Assessment of an Orthopedic Surgery Rotation on Musculoskeletal Competency in Emergency Medicine Residency Training.

OBJECTIVE: To determine baseline knowledge of emergency medicine (EM) residents at 2 different residency training programs and assess if a 4-week orthopedic surgery rotation would improve musculoskeletal (MSK) knowledge as assessed by the basic competency exam (BCE). This study also sought to compare variations of the BCE to determine how emergency physicians would perform on the full 25-question assessment vs a modified 18-question test. DESIGN: Residents from 2 different EM residency training programs were given the BCE to determine baseline MSK knowledge prior to their orthopedic surgery rotations. A postrotation BCE was given to the residents from both EM training programs upon completion of their orthopedic surgery rotation. Both prerotation and postrotation tests were reviewed and scored independently by a panel of experts and later assessed by 2 independent reviewers. SETTING: San Antonio Military Medical Center, SA Tx Level I Trauma, Tertiary Care Center University of Texas Health, SA, Tx, Level 1 Trauma, Tertiary Care Center. PARTICIPANTS: A total of 54 EM residents completed both the prerotation test and pos-rotation test. RESULTS: EM residents at