）测量了关联的强度。结果在664位受邀的EDs（占美国所有EDs的15.3%）中，来自50个州和华盛顿特区的423位完成了调查（63.8%的回复率）。与非学术急诊科（54.2%拥有≤1台，p < 0.001）相比，学术急诊科（n = 220）更有可能拥有4台或更多超声仪（54.1%）。与非学术机构（46.7%±27.2%,p < 0.001）相比，更多的医生定期在学术机构（58.7%±28.1%）进行超声检查，但近期住院医师培训与超声使用之间没有关联（r = - 0.008, p = 0.875）。学术部门的EDs具有更强的工作流程整合（OR为3.9,95%可信区间[CI] 2.6-5.9, p < 0.001），并且更有可能为PoCUS付费（OR为3.8,95% CI为2.4-6.0,p < 0.001）。结论：非学术性急诊科的PoCUS使用率较低，工作流程不理想，计费实践较少。解决这些差异可能会加强PoCUS的实施并改善患者护理。

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引用次数: 0

The effects of overcrowding, boarding, and physician-in-triage on resident education: A scoping review 过度拥挤、寄宿和医生分诊对住院医师教育的影响：一项范围审查

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2025-05-13 DOI: 10.1002/aet2.70040

Jeffery Hill MD, MEd, Grace Hickam MD, MEHP, Jazmyn Shaw MD, Joel Moll MD, John W. Cyrus MLIS, Sally A. Santen MD, PhD, Michael Gottlieb MD

Background

Emergency department (ED) overcrowding and boarding has been shown to have negative effects on patient care. However, there has been less focus on the effects of overcrowding and boarding on resident education.

Methods

We conducted a scoping review to map the current literature on the educational effects of ED overcrowding, summarizing the current research findings and identifying gaps for future research. We sought to answer (1) How is overcrowding defined by individual studies? (2) What educational outcomes have been studied in overcrowding and how have they been measured? (3) What are the educational effects of physician-in-triage (PIT) care models? (4) What educational responses have been initiated in response to ED overcrowding? and (5) What are the effects of those educational responses? We searched Medline, Embase, ERIC, MedEdPortal, Web of Science, and Google Scholar. Two authors independently extracted data. All authors performed quantitative and qualitative synthesis, consistent with best practice recommendations for scoping reviews.

Results

The initial search strategy identified 2570 articles, with 14 articles meeting inclusion criteria. The literature found perceptions of a negative impact of overcrowding and boarding on resident education. However, these negative perceptions have not consistently translated to demonstrably negative educational outcomes. Educational outcomes assessed include measures of resident productivity, procedural experience, in-training examination scores, and perceived measures of teaching quality and educational value. Several studies assessed the impact of PIT models finding changes in the type and volume of patients seen by residents as a result.

Conclusions

This scoping review summarizes the existing literature assessing the educational impact of ED overcrowding and boarding as well as PIT models. The review provides context and insights for future research into these effects.

急诊科（ED）过度拥挤和登机已被证明对病人护理有负面影响。然而，对过度拥挤和寄宿对居民教育的影响的关注较少。方法对ED过度拥挤对教育影响的现有文献进行了范围综述，总结了目前的研究成果，并确定了未来研究的差距。我们试图回答(1)个体研究如何定义过度拥挤？(2)在过度拥挤的情况下，研究了哪些教育成果？如何衡量这些成果？(3)医师分诊（PIT）护理模式的教育效果如何？(4)针对急诊科人满为患的情况，当局采取了哪些教育措施？(5)这些教育反应的影响是什么？我们搜索了Medline， Embase， ERIC, MedEdPortal， Web of Science和b谷歌Scholar。两位作者独立提取数据。所有作者都进行了定量和定性综合，与范围审查的最佳实践建议一致。结果初始检索策略共筛选到2570篇文献，其中14篇符合纳入标准。文献发现过度拥挤和寄宿对居民教育的负面影响。然而，这些负面看法并没有始终转化为明显的负面教育成果。评估的教育成果包括住院医师生产力、程序经验、培训考试分数以及教学质量和教育价值的感知指标。几项研究评估了PIT模型的影响，结果发现住院医生看到的患者类型和数量发生了变化。本综述总结了现有的评估ED过度拥挤和寄宿以及PIT模型对教育影响的文献。这篇综述为未来对这些影响的研究提供了背景和见解。

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引用次数: 0

Evaluating the role of traditional and nontraditional educational resources in point-of-care ultrasound training: A cross-sectional survey of educator preferences and practices 评估传统和非传统教育资源在现场超声培训中的作用：教育者偏好和实践的横断面调查

