AEM Education and Training最新文献_第9页

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。

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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。

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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

SAEM systematic online academic resource (SOAR) review: Gastrointestinal illnesses SAEM 系统性在线学术资源 (SOAR) 回顾：胃肠道疾病

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-03-22 DOI: 10.1002/aet2.10954

Lisa Zhao MD, Sabrina Tom MD, Neil Patel MD, Patricia Fermin MD, Ryan Pedigo MD, Shirley Whiinh Bae MD, JooYeon Jung MD, Teresa Chan MD, MHPE, MBA, Jonie Hsiao MD

Background and Objectives

Free open access medical education (FOAM) has become an essential tool for emergency medicine (EM) education and can be valuable to clinicians as a point-of-care resource. The development of the revised Medical Education Translational Resources Impact and Quality (rMETRIQ) tool provides a standardized means of quality assessment. Previous entries of the Society for Academic Emergency Medicine systematic online academic resource (SOAR) series have focused on renal, endocrine, and sickle cell disorders. In this iteration, we strive to identify, curate, and describe FOAM topics specific to acute gastrointestinal (GI) illnesses.

Methods

We searched 389 keywords across 11 GI topics that were modified from the 2019 Model of the Clinical Practice of EM (EM Model) using the search engine Google FOAM and within the top 50 websites listed on Academic Life in Emergency Medicine's Social Media Index. The sites underwent preliminary screening to eliminate resources that were not relevant to EM or GI illnesses. Identified resources were evaluated with the rMETRIQ tool by five board-certified EM physicians who received rMETRIQ tool rater training.

Results

After duplicates of the initial 39,505 resources were eliminated, 8059 remained. Primary screening resulted in a final 1202 resources. The most common categories were large bowel (18%), small bowel (13%), stomach (11%), esophagus (11%), biliary (11%), and liver (10%). Many resources covered multiple topics and subtopics. The final mean intraclass correlation coefficient among the five physicians was 0.95 (95% CI 0.92–0.98) for rMETRIQ scoring. We identified 256 sites considered “high quality” with a rMETRIQ score of 16 or higher as designated in prior reviews.

Conclusions

This iteration of the SOAR review resulted in the highest number of high-quality resources compared to other SOAR reviews, with 21% of resources thus far scoring ≥ 16. A final list of high-quality resources can guide trainees, educator recommendations, and FOAM authors.

背景与目标免费开放医学教育（FOAM）已成为急诊医学（EM）教育的重要工具，并可作为临床医生的宝贵资源。经修订的医学教育转化资源影响与质量（rMETRIQ）工具为质量评估提供了标准化手段。急诊医学学术学会系统性在线学术资源（SOAR）系列的前几期主要关注肾脏、内分泌和镰状细胞疾病。在这次迭代中，我们将努力识别、整理和描述急性胃肠道疾病（GI）特有的 FOAM 主题。方法我们使用谷歌 FOAM 搜索引擎，在急诊医学学术生活社交媒体索引列出的前 50 个网站中搜索了 11 个胃肠道主题中的 389 个关键词，这些主题是根据 2019 年急诊医学临床实践模型（EM 模型）修改而来的。这些网站经过初步筛选，剔除了与急诊医学或消化道疾病无关的资源。由五名接受过 rMETRIQ 工具评测员培训的经董事会认证的急诊科医生使用 rMETRIQ 工具对确定的资源进行评估。结果在剔除了最初的 39,505 个重复资源后，还剩下 8059 个。初筛最终得到了 1202 个资源。最常见的类别是大肠（18%）、小肠（13%）、胃（11%）、食道（11%）、胆道（11%）和肝脏（10%）。许多资源涵盖多个主题和子主题。五位医生对 rMETRIQ 评分的最终平均类内相关系数为 0.95（95% CI 0.92-0.98）。我们确定了 256 个 rMETRIQ 得分为 16 分或更高的 "高质量 "网站，这些网站在之前的评测中被指定为 "高质量 "网站。结论与其他 SOAR 评审相比，本次迭代 SOAR 评审产生的高质量资源数量最多，迄今为止有 21% 的资源评分≥16。高质量资源的最终清单可以为受训者、教育者建议和 FOAM 作者提供指导。

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引用次数: 0

Women's professional development programs for emergency physicians: A scoping review 急诊医生的女性职业发展计划：范围审查

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-03-22 DOI: 10.1002/aet2.10971

Stacey Frisch MD, MS-HPEd, Riddhi Desai DO, Arlene S. Chung MD, MACM, Jennifer S. Love MD, MSCR, Bobbie Ann Adair White EdD, MA

Background

Gender disparities in emergency medicine (EM) persist, with women underrepresented in leadership positions and faced with unique challenges, such as gender discrimination and harassment. To address these issues, professional development programs for women have been recommended.

