A Model Longitudinal Observation Medicine Curriculum for an Emergency Medicine Residency

Wheatley, Matthew; Baugh, Christopher W.; Osborne, Anwar; Clark, Carol; Shayne, Philip; Ross, Michael A.

doi:10.1111/acem.12909

Cited by 6 publications

(8 citation statements)

References 42 publications

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“…7 Observation medicine training curricula have been developed and incorporated into Emergency Medicine residencies. 15,16 Similar to other clinical tools such as an ultrasound machine, the uses of this tool evolve over time as result of research and clinical innovations. This is what was found in the present study with chest pain.…”

Section: Discussionmentioning

confidence: 99%

The Changing Role of Chest Pain in the Emergency Department Observation Unit

Terry

Franks²,

Moran³

et al. 2021

Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine

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Background: This study objective was to describe changes in the utilization of a protocol-driven emergency department observation unit (EDOU) for chest pain over time. Methods: This is a retrospective serial cross-sectional study of data from a clinical data warehouse of a single integrated healthcare system. We estimated long-term trends (2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018)(2019) in EDOU visits at 4 system hospitals, using monthly proportions as the main outcome, and month of visit as the exposure variable, accounting for age and sex. Rate changes associated with compulsory use of the History, EKG, Age, Risk factors, Troponin (HEART) score in 2016 were analyzed. Results: There were 83,168 EDOU admissions among 1.3 million ED visits during the study interval, with an average admission rate of 5.9% of ED visits. The most common conditions were chest pain (41.2%), transient ischemic attack (7.8%), dehydration (6.3%), syncope (5.8%), and abdominal pain (5.2%). In each hospital, there was a temporal annual decline in the proportion of EDOU visits for chest pain protocols ranging from −7.9% to −2.8%, an average rate of −3.3% per year (95% CI, −4.6% to −2.0%) or a 54% (from 54% to 25%) relative decline in over the 11-year study interval. This decline was significantly steeper in younger middle-aged patients (ages 39-49). The HEART score intervention had a small impact on baseline decline of −3.1% at the 2 intervention hospitals, reducing it by −1.5% (95% CI, −2.2% to −0.8%). Conclusions: Utilization of the EDOU for chest pain decreased over time, with corresponding increases in other conditions. This decline preceded the introduction of the HEART score.

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Section: Discussionmentioning

confidence: 99%

The Changing Role of Chest Pain in the Emergency Department Observation Unit

Terry

Franks²,

Moran³

et al. 2021

Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine

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“…Resident evaluation content will be based on a selection of the EM Milestones identified by Wheatley et al, that have been determined by the authors as relevant to their observation medicine rotation. 5 At the end of the rotation, the rotation directors will review all evaluations and provide summative feedback of the resident to the residency program director.…”

Section: Educational Strategiesmentioning

confidence: 99%

An Observation Medicine Curriculum for Emergency Medicine Education

Ty¹,

Gruber²,

Klein³

et al. 2021

Journal of Education and Teaching in Emergency Medicine

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Audience and type of curriculum: This curriculum, designed and implemented at the Ronald O. Perelman Department of Emergency Medicine at NYU Langone Health, primarily targets third-and fourth-year emergency medicine (EM) residents, and is an immersive observation medicine rotation that can be integrated into existing emergency medicine residency training. Length of curriculum:The curriculum is designed for a dedicated rotation of two weeks for senior residents and can be expanded to 4 weeks. Introduction: Observation medicine is an extension of emergency medicine and is increasingly playing a role in the delivery of acute healthcare, with over half of all observation units (OUs) in the nation being led by emergency medicine. 1 Despite this, many emergency medicine residencies have yet to establish a formal observation medicine curriculum. In a 2002 study by Mace and Shah, only 10% of emergency medicine residencies had a dedicated observation medicine rotation, despite 85% of emergency medicine residency directors believing this was an important part of emergency medicine training. 2 The first description of a model longitudinal observation medicine curriculum did not appear until 2016. 3 In order to prepare our graduates for the evolving demands of the EM workplace, we must provide diverse educational experiences that train and showcase the expanding skill set of future emergency physicians.Educational Goals: The primary goal of this observation medicine curriculum is to train current EM residents in short-term acute care beyond the initial ED visit. This entails caring for patients from the time of their CURRICULUM 2 Section break arrival to the OU to the point when a final disposition from the OU is determined, be it inpatient admission or discharge to home. Educational Methods:The educational strategies used in this curriculum include experiential learning through supervised direct patient care, independent learning based on prescribed literature, and didactic teaching.Research Methods: Education content was evaluated by the learners through pre-and post-rotation surveys, as well as written attending evaluations describing the progress of the learners during the rotation.Results: All residents reported increases in the confidence of their abilities to perform observation care.Discussion: Observation medicine is an increasingly vital aspect of emergency medicine, but education in observation medicine has not developed in tandem with its implementation. A lack of observation medicine training represents a missed opportunity for each trainee to gain a robust understanding of the interface between inpatient and outpatient care, and how to arrive at the most appropriate disposition for ED patients. Considering the wide breadth of clinical conditions managed in OUs and the variability of OU management at various learning sites, the curriculum must be tailored to the specific unit to maximize effectiveness of the learning experience.

