International emergency medicine: a review of the literature from 2007

The subspecialty of international emergency medicine (IEM) continues to grow within the United States, just as the specialty of emergency medicine (EM) continues to spread to both developed and developing countries around the world. One of the greatest obstacles, however, faced by IEM researchers and practitioners alike, remains the lack of a high-quality, consolidated, and easily accessible evidence-base of literature. In response to this perceived need, members of the Emergency Medicine Resident Association (EMRA) International Emergency Medicine Committee, in conjunction with members of the Society for Academic Emergency Medicine (SAEM) International Health Interest Group, have embarked on the task of creating a recurring review of IEM literature. This publication represents the third annual review, covering the top 30 IEM research articles published in 2007. Articles were selected for the review according to explicit, predetermined criteria that included both methodologic quality and perceived impact of the research. It is hoped that this annual review will act as a forum for disseminating best practices, while also stimulating further research in the field of IEM.     

International Emergency Medicine: A Review of the Literature

The field of international emergency medicine has grown rapidly over the past several decades, with an increase in the number of interested individuals and in the range of topics included under its rubric. One of the greatest obstacles, however, faced by international emergency medicine researchers and practitioners alike remains the lack of a high-quality, consolidated, and easily accessible evidence base of literature. In response to this perceived need, members of the Emergency Medicine Residents' Association International Emergency Medicine Committee, in conjunction with members of the Society for Academic Emergency Medicine International Interest Group, embarked on the task of creating a recurring review of international emergency medicine literature. Articles for this first annual review, covering research published in 2005, were selected according to explicit, predetermined criteria that included both methodological quality and perceived impact of the research. It is our hope that this annual review will act as a forum for disseminating best practices, while also stimulating further research in the field of international emergency medicine.     

International Emergency Medicine: A Review of the Literature From 2008

As the specialty of emergency medicine (EM) continues to evolve in countries around the world, and as interest in international emergency medicine (IEM) continues to grow within the United States, the IEM Literature Review Group recognizes a need for a high‐quality, consolidated, and easily accessible evidence base of literature. In response to that need, the group created an annual publication that strives to provide readers with access to the highest quality and most relevant IEM research. This publication represents our fourth annual review, covering the top 26 IEM research articles published in 2008. Articles were selected for the review according to explicit, predetermined criteria that include both methodologic quality and perceived impact of the research. It is our hope that this annual review will act as a forum for disseminating best practices while also stimulating further research in the field of IEM.     

International emergency medicine: How to train for it

This article provides background information about the emerging field of international emergency medicine (IEM) and how emergency physicians in Australasia can participate in its practice and development. It reviews the seven key areas of knowledge and skills involved in the practice of IEM as put forward by US fellowship programmes: (i) Emergency Medicine Systems Development; (ii) Humanitarian Relief; (iii) Disaster Management; (iv) Public Health; (v) Travel and Field Medicine; (vi) Programme Administration; and (vii) Academic Skills. Current obstacles to the development of similar programmes in Australasia are explored and identified as primarily financial. Means by which individuals can fund and engage in IEM activities are proposed. This article provides a reference of domestic and international IEM training resources that can be obtained by Australasian emergency physicians and trainees today.     

Review article: Burnout in emergency medicine physicians

Training and the practice of emergency medicine are stressful endeavours, placing emergency medicine physicians at risk of burnout. Burnout syndrome is associated with negative outcomes for patients, institutions and the physician. The aim of this review is to summarise the available literature on burnout among emergency medicine physicians and provide recommendations for future work in this field. A search of MEDLINE (1946–present) (search terms: ‘Burnout, Professional’ AND ‘Emergency Medicine’ AND ‘Physicians’; ‘Stress, Psychological’ AND ‘Emergency Medicine’ AND ‘Physicians’) and EMBASE (1988–present) (search terms: ‘Burnout’ AND ‘Emergency Medicine’ AND ‘Physicians’; ‘Mental Stress’ AND ‘Emergency Medicine’ AND ‘Physicians’) was performed. The authors focused on articles that assessed burnout among emergency medicine physicians. Most studies used the Maslach Burnout Inventory to quantify burnout, allowing for cross‐study (and cross‐country) comparisons. Emergency medicine has burnout levels in excess of 60% compared with physicians in general (38%). Despite this, most emergency medicine physicians (>60%) are satisfied with their jobs. Both work‐related (hours of work, years of practice, professional development activities, non‐clinical duties etc.) and non‐work‐related factors (age, sex, lifestyle factors etc.) are associated with burnout. Despite the heavy burnout rates among emergency medicine physicians, little work has been performed in this field. Factors responsible for burnout among various emergency medicine populations should be determined, and appropriate interventions designed to reduce burnout.     

