An Educator''s Guide to Teaching Emergency Medicine to Medical Students

There is a need for every medical school graduate to handle emergencies as they arise in the daily practice of medicine. Emergency medicine (EM) educators are in a unique position to provide students with basic life support skills, guidance in assessing the undifferentiated patient, and exposure to the specialty of EM during all years of medical school. Emergency physicians can become involved in a variety of education experiences that can supplement the preclinical curriculum and provide access to our specialty at an early stage. A well-designed course in the senior year allows students to develop critical thinking and patient management skills that are necessary for any medical career path. It can ensure that all medical students are exposed to the skills essential for evaluating and stabilizing the acutely ill patient. To implement this type of course, learning objectives and evaluation methods must be set when the curriculum is developed. An effective course combines didactic and clinical components that draw on the strengths of the teaching institution and faculty of the department. A structured clerkship orientation session and system for feedback to students are essential in nurturing the development of student learners. This article provides an approach to assist the medical student clerkship director in planning and implementing EM education experiences for students at all levels of training, with an emphasis on the senior-year rotation.     

Reliability of Faculty Clinical Evaluations of Non-Emergency Medicine Residents during Emergency Department Rotations

Objectives: To assess the reliability of faculty evaluations of non-emergency medicine (non-EM) residents during clinical ED rotations and to determine the effect that the “leniency” of grading by these evaluators had on the residents' final evaluations. Methods: A prospective, observational study of the evaluation patterns of EM faculty was performed in an academic ED (50, 000 visits yearly census). Each resident was evaluated on a daily basis by a board-certified or board-prepared emergency physician. The evaluation form rated 7 characteristics, but only the rating for overall clinical competence was used for data analysis. If an attending evaluated the same resident more than once, only the first evaluation was used to avoid bias from prior exposure. The scoring patterns of the evaluators, both individually and in groups, were analyzed using 1-way analysis of variance. Evaluator leniency was estimated using the mean evaluator score across all residents. Since each resident was evaluated by a different combination of evaluators, evaluator leniency for each resident was estimated from the mean leniency of the evaluators who specifically assessed that resident. Results: During the period of the study, 66 residents rotated through the ED, yielding a total of 401 evaluations. When the scoring patterns of individual evaluators were analyzed, a high degree of variability was found in the mean scores (range 5.23–8.09) and SDs (range 0.45–1.55) across evaluators; p = 0.0001. There was a moderate correlation between the mean overall competence score received by each resident and that resident's evaluators' leniency, r = 0.52; p = 0.0001. Conclusions: There is significant variability in the scoring patterns of individual evaluators. The evaluators in this study showed large variations in both leniency (as measured by their mean score) and range restriction (as measured by their SD). The differences in evaluator scoring leniency have a moderate correlation with the overall score received by the resident.     

Unique Curriculum for Emergency Medicine Residents as Medical Directors for Rural Out-of-hospital Agencies

BACKGROUND: Many rural communities have difficulty maintaining a medical director for their emergency medical services (EMS). Local physicians may be overwhelmed, be hesitant to take on additional responsibilities, and feel unskilled in providing the necessary leadership. Without a medical director, rural EMS agencies are frequently forced to shut down, thus depriving the community of local out-of-hospital care. OBJECTIVES: To meet the needs of rural EMS agencies for medical direction, to provide a unique opportunity for emergency medicine (EM) residents to acquire EMS medical direction skills, and to fulfill the obligation of EM residencies to provide both didactic and experiential training in EMS. PROGRAM DESCRIPTION: This article describes a curriculum, now being used in Colorado, for placing EM residents as EMS medical directors for rural out-of-hospital agencies that have lost their medical directors. Residents visit these rural communities 6-12 times a year, provide continuing education through interactive lectures, develop or revise EMS protocols and policies, perform quality assurance reviews, troubleshoot problems, and assist in EMS planning for the community. Residents are supervised by the Colorado state EMS medical director. CONCLUSIONS: This unique program enables local EMS agencies to continue their service while providing clear educational benefit for the EM residents. This paper demonstrates how this program has been working successfully in the state of Colorado by placing residents in four distinct rural and mountainous communities.     