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“…There are avenues for EM residents to be involved in OM national and local committees and/or interest groups or attend OM conferences offered yearly to learn more about the OM field and network with OM experts and OU directors. OM educational resources and materials such as textbooks and a journal issue dedicated to OM are available as well as a model longitudinal curriculum developed by a consensus of OM content experts and approved by the SAEM and ACEP Board of Directors that has recently been published . The curriculum paper also includes a list of suggested reading for EM residents by postgraduate year (PGY) that could be included in a program’s resident reading list.…”

Section: The Current State Of Om Educationmentioning

confidence: 99%

“…The longitudinal OM curriculum based on ACGME core competencies describes three elements essential to teaching OM: didactic presentations, self‐directed learning, and longitudinal learning (bedside instruction) . Incorporation of any of these elements into an existing residency program can be challenging as educators need to balance resident duty hours, existing rotation agreements, and other department coverage priorities.…”

Section: The Current State Of Om Educationmentioning

confidence: 99%

“…This can be accomplished through dedicated class conference days. PGY‐1 instruction should focus on review of the foundational literature, patient selection for observation care, applying inclusion and exclusion criteria, and case review . PGY‐2 residents should focus on the specifics of protocol design and in‐unit management of observation patients.…”

Section: The Current State Of Om Educationmentioning

confidence: 99%

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The Case for Observation Medicine Education and Training in Emergency Medicine

Pena

Wheatley

Suri

et al. 2019

AEM Education and Training

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Background: Many hospitals have or will be opening an observation unit (OU), the majority managed by the emergency department (ED). Graduating emergency medicine (EM) residents will be expected to have the knowledge and skills necessary to appropriately identify and manage patients in this setting. Our objective is to examine the current state of observation medicine (OM) education and prevalence in EM training. Methods:In a follow-up to the 2019 Society for Academic Emergency Medicine (SAEM) OM Interest Group meeting, we convened an expert panel of OM physicians who are members of both the SAEM OM Interest Group and the American College of Emergency Physicians Section of OM. The panel of six emergency physicians representing geographic diversity was formed. A structured literature review was performed yielding 16 educational publications and sources pertaining to OM education and training across all specialties.Report on the Existing Literature: Only a small number of EM residencies have a required or elective OM rotation in an OU. An OM rotation in a protocol-driven ED OU gives residents experience managing patients in this setting and improves skills integral to EM and part of the EM milestones and Accreditation Council for Graduate Medical Education (ACGME) core competencies: reassessment, disposition decision making, risk stratification, team management, and practicing cost-appropriate care. Even without a formal rotation, multiple OM educational resources can be incorporated into EM resident education and didactics. Education research opportunity exists. Conclusions: This panel believes that OM is an important component of EM that should be incorporated into EMresidency as the knowledge and skills learned such as risk stratification, disposition decision making, and team management augment those needed for the practice of EM. There is a distinct opportunity for EM educators to better equip their trainees for a career in EM by including OM education and experience in EM residency training.From the

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A Model Longitudinal Observation Medicine Curriculum for an Emergency Medicine Residency

Cited by 6 publications

References 42 publications

The Changing Role of Chest Pain in the Emergency Department Observation Unit

The Changing Role of Chest Pain in the Emergency Department Observation Unit

An Observation Medicine Curriculum for Emergency Medicine Education

The Case for Observation Medicine Education and Training in Emergency Medicine

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