The dawn of emergency medicine in Vietnam

In 2009 emergency medicine had not been officially established as a specialty in Vietnam. As a result of a non‐government organization identifying the need to improve the delivery of emergency care, the Vietnam2010 Symposium in Emergency Medicine was held in Hue in March 2010. This involved 1 week of activity including: an Emergency Medicine Conference, providing lectures and practical workshops in topics of emergency medicine; a Deans' Conference, dedicated to the development of emergency medicine as a specialty; a Disaster and EMS Conference; and an Emergency Nursing Conference. Vietnam2010 was a high impact event and was successful in raising the profile of emergency medicine. It formalized key international linkages, showcased the role of the knowledge and skills relevant to emergency care and provided the impetus for emergency medicine specialization in Vietnam. A consensus document committing to the development of emergency medicine as a specialty in Vietnam was signed by multiple national and international governmental, university and emergency medicine representatives. Challenges included a tendency for international flagbearers from mature systems to promote the specialty according to local expectations, with a consequent emphasis on vertical specialty topics and on technology, and the running of medical and nursing conferences separately. Vietnam now needs a medium‐term plan to develop the specialty to ensure these initial steps are translated into a sustainable capacity to provide emergency care nationally.     

Gender Trends in Emergency Medicine Publications

Background In recent years, the number of women entering the field of emergency medicine (EM) has increased.
Objectives To determine if authorship in EM publications has increased in parallel with this trend.
Methods The gender of first and last authors of EM articles in Academic Emergency Medicine , American Journal of Emergency Medicine , Annals of Emergency Medicine , and Journal of Emergency Medicine were examined. The authors reviewed articles from 1985, 1995, and 2005 for American Journal of Emergency Medicine , Annals of Emergency Medicine , and Journal of Emergency Medicine and from 1999 and 2005 for Academic Emergency Medicine . The primary outcomes were the proportions of female authors.
Results A total of 2,016 articles were reviewed. Overall, 18% of first and last authors were female. Respectively, for 1985, 1995, 1999, and 2005, the proportions of female first authors were 9%, 15%, 19%, and 24%; the proportions of female last authors were 9%, 18%, 19%, and 22%. The trend of increases in female authorship was statistically significant.
Conclusions Although female authorship remains a minority in EM publications, it has increased significantly in parallel with increases in female participation in EM.     

Advanced Opportunities for Student Education in Emergency Medicine

Many medical students are excited about emergency medicine (EM) following a standard clerkship and seek out additional learning opportunities. An advanced EM elective may accomplish several educational goals, including development of clinical skills in evaluating the undifferentiated patient, broader exploration of the field of EM, and more focused study of one particular aspect of EM. Previously cited examples include pediatric EM, medical toxicology, occupational medicine, sports medicine, and EM research. Numerous other EM specialty courses for senior medical students are emerging, as reflected in the “Undergraduate Rotations” listings on the Society for Academic Emergency Medicine. A few examples drawn from the list include emergency ultrasound, international EM, wilderness medicine, disaster medicine, geriatric EM, and hyperbaric medicine. Educators aspiring to develop, or in the process of developing, an advanced EM elective may benefit from a brief overview of necessary course considerations, including didactic format, the clinical role of the medical student in the emergency department, and involvement with patient procedures. Suggestions are made regarding additional educational opportunities, including follow‐up of patients seen in the emergency department and development of an emergency department radiology case file. This article also addresses several related concerns, including suggested prerequisites, administration and cost considerations, appropriate didactic topics, and methods for evaluating students. Several EM subspecialty areas, namely pediatric EM, medical toxicology, and out‐of‐hospital care, are specifically discussed. Formal advanced cardiac life support training is also often included in an advanced EM elective and is briefly discussed. The overall intent of this article is to provide medical student educators with resources and ideas to assist them in developing a unique advanced EM elective.     

Emergency medicine Joint Fellowship Curriculum

Background

The authors describe a Joint Fellowship Curriculum instituted for emergency medicine fellows in diverse fellowships. The curriculum is based on commonalities established among the varying fellowships offered within their Department of Emergency Medicine. Fellowships included in the curriculum development include Disaster/Emergency Medical Services, International Emergency Medicine, Health Policy, Ultrasonography, and Medical Toxicology.

Objectives

The focus of this educational activity is to promote the development of the fellow into an expert within their field of specialization.

Discussion

Recognizing that topics such as scholarly activities, career development, clinical practice of medicine, business of medicine, and personal development are universally applicable to a variety of emergency medicine fellowships, the curriculum attempts to provide uniform instruction. The quality and applicability of this instruction was assessed and found to have been very well received by the participating fellows.

