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resident physicians emergency

Joshua W Joseph, Samuel Davis, Elissa H Wilker, Matthew L Wong, Ori Litvak, Stephen J Traub, Larry A Nathanson, Leon D Sanchez
OBJECTIVES: Emergency physician productivity, often defined as new patients evaluated per hour, is essential to planning clinical operations. Prior research in this area considered this a static quantity; however, our group's study of resident physicians demonstrated significant decreases in hourly productivity throughout shifts. We now examine attending physicians' productivity to determine if it is also dynamic. METHODS: This is a retrospective cohort study, conducted from 2014 to 2016 across three community hospitals in the north-eastern USA, with different schedules and coverage...
March 15, 2018: Emergency Medicine Journal: EMJ
Sarah Mousseau, Annie Lapointe, Jocelyn Gravel
BACKGROUND: The CellScope Oto® is a smartphone otoscope attachment allowing physicians to share diagnostic-quality images of the ears. Our primary objective was to evaluate the residents' accuracy in diagnosing acute otitis media in children using the CellScope Oto® attachment compared to traditional otoscope. METHODS: A randomized crossover controlled trial was performed at a single, tertiary care, pediatric emergency department. Participants were a convenience sample of preschool children, consulting for fever and respiratory symptoms...
January 31, 2018: American Journal of Emergency Medicine
David A Kalmbach, Yu Fang, J Todd Arnedt, Amy L Cochran, Patricia J Deldin, Adam I Kaplin, Srijan Sen
BACKGROUND: Although short sleep, shift work, and physical inactivity are endemic to residency, a lack of objective, real-time information has limited our understanding of how these problems impact physician mental health. OBJECTIVE: To understand how the residency experience affects sleep, physical activity, and mood, and to understand the directional relationships among these variables. DESIGN: A prospective longitudinal study. SUBJECTS: Thirty-three first-year residents (interns) provided data from 2 months pre-internship through the first 6 months of internship...
March 14, 2018: Journal of General Internal Medicine
Joaquín M González-Cabrera, María Fernández-Prada, Concepción Iribar, Rogelio Molina-Ruano, María Salinero-Bachiller, José M Peinado
The objectives of this longitudinal study were to compare salivary cortisol release patterns in medical residents and their self-perceived anxiety levels between a regular working day and a day when on call in the emergency department (ED-duty day) and to determine any differences in cortisol release pattern as a function of years of residency or sex. The study included 35 residents (physicians-in-training) of the Granada University Hospital, Granada, Spain. Acute stress was measured on a regular working day and an ED-duty day, evaluating anxiety-state with the Spanish version of the State-Trait Anxiety Inventory...
March 13, 2018: International Journal of Environmental Research and Public Health
Finlay A McAlister, Jeffrey A Bakal, Lee Green, Brad Bahler, Richard Lewanczuk
BACKGROUND: Primary care networks are designed to facilitate access to inter-professional, team-based care. We compared health outcomes associated with primary care networks versus conventional primary care. METHODS: We obtained data on all adult residents of Alberta who visited a primary care physician during fiscal years 2008 and 2009 and classified them as affiliated with a primary care network or not, based on the physician most involved in their care. The primary outcome was an emergency department visit or nonelective hospital admission for a Patient Medical Home indicator condition (asthma, chronic obstructive pulmonary disease, heart failure, coronary disease, hypertension and diabetes) within 12 months...
March 12, 2018: CMAJ: Canadian Medical Association Journal, Journal de L'Association Medicale Canadienne
Robert Soegtrop, Matthew Douglas-Vail, Taylor Bechamp, Melanie P Columbus, Kevin Wood, Kristine Van Aarsen, Robert Sedran
An increase in physical activity has been shown to improve outcomes in many diseases. An estimated 600,000 Canadians receive their primary health care from emergency departments (ED). This study aims to examine physical activity prescription by emergency medicine physicians (EPs) to determine factors that influence decisions to prescribe physical activity. A survey was distributed to EPs via email using the Canadian Association of Emergency Physicians (CAEP) survey distribution protocol. Responses from 20% (n=332) of emergency physician/residents in Canada were analyzed...
