No abstract

Introduction Musculoskeletal (MSK) complaints and injuries comprise 18.7% of emergency department visits. However, only 61% of emergency physicians (EP) pass a validated written Freedman and Bernstein MSK examination (FB-MSK). Educational interventions such as a primary care sports medicine (PCSM) rotation aid in MSK residency education. This study utilizes a validated MSK examination to evaluate and compare MSK knowledge acquisition following a traditional orthopedic rotation and a PCSM rotation. Methods Forty-nine interns were recruited to participate in this study over two academic years. The FB-MSK was administered to all participants at the start of residency. Participants were divided into two groups based on their residency sites; one group completed a traditional four-week orthopedic surgery rotation and the second group completed a four-week PCSM rotation. Forty-six of the forty-nine participants were administered the FB-MSK after completion of their rotations. Results Individual post-rotation scores significantly improved regardless of rotation (mean difference 2.78, p< 0.001; 95% CI 2.05-3.52). The orthopedic surgery group significantly improved (mean difference 2.84, p <0.001; 95% CI 1.93-3.73) and the PCSM group significantly improved (mean difference 2.64, p =0.002; 95% CI 1.23-4.07). There was no significant difference in pre-rotation scores between the two groups ( p =0.86; 95% CI -2.13 to 1.79). There was no significant difference in post-rotation scores between the two groups ( p =0.66; 95% CI -1.98 to 1.26). There was no significant difference in mean score improvement between the two groups ( p =0.81; 95% CI -1.33 to 1.69). Conclusion This study demonstrates significant MSK knowledge acquisition and no difference in the level of knowledge acquisition after completion of either traditional orthopedic surgery or PCSM residency rotation.

No abstract

Background As Acute Care Surgery and shift-based models increase in popularity, there is evidence of better outcomes for many types of emergency general surgery patients. We explored the difference in outcomes for patients with acute biliary disorders, treated by either Acute Care Surgery (ACS) model or traditional call model (TRAD) during the same period. Methods Retrospective review of patients undergoing laparoscopic cholecystectomy for acute biliary disease 2017-2018. Demographics, clinical presentation, operative details, and outcomes were compared. Results Demographics, clinical presentation, and complication rates were similar between groups. Time from surgical consult to operating room (Δ = −15.34 hours [−24.57, −6.12], P = .001), length of stay (Δ = −1.4 days [−2.45, −.35], P = .009), and total charges were significantly decreased in ACS group compared to TRAD (Δ$2797.76 [−4883.12, −712.41], P = .009). Conclusions Acute biliary disease can be managed successfully in an ACS shift-based model with reduced overall hospital charges and equivalent outcomes.