Emergency Medicine Research Directors and Research Programs: Characteristics and Factors Associated with Productivity

Background: Periodic surveys of research directors (RDs) in emergency medicine (EM) are useful to assess the specialty's development and evolution of the RD role. Objectives: To assess associations between characteristics and research productivity of RDs and EM programs. Methods: A survey of EM RDs was developed using the nominal group technique and pilot tested. RDs or surrogate respondents at programs certified by the Accreditation Council for Graduate Medical Education were contacted by e‐mail in early 2005. The survey assessed programs' research infrastructure and productivity, as well as RD characteristics, responsibilities, and career satisfaction. Three measures of research productivity were empirically defined: research publications, grant awards, and grant revenue. Results: Responses were received from 86% of 123 EM programs. Productivity was associated with the presence of nonclinical faculty, dedicated research coordinators, and reduced clinical hours for research faculty. Programs with an RD did not have greater research productivity, using any measure, than those without an RD. The majority of RDs cited pursuing their own studies, obtaining funding, research mentoring, and research administration to be major responsibilities. The majority characterized internal research funding, grant development support, and support from other faculty as inadequate. Most RDs are satisfied with their careers and expect to remain in the position for three or more years. Conclusions: Research productivity of EM residency programs is associated with the presence of dedicated research faculty and staff and with reduced clinical demands for research faculty. Despite perceiving deficiencies in important resources, most RDs are professionally satisfied.     

Observation Medicine in Emergency Medicine Residency Programs

OBJECTIVE: To evaluate observation unit (OU) prevalence, emergency medicine (EM) resident exposure in observation medicine (OM), EM faculty/residency director (RD) OM training, and RD attitudes toward OM. METHODS: Information was obtained from residency programs by telephone during a four-month period. RESULTS: Survey respondents indicated that 36.1% have OUs and 44.9% plan to have an OU. Observation medicine resources include textbooks 32.0%, articles 45.9%, lectures 36.9%, fellowships 2.5%, and research 26.2%. Observation medicine patient care occurs: 1) during residency: 25.4% of RDs, 11.3% of entire faculty; 2) as an attending: 45.1% of RDs. CONCLUSIONS: Nearly two-thirds of EM programs have or are planning an OU. Resources are lagging behind. This survey describes current OM education strategies to teach OM.     

Sabbatical Programs and the Status of Academic Emergency Medicine: A Survey

OBJECTIVES: The Society for Academic Emergency Medicine (SAEM) commissioned a survey in 1998 to describe sabbatical programs, academic rank, and tenure, and to shed light on factors affecting the continuum of faculty development, as a context for evaluating the potential importance of emergency medicine (EM) sabbatical programs. METHODS: The chairs of 120 EM residency programs were surveyed. RESULTS: The response rate was 90%. Of 108 responses, 44 were academic EM departments (AEMDs); ten were their affiliates. The setting was urban for 82%; 37% were publicly funded and 58% privately. AEMDs were more likely to have a tenure track and eligibility for a sabbatical program, but not more likely to use a sabbatical program. Among 2,042 ranked EM faculty, there were 121 professors and 346 associate professors. Mean sabbatical length was six months, provided at full pay requiring a mean of 5.7 years of employment. Among 39 programs reporting eligibility for an EM sabbatical, requirements included: tenure (43%), academic rank of associate professor (78%), an application with multiple approval levels (92%), and a formal report (75%). Thirteen EM programs used sabbaticals; only 40 faculty members altogether (9% of senior faculty) have taken sabbaticals. The mean value of sabbaticals (rated by users on a scale of 1 to 10) was 6.8. Reduced funding, lack of departmental status, difficulty retaining faculty, Health Care Financing Administration (HCFA) regulations, graduate medical education (GME) cutbacks, and no release time were identified as challenges for emergency physicians (EPs) wishing to participate in sabbaticals. Strategies proposed to overcome these obstacles include quality customer service, streamlined operations, outside contracts, computerization, hiring individuals with PhDs, collaboration, political activity, and faculty development. CONCLUSIONS: A sabbatical can be beneficial for individuals and their institutions, but presently EPs have not been able to maximize use of available opportunities. Some obstacles to successful participation of EM in sabbatical programs might be overcome with creative strategies and the active support of professional academic organizations.     

