The 2011 Model of the Clinical Practice of Emergency Medicine

Perina, Debra G.; Brunett, Patrick; An, David; Char, Douglas; Chisholm, Carey D.; Counselman, Francis L.; Heidt, Jonathan; Keim, Samuel M.; John, Oommen

doi:10.1111/j.1553-2712.2012.01385.x

Cited by 43 publications

(9 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Focused bedside renal US for the detection of hydronephrosis by emergency physicians (EP) is an established practice and is now integrated within the core emergency medicine curriculum of residency training programs 4. The finding of hydronephrosis on emergency bedside US is an indirect sign of a ureteral stone and has a reported sensitivity of 72–83% when compared to CT 5,6…”

Section: Introductionmentioning

confidence: 99%

Sensitivity of Emergency Bedside Ultrasound to Detect Hydronephrosis in Patients with Computed Tomography-proven Stones

Riddell¹,

Case²,

Wopat³

et al. 2014

WestJEM

View full text Add to dashboard Cite

IntroductionNon-contrast computed tomography (CT) is widely regarded as the gold standard for diagnosis of urolithiasis in emergency department (ED) patients. However, it is costly, time-consuming and exposes patients to significant doses of ionizing radiation. Hydronephrosis on bedside ultrasound is a sign of a ureteral stone, and has a reported sensitivity of 72–83% for identification of unilateral hydronephrosis when compared to CT. The purpose of this study was to evaluate trends in sensitivity related to stone size and number.MethodsThis was a structured, explicit, retrospective chart review. Two blinded investigators used reviewed charts of all adult patients over a 6-month period with a final diagnosis of renal colic. Of these charts, those with CT evidence of renal calculus by attending radiologist read were examined for results of bedside ultrasound performed by an emergency physician. We included only those patient encounters with both CT-proven renal calculi and documented bedside ultrasound results.Results125 patients met inclusion criteria. The overall sensitivity of ultrasound for detection of hydronephrosis was 78.4% [95% confidence interval (CI)=70.2–85.3%]. The overall sensitivity of a positive ultrasound finding of either hydronephrosis or visualized stones was 82.4% [95%CI: 75.6%, 89.2%]. Based on a prior assumption that ultrasound would detect hydronephrosis more often in patients with larger stones, we found a statistically significant (p=0.016) difference in detecting hydronephrosis in patients with a stone ≥6 mm (sensitivity=90% [95% CI=82–98%]) compared to a stone <6 mm (sensitivity=75% [95% CI=65–86%]). For those with 3 or more stones, sensitivity was 100% [95% CI=63–100%]. There were no patients with stones ≥6 mm that had both a negative ultrasound and lack of hematuria.ConclusionIn a population with CT-proven urolithiasis, ED bedside ultrasonography had similar overall sensitivity to previous reports but showed better sensitivity with increasing stone size and number. We identified 100% of patients with stones ≥6 mm that would benefit from medical expulsive therapy by either the presence of hematuria or abnormal ultrasound findings.

show abstract

Section: Introductionmentioning

confidence: 99%

Sensitivity of Emergency Bedside Ultrasound to Detect Hydronephrosis in Patients with Computed Tomography-proven Stones

Riddell¹,

Case²,

Wopat³

et al. 2014

WestJEM

View full text Add to dashboard Cite

show abstract

“…The Model of the Clinical Practice of Emergency Medicine23 (EM Model) serves as the basis for the content specifications for all American Board of Emergency Medicine (ABEM) examinations 24. The knowledge required to practice competent EM increases daily.…”

Section: Discussionmentioning

confidence: 99%

“…The GEMC are high impact geriatric topics developed by Hogan et al and identified through expert consensus as most important in the emergency care of older adults 22,23. The GEMCs were used as a basis for development of an educational intervention, and multiple choice assessment tool.…”

Section: Methodsmentioning

confidence: 99%

Assessing Knowledge Base on Geriatric Competencies for Emergency Medicine Residents

