Do Emergency Medicine Residency Graduates Feel Prepared to Manage Closed Fractures After Training?

Abstract

Objectives: Fractures comprise 3% of all emergency department (ED) visits. Although emergency physicians are often responsible for managing most of the initial care of these patients, many report a lack of proficiency and comfort with these skills. The primary objective was to assess how prepared recent emergency medicine (EM) residency graduates felt managing closed fractures upon completion of residency. Secondary objectives included whether residency training or independent practice contributed most to the current level of comfort with these procedures and which fractures were most commonly reduced without orthopedic consultation.Methods: An anonymous online survey was sent to graduates from seven EM residency programs over a 3-month period to evaluate closed fracture reduction training, practice, and comfort level. Each site primary investigator invited graduates from 2010 to 2014 to participate and followed a set schedule of reminders.Results: The response rate was 287/384 (74.7%) and included 3-year (198/287, 69%) and 4-year (89/287, 31%) programs. Practice in community, academic, and hybrid ED settings was reported by 150/287 (52.3%), 64/287 (22.3%), and 73/287 (25.4%), respectively. It was indicated by 137/287 (47.7%) that they reduce closed fractures without a bedside orthopedic consultation greater than 75% of the time. The majority of graduates felt not at all prepared (35/287, 12.2%) or somewhat prepared (126/287, 43.9%) upon residency graduation. Postresidency independent practice contributed most to the current level of comfort for 156/287 (54.4%). The most common fractures requiring reduction were wrist/distal radius and/or ulna, next finger/hand, and finally, ankle/distal tibia and/or fibula.Conclusions: Although most recent graduates feel at least "somewhat" prepared to manage closed fractures in the ED, most felt that independent practice was a greater contributor to their current level of comfort than residency training. Recent graduates indicate that fracture reduction without orthopedic consultation is common in today's clinical practice. This survey identifies common fractures requiring reduction which EM residencies may wish to consider prioritizing in their emergency orthopedic curricula to better prepare their residents for independent clinical practice.

Intern Orthopedic Rotation Versus Emergency Medicine Procedure Month: Which one Derives More Opportunity?

“… 11 However, over 40% of residency graduates across multiple programs felt only “somewhat prepared” upon graduation to handle common fracture reductions. 12 Some of this could be due to the less standardized teaching and direct feedback from orthopedic attendings, while other rotations may emphasize more observation of procedures rather than actual hands-on practice. 13 …”

“…11 However, over 40% of residency graduates across multiple programs felt only "somewhat prepared" upon graduation to handle common fracture reductions. 12 Some of this could be due to the less standardized teaching and direct feedback from orthopedic attendings, while other rotations may emphasize more observation of procedures rather than actual hands-on practice. 13 The PGY-1 year traditionally contains the most off-service rotations, allowing PGY-1 residents to become familiar with other specialties and their practices, build interdepartmental camaraderie, and learn unique approaches to common procedures in that particular field.…”

Impact of Sports Medicine and Orthopedic Surgery Rotations on Musculoskeletal Knowledge in Residency

“…However, the Accreditation Council for Graduate Medical Education does not require nor mention MSK curricula for Emergency Medicine (EM) Residency Program accreditation [13]. A recent study demonstrated 56.1% of new EM residency graduates felt "not at all prepared" or "somewhat prepared" for MSK medicine [14]. The lack of a comprehensive MSK curriculum in EM training programs highlights the need for novel strategies to provide the essential and practical foundation of MSK education.…”

Presence of Orthopedic Residency Decreases Emergency Physician’s Confidence in Orthopedic Procedures

“…Another recent 2016 study evaluated 287 recent EM residency graduates from seven different residency programs to assess their level of preparedness in managing closed fractures upon completion of their residency. The study found that many graduates felt either not at all prepared (12%) or only somewhat prepared (44%) [ 3 ].…”

“…Another study asked attending physicians to rate their subjective preparation of independent fracture reduction, which gave respondents one of four categories to choose from. These ranged from “not at all prepared,” “somewhat prepared,” “fairly well prepared,” to “very well prepared” [ 3 ], with the majority answering that they felt “somewhat prepared” [ 3 ].…”