Objectives

The purpose of this scoping review was to examine current women's professional development programs for EM and develop a collection of program characteristics, meeting topics, and tips for success that can be useful to new or existing women's professional development programs.

Methods

The authors systematically searched research databases for literature detailing current women's professional development programs for EM physicians. Studies detailing professional development programs for female physicians in EM were included.

Results

After 149 unique articles were screened, 11 studies met inclusion criteria, describing 10 professional development programs for women in EM. The most commonly cited program objectives included providing mentors and role models (n = 9, 90%), offering career advice and promoting professional advancement and leadership skills (n = 5, 50%), increasing academic recognition for women (n = 4, 40%), and promoting work–life balance and integration (n = 2, 20%). The most common topics covered in program sessions included mentorship and coaching, compensation and/or negotiation, leadership skills, and career advancement and promotion. Challenges and barriers to the success of these programs included a lack of funding and support, difficulty in recruiting participants, lack of institutional recognition and support, lack of time, and difficulty in sustaining the program over time.

Conclusions

The study's findings can inform the development of programs that promote gender equity and support the advancement of women in EM.

背景急诊医学（EM）中的性别差异依然存在，女性在领导岗位上的人数不足，并面临着独特的挑战，如性别歧视和骚扰。为解决这些问题，建议为女性提供职业发展计划。目的本次范围界定综述旨在研究目前针对急诊科的女性职业发展项目，并收集项目特点、会议主题和成功秘诀，以便对新的或现有的女性职业发展项目有所帮助。方法作者系统地搜索了研究数据库中详细介绍目前针对急诊科医生的女性职业发展计划的文献。其中包括针对急诊科女医生的职业发展项目的详细研究。结果在筛选了 149 篇文章后，有 11 项研究符合纳入标准，介绍了 10 项针对急诊科女性的专业发展项目。最常引用的项目目标包括提供导师和榜样（9 项，占 90%）、提供职业建议并促进专业进步和领导技能（5 项，占 50%）、提高女性的学术认可度（4 项，占 40%）以及促进工作与生活的平衡和融合（2 项，占 20%）。计划课程中最常见的主题包括导师和辅导、薪酬和/或谈判、领导技能以及职业发展和晋升。这些计划取得成功所面临的挑战和障碍包括缺乏资金和支持、难以招募参与者、缺乏机构认可和支持、缺乏时间以及难以长期维持计划。结论研究结果可以为制定促进性别平等和支持提高妇女在教育管理中的地位的计划提供参考。

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引用次数: 0

Prehospital mass casualty incident triage simulation builds knowledge and confidence in medical trainees 院前大规模伤亡事件分流模拟可培养医疗学员的知识和信心

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-03-21 DOI: 10.1002/aet2.10962

Elaine Yu DO, Christanne Coffey MD

Background

Mass casualty incident (MCI) triage simulation is an increasingly useful tool for teaching triage systems to medical students, trainees, and hospital staff. MCI simulation in the prehospital setting has not yet been studied in this population.

Objectives/Aims

We aimed to assess the effectiveness of a prehospital MCI simulation in medical students, residents, and fellows. Our primary outcome was knowledge of the components of the triage algorithms used in MCI response. Our secondary outcome was each participant's confidence level if required to assist with or lead a MCI response.

Methods

This was an observational study with pre–post surveys. We recruited 30 medical students, 14 emergency medicine (EM) residents, and four pediatric EM fellows to fill out a survey before and after a 3-h simulation session practicing the START and JumpSTART algorithms on two prehospital MCI scenarios.

Results

Overall, all groups demonstrated significant improvement in knowledge of triage colors, information needed to assign a triage color, pediatric airway management during a MCI, and indications for breaths-first CPR. They also demonstrated significant increase in confidence both in assisting with and in leading a MCI response.

Conclusions

Simulated practice triaging patients in prehospital MCI scenarios improves knowledge of triage algorithms and increases confidence in assisting with or leading a MCI response in medical trainees.

