A comparison of emergency medicine resident clinical experience in a rural versus urban emergency department

Wadman, Michael C.; Fago, Benjamin; Hoffman, Lance H.; Tran, T. Paul; Muelleman, Robert L.

doi:10.22605/rrh1442

Cited by 7 publications

(3 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Procedural competence is a core aspect of EM training and has been noted to be essential for independent practice. 7,10 Unfortunately, many EM procedures occur at low frequencies, [28][29][30][31][32] and may be associated with high-risk complications. 33 Key index procedure numbers coupled with procedure logs have been traditionally used by residency programs as indicators of procedural experience or mastery.…”

Section: Discussionmentioning

confidence: 99%

Procedural Curriculum to Verify Intern Competence Prior to Patient Care

Yee

Miguel

Khandelwal

et al. 2022

WestJEM

View full text Add to dashboard Cite

Introduction: Emergency medicine (EM) programs train residents to perform clinical procedures with known iatrogenic risks. Currently, there is no established framework for graduating medical students to demonstrate procedural competency prior to matriculating into residency. Mastery-based learning has demonstrated improved patient-safety outcomes. Incorporation of this framework allows learners to demonstrate procedural competency to a predetermined standard in the simulation laboratory prior to performing invasive procedures on patients in the clinical setting. This study describes the creation and implementation of a competency-based procedural curriculum for first-year EM residents using simulation to prepare learners for supervised participation in procedures during patient care. Methods: Checklists were developed internally for five high-risk procedures (central venous line placement, endotracheal intubation, lumbar puncture, paracentesis, chest tube placement). Performance standards were developed using Mastery-Angoff methods. Minimum passing scores were determined for each procedure. Over a two-year period, 38 residents underwent baseline assessment, deliberate practice, and post-testing against the passing standard score to demonstrate procedural competency in the simulation laboratory during intern orientation. Results: We found that 37% of residents required more than one attempt to achieve the minimum passing score on some procedures, however, all residents ultimately met the competency standard on all five high-risk procedures in simulation. One critical incident of central venous catheter guideline retention was identified in the simulation laboratory during the second year of implementation. Conclusion: All incoming first-year EM residents demonstrated procedural competence on five different procedures using a mastery-based educational framework. A competency-based EM curriculum allowed for demonstration of procedural competence prior to resident participation in supervised clinical patient care.

show abstract

Section: Discussionmentioning

confidence: 99%

Procedural Curriculum to Verify Intern Competence Prior to Patient Care

Yee

Miguel

Khandelwal

et al. 2022

WestJEM

View full text Add to dashboard Cite

show abstract

“…4,5 Despite the suggested potential of rural rotations, there has been very little research describing the exact nature of the unique clinical experiences these rotations offer to residents. A small study by Wadman et al 6 (five total residents in the study) suggested that residents on a month-long rural rotation saw similar patient volumes to their academic center with significantly increased rates of exposure to fracture/dislocation reductions and pediatric trauma resuscitations. Another study by Carey et al 7 compared resident performance of "simple" and "complex" procedures at academic versus rural EDs and found no significant differences in procedural experiences.…”

Section: Introductionmentioning

confidence: 99%

Defining the clinical and procedural opportunities available to residents during rural rotations

Haefke,

Scholz,

Homme

et al. 2023

AEM Education and Training

View full text Add to dashboard Cite

IntroductionMany emergency medicine (EM) residency programs include clinical rotations in rural emergency departments (“rural rotations”) as part of their curriculum. These rotations are designed to expose residents to clinical scenarios that are less frequently encountered in tertiary centers. The objective of this study was to determine the rate at which residents were exposed to certain clinical and procedural experiences (CPEs) while on rural rotations compared to their usual academic training hospital.MethodsWe conducted a retrospective chart review of all patient encounters involving EM residents at a large academic hospital in Rochester, Minnesota, compared with two rural hospitals in Austin, Minnesota, and Albert Lea, Minnesota, from July 1, 2019, to June 30, 2020. The frequency of each CPE was calculated and expressed as the number of CPEs encountered per 100 clinical hours worked. These values were compared between the rural and academic sites.ResultsA total of 33,417 patient encounters over a total of 41,700 resident clinical hours were analyzed between the three study sites. The two settings (rural vs. academic) had significant differences in baseline patient demographics including age, acuity, and admission rates. Several CPEs were found to occur at a higher frequency in the rural hospitals versus the academic hospital: ambulance necessity documentation (9.3/100 h rural vs. 0.07/100 h academic, p ≤ 0.0001), laceration repair (3.39/100 h rural vs. 2.0/100 h academic, p = 0.0004), and splint/cast application (1.53/100 h rural vs. 0.07/100 h academic, p ≤ 0.0001).ConclusionsRural EM rotations provide residents exposure to a variety of valuable educational experiences. These rotations may provide residents with superior exposures to some clinical experiences compared to academic hospitals, particularly out‐of‐ED transfers and orthopedic procedures. Residency programs without a current rural rotation should consider creating this as an option for their trainees.

show abstract

“…For emergency medicine (EM) residency training, clinical experience was important to foster the competency of residents [ 15 ]. Clinical experience based on seeing a variety of patients with different chief complaints and diagnoses is essential for the development of comprehensive competency and multitask ability [ 16 , 17 ]. Continued reduction of ED patient volume during the COVID-19 pandemic may decrease the clinical exposure of EM residents, especially for pediatric EM training.…”

Section: Introductionmentioning

confidence: 99%

Pediatric Training Crisis of Emergency Medicine Residency during the COVID-19 Pandemic

et al. 2022

View full text Add to dashboard Cite

Coronavirus disease 2019 (COVID-19) is an emerging viral disease that has caused a global pandemic. Among emergency department (ED) patients, pediatric patient volume mostly and continuously decreased during the pandemic period. Decreased pediatric patient volume in a prolonged period could results in inadequate pediatric training of Emergency Medicine (EM) residents. We collected data regarding pediatric patients who were first seen by EM resident physicians between 1 February 2019, and 31 January 2021, which was divided into pre-epidemic and epidemic periods by 1 February 2020. A significant reduction in pediatric patients per hour (PPH) of EM residents was noted in the epidemic period (from 1.55 to 0.81, p < 0.001). The average patient number was reduced significantly in the classification of infection (from 9.50 to 4.00, p < 0.001), respiratory system (from 84.00 to 22.00, p < 0.001), gastrointestinal system (from 52.00 to 34.00, p = 0.007), otolaryngology (from 4.00 to 2.00, p = 0.022). Among the diagnoses of infectious disease, the most obvious drop was noted in the diagnosis of influenza and enterovirus infection. Reduced pediatric patient volume affected clinical exposure to pediatric EM training of EM residency. Changes in the proportion of pediatric diseases presented in the ED may induce inadequate experience with common and specific pediatric diseases.

show abstract

A comparison of emergency medicine resident clinical experience in a rural versus urban emergency department

Cited by 7 publications

References 11 publications

Procedural Curriculum to Verify Intern Competence Prior to Patient Care

Procedural Curriculum to Verify Intern Competence Prior to Patient Care

Defining the clinical and procedural opportunities available to residents during rural rotations

Pediatric Training Crisis of Emergency Medicine Residency during the COVID-19 Pandemic

Contact Info

Product

Resources

About