Rebecca Smith-Coggins, MD

All Publications

• Creating leaders through scholarship: The development of a physician wellness fellowship in emergency medicine. AEM education and training Singh, J., Poffenberger, C., Smith-Coggins, R. 2021; 5 (4): e10627

  Abstract

  Need for innovation: There is a clear need for physician leaders with expertise in wellness given the high incidence of physician burnout, especially during the COVID-19 pandemic. A fellowship in physician wellness provides structured opportunity for the development of expertise in the science and administration of physician wellness through a tailored curriculum and academic scholarship.Background: Currently, limited opportunities exist to pursue formal wellness training in graduate medical education. This lack of specific training may make the path to expertise and leadership in physician wellness difficult.Objective: Our objective was to design and implement a physician wellness fellowship in a department of emergency medicine. Completion of this fellowship, with ongoing professional development, will give physicians the skills to fill various leadership roles within the house of medicine, such as chief wellness officer, department, organization, national wellness leader, or wellness consultant.Development process: The fellowship curriculum was developed according to Kern's six-step approach with expert consultation. The Stanford WellMD Model of Professional Fulfillment was used as a framework to define the core content. The curriculum has five principal components developed utilizing competency-based education in medicine: dissemination of knowledge (teaching), clinical, educational foundation, implementation (administrative), and critical investigation (research).Implementation phase: The physician wellness fellowship was implemented for the academic year 2019-2020. The fellow completed all the required fellowship activities. In addition, the fellow completed the American College of Emergency Physician's teaching fellowship program. The fellowship is budget neutral because the fellow's half-time clinical revenue is sufficient to cover the fellow's salary and education and support for fellowship direction.Reflective discussion: Outcomes of this novel program will be measured over time. Although the format of this fellowship is designed for emergency medicine, the skills and content are relevant to and may be adopted in other medical specialties at other institutions.

  View details for DOI 10.1002/aet2.10627

  View details for PubMedID 34471796

• Physician Wellness Measures and Clinical Performance on a Critically Ill Simulated Patient: Does a Lack of Well-Being Impact Patient Care? CUREUS Peng, C., Lung, L., Grade, M., Wong, N., Smith-Coggins, R. 2021; 13 (7)

  View details for DOI 10.7759/cureus.16369

  View details for Web of Science ID 000675634500003

• 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 Gordon, A. J., Sebok-Syer, S., Dohn, A. M., Smith-Coggins, R., Wang, N. E., Williams, S. R., Gisondi, M. A. 2019

  Abstract

  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 PubMedID 30636353

• Estimating institutional physician turnover attributable to self-reported burnout and associated financial burden: a case study. BMC health services research Hamidi, M. S., Bohman, B., Sandborg, C., Smith-Coggins, R., de Vries, P., Albert, M. S., Murphy, M. L., Welle, D., Trockel, M. T. 2018; 18 (1): 851

  Abstract

  BACKGROUND: Awareness of the economic cost of physician attrition due to burnout in academic medical centers may help motivate organizational level efforts to improve physician wellbeing and reduce turnover. Our objectives are: 1) to use a recent longitudinal data as a case example to examine the associations between physician self-reported burnout, intent to leave (ITL) and actual turnover within two years, and 2) to estimate the cost of physician turnover attributable to burnout.METHODS: We used de-identified data from 472 physicians who completed a quality improvement survey conducted in 2013 at two Stanford University affiliated hospitals to assess physician wellness. To maintain the confidentially of survey responders, potentially identifiable demographic variables were not used in this analysis. A third party custodian of the data compiled turnover data in 2015 using medical staff roster. We used logistic regression to adjust for potentially confounding factors.RESULTS: At baseline, 26% of physicians reported experiencing burnout and 28% reported ITL within the next 2years. Two years later, 13% of surveyed physicians had actually left. Those who reported ITL were more than three times as likely to have left. Physicians who reported experiencing burnout were more than twice as likely to have left the institution within the two-year period (Relative Risk (RR)=2.1; 95% CI=1.3-3.3). After adjusting for surgical specialty, work hour categories, sleep-related impairment, anxiety, and depression in a logistic regression model, physicians who experienced burnout in 2013 had 168% higher odds (Odds Ratio=2.68, 95% CI: 1.34-5.38) of leaving Stanford by 2015 compared to those who did not experience burnout. The estimated two-year recruitment cost incurred due to departure attributable to burnout was between $15,544,000 and $55,506,000. Risk of ITL attributable to burnout was 3.7 times risk of actual turnover attributable to burnout.CONCLUSIONS: Institutions interested in the economic cost of turnover attributable to burnout can readily calculate this parameter using survey data linked to a subsequent indicator of departure from the institution. ITL data in cross-sectional studies can also be used with an adjustment factor to correct for overestimation of risk of intent to leave attributable to burnout.

  View details for PubMedID 30477483

• WELL-BEING AMONG EMERGENCY MEDICINE RESIDENT PHYSICIANS: RESULTS FROM THE ABEM LONGITUDINAL STUDY OF EMERGENCY MEDICINE RESIDENTS JOURNAL OF EMERGENCY MEDICINE Perina, D. G., Marco, C. A., Smith-Coggins, R., Kowalenko, T., Johnston, M. M., Harvey, A. 2018; 55 (1): 101-+

  Abstract

  The Longitudinal Study of Emergency Medicine Residents (LSEMR) conducted by the American Board of Emergency Medicine queries a randomized cohort of emergency medicine (EM) residents. It is designed to identify residents' perceptions of their training, sources of stress, well-being level, and career choice satisfaction over time.This study utilizes LSEMR to identify resident well-being levels, career satisfaction, factors producing stress, and whether a specific cohort is more stressed than the overall respondent group.Data from five longitudinal cohorts were analyzed using descriptive statistics to assess stressors, career satisfaction, and self-reported resident well-being. Participants' answers were reported on a 5-point Likert scale.There were 766 residents who completed the survey in five cohorts. Respondents were 30 years old (median 29), male (66%), and predominantly White (79%). The most frequently encountered problems included "time devoted to documentation and bureaucratic issues," "knowing enough," and "crowding in the emergency department." In contrast, the least frequently reported problems included "gender discrimination," "EMS support," "minority discrimination," and "other residents." Respondents thought being an EM resident was fun and would select EM again. Less than 20% indicated they had seriously considered transferring to another EM program. Resident reports of health concerns changed over time, with fewer residents reporting they were exceptionally healthy in 2016.Residents are, overall, happy with their career choice. However, concern was expressed regarding continued well-being in training. Sources of stress in training are identified. Strategies should be developed to decrease identified stressors and increase well-being among EM residents.

