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Residency Curricula (residency + curriculum)
Selected AbstractsDevelopment of Geriatric Competencies for Emergency Medicine Residents Using an Expert Consensus ProcessACADEMIC EMERGENCY MEDICINE, Issue 3 2010Teresita M. Hogan MD Abstract Background:, The emergency department (ED) visit rate for older patients exceeds that of all age groups other than infants. The aging population will increase elder ED patient utilization to 35% to 60% of all visits. Older patients can have complex clinical presentations and be resource-intensive. Evidence indicates that emergency physicians fail to provide consistent high-quality care for elder ED patients, resulting in poor clinical outcomes. Objectives:, The objective was to develop a consensus document, "Geriatric Competencies for Emergency Medicine Residents," by identified experts. This is a minimum set of behaviorally based performance standards that all residents should be able to demonstrate by completion of their residency training. Methods:, This consensus-based process utilized an inductive, qualitative, multiphase method to determine the minimum geriatric competencies needed by emergency medicine (EM) residents. Assessments of face validity and reliability were used throughout the project. Results:, In Phase I, participants (n = 363) identified 12 domains and 300 potential competencies. In Phase II, an expert panel (n = 24) clustered the Phase I responses, resulting in eight domains and 72 competencies. In Phase III, the expert panel reduced the competencies to 26. In Phase IV, analysis of face validity and reliability yielded a 100% consensus for eight domains and 26 competencies. The domains identified were atypical presentation of disease; trauma, including falls; cognitive and behavioral disorders; emergent intervention modifications; medication management; transitions of care; pain management and palliative care; and effect of comorbid conditions. Conclusions:, The Geriatric Competencies for EM Residents is a consensus document that can form the basis for EM residency curricula and assessment to meet the demands of our aging population. ACADEMIC EMERGENCY MEDICINE 2010; 17:316,324 © 2010 by the Society for Academic Emergency Medicine [source] Preparedness for rural community leadership and its impact on practice location of family medicine graduatesAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 1 2005Wayne Woloschuk Abstract Objective:,To identify non-clinical dimensions of preparedness for rural practice and to determine whether preparedness for rural practice is predictive of rural practice location. Design:,Cross-sectional postal survey mailed in 2001. Setting:,Communities across Canada where graduates were practising. Subjects:,,Graduates (n = 369) of the family medicine residency program at the universities of Alberta (U of A) and Calgary (U of C) between 1996 and 2000, inclusive. Interventions:,Using a 4-point scale, graduates rated the extent to which the residency program prepared them for eight dimensions of rural practice: clinical demands of rural practice, understanding rural culture, small community living, balancing work and personal life, establishing personal/professional boundaries, becoming a community leader, handling a ,fish bowl' lifestyle, and choosing a suitable community. Main outcome measure:,Identification of non-clinical dimensions of preparedness for rural practice and whether scores on preparedness scales are predictive of rural practice location. Results:,The overall response rate was 76.4%. Factor analysis of the eight preparedness items produced two factors, ,rural culture' and ,rural community leader' which explained 72% of the variance. The alpha coefficient for each factor was 0.87. Odds ratios revealed that family medicine graduates prepared for rural community leadership roles were 1.92 (CI = 1.03,3.61) times more likely to be in rural practice. Rural physicians were also 2.14 (CI = 1.13,4.03) times as likely to have a rural background. Conclusions:,Preparedness to be a rural community leader and having a rural background were predictive of rural practice. Educators should consider this in both family medicine residency admissions policy and practice and when designing and implementing family medicine residency curricula. [source] 14 The Use of Medical Simulation to Enhance the Clinical Exposure to International Emergency MedicineACADEMIC EMERGENCY MEDICINE, Issue 2008David Bouslough Study Objectives:, Increasing numbers of immigrants and returned travelers use emergency departments for health care. Many physicians-in-training are interested in participating in health electives abroad, yet residency curricula generally address global health inadequately. Advanced medical simulation (SIM) is an educational modality used to artificially re-create clinical experiences. Authors explored the application of SIM and standardized patient encounters to teach emergency medicine residents select topics in tropical medicine, public health, and decision-making in varied-resource settings. Methods:, International Emergency Medicine (IEM) faculty created four case scenarios interspersed into the established residency simulation curriculum. Moulaged manikins and standardized patients