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An innovative interprofessional mock trial experience: Collaboration between emergency medicine residency program and law school as a tool to demonstrate medical malpractice litigation 创新的跨专业模拟审判经验:急诊医学住院医师计划和法学院之间的合作,作为展示医疗事故诉讼的工具
IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES Pub Date : 2025-06-11 DOI: 10.1002/aet2.70055
Adaeze Stephanie Onyechi MD, Cedric Dark MD, Vidya Eswaran MD

Background

Due to the nature of the job and healthcare climate, emergency medicine physicians are constantly at risk for malpractice claims. Despite this, there is a gap in education around malpractice litigation. Given the considerable number of curricular topics residency programs must cover in conjunction with the volume of clinical hours residents work, we found that there is a need for an educational experience that is thorough yet compact enough to cause minimal disruption for educators and trainees. We created an easily reproducible educational session featuring collaboration between an emergency medicine residency program and a law school that covers medical malpractice proceedings in a single session.

Methods

We orchestrated a high-fidelity simulation of a mock trial held inside a courtroom with the help of a collaborating judge. Medical residents made up the defendant and plaintiff, while the legal representation was made up of a law student and a recent law graduate. The details of the case were taken from Medmalreviewer.com and was reviewed by participants prior to the simulation.

Results

Learning objectives included: Defining terminology around adverse events, medical errors, and malpractice, Describing the impact of medical errors, and diagraming the process of a medical malpractice lawsuit. Residents reported feeling more comfortable with the litigation process. The law student and recent law school graduate reported gaining a greater appreciation for medical practice in addition to increased confidence communicating with medical professionals.

Conclusions

We believe this educational experience is sustainable and reproducible, thereby is a viable framework for other emergency medicine programs to adopt to introduce trainees to malpractice litigation.

由于工作性质和医疗环境,急诊医师经常面临医疗事故索赔的风险。尽管如此,医疗事故诉讼教育仍存在差距。鉴于住院医师项目必须涵盖相当数量的课程主题以及住院医师的临床工作时数,我们发现需要一种彻底而紧凑的教育体验,以尽量减少对教育者和受训者的干扰。我们创建了一个易于复制的教育课程,以急诊医学住院医师项目和法学院之间的合作为特色,在一次课程中涵盖医疗事故诉讼。方法在一名合作法官的帮助下,我们精心策划了一场高保真模拟法庭内的模拟审判。被告和原告由住院医生组成,而法律代表则由一名法律系学生和一名刚毕业的法律系学生组成。该病例的详细信息来自Medmalreviewer.com,并在模拟之前由参与者审阅。结果学习目标包括:定义不良事件、医疗事故和医疗事故的术语,描述医疗事故的影响,以及绘制医疗事故诉讼的过程。居民们表示,他们对诉讼过程感到更自在了。法律系学生和最近的法学院毕业生报告说,除了增加了与医疗专业人员沟通的信心外,他们对医疗实践也有了更大的欣赏。结论本研究的教学经验具有可持续性和可复制性,为其他急诊医学项目提供了一个可行的框架,可用于向学员介绍医疗事故诉讼。
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引用次数: 0
Association of individual item characteristics with faculty competitiveness rankings in emergency medicine standardized letters of evaluation 急诊医学标准化评价信单项特征与教师竞争力排名的关系
IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES Pub Date : 2025-06-11 DOI: 10.1002/aet2.70009
Jenna Hegarty, Morgan Sehdev MD, Alexis Pelletier-Bui MD, Nicole M. Dubosh MD, Alai Alvarez MD, Caitlin Schrepel MD, Benjamin Schnapp MD, MEd, Sharon Bord MD, Yoon Soo Park PhD, Eric Shappell MD, MHPE

Objective

Our objective was to compare the association between norm-referenced versus criterion-referenced items and faculty consensus ratings of applicant competitiveness based on the two most recent versions of the emergency medicine (EM) standardized letter of evaluation (SLOE).

Methods

Faculty consensus ratings of mock EM SLOE competitiveness were obtained from prior studies of the current (2022) and previous (2016) SLOE formats. Items from each SLOE version were categorized by scope as either (1) focused or (2) global and by their referencing as (1) norm-referenced, (2) criterion-referenced, or (3) mixed. We used a linear regression model to measure the association between individual items and consensus rankings of SLOE competitiveness. We then evaluated which item types were most associated with competitiveness rankings.

Results

Regarding scope, five items were focused and four were global in the 2016 SLOE compared to 11 focused items and two global items in the 2022 SLOE. The 2016 version of the SLOE contained eight norm-referenced items and one criterion-referenced item compared to four criterion-referenced items, two norm-referenced items, and seven mixed items in the 2022 version. Two items were significantly associated with competitiveness rankings in the 2016 SLOE. Both were global in scope and norm-referenced. Only one item was significantly associated with competitiveness rankings in the 2022 SLOE—the global norm-referenced item regarding the anticipated rank position.

Conclusion

Only global norm-referenced items were significantly associated with faculty competitiveness ratings across two versions of the EM SLOE, which place different emphasis on norm-referenced versus criterion-referenced items. If the ability to stratify applicants remains a priority of the EM SLOE, global norm-referenced assessments should continue to be included.