  View details for PubMedID 29759656

• Zero Tolerance: Implementation and Evaluation of the Stanford Medical Student Mistreatment Prevention Program ACADEMIC PSYCHIATRY Smith-Coggins, R., Prober, C. G., Wakefield, K., Farias, R. 2017; 41 (2): 195-199

  View details for DOI 10.1007/s40596-016-0523-1

  View details for Web of Science ID 000398707600008

• Residents values in a rational decision-making model: an interest in academics in emergency medicine. Internal and emergency medicine Burkhardt, J. C., Smith-Coggins, R., Santen, S. 2016; 11 (7): 993-997

  Abstract

  Academic physicians train the next generation of doctors. It is important to understand the factors that lead residents to choose an academic career to continue to effectively recruit residents who will join the national medical faculty. A decision-making theory-driven, large scale assessment of this process has not been previously undertaken. To examine the factors that predict an Emergency resident's interest in pursuing an academic career at the conclusion of training. This study employs the ABEM Longitudinal Survey (n = 365). A logistic regression model was estimated using an interest in an academic career in residency as the dependent variable. Independent variables include gender, under-represented minority status, survey cohort, number of dependent children, possession of an advanced degree, ongoing research, publications, and the appeal of science, independence, and clinical work in choosing EM. Logistic regression resulted in a statistically significant model (p < 0.001). Residents who chose EM due to the appeal of science, had peer-reviewed publications and ongoing research were more likely to be interested in an academic career at the end of residency (p < 0.05). An increased number of children (p < 0.05) was negatively associated with an interest in academics. Individual resident career interests, research productivity, and lifestyle can help predict an interest in pursuing an academic career. Recruitment and enrichment of residents who have similar values and behaviors should be considered in programs interested in generating more graduates who enter an academic career.

  View details for DOI 10.1007/s11739-016-1408-8

  View details for PubMedID 26885848

• Disaster Medicine: A Multi-Modality Curriculum Designed and Implemented for Emergency Medicine Residents. Disaster medicine and public health preparedness Ngo, J., Schertzer, K., Harter, P., Smith-Coggins, R. 2016; 10 (4): 611-614

  Abstract

  Few established curricula are available for teaching disaster medicine. We describe a comprehensive, multi-modality approach focused on simulation to teach disaster medicine to emergency medicine residents in a 3-year curriculum.Residents underwent a 3-year disaster medicine curriculum incorporating a variety of venues, personnel, and roles. The curriculum included classroom lectures, tabletop exercises, virtual reality simulation, high-fidelity simulation, hospital disaster drills, and journal club discussion. All aspects were supervised by specialty emergency medicine faculty and followed a structured debriefing. Residents rated the high-fidelity simulations by using a 10-point Likert scale.Three classes of emergency medicine residents participated in the 3-year training program. Residents found the exercise to be realistic, educational, and relevant to their practice. After participating in the program, residents felt better prepared for future disasters.Given the large scope of impact that disasters potentiate, it is understandably difficult to teach these skills effectively. Training programs can utilize this simulation-based curriculum to better prepare the nation's emergency medicine physicians for future disasters. (Disaster Med Public Health Preparedness. 2016;0:1-4).

  View details for DOI 10.1017/dmp.2016.8

  View details for PubMedID 27040319

• Health and wellness among emergency physicians: results of the 2014 ABEM longitudinal study. The American journal of emergency medicine Marco, C. A., Broderick, K., Smith-Coggins, R., Goyal, D. G., Joldersma, K. B., Coombs, A. B. 2016; 34 (8): 1715-6

  View details for DOI 10.1016/j.ajem.2016.06.019

  View details for PubMedID 27321937

• Night shifts in emergency medicine: the american board of emergency medicine longitudinal study of emergency physicians. journal of emergency medicine Smith-Coggins, R., Broderick, K. B., Marco, C. A. 2014; 47 (3): 372-378

  Abstract

  Night shift work is an integral component of the practice of emergency medicine (EM). Previous studies have demonstrated the challenges of night shift work to health and well being among health care providers.This study was undertaken to describe the self-reported experience of emergency physicians regarding night shift work with respect to quality of life and career satisfaction.The 2008 American Board of Emergency Medicine (ABEM) Longitudinal Study of Emergency Physicians (LSEP) was administered by mail to 1003 ABEM diplomates.Among 819 participants in the 2008 LSEP Physician Survey, most participants responded that night shift work negatively influenced job satisfaction with a moderate or major negative influence (58%; n = 467/800). Forty-three percent of participants indicated that night shifts had caused them to think about leaving EM (n = 344/809). Most participants responded that working night shifts has had mild negative effects (51%; n = 407/800) or major negative effects (9%; n = 68) on their health. Respondents were asked to describe how working night shifts has affected their health. Common themes included fatigue (36%), poor quality of sleep (35%), mood decrement/irritability (29%), and health maintenance challenges (19%). Among participants in the 2008 LSEP Retired Physician Survey, night shifts were a factor in the decision to retire for 56% of participants.Emergency physicians report negative impacts of night shift work, including fatigue, poor quality of sleep, mood decrement, irritability, and health challenges. Night shifts have a negative influence on job satisfaction and can be a factor in the decision to retire.

