The Relationship Between ACGME Duty Hour Requirements and Performance on the American Board of Emergency Medicine Qualifying Examination

Wilderness Paramedic-A Practice Analysis

Emergency medical services (EMS) has existed in its modern form for over 50 years. EMS has become a critical public safety net and access point to the larger health care system. Mature EMS systems are in place in most urban areas. However, EMS systems are not as developed in wilderness areas. A barrier to further development of these systems is the lack of an agreed-upon standard of minimum competence and validation of specialized practice. A practice analysis was completed to create such standards. The practice analysis was completed using a multi-step process. A group of subject matter experts constructed a survey of tasks and knowledge needed for wilderness EMS (WEMS) specialty practice. The tasks and knowledge were validated through an industry survey. A total of 947 surveys were submitted for analysis. Of these, 196 were at least 55% complete and used for analysis. North America was heavily represented as a primary practice location with 177 (90.3%) responses out of the 196 total. Of these 177 responses, 164 (92.7%) were from the United States and 12 (6.8%) were from Canada. One hundred seven of the 116 tasks identified by the subject matter expert group were passed by the survey group, and 164 of the 175 knowledge statements were passed by the survey group. An index of agreement (IOA) was calculated and found to be greater than 0.9 for each task and knowledge statement across all subgroups. A content coverage rating was also calculated and the results indicate survey participants felt the content was "adequate" to "well" covered. The survey results were used to construct a pilot examination. Beta testing of the pilot examination was performed. The beta test results were analyzed and a cut score was determined using the Angoff method with a Beuk compromise. The final product of this process is a defensible exam that will certify candidates' cognitive knowledge of the specialty of WEMS. Completion of this practice analysis solidifies WEMS as distinct subspecialty of out-of-hospital medicine. Additionally, it establishes a consensus definition of wilderness paramedicine and standards that may be used by WEMS systems and regulatory entities.

Comparison of performance data between emergency medicine 1-3 and 1-4 program formats

Objective

This study compares performance data from physicians completing 3-year versus 4-year emergency medicine residency training programs. Currently, there are 2 training formats and little is known about objective performance differences.

Methods

This was a retrospective cross-sectional analysis of emergency residents and physicians. Multiple analyses were conducted comparing physicians' performances, including Accreditation Council of Graduate Medical Education Milestones and American Board of Emergency Medicine In-training Examination (ITE), Qualifying Examination (QE), Oral Certification Examination (OCE), and program extensions from 3-year and 4-year residency programs. Some confounding variables were not or could not be considered, such as rationale for medical students to choose one format over another, as well as application and final match rates.

Results

Milestone scores are higher for emergency medicine 3 residents in 1-3 programs (3.51) versus emergency medicine 3 residents in 1-4 programs (3.07; P < 0.001, d = 1.47) and highest for emergency medicine 4 residents (3.67). There was no significant difference in program extension rates (emergency medicine 1-3, 8.1%; emergency medicine 1-4, 9.6%; P = 0.05, ω = 0.02). ITE scores were higher for emergency medicine 1, 2, and 3 residents from 1-3 programs and emergency medicine 4 residents from 1-4 programs scored highest. Mean QE score was slightly higher for emergency 1-3 physicians (83.55 vs 83.00; P < 0.01, d = 0.10). QE pass rate was higher for emergency 1-3 physicians (93.1% vs 90.8%; P < 0.001, ω = 0.08). Mean OCE score was slightly higher for emergency 1-4 physicians (5.67 vs 5.65; P = 0.03, d = -0.07) but did not reach a priori statistical significance (α < 0.01). OCE pass rate was also slightly higher for emergency 1-4 physicians (96.9% vs 95.5%; P = 0.06, ω = -0.07) but also non-significant.

Conclusions

These results suggest that although performance measures demonstrate small differences between physicians from emergency medicine 1-3 and 1-4 programs, these differences are limited in their ability to make causal claims about performance on the basis of program format alone.