in immersive IEM clinical settings provided history and physical exam cues to learners during the following clinical encounters: - "Tent-side" mobile clinic, East Africa: "Dizzy" pregnant patient (Hookworm). - Rural health clinic, Southeast Asia: Infant with "altered mental status" (Dengue). - Emergency department, North America: Central American immigrant with "dyspnea" (Chagas). - Emergency department, North America: Returned traveler from East Africa with "fever" (Typhoid). Post-scenario debriefings addressed unique elements of IEM including [source] The Status of Bedside Ultrasonography Training in Emergency Medicine Residency ProgramsACADEMIC EMERGENCY MEDICINE, Issue 1 2003Francis L. Counselman MD Abstract Bedside ultrasonography (BU) is rapidly being incorporated into emergency medicine (EM) training programs and clinical practice. In the past decade, several organizations in EM have issued position statements on the use of this technology. Program training content is currently driven by the recently published "Model of the Clinical Practice of Emergency Medicine," which includes BU as a necessary skill. Objective: The authors sought to determine the current status of BU training in EM residency programs. Methods: A survey was mailed in early 2001 to all 122 Accreditation Council for Graduate Medical Education (ACGME)-accredited EM residency programs. The survey instrument asked whether BU was currently being taught, how much didactic and hands-on training time was incorporated into the curriculum, and what specialty representation was present in the faculty instructors. In addition, questions concerning the type of tests performed, the number considered necessary for competency, the role of BU in clinical decision making, and the type of quality assurance program were included in the survey. Results: A total of 96 out of 122 surveys were completed (response rate of 79%). Ninety-one EM programs (95% of respondents) reported they teach BU, either clinically and/or didactically, as part of their formal residency curriculum. Eighty-one (89%) respondents reported their residency program or primary hospital emergency department (ED) had a dedicated ultrasound machine. BU was performed most commonly for the following: the FAST scan (focused abdominal sonography for trauma, 79/87%); cardiac examination (for tamponade, pulseless electrical activity, etc., 65/71%); transabdominal (for intrauterine pregnancy, ectopic pregnancy, etc., 58/64%); and transvaginal (for intrauterine pregnancy, ectopic pregnancy, etc., 45/49%). One to ten hours of lecture on BU was provided in 43%, and one to ten hours of hands-on clinical instruction was provided in 48% of the EM programs. Emergency physicians were identified as the faculty most commonly involved in teaching BU to EM residents (86/95%). Sixty-one (69%) programs reported that EM faculty and/or residents made clinical decisions and patient dispositions based on the ED BU interpretation alone. Fourteen (19%) programs reported that no formal quality assurance program was in place. Conclusions: The majority of ACGME-accredited EM residency programs currently incorporate BU training as part of their curriculum. The majority of BU instruction is done by EM faculty. The most commonly performed BU study is the FAST scan. The didactic component and clinical time devoted to BU instruction are variable between programs. Further standardization of training requirements between programs may promote increasing standardization of BU in future EM practice. [source] 11 Dawn Patrol Patient Follow-up ProtocolACADEMIC EMERGENCY MEDICINE, Issue 2008Justin Williams Follow-up of patients after their emergency department course provides a rich educational experience for residents, but due to time and logistical constraints, is infrequently performed in a scheduled and rigorous manner. The Dawn Patrol initiative was added to our residency curriculum to facilitate and protocolize patient follow-up for education and feedback on patient care. It also strives to improve communication with inpatient services, and provides a means of collection for morbidity / mortality and risk management cases. Our process functions by charging the clinical senior resident who is going off-shift, with reviewing the admission record for the past 24 hours. Interesting, clinically important, or cryptic case presentations are selected via our electronic medical record for review at the end of Morning Report. Generally, 1-3 new cases are selected for review each weekday morning. These cases are then recorded on a dry erase board in the Morning Report room, and the cases are followed until inpatient discharge, or are no longer of clinical interest. Visits to the inpatient wards are encouraged. Patient callbacks of outpatients are also eligible for inclusion. The cases are updated daily, and generally 5-10 cases are reviewed per day in approximately 10 minutes. The staff member attending Morning Report is responsible for providing bulleted teaching points on each case. The Dawn Patrol patient follow-up initiative seeks to improve emergency medicine resident education by facilitating and protocolizing patient follow-up, and provides real-time feedback on patient care performed in the emergency department. [source] | ||||||||||