March 9, 2018: Applied Physiology, Nutrition, and Metabolism, Physiologie Appliquée, Nutrition et Métabolisme
Jessica M Goldonowicz, Michael S Runyon, Mark J Bullard
BACKGROUND: To investigate the value of a novel simulation-based palliative care educational intervention within an emergency medicine (EM) residency curriculum. METHODS: A palliative care scenario was designed and implemented in the simulation program at an urban academic emergency department (ED) with a 3-year EM residency program. EM residents attended one of eight high-fidelity simulation sessions, in groups of 5-6. A standardized participant portrayed the patient's family member...
March 7, 2018: BMC Palliative Care
Matthew L Wong, Jared Anderson, Thomas Knorr, Joshua W Joseph, Leon D Sanchez
INTRODUCTION: The personality traits of emergency physicians are infrequently studied, though interest in physician wellness is increasing. The objective of this study is to acquire pilot data about the amount of grit, anxiety, and stress in emergency physicians using established psychological survey instruments, and to examine their associations of each of these traits with each other. METHODS: Thirty-six emergency medicine resident and attending physicians from an urban academic medical center consented for enrollment...
February 26, 2018: American Journal of Emergency Medicine
Niran Argintaru, Jared Baylis, Jodie Pritchard, Ali Mulla, Alice Gray, Alexander Hart, Christina Bova, Teri-Leigh Armstrong, Ahmed Taher
Canadian emergency medicine Royal College residency training allows for pursuing extra training in enhanced competency areas. A wealth of enhanced competency training opportunities exist nationally. However, the search for the right fit is a challenging one because there is no centralized resource that catalogues all of these opportunities. A working group of the Canadian Association of Emergency Physicians (CAEP) Resident Section was assembled in 2016 to create a freely accessible and comprehensive directory of Canadian enhanced competency areas...
March 4, 2018: CJEM
Rein Ketelaars, Joram T Stollman, Evelien van Eeten, Ties Eikendal, Jörgen Bruhn, Geert-Jan van Geffen
BACKGROUND: The treatment of acute pain in the emergency department is not always optimal. Peripheral nerve blocks using "blind" or nerve stimulator techniques have substantial disadvantages. Ultrasound-guided regional anesthesia may provide quick, safe, and effective pain relief in patients with proximal femoral fractures with severe pain. However, no evidence exists on emergency physician-performed ultrasound-guided regional anesthesia in these patients in Dutch emergency departments...
March 2, 2018: International Journal of Emergency Medicine
Sean S Michael, Kavita M Babu, Christopher Androski, Martin A Reznek
OBJECTIVE: Little is known about accuracy of provider self-perception of opioid prescribing. We hypothesized that an intervention asking emergency department (ED) providers to self-identify their opioid prescribing practices compared to group norms-and subsequently providing them with their actual prescribing data-would alter future prescribing compared to controls. METHODS: This was a prospective, multi-center randomized trial in which all attending physicians, residents, and advanced practice providers at four EDs were randomly assigned to either no intervention or a brief data-driven intervention during which providers were: (1) asked to self-identify and explicitly report to research staff their perceived opioid prescribing in comparison to their peers, and then (2) given their actual data with peer group norms for comparison...
March 2, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Elizabeth M Schoenfeld, Sarah L Goff, Tala R Elia, Errel R Khordipour, Kye E Poronsky, Kelly A Nault, Peter K Lindenauer, Kathleen M Mazor
Background : Physicians need to rapidly and effectively facilitate patient-centered, shared decision-making (SDM) conversations, but little is known about how residents or attending physicians acquire this skill. Objective : We explored emergency medicine (EM) attending physicians' use of SDM in the context of their experience as former residents and current educators and assessed the implications of these findings on learning opportunities for residents. Methods : We used semistructured interviews with a purposeful sample of EM physicians...
February 2018: Journal of Graduate Medical Education
Arlene Chung, Nicole Battaglioli, Michelle Lin, Jonathan Sherbino
Background : Physician well-being is garnering increasing attention. In 2016, the Journal of Graduate Medical Education ( JGME ) published a review by Kristin Raj, MD, entitled "Well-Being in Residency: A Systematic Review." There is benefit in contextualizing the literature on resident well-being through an academic journal club. Objective : We summarized an asynchronous, online journal club discussion about this systematic review and highlighted themes that were identified in the review...