Impact of duty hours on competency-related knowledge acquisition among community hospital residents

Background

The effect of duty hour (DH) restrictions on postgraduate residents' acquisition of clinical competencies is unclear. We evaluated the relationship between DHs and competency-related knowledge acquisition using the General Medicine In-training Examination (GM-ITE).

Methods

We conducted a multicenter, cross-sectional study of community hospital residents among 2019 GM-ITE examinees. Self-reported average DHs per week were classified into five DH categories and the competency domains were classified into four areas: symptomatology and clinical reasoning (CR), physical examination and clinical procedure (PP), medical interview and professionalism (MP), and disease knowledge (DK). The association between these scores and DHs was examined using random-intercept linear models with and without adjustment for confounding factors.

Results

We included 4753 participants in the analyses. Of these, 31% were women, and 49.1% were in the postgraduate year (PGY) 2. Mean CR and MP scores were lower among residents in Category 1 (<50 h) than in residents in Category 3 (≥60 and <70 h; reference group). Mean DK scores were lower among residents in Categories 1 and 2 (≥50 and <60 h) than in the reference group. PGY-2 residents in Categories 1 and 2 had lower CR scores than those in Category 3; however, PGY-1 residents in Category 5 showed higher scores.

Conclusions

The relationship between DHs and each competency area is not strictly linear. The acquisition of knowledge of physical examination and clinical procedures skills in particular may not be related to DHs.

Associations Between National Board Exam Performance and Residency Program Emphasis on Patient Safety and Interprofessional Teamwork

OBJECTIVE

Several aspects of medical training may contribute to the ultimate goal of producing excellent physicians whose patients will have the best possible outcomes. However, the relative importance of education, evaluation and feedback, duty hours, practice structure, and program culture in achieving this goal is unclear. This study assessed associations among in-training exam performance, Accreditation Council for Graduate Medical Education (ACGME) Resident Survey responses, and American Board of Medical Specialties (ABMS) national board exam performance.

METHODS

Residency training programs at a university teaching hospital were classified as having 5-year first-time ABMS pass rates above (n=12) or below (n=3) the national average for their specialty. These groups were compared by ACGME Resident Survey data and in-training exam performance.

RESULTS

Surveys were collected from 484/543 eligible residents (89%), including 177 surveys from programs with below-average board pass rates and 307 surveys from programs with aboveaverage board pass rates. In-training exam performance was similar between groups. Aboveaverage programs had stronger agreement with statements that their culture reinforced patient safety (4.72 vs. 4.30, p=0.006) and that information was not lost during transitions of care (4.14 vs. 3.63, p=0.001). Although the occurrence of interprofessional teamwork was similar between groups, above-average programs had stronger agreement with the statement that interprofessional teamwork was effective (4.60 vs. 4.17, p=0.003).

CONCLUSION

Residency programs emphasizing patient safety and effective interprofessional teamwork had above-average first-time national board pass rates.

Critical Appraisal of Emergency Medicine Educational Research: The Best Publications of 2016

OBJECTIVES

The objectives were to critically appraise the emergency medicine (EM) medical education literature published in 2016 and review the highest-quality quantitative and qualitative studies.

METHODS

A search of the English language literature in 2016 querying MEDLINE, Scopus, Education Resources Information Center (ERIC), and PsychInfo identified 510 papers related to medical education in EM. Two reviewers independently screened all of the publications using previously established exclusion criteria. The 25 top-scoring quantitative studies based on methodology and all six qualitative studies were scored by all reviewers using selected scoring criteria that have been adapted from previous installments. The top-scoring articles were highlighted and trends in medical education research were described.

RESULTS

Seventy-five manuscripts met inclusion criteria and were scored. Eleven quantitative and one qualitative papers were the highest scoring and are summarized in this article.

CONCLUSION

This annual critical appraisal series highlights the best EM education research articles published in 2016.