Resident Clinical Experience in the Emergency Department: Patient Encounters by Postgraduate Year

Douglass, Amy M.; Yip, Kathleen; Lumanauw, Debryna Dewi; Fleischman, Ross J.; Jordan, Jaime; Tanen, David A.

doi:10.1002/aet2.10326

Cited by 16 publications

(26 citation statements)

References 15 publications

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“…This study capitalizes on the availability of clinical information associated with the increased reliance on electronic medical records (EMRs). As demonstrated by Douglass et al . this type of approach can inform current and future curricular interventions based on the diversity that exists in the current training environment.…”

Section: Discussionmentioning

confidence: 99%

“…The ABEM Model provides the structure and guidance for current EM training, so it is reassuring that all categories were represented, albeit some in lower volumes. Several prior studies have identified challenges with tracking the EM resident clinical experience and assuring adequate clinical exposure . New approaches are required to assess the training environment and the current training standards.…”

Section: Discussionmentioning

confidence: 99%

“…Clinical patient encounters serve as the key component of residency training and in theory should be reflected in the ABEM Model. However, the case mix and content of patient care encounters are difficult to characterize . To our knowledge, although the ABEM Model framework was derived from clinical practice experience by expert panels, it has not been formally compared with the clinical experience of EM residents.…”

mentioning

confidence: 99%

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

Bischof

Emerson

Mitzman

et al. 2019

AEM Education and Training

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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

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

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

Bischof

Emerson

Mitzman

et al. 2019

AEM Education and Training

View full text Add to dashboard Cite

show abstract

“…Characteristics of patients seen by residents in Taipei and Keelung branches Pre-epidemic period Epidemic period P valueDiscussionThe objective of EM residency training is to enhance residents' knowledge and breadth of clinical experience. Speci cally, the primary goal of EM residency training programs is to ensure that residents gain the required clinical experience to master the knowledge and clinical skills necessary to practice EM (12). Case exposure based on seeing a variety of patients with varying acuity levels, chief complaints, and…”

mentioning

confidence: 99%

What is the impact of the COVID-19 Pandemic on Emergency Medicine Residency Training: An observational study

Lin

Chaou

et al. 2020

Preprint

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Background The coronavirus disease 2019 (COVID-19) pandemic has engendered difficulties for health systems globally; however, the effect of the pandemic on emergency medicine (EM) residency training programs is unknown. The pandemic has caused reduced volumes of emergency department (ED) patients, except for those with COVID-19 infections, and this may reduce the case exposure of EM residents. The primary objective of this study was to compare the clinical exposure of EM residents between the prepandemic and pandemic periods. Methods This was a retrospective study of EM resident physicians’ training in a tertiary teaching hospital with two branch regional hospitals in Taiwan. We retrieved data regarding patients seen by EM residents in the ED between September 1, 2019, and April 30, 2020. The first confirmed COVID-19 case in Taiwan was reported on January 11, so the pandemic period in our study was defined as spanning from February 1, 2020, to April 30, 2020. The number and characteristics of patients seen by residents were recorded. We compared the data between the prepandemic and pandemic periods.Results The mean number of patients per hour (PPH) seen by EM residents in the adult ED decreased in all three hospitals during the pandemic. The average PPH of critical area of medical ED was 1.68 in the pre-epidemic period and decreased to 1.33 in the epidemic period (p value < 0.001). The average number of patients managed by residents decreased from 1.24 to 0.82 in the trauma ED (p value= 0.01) and 1.56 to 0.51 in the pediatric ED (p value=0.003) during the pandemic, respectively. The severity of patient illness did not change significantly between the periods. Conclusions The COVID-19 pandemic engendered a reduced ED volume and decreased EM residents’ clinical exposure. All portion of EM residency training were affected by the pandemic, with pediatric EM being the most affected. The patient volume reduction may persist and in turn reduce patients’ case exposure until the pandemic subsides. Adjustment of the training programs may be necessary and ancillary methods of learning should be used to ensure adequate EM residency training.

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“…Characteristics of patients seen by residents in Linkou general hospital Pre-epidemic period Epidemic period P valueDiscussionThe objective of EM residency training is to enhance residents' knowledge and breadth of clinical experience. Speci cally, the primary goal of EM residency training programs is to ensure that residents gain the required clinical experience to master the knowledge and clinical skills necessary to practice EM (12). Case exposure based on seeing a variety of patients with varying acuity levels, chief complaints, and diagnoses is crucial for the development of comprehensive experience (13)(14)(15).…”

mentioning

confidence: 99%

What is the Impact of the COVID-19 Pandemic on Emergency Medicine Residency Training: An Observation Study

Lin

Chaou

et al. 2020

Preprint

View full text Add to dashboard Cite

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has engendered difficulties for health systems globally; however, the effect of the pandemic on emergency medicine (EM) residency training programs is unknown. The pandemic has engendered reduced volumes of emergency department (ED) patients, except for those with COVID-19 infections, and this may reduce the case exposure of EM residents. The primary objective of this study was to compare the clinical exposure of EM residents between the prepandemic and pandemic periods. MethodsThis was a retrospective study of EM resident physicians in Taiwan. We performed a medical record review and retrieved data regarding patients seen by EM residents in the ED between September 1, 2019, and April 30, 2020. The number and characteristics of patients seen by residents were recorded, and the training schedules, including clinical working hours, of EM residents were determined. We compared the data between the prepandemic and pandemic periods.ResultsA total of 51,337 patients were managed by 36 EM residents during the 8-month study period. The mean number of patients per hour (PPH) seen by EM residents decreased significantly during the pandemic period. The PPH seen by residents in the adult ED decreased in all three hospitals during the pandemic. The average number of patients managed by residents decreased by 50% and 70% in the trauma ED and pediatric ED during the pandemic, respectively. The severity of patient illness did not change significantly between the periods. ConclusionsThe COVID-19 pandemic engendered a reduced ED volume and decreased EM residents’ clinical exposure. All portion of EM residency training were affected by the pandemic, with pediatric EM being the most affected. The patient volume reduction may persist and in turn reduce patients’ case exposure until the pandemic subsides. Adjustment of the training programs may be necessary and ancillary methods of learning should be used to ensure adequate EM residency training.

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Resident Clinical Experience in the Emergency Department: Patient Encounters by Postgraduate Year

Cited by 16 publications

References 15 publications

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

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

What is the impact of the COVID-19 Pandemic on Emergency Medicine Residency Training: An observational study

What is the Impact of the COVID-19 Pandemic on Emergency Medicine Residency Training: An Observation Study

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