CJEM最新文献

Purpose: The transition from training to independent practice in Emergency Medicine is challenging. Early career physicians need specific knowledge to function in new roles. However, this knowledge can be unwritten and implicit. It is unclear what skills newly graduated emergency physicians need to succeed in their early independent practice. We wished to understand these elements in order to inform further development of the current transition to practice curriculum.

Methods: We interviewed 23 emergency physicians in their first 5 years of practice at an urban academic center to explore the knowledge they acquired in early practice. Employing a constructivist stance, data collection and analysis occurred iteratively until thematic saturation. We constructed themes using inductive thematic analysis.

Results: Newly graduated emergency physicians identified the knowledge needed in early clinical practice. This knowledge was unwritten, dynamic, nuanced, difficult to transfer, and vital for them to function effectively. Knowledge was needed in four facets of clinical practice: patient interaction, learner supervision, institutional processes and group culture. Within patient interaction, they required skills and knowledge for their responsibility, gestalt, decision-making and communication. They needed skills to supervise learners, delegate them with tasks and provide feedback. To function effectively, they needed to learn institutional processes and how to manage departmental tasks. They also required knowledge of tacit group norms about work efficiency, code of conduct and patient care. Newly graduated physicians sought strategies to manage aspects within each of these four facets.

Conclusion: Specific knowledge is necessary in multiple facets of independent Emergency Medicine practice. Such knowledge is often unwritten and contextual, but the associated skills and strategies can be made explicit. Educators should incorporate these components in their transition-to-practice curriculum to support graduating trainees in becoming successful attending physicians.

Objectives: Typhoid fever, caused by Salmonella enterica serotype Typhi, remains a concern in non-endemic regions, particularly for travelers returning from endemic areas, as it can cause severe systemic infections. Complications, such as gastrointestinal bleeding, could be avoided with timely diagnosis and management, and the optimal timeframe for clinical suspicion post-travel remains debated. This study aimed to determine the post-travel period during which clinicians should suspect typhoid fever in children returning to Canada.

Methods: This was a secondary analysis of two cohort studies conducted in a tertiary care pediatric hospital in Montreal, Canada between 2018 and 2024. The full cohorts included all children with positive blood cultures from the emergency department (ED), while this study focusses on Salmonella Typhi bacteremia. The primary outcome was the number of days between return to Canada and positive blood culture. Independent variables included age, sex, fever at triage, country visited, and medical history. For participants who had traveled, the analysis focused on the time, in days, between the date of return from travel and presentation at the ED.

Results: Out 38,541 blood cultures drawn, 368 bacteremia cases were identified. Of these, seven (1.9%) were caused by Salmonella Typhi. The median delay between return and presentation was 23 days (range: 7-49 days). Four patients had traveled to India and two to Pakistan, with four of the six cases presented to the ED more than 3 weeks post-travel. One patient had not traveled but had exposure to a potential carrier returning from Ivory Coast. Of note, most cases were initially misdiagnosed as viral illness.

Conclusion and relevance: Our small study demonstrated delays up to 7 weeks between travel and clinical presentation of typhoid fever in a cohort of children in a Canadian ED. This emphasizes the importance of collecting travel history in febrile children.