  View details for DOI 10.1016/j.jemermed.2014.04.020

  View details for PubMedID 24881892

• Use of Ultrasound Guidance for Central Venous Catheter Placement: Survey From the American Board of Emergency Medicine Longitudinal Study of Emergency PhysiciansUso de la Ecografia para Guiar la Insercion de un Cateter Venoso Central: Encuesta a los Urgenciologos del Estudio Longitudinal de Medicina de Urgencias y Emergencias de la American Board ACADEMIC EMERGENCY MEDICINE Buchanan, M. S., Backlund, B., Liao, M. M., Sun, J., Cydulka, R. K., Smith-Coggins, R., Kendall, J. 2014; 21 (4): 416-421

  Abstract

  The objective was to survey practicing emergency physicians (EPs) across the United States regarding the frequency of using ultrasound (US) guidance in central venous catheter (CVC) placement and, secondarily, to determine factors associated with the use or barriers to the use of US guidance.This was a cross-sectional survey mailed to presumed practicing EPs as part of the American Board of Emergency Medicine (ABEM)'s longitudinal study of EPs. The selection process used stratified, random sampling of cohorts thought to represent four different stages within the development of the specialty of emergency medicine (EM). Multivariable logistic regression was used to identify independent factors associated with both high comfort using US guidance and high-percentage usage of US guidance.The survey was mailed to 1,165 subjects, and the response rate was 79%. The median number of years of practice was 20 (interquartile range [IQR]=7 to 28 years). As their primary practice setting, 64% work in private or community hospitals, 60% received training in US-guided vascular access, and 44% never use US guidance in placing CVCs. Barriers differed in those who never use US and those who sometimes or always used US guidance. In those who never use US, top barriers were insufficient training (67%) and lack of equipment (25%). In those who use US, top barriers were the perceptions that US was too time-consuming (27%) and that the preferred site was not amenable to US (24%). Independent factors associated with high comfort and high-percentage use of US guidance were training in US-guided vascular access (adjusted odds ratio=5.1 [high comfort]; 95% confidence interval [CI]=2.6 to 10.1; adjusted odds ratio 11.1=(high percentage); 95% CI=5.0 to 24.8) and being a recent residency graduate.Among EPs, the translation of evidence to clinical practice regarding the benefits of US guidance for CVC placement is poor and still faces many barriers. Training and education are potentially the best ways to overcome such barriers.

  View details for DOI 10.1111/acem.12350

  View details for Web of Science ID 000334288100008

• LIFELONG LEARNING AND SELF-ASSESSMENT IS RELEVANT TO EMERGENCY PHYSICIANS JOURNAL OF EMERGENCY MEDICINE Jones, J. H., Smith-Coggins, R., Meredith, J. M., Korte, R. C., Reisdorff, E. J., Russ, C. M. 2013; 45 (6): 935-940

  Abstract

  The Lifelong Learning and Self-assessment (LLSA) component of the American Board of Emergency Medicine (ABEM) Maintenance of Certification (MOC) program is a self-assessment exercise for physicians. Beginning in 2011, an optional continuing medical education (CME) activity was added.As a part of a CME activity option for the LLSA, a survey was used to determine the relevancy of the LLSA readings and the degree to which medical knowledge garnered by the LLSA activity would modify clinical care.Survey results from the 2011 LLSA CME activity were reviewed. This survey was composed of seven items, including questions about the relevancy of the readings and the impact on the physician's clinical practice. The questions used a 5-point Likert scale and data underwent descriptive analyses.There were 2841 physicians who took the LLSA test during the study period, of whom 1354 (47.7%) opted to participate in the 2011 LLSA CME activity. All participants completed surveys. The LLSA readings were reported to be relevant to the overall clinical practice of Emergency Medicine (69.6% strongly relevant, 28.1% some relevance, and 2.3% little or no relevance), and provided information that would likely help them change their clinical practices (high likelihood 38.8%, some likelihood 53.0%, little or no change 8.2%).The LLSA component of the ABEM MOC program is relevant to the clinical practice of Emergency Medicine. Through this program, physicians gain new knowledge about the practice of Emergency Medicine, some of which is reported to change physicians' clinical practices.

  View details for DOI 10.1016/j.jemermed.2013.05.050

  View details for Web of Science ID 000327535800038

  View details for PubMedID 23937810

• American Board of Emergency Medicine Report on Residency Training (2012-2013) Annals of Emergency Medicine Smith-Coggins R, Baren JM, Counselman FL, Kowalenko T, Marco CA, Muelleman RL, Wahl RP, Korte RC 2013; 61 (5): 584-592
• Lifelong Learning and Self-assessment is Relevant to Emergency Physicians J Emerg Med Jones, J. H., Smith-Coggins, R., Meredith, J. M., korte, R. C., Reisdorff, E. J., Russ, C. M. 2013; 45 (6): 935-41
• Report on residency training information (2011-2012) Annals of Emergency Medicine Smith-Coggins R, Carius ML, Collier RE, Counselman FL, Kowalenko T, Marco CA, Muelleman RL, Korte RC 2012; 59 (5): 416-24
• How Involved are Non-VA Chaplains in Supporting Veterans? JOURNAL OF RELIGION & HEALTH Kopacz, M. S., Feldstein, B. D., Asekoff, C. A., Kaprow, M. S., Smith-Coggins, R., Rasmussen, K. A. 2016; 55 (4): 1206-1214

  Abstract

  In terms of supporting veteran populations, little is known of the experiences of chaplains professionally active outside of Department of Veterans Affairs (VA) healthcare settings. The present study looks to examine how involved non-VA chaplains are in supporting veterans as well as their familiarity with the VA. An online survey was distributed in a convenience sample of chaplains, of which n = 39 met the inclusion criterion for this study (i.e., no past or present VA affiliation). The results find that most of the non-VA chaplains encounter veteran service users either on a weekly or monthly basis. Though familiar with VA services, non-VA chaplains were not sure of their veteran service users' VA enrollment status nor did they feel able to adequately advise their veteran service users on VA enrollment. The results suggest that non-VA chaplains actively support veteran populations. Opportunities for enhancing chaplaincy services and VA outreach programs are discussed.