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2025-05-08 DOI: 10.1002/aet2.70039

Arthur Broadstock MD, Annahieta Kalantari DO, MEd, Almaz S. Dessie MD, Al’ai Alvarez MD, Resa E. Lewiss MD, Josie Acuna MD, Anthony Weekes MD, MSc, Kaylah Maloney MD, Uwe Stolz PhD, MPH, Lori Stolz MD, Aalap Shah MD

Background

Recently, nontraditional educational resources like podcasts, blogs, and online media have gained prominence in medical education and are abundant within the field of point-of-care ultrasound (POCUS). However, the extent to which POCUS educators utilize online resources compared to traditional resources, like textbooks, journal articles, and in-person workshops, is unknown. We aim to define which types of educational resources are used and preferred by POCUS educators to teach trainees.

Methods

An expert working group developed a survey aimed to characterize the types of materials used by POCUS educators and their perceived importance on a 6-point forced ranking scale. We administered the survey to POCUS educators at the 2023 Society for Clinical Ultrasound Fellowships conference. Responses were analyzed using random-effects regression analyses.

Results

Sixty-two participants completed the questionnaire. In-person workshops (mean importance 5.1, 95% confidence interval [CI] 4.8–5.4) and online media (mean importance 4.8, 95% CI 4.4–5.1) were ranked as the most important resources for POCUS education overall, though not statistically different from each other (p > 0.001). Journal articles (mean importance 3.4, 95% CI 2.2–4.6), eBooks (mean importance 2.9, 95% CI 1.4–4.4), and podcasts (mean importance 2.8, 95% CI 1.5–4.1) were found to be of moderate importance and were not statistically different from each other. Respondents reported that textbooks were of least importance (mean importance 2.1, 95% CI 0.7–3.5).

Conclusions

POCUS educators view nontraditional educational materials with great importance, though in-person workshops remain the mainstay of POCUS education. POCUS educators utilize nontraditional educational materials and consider them more important than textbooks within POCUS curricula.

最近，非传统的教育资源，如播客、博客和在线媒体在医学教育中获得了突出的地位，并且在护理点超声（POCUS）领域中非常丰富。然而，与传统资源（如教科书、期刊文章和面对面研讨会）相比，POCUS教育者利用在线资源的程度尚不清楚。我们的目标是确定POCUS教育者使用和首选的教育资源类型来教授学员。方法一个专家工作组开展了一项调查，旨在描述POCUS教育者使用的材料类型及其在6分强制排名量表上的重要性。我们在2023年临床超声学会会议上对POCUS的教育工作者进行了调查。采用随机效应回归分析对反应进行分析。结果共62人完成问卷调查。面对面研讨会（平均重要性5.1,95%可信区间[CI] 4.8 - 5.4）和在线媒体（平均重要性4.8,95% CI 4.4-5.1）被列为POCUS教育总体上最重要的资源，尽管彼此之间没有统计学差异（p > 0.001）。期刊文章（平均重要性3.4,95% CI 2.2-4.6）、电子书（平均重要性2.9,95% CI 1.4-4.4）和播客（平均重要性2.8,95% CI 1.5-4.1）被认为具有中等重要性，彼此之间没有统计学差异。受访者报告说教科书是最不重要的（平均重要性2.1,95% CI 0.7-3.5）。结论POCUS教育工作者非常重视非传统的教育材料，尽管面对面的研讨会仍然是POCUS教育的主要形式。POCUS教育者利用非传统的教育材料，并认为它们比POCUS课程中的教科书更重要。

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引用次数: 0

Procedural skill retention in transvenous pacer placement among emergency medicine physician trainees 急诊医师实习生经静脉起搏器放置的程序技能保留

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2025-05-08 DOI: 10.1002/aet2.70042

Christopher D. Thom MD RDMS, Kathryn Mutter MD, James Martindale PhD, Vanessa Khoury MD, Margaret Sande MD

Background

Transvenous cardiac pacing (TVP) is a life-saving intervention that is infrequently performed in emergency medicine (EM). While competency can be achieved through dedicated procedural training, the longevity of skill retention in TVP placement has not been well demonstrated. Our study sought to assess retention of procedural skills among EM resident physicians following an immersive TVP training simulation.

Methods

EM residents at a single academic tertiary care center participated in an immersive TVP training session using a high-fidelity simulator. The paradigm of deliberate practice was used to establish competency in the procedure, which was defined by success on a previously published checklist. Immediately following the training, each resident was tested on the checklist and a Global Rating Scale (GRS; 0–100). Three faculty raters assessed resident performance on these instruments. Inter-rater reliability (IRR) was assessed using the intraclass correlation coefficient. Competency in TVP placement skill retention was then reassessed at 3 months. The paired-samples t-test was used to evaluate the difference in performance between the time intervals.

