Dr. Michael Gisondi is the inaugural Vice Chair of Education in the Department of Emergency Medicine at Stanford University. He is a medical education researcher and an expert in the application of social media in medical education. He is a leader in the fields of medical education and emergency medicine, recently serving on the Board of Directors of the Council of Emergency Medicine Residency Directors, as well as the editorial boards of Academic Life in Emergency Medicine, the Journal of Education and Teaching in Emergency Medicine, and the international medical education conference, Medutopia. He is an associate editor for the textbook, Emergency Medicine, and conference faculty with the national certification course, EPEC-EM: Education in Palliative and End-of-life Care in Emergency Medicine.
Born and raised in upstate New York, Dr. Gisondi earned his Bachelor of Science with honors from The Catholic University of America in Washington, DC and his medical degree from Loyola University Chicago Stritch School of Medicine, where he was inducted in Alpha Omega Alpha. He completed his residency in Emergency Medicine at Stanford University, spending an additional year as Chief Resident. While at Stanford, he also completed a fellowship in Faculty Development with the Division of Emergency Medicine. Dr. Gisondi was a faculty member at Northwestern University Feinberg School of Medicine from 2003 – 2017, where he held several leadership roles including Residency Program Director, Medical Education Scholarship Fellowship Director, and Director of the Feinberg Academy of Medical Educators. He was a Junior Fellow of the Searle Center for Teaching Excellence at Northwestern and a member of the Northwestern McGaw Graduate Medical Education Committee.
In 2014, Dr. Gisondi was awarded the National Faculty Teaching Award of the American College of Emergency Physicians and was named Alumnus of the Year for recognition of his early career achievements by Loyola University Chicago Stritch School of Medicine. He completed the SAEM Chair Development Program in 2018 and he is a participant in the 2018-20 Stanford Medicine Leadership Academy.
- Emergency Medicine
Associate Professor - Med Center Line, Emergency Medicine
Vice Chair of Education, Department of Emergency Medicine (2017 - Present)
Mentor, Scholarly Concentration in Medical Education, School of Medicine (2018 - Present)
Honors & Awards
Alpha Omega Alpha, Alpha Omega Alpha National Medical Honor Society (1999)
National Finals, Clinical Pathological Case Competition: First Place, Best Resident Presenter, Co-Sponsors: CORD-EM, SAEM, ACEP (2001)
Junior Fellow, Northwestern University Searle Center for Teaching and Learning (2006)
Feinberg Academy of Medical Educators, Inaugural Inductee, Northwestern University Feinberg School of Medicine (2010)
Alumnus of the Year for Early Career Achievement, Loyola University Stritch School of Medicine (2014)
National Faculty Teaching Award, American College of Emergency Physicians (2014)
Leape Ahead Award, American Association for Physician Leadership (2015)
Boards, Advisory Committees, Professional Organizations
Chief Strategy Officer, Emergency Medicine Chief Resident Incubator, Academic Life in Emergency Medicine (2014 - 2016)
Editor, Emergency Medicine Match Advice Digital Series, Academic Life in Emergency Medicine (2014 - Present)
Member at Large, Board of Directors, Council of Residency Directors in Emergency Medicine (2017 - 2019)
Editorial Board, Journal of Education and Training in Emergency Medicine (2017 - Present)
Editorial Board, International Clinician Educators Blog (2017 - Present)
Board of Innovators, Medutopia (2018 - Present)
Medical Education:Loyola University Stritch School of Medicine (1999) IL
Residency:Stanford University School of Medicine Registrar (2002) CA
Fellowship:Stanford University School of Medicine Registrar (2003) CA
Board Certification: Emergency Medicine, American Board of Emergency Medicine (2003)
Community and International Work
Medutopia, Santiago, Chile
Medical Education, Faculty Development
Medicina de Urgencia y Emergencia, Universidad San Sebastian
Medical Educators and Physician Trainees
Opportunities for Student Involvement
Aiming Beyond Competent: The Application of the Taxonomy of Significant Learning to Medical Education.
Teaching and learning in medicine
ISSUE: Competency-Based Medical Education (CBME) focuses on demonstrable outcomes, as well as upholding medical education's accountability to society. Despite calls for a robust, multifaceted approach to competency-based assessment (CBA), lingering critiques exist. These critiques include reductionism, reinforcement of an external locus of control within learners, an loss of focus on learner development. Both CBME and CBA may be strengthened if viewed through the lens of a complementary curriculum design framework that broadens the focus on the learner.EVIDENCE: Researchers and physician organizations have articulated the need for medical practitioners trained to provide optimal care in the rapidly changing care environment. In the drive to ensure accountability to patients and society, CBME may overlook the duty of educators to foster the necessary intrinsic development of learners as holistic professionals. The focus of CBA on outcomes may reward memorization and rote performance but may fail to ensure the underlying comprehension or critical thinking necessary to adapt to the variability of real-life patient care. Learners focus on tasks chosen for assessment; thus, areas less easily assessed may be overlooked or deemed unimportant. Reinforcement for learner motivation becomes externalized in CBA, as opposed to being driven by the desire for self-improvement and self-actualization. A recently proposed framework that views learner development as a process-based improvement cycle, the "Master Adaptive Learner," may help remedy this issue. L. Dee Fink's Taxonomy of Significant Learning aims to create meaningful learning experiences in higher education. This taxonomy consists of six interwoven domains: (a) Learning How to Learn, (b) Foundational Knowledge, (c) Application, (d) Integration, (e) Human Dimension, and (f) Caring. Each domain encompasses a unique perspective on the learning process, and when collectively applied to curriculum design, significant learning occurs. This taxonomy has not been widely applied to medical education but may offer an important counterbalance to the outcomes-based focus of CBME.IMPLICATIONS: The outcomes-based focus of CBME is well suited for skill-based tasks, such as procedures, that are observable and measurable. However, other essential physician skills-such as critical thinking, reflection, empathy, and self-directed learning-are not easily assessed, and thus may receive little focus in an outcomes-based model. A holistic approach, such as the Taxonomy of Significant Learning, can counter the deficits of CBME and provide a balanced approach to education program design and assessment.
View details for DOI 10.1080/10401334.2018.1561368
View details for PubMedID 30686049
The Birth of a Return to Work Policy for New Resident Parents in Emergency Medicine.
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
OBJECTIVE: With the rising number of female physicians, there will be more children than ever born in residency and the current system is inadequate to handle this increase in new resident parents. Residency is stressful and rigorous in isolation, let alone when pregnant or with a new child. Policies that ease these stressful transitions are generally either insufficient or do not exist. Therefore, we created a comprehensive Return to Work Policy for resident parents and piloted its implementation. Our policy aims to: 1) establish a clear, shared understanding of the regulatory and training requirements as they pertain to parental leave, 2) facilitate a smooth transition for new parents returning back to work, and 3) summarize the local and institutional resources available for both males and females during residency training.METHOD: In Fall 2017, a task force was convened to draft a Return to Work Policy for New Resident Parents. The task force included 9 key stakeholders (i.e., residents, faculty, and administration) at our institution and was made up of 3 Graduate Medical Education (GME) Program Directors, a Vice Chair of Education, a Designated Institutional Official (DIO), a Chief Resident, and 3 members of our academic department's Faculty Affairs Committee. The task force was selected because of individual expertise in gender equity issues, mentorship of resident parents, GME, and departmental administration.RESULTS: After development, the policy was piloted from November 2017 to June 2018. Our pilot implementation period included 7 new resident parents. All of these residents received schedules that met the return to work scheduling terms of our Return to Work Policy including no overnight shifts, no sick call, no more than 3 shifts in a row. Of equal importance, throughout our pilot, the emergency department schedules at all of our clinical sites remained fully staffed and our sick call pool was unaffected.CONCLUSION: Our Return to Work Policy for New Resident Parents provides a comprehensive guide to training requirements and family leave policies, an overview of available resources, and a scheduling framework that makes for a smooth transition back to clinical duties. This article is protected by copyright. All rights reserved.