Model Curriculum in Emergency Medical Services for Emergency Medicine Residency Programs

An emergency medical services (EMS) curriculum, as developed by the SAEM Emergency Medical Services Committee, is provided for the training of emergency medicine residents in EMS.     

A Case–based Emergency Medicine Curriculum for Senior Medical Students

Objective: To determine the effects of a case–based, core content–oriented emergency medicine (EM) curriculum on the basic EM knowledge of senior medical students.
Methods: All senior medical students rotating through the Milwaukee County EM elective during the 1992–1993 academic year were assigned specific chapter readings from a case–oriented EM textbook. A course curriculum consisting of goals and objectives for each chapter and two to three representative cases for the discussion topic also was distributed to each student. Interspersed with the cases was a series of questions directed at pathophysiology, diagnosis, management, and disposition. The EM faculty and residents conducted case discussions three times per week. AH students completing the rotation were given a pretest at the beginning and a final examination at the end of the rotation. In addition, the students rated the textbook, coursebook, and lecture series at the end of the rotation using a five–point Likert scale.
Results: Seventy–five students rotated through the elective. The students showed a significant improvement in their EM knowledge base as judged by improvement in final examination scores compared with pretest scores (pretest score 62.2 ± 7.1%; final examination score 76.2 ± 6.3%; p < 0.0001). The mean change in scores was 14.8%, with a range of –1.6% to 34%. The students also rated the textbook, coursebook, and lecture series as effective, as shown by high median scores on a Likert scale.
Conclusions: A case–based EM curriculum coupled with ED clinical experience improves basic EM diagnostic and management knowledge of senior medical students.     

The Extent and Effects of Abuse and Harassment of Emergency Medicine Residents

OBJECTIVE: To determine the extent and effects of abuse and harassment, including sexual harassment and racial or ethnic discrimination, experienced by residents in emergency medicine (EM). METHOD: The study instrument was an anonymous, self-report survey administered to a national sample of EM residents. The survey was timed to coordinate with the American Board of Emergency Medicine's annual In-Service Examination in February 1993. The residents reported whether they had experienced nine types of abuse or harassment during their residency training, the sources of these incidents, the effects on the residents, and whether they chose to file a formal complaint regarding these events. RESULTS: Surveys were returned by 1,774 (80%) of the 2,229 residents who sat for the examination--74.4% men and 24.6% women. Overall, 98% reported at least one occurrence of abuse or harassment, with patients being the most frequent source. More than half of the more senior residents reported having been physically hit or pushed. Other health care professionals were a frequent source of verbal abuse and sexual harassment. Women were significantly more likely than men to report unwanted sexual advances (63% vs 32%, p < 0.001), discomfort from sexual humor (66% vs 27%, p < 0.001), and unfair treatment because of gender (71% vs 15%, p < 0.001). Non-Caucasians reported a higher rate of racial or ethnic discrimination than did Caucasians (51% vs 23%, p < 0.001). As a result of these episodes, 19% of the respondents had questioned their decision to become a physician, 20% had questioned entering the specialty of EM, 11% had experienced emotional effects lasting over one month, and 11% had experienced disruption of their family lives. Only 56 (3.2%) had filed formal complaints. CONCLUSIONS: Residents frequently encounter abuse or harassment, particularly from patients. They also report adverse consequences from these episodes.     

Academic Career Development for Emergency Medicine Residents: A Road Map

As the marketplace for academic positions in emergency medicine grows more competitive, it becomes increasingly important for residents who desire academic careers to distinguish themselves during their residency. This report attempts to outline a road map for department and residency program leaders to help their houseofficers become successful candidates for an academic emergency medicine position. Specific ways a resident can enhance his or her "academic marketability" include 1) involvement in research, 2) establishment of a track record of productivity via scholarly writing, 3) awareness of the literature in the specialty, 4) involvement in specialty organizations and hospital committees, 5) competition for national awards, 6) gaining education skills, 7) developing an academic niche, and 8) fellowship training.     

Developing a Curriculum for Emergency Medicine Residency Orientation Programs

Background

New residents enter emergency medicine (EM) residency programs with varying EM experiences, which makes residency orientation programs challenging to design. There is a paucity of literature to support best practices.