Conclusion

The authors encourage academic emergency medicine departments with a number of fellowship training opportunities to consider providing such a uniform curriculum of instruction as well.     

Comparison of Types of Research Articles Published in Emergency Medicine and Non-Emergency Medicine Journals

Introduction : As the specialty of emergency medicine (EM) matures, its journals should be publishing research of a quality similar to that which appears in other premier journals.
Objective : To compare the types of original research published in 4 EM vs 3 non-EM journals.
Methods : Retrospective review of all 1995 articles published in Academic Emergency Medicine, American Journal of Emergency Medicine, Annals of Emergency Medicine, Journal of Emergency Medicine, Annals of Internal Medicine, JAMA , and New England Journal of Medicine . Research articles were classified as longitudinal vs cross-sectional, prospective vs retrospective, and interventional vs observational. Other characteristics noted were number of subjects, randomization, blinding, control, and power calculations. Journals were reviewed by 4 investigators who received specific training in research classification, adhering to previously reported criteria for retrospective reviews. Interobserver reliability was independently validated.
Results : The authors reviewed 3,524 articles, of which 874 (24.8%) were original research. Compared with research reported in non-EM journals, EM journals contained fewer longitudinal studies (40.5% vs 60.4%, p < 0.0001) and fewer prospective studies (70.8% vs 78.7%, p = 0.008). Fewer EM journals had studies that were blinded (13.7% vs 18.9%, p = 0.047) or controlled (36.3% vs 50.0%, p = 0.003). Studies reported in EM journals had fewer subjects (138 vs 300, p < 0.001). Research reports in EM journals were less likely to have been funded, even after adjustment for the differences in study designs (adjusted odds ratio 7.0, 95% CI 5.1–9.7).
Conclusion : Significant differences in types of research published in EM and non-EM journals were identified.     

Researching Racial and Ethnic Disparities in Emergency Medicine

The recent Institute of Medicine report "Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care" chronicles a growing body of literature describing racial and ethnic disparities in health care delivery. It suggests a research agenda designed to better understand and eventually eliminate these disparities. Prompted by this report, Academic Emergency Medicine convened a Consensus Conference on Disparities in Emergency Health Care on May 28, 2003, in Boston. One of the goals of that meeting was to develop a research agenda for emergency medicine researchers working on disparities in health care. This report describes the results of the consensus conference and suggests such a research agenda.     

The geriatric emergency literature 2019

Geriatric Emergency Medicine is an important frontier for study and innovation by emergency practitioners. The rapid growth of this patient population combined with complex medical and social needs has prompted research ranging from which tests and screening tools are most effective for geriatric evaluation to how we can safely manage pain in the elderly or address goals of care in the Emergency Department. This review summarizes emergency medicine articles focused on the older patient population published in 2019, which the authors consider critical to the practice of geriatric emergency medicine.     

A Research Agenda for Geriatric Emergency Medicine

OBJECTIVES: The Research Agenda Setting Process (RASP), part of the American Geriatric Society's (AGS's) project "Increasing Geriatric Expertise in Surgical and Related Medical Specialties," was designed to define a research agenda for the geriatrics aspects of participating specialties. This paper presents a summary of the research agenda for emergency medicine. METHODS: The RASP was developed by the AGS in conjunction with experts from the participating specialty organizations. A "content expert" (CE) for each specialty developed a Medline search strategy in conjunction with RAND Health librarians. The CE reviewed the search to identify papers that were germane to research in the emergency care of older patients. The CE and a senior writing group member drafted a paper that synthesized the current literature and suggested areas for further research. A panel consisting of AGS members and emergency physicians with geriatrics expertise reviewed this paper. The research agenda was further refined at a two-day retreat. Two senior geriatricians reviewed the resulting paper. RESULTS: The Medline search for emergency medicine resulted in a list of 3,348 articles; 299 articles were pertinent and reviewed. The search for trauma resulted in a list of 1,838 articles; 133 were reviewed. Research agenda items were defined for multiple topics within geriatric emergency medicine and trauma. CONCLUSION: A research agenda for geriatric emergency medicine has been developed, using a combination of review of current literature and expert opinion.     

