Availability of Emergency Medicine Away Rotations.
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ABSTRACT: Objectives
Residency directors in emergency medicine (EM) have been placing increased value on the Standardized Letter of Evaluation to evaluate the escalating numbers of residency applications received each year. This has placed added significance on EM away rotations (ARs). We sought to determine the overall availability of ARs in EM.Methods
We surveyed clerkships sites at the end of 2018-2019 application season. The survey requested data about maximum rotation spots available, actual number of students that rotated, and data about application processing and rotation offer decision making.Results
We received 190 responses, of which 129 (49% of 262 clerkship sites surveyed) provided data regarding available positions and student rotators. A total of 3,472 ARs were completed at the responding sites. The average capacity ratio (CR; maximum available AR spots divided by AR completed by students) for responding sites was 1.57. AR availability varied by time and geography. Most AR positions were filled during peak season (CR = 1.22); however, many went unfilled outside of this time frame (CR = 2.41). Geographic data showed some locations had significant unfilled AR availability.Conclusions
Our survey data show that there are at least 1.5 AR positions per applicant. Students can be reasonably expected to complete one AR and, in select cases, a second. CR during peak season indicates nearly saturated AR positions. Flexibility of rotation timing and tools to link open AR positions with students needing to complete a rotation will help optimize filling available AR positions. Continued effort in application advising from home clerkships and processes to ensure equitable distribution of AR positions among students will help ensure interested students obtain a position.
SUBMITTER: Kiemeney M
PROVIDER: S-EPMC8019196 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Background:As the role of the resident-as-teacher grows, some residents are inspired to develop themselves early as leaders in education while in training. We describe the successful implementation of a resident liaison (RL) to medical students in emergency medicine (EM) as a way to develop resident leaders in medical education. Methods:This position was implemented to develop interested residents as leaders in medical education and to provide medical students access to an EM physician who is closer to their training level and may be more approachable than the clerkship director. RLs are mentored by the clerkship director and are involved in curricular programming and education research. Results:This innovation has strengthened our student EM rotations and has provided residents with a unique opportunity to explore a career in medical education. Residents have made tangible contributions to our educational programming in this role and have pursued careers in medical education. The program has been recognized as a "best practice" by students and the school of medicine. Conclusions:The RL initiative has conferred significant benefits to residents and medical students. Implementation of a RL program may benefit EM rotations outside of our institution and perhaps outside of the EM specialty.
| S-EPMC6965669 | biostudies-literature
Project description:IntroductionThere are over 200 emergency medicine (EM) residency programs in the United States. While there are basic criteria defined by the Accreditation Council for Graduate Medical Education (ACGME), there can be significant variation between programs with regard to rotation distribution. Therefore, it would be valuable to have a benchmark for programs to understand their rotation mix in the context of the national landscape. This study aimed to provide a breakdown of the length and percentage of EM residency programs with each clinical rotation in the United States. This study also sought to examine trends and changes in EM residency programs since 1986.MethodsA list of all current EM residency programs was obtained using the ACGME website. All program websites were reviewed, and data were independently dual extracted by two investigators with discrepancies resolved by consensus with a third investigator. Programs without curricular data available online were queried via e-mail for the data. Programs were separated into 3- versus 4-year lengths. Mean, standard deviation, and range were calculated for each rotation.ResultsA total of 200 of 202 programs (99%) had data available. Of these programs, 84.5% had a dedicated pediatric EM rotation with mean length of 9.7 weeks among 3-year programs and 12.1 weeks among 4-year programs. A total of 88% had a dedicated ultrasound rotation, 60% had a dedicated toxicology rotation, 73.5% had a dedicated emergency medical services rotation, 74% had a dedicated orthopedics rotation, 60% had a dedicated administration rotation, 29% had a dedicated research rotation, and 95% had dedicated elective time.DiscussionThis study provides summative data regarding the rotation distribution among EM programs in the United States. Compared with prior data, there is less time dedicated to internal medicine rotations and increased pediatric, trauma, ultrasound, toxicology, and critical care experiences. These data will inform current and new EM residency programs when determining rotation selection.