View details for DOI 10.1111/acem.13684
View details for PubMedID 30636353
- In Reply to Walls and Gingles. Academic medicine : journal of the Association of American Medical Colleges 2018; 93 (9): 1266
Online Mastermind Groups: A Non-hierarchical Mentorship Model for Professional Development.
2018; 10 (7): e3013
Mentorship is an important driver of professional development and scholarship in academic medicine. Several mentorship models have been described in the medical education literature, with the majority featuring a hierarchical relationship between senior and junior members of an institution. 'Mastermind Groups', popularized in the business world, offer an alternative model of group mentorship that benefits from the combined intelligence and accumulated experience of the participants involved. We describe an online application of the Mastermind model, used as an opportunity for faculty development by a globally distributed team of health professions educators. The majority of our participants rated their experiences over two online Mastermind group mentoring sessions as 'very valuable', resulting in recommendations of specific developmental resources, professional referrals, and identifiable immediate 'next steps' for their careers. Our experience suggests that online Mastermind groups are an effective, feasible, zero-cost model for group mentorship and professional development in medicine.
View details for DOI 10.7759/cureus.3013
View details for PubMedID 30397564
More Learners, Finite Resources, and the Changing Landscape of Procedural Training at the Bedside.
Academic medicine : journal of the Association of American Medical Colleges
2018; 93 (5): 699–704
There is growing competition for nonoperative, procedural training in teaching hospitals, due to an increased number of individuals seeking to learn procedures from a finite number of appropriate teaching cases. Procedural training is required by students, postgraduate learners, and practicing providers who must maintain their skills. These learner groups are growing in size as the number of medical schools increases and advance practice providers expand their skills to include complex procedures. These various learner needs occur against a background of advancing therapeutic techniques that improve patient care but also act to reduce the overall numbers of procedures available to learners. This article is a brief review of these and other challenges that are arising for program directors, medical school leaders, and hospital administrators who must act to ensure that all of their providers acquire and maintain competency in a wide array of procedural skills. The authors conclude their review with several recommendations to better address procedural training in this new era of learner competition. These include a call for innovative clinical rotations deliberately designed to improve procedural training, access to training opportunities at new clinical sites acquired in health system expansions, targeted faculty development for those who teach procedures, reporting of competition for bedside procedures by trainees, more frequent review of resident procedure and case logs, and the creation of an institutional oversight committee for procedural training.
View details for DOI 10.1097/ACM.0000000000002062
View details for PubMedID 29166352
A Multicenter Collaboration for Simulation-Based Assessment of ACGME Milestones in Emergency Medicine.
Simulation in healthcare : journal of the Society for Simulation in Healthcare
STATEMENT: In 2014, the six allopathic emergency medicine (EM) residency programs in Chicago established an annual, citywide, simulation-based assessment of all postgraduate year 2 EM residents. The cases and corresponding assessment tools were designed by the simulation directors from each of the participating sites. All assessment tools include critical actions that map directly to numerous EM milestones in 11 different subcompetencies. The 2-hour assessments provide opportunities for residents to lead resuscitations of critically ill patients and demonstrate procedural skills, using mannequins and task trainers respectively. More than 80 residents participate annually and their assessment experiences are essentially identical across testing sites. The assessments are completed electronically and comparative performance data are immediately available to program directors.
View details for DOI 10.1097/SIH.0000000000000291
View details for PubMedID 29620703
Curriculum Design and Implementation of the Emergency Medicine Chief Resident Incubator.
2018; 10 (2): e2223
Background Chief residents receive minimal formal training in preparation for their administrative responsibilities. There is a lack of professional development programs specifically designed for chief residents. Objective In 2015, Academic Life in Emergency Medicine designed and implemented an annual, year-long, training program and virtual community of practice for chief residents in emergency medicine (EM). This study describes the curriculum design process and reports measures of learner engagement during the first two cycles of the curriculum. Methods Kern's Six-Step Approach for curriculum development informed key decisions in the design and implementation of the Chief Resident Incubator. The resultant curriculum was created using constructivist social learning theory, with specific objectives that emphasized the needs for a virtual community of practice, longitudinal content delivery, mentorship for participants, and the facilitation of multicenter digital scholarship. The 12-month curriculum included 11 key administrative or professional development domains, delivered using a combination of digital communications platforms. Primary outcomes measures included markers of learner engagement with the online curriculum, recognized as modified Kirkpatrick Level One outcomes for digital learning. Results An average of 206 chief residents annually enrolled in the first two years of the curriculum, with an overall participation by 33% (75/227) of the allopathic EM residency programs in the United States (U.S.). There was a high level of learner engagement, with an average 13,414 messages posted per year. There were also 42 small group teaching sessions held online, which included 39 faculty and 149 chief residents. The monthly e-newsletter had a 50.7% open rate. Digital scholarship totaled 23 online publications in two years, with 67 chief resident co-authors and 21 faculty co-authors. Conclusions The Chief Resident Incubator is a virtual community of practice that provides longitudinal training and mentorship for EM chief residents. This incubator conceptual framework may be used to design similar professional development curricula across various health professions using an online digital platform.
View details for DOI 10.7759/cureus.2223
View details for PubMedID 29696101
A Ten-year Program Evaluation of an Emergency Medicine Scholarly Track in Education Using a Qualitative Approach.
AEM education and training
2017; 1 (3): 215–20
Background: Residency scholarly tracks have allowed training programs to better prepare residents for a future in academia. Despite their success, however, few evaluations of these scholarly tracks have been completed to ensure they are meeting the goals of their stakeholders.Objective: The objective was to evaluate the education scholarly track at Northwestern University Emergency Medicine by querying key stakeholders on the current state of the track and its ideal state.Methods: Current emergency medicine residents, faculty, and track alumni were identified as essential stakeholders. Their perspectives on the track were elicited with a focus group and online survey, respectively, and responses were analyzed using grounded theory.Results: Four distinct themes emerged from the analysis as critical to the track: "education skills and learning theory," "education research methodology," "leadership," and "collaboration."Conclusion: These themes will be used to inform further development of the track. A similar self-reflection process may benefit other programs with scholarly tracks.
View details for DOI 10.1002/aet2.10040
View details for PubMedID 30051037
Measuring the Correlation Between Emergency Medicine Resident and Attending Physician Patient Satisfaction Scores Using Press Ganey.