Results

Thirty-one EM resident physicians participated in the study, with 25 completing the 3-month follow-up assessment. Immediately following the workshop, the mean (±SD) score on the 0–30 checklist was 29.7 (±0.51), while the mean score on the GRS was 98.3 (±1.9). At 3-month follow-up, the mean (±SD) score on the checklist decreased to 21.6 (±5; p < 0.001), and GRS was 75.4 (±19.7; p < 0.001). IRR between raters was 0.81 for the GRS and 0.75 for the checklist score, indicating excellent agreement.

Conclusions

Decay of skills in transvenous pacemaker placement was apparent at 3 months following initial baseline competency demonstration after an immersive training session. These findings may help inform TVP procedural teaching frequency for EM resident trainees.

背景经静脉心脏起搏（TVP）是一种抢救生命的干预措施，在急诊医学（EM）中很少实施。虽然能力可以通过专门的程序性培训获得，但在TVP安置中技能保留的寿命并没有得到很好的证明。我们的研究旨在评估急诊住院医师在沉浸式TVP模拟培训后的程序技能保留情况。方法在一个单一的学术三级医疗中心，EM居民使用高保真模拟器参加沉浸式TVP培训课程。刻意练习的范例被用来建立程序中的能力，这是由先前公布的检查表上的成功来定义的。培训结束后，每位住院医生立即接受检查表和全球评分量表(GRS；0 - 100)。三位教员评价员评估了住院医师在这些工具上的表现。等级间信度（IRR）采用等级内相关系数评估。然后在3个月时重新评估TVP安置技能保留的能力。使用配对样本t检验来评估时间间隔之间的性能差异。结果31名急诊住院医师参与了研究，其中25名完成了为期3个月的随访评估。工作坊结束后，0-30分的平均（±SD）得分为29.7（±0.51）分，GRS的平均得分为98.3（±1.9）分。在3个月的随访中，检查表上的平均（±SD）评分降至21.6分(±5分；p < 0.001)， GRS为75.4(±19.7；p < 0.001)。评分者对GRS评分的IRR为0.81，对检查表评分的IRR为0.75，表明非常一致。结论：在沉浸式训练后的初始基线能力论证后3个月，经静脉放置起搏器的技能衰退是明显的。这些发现可能有助于为急诊住院实习医师提供TVP程序教学频率。

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引用次数: 0

Beyond diversity recruitment: Next steps to ensure that underrepresented emergency medicine residents thrive 多元化招聘之外：确保代表性不足的急诊住院医师茁壮成长的下一步措施

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2025-05-08 DOI: 10.1002/aet2.70037

Rosemarie Diaz MD, MPH, Adam McFarland MD, Ryan Tsuchida MD, Tanesha Beckford MD, Sandra Coker MD, Jeremy Collado MD, Arthur Pope MD, PhD, Jeffrey I. Schneider MD, Alden Landry MD, MPH, Teresa Y. Smith MD, MSEd, Jessica Faiz MD, MS

A diverse workforce in emergency medicine (EM) aims to improve patient care by addressing racism in health care, increasing representation in medicine, and improving the quality of training for all residents. Many EM residency programs have launched recruitment efforts to attract residents from diverse backgrounds. However, recruitment efforts only represent the first step in building a culturally responsible workforce. Trainees who are underrepresented in medicine must be welcomed into an inclusive training environment that has been thoughtfully constructed before they arrive. This type of supportive environment can be achieved by shifting away from majority-serving ideals and building an informed infrastructure that functions to help all trainees succeed. We expand upon challenges and areas of opportunity at the individual, departmental, and institutional levels and describe common pitfalls when trying to create inclusive spaces for residents including lack of vision alignment, inadequate financial investment, and performative allyship. We also propose strategies that focus specifically on actionable changes that residency program, departmental, and institutional leadership can implement to mitigate these challenges.