Academic Emergency Medicine Staffing Nonacademic Emergency Department Sites: A National Survey

Changing health care markets have threatened academic health centers and their traditional focus on teaching and research. OBJECTIVES: To determine the number of academic emergency medicine departments (AEMDs) that staff additional non-academic ED sites and to determine whether clinical reimbursement monies from those ED sites are used for academic purposes. METHODS: A two-part survey of all 119 academic EM programs listed in the 1997-1998 Graduate Medical Education Directory was conducted. Questionnaires were addressed to each AEMD chair. AEMDs and ED sites were characterized. Hiring difficulties, EM faculty academic productivity, and use of ED site reimbursement monies for academic activities were assessed. RESULTS: Ninety-nine of 119 (83%) AEMDs responded. Twenty-three (23%) AEMDs staffed 28 added ED sites. These sites tended to be urban (65%), with moderate volumes (25,000-35,000 patients/year), and had an equal or better reimbursement rate than the AEMD (89%). ED sites were commonly staffed by academic EM faculty (79%) and EM residents (29%). Ninety-six percent of the AEMDs had hired additional faculty; hiring new faculty was considered easy. Academic productivity at AEMDs with added ED sites was reported as unchanged. Reimbursement monies from these ED sites were commonly used for faculty salary support, faculty development, and EM research and residency activities. CONCLUSIONS: Academic EM departments are often affiliated with nonacademic ED sites. These additional sites are commonly staffed by academic EM faculty and EM residents. Academic productivity does not appear to decrease when additional ED sites are added. Reimbursement monies from these ED sites commonly supports academic activities.     

Nurse educators' involvement in research

The purposes of the study were: (1) to determine the relationship between selected demographic characteristics of nurse educators and research productivity; (2) to identify barriers to faculty research; (3) to examine the support being provided by educational institutions for faculty research; and (4) to determine the use of research productivity in the evaluation of faculty members for tenure, promotion and salary increase. Research productivity was defined as: (1) the number of past research studies conducted in relation to degree requirements, (2) the number of past research studies conducted which were not in connection with degree requirements, (3) the number of research studies that have been published, and (4) the number of ongoing research studies. The study population was composed of nurse educators teaching in institutions granting a diploma, associate degree, baccalaureate degree or higher degree in nursing. A systematic random sample of 500 names was chosen from nurse educators who were members of the American Nurses' Association. The major findings of the study were: (1) only 25% of the sample indicated current involvement in research; (2) nurse educators holding doctorates are the most productive researchers; (3) nurse educators who have taught more than 20 years reported the smallest percentage of ongoing research studies; (4) the majority of the current research is being conducted by faculty teaching in schools which grant graduate degrees; and (5) educational institutions are providing minimal support for faculty research and 50% of these institutions do not consider research productivity in the evaluation of faculty members for tenure, promotion, or salary increase.     

Scholarly activities among clinical laboratory science faculty.

OBJECTIVES: To describe the research and scholarly productivity of faculty in four-year college and university clinical laboratory science (CLS) programs. To identify meaningful scholarship, to assign values to that scholarship, and to list the top 15 CLS programs according to faculty research productivity. DESIGN: In 1996, a national study involving 127 college and university CLS programs was conducted to determine whether faculty were participating in research. A questionnaire was distributed to 505 faculty members. Data from 286 respondents (57% response) representing 114 of 127 (90%) CLS programs were analyzed. SETTING: The study took place at The Ohio State University with collaboration from the University of Tennessee-Memphis and the University of Minnesota. PARTICIPANTS: All CLS faculty within a four-year university or college sponsoring a CLS program were invited to participate. MAIN OUTCOME MEASURES: To determine whether CLS faculty scholarly activities have been strengthened in the last decade, to quantitate scholarship productivity by point assessment, and to list the top 15 CLS programs according to faculty research productivity. RESULTS: Research productivity included time spent in research, numbers of publications and presentations, and grantsmanship. Data indicate that faculty who possess earned doctorates and are employed by research universities have higher levels of research productivity. While 46% of the CLS faculty hold doctorates and 50% are tenured, 42% of all CLS faculty members have not published a research paper or abstract since 1990. Conversely, faculty in some non-research institutions may not be expected to participate in such scholarly activities. On the other hand, 23% of the faculty responding had published six or more articles or abstracts since 1990, 46% were successful in obtaining external funding, and 15% of faculty members had been awarded grants larger than $100,000. CONCLUSIONS: The top 10% of clinical laboratory science faculty researchers are performing approximately one-half of all scholarly activities. The top fifteen research programs in CLS are identified, and not surprisingly, are located in research universities. In the past decade, and generally speaking, CLS faculty have made progress in scholarship including highest degree obtained, publications, presentations, and grantsmanship.     