AEM education and training
2017; 1 (3): 179–84
Objective: The purpose of this study was to assess the relationship between emergency medicine (EM) resident and attending physician patient satisfaction scores.Methods: We added four resident questions to the standard Press Ganey survey used at a large, urban, university hospital with a PGY-1 to -4 EM residency. The resident questions were identical to the traditional attending questions. Press Ganey distributed the modified survey to a random sample of 30% of discharged patients. We assessed the correlation between resident and attending top-box Press Ganey scores using Pearson's coefficients. Two-tailed two-sample comparisons of proportions were used to compare top-box responses between residents and attendings.Results: From September 1, 2012, to August 31, 2015, a total of 66,216 patients received surveys, and 7,968 responded, resulting in a 12.03% response rate, similar to Press Ganey survey response rate at comparable peer institutions. Patients were able to discriminate between residents and attendings; however, 751 surveys did not contain responses for residents, resulting in a total number of 6,957. All 64 of the EM residents had a minimum of 5 or more surveys returned. There was a high degree of correlation between resident and attending top-box scores with correlation coefficients ranging from 0.75 to 0.80. However, the proportion of top-box scores was consistently higher for residents (p<0.05).Conclusions: There is a high degree of correlation between resident and attending top-box scores on Press Ganey surveys, with residents scoring slightly higher than attendings. The addition of resident questions to the standard Press Ganey survey does not appear to decrease overall attending scores.
View details for DOI 10.1002/aet2.10039
View details for PubMedID 30051032
A User's Guide to the ALiEM Emergency Medicine Match Advice Web Series
WESTERN JOURNAL OF EMERGENCY MEDICINE
2017; 18 (4): 698–704
ALiEM EM Match Advice is a web series hosted on the Academic Life in Emergency Medicine website. The intended audience includes senior medical students seeking a residency in emergency medicine (EM) and the faculty members who advise them. Each episode features a panel of three EM program directors who discuss a critical step in the residency application process. This article serves as a user's guide to the series, including a timeline for viewing each episode, brief summaries of the panel discussions, and reflection questions for discussion between students and their faculty advisors.
View details for DOI 10.5811/westjem.2017.3.33841
View details for Web of Science ID 000412223200020
View details for PubMedID 28611891
View details for PubMedCentralID PMC5468076
A Novel Collaboration to Reduce the Travel-Related Cost of Residency Interviewing
WESTERN JOURNAL OF EMERGENCY MEDICINE
2017; 18 (3): 539–43
Interviewing for residency is a complicated and often expensive endeavor. Literature has estimated interview costs of $4,000 to $15,000 per applicant, mostly attributable to travel and lodging. The authors sought to reduce these costs and improve the applicant interview experience by coordinating interview dates between two residency programs in Chicago, Illinois.Two emergency medicine residency programs scheduled contiguous interview dates for the 2015-2016 interview season. We used a survey to assess applicant experiences interviewing in Chicago and attitudes regarding coordinated scheduling. Data on utilization of coordinated dates were obtained from interview scheduling software. The target group for this intervention consisted of applicants from medical schools outside Illinois who completed interviews at both programs.Of the 158 applicants invited to both programs, 84 (53%) responded to the survey. Scheduling data were available for all applicants. The total estimated cost savings for target applicants coordinating interview dates was $13,950. The majority of target applicants reported that this intervention increased the ease of scheduling (84%), made them less likely to cancel the interview (82%), and saved them money (71%).Coordinated scheduling of interview dates was associated with significant estimated cost savings and was reviewed favorably by applicants across all measures of experience. Expanding use of this practice geographically and across specialties may further reduce the cost of interviewing for applicants.
View details for DOI 10.5811/westjem.2017.1.33085
View details for Web of Science ID 000412222900030
View details for PubMedID 28435508
View details for PubMedCentralID PMC5391907
TRIAD VIII: Nationwide Multicenter Evaluation to Determine Whether Patient Video Testimonials Can Safely Help Ensure Appropriate Critical Versus End-of-Life Care.
Journal of patient safety
End-of-life interventions should be predicated on consensus understanding of patient wishes. Written documents are not always understood; adding a video testimonial/message (VM) might improve clarity. Goals of this study were to (1) determine baseline rates of consensus in assigning code status and resuscitation decisions in critically ill scenarios and (2) determine whether adding a VM increases consensus.We randomly assigned 2 web-based survey links to 1366 faculty and resident physicians at institutions with graduate medical education programs in emergency medicine, family practice, and internal medicine. Each survey asked for code status interpretation of stand-alone Physician Orders for Life-Sustaining Treatment (POLST) and living will (LW) documents in 9 scenarios. Respondents assigned code status and resuscitation decisions to each scenario. For 1 of 2 surveys, a VM was included to help clarify patient wishes.Response rate was 54%, and most were male emergency physicians who lacked formal advanced planning document interpretation training. Consensus was not achievable for stand-alone POLST or LW documents (68%-78% noted "DNR"). Two of 9 scenarios attained consensus for code status (97%-98% responses) and treatment decisions (96%-99%). Adding a VM significantly changed code status responses by 9% to 62% (P ≤ 0.026) in 7 of 9 scenarios with 4 achieving consensus. Resuscitation responses changed by 7% to 57% (P ≤ 0.005) with 4 of 9 achieving consensus with VMs.For most scenarios, consensus was not attained for code status and resuscitation decisions with stand-alone LW and POLST documents. Adding VMs produced significant impacts toward achieving interpretive consensus.
View details for DOI 10.1097/PTS.0000000000000357
View details for PubMedID 28198722
Supplemental Milestones for Emergency Medicine Residency Programs: A Validation Study.
The western journal of emergency medicine
2017; 18 (1): 69–75
INTRODUCTION: Emergency medicine (EM) residency programs may be 36 or 48 months in length. The Residency Review Committee for EM requires that 48-month programs provide educational justification for the additional 12 months. We developed additional milestones that EM training programs might use to assess outcomes in domains that meet this accreditation requirement. This study aims to assess for content validity of these supplemental milestones using a similar methodology to that of the original EM Milestones validation study.METHODS: A panel of EM program directors (PD) and content experts at two institutions identified domains of additional training not covered by the existing EM Milestones. This led to the development of six novel subcompetencies: "Operations and Administration," "Critical Care," "Leadership and Management," "Research," "Teaching and Learning," and "Career Development." Subject-matter experts at other 48-month EM residency programs refined the milestones for these subcompetencies. PDs of all 48-month EM programs were then asked to order the proposed milestones using the Dreyfus model of skill acquisition for each subcompetency. Data analysis mirrored that used in the original EM Milestones validation study, leading to the final version of our supplemental milestones.RESULTS: Twenty of 33 subjects (58.8%) completed the study. No subcompetency or individual milestone met deletion criteria. Of the 97 proposed milestones, 67 (69.1%) required no further editing and remained at the same level as proposed by the study authors. Thirty milestones underwent level changes: 15 (15.5%) were moved one level up and 13 (13.4%) were moved one level down. One milestone (1.0%) in "Leadership and Management" was moved two levels up, and one milestone in "Operations and Administration" was moved two levels down. One milestone in "Research" was ranked by the survey respondents at one level higher than that proposed by the authors; however, this milestone was kept at its original level assignment.CONCLUSION: Six additional subcompetencies were generated and assessed for content validity using the same methodology as was used to validate the current EM Milestones. These optional milestones may serve as an additional set of assessment tools that will allow EM residency programs to report these additional educational outcomes using a familiar milestone rubric.