急诊医学（EM）的多元化劳动力旨在通过解决医疗保健中的种族主义问题、增加医学代表性和提高所有居民的培训质量来改善患者护理。许多新兴市场住院医师项目已经启动了招聘工作，以吸引来自不同背景的住院医师。然而，招聘工作只是建立一支具有文化责任感的员工队伍的第一步。在医学领域代表性不足的受训者必须被欢迎进入一个包容性的培训环境，这个环境在他们到来之前就已经经过深思熟虑的构建。这种支持性的环境可以通过改变为多数人服务的理想，建立一个知情的基础设施来帮助所有受训者取得成功。我们扩展了个人、部门和机构层面的挑战和机遇领域，并描述了在试图为居民创造包容性空间时常见的陷阱，包括缺乏愿景一致性、财政投资不足和绩效同盟。我们还提出了一些策略，专门针对住院医师计划、部门和机构领导层可以实施的可操作变化，以减轻这些挑战。

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引用次数: 0

Trends in parallel application to emergency medicine residency between 2009 and 2023 2009 - 2023年急诊医学住院医师平行申请趋势

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2025-05-08 DOI: 10.1002/aet2.70043

Udoka Oji MD, Samuel Bunting MD, Nitin Vidyasagar BS, Emily Jameyfield MD, MHPE, Paul Kukulski MD, MHPE

Objectives

The residency match can be a stressful and costly period for applicants. A notable portion of applicants choose to apply to multiple specialties during the residency match process, known as “parallel applying.” This study investigated the trends in parallel applications among emergency medicine (EM) residency applicants from 2009 to 2023.

Methods

This is a retrospective analysis on data obtained from the Association of American Medical Colleges (AAMC) Electronic Residency Application System (ERAS). The data set comprised applicants who applied either exclusively to EM or to EM in combination with other specialties. Variables analyzed included the number of applications submitted and the frequency of parallel applications across different applicant groups including international medical graduates (IMGs), U.S. international medical graduates (USIMGs), and graduates from U.S. allopathic and osteopathic institutions.

Results

The study included 64,095 applicant records corresponding to 57,572 unique individuals. The percentage of applicants to EM residency parallel applying decreased between 2009 (62.0%) and 2020 (43.0%) but subsequently increased through 2023 (62.6%). The total number of applications submitted by both single-specialty and parallel applicants increased over the same period. The mean number of applications to EM programs by parallel applicants rose significantly, reflecting a broader trend of increasing application volumes across all applicant groups while the proportion of applications that were to EM programs decreased, especially following 2021.

Conclusions

The trend of parallel applying among EM residency applicants slowly decreased from 2009 to 2021 and then increased through 2023, with the trend largely driven by an increase in the proportion of IMG applicants who were parallel applying. Understanding the motivations and impacts of parallel applications is crucial for developing strategies to support applicants and improve the matching process. Further research is needed to explore the factors influencing these trends and to inform policy and advising practices in medical education.

对申请人来说，实习匹配可能是一个压力大、成本高的阶段。在住院医师匹配过程中，相当一部分申请人选择申请多个专业，称为“并行申请”。本研究调查了2009年至2023年急诊医学（EM）住院医师申请人平行申请的趋势。方法回顾性分析美国医学院协会（AAMC）电子住院医师申请系统（ERAS）的数据。数据集包括专门申请EM或EM与其他专业结合的申请人。分析的变量包括提交的申请数量和不同申请人群体平行申请的频率，包括国际医学毕业生（IMGs）、美国国际医学毕业生（USIMGs）和来自美国对抗疗法和整骨疗法机构的毕业生。结果该研究包括64,095个申请人记录，对应57,572个独特的个体。在2009年（62.0%）至2020年（43.0%）期间，平行申请新兴市场居留权的申请人比例有所下降，但随后上升至2023年（62.6%）。同一时期，单一专业和平行专业申请人提交的申请总数均有所增加。平行申请人对新兴市场项目的平均申请数量显著增加，反映了所有申请人群体的申请数量增加的更广泛趋势，而新兴市场项目的申请比例下降，尤其是在2021年之后。从2009年到2021年，新兴市场居民申请人的平行申请趋势缓慢下降，然后在2023年增加，这一趋势主要是由IMG申请人平行申请比例的增加所驱动的。了解并行申请的动机和影响对于制定支持申请人和改进匹配过程的策略至关重要。需要进一步研究以探索影响这些趋势的因素，并为医学教育的政策和实践提供信息和建议。

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引用次数: 0

Emergency departments are part of the maternal health solution: Findings from piloting an educational toolkit in Illinois 急诊科是孕产妇保健解决方案的一部分：伊利诺伊州试点教育工具包的结果

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2025-05-08 DOI: 10.1002/aet2.70046

Katherine A. Craemer MPH, Lauren Sayah MPH, Emilie Glass-Riveros MA, Cara J. Bergo PhD, Autumn Mels DNP, Roma Allen DNP, Diedra Stewart MSN, Stacie E. Geller PhD

Background

In Illinois, an average of 88 pregnant and postpartum individuals died annually from 2018 to 2020. Of these, 66% had at least one emergency department (ED) visit. To improve maternal health outcomes, the Illinois Maternal Mortality Review Committees recommended ED education on obstetric care, mental health conditions, and substance use disorders (SUD).

