The model of the clinical practice of emergency medicine: a 2-year update.
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Biomedical subjects
Stephen R Hayden
Publications and source records attributed to Stephen R Hayden.
What characteristics of applicants to emergency medicine residency programs predict future success as an emergency medicine resident?
OBJECTIVES: Program directors of emergency medicine (EM) residencies attempt to select candidates who will subsequently perform well as residents. This study was undertaken to identify characteristics available at the time of application to an EM residency that predict future success in residency. METHODS: The EM faculty at the University of California San Diego (UCSD) completed a one-time confidential assessment of EM residents on performance in residency at the time of graduation. The faculty member compared the graduate with all residents (both EM and non-EM) with whom the faculty member had previously worked using the five-point scale: > or =90th percentile, 70th-89th percentile, 50th-69th percentile, 30th-49th percentile, or < 30th percentile. Descriptive statistics, ordinal logistic regression (OLR), classification and regression tree (CART) analysis, and multiple additive regression tree (MART) analysis were used to find predictors for each of the outcome variables. RESULTS: Fifty-four graduates were evaluated. The medical school attended (MSA) was the strongest predictor of overall performance in residency in all regression models. OLR showed that MSA and "distinctive factors" (being a championship athlete, medical school officer, etc.) were significant predictors and may deserve greater weighting in the selection process. The most robust MART model demonstrated that MSA, dean's letter of recommendation, and distinctive factors had the most impact on overall performance in an EM residency. CONCLUSIONS: Using regression modeling, it may be possible to predict future resident performance from characteristics contained in residency applications. Applicants from top-tier medical schools and those with distinctive talents were more successful in the UCSD EM residency.
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Definitions and competencies for practice-based learning and improvement.
The Outcome Project is a long-term initiative by which the Accreditation Council for Graduate Medical Education (ACGME) is increasing emphasis on educational outcomes in the evaluation of residency programs. The ACGME initiated the Outcome Project to "ensure and improve the quality of graduate medical education." In order to assist program directors in emergency medicine (EM) to begin complying with components of the ACGME Outcome Project, the Council of Residency Directors in Emergency Medicine (CORD-EM) convened a consensus conference in March 2002 in conjunction with several other EM organizations. The working group for the competency of Practice-based Learning and Improvement (PBL) defined the components of PBL as: 1) analyze and assess practice experience and perform practice-based improvement; 2) locate, appraise, and utilize scientific evidence related to the patient's health problems and the larger population from which they are drawn; 3) apply knowledge of study design and statistical methods to critically appraise the medical literature; 4) utilize information technology to enhance personal education and improve patient care; and 5) facilitate the learning of students, colleagues, and other health care professionals in EM principles and practice. Establishing resident portfolios is a preferred method to chronicle resident competence in PBL. Traditional global evaluation of resident performance is de-emphasized. Checklist evaluation is appropriate for assessing any competency that can be broken down into specific behaviors or actions. 360-degree evaluation may be used to assess teamwork, communication skills, management skills, and clinical decision making. Chart-stimulated recall and record review are additional evaluation methods that can be used to assess resident competency in PBL. Simulations and models, such as computer-based scenarios, may be ideal for low-frequency but critical procedures.
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