背景大规模伤亡事件（MCI）分诊模拟是向医科学生、受训人员和医院员工教授分诊系统的一种越来越有用的工具。目前尚未对院前环境中的 MCI 模拟进行研究。目的我们旨在评估院前 MCI 模拟在医学生、住院医师和研究员中的效果。我们的主要结果是了解 MCI 反应中使用的分诊算法的组成部分。我们的次要结果是每位参与者在需要协助或领导 MCI 响应时的信心水平。方法这是一项采用前后调查的观察性研究。我们招募了 30 名医科学生、14 名急诊医学（EM）住院医师和 4 名儿科 EM 研究员，让他们在两个院前 MCI 情景中练习 START 和 JumpSTART 算法的 3 小时模拟课程前后填写调查问卷。结果总体而言，所有小组在以下方面的知识都有显著提高：分诊颜色、分配分诊颜色所需的信息、MCI 期间的儿科气道管理以及呼吸第一心肺复苏术的适应症。他们在协助和领导 MCI 响应方面的信心也明显增强。结论在院前 MCI 情景中对患者进行分诊的模拟练习可提高医学受训者对分诊算法的了解，并增强其协助或领导 MCI 反应的信心。

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引用次数: 0

Consensus-based ethical best practices for performing educational point-of-care ultrasonography in the emergency department 在急诊科进行教育性护理点超声波检查的最佳伦理实践共识

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-03-21 DOI: 10.1002/aet2.10963

Samantha K. Chao MD, Yiju T. Liu MD, Charles W. Kropf MD, Robert D. Huang MD, Nik Theyyunni MD, Lindsay A. Taylor MD, Janice I. Firn PhD, Ross Kessler MD, Daniel R. Micheller MD, Alethia J. Battles JD, Natalja P. Rosculet MD, Emily E. Ager MD, MPH, Alyssa A. Valentyne MD, Christine J. Schellack, John P. Hennessy MS, Cameron White, Ryan V. Tucker MD

Objectives

There is no standardized protocol for performing educational point-of-care ultrasonography (POCUS) that addresses patient-centered ethical issues such as obtaining informed consent. This study sought to define principles for ethical application of educational POCUS and develop consensus-based best practice guidance.

Methods

A questionnaire was developed by a trained ethicist after literature review with the help of a medical librarian. A diverse panel including experts in medical education, law, and bioethics; medical trainees; and individuals with no medical background was convened. The panel voted on their level of agreement with ethical principles and degree of appropriateness of behaviors in three rounds of a modified Delphi process. A high level of agreement was defined as 80% or greater consensus.

Results

Panelists voted on 38 total items: 15 related to the patient consent and selection process, eight related to practices while performing educational POCUS, and 15 scenarios involving POCUS application. A high level of agreement was achieved for 13 items related to patient consent and selection, eight items related to performance practices, and 10 scenarios of POCUS application.

Conclusions

Based on expert consensus, ethical best practices include obtaining informed consent before performing educational POCUS, allowing patients to decline educational POCUS, informing patients the examination is not intended to be a part of their medical evaluation and is not billed, using appropriate draping techniques, maintaining a professional environment, and disclosing incidental findings in coordination with the primary team caring for the patient. These practices could be implemented at institutions to encourage ethical use of educational POCUS when training physicians, fellows, residents, and medical students.

目的目前还没有针对以患者为中心的伦理问题（如获得知情同意）的护理点教育性超声波检查（POCUS）标准化协议。本研究旨在确定教育性 POCUS 的伦理应用原则，并制定基于共识的最佳实践指南。方法一位训练有素的伦理学家在医学图书馆员的帮助下查阅文献后编制了一份问卷。召集了一个包括医学教育、法律和生物伦理学专家、医学受训人员和无医学背景人员在内的多元化小组。小组成员通过三轮改良德尔菲程序，就他们对伦理原则的认同程度和行为的适当性进行投票。高度一致被定义为 80% 或以上的共识。结果小组成员共对 38 个项目进行了投票：其中 15 项与患者同意和选择过程有关，8 项与实施教育性 POCUS 时的做法有关，15 项涉及 POCUS 应用场景。13个与患者同意和选择相关的项目、8个与执行实践相关的项目以及10个涉及POCUS应用的场景均达成了高度一致。结论根据专家共识，最佳伦理实践包括：在实施教育性 POCUS 之前获得知情同意；允许患者拒绝接受教育性 POCUS；告知患者该检查并非其医疗评估的一部分且不收费；使用适当的铺巾技术；保持专业的环境；与护理患者的主要团队协调披露偶然发现。各医疗机构在培训医生、研究员、住院医师和医科学生时，可采用这些做法来鼓励合乎道德地使用教育性 POCUS。