我们的目的是比较基于两个最新版本的急诊医学(EM)标准化评估信(SLOE)的规范参考与标准参考项目和教师对申请人竞争力的共识评级之间的关系。方法从当前(2022年)和之前(2016年)的swe格式的先前研究中获得模拟EM swe竞争力的教师共识评级。来自每个SLOE版本的项目按范围分类为(1)集中的或(2)全局的,并根据它们的引用(1)规范引用,(2)标准引用,或(3)混合的。我们使用线性回归模型来衡量个别项目与企业竞争力共识排名之间的关系。然后,我们评估了哪些项目类型与竞争力排名最相关。在范围方面,2016年SLOE有5个重点项目和4个全球项目,而2022年SLOE有11个重点项目和2个全球项目。2016年版SLOE包含8个标准参考项目和1个标准参考项目,而2022年版SLOE包含4个标准参考项目、2个标准参考项目和7个混合项目。2016年SLOE中有两个项目与竞争力排名显著相关。两者的作用域都是全局的,都是规范引用的。在2022年的sloe中,只有一个项目与竞争力排名显著相关——关于预期排名位置的全球规范参考项目。结论:在两个版本的EM SLOE中,只有全球规范参考项目与教师竞争力评级显著相关,这两个版本对规范参考项目和标准参考项目的重视程度不同。如果对申请人进行分层的能力仍然是EM SLOE的优先事项,则应继续包括全球规范参考评估。
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引用次数: 0
Cross-country coverage: Sibling reflections on emergency medicine from opposite coasts 跨国报道:来自两岸的同胞对急诊医学的反思
IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES Pub Date : 2025-06-11 DOI: 10.1002/aet2.70048
Vanya Zvonar MD, Ivan Zvonar MD
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引用次数: 0
Allotted alonement 分配alonement
IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES Pub Date : 2025-06-11 DOI: 10.1002/aet2.70003
Zhaohui Su PhD
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引用次数: 0
Advancing entrustable professional activities in emergency medicine: A call for Latin American engagement 推进急诊医学领域可信赖的专业活动:呼吁拉丁美洲参与
IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES Pub Date : 2025-05-29 DOI: 10.1002/aet2.70050
Manuel Millán-Hernández, Daniela F. Albarrán-Pérez
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引用次数: 0
Response to “Advancing entrustable professional activities in emergency medicine: A call for Latin American engagement” 对“推进急诊医学领域可信赖的专业活动:呼吁拉丁美洲参与”的答复
IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES Pub Date : 2025-05-29 DOI: 10.1002/aet2.70049
Tim Baker MBBS (Hons), BMedSc (Hons), MClinEd, FACEM, Hannah Beks PhD, MPH, BN, RN, Franco Schreve MbChB, MBA, FACEM, Mary Lawson, Vincent L. Versace PhD, BSc (Hons)
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引用次数: 0
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 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。
{"title":"Differences in language used to describe racial groups in emergency medicine standardized letter of evaluation","authors":"Felisha Gonzalez MD,&nbsp;Laura Welsh MD,&nbsp;Johanna Caicedo MD,&nbsp;Avery Clark MD,&nbsp;Ijeoma M. Okafor MPH,&nbsp;Kerrie P. Nelson PhD,&nbsp;Sula Frausto,&nbsp;Emily C. Cleveland Manchanda MD, MPH","doi":"10.1002/aet2.70054","DOIUrl":"https://doi.org/10.1002/aet2.70054","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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 <i>p</i> = 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 <i>p</i> = 0.030) compared to non-URiM SLOEs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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 (<i>p</i> = 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.</","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085391","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
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 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。
{"title":"Comparison of direct laryngoscopy and digital intubation with and without bougie assistance in novice learners: A simulation-based study","authors":"Bjarni Dagur Bakkmann Thordarson BS,&nbsp;Nils Danielsson MD,&nbsp;Eric Contant MD,&nbsp;Hjalti Mar Bjornsson MD","doi":"10.1002/aet2.70053","DOIUrl":"https://doi.org/10.1002/aet2.70053","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143949972","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
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 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。
{"title":"A nationwide survey of point-of-care ultrasound utilization in academic versus nonacademic general emergency departments","authors":"Catriana R. Thorne,&nbsp;Colin Shaughnessy,&nbsp;Lindsay Adelson MD,&nbsp;David Cannata,&nbsp;Emily Orosco,&nbsp;Katie Rong MD,&nbsp;Regina Kostyun PhD,&nbsp;Meghan Kelly Herbst MD","doi":"10.1002/aet2.70051","DOIUrl":"https://doi.org/10.1002/aet2.70051","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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 <i>U</i>, and unpaired <i>t</i>-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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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 (<i>n</i> = 220) were more likely to own four or more ultrasound machines (54.1%) compared to nonacademic EDs (54.2% owned ≤1, <i>p</i> &lt; 0.001). More physicians performed ultrasound regularly at academic sites (58.7% ± 28.1%) versus nonacademic sites (46.7% ± 27.2%, p &lt; 0.001), but there was no association between recent residency training and ultrasound utilization (<i>r</i> = −0.008, <i>p</i> = 0.875). Academic EDs had stronger workflow integration (OR 3.9, 95% confidence interval [CI] 2.6–5.9, <i>p</i> &lt; 0.001) and were more likely to bill for PoCUS (OR 3.8, 95% CI 2.4–6.0, <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143949971","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
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 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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AEM Education and Training
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