The Status of Bedside Ultrasonography Training in Emergency Medicine Residency Programs

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.     

An Innovative Strategy for Conducting Clinical Research: The Academic Associate Program

Performance of high-quality clinical research usually requires procurement of substantial funding to support and sustain the research infrastructure. The authors have developed a program to support a research infrastructure that minimizes financial start-up costs and maximizes productivity of clinical-educator faculty with limited protected time. The program integrates clinical research with undergraduate education. The authors report the experience with the academic associate program at two academic institutions. They describe the program, provide measures of program success, and discuss potential methods for other institutions to initiate similar programs. Similar programs can be developed in a variety of outpatient and inpatient settings allowing the performance of high-quality clinical research in a time-efficient and cost-effective manner.     

An Assessment of the Faculty Development Needs of Junior Clinical Faculty in Emergency Medicine

Objectives: Academic physicians must be able to access the resources necessary to support their ongoing professional development and meet requirements for continued academic advancement. The authors sought to determine the self‐perceived career development needs of junior clinical faculty in emergency medicine (EM) and the availability of educational resources to meet those needs. Methods: An educational “needs assessment” survey was distributed to 954 American College of Emergency Physicians (ACEP) members listed in the ACEP database as being faculty at EM residency programs in the United States and having graduated from an EM residency within the past 7 years. Respondents were asked to rank the importance of 22 areas of faculty development to their own professional growth and then to indicate whether educational resources in each area were available to them. Respondents were also asked to note the educational formats they prefer. A search for currently available resources in each topic area was undertaken and compared to the survey results. Results: A total of 240 responses were received. Self‐perceived career development needs were identified in the following areas: bedside teaching, lecture development, business skills, managerial skills, educational research, mentorship and career counseling, interpersonal skills, leadership skills, scholarly writing skills, physician wellness, and knowledge of the faculty development process. While a review of currently available educational resources revealed lectures, conferences, and online materials pertinent to most of these topics, a relative lack of resources in the areas of mentorship and physician wellness was identified. Conclusions: Junior clinical faculty in EM perceive a lack of educational resources in a number of areas of faculty development. The academic community of EM should strive to improve awareness of and access to currently existing resources and to develop additional resources to address the area of physician wellness. The lack of mentorship in academic EM continues to be a problem in search of a solution. ACADEMIC EMERGENCY MEDICINE 2008; 15:1–5 © 2008 by the Society for Academic Emergency Medicine     

Characteristics of Emergency Medicine Program Directors

Objectives: To characterize emergency medicine (EM) program directors (PDs) and compare the data, where possible, with those from other related published studies. Methods: An online survey was e‐mailed in 2002 to all EM PDs of programs that were approved by the Accreditation Council of Graduate Medical Education. The survey included questions concerning demographics, work hours, support staff, potential problems and solutions, salary and expenses, and satisfaction. Results: One hundred nine of 124 (88%) PDs (69.7% university, 27.5% community, and 2.8% military) completed the survey; 85.3% were male. Mean age was 43.6 years (95% confidence interval [CI] = 42.6 to 44.7 yr). The mean time as a PD was 5.7 years (95% CI = 4.9 to 6.5 yr), with 56% serving five years or less. The mean time expected to remain as PD is an additional 6.0 years (95% CI = 5.2 to 6.8). A 1995 study noted that 50% of EM PDs had been in the position for less than three years, and 68% anticipated continuing in their position for less than five years. On a scale of 1 to 10 (with 10 as highest), the mean satisfaction with the position of PD was 8.0 (95% CI = 7.2 to 8.3). Those PDs who stated that the previous PD had mentored them planned to stay a mean of 2.0 years longer than did those who were not mentored (95% CI of difference of means = 0.53 to 3.53). Sixty‐five percent of PDs had served previously as an associate PD. Most PDs (92%) have an associate or assistant PD, with 54% reporting one; 25%, two; and 9%, three associate or assistant PDs. A 1995 study noted that 62% had an associate PD. Ninety‐two percent have a program coordinator, and 35% stated that they have both a residency secretary and a program coordinator. Program directors worked a median of 195 hours per month: clinical, 75 hours; scholarly activity, 20 hours; administrative, 80 hours; and teaching and residency conferences, 20 hours; compared with a median total hours of 220 previously reported. Lack of adequate time to do the job required, career needs interfering with family needs, and lack of adequate faculty help with residency matters were identified as the most important problems (means of 3.5 [95% CI = 3.2 to 3.7], 3.4 [95% CI = 3.2 to 3.6], and 3.1 [95% CI = 2.9 to 3.3], respectively, on a scale of 1 to 5, with 5 as maximum). This study identified multiple resources that were found to be useful by >50% of PDs, including national meetings, lectures, advice from others, and self‐study. Conclusions: Emergency medicine PDs generally are very satisfied with the position of PD, perhaps because of increased support and resources. Although PD turnover remains an issue, PDs intend to remain in the position for a longer period of time than noted before this study. This may reflect the overall satisfaction with the position as well as the increased resources and support now available to the PD. PDs have greater satisfaction if they have been mentored for the position.     