Residency Training in Emergency Ultrasound: Fulfilling the Mandate

Although bedside ultrasound is listed in the Model of the Clinical Practice of Emergency Medicine as an integral diagnostic procedure, the manner in which the didactic, hands-on, and experiential components of emergency ultrasound are taught is not specifically prescribed by the Residency Review Committee for Emergency Medicine (RRC-EM) or any single sponsoring group. Seven professional organizations [the American Board of Emergency Medicine (ABEM), the American College of Emergency Medicine (ACEP), the Council of Emergency Medicine Residency Directors (CORD), the Emergency Medicine Residents Association (EMRA), the National Association of EMS Physicians (NAEMSP), the RRC-EM, and the Society for Academic Emergency Medicine (SAEM)] developed the Scope of Training Task Force, with the goal of identifying emerging areas of clinical importance to the specialty of emergency medicine, including emergency department (ED) ultrasound. The Task Force then identified a group of recognized authorities to thoughtfully address the issue of ED ultrasound training. This report represents a consensus of these identified experts on how emergency ultrasound training should be incorporated into emergency medicine residency programs.     

Multiple authorship, basic research, and other trends in the emergency medicine literature (1975 to 1986)

As emergency medicine comes of age, it is interesting to examine the scientific nature of the specialty as reflected in the literature. Representative volumes of three emergency medicine journals were reviewed for number and type of article, institutional origin, article length, and number of authors. For Annals of Emergency Medicine, (AEM) volumes for 1975, 1980, and 1985 were studied. For The American Journal of Emergency Medicine (AJEM) and The Journal of Emergency Medicine (JEM), articles from the first 12 months of publication (1983 to 1984) and the complete 1986 issue were examined. Analysis of the scientific sections of the journals discloses some interesting trends. While the average article length has remained about the same (four to six pages), the average number of authors per article has steadily risen. The percentage of articles listing an academic origin has remained steady in AEM and JEM, but has risen in AJEM. Multicenter collaborations and basic science articles are appearing with significantly increased frequency. A noteworthy trend is the rise in multiple authorship of articles. There have been significant p < 10⁻⁴) increases in the number of multiple-authored (more than three authors) articles in AEM and JEM. As reflected by the literature, scientific progress in EM is maintaining a rapid pace. However, there are increasing numbers of papers with multiple authors. Listing of multiple authors on papers has prompted critlcism of the literature in other medical specialties. If this trend continues, there may be a risk of compromising the integrity of the published research.     

2015~2019年急诊医学研究热点分析——基于CiteSpace的可视化研究

目的:分析急诊医学领域的核心期刊2015-2019年刊载论文的的知识图谱,展示急诊医学研究领域研究的整体情况,突显研究进展中的重要内容,并挖掘出急诊医学期刊报道的研究热点。方法:在中国知网和万方数据库以2015-2019年为条件检索7本急诊医学核心期刊的相关文献并导出数据,共纳入7 753篇有效文献,并利用可视化软件CiteSpace分析纳入文献的发文作者、机构、关键词等信息,生成可视化图谱。结果:通过分析2015-2019年的知识图谱发现,于学忠、朱华栋、张劲松、张茂、刘欣伟、刘颖、徐军、聂时南等作者是急诊医学领域作者群中的中坚力量;北京协和医院急诊科、首都医科大学附属北京朝阳医院急诊科、解放军总医院急诊科、东部战区总医院急救医学科、西京医院急诊科、沈阳军区总医院急诊医学部等是发文量最多的机构;近5年急诊核心期刊研究重点集中于病死率、急性肺损伤、心搏骤停、预后、机械通气、急性心肌梗死、血液灌流等主题。结论:CiteSpace生成可视化图谱有助于直观了解急诊医学研究领域演化的关键路径、发展趋势及前沿热点,为今后的相关研究提供了更多依据。     

Professionalism in Emergency Medicine

Abstract. The Society for Academic Emergency Medicine (SAEM), with the support and participation of the American Board of Emergency Medicine (ABEM), the Council of Residency Directors (CORD), the American College of Emergency Physicians (ACEP), the Emergency Medicine Residents Association (EMRA), the American Academy of Emergency Medicine (AAEM), and the Association of Academic Chairs of Emergency Medicine (AACEM), initiated a project entitled Professionalism in Emergency Medicine. Its concepts were developed by the SAEM Ethics Committee, and are intended to describe proper behaviors and attitudes of the successful practitioner of emergency medicine. The behaviors described are not primarily scientific or technical, since those are defined by the core curriculum for residency training and are tested through certification examinations. This document identifies attitudes and behaviors that enhance trust by placing the patient's interest above other interests. This concept serves as the operative definition of professionalism. The purpose of this article is to clarify the professional attitudes and knowledge that are important to the emergency physician (EP). While no physician is likely to meet idealized standards, all EPs must meet basic standards while striving for the ideal. Awareness of these standards must begin early in the socialization process of emergency medical professionals. The standards must be integrated into residency training as well as the clinical practice of all EPs.