  View details for DOI 10.1007/s10943-016-0223-x

  View details for Web of Science ID 000376880500008

  View details for PubMedID 27023459

• A preliminary study examining chaplains' support for veterans at the end of life. International journal of palliative nursing Kopacz, M. S., Feldstein, B. D., Asekoff, C. A., Kaprow, M. S., Smith-Coggins, R., Connery, A. L. 2016; 22 (6): 300-302

  Abstract

  This descriptive study examines the involvement of professional chaplains in addressing loss of dignity, inconsequential life or not having a legacy, fear of burdensomeness, and fear of pain in veterans at the end of life. A convenience sample of Jewish chaplains responded to an online survey gauging their involvement in these areas. Results are presented descriptively. Most respondents stated either rarely (≤1 x month) or sometimes (≥1 x month) encountering veterans with end-of-life issues. Respondents reported varying degrees of involvement in supporting veterans at the end of life with respect to the aforementioned areas. As research into the end-of-life care needs of veterans continues to develop, recognising chaplains as a source of both spiritual and psychosocial support can serve as an opportunity for better meeting the needs of this population.

  View details for DOI 10.12968/ijpn.2016.22.6.300

  View details for PubMedID 27349849

• American Board of Emergency Medicine Report on Residency Training Information (2014-2015) ANNALS OF EMERGENCY MEDICINE Smith-Coggins, R., Marco, C. A., Baren, J. M., Beeson, M. S., Carius, M. L., Counselman, F. L., Heller, B. N., Kowalenko, T., Muelleman, R. L., Nelson, L. S., Wahl, R. P., Korte, R. C., Joldersma, K. B. 2015; 65 (5): 584-594

  Abstract

  The American Board of Emergency Medicine (ABEM) gathers extensive background information on emergency medicine residency programs and the residents in those programs. We present the 2015 annual report on the status of US emergency medicine training programs.

  View details for DOI 10.1016/j.annemergmed.2015.03.014

  View details for Web of Science ID 000353927000022

  View details for PubMedID 25910762

• Generational Influences in Academic Emergency Medicine: Structure, Function, and Culture (Part II) ACADEMIC EMERGENCY MEDICINE Mohr, N. M., Smith-Coggins, R., Larrabee, H., Dyne, P. L., Promes, S. B. 2011; 18 (2): 200-207

  Abstract

  Strategies for approaching generational issues that affect teaching and learning, mentoring, and technology in emergency medicine (EM) have been reported. Tactics to address generational influences involving the structure and function of the academic emergency department (ED), organizational culture, and EM schedule have not been published. Through a review of the literature and consensus by modified Delphi methodology of the Society for Academic Emergency Medicine Aging and Generational Issues Task Force, the authors have developed this two-part series to address generational issues present in academic EM. Understanding generational characteristics and mitigating strategies can address some common issues encountered in academic EM. By understanding the differences and strengths of each of the cohorts in academic EM departments and considering simple mitigating strategies, faculty leaders can maximize their cooperative effectiveness and face the challenges of a new millennium.

  View details for DOI 10.1111/j.1553-2712.2010.00986.x

  View details for Web of Science ID 000287248200015

  View details for PubMedID 21314780

• DUTY HOURS IN EMERGENCY MEDICINE: BALANCING PATIENT SAFETY, RESIDENT WELLNESS, AND THE RESIDENT TRAINING EXPERIENCE: A CONSENSUS RESPONSE TO THE 2008 INSTITUTE OF MEDICINE RESIDENT DUTY HOURS RECOMMENDATIONS JOURNAL OF EMERGENCY MEDICINE Wagner, M. J., Wolf, S., Promes, S., McGee, D., Hobgood, C., Doty, C., McErlean, M. A., Janssen, A., Smith-Coggins, R., Ling, L., Mattu, A., Tantama, S., Beeson, M., Brabson, T., Christiansen, G., King, B., Luerssen, E., Muelleman, R. 2010; 39 (3): 348-355

  Abstract

  Representatives of emergency medicine (EM) were asked to develop a consensus report that provided a review of the past and potential future effects of duty hour requirements for EM residency training. In addition to the restrictions made in 2003 by the Accreditation Council for Graduate Medical Education, the potential effects of the 2008 Institute of Medicine (IOM) report on resident duty hours were postulated.The elements highlighted include patient safety, resident wellness, and the resident training experience. Many of the changes and recommendations did not affect EM as significantly as other specialties. Current training standards in EM have already emphasized patient safety by requiring continuous onsite supervision of residents. Resident fatigue has been addressed with restrictions of shift lengths and limitation of consecutive days worked.One recommendation from the IOM was a required 5-h rest period for residents on call. Emergency department (ED) patient safety becomes an important concern with the decrease in the availability and in the patient load of a resident consultant that may result from this recommendation. Of greater concern is the already observed slower throughput time for admitted patients waiting for resident care, which will increase ED crowding and decrease patient safety in academic institutions. A balance between being overly prescriptive with duty hour restrictions and trying to improve resident wellness was recommended. Discussion is included regarding the appropriate length of EM training programs if clinical experiences were limited by new duty hour regulations. Finally, this report presents a review of the financing issues associated with any changes.