Methods

From January 1, 2023, to June 30, 2024, the Maternal Health Emergency Department Toolkit (Toolkit) training was piloted in six diverse Illinois hospitals. The Toolkit's effectiveness was evaluated using electronic medical record (EMR) data to assess changes in practice within the ED.

Results

A total of 281 (63%) ED providers and staff completed the training. From pre- to post-pilot, EMR documentation of pregnancy or postpartum status in female patients of reproductive age increased from 56.4% to 83.4%, and screening pregnant and postpartum patients for mental health or SUD rose from 52.2% to 69.6%.

Conclusions

The Toolkit is an evidence-based training of educational modules that led to positive changes in ED provider and staff's practice when caring for pregnant and postpartum patients. By fostering education, engagement, and collaboration, the Toolkit has the potential to play a key role in helping reduce maternal mortality and morbidity in Illinois. The Toolkit is now available statewide for all Illinois EDs.

在伊利诺伊州，从2018年到2020年，每年平均有88名孕妇和产后死亡。其中，66%至少有一次急诊就诊。为了改善孕产妇健康结果，伊利诺伊州孕产妇死亡率审查委员会建议对产科护理、精神健康状况和物质使用障碍（SUD）进行ED教育。方法从2023年1月1日至2024年6月30日，在伊利诺伊州6家不同医院开展孕产妇保健急诊科工具包（Toolkit）培训试点。使用电子病历（EMR）数据评估工具包的有效性，以评估急诊科内实践的变化。结果共有281名（63%）急诊科提供者和工作人员完成了培训。从试点前到试点后，女性育龄患者妊娠或产后状态的EMR记录从56.4%增加到83.4%，对孕妇和产后患者进行心理健康或SUD筛查从52.2%增加到69.6%。结论：该工具包是一个基于证据的教育模块培训，在护理孕妇和产后患者时，ED提供者和工作人员的做法发生了积极的变化。通过促进教育、参与和合作，该工具包有可能在帮助降低伊利诺伊州孕产妇死亡率和发病率方面发挥关键作用。该工具包现在适用于伊利诺斯州的所有急诊科。

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引用次数: 0

A primer on creating a rank order list for medical students applying to residency 为申请住院医师的医学生创建排序列表的入门

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2025-05-08 DOI: 10.1002/aet2.70052

Adaira I. Landry MD, MEd, Wendy Coates MD, Michael Gottlieb MD

In 2024, over 50,000 applicants submitted their rank order list (ROL) to the National Resident Matching Program (NRMP, The Match), which uses these rankings to match candidates with residency programs. Recent years have shown that many applicants find emergency medicine (EM) a desired speciality. In 2024 and 2025, 95% and 98% of EM residency spots were filled, respectively. To match, applicants must understand every aspect of the application process, including rank order strategies. The ROL is an essential step in the residency application process where applicants rank programs based on personal and professional priorities. Applicants weigh both tangible factors—such as program size, location, and salary—and intangible factors—such as work–life balance, faculty support, and the overall “feel” of a program. Virtual interviews have limited opportunities to assess both tangible and intangible factors hindering the more comprehensive evaluation EM applicants previously had with in-person interviews. We offer strategic advice to medical students and their mentors, on an approach to creating a ROL, evaluating the intangible and tangible aspects of each program, additional considerations for less common scenarios, and effective communication with program directors.

2024年，超过50,000名申请人向国家居民匹配计划（NRMP, the Match）提交了他们的排名名单（ROL），该计划使用这些排名来匹配候选人与居住计划。近年来，许多申请者发现急诊医学（EM）是一个理想的专业。2024年和2025年，分别有95%和98%的新兴市场住院医师名额被填补。为了匹配，申请人必须了解申请过程的各个方面，包括排名策略。ROL是居留申请过程中必不可少的一步，申请人根据个人和专业优先级对项目进行排名。申请人既要考虑有形因素——比如项目规模、地点和薪水，也要考虑无形因素——比如工作与生活的平衡、教员的支持和项目的整体“感觉”。虚拟面试评估有形和无形因素的机会有限，这些因素阻碍了EM申请人以前通过面对面面试进行更全面的评估。我们为医学生和他们的导师提供战略建议，包括创建ROL的方法、评估每个项目的无形和有形方面、对不常见情况的额外考虑以及与项目主管的有效沟通。

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