Objective

We report on a curriculum development project for EM residency orientation using the Kern Model.

Curriculum

Components of the revised curriculum include administrative inculcation into the program; delivering skills and knowledge training to ensure an entering level of competence; setting expectations for learning in the overall residency curriculum; performing an introductory performance evaluation; and socialization into the program.

Results

Post-implementation resident surveys found the new curriculum to be helpful in preparing them for the first year of training.

Conclusions

The Kern Model was a relevant and useful method for redesigning a new-resident orientation curriculum.     

Patient Safety: A Curriculum for Teaching Patient Safety in Emergency Medicine

The last decade has witnessed a growing awareness of medical error and the inadequacies of our health care delivery systems. The Harvard Practice Study and subsequent Institute of Medicine Reports brought national attention to long-overlooked problems with health care quality and patient safety. The Committee on Quality of Health Care in America challenged professional societies to develop curriculums on patient safety and adopt patient safety teaching into their training and certification requirements. The Patient Safety Task Force of the Society for Academic Emergency Medicine (SAEM) was charged with that mission. The curriculum presented here offers an approach to teaching patient safety in emergency medicine.     

Resident-As-Teacher: A Suggested Curriculum for Emergency Medicine

Resident teaching is a competency that must be recognized, developed, and assessed. The ACGME core competencies include the role of physician as educator to “educate patients and families” and to “facilitate the learning of students and other health care professionals.” Residents spend a significant proportion of their time in teaching activities, and students report achieving much of their clinical learning from their interactions with residents. Although many residents enjoy their critical role as teacher, many do not feel well prepared to teach. This article summarizes a preliminary curriculum of modules for a resident teacher‐training program for emergency medicine residents. The goal of these modules is to provide learning objectives and an initial structure through which residents could improve basic teaching skills. Many of these skills are adaptable to residents' interactions with each other and with students, other healthcare professionals, and patients. Each module and corresponding teaching exercises can be found at http:www.saem.org     

Rate of Patient Workups by Non–Emergency Medicine Residents in an Academic Emergency Department

Objective: To quantify the number of patients seen per hour by non–emergency medicine (non–EM) residents in a university hospital ED.
Methods: This retrospective observational study was performed in a university hospital ED and level I trauma center. The facility had no EM residency, but was staffed with 24–hour EM faculty coverage. A computerized tracking system was searched for the number of patients seen by each of 93 non–EM residents for 12 nonconsecutive months. The ED schedule for each month was used to calculate the number of hours worked by each resident. From these figures, the number of patients seen per hour by each resident was calculated.
Results: The postgraduate years of training of the residents were as follows: 78 (84%) were PGY1, ten (11%) were PGY2, and five (5%) were PGY3. All the residents combined saw a mean 0. 95 ± 0. 20 patients/ hour, with a range from 0. 58 to 1. 75 patients/hour. There was no significant difference between the numbers of patients seen when compared by specialty using the Tukey–Kramer test (α = 0. 05).
Conclusion: The rate at which non–EM residents work up patients is consistent with previously reported rates for EM residents.     

The Development and Evaluation of a Geriatric Emergency Medicine Curriculum

Objective : To summarize the processes used to develop a curriculum and model of care for the emergency medical treatment of elder patients and to assess the efficacy of the teaching material in a pilot course.
Methods : A survey of emergency medicine (EM) residency directors and geriatric fellowship directors was used to identify key topics for inclusion in the didactic material. An interdisciplinary consensus process was used to develop didactic as well as teaching material in geriatric EM. Pretests and posttests were administered to 46 participants in the initial course to assess knowledge gain. Subjective course evaluations were also done.
Results : Test scores significantly increased from 54% correct on the pretest to 77% correct on the posttest (p < 0.001). Significant improvement in knowledge as judged by pretest and posttest results occurred in 6 of the 7 teaching modules. Subjective evaluations demonstrated good to excellent ratings for each module as well as the overall workshop.
Conclusions : The process of developing a curriculum for geriatric EM is described. The initial training of instructors was effective in improving participants' knowledge of geriatric issues in EM. Participants considered the training to be effective. The effect of the training on the emergency care of elder persons remains to be determined.