A survey to determine the prevalence and characteristics of training in Evidence-Based Medicine in emergency medicine residency programs

We conducted a survey to determine the prevalence, training methods, and allotment of time for teaching evidence-based medicine (EBM) skills within accredited Emergency Medicine (EM) residency programs in the United States. A survey was mailed to program directors of all 122 accredited Emergency Medicine residency programs. The survey was also sent to program directors using an e-mail listserv. Responses were obtained from 53% of programs; 80% (95% CI: 68-89) of EM programs reported teaching some EBM. Although respondents believed a median of 10 hours were required to adequately cover this topic, only 22% provided more than 5 hours per year. Sixtey-three percent (95% CI: 50-75) of respondents reported using the JAMA Users' Guides series in journal club and 83% reported efforts to link journal clubs to patient care. Perceived barriers to integrating EBM into teaching and patient care included lack of trained faculty, lack of time, lack of familiarity with EBM resources, insufficient funding, and lack of interested faculty. In summary, academic EM programs are attempting to train residents in EBM, but perceive a lack of trained faculty, time, and funding as barriers. Desired resources include a defined curriculum, on-line training for faculty, and defined strategies for integration of EBM into training and patient care.     

Journal publication productivity in academic physical therapy programs in the United States and Puerto Rico from 1998 to 2002

BACKGROUND AND PURPOSE: The peer-reviewed journal article is the basic unit by which scholarship is defined. Few studies have examined peer-reviewed publication productivity in academic physical therapy programs. In this study, the publication productivity in academic physical therapy programs in the United States and Puerto Rico from 1998 to 2002 was documented, and publication productivity was examined in the context of selected program characteristics. SUBJECTS AND METHODS: A total of 194 programs listed on the Commission on Accreditation in Physical Therapy Education (CAPTE) Web site in the spring of 2004 were examined. The databases were searched for bibliographic citations of journal articles attributed to particular programs. The program characteristics of faculty size, offering of a research doctorate, and listing in the Carnegie Classification of Institutions of Higher Education (Carnegie Classification) were compared with the number of citations. RESULTS: A total of 169 programs had at least 1 attributed citation, 50.3% of the programs had fewer than 5 citations, and 3% had 44 or more citations. Rankings based on the number of citations changed when adjusted for faculty size. Of the 38 programs offering a research doctoral degree, 16 had 20 or more citations. Five programs with 44 or more citations were all categorized by the Carnegie Classification as doctoral intensive or extensive. DISCUSSION AND CONCLUSION: A few programs had a large number of attributed bibliographic citations, but the majority of programs had limited publication productivity in the 5 years studied. These results may provide a baseline for studying the effectiveness of the relatively new CAPTE standards mandating scholarship by physical therapy faculty over time and the impact of the Doctor of Physical Therapy degree on research in physical therapy.     

Development and Implementation of a School-Wide Institute for Excellence in Education to Enable Educational Scholarship by Medical School Faculty