| S-EPMC6194041 | biostudies-literature
Project description:PurposeMedical students often complete clinical rotations at other institutions (away rotations). This study assesses the number of away rotations undertaken by radiation oncology residency applicants and their value from the applicants' perspective.Methods and materialsA survey was sent to applicants to a single radiation oncology program from 2015 to 2017. Questions addressed away rotation frequency, funding, motivations, barriers, and match results. A χ2 test was used to assess the correlation between number of away rotations and matching to an away program. Binary logistic regression was used to assess factors associated with undertaking >2 away rotations.ResultsThe response rate was 39% (n = 194); 89% of respondents completed ≥1 away rotation (median, 2; interquartile range, 2-3), of whom 39% (n = 67) matched to an away program. The number of away rotations completed did not differ between those who did and did not match (P = .29). Furthermore, the number of away rotations did not correlate with matching at an away program (P = .40). Factors associated with completing more away rotations included male sex and high loan burden (P < .05). Away rotations were perceived as extremely important (71%), with interest in a specific program (44%) and obtaining letters of recommendation (31%) the most common reasons to pursue away rotations. Only 9% (n = 15) of applicants did away rotations because they had no home program. Funding sources included personal savings (29%), family support (26%), and loans (22%). If costs were inconsequential, 67 applicants (35%) noted they would do more away rotations.ConclusionsAway rotations are common and often result in students matching to an away program, although benefits of ≥2 away rotations appear limited and have associated costs. Limiting the number of away rotations in radiation oncology may decrease costs without sacrificing one's chances of matching.
| S-EPMC7381360 | biostudies-literature
Project description:ObjectivesNeurovascular and neurocritical care emergencies constitute a leading cause of morbidity/mortality. There has been great evolution in this field, including but not limited to extended time-window therapeutic interventions for acute ischemic stroke. The intent of this article is to evaluate the goals and future direction of clinical rotations in neurovascular and neurocritical care for emergency medicine (EM) residents.MethodsA panel of 13 board-certified emergency physicians from the Society for Academic Emergency Medicine (SAEM) neurologic emergencies interest group (IG) convened in response to a call for publications-three with fellowship training/board certification in stroke and/or neurocritical care; five with advanced research degrees; three who have been authors on national practice guidelines; and six who have held clinical duties within neurology, neurosurgery, or neurocritical care. A mixed-methods analysis was performed including a review of the literature, a survey of Council of Emergency Medicine Residency Directors (CORD) residency leaders/faculty and SAEM neuro-IG members, and a consensus review by this panel of select neurology rotations provided by IG faculty.ResultsThirteen articles for residency neurovascular education were identified: three studies on curriculum, three studies evaluating knowledge, and seven studies evaluating knowledge after an educational intervention. Intervention outcomes included the ability to recognize and manage acute strokes, manage intracerebral hemorrhage, calculate National Institutes of Health Stroke Scale (NIHSS), and interpret images. In the survey sent to CORD residency leaders and neuro-IG faculty, response was obtained from 48 programs. A total of 52.1% indicated having a required rotation (6.2% general neurology, 2% stroke service, 18.8% neurologic intensive care unit, 2% neurosurgery, 22.9% on a combination of services). The majority of programs with required rotations have a combination rotation (residents rotate through multiple services) and evaluations were positive.ConclusionsVariability exists in the availability of neurovascular/neurocritical care rotations for EM trainees. Dedicated clinical time in neurologic education was beneficial to participants. Given recent advancements in the field, augmentation of EM residency training in this area merits strong consideration.