View details for DOI 10.5811/westjem.2016.10.31499
View details for PubMedID 28116011
Workplace Violence and Harassment Against Emergency Medicine Residents
WESTERN JOURNAL OF EMERGENCY MEDICINE
2016; 17 (5): 567–73
Several studies have shown that workplace violence in the emergency department (ED) is common. Residents may be among the most vulnerable staff, as they have the least experience with these volatile encounters. The goal for this study was to quantify and describe acts of violence against emergency medicine (EM) residents by patients and visitors and to identify perceived barriers to safety.This cross-sectional survey study queried EM residents at multiple New York City hospitals. The primary outcome was the incidence of violence experienced by residents while working in the ED. The secondary outcomes were the subtypes of violence experienced by residents, as well as the perceived barriers to safety while at work.A majority of residents (66%, 78/119) reported experiencing at least one act of physical violence during an ED shift. Nearly all residents (97%, 115/119) experienced verbal harassment, 78% (93/119) had experienced verbal threats, and 52% (62/119) reported sexual harassment. Almost a quarter of residents felt safe "Occasionally," "Seldom" or "Never" while at work. Patient-based factors most commonly cited as contributory to violence included substance use and psychiatric disease.Self-reported violence against EM residents appears to be a significant problem. Incidence of violence and patient risk factors are similar to what has been found previously for other ED staff. Understanding the prevalence of workplace violence as well as the related systems, environmental, and patient-based factors is essential for future prevention efforts.
View details for DOI 10.5811/westjem.2016.6.30446
View details for Web of Science ID 000382837900013
View details for PubMedID 27625721
View details for PubMedCentralID PMC5017841
Program Director Opinion on the Ideal Length of Residency Training in Emergency Medicine
ACADEMIC EMERGENCY MEDICINE
2016; 23 (7): 823–27
This study sought to define expert opinion on the ideal length of training (LoT) for Accreditation Council of Graduate Medical Education (ACGME)-accredited emergency medicine (EM) residency programs.A cross-sectional Web-based survey was sent to program directors (PDs) at all ACGME-accredited EM residency programs during a study period of August to October 2014. The primary outcome of ideal LoT was determined in two ways: 1) subjects provided the ideal total LoT in months and 2) then separately selected the type and number of rotations for an ideal EM residency curriculum by month, the sum of which provided an alternative measurement of their ideal LoT. We did not include vacation time. Descriptive statistics and an analysis of variance are reported.Response rate was 68.0% (108/159) with 72% of respondents (78/108) directing programs in the PGY 1-3 (36-month) format and 28% directing PGY 1-4 (48-month) programs. More than half of subjects (51.9%) have direct personal experience with both formats. When asked about ideal total LoT, PDs averaged 41.5 months (n = 107; SD = 5.5 months, range = 36-60 months). When asked to provide durations of individual clinical experiences for their ideal EM program, the sum total (n = 104) averaged 45.0 months. Results from a factorial analysis of variance revealed statistically significant effects of PDs' past training experiences: participants who trained in a 36-month program had statistically significantly lower LoT (mean = 39.2 months) than participants who trained in a 48-month program (mean = 44.5 months). There was also a statistically significant effect of current program format on ideal LoT: participants who directed a 36-month program had statistically significantly lower LoT (mean = 39.8 months) than participants who directed a 48-month program (mean = 45.8 months).PD opinion on ideal LoT averages between 36 and 48 months, but is longer when the sum of desired clinical rotations is considered. While half of the respondents reported direct experience with both PGY 1-3 and PGY 1-4 training programs, opinions on ideal LoT through both methods corresponded strongly with the length of the program the PDs trained in and the format of the program they currently direct. PD opinions may be too biased by their own experiences to provide objective input on the ideal LoT for EM residency programs.
View details for DOI 10.1111/acem.12968
View details for Web of Science ID 000383376400011
View details for PubMedID 26999762
Impact of Burnout on Self-Reported Patient Care Among Emergency Physicians
WESTERN JOURNAL OF EMERGENCY MEDICINE
2015; 16 (7): 996–1001
Burnout is a syndrome of depersonalization, emotional exhaustion and sense of low personal accomplishment. Emergency physicians (EPs) experience the highest levels of burnout among all physicians. Burnout is associated with greater rates of self-reported suboptimal care among surgeons and internists. The association between burnout and suboptimal care among EPs is unknown. The objective of the study was to evaluate burnout rates among attending and resident EPs and examine their relationship with self-reported patient care practices.In this cross-sectional study burnout was measured at two university-based emergency medicine residency programs with the Maslach Burnout Inventory. We also measured depression, quality of life (QOL) and career satisfaction using validated questionnaires. Six items assessed suboptimal care and the frequency with which they were performed.We included 77 out of 155 (49.7%) responses. The EP burnout rate was 57.1%, with no difference between attending and resident physicians. Residents were more likely to screen positive for depression (47.8% vs 18.5%, p=0.012) and report lower QOL scores (6.7 vs 7.4 out of 10, p=0.036) than attendings. Attendings and residents reported similar rates of career satisfaction (85.2% vs 87.0%, p=0.744). Burnout was associated with a positive screen for depression (38.6% vs 12.1%, p=0.011) and lower career satisfaction (77.3% vs 97.0%, p=0.02). EPs with high burnout were significantly more likely to report performing all six acts of suboptimal care.A majority of EPs demonstrated high burnout. EP burnout was significantly associated with higher frequencies of self-reported suboptimal care. Future efforts to determine if provider burnout is associated with negative changes in actual patient care are necessary.
View details for DOI 10.5811/westjem.2015.9.27945
View details for Web of Science ID 000373126600005
View details for PubMedID 26759643
View details for PubMedCentralID PMC4703144
- R & P: The Medical Education Scarlet Letters ACADEMIC EMERGENCY MEDICINE 2015; 22 (1): 91–93
FACULTY PREDICTION OF IN-TRAINING EXAMINATION SCORES OF EMERGENCY MEDICINE RESIDENTS
JOURNAL OF EMERGENCY MEDICINE
2014; 46 (3): 390–94
The Emergency Medicine In-Training Examination (EMITE) is one of the only valid tools for medical knowledge assessment in current use by emergency medicine (EM) residencies. However, EMITE results return late in the academic year, providing little time to institute potential remediation.The goal of this study was to determine the ability of EM faculty to accurately predict resident EMITE scores prior to results return.We asked EM faculty at the study site to predict the 2012 EMITE scores of the 50 EM residents 2 weeks prior to results being available. The primary outcome was prediction accuracy, defined as the proportion of predictions within 6% of the actual score. The secondary outcome was prediction precision, defined as the mean deviation of predictions from the actual scores. We assessed several faculty background variables, including years of experience, educational leadership status, and clinical hours worked, for correlation with the two outcomes.Thirty-two of the 38 faculty (84.2%, 95% confidence interval [CI] 69.6-92.6) participated in the study, rendering a total of 1600 predictions for 50 residents. Mean resident EMITE score was 81.1% (95% CI 79.5-82.8%). Mean prediction accuracy for all faculty participants was 69% (95% CI 65.9-72.1%). Mean prediction precision was 5.2% (95% CI 4.9-5.5%). Education leadership status was the only background variable correlated with the primary and secondary outcomes (Spearman's ρ = 0.51 and -0.53, respectively).Faculty possess only moderate accuracy at predicting resident EMITE scores. We recommend a multicenter study to evaluate the generalizability of the present results.