  View details for DOI 10.1016/j.jemermed.2010.05.058

  View details for Web of Science ID 000282072800019

  View details for PubMedID 20634017

• Duty Hours in Emergency Medicine: Balancing Patient Safety, Resident Wellness, and the Resident Training Experience: A Consensus Response to the 2008 Institute of Medicine Resident Duty Hours Recommendations ACADEMIC EMERGENCY MEDICINE Wagner, M. J., Wolf, S., Promes, S., McGee, D., Hobgood, C., Doty, C., McErlean, M. A., Janssen, A., Smith-Coggins, R., Ling, L., Mattu, A., Tantama, S., Beeson, M., Brabson, T., Christiansen, G., King, B., Luerssen, E., Muelleman, R. 2010; 17 (9): 1004-1011

  Abstract

  Representatives of emergency medicine (EM) were asked to develop a consensus report that provided a review of the past and potential future effects of duty hour requirements for EM residency training. In addition to the restrictions made in 2003 by the Accreditation Council for Graduate Medical Education (ACGME), the potential effects of the 2008 Institute of Medicine (IOM) report on resident duty hours were postulated. The elements highlighted include patient safety, resident wellness, and the resident training experience. Many of the changes and recommendations did not affect EM as significantly as other specialties. Current training standards in EM have already emphasized patient safety by requiring continuous on-site supervision of residents. Resident fatigue has been addressed with restrictions of shift lengths and limitation of consecutive days worked. One recommendation from the IOM was a required 5-hour rest period for residents on call. Emergency department (ED) patient safety becomes an important concern with the decrease in the availability and in the patient load of a resident consultant that may result from this recommendation. Of greater concern is the already observed slower throughput time for admitted patients waiting for resident care, which will increase ED crowding and decrease patient safety in academic institutions. A balance between being overly prescriptive with duty hour restrictions and trying to improve resident wellness was recommended. Discussion is included regarding the appropriate length of EM training programs if clinical experiences were limited by new duty hour regulations. Finally, this report presents a review of the financing issues associated with any changes.

  View details for DOI 10.1111/j.1553-2712.2010.00789.x

  View details for Web of Science ID 000281632000016

  View details for PubMedID 20836785

• The Assessment of Individual Cognitive Expertise and Clinical Competency: A Research Agenda ACADEMIC EMERGENCY MEDICINE Spillane, L., Hayden, E., Fernandez, R., Adler, M., Beeson, M., Goyal, D., Smith-Coggins, R., Boulet, J. 2008; 15 (11): 1071-1078

  Abstract

  There is a large push to utilize evidence-based practices in medical education. At the same time, credentialing bodies are evaluating the use of simulation technologies to assess the competency and safety of its practitioners. At the 2008 Academic Emergency Medicine Consensus Conference on "The Science of Simulation in Healthcare," our breakout session critically evaluated several issues important to the use of simulation in emergency physician (EP) assessment. In this article, we discuss five topics felt to be most critical to simulation-based assessment (SBA). We then offer more specific research questions that would help to define and implement a SBA program in emergency medicine (EM).

  View details for DOI 10.1111/j.1553-2712.2008.00271.x

  View details for Web of Science ID 000261051700014

  View details for PubMedID 19032553

• The Assessment of Individual Cognitive Expertise and Clinical Competency: A Research Agenda Acad Emerg Med Spillane L, Hayden E, Fernandez R, Adler M, Beeson M, Goyal D, Smith-Coggins R, Boulet J 2008; 15 (11): 1071-1078
• Using patient care quality measures to assess educational outcomes ACADEMIC EMERGENCY MEDICINE Swing, S. R., Schneider, S., Bizovi, K., Chapman, D., Graff, L. G., Hobgood, C., Lukens, T., Radford, M. J., Sanders, A., Smith-Coggins, R., Spillane, L., Hruska, L., Wears, R. L. 2007; 14 (5): 463-473

  Abstract

  To report the results of a project designed to develop and implement a prototype methodology for identifying candidate patient care quality measures for potential use in assessing the outcomes and effectiveness of graduate medical education in emergency medicine.A workgroup composed of experts in emergency medicine residency education and patient care quality measurement was convened. Workgroup members performed a modified Delphi process that included iterative review of potential measures; individual expert rating of the measures on four dimensions, including measures quality of care and educational effectiveness; development of consensus on measures to be retained; external stakeholder rating of measures followed by a final workgroup review; and a post hoc stratification of measures. The workgroup completed a structured exercise to examine the linkage of patient care process and outcome measures to educational effectiveness.The workgroup selected 62 measures for inclusion in its final set, including 43 measures for 21 clinical conditions, eight medication measures, seven measures for procedures, and four measures for department efficiency. Twenty-six measures met the more stringent criteria applied post hoc to further stratify and prioritize measures for development. Nineteen of these measures received high ratings from 75% of the workgroup and external stakeholder raters on importance for care in the ED, measures quality of care, and measures educational effectiveness; the majority of the raters considered these indicators feasible to measure. The workgroup utilized a simple framework for exploring the relationship of residency program educational activities, competencies from the six Accreditation Council for Graduate Medical Education general competency domains, patient care quality measures, and external factors that could intervene to affect care quality.Numerous patient care quality measures have potential for use in assessing the educational effectiveness and performance of graduate medical education programs in emergency medicine. The measures identified in this report can be used as a starter set for further development, implementation, and study. Implementation of the measures, especially for high-stakes use, will require resolution of significant measurement issues.

  View details for DOI 10.1197/j.aem.2006.12.011

  View details for Web of Science ID 000245960100013

  View details for PubMedID 17395960

• The use of simulation in emergency medicine: A research agenda ACADEMIC EMERGENCY MEDICINE Bond, W. F., Lammers, R. L., Spillane, L. L., Smith-Coggins, R., Fernandez, R., Reznek, M. A., Vozenilek, J. A., Gordon, J. A. 2007; 14 (4): 353-363

  Abstract

  Medical simulation is a rapidly expanding area within medical education. In 2005, the Society for Academic Emergency Medicine Simulation Task Force was created to ensure that the Society and its members had adequate access to information and resources regarding this new and important topic. One of the objectives of the task force was to create a research agenda for the use of simulation in emergency medical education. The authors present here the consensus document from the task force regarding suggested areas for research. These include opportunities to study reflective experiential learning, behavioral and team training, procedural simulation, computer screen-based simulation, the use of simulation for evaluation and testing, and special topics in emergency medicine. The challenges of research in the field of simulation are discussed, including the impact of simulation on patient safety. Outcomes-based research and multicenter efforts will serve to advance simulation techniques and encourage their adoption.

