Dealing with the difficult student in emergency medicine.
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ABSTRACT:
SUBMITTER: Ronan-Bentle SE
PROVIDER: S-EPMC3141387 | biostudies-other | 2011
REPOSITORIES: biostudies-other
Publications
Dealing with the difficult student in emergency medicine.
Ronan-Bentle Sarah E SE Avegno Jennifer J Hegarty Cullen B CB Manthey David E DE
International journal of emergency medicine 20110629
Dealing with a student who is perceived as difficult to work with or teach is inevitable in any academic physician's career. This paper will outline the basic categories of these difficulties pertinent to Emergency Medicine rotations in order to facilitate appropriate identification of problems. Strategies for evaluation and reporting of the difficult student are presented. Remediation, based on the type of difficulty, is addressed. Timeliness of reporting, evaluation, and feedback are invaluabl ...[more]
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Project description:BackgroundAcademic emergency medicine (EM) communities have viewed anonymous online communities (AOC) such as Reddit or specialty-specific "applicant spreadsheets" as poor advising resources. Despite this, robust EM AOCs exist, with large user bases and heavy readership. Insights about applicants' authentic experiences can be critical for applicants and program leadership decision-making. To date, there are no EM studies to qualitatively assess EM AOC narratives during the application cycle. Our goal was to perform a qualitative analysis of students' EM program experiences through a publicly available AOC.MethodsThis was a qualitative analysis of a publicly available, time-stamped, user-locked AOC dataset: "Official 2020-2021 Emergency Medicine Applicant Spreadsheet." We extracted and then de-identified all data from selected sub-sheets entitled "Virtual Interview Impressions" and "Rotation Impressions." Four investigators used constant comparative method to analyze the data inductively, and they subsequently met to generate common themes discussed by students. Preliminary thematic analysis was conducted on a random sample of 37/183 (20%) independent narratives to create the initial codebook. This was used and updated iteratively to analyze the entire narrative set consisting of 841 discrete statements. Finally, two unique codes were created to distinguish whether the identified sub-themes, or program attributes, were likely "modifiable" or "non-modifiable."ResultsWe identified six major themes: living and working conditions; interpersonal relationships; learning experiences, postgraduate readiness, and online/virtual supplements. Common sub-themes included patient population (13%); resident personality (7%); program leadership personality (7%); relationship with faculty/leadership (6%); geography (4%); practice setting (4%); program reputation (4%), and postgraduate year-3 experiences (4%). Modifiable sub-themes outnumbered non-modifiable sub-themes, 60.7% to 39.3%.ConclusionIn this analysis of selected medical students' narratives in an AOC, the majority of identified themes represented topics that may serve as external feedback for EM residency programs and their clerkships. Selective use of AOCs may set a precedent for future program assessments by applicants and inform program leadership of important programmatic elements in the eyes of applicants. It elucidates important themes in their interactions or learning experiences with programs and creates opportunities for learner-centric program improvement.
| S-EPMC11000561 | biostudies-literature
Project description:BackgroundThe COVID-19 pandemic added new and great uncertainty to the typical approach to applying into emergency medicine (EM) for medical students. There are little data on students' lived experience of applying during this time period. We performed a multi-institutional survey of EM-bound students' experiences with preparing to apply into EM during the pandemic.MethodsThis was a cross-sectional survey design study of fourth-year students preparing to apply into EM during the 2020-2021 academic year. All self-identified EM-bound students at four participating institutions were recruited by email in June 2020 to participate in a 13-item, 5-point Likert-scale survey. Univariate descriptive statistics, response rate, and nonresponse bias were calculated.ResultsSixty-seven of 125 eligible students responded for an overall response rate of 53.6%. Nonresponse bias for specific survey items ranged from 0.01 to 0.12. Students rated the importance of securing an EM rotation at their home institution the highest of any item (mean ± SD = 4.81 ± 0.68). Students indicated higher satisfaction with advice from their department of EM (mean ± SD = 4.28 ± 0.75) than from their school of medicine (mean ± SD = 3.52 ± 0.89). Students indicated higher confidence in their home EM rotations' ability to assure adequate personal protective equipment (PPE; mean ± SD = 3.91 ± 0.83) than an away rotation (mean ± SD = 2.82, 1.09). Students reported feeling between moderately and quite stressed about applying into EM this year (mean ± SD = 3.49 ± 1.01), but reported the financial stress the lowest of any item (mean ± SD = 1.46 ± 0.84). Students rated it highly important that away rotations prioritize students from institutions without an EM residency (mean ± SD = 4.51 ± 0.93).ConclusionMedical students applying into EM during the COVID-19 pandemic felt confident in their EM advisors' recommendations and their home institution's PPE provision. Students with EM residency programs at their schools recognized the importance of away rotations being prioritized for students from schools without EM residency programs. Strong EM advising is important to students.