February 2018: Journal of Graduate Medical Education
Jeffrey H Barsuk, Elaine R Cohen, Diane B Wayne, William C McGaghie, Rachel Yudkowsky
PURPOSE: Defensible minimum passing standards (MPSs) must be used to evaluate learner performance outcomes in health professions education. In this study, the authors compared the results of traditional Angoff and Hofstee standard-setting exercises with the Mastery Angoff and Patient-Safety approaches for central venous catheter (CVC) insertion skills examinations. The authors also evaluated how these standards affected evaluation of the historical performance of residents who participated in a simulation-based mastery learning (SBML) curriculum for CVC insertion skills...
February 20, 2018: Academic Medicine: Journal of the Association of American Medical Colleges
Sabina Abou Malham, Nassera Touati, Lara Maillet, Mylaine Breton
BACKGROUND: The advanced access (AA) model is a highly recommended innovation to improve timely access to primary healthcare. Despite that many studies have shown positive impacts for healthcare professionals, and for patients, implementing this model in clinics with a teaching mission for family medicine residents poses specific challenges. OBJECTIVE: To identify these challenges within these clinics, as well as potential strategies to address them. DESIGN: The authors adopted a qualitative multiple case study design, collected data in 2016 using semi-structured interviews (N = 40) with healthcare professionals and clerical staff in four family medicine units in Quebec, and performed a thematic analysis...
December 2018: Medical Education Online
Lena M Napolitano, Venkatakrishna Rajajee, Kyle J Gunnerson, Michael D Maile, Michael Quasney, Robert C Hyzy
Critical care fellowship training in the United States differs based on specific specialty, and includes medicine, surgery, anesthesiology, pediatrics, emergency medicine and neurocritical care training pathways. We provide an update regarding the number and growth of U.S. critical care fellowship training programs, on-duty residents and certified diplomates, and review the different critical care physician training pathways available to residents interested in pursuing a fellowship in critical care. Data were obtained from the Accreditation Council for Graduate Medical Education (ACGME) and specialty boards [American Board of Internal Medicine (ABIM), American Board of Surgery (ABS), American Board of Anesthesiology (ABA), American Board of Pediatrics (ABP), American Board of Emergency Medicine (ABEM)] and the United Council for Neurologic Subspecialties (UCNS) for the last 16 years (2001-2017)...
February 17, 2018: Journal of Trauma and Acute Care Surgery
Ikwan Chang, Young Ho Kwak, Do Kyun Kim, Jin Hee Lee, Jae Yun Jung, Hyuksool Kwon, Jin Hee Jung, Bongjin Lee, So Hyun Paek
OBJECTIVES: This study aimed to introduce an easily made chicken breast simulator for ultrasound (US)-guided vascular access, foreign body (FB) detection, and hydrodissection in pediatric patients and to validate the effectiveness for training using this phantom tissue model. METHODS: The authors made the tissue phantom simulator using a chicken breast and rubber tourniquet for vascular access and fragments of a tongue blade and steel clip for FB detection and hydrodissection using a very simple method...
February 15, 2018: Pediatric Emergency Care
Susan L Bannister, Mark S Dolson, Lorelei Lingard, David A Keegan
CONTEXT: As part of their training, physicians are required to learn how to perform technical skills on patients. The previous literature reveals that this learning is complex and that many opportunities to perform these skills are not converted into attempts to do so by learners. This study sought to explore and understand this phenomenon better. METHODS: A multi-phased qualitative study including ethnographic observations, interviews and focus groups was conducted to explore the factors that influence technical skill learning...
February 15, 2018: Medical Education
Russell Fung, Jensen Hart Hyde, Mike Davis
The process of admitting patients from the emergency department (ED) to an academic internal medicine (AIM) service in a community teaching hospital is one fraught with variability and disorder. This results in an inconsistent volume of patients admitted to academic versus private hospitalist services and results in frustration of both ED and AIM clinicians. We postulated that implementation of a mobile application (app) would improve provider satisfaction and increase admissions to the academic service. The app was designed and implemented to be easily accessible to ED physicians, regularly updated by academic residents on call, and a real-time source of the number of open AIM admission spots...
2018: Journal of Community Hospital Internal Medicine Perspectives
Robert Fritze, Anita Graser, Markus Sinnl
OBJECTIVES: Emergency medical services have been established in many countries all over the world. Good first care improves the outcome of patients in terms of hospital stay duration, chances of full recovery and of treatment costs. In this paper, we present an integrated approach combining spatial information and integer optimization for emergency medical service location planning. The research is motivated by a recent call for bids to restructure the location of emergency medical services in the Austrian federal state of Lower Austria by the local state government...
March 2018: International Journal of Medical Informatics
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