Hogan¹,

Hansoti²,

Chan³

2014

WestJEM

View full text Add to dashboard Cite

IntroductionEmergency care of older adults requires specialized knowledge of their unique physiology, atypical presentations, and care transitions. Older adults often require distinctive assessment, treatment and disposition. Emergency medicine (EM) residents should develop expertise and efficiency in geriatric care. Older adults represent over 25% of most emergency department (ED) volumes. Yet many EM residencies lack curricula or assessment tools for competent geriatric care. Fully educating residents in emergency geriatric care can demand large amounts of limited conference time. The Geriatric Emergency Medicine Competencies (GEMC) are high-impact geriatric topics developed to help residencies efficiently and effectively meet this training demand. This study examines if a 2-hour didactic intervention can significantly improve resident knowledge in 7 key domains as identified by the GEMC across multiple programs.MethodsA validated 29-question didactic test was administered at six EM residencies before and after a GEMC-focused lecture delivered in summer and fall of 2009. We analyzed scores as individual questions and in defined topic domains using a paired student t test.ResultsA total of 301 exams were administered; 86 to PGY1, 88 to PGY2, 86 to PGY3, and 41 to PGY4 residents. The testing of didactic knowledge before and after the GEMC educational intervention had high internal reliability (87.9%). The intervention significantly improved scores in all 7 GEMC domains (improvement 13.5% to 34.6%; p<0.001). For all questions, the improvement was 23% (37.8% pre, 60.8% post; P<0.001) Graded increase in geriatric knowledge occurred by PGY year with the greatest improvement post intervention seen at the PGY 3 level (PGY1 19.1% versus PGY3 27.1%).ConclusionA brief GEMC intervention had a significant impact on EM resident knowledge of critical geriatric topics. Lectures based on the GEMC can be a high-yield tool to enhance resident knowledge of geriatric emergency care. Formal GEMC curriculum should be considered in training EM residents for the demands of an aging population.

show abstract

“…Finally, extensive changes were made to Appendix 1 and Appendix 2. Appendix 1 became category “19.0 Procedures and Skills Integral to the Practice of Emergency Medicine” under the table of “Medical Knowledge, Patient Care, and Procedural Skills”; Appendix 2 became category “20.0 Other Core Competencies of the Practice of Emergency Medicine.” Within each of these two sections, additional changes were made . All of these changes were approved by the collaborating organizations and the revised Model was published electronically in Academic Emergency Medicine in July 2012.…”

Section: Evolutionmentioning

confidence: 99%

Evolution of the Model of the Clinical Practice of Emergency Medicine: 1979 to Present

Counselman

Beeson

Marco

et al. 2017

Academic Emergency Medicine

Self Cite

View full text Add to dashboard Cite

The Model of the Clinical Practice of Emergency Medicine (the EM Model) is a three-dimensional representation of the clinical practice of emergency medicine. It is a product of successful collaboration involving the American Board of Emergency Medicine (ABEM), the American College of Emergency Physicians (ACEP), the Society for Academic Emergency Medicine (SAEM), the Emergency Medicine Residents' Association (EMRA), the Council of Emergency Medicine Residency Directors (CORD), the Residency Review Committee for Emergency Medicine (RRC-EM), and the American Academy of Emergency Medicine (AAEM). In 2017, the most recent update and revision of the EM Model will be published. This document will represent the culmination of nearly 40 years of evolution, from a simple listing of presenting patient complaints, clinical symptoms, and disease states into a three-dimensional representation of the clinical practice of emergency medicine. These dimensions include conditions and components, physician tasks, and patient acuity. In addition, over the years, two other documents have been developed, the Knowledge, Skills, and Abilities (KSAs) and the Emergency Medicine Milestones. Both serve as related and complementary educational and assessment tools. This article will review the development of the EM Model from its inception in 1979 to today.

show abstract

The 2011 Model of the Clinical Practice of Emergency Medicine

Abstract: The 2011 Model of the Clinical Practice of Emergency Medicine. ACADEMIC EMERGENCY MEDICINE 2012; 19:000–000 © 2012 by the Society for Academic Emergency Medicine

Cited by 43 publications

References 16 publications

Sensitivity of Emergency Bedside Ultrasound to Detect Hydronephrosis in Patients with Computed Tomography-proven Stones

Sensitivity of Emergency Bedside Ultrasound to Detect Hydronephrosis in Patients with Computed Tomography-proven Stones

Assessing Knowledge Base on Geriatric Competencies for Emergency Medicine Residents

Evolution of the Model of the Clinical Practice of Emergency Medicine: 1979 to Present

Contact Info

Product

Resources

About