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引用次数: 0

“Cold feet”: A qualitative study of medical students who seriously considered emergency medicine but chose another specialty "冷脚"：对认真考虑过急诊医学但选择了其他专业的医学生的定性研究

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-03-21 DOI: 10.1002/aet2.10967

Arvin R. Akhavan MD, MPA, Amy V. Kontrick MD, Haley Egan MD, Stephanie A. Balint MSN, Bryan G. Kane MD, Joseph B. House MD, Charles S. Graffeo MD, D. Mark Courtney MD, MS, Dave W. Lu MD, MS, MBE

Introduction

Emergency medicine (EM) has historically been among the most competitive specialties in the United States. However, in 2022 and 2023, 219 of 2921 and 554 of 3010 respective National Resident Matching Program positions were initially unfilled. Medical students’ selection of a medical specialty is a complex process. To better understand recent trends in the EM residency match, this qualitative study explored through one-on-one interviews the rationale of senior medical students who seriously considered EM but ultimately pursued another specialty.

Methods

A convenience sample of senior medical students from across the United States was recruited via multiple mechanisms after the 2023 match. Participant characteristics were collected via an online survey. Qualitative data were generated through a series of one-on-one semistructured interviews and thematic analysis of the data was performed using a constant comparative approach.

Results

Sixteen senior medical students from 12 different institutions participated in the study. Thematic saturation was reached after 12 interviews but data from all 16 interviews were included for qualitative analyses. Five major themes emerged as important in students’ consideration but ultimate rejection of EM as a career: (1) innate features of EM attracted or dissuaded students, (2) widespread awareness of a recent workforce report, (3) burnout in EM, (4) their perception of EM's standing in the health care landscape, and (5) early EM experience and exposure.

Conclusions

This qualitative study identified five major themes in the career decisions of senior medical students who seriously considered EM but chose another specialty. These findings may help inform the perceptions of students and guide future EM recruitment efforts.

引言急诊医学（EM）历来是美国竞争最激烈的专业之一。然而，在 2022 年和 2023 年，分别有 2921 个和 3010 个国家住院医师配对计划职位中的 219 个和 554 个最初未填补。医学生选择医学专业是一个复杂的过程。为了更好地了解最近新兴医学住院医师匹配的趋势，本定性研究通过一对一访谈，探讨了认真考虑过新兴医学但最终选择了其他专业的高年级医学生的理由。方法在2023年比赛结束后，通过多种机制从美国各地招募高年级医学生作为方便样本。通过在线调查收集参与者的特征。通过一系列一对一的半结构化访谈获得定性数据，并采用恒定比较法对数据进行主题分析。结果来自 12 所不同院校的 16 名高年级医学生参与了研究。在进行了 12 次访谈后，主题达到饱和，但所有 16 次访谈的数据都被纳入定性分析。在学生考虑但最终拒绝将医学作为职业时，有五大主题：（1）医学的先天特征吸引或劝阻了学生；（2）对最近一份劳动力报告的广泛认识；（3）医学中的职业倦怠；（4）他们对医学在医疗保健领域地位的看法；（5）早期的医学经历和接触。结论这项定性研究发现了高年级医学生职业决定中的五大主题，他们曾认真考虑过电磁学，但最终选择了其他专业。这些发现可能有助于了解学生的看法，并指导未来的 EM 招聘工作。

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引用次数: 0

Emergency medicine residency pathways for MD/PhD trainees: A national cross-sectional study of physician-scientist training programs 医学博士/博士学员的急诊医学住院医师培训途径：全国医生-科学家培训项目横断面研究

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-03-21 DOI: 10.1002/aet2.10960

Karen Cyndari MD, PhD, Libby White, Philip A. Mudd MD, PhD, J. Priyanka Vakkalanka PhD, Sydney Krispin MPH, MA, Kelli Wallace MS, Megan Schagrin MBA, Nicholas Mohr MD, MS

Background

Combined clinical and research training is common in residency programs outside emergency medicine (EM), and these pathways are particularly valuable for combined MD/PhD graduates planning to pursue a career as a physician-scientist. However, EM departments may not know what resources to provide these trainees during residency to create research-focused, productive, future faculty, and trainees may not know which programs support their goal of becoming a physician-scientist in EM. The objective of this study was to describe research training and resources available to MD/PhD graduates in EM residency training with a focus on dedicated research pathways.

Methods

This study was a cross-sectional inventory conducted through an electronic survey of EM residency program directors. We sought to identify dedicated MD/PhD research training pathways, with a focus on both resources and training priorities. Descriptive statistics were used to summarize survey responses.

