Assessment of the "scholarly project" requirement for emergency medicine residents: report of the SAEM Research Directors' workshop. SAEM Research Directors' Interest Group

OBJECTIVES

Differences in interpretation of the residency review committee (RRC) directive concerning resident scholarly activity have resulted in inconsistencies in the practical fulfillment of this responsibility among the various training programs in emergency medicine. During a workshop organized by the SAEM Research Directors' Interest Group (RDIG), a consensus statement was developed regarding the scope, definition, and purpose of the scholarly project requirement.

METHODS

During the workshop, the NIH model of consensus building was used to develop statements pertaining to specific questions of the goals, definition, and endpoints of the scholarly project. The program consisted of an overview of the history and issues related to the scholarly project and presentations of varying viewpoints from interested parties. A final consensus of answers to the defined questions was then developed by the workshop participants during roundtable discussions and further refined through interactive debate using the RDIG e-mail list server.

RESULTS

By consensus it was agreed that the primary role of the scholarly project is to instruct residents in the process of scientific inquiry, to teach problem-solving skills, and to expose the resident to the mechanics of research. To realize these goals, the project should include the general elements of hypothesis formulation, data collection, analytic thinking, and interpretation of results. It was also thought that these elements should be documented in some written form with a literature review.

CONCLUSIONS

While each residency program must implement the RRC residency requirements in a manner that best suits the needs and culture of its individual environment, a concurrence of definition and approach to satisfying the scholarly project requirement would provide better consistency in resident training. Guidelines developed by consensus during the SAEM RDIG workshop may serve as a general recipe that can be used to fulfill the goals of the scholarly project and the spirit of the RRC directive.

The use of corticosteroids in croup: a survey

The use of corticosteroids to treat laryngotracheobronchitis (croup) is controversial. Although some evidence supports the efficacy of treating hospitalized patients with croup, there is no published information on the use of corticosteroids in the outpatient population. We sought to determine what the current practice in the use of corticosteroids to treat croup was in our community. One hundred thirty-eight questionnaires were mailed to pediatricians and family practitioners in our geographic region. One hundred twelve surveys were completed and returned. The majority of responding physicians used corticosteroids to treat both inpatients and outpatients with croup at least some of the time. A significantly greater percentage used them to treat hospitalized patients (93%) compared with nonhospitalized patients (68%). The drug used by the majority of respondents was dexamethasone (87% in treating inpatients, 56% in treating outpatients). The initial dosage, cumulative dosage, number of doses, and route of administration varied greatly among the respondents. This survey demonstrates that most physicians in our area are using corticosteroids to treat both hospitalized and non-hospitalized patients with croup. However, the form of drug used, dosing regimen, and route of administration are highly variable. This survey highlights the need for clinical studies to assess the efficacy of using corticosteroids to treat outpatients with croup and to determine how best to use them.