  View details for DOI 10.1197/j.aem.2006.11.021

  View details for Web of Science ID 000245579300010

  View details for PubMedID 17303646

• Improving alertness and performance in emergency department physicians and nurses: The use of planned naps ANNALS OF EMERGENCY MEDICINE Smith-Coggins, R., Howard, S. K., Mac, D. T., Wang, C., Kwan, S., Rosekind, M. R., Sowb, Y., Ballise, R., Levis, J., Gaba, D. M. 2006; 48 (5): 596-604

  Abstract

  We examine whether a 40-minute nap opportunity at 3 AM can improve cognitive and psychomotor performance in physicians and nurses working 12-hour night shifts.This is a randomized controlled trial of 49 physicians and nurses working 3 consecutive night shifts in an academic emergency department. Subjects were randomized to a control group (no-nap condition=NONE) or nap intervention group (40-minute nap opportunity at 3 AM=NAP). The main outcome measures were Psychomotor Vigilance Task, Probe Recall Memory Task, CathSim intravenous insertion virtual reality simulation, and Profile of Mood States, which were administered before (6:30 PM), during (4 AM), and after (7:30 AM) night shifts. A 40-minute driving simulation was administered at 8 AM and videotaped for behavioral signs of sleepiness and driving accuracy. During the nap period, standard polysomnographic data were recorded.Polysomnographic data revealed that 90% of nap subjects were able to sleep for an average of 24.8 minutes (SD 11.1). At 7:30 AM, the nap group had fewer performance lapses (NAP 3.13, NONE 4.12; p<0.03; mean difference 0.99; 95% CI: -0.1-2.08), reported more vigor (NAP 4.44, NONE 2.39; p<0.03; mean difference 2.05; 95% CI: 0.63-3.47), less fatigue (NAP 7.4, NONE 10.43; p<0.05; mean difference 3.03; 95% CI: 1.11-4.95), and less sleepiness (NAP 5.36, NONE 6.48; p<0.03; mean difference 1.12; 95% CI: 0.41-1.83). They tended to more quickly complete the intravenous insertion (NAP 66.40 sec, NONE 86.48 sec; p=0.10; mean difference 20.08; 95% CI: 4.64-35.52), exhibit less dangerous driving and display fewer behavioral signs of sleepiness during the driving simulation. Immediately after the nap (4 AM), the subjects scored more poorly on Probed Recall Memory (NAP 2.76, NONE 3.7; p<0.05; mean difference 0.94; 95% CI: 0.20-1.68).A nap at 3 AM improved performance and subjective report in physicians and nurses at 7:30 AM compared to a no-nap condition. Immediately after the nap, memory temporarily worsened. The nap group did not perform any better than the no-nap group during a simulated drive home after the night shift.

  View details for DOI 10.1016/j.annemergmed.2006.02.005

  View details for Web of Science ID 000241749400017

  View details for PubMedID 17052562

• : Measuring Sleep Onset: Comparing The Standard Versus An Experimental Montage Sleep Howard SK, Smith-Coggins R, Nevarez M, Sohoni A, Gaba D, Rosekind M 2005; 28: A1324-325
• : Sleep Propensity and Performance: Evaluating A Brief Protocol In Health Care Providers Sleep Howard SK, Smith-Coggins R, Nevarez M, Sohoni A, Gaba D, Rosekind M 2005; 28: A133
• Assessment of resident professionalism using high-fidelity simulation of ethical dilemmas Annual Educational Conference of the Accreditation-Council-for-Graduate-Medical-Education Gisondi, M. A., Smith-Coggins, R., Harter, P. M., Soltysik, R. C., Yarnold, P. R. WILEY-BLACKWELL PUBLISHING, INC. 2004: 931–37

  Abstract

  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 PubMedID 15347542

• Integrating the Accreditation Council for Graduate Medical Education core competencies into the Model of the Clinical Practice of Emergency Medicine ACADEMIC EMERGENCY MEDICINE Chapman, D. M., Hayden, S., Sanders, A. B., Binder, L. S., Chinnis, A., Corrigan, K., LaDuca, T., Dyne, P., Perina, D. G., Smith-Coggins, R., Sulton, L., Swing, S. 2004; 11 (6): 674-685

  View details for DOI 10.1197/j.aem.2004.02.008

  View details for Web of Science ID 000221905700012

  View details for PubMedID 15175209

• Use of High-Fidelity Simulation to Evaluate Resident Professionalism During Critical Patient Encounters Acad Emerg Med Gisondi M, Smith-Coggins R, Harter P 2004; 11 (9): 931-937
• Integrating the Accreditation Council for Graduate Medical Education Core Competencies Into the Model o f the Clinical Practice of Emergency Medicine Acad Emerg Med Chapman D, Hayden S, Sanders A, Binder L, Chinnis A, Corrigan K, LaDuca, Dyne P, Perina D, Smith-Coggins R, Sulton L, Swing S 2004; 11 (6): 674-685
• Integrating the Accreditation Council for Graduate Medical Education Core Competencies Into the Model of the Clinical Practice of Emergency Medicine Ann Emerg Med, Chapman D, Hayden S, Sanders A, Binder L, Chinnis A, Corrigan K, LaDuca T, Dyne P, Perina D, Smith-Coggins R, Sulton L, Swing S 2004; 43 (6): 756-769
• Global Assessment Tool for Emergency Medicine-Specific Core Competency Evaluation Academic Emergency Medicine Wang E, Chapman D, Hayden S, Sanders A, Binder L, Chinnis A, Corrigan K, LaDuca R, Dyne P, Perina D, Smith-Coggins R, Sulton L, Swing S 2004; 11 (12): 1370-1
• Emergency medicine crisis resource management (EMCRM): Pilot study of a simulation-based crisis management course for emergency medicine ACADEMIC EMERGENCY MEDICINE Reznek, M., Smith-Coggins, R., Howard, S., Kiran, K., Harter, P., Sowb, Y., Gaba, D., Krummel, T. 2003; 10 (4): 386-389