| S-EPMC8013912 | 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: Not available
| S-EPMC7051183 | 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: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
Project description: Not available
| S-EPMC7193814 | biostudies-literature
Project description:BackgroundGamification in medical education has gained popularity over the past several years. We describe a virtual escape box in emergency medicine clerkship didactics to teach chest pain and abdominal pain and compare this instructional method to a traditional flipped classroom format.MethodsA virtual escape box was designed at our institution and incorporated into the mandatory two-week emergency medicine clerkship. The game consisted of a PDF with four cases containing puzzles to unlock a final clue. Likert scale surveys were administered to assess participants' perceptions of the escape box format; of clerkship didactics as a whole; and of the clerkship overall. These responses were compared to the prior year's evaluations on flipped classroom didactics and clerkship.ResultsOne hundred thirty-four learners participated in the escape box and completed the survey. Eighty-six percent strongly agreed with feeling more engaged with the escape box, 84% strongly agreed with learning something new, 81% strongly agreed with finding the escape box to be satisfying, 78% strongly agreed with being able to apply knowledge gained, and 74% strongly agreed with wanting more escape boxes incorporated into medical education. The escape box showed a higher average score (3.6 ± 0.63) compared to chest pain (3.5 ± 0.67) and abdominal pain (3.2 ± 0.77) flipped classroom sessions (p = 0.0491) for the category of "lecturer explaining content clearly and at the proper level of complexity." For the category of "lecturer provided effective instructional materials," the escape box showed higher scores (3.6 ± 0.63) compared to flipped classroom for chest pain (3.4 ± 0.77) and abdominal pain (3.1 ± 0.80) (p < 0.001).ConclusionsEscape boxes are adaptable to a virtual format and can teach abstract concepts such as teamwork and communication in addition to traditional lecture content. Ratings of didactics were higher for the escape box compared to the flipped classroom, while ratings of overall clerkship experience were not found to change significantly.
| S-EPMC9250221 | biostudies-literature
Project description:Objectives:Provider efficiency has been reported in the literature but there is a lack of efficiency analysis among emergency medicine (EM) residents. We aim to compare efficiency of EM residents of different training levels and determine if EM resident efficiency is affected by emergency department (ED) crowding. Methods:We conducted a single-center retrospective observation study from July 1, 2014, to June 30, 2017. The number of new patients per resident per hour and provider-to-disposition (PTD) time of each patient were used as resident efficiency markers. A crowding score was assigned to each patient upon the patient's arrival to the ED. We compared efficiency among EM residents of different training levels under different ED crowding statuses. Dynamic efficiency changes were compared monthly through the entire academic year (July to next June). Results:The study enrolled a total of 150,920 patients. A mean of 1.9 patients/hour was seen by PGY-1 EM residents in comparison to 2.6 patients/hour by PGY-2 and -3 EM residents. Median PTD was 2.8 hours in PGY-1 EM residents versus 2.6 hours in PGY-2 and -3 EM residents. There were no significant differences in acuity across all patients seen by EM residents. When crowded conditions existed, residency efficiency increased, but such changes were minimized when the ED became overcrowded. A linear increase of resident efficiency was observed only in PGY-1 EM residents throughout the entire academic year. Conclusion:Resident efficiency improved significantly only during their first year of EM training. This efficiency can be affected by ED crowding.
| S-EPMC6637007 | biostudies-literature