View details for DOI 10.1016/j.jemermed.2013.08.047
View details for Web of Science ID 000332391300033
View details for PubMedID 24161228
Altered Mental Status in a Young, Healthy Female
AMERICAN JOURNAL OF THERAPEUTICS
2013; 20 (5): 558–63
A young previously healthy patient presented with fever and altered mental status. Her evaluation would eventually reveal a profound hyponatremia in the setting of a viral meningoencephalitis. This case report reviews the evaluation of hyponatremia and treatment options for syndrome of inappropriate antidiuretic hormone hypersecretion, her ultimate diagnosis.
View details for DOI 10.1097/MJT.0b013e31822048ed
View details for Web of Science ID 000324543900017
View details for PubMedID 21822118
Fibrinolysis and Thrombectomy for Massive Pulmonary Embolus
AMERICAN JOURNAL OF THERAPEUTICS
2013; 20 (5): 576–80
Treatment options for massive and submassive pulmonary embolus may include hemodynamic support, fibrinolysis, anticoagulation, and thrombectomy. Selection of the appropriate therapy requires scrutiny of the patient's hemodynamic status, preexisting conditions, risk of complications, and availability of services at the treatment center. This article illustrates a case of successful fibrinolysis and thrombectomy in a woman with massive pulmonary embolus. A discussion of the indications, benefits, and disadvantages of several pharmacologic, radiologic, and surgical interventions considered in pulmonary embolus will follow.
View details for DOI 10.1097/MJT.0b013e3182062e22
View details for Web of Science ID 000324543900022
View details for PubMedID 21317623
Evaluating Educational Interventions in Emergency Medicine
ACADEMIC EMERGENCY MEDICINE
2012; 19 (12): 1442–53
This article presents the proceedings of the 2012 Academic Emergency Medicine consensus conference breakout group charged with identifying areas necessary for future research regarding effectiveness of educational interventions for teaching emergency medicine (EM) knowledge, skills, and attitudes outside of the clinical setting. The objective was to summarize both medical and nonmedical education literature and report the consensus formation methods and results. The authors present final statements to guide future research aimed at evaluating the best methods for understanding and developing successful EM curricula using all types of educational interventions.
View details for DOI 10.1111/acem.12022
View details for Web of Science ID 000312740100019
View details for PubMedID 23279250
Palliative Care Symptom Assessment for Patients with Cancer in the Emergency Department: Validation of the Screen for Palliative and End-of-Life Care Needs in the Emergency Department Instrument
JOURNAL OF PALLIATIVE MEDICINE
2011; 14 (6): 757–64
We sought to develop and validate a novel palliative medicine needs assessment tool for patients with cancer in the emergency department.An expert panel trained in palliative medicine and emergency medicine reviewed and adapted a general palliative medicine symptom assessment tool, the Needs at the End-of-Life Screening Tool. From this adaptation a new 13-question instrument was derived, collectively referred to as the Screen for Palliative and End-of-life care needs in the Emergency Department (SPEED). A database of 86 validated symptom assessment tools available from the palliative medicine literature, totaling 3011 questions, were then reviewed to identify validated test items most similar to the 13 items of SPEED; a total of 107 related questions from the database were identified. Minor adaptations of questions were made for standardization to a uniform 10-point Likert scale. The 107 items, along with the 13 SPEED items were randomly ordered to create a single survey of 120 items. The 120-item survey was administered by trained staff to all patients with cancer who met inclusion criteria (age over 21 years, English-speaking, capacity to provide informed consent) who presented to a large urban academic emergency department between 8:00 am and 11:00 pm over a 10-week period. Data were analyzed to determine the degree of correlation between SPEED items and the related 107 selected items from previously validated tools.A total of 53 subjects were enrolled, of which 49 (92%) completed the survey in its entirety. Fifty-three percent of subjects were male, age range was 24-88 years, and the most common cancer diagnoses were breast, colon, and lung. Cronbach coefficient α for the SPEED items ranged from 0.716 to 0.991, indicating their high scale reliability. Correlations between the SPEED scales and related assessment tools previously validated in other settings were high and statistically significant.The SPEED instrument demonstrates reliability and validity for screening for palliative care needs of patients with cancer presenting to the emergency department.
View details for DOI 10.1089/jpm.2010.0456
View details for Web of Science ID 000291433700016
View details for PubMedID 21548790
View details for PubMedCentralID PMC3107583
Adaptation of EPEC-EM (TM) Curriculum in a Residency with Asynchronous Learning
WESTERN JOURNAL OF EMERGENCY MEDICINE
2010; 11 (5): 491–99
The Education in Palliative and End-of-life Care for Emergency Medicine Project (EPEC™-EM) is a comprehensive curriculum in palliative and end-of-life care for emergency providers. We assessed the adaptation of this course to an EM residency program using synchronous and asynchronous learning.Curriculum adaptation followed Kern's standardized six-step curriculum design process. Post-graduate year (PGY) 1-4 residents were taught all EPEC™-EM cognitive domains, divided as seven synchronous and seven asynchronous modules. All synchronous modules featured large group didactic lectures and review of EPEC™-EM course materials. Asynchronous modules use only EPEC™-EM electronic course media for resident self-study. Targeted evaluation for EPEC™-EM knowledge objectives was conducted by a prospective case-control crossover study, with synchronous learning serving as the quasi-control, using validated exam tools. We compared de-identified test scores for effectiveness of learning method, using aggregate group performance means for each learning strategy.Of 45 eligible residents 55% participated in a pre-test for local needs analysis, and 78% completed a post-test to measure teaching method effect. Post-test scores improved across all EPEC™-EM domains, with a mean improvement for synchronous modules of +28% (SD=9) and a mean improvement for asynchronous modules of +30% (SD=18). The aggregate mean difference between learning methods was 1.9% (95% CI -15.3, +19.0). Mean test scores of the residents who completed the post-test were: synchronous modules 77% (SD=12); asynchronous modules 83% (SD=13); all modules 80% (SD=12).EPEC™-EM adapted materials can improve resident knowledge of palliative medicine domains, as assessed through validated testing of course objectives. Synchronous and asynchronous learning methods appear to result in similar knowledge transfer, feasibly allowing some course content to be effectively delivered outside of large group lectures.