  Abstract

  To determine participant perceptions of Emergency Medicine Crisis Resource Management (EMCRM), a simulation-based crisis management course for emergency medicine.EMCRM was created using Anesthesia Crisis Resource Management (ACRM) as a template. Thirteen residents participated in one of three pilot courses of EMCRM; following a didactic session on principles of human error and crisis management, the residents participated in simulated emergency department crisis scenarios and instructor-facilitated debriefing. The crisis simulations involved a computer-enhanced mannequin simulator and standardized patients. After finishing the course, study subjects completed a horizontal numerical scale survey (1 = worst rating to 5 = best rating) of their perceptions of EMCRM. Descriptive statistics were calculated to evaluate the data.The study subjects found EMCRM to be enjoyable (4.9 +/- 0.3) (mean +/- SD) and reported that the knowledge gained from the course would be helpful in their practices (4.5 +/- 0.6). The subjects believed that the simulation environment prompted realistic responses (4.6 +/- 0.8) and that the scenarios were highly believable (4.8 +/- 0.4). The participants reported that EMCRM was best suited for residents (4.9 +/- 0.3) but could also benefit students and attending physicians. The subjects believed that the course should be repeated every 8.2 +/- 3.3 months.The EMCRM participants rated the course very favorably and believed that the knowledge gained would be beneficial in their practices. The extremely positive response to EMCRM found in this pilot study suggests that this training modality may be valuable in training emergency medicine residents.

  View details for Web of Science ID 000181995500016

  View details for PubMedID 12670855

• Development of a Three-Level Curriculum for Crisis Resource management Training in Emergency Medicine International Meeting on Medical Simulation Sowb Y, Kiran K, Reznec M, Smith-Coggins R, Harter P, Stafford-Cecil S, Howard S, Gaba D 2003: 47
• Use of High-fidelity simulation to Evaluate Resident Professionalism during Critical Patient Encounters ACGME/ABMS Conference, Fostering Professionalism: Challenges and Opportunities Gisondi M, Smith-Coggins R, Harter P 2003: 12
• Do Naps During the Night Shift Improve Performance in the Emergency Department Sleep Smith-Coggins R, Howard S, Kwan S, Wang C, Mac DT, Rosekind M, Sowb Y, Balise R, Gaba D 2002: A116-A117
• Development of a Standard Crisis Management Curriculum for Emergency Medicine Academic Emergency Medicine Reznek M, Smith-Coggins R, Howard S, Harter P, Sowb Y, Gaba D, Krummel T 2002; 9 (5): 430
• Do Naps During the Night Shift Improve Performance in the Emergency Department Annals of Emergency Medicine Smith-Coggins R, Howard S, Kwan S, Wang C, Mac DT, Rosekind M, Sowb Y, Balise R, Gaba D 2002; 9 (5): 466
• Rotating shiftwork schedules: Can we enhance physician adaptation to night shifts? SAEM Annual Meeting SMITHCOGGINS, R., Rosekind, M. R., BUCCINO, K. R., Dinges, D. F., MOSER, R. P. HANLEY & BELFUS INC. 1997: 951–61

  Abstract

  To evaluate the effectiveness of a broad, literature-based night shiftwork intervention for enhancement of emergency physicians' (EPs') adaptation to night rotations.A prospective, double-blind, active placebo-controlled study was conducted on 6 attending physicians in a university hospital ED. Three data sets were collected under the following conditions: baseline, after active placebo intervention, and after experimental intervention. In each condition, data were collected when the physicians worked both night and day shifts. Measurements included ambulatory polysomnographic recordings of the main sleep periods, objective performance tests administered several times during the subjects' shifts, and daily subjective ratings of the subjects' sleep, moods, and intervention use.The subjects slept an average of 5 hr 42 min across all conditions. After night shifts, the subjects slept significantly less than they did after day shifts (5 hr 13 min vs 6 hr 20 min; p < 0.05). The physicians' vigilance reaction times and times for intubation of a mannequin were significantly slower during night shifts than they were during day shifts (p = 0.007 and p < 0.04, respectively), but performances on ECG analysis did not significantly differ between night and day shifts. Mood ratings were significantly more negative during night shifts than they were during day shifts (more sluggish p < 0.04, less motivated p < 0.03, and less clear thinking p < 0.04). The strategies in the experimental intervention were used 85% of the time according to logbook entries. The experimental and active placebo interventions did not significantly improve the physician's performance, or mood on the night shift, although the subjects slept more after both interventions.Although the experimental intervention was successfully implemented, it failed to significantly improve attending physicians' sleep, performance, or mood on night shifts. A decrease in speed of intubation, vigilance reaction times, and subjective alertness was evident each time the physicians rotated through the night shift. These findings plus the limited sleep across all conditions and shifts suggest that circadian-mediated disruptions of waking neurobehavioral functions and sleep deprivation are problems in EPs.