Results

We collected 192 survey responses (69.6% response rate). Among respondents, 41 programs (21.4%) offered a research pathway/track, 52 (27.4%) offered a research fellowship, 22 (11.5%) offered both a residency research pathway/track and a research fellowship, and two (1.0%) offered a dedicated EM physician-scientist training pathway. Most programs considered research a priority and were enthusiastic about interviewing applicants planning a research career, but recruitment of physician-scientist applicants was not generally prioritized.

Conclusions

Some EM residency programs offer combined clinical and mentored research training for prospective physician-scientists, and nearly all residency programs considered research important. Future work will focus on improving the EM physician-scientist pipeline by optimizing pathways available to trainees during residency and fellowship.

背景在急诊医学（EM）以外的住院医师培训项目中，临床与研究相结合的培训很常见，这些培训途径对于计划从事医生-科学家职业的医学博士/博士联合毕业生尤其有价值。然而，急诊医学系可能不知道在住院医师培训期间应为这些学员提供哪些资源，以培养注重研究、富有成效的未来教师队伍，学员也可能不知道哪些项目支持他们成为急诊医学科的医生科学家这一目标。本研究的目的是描述医学博士/博士毕业生在急诊科住院医师培训中可获得的研究培训和资源，重点是专门的研究途径。方法本研究是通过对急诊科住院医师培训项目主任的电子调查进行的横断面调查。我们试图找出专门的医学博士/博士研究培训途径，重点关注资源和培训优先事项。我们使用了描述性统计来总结调查回复。结果我们共收集到 192 份调查回复（回复率为 69.6%）。在回复者中，41个项目（21.4%）提供了研究途径/方向，52个项目（27.4%）提供了研究奖学金，22个项目（11.5%）同时提供了住院医师研究途径/方向和研究奖学金，2个项目（1.0%）提供了专门的急诊科医生-科学家培训途径。大多数项目认为研究是优先事项，并热衷于面试计划从事研究工作的申请人，但一般不优先招聘医生-科学家申请人。结论一些急诊科住院医师培训项目为未来的医生科学家提供临床和指导研究相结合的培训，几乎所有的住院医师培训项目都认为研究很重要。今后的工作重点是通过优化住院医师和研究员培训期间受训者的途径来改善急诊科医生-科学家的渠道。

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引用次数: 0

Cracking the code on the emergency medicine match: It's about supply and demand, not interviews 破解急诊医学匹配密码：关键在于供需，而非面试

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-03-21 DOI: 10.1002/aet2.10961

Alexis E. Pelletier-Bui MD, Laura R. Hopson MD, Jason I. Reminick MD, MBA, MS, Michael C. Bond MD, Alisa Hayes MD, Ephy Love PhD

<p>Emergency medicine (EM), a historically highly competitive specialty, experienced an abrupt change in the National Resident Matching Program (NRMP)'s Main Residency Match (hereafter referred to as “The Match”) results in 2022 and 2023. Unfilled residency positions increased from an average of 0.48% (2012–2021) to 7.4% (2022) and 18.4% (2023), leaving 46% of EM residency programs facing vacancies in 2023.<span><sup>1</sup></span></p><p>This drastic shift produced keen scrutiny to the cause. Potential factors fall into three areas: excess supply of positions, lack of student demand for EM and problems embedded in the recruitment process.</p><p>Key insights into EM's current challenges can be gleaned from publicly available data from the Electronic Residency Application Service (ERAS), the NRMP, and the Accreditation Council for Graduate Medical Education (ACGME) as well as data from Thalamus (a graduate medical education interview management platform representing approximately 25% of EM programs; “Thalamus”) and additional NRMP data as a result of a data sharing agreement with Thalamus (“NRMP/Thalamus”).</p><p>EM programs in The Match increased from 170 to 287 (69%) from 2014 to 2023,<span><sup>1</sup></span> which includes 50 American Osteopathic Association programs that transitioned to the ACGME.<span><sup>2</sup></span> EM positions increased from 1786 to 3010 (69%) over the same period through both contribution from new programs and expansion of existing programs.<span><sup>1, 2</sup></span></p><p>After a steady increase in applicants from 2019 to 2021, allopathic and osteopathic applicants decreased substantially in 2022 and 2023, with the steepest decline in allopathic applicants (Figure 1). Total applications from all applicant types declined by approximately 17% year-over-year for the last two Match cycles (email communication from ERAS Strategy & Engagement Director, Michele Oesterheld, May 2023). In both 2022 and 2023, the number of applicants preferring EM who submitted a rank order list (ROL) in EM was lower than the number of positions available (NRMP/Thalamus; Figure 1).</p><p>In sum, almost every 2023 EM applicant in ERAS would have needed to match in EM to fill the available positions, which was unrealistic. For the past 2 years, approximately 30% of applicants to EM also applied to at least one other specialty (email from ERAS Pilot Administration Director, Jayme Bograd, October 2022), with some preferring that other specialty (NRMP/Thalamus). Other applicants may have had academic challenges, visa, licensing, or credentialing issues that hindered their consideration at many institutions. These data clearly illustrate that a supply-and-demand mismatch exists between EM applicants and currently available positions.</p><p>Some propose that potentially modifiable program and applicant interview behaviors contribute to Match results.<span><sup>3, 4</sup></span> These are likely limited in their impact.</p><p>We need to understa