| S-EPMC6304277 | biostudies-literature
Project description:PurposeUsing 2020 match applicants, the purpose of this study was to identify baseline applicant perspectives on the match process surveying (1) away rotations, (2) interview/postinterview communications, and (3) factors influencing applicant rank order lists.Methods and materialsApplicants in the 2020 match cycle at a large radiation oncology (RO) residency program received a questionnaire covering demographics and the match process: away rotations, interview/postinterview communications, and ranking. Univariable and multivariable logistic regression analyses were used to identify factors associated with completing fewer away rotations.ResultsOf 141 surveys sent, 76 were completed, for a response rate of 54%. Most applicants were White, male, and matched into RO. One in 3 applicants did not have a home RO program. Most applicants completed 2 RO rotations (ie, a home rotation and an additional away rotation; range, 0-4 total rotations); RO rotations influenced the applicant rank order lists and the ultimate match result for 94% and 79% of applicants, respectively. Forty-seven percent of applicants reported being asked inappropriate questions during the interview (eg, parental or marital status). Applicants did not perceive a consistent message regarding postinterview communications from program directors. Most applicants were contacted postinterview. Interviews cost most applicants more than $5000. Thirty-seven percent of respondents reported submitting a letter of interest after the interview, hoping to improve their rank. When applying to programs, general reputation and location were the most common influential factors mentioned. When ranking programs, informal conversations with residents and program culture observations were the most common influential factors mentioned. Based on multivariable analysis, applicants who completed fewer RO rotations (including away rotations) had greater odds of matching to their home program (odds ratio [OR], 12.05; 95% CI, 1.27-206.69), lower odds of program location influencing where to apply (OR, 0.04; 95% CI, 0.003-0.37), and lower odds of the program's general reputation affecting their rank list (OR, 0.04; 95% CI, 0.001-0.47).ConclusionsThe results suggest that medical students perceive away rotations as an important influencer of their match process. Although applicants and program directors both participate in postinterview communications, interactions with residents influence rank order lists. These data may serve as an up-to-date baseline to evaluate the influence of the COVID-19 pandemic on the RO match process.
| S-EPMC8170351 | biostudies-literature
Project description:Relatively little is understood about which factors influence students' choice of specialty and when learners ultimately make this decision.The objective is to understand how experiences of medical students relate to the timing of selection of Emergency Medicine (EM) as a specialty. Of specific interest were factors such as how earlier and more positive specialty exposure may impact the decision-making process of medical students.A cross-sectional survey study of EM bound 4th year US medical students (MD and DO) was performed exploring when and why students choose EM as their specialty. An electronic survey was distributed in March 2015 to all medical students who applied to an EM residency at 4 programs representing different geographical regions. Descriptive analyses and multinomial logistic regressions were performed.793/1372 (58%) responded. Over half had EM experience prior to medical school. When students selected EM varied: 13.9% prior to, 50.4% during, and 35.7% after their M3 year. Early exposure, presence of an EM residency program, previous employment in the ED, experience as a pre-hospital provider, and completion of an M3 EM clerkship were associated with earlier selection. Delayed exposure to EM was associated with later selection of EM.Early exposure and prior life experiences were associated with choosing EM earlier in medical school. The third year was identified as the most common time for definitively choosing the specialty.
| S-EPMC5942813 | biostudies-other
Project description:PURPOSE:To determine the impact of an emergency medicine (EM) clerkship on senior (4th year) medical students' perceptions of the EM specialty. SUBJECTS AND METHODS:This was a pre/posttest observational study in a mandatory 4-week EM clerkship. Students were anonymously surveyed pre- and postclerkship regarding perceptions of EM. The survey used 24 statements grouped across four domains: 1) student EM clerkship expectations/experiences, 2) perceptions regarding EM physicians, 3) perceptions regarding patients in the emergency department (ED), and 4) EM as a desirable career. Data were analyzed using paired-sample t-tests, and comparisons made using McNemar's χ (2) test. RESULTS:A total of 385 of 407 students (94.6%) completed the pre- and postclerkship survey. There was no significant difference between mean ratings before and after related to perceptions regarding EM physicians (3.71 versus 3.71), ED patients (3.80 versus 3.76), or EM as a desirable career (3.88 versus 3.84). However, ratings regarding clerkship expectations/experiences decreased (3.88 versus 3.56, P=0.001). Of the 292 students that ranked their top three specialties in both pre- and postclerkship surveys, 46 (16%) included EM as a top choice preclerkship, with 31 of these maintaining this interest postclerkship. Conversely, 12 students (5%) became interested in EM postclerkship. Some survey-statement ratings were influenced and varied by urban versus community clerkship-rotation site. CONCLUSION:A mandatory senior EM clerkship did not significantly change overall students' perceptions regarding EM. Students with an interest in EM rated domains higher than those not interested, though there may have been an overall decline in perceptions related to clerkship expectations and experiences. Larger, multisite studies may help identify aspects of the field or EM clerkship that influence a student's ultimate career choice.
