Does the Emergency Medicine In‐training Examination Accurately Reflect Residents’ Clinical Experiences?

Abstract

Objective: The American Board of Emergency Medicine Model of the Clinical Practice of Emergency Medicine (ABEM Model) serves as a guide for resident education and the basis for the resident In-training Examination (ITE) and the Emergency Medicine Board Qualification Examinations. The purpose of this study was to determine how closely resident-patient encounters in our emergency departments (EDs) matched the ABEM Model as presented in the specifications of the content outline for the ITE.Methods: This single-site study of an academic residency program analyzed all documented resident-patient encounters in the ED during a 2.5-year period recorded in the electronic medical record. The chief complaints from these encounters were matched to the 20 categories of the ABEM Model. Chi-square goodness-of-fit tests were performed to compare the proportions of categorized encounters and proportions of patient acuity levels to the proportions of categories as outlined in the content blueprint of the ITE.Results: After the exclusion of encounters with missing data and those not involving EM residents, 125,405 encounters were analyzed. We found a significant difference between the clinical experience of EM residents and the ABEM Model as reflected in the ITE for both case categories (p < 0.01) and patient acuity (p < 0.01). The following categories were the most overrepresented in clinical care: signs, symptoms, and presentations; psychobehavioral disorders; and abdominal and gastrointestinal disorders. The most underrepresented were procedures and skills, systemic infectious disorders, and thoracic-respiratory disorders. Conclusion:The clinical experience of EM residents differs significantly from the ITE Content Blueprint, which reflects the ABEM Model. This type of inquiry may help to provide custom education reports to residents about their clinical encounters to help identify clinical knowledge gaps that may require supplemental nonclinical training.From the

Emergency medicine resident clinical experience vs. in‐training examination content: A national database study

“…A recent manuscript evaluated the clinical encounters at a single academic medical center and, like our findings, demonstrated discrepancies between the clinical experience of its resident physicians and the ITE content. 4 The overrepresentation of signs, symptoms, and presentations and psychobehavioral disorders categories seen in the NHAMCS dataset is consistent with the findings in Bischof et al 4 ; however, the abdominal and gastrointestinal disorders category was not overrepresented in our national sample. This may be explained by the patient population variation between sites, and this highlights the potential impact of site-by-site variation in clinical experience.…”

“…A recent manuscript evaluated the clinical encounters at a single academic medical center and, like our findings, demonstrated discrepancies between the clinical experience of its resident physicians and the ITE content 4 4 ; however, the abdominal and gastrointestinal disorders category was not overrepresented in our national sample.…”

“…The following categories were overrepresented: signs, symptoms and presentations, psychobehavioral disorders, and abdominal and gastrointestinal disorders. The following were underrepresented: procedures and skills, systemic infectious disorders, and thoracic‐respiratory disorders 4 . It is unknown if these single site results are generalizable to all of emergency medicine practice or training programs nationwide.…”

Holes in the FOAM: An Analysis of Curricular Comprehensiveness in Online Educational Resources

“…One investigation, limited to an analysis of a single academic site, did demonstrate a mismatch in the MCPEM in comparison to the resident clinical experience. 41 Additionally, as medical content such as determining the best diagnostic test or treatment become more and more easily available online while on shift, educators may want to focus true learning on topics of medicine less accessible such as medical decision making. Additionally, as recertification testing for EM transitions to an open resource model, changes to the MCPEM may be required.…”

The current state of acute oncology training for emergency physicians: a narrative review

“…Programs associated with a Comprehensive Cancer Center may benefit from local resources, however, additional support provided by national organizations to help standardize acute oncology education of all EM residents and practicing physicians is warranted. This can be achieved by a variety of approaches: (1) the open publication and sharing of curricular modules that have been previously or are currently in development by residency programs, national interest groups, and current programs that have oncologic EM fellowships [14][15][16]; (2) the adoption of specialty-specific guidelines by national EM organizations [17,18]; and (3) leveraging and recognizing current bedside care as key learning opportunities [19]. In addition to trainees, practicing emergency physicians require additional training opportunities addressing this topic.…”