急诊医学（EM）历来是一个竞争激烈的专业，但在 2022 年和 2023 年，国家住院医师匹配计划（NRMP）的主要住院医师匹配（以下简称 "匹配"）结果却发生了突变。未填补的住院医师职位从平均0.48%（2012-2021年）增加到7.4%（2022年）和18.4%（2023年），使得46%的急诊科住院医师项目在2023年面临职位空缺。潜在因素可分为三个方面：职位供应过剩、学生对 EM 需求不足以及招聘过程中存在的问题。我们可以从住院医师电子申请服务（ERAS）、NRMP和毕业后医学教育认证委员会（ACGME）的公开数据，以及Thalamus（一个毕业后医学教育面试管理平台，代表了约25%的EM项目；"Thalamus"）的数据和NRMP与Thalamus达成的数据共享协议（"NRMP/Thalamus"）中获得有关EM当前挑战的关键信息。从 2014 年到 2023 年，The Match 中的 EM 项目从 170 个增加到 287 个（69%），1 其中包括 50 个过渡到 ACGME 的美国骨科协会项目。同期，通过新项目的贡献和现有项目的扩展，EM职位从1786个增加到3010个（69%）。1, 2A 在2019年至2021年申请者稳步增加之后，2022年和2023年，全科和骨科申请者大幅减少，其中全科申请者的降幅最大（图1）。在过去两个Match周期中，所有类型申请人的申请总数同比下降了约17%（ERAS战略与amp的电子邮件通信；参与总监Michele Oesterheld，2023年5月）。总之，ERAS中几乎所有2023年的EM申请人都需要通过EM匹配来填补现有职位，这是不现实的。在过去两年中，约有30%的电磁学申请人还申请了至少一个其他专业（ERAS试点管理主任Jayme Bograd的电子邮件，2022年10月），其中一些人更喜欢其他专业（NRMP/Thalamus）。其他申请人可能在学术上遇到困难、签证、执照或证书问题，阻碍了许多机构对他们的考虑。这些数据清楚地表明，电磁学申请者与现有职位之间存在供需不匹配的情况。一个主要的问题是，到 2030 年，预计将有 7845 名急诊科医生过剩，这将限制未来的就业前景。7 虽然在许多地区仍将存在急诊科工作岗位短缺的问题，8 但在选择培训和执业地点时，地理因素会促使大多数人做出决定。1 无论最初的劳动力研究的假设是否成立，8 最初报告的影响可能不会迅速减弱。从 20 世纪 80 年代末到 90 年代初，麻醉科住院医师职位激增。1994 年的一项劳动力评估预测未来将供过于求。到 2000 年，IMGs 已占美国麻醉医师毕业人数的一半以上。9 直到 2001 年的数据预测麻醉医师队伍将出现严重短缺时，麻醉医师的申请总人数才开始恢复。2011 年对麻醉科劳动力的重新评估显示，麻醉科的入职率仍低于 1993 年的水平，并预计由于培训职位的进一步收缩，劳动力短缺将持续存在。9 从麻醉科推断，在学生对未来工作机会充满信心之前，他们对急诊医学的兴趣不太可能增加。改变面试行为并不能解决这一问题。未来 Match 周期的改善需要学生兴趣的改变。急诊医学必须解决其不利因素，包括劳动力预测和工作环境。我们必须让申请者了解选择急诊医学职业的诸多好处。我们需要支持我们的培训计划，在计划规模方面做出艰难的决定，并应对机构和国家政策的变化：研究概念和设计、手稿起草、对手稿中重要的知识性内容进行批判性修改、分析和解释数据。Laura R.

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引用次数: 0