| S-EPMC4329998 | biostudies-literature
Project description:IntroductionEmergency medicine physicians must have the knowledge and skills to stabilize all life-and-limb-threatening conditions. These skills are especially important considering that the 1989 COBRA act clearly defines active labor as a condition unsuitable to transfer. Given this context, we thought it necessary to create a work that could be used to provide emergency physicians with the necessary skills to assist in deliveries both routine and complex.MethodsThe total time requirement for the workshop is 4 hours. Before the session begins, learners are asked to fill out a survey. Learners complete two 40-minute small-group sessions on the topics of normal vaginal delivery and shoulder dystocia with hands-on training with birthing manikins. After a short break learners complete a 65-minute small-group session for breech delivery with hands-on training. Each small-group session is preceded by a whole-group demonstration of required skills lasting 15 minutes as well a mini lecture on maternal hemorrhage and estimation of blood loss.ResultsOur workshop has been shown to successfully educate emergency physicians with a range of obstetric experience and improve their knowledge base and hands-on skills. One hundred percent of our learners felt this workshop was appropriate for them and met its stated goals.DiscussionWhile this is not the first workshop to educate on obstetric deliveries and their possible complications, it is the first to be created with the emergency medicine provider as the intended audience and the first to create a curriculum around uncomplicated delivery, shoulder dystocia, breech delivery, and postpartum hemorrhage.
| S-EPMC6440410 | biostudies-literature
Project description:BackgroundThe majority of children seeking care in emergency departments are seen by general emergency medicine (EM) residency program graduates. Throughout training, EM residents manage fewer critically ill pediatric patients compared to adults, and the exposure to children with illness and injury requiring emergent assessment and management is often limited and sporadic across training sites. This report describes the creation of a robust set of simulation cases for EM trainees incorporating topics identified during a previous modified Delphi study to improve their pediatric acute care knowledge and skills.MethodsAll 30 pediatric EM topics and 19/26 procedures previously identified as "must be taught by simulation" to EM residents were mapped to 15 simulation case topics. Twenty-seven authors from 16 institutions created cases and supporting materials. Each case was iteratively implemented during a peer review process at two to five sites with EM residents. Feedback from learners and facilitators was collected via electronic surveys and used to revise each case before the next implementation.ResultsThirty-five institutions participated in the peer review process. Fifty-one facilitators and 281 participants (90% EM residents) completed surveys. Most facilitators (98%) agreed or strongly agreed with the statement "This simulation case is relevant to the field of emergency medicine." A majority of facilitators and participants agreed or strongly agreed with the statements "The simulation case was realistic" (98% of facilitators, 94% of participants) and "This simulation case was effective in teaching resuscitation skills" (92% of facilitators, 98% of participants). Most participants reported confidence in knowledge and skills addressed in the learning objectives after participation.ConclusionsFacilitators and EM residents found cases from a novel simulation-based curriculum covering critical pediatric EM topics relevant, realistic, and effective. This curriculum can help provide a standardized, uniform experience for EM residents who will care for critically ill pediatric patients in their communities.
| S-EPMC8489268 | biostudies-literature
Project description:ObjectivesEmergency medicine (EM) is dedicated to the treatment of urgent and emergent illness requiring physicians to evaluate, treat, and diagnose patients of all ages. EM residency provides the foundation of knowledge enabling trainees to care for any patient. However, specific pediatric curriculum guidance from governing bodies is limited. The literature includes two potential curricula that are cumbersome to implement. Our primary objective was to identify the components of this curricula that were specific to pediatric emergency medicine (PEM). Secondary objectives were to provide a methods framework and to compare the results with the American Board of Emergency Medicine Model of Clinical Practice (EM Model).MethodsWith the modified Delphi technique, iterative rounds of expert panels sought to reach consensus on PEM-specific topics. We utilized the published curricula as the foundation and focused this list using a group of local experts. Predetermined consensus was defined as 80% agreement.ResultsThe literature-derived list of 190 topics was reviewed by the expert panel. Experts identified 92 PEM-specific topics, and the remaining 98 topics were deemed adequately covered by general EM curricula. All topics reached consensus after three rounds. The final list was sorted in accordance with the EM Model categories. Redundant topics were consolidated resulting in 68 PEM topics. Of these 68 topics, we identified 20 topics (five of which are critical) that were incompletely covered by the EM Model.ConclusionsEmergency medicine residency programs should focus their PEM curriculum by deliberately assessing their coverage of key PEM topics. The methods of this study can be replicated to yield locally applicable results in other EM programs. Additionally, the next iteration of the EM Model of Clinical Practice should inform their PEM topics from the available curricula in the literature.
| S-EPMC7821070 | biostudies-literature