Problem: Educational scholarship is an important component for faculty at Academic Medical Centers, especially those with single-track promotion systems. Yet, faculty may lack the skills and mentorship needed to successfully complete projects. In addition, many educators feel undervalued. Intervention: To reinvigorate our school's educational mission, the Institute for Excellence in Education (IEE) was created. Here we focus on one of the IEE's strategic goals, that of inspiring and supporting educational research, scholarship, and innovation. Context: Using the 6-step curriculum development process as a framework, we describe the development and outcomes of IEE programs aimed at enabling educational scholarship at the Johns Hopkins University School of Medicine. Outcome: Four significant programs that focused on educational scholarship were developed and implemented: (a) an annual conference, (b) a Faculty Education Scholars' Program, (c) “Shark Tank” small-grant program, and (d) Residency Redesign Challenge grants. A diverse group of primarily junior faculty engaged in these programs with strong mentorship, successfully completing and disseminating projects. Faculty members have been able to clarify their personal goals and develop a greater sense of self-efficacy for their desired paths in teaching and educational research. Lessons Learned: Faculty require programs and resources for educational scholarship and career development, focused on skills building in methodology, assessment, and statistical analysis. Mentoring and the time to work on projects are critical. Key to the IEE's success in maintaining and building programs has been ongoing needs assessment of faculty and learners and a strong partnership with our school's fund-raising staff. The IEE will next try to expand opportunities by adding additional mentoring capacity and further devilment of our small-grants programs.     

Directing an Emergency Medicine Residency: The Problems and Their Potential Solutions

Objective: To characterize the problems facing emergency medicine residency directors (EMRDs), to describe potential solutions, and to associate perceptions with anticipated duration in the position of EMRD. Methods: A confidential questionnaire was mailed to the EMRDs at all Accreditation Council for Graduate Medical Education-approved programs. The survey included a problem and solution list constructed by a panel of EMRDs. The respondents were asked to rate problems using a Likert-like scale and were asked to indicate which of the listed solutions they had used and had found useful, or thought would be useful. Associations of these features and demographic variables with the intention to leave the position of EMRD within S years were sought. Results: Eighty-seven of 93 EMRDs (93.5%) completed the survey. Their mean age was 40 years; 50% had been EMRDs for <3 years. Most of the EMRDs (62%) had an associate EMRD, and 77% had at least one secretary. The EMRDs worked a median of 220 hours per month. Major problems included: insufficient time for the job (57%). career interfering with family needs (44%). and lack of adequate faculty help (38%). The most frequently cited and useful solutions included: attending education courses, self-reading on education and management techniques. and discussing problems with and seeking advice from others. Most (68%) of the EMRDs anticipated continuing as program director for ≤5 years. Neither age, gender, previous amount of time in the position, number of hours worked, nor nature of the problems faced on the job was a significant predictor of which of the EMRDs anticipated leaving. Conclusions: Half the responding EMRDs were <40 years of age. half had been EMRDs for ≤3 years, and 68% anticipated continuing in their position for ≤5 years. Major frustrations included lack of knowledge and time. Family and career conflicts were frequent. These problems are similar to those of program directors in other specialties. Some recommendations are made to assist EMRDs.     

The Impact of Changes in HCFA Documentation Requirements on Academic Emergency Medicine Results of a Physician Survey

BACKGROUND: The Health Care Financing Administration (HCFA) has dramatically increased documentation and procedural supervision required by faculty in academic emergency departments (EDs). OBJECTIVES: To determine academic emergency medicine (EM) physicians' perceptions of the impact of HCFA documentation requirements (HDR) on teaching time, clinical efficiency, and job satisfaction. METHODS: An observational cross-sectional study was done using a survey of New England academic EM faculty from September to December 1999. E-mail surveys were followed by hard copy to nonresponders. Teaching time, clinical efficiency, and job satisfaction were rated on a five-point Likert scale. Yes/no questions about other possible benefits of HCFA regulations were asked. Frequency (95% CI) and chi-square analyses were performed. RESULTS: One hundred seventy-four of 233 (75%) responded. Eighty-nine percent (95% CI = 84% to 93%) of the respondents thought teaching time was somewhat or markedly decreased by changes in HDR (somewhat 46%, markedly 43%). Seventy-nine percent (95% CI = 73% to 85%) believed clinical efficiency was somewhat or markedly decreased by changes in HDR (somewhat 49%, markedly 30%). Eighty percent (95% CI = 73% to 86%) reported somewhat or markedly decreased job satisfaction due to changes in HDR (somewhat 56%, markedly 24%). Twenty-one percent (95% CI = 15% to 27%) believed changes in HDR had improved patient care by requiring increased patient supervision. Forty-eight percent (95% CI = 40% to 56%) thought that changes in documentation requirements had decreased medicolegal risk by improving patient documentation. CONCLUSIONS: Most academic EM physicians in New England perceive that HDR have decreased clinical efficiency, teaching time, and job satisfaction. These findings suggest that changes in HDR may have a substantial impact on many different aspects of emergency care provided in academic settings.