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

Abstract

Objectives Emergency medicine (EM) residents take the In‐Training Examination (ITE) annually to assess medical knowledge. Question content is derived from the Model of Clinical Practice of Emergency Medicine (EM Model), but it is unknown how well clinical encounters reflect the EM Model. The objective of this study was to compare the content of resident patient encounters from 2016–2018 to the content of the EM Model represented by the ITE Blueprint. Methods This was a retrospective cross‐sectional study utilizing the National Hospital Ambulatory Medical Care Survey (NHAMCS). Reason for visit (RFV) codes were matched to the 20 categories of the American Board of Emergency Medicine (ABEM) ITE Blueprint. All analyses were done with weighted methodology. The proportion of visits in each of the 20 content categories and 5 acuity levels were compared to the proportion in the ITE Blueprint using 95% confidence intervals (CIs). Results Both resident and nonresident patient visits demonstrated content differences from the ITE Blueprint. The most common EM Model category were visits with only RFV codes related to signs, symptoms, and presentations regardless of resident involvement. Musculoskeletal disorders (nontraumatic), psychobehavioral disorders, and traumatic disorders categories were overrepresented in resident encounters. Cardiovascular disorders and systemic infectious diseases were underrepresented. When residents were involved with patient care, visits had a higher proportion of RFV codes in the emergent and urgent acuity categories compared to those without a resident. Conclusions Resident physicians see higher acuity patients with varied patient presentations, but the distribution of encounters differ in content category than those represented by the ITE Blueprint.

Number of Patient Encounters in Emergency Medicine Residency Does Not Correlate with In-Training Exam Domain Scores

“…Instead, residents would be best served with a broad study plan regardless of the range of their clinical encounters, which is in line with previous studies demonstrating the differences between residents’ patient care experiences and the blueprint provided by the Model. 6 , 8 There remains room for further study to more clearly elucidate the link, if any, between clinical training and ITE performance.…”

Integration of Geriatric Education Within the American Board of Emergency Medicine Model

“…This includes the skills needed to care for older patients, who make up 16–20% of their patients. 1 , 2 The American Board of Emergency Medicine (ABEM) codifies the skills needed for competency in EM in the Model of the Clinical Practice of Emergency Medicine (EM Model) and the 2021 knowledge, skills, and abilities (KSA). 3 , 4 The EM Model lists clinical presentations and disease types and the KSAs are a list of skills and abilities integral to EM practice.…”