View details for Web of Science ID 000422591200020
View details for PubMedID 21293772
View details for PubMedCentralID PMC3027445
Characteristics of Pediatric Trauma Transfers to a Level I Trauma Center: Implications for Developing a Regionalized Pediatric Trauma System in California
ACADEMIC EMERGENCY MEDICINE
2010; 17 (12): 1364-1373
since California lacks a statewide trauma system, there are no uniform interfacility pediatric trauma transfer guidelines across local emergency medical services (EMS) agencies in California. This may result in delays in obtaining optimal care for injured children.this study sought to understand patterns of pediatric trauma patient transfers to the study trauma center as a first step in assessing the quality and efficiency of pediatric transfer within the current trauma system model. Outcome measures included clinical and demographic characteristics, distances traveled, and centers bypassed. The hypothesis was that transferred patients would be more severely injured than directly admitted patients, primary catchment transfers would be few, and out-of-catchment transfers would come from hospitals in close geographic proximity to the study center.this was a retrospective observational analysis of trauma patients ≤ 18 years of age in the institutional trauma database (2000-2007). All patients with a trauma International Classification of Diseases, 9th revision (ICD-9) code and trauma mechanism who were identified as a trauma patient by EMS or emergency physicians were recorded in the trauma database, including those patients who were discharged home. Trauma patients brought directly to the emergency department (ED) and patients transferred from other facilities to the center were compared. A geographic information system (GIS) was used to calculate the straight-line distances from the referring hospitals to the study center and to all closer centers potentially capable of accepting interfacility pediatric trauma transfers.of 2,798 total subjects, 16.2% were transferred from other facilities within California; 69.8% of transfers were from the catchment area, with 23.0% transferred from facilities ≤ 10 miles from the center. This transfer pattern was positively associated with private insurance (risk ratio [RR] = 2.05; p < 0.001) and negatively associated with age 15-18 years (RR = 0.23; p = 0.01) and Injury Severity Score (ISS) > 18 (RR = 0.26; p < 0.01). The out-of-catchment transfers accounted for 30.2% of the patients, and 75.9% of these noncatchment transfers were in closer proximity to another facility potentially capable of accepting pediatric interfacility transfers. The overall median straight-line distance from noncatchment referring hospitals to the study center was 61.2 miles (IQR = 19.0-136.4), compared to 33.6 miles (IQR = 13.9-61.5) to the closest center. Transfer patients were more severely injured than directly admitted patients (p < 0.001). Out-of-catchment transfers were older than catchment patients (p < 0.001); ISS > 18 (RR = 2.06; p < 0.001) and age 15-18 (RR = 1.28; p < 0.001) were predictive of out-of-catchment patients bypassing other pediatric-capable centers. Finally, 23.7% of pediatric trauma transfer requests to the study institution were denied due to lack of bed capacity.from the perspective an adult Level I trauma center with a certified pediatric intensive care unit (PICU), delays in definitive pediatric trauma care appear to be present secondary to initial transport to nontrauma community hospitals within close proximity of a trauma hospital, long transfer distances to accepting facilities, and lack of capacity at the study center. Given the absence of uniform trauma triage and transfer guidelines across state EMS systems, there appears to be a role for quality monitoring and improvement of the current interfacility pediatric trauma transfer system, including defined triage, transfer, and data collection protocols.
View details for DOI 10.1111/j.1553-2712.2010.00926.x
View details for Web of Science ID 000284848100018
View details for PubMedID 21122022
View details for PubMedCentralID PMC3059150
Examining Emergency Department Communication Through a Staff-Based Participatory Research Method: Identifying Barriers and Solutions to Meaningful Change
ANNALS OF EMERGENCY MEDICINE
2010; 56 (6): 614–22
We test an initiative with the staff-based participatory research (SBPR) method to elicit communication barriers and engage staff in identifying strategies to improve communication within our emergency department (ED).ED staff at an urban hospital with 85,000 ED visits per year participated in a 3.5-hour multidisciplinary workshop. The workshop was offered 6 times and involved: (1) large group discussion to review the importance of communication within the ED and discuss findings from a recent survey of patient perceptions of ED-team communication; (2) small group discussions eliciting staff perceptions of communication barriers and best practices/strategies to address these challenges; and (3) large group discussions sharing and refining emergent themes and suggested strategies. Three coders analyzed summaries from group discussions by using latent content and constant comparative analysis to identify focal themes.A total of 127 staff members, including attending physicians, residents, nurses, ED assistants, and secretaries, participated in the workshop (overall participation rate 59.6%; range 46.7% to 73.3% by staff type). Coders identified a framework of 4 themes describing barriers and proposed interventions: (1) greeting and initial interaction, (2) setting realistic expectations, (3) team communication and respect, and (4) information provision and delivery. The majority of participants (81.4%) reported that their participation would cause them to make changes in their clinical practice.Involving staff in discussing barriers and facilitators to communication within the ED can result in a meaningful process of empowerment, as well as the identification of feasible strategies and solutions at both the individual and system levels.
View details for DOI 10.1016/j.annemergmed.2010.03.017
View details for Web of Science ID 000285125100008
View details for PubMedID 20382446
Scholarly Tracks in Emergency Medicine
ACADEMIC EMERGENCY MEDICINE
2010; 17 (10): S87–S94
Over the past decade, some residency programs in emergency medicine (EM) have implemented scholarly tracks into their curricula. The goal of the scholarly track is to identify a niche in which each trainee focuses his or her scholarly work during residency. The object of this paper is to discuss the current use, structure, and success of resident scholarly tracks. A working group of residency program leaders who had implemented scholarly tracks into their residency programs collated their approaches, implementation, and early outcomes through a survey disseminated through the Council of Emergency Medicine Residency Directors (CORD) list-serve. At the 2009 CORD Academic Assembly, a session was held and attended by approximately 80 CORD members where the results were disseminated and discussed. The group examined the literature, discussed the successes and challenges faced during implementation and maintenance of the tracks, and developed a list of recommendations for successful incorporation of the scholarly track structure into a residency program. Our information comes from the experience at eight training programs (five 3-year and three 4-year programs), ranging from 8 to 14 residents per year. Two programs have been working with academic tracks for 8 years. Recommendations included creating clear goals and objectives for each track, matching track topics with faculty expertise, protecting time for both faculty and residents, and providing adequate mentorship for the residents. In summary, scholarly tracks encourage the trainee to develop an academic or clinical niche within EM during residency training. The benefits include increased overall resident satisfaction, increased success at obtaining faculty and fellowship positions after residency, and increased production of scholarly work. We believe that this model will also encourage increased numbers of trainees to choose careers in academic medicine.
View details for DOI 10.1111/j.1553-2712.2010.00890.x
View details for Web of Science ID 000282877900016
View details for PubMedID 21199090
Curriculum Design of a Case-based Knowledge Translation Shift for Emergency Medicine Residents
WILEY. 2010: S42–S48
Principles of evidence-based medicine (EBM) may be inconsistently applied to clinical decision-making due to lack of practice-based training, experience, and time.The authors sought to design, implement, and test the feasibility of an experiential learning model for senior emergency medicine (EM) residents to apply EBM principles during real-time clinical practice.Targeted program evaluation of this learning model was conducted through a prospective observational cohort study involving EM residents at a large, urban, 4-year EM residency program. The curriculum development of a case-based knowledge translation shift followed Kern's six-step design process. Subjects asynchronously completed a 1-hour EBM tutorial and were then assigned to clinical shifts in which they contributed to the care of emergency department (ED) patients by completing formal literature searches related to active management questions. Pre- and post-intervention self-assessments of practice norms and attitudes were used to evaluate the effect of this experiential learning model for individual residents. Self-assessments of the likelihood that the experience would result in future practice change were reported on a five-point Likert scale (1 = greatly impeded, 2 = somewhat impeded, 3 = no change, 4 = somewhat improved, 5 = greatly improved). Subjects presented available evidence to the primary ED team, formally disseminated their findings as a brief "EBM rounds" at sign-out and completed an "EBM consult note" and case log to document shift performance. Changes in patient management and/or disposition were recorded. EBM search questions and resultant findings were entered in a local database.Of the 45 eligible senior EM resident shifts, 91% resulted in complete sets of performance data and self-assessments. A total of 80 patient encounters were documented during 45 scheduled shifts over a 3-month study period. Literature review took a mean (±SD) of 36.2 (±26.4) minutes per case. During the 3-hour interval before or after shift sign-out, residents completed a mean (±SD) of 2.11 (±1.4) literature searches and recorded a mean (±SD) of 3.0 (±1.5) articles for each case. Alterations in ED management for 13 of 80 patient encounters (16.3%) were documented to be the direct result of on-shift literature searches.Case-based knowledge translation shifts for senior EM residents can provide opportunities to practice EBM skills in the ED. This experiential learning model may result in future practice change by resident learners, as well as affect the management of active patients in the ED.