  View details for Web of Science ID A1997YA21000008

  View details for PubMedID 9332626

• Morningness-eveningness preferences of emergency medicine residents are skewed toward eveningness ACADEMIC EMERGENCY MEDICINE Steele, M. T., McNamara, R. M., SMITHCOGGINS, R., Watson, W. A. 1997; 4 (7): 699-705

  Abstract

  To determine the morningness-eveningness (ME) distribution of emergency medicine (EM) residents.A voluntary, modified ME questionnaire was administered to all EM residents in the United States at the time of the 1995 American Board of Emergency Medicine's annual In-Training Examination.Seventy-eight percent (2,047/2,614) of the surveys were returned. ME scores ranged from 24 to 76, with a median score of 49 (interquartile range 44, 56). The scores were distributed differently from those of the normal population (p < 0.001), being skewed toward eveningness. There was a correlation (r = 0.13, p < 0.0001) between resident age and ME score, with older residents being more morning-oriented. Males were more morning-oriented than females (p = 0.005), and respondents with children living at home also were significantly more morning-oriented (p < 0.001). Stepwise logistic regression showed that the influence of age, gender, and children was cumulative (r = 0.19) but accounted for only 4% of the observed variability.EM residents are distributed differently from the normal population in terms of their ME preferences, tending slightly toward eveningness. The importance of this distribution in EM residents in unknown. A longitudinal follow-up of this cohort may help to determine the association of ME preference with overall practice satisfaction, tolerance of shift work, and career longevity.

  View details for Web of Science ID A1997XJ85200012

  View details for PubMedID 9223694

• Morningness-Eveningness Preference of Emergency Medicine Residents are Skewed Toward Eveningness . Acad Emerg Med Steele MT, McNamara RM, Smith-Coggins R. Watson WA 1997; 4 (7): 699-705
• GENDER-ASSOCIATED DIFFERENCES IN EMERGENCY DEPARTMENT PAIN MANAGEMENT Society-for-Academic-Emergency-Medicine Annual Meeting RAFTERY, K. A., SMITHCOGGINS, R., GHEN, A. H. MOSBY-YEAR BOOK INC. 1995: 414–21

  Abstract

  To determine whether patient or provider gender is associated with the number, type, and strength of medications received by emergency department patients with headache, neck pain, or back pain.Prospective cohort study.Stanford University Hospital ED PARTICIPANTS: Patients 18 years and older who arrived at the ED with a chief complaint of headache, neck pain, or back pain between February 1, 1993, and September 30, 1993. Provider participants included medical students, interns, residents, nurse practitioners, and attending physicians.ED administration of analgesic versus no analgesic, strength of analgesic administered, and administration of multiple medications. The study group consisted of 190 patients, 110 of them female. The patients were evaluated by 84 providers, 60 of them male. According to the providers surveyed, female patients described more pain than did male patients (P < .01) and were perceived by providers to experience more pain (P = .03). Female patients received more medications (P < .01) and were less likely to receive no medication (P = .01). Female patients also received more potent analgesics (P = .03). Linear and logistic regression analysis showed that patient perception of pain was the strongest predictor of the number and strength of medications given; patient gender was not a predictor.Female patients with headache, neck pain, or back pain describe more pain and are perceived by providers to have more pain than male patients in the ED. Female patients also receive more medications and stronger analgesics. In this study, severity of patient pain rather than gender stereotyping appeared to correlate most with pain-management practices.

  View details for Web of Science ID A1995RX46800002

  View details for PubMedID 7574121

• RELATIONSHIP OF DAY VERSUS NIGHT SLEEP TO PHYSICIAN PERFORMANCE AND MOOD ANNALS OF EMERGENCY MEDICINE SMITHCOGGINS, R., Rosekind, M. R., Hurd, S., BUCCINO, K. R. 1994; 24 (5): 928-934

  Abstract

  To document and analyze the quality and quantity of emergency physicians' sleep as a function of day and night shift work, and to compare cognitive and motor performance and mood during day and night shifts.Six physicians were monitored for two 24-hour periods. One period consisted of daytime work and nocturnal sleep and the second consisted of daytime sleep and nighttime work.The emergency department of Stanford University Medical Center and physicians' homes.Six attending emergency physicians.Ambulatory polysomnographic recorders continuously gathered EEG, electro-oculogram, and electromyograph data throughout each observation period. Physicians filled out hourly mood ratings and completed a set of two performance tests five times throughout the day.Physicians had significantly less sleep (496.6 minutes versus 328.5 minutes, P = .02) when sleeping during the day as compared with sleeping at night. Significant performance decrements were also found. Physicians working nights were slower at intubating a mannequin (31.56 seconds versus 42.2 seconds, P = .04) and were more likely to commit errors as their shift progressed (P = .04). Physicians in both conditions were more likely to make errors during a simulated triage test toward the end of their shifts (P = .02). Subjects also rated themselves significantly less sleepy (P < .01), happier (P < .01), and more clear thinking (P < .01) when working day versus night shifts.Attending emergency physicians get less sleep and are less effective when performing manual and cognitive tests while working night shifts with day sleep compared with working day shifts with night sleep.

  View details for Web of Science ID A1994PP22500014

  View details for PubMedID 7978567

• Gender-Associated Differences in Emergency Department Pain Management Academic Emergency Medicine Raftery KA, Smith-Coggins R, Chen AHM 1994; 1 (2): A52
• Promoting Alertness and Performance on the Night Shift: An Intervention Study Annals of Emergency Medicine Smith-Coggins R, Rosekind MR, Buccino KR, Cole W 1993; 22 (5): 946
• The Relationship of Day vs. Night Sleep to Physician Performance and Mood Annals of Emergency Medicine Smith-Coggins R, Rosekind M, Hurd S, Buccino K 1991; 20 (4): 455
• A Technique for Producing Constant Plasma Drug Concentrations. Annals of Internal Medicine Ambre JJ, Smith-Coggins R, Belnap S, Nelson J 1987: 122
• Mothball Composition: Three Simple Tests for Distinguishing Paradichlorobenzene From Naphthalene Annals of Emergency Medicine Ambre JJ, Smith-Coggins R 1986: 724-726
• Local Anesthetics Annals of Emergency Medicine Altman RS, Smith-Coggins R, Ampel LL 1985: 1209-1217
• Unsaturated Fatty Acids and Human Mononuclear Cell Function. Prog of Lipid Research Utermohlen V, Coniglio J, Mao D, sierra J, Smith R, Besner G, Hutchins S, Spitzer K, Tomasso J, Boyar A 1981: 739-741