View details for DOI 10.1111/j.1553-2712.2010.00879.x
View details for Web of Science ID 000282877900009
View details for PubMedID 21199083
- Impact of the Education in Palliative and End-of-Life Care Project on Emergency Medicine Education and Practice ELSEVIER SCIENCE INC. 2010: 334–35
CAN EDUCATION AND STAFF-BASED PARTICIPATORY RESEARCH CHANGE NURSING PRACTICE IN AN ERA OF ED OVERCROWDING? A FOCUS GROUP STUDY
JOURNAL OF EMERGENCY NURSING
2009; 35 (4): 290–98
In our facility an operational process intervention was implemented to decrease overcrowding. The intervention consisted of implementing criteria (developed from a series of 8 interactive workshops led by the investigators with all charge and staff nurses) describing when we should "close the waiting room." The purpose of this study was to explore the charge nurses' perceptions of the intervention and their experiences with implementation several months after the operational change began.All charge nurses were invited to attend 1 of 2 focus groups that elicited participants' knowledge of the closing criteria as well as their use and perceptions of the criteria. Participants were asked to identify how often they had been able to close the waiting room or keep it closed and to note whether they used the developed criteria. Barriers and facilitators to closing the waiting room were also discussed.Charge nurses had internalized the criteria and reported that most of the time the waiting room was often closed between the hours of 3 and 9 am. Evening charge nurses, in particular, reported feeling a positive impact from waiting room closure during these hours earlier in the day. Facilitators included charge nurses receiving positive feedback from patients and perceiving an improvement in patient safety as fewer patients were waiting. Specific barriers included negative staff attitudes and hospital overcrowding.Feedback from focus group analysis with charge nurses responsible for closing the ED waiting room suggests that the operational change has been positive because of the staff-based participatory research methodology used to create the intervention.
View details for DOI 10.1016/j.jen.2008.07.013
View details for Web of Science ID 000268704400008
View details for PubMedID 19591722
- A Case for Education in Palliative and End-of-life Care in Emergency Medicine ACADEMIC EMERGENCY MEDICINE 2009; 16 (2): 181–83
Patient perspectives on communication with the medical team: Pilot study using the communication assessment tool-team (CAT-T)
PATIENT EDUCATION AND COUNSELING
2008; 73 (2): 220-223
Effective communication is an essential aspect of high-quality patient care and a core competency for physicians. To date, assessment of communication skills in team-based settings has not been well established. We sought to tailor a psychometrically validated instrument, the Communication Assessment Tool, for use in Team settings (CAT-T), and test the feasibility of collecting patient perspectives of communication with medical teams in the emergency department (ED).A prospective, cross-sectional study in an academic, tertiary, urban, Level 1 trauma center using the CAT-T, a 15-item instrument. Items were answered via a 5-point scale, with 5 = excellent. All adult ED patients (> or = 18 y/o) were eligible if the following exclusion criteria did not apply: primary psychiatric issues, critically ill, physiologically unstable, non-English speaking, or under arrest.81 patients were enrolled (mean age: 44, S.D. = 17; 44% male). Highest ratings were for treating the patient with respect (69% excellent), paying attention to the patient (69% excellent), and showing care and concern (69% excellent). Lowest ratings were for greeting the patient appropriately (54%), encouraging the patient to ask questions (54%), showing interest in the patient's ideas about his or her health (53% excellent), and involving the patient in decisions as much as he or she wanted (53% excellent).Although this pilot study has several methodological limitations, it demonstrates a signal that patient assessment of communication with the medical team is feasible and offers important feedback. Results indicate the need to improve communication in the ED.In the ED, focusing on the medical team rather then individual caregivers may more accurately reflect patients' experience.
View details for DOI 10.1016/j.pec.2008.07.003
View details for Web of Science ID 000261023500010
View details for PubMedID 18703306
Should you close your waiting room? Addressing ED overcrowding through education and staff-based participatory research
JOURNAL OF EMERGENCY NURSING
2008; 34 (4): 285–89
The purpose of this project was to develop operational criteria to "close the ED waiting room".A prospective, staff-based participatory research model was used. Nurses at an urban ED with 70,000 visits attended a four-hour workshop concerning ED overcrowding. The workshops consisted of two parts, (1) educational sessions that reviewed key concepts of ED overcrowding, followed by (2) discussions of a proposal to "close the waiting room" as a means to decrease overcrowding. During the discussions, nurses were asked to develop guidelines to safely and consistently "close the waiting room." The investigators defined the waiting room as "closed" when (1) ambulatory patients could be taken directly to a room or hallway space for bedside triage, registration, and initiation of care, or (2) patients were triaged in the waiting room and then taken directly to a care space for registration at the bedside. The primary outcome measure of the project was the development of guidelines to open (use) or close (not use) the ED waiting room.Seventy three of 100 nurses participated in the workshops. ED waiting room closure criteria were developed as 4 "Questions to Guide the Use of the Waiting Room." These dichotomous (yes/no) questions reflected issues of available staff, available care space (traditional ED bed spaces and designated hall spaces), patient acuity, and additional surge capacity.Staff-based participatory research was an effective method to design an operational change. Nurses developed four explicit criteria describing when the waiting room should be closed.
View details for DOI 10.1016/j.jen.2007.08.009
View details for Web of Science ID 000257958600003
View details for PubMedID 18640406
- Images in emergency medicine. Ellis III and I tooth fractures. Annals of emergency medicine 2007; 49 (6): e1–2
Bedside teaching in the emergency department
ACADEMIC EMERGENCY MEDICINE
2006; 13 (8): 860–66
Bedside teaching is a valuable instructional method that facilitates the development of history and physical examination skills, the modeling of professional behaviors, and the direct observation of learners. The emergency department (ED) is an ideal environment for the practice of bedside teaching, because its high patient volume, increased acuity of illness, and variety of pathology provide plentiful patient-centered teaching opportunities. Unfortunately, the pressures of ED overcrowding at many institutions now limit the available time for formal bedside teaching per patient. This article will discuss the historical decline of bedside teaching on the wards, address obstacles to its use in the ED, and reestablish its specific benefits as a unique educational tool. The authors propose several practical strategies to increase bedside teaching by academic emergency physicians (EPs). These techniques emphasize careful preparation and a focused teaching approach to overcome the inherent challenges of a typically busy ED shift.
View details for DOI 10.1197/j.aem.2006.03.557
View details for Web of Science ID 000242967300008
View details for PubMedID 16766739
Characteristics of pediatric patients at risk of poor emergency department aftercare
ACADEMIC EMERGENCY MEDICINE
2006; 13 (8): 840-847
To identify and characterize subgroups of a pediatric population at risk of poor emergency department (ED) aftercare compliance.This was a prospective, cohort study conducted at a university hospital ED with a 2003 pediatric census of 11,040 patients. A convenience sample of 461 children was enrolled. The study follow-up rate was 97%. The primary outcomes were guardian compliance with instructions for physician follow-up appointment and with obtaining prescribed medications. Predictors of compliance outcomes were analyzed by using recursive partitioning to describe population subgroups at risk of poor compliance.Only 60.4% of patient guardians followed up with instructions to see a physician. Children with private insurance were more likely to follow up than were children without private insurance (76.8% vs. 46.5%, p < 0.001). Of children with private insurance, those with high-acuity diagnoses were more likely to follow up than were patients with low-acuity diagnoses (80.0% vs. 38.5%, p < 0.001). Of children who were considered underinsured (defined as publicly insured or uninsured), those with English-speaking guardians were more likely to follow up than were those with non-English-speaking guardians (58.0% vs. 40.0%, p < 0.05). Only 63.3% of patient guardians obtained prescribed medications. Privately insured children were more likely to obtain medications than were underinsured children (71.0% vs. 58.0%, p < 0.05). Descriptive profiles of the subgroups revealed that those with lower socioeconomic status were at greatest risk of poor aftercare compliance.Compliance with ED aftercare instructions remains a challenge. Health insurance disparities are associated with poor ED aftercare compliance in our pediatric population. Interventions aimed at improving compliance could be targeted to specific subgroups on the basis of their descriptive profiles.
View details for DOI 10.1197/j.aem.2006.04.021
View details for Web of Science ID 000242967300005
View details for PubMedID 16880500
Assessment of resident professionalism using high-fidelity simulation of ethical dilemmas
Annual Educational Conference of the Accreditation-Council-for-Graduate-Medical-Education
WILEY-BLACKWELL PUBLISHING, INC. 2004: 931–37
To examine the responses of emergency medicine residents (EMRs) to ethical dilemmas in high-fidelity patient simulations as a means of assessing resident professionalism.This cross-sectional observational study included all EMRs at a three-year training program. Subjects were excluded if they were unable or unwilling to participate. Each resident subject participated in a simulated critical patient encounter during an Emergency Medicine Crisis Resource Management course. An ethical dilemma was introduced before the end of each simulated encounter. Resident responses to that dilemma were compared with a professional performance checklist evaluation. Multi-response permutation procedure analysis was used to compare performance measures between resident classes, with the a priori hypothesis that mean performance should increase as experience increases.Of the 30 potential subjects, 90% (27) participated. The remaining three residents were unavailable due to scheduling conflicts. It was observed that senior residents (second and third year) performed more checklist items than did first-year residents (p < 0.028 for each senior class). Omnibus comparison of mean critical actions completed across all three years was not statistically significant (p < 0.13). Residents performed a critical action with 100% uniformity across training years in only one ethical scenario ("Practicing Procedures on the Recently Dead"). Residents performed the fewest critical actions and overall checklist items for the "Patient Confidentiality" case.Senior residents had better overall performance than incoming interns, suggesting that professional behaviors are learned through some facet of residency training. Although limited by small sample size, the application of this performance-assessment tool showed the ability to discriminate between experienced and inexperienced EMRs with respect to a variety of aspects of professional competency. These findings suggest a need for improved resident education in areas of professionalism and ethics.
View details for DOI 10.1197/j.aem.2004.04.005
View details for Web of Science ID 000223732700005
View details for PubMedID 15347542
Emergency department orientation utilizing web-based streaming video
ACADEMIC EMERGENCY MEDICINE
2004; 11 (8): 848-852
To assure a smooth transition to their new work environment, rotating students and housestaff require detailed orientations to the physical layout and operations of the emergency department. Although such orientations are useful for new staff members, they represent a significant time commitment for the faculty members charged with this task. To address this issue, the authors developed a series of short instructional videos that provide a comprehensive and consistent method of emergency department orientation. The videos are viewed through Web-based streaming technology that allows learners to complete the orientation process from any computer with Internet access before their first shift. This report describes the stepwise process used to produce these videos and discusses the potential benefits of converting to an Internet-based orientation system.
View details for DOI 10.1197/j.aem.2003.10.032
View details for Web of Science ID 000223090900006
View details for PubMedID 15289191
Socioeconomic disparities are negatively associated with pediatric emergency department aftercare compliance
ACADEMIC EMERGENCY MEDICINE
2003; 10 (11): 1278-1284
This study sought to identify demographic, socioeconomic, and clinical predictors of aftercare noncompliance by pediatric emergency department (ED) patients.The authors conducted a prospective, observational study of pediatric patients presenting to a university teaching hospital ED from July 1, 2002, through August 31, 2002. Demographic and clinical information was obtained from guardians during the ED visit. Guardians were contacted after discharge to determine compliance with ED aftercare instructions. Subjects were excluded if they were admitted or if guardians were unavailable or unwilling to consent. Data were analyzed using multivariable logistic regression to identify predictors of noncompliance from a list of predetermined variables.Of the 409 patients enrolled in the study, 111 were prescribed medications and 364 were given specific follow-up instructions. Subtypes of the variable "insurance status" were significantly associated with medication noncompliance in multivariable regression analysis. "Insurance status" and "low-acuity discharge diagnoses" were significantly associated with follow-up noncompliance.Disparity in health insurance has been shown to be a predictor of poor aftercare compliance for pediatric ED patients within the patient population.
View details for DOI 10.1197/S1069-6563(03)00499-8
View details for Web of Science ID 000186426300019
View details for PubMedID 14597505
Adverse cardiac events in emergency department patients with chest pain six months after a negative inpatient evaluation for acute coronary syndrome
Annual Meeting of the Society-for-Academic-Emergency-Medicine
WILEY-BLACKWELL PUBLISHING, INC. 2002: 896–902
To evaluate the impact of the diagnostic test setting-inpatient versus outpatient-on adverse cardiac events (ACEs) after six months in emergency department (ED) patients with chest pain who were admitted to the hospital and subsequently had a negative evaluation for acute coronary syndrome (ACS).The authors retrospectively studied a consecutive sample of ED patients with chest pain over a nine-month period. All patients were admitted to the hospital and underwent negative evaluations for ACS, defined as the absence of diagnostic changes on serial electrocardiograms or cardiac markers (creatine kinase-MB and troponin T), and a negative diagnostic cardiac study. Subjects were classified according to cardiac diagnostic study setting-either inpatient or outpatient. Diagnostic testing included exercise treadmill, angiography, stress echocardiography, or stress thallium scans. Acute cardiac events at six months were defined as cardiac death, myocardial infarction, unstable angina, cardiac arrest, or emergent revascularization.The six-month rate of ACEs among 157 subjects was 14%, with 2% cardiac mortality. The outpatient group had higher ACE risk when compared with the inpatient group using multivariate logistic regression, both for the entire cohort (OR 3.5, p < 0.03) and for a subgroup excluding patients with prior coronary artery disease (OR 6.7, p < 0.05). The outpatient group included 19 of 52 (37%) noncompliant subjects who did not receive a diagnostic study.Long-term cardiac morbidity of patients after a negative ACS evaluation may be higher than previously thought. Risk of ACE is significantly higher in subjects scheduled for outpatient diagnostic tests. Inpatient diagnostic testing is justified for subjects at risk for poor compliance.
View details for Web of Science ID 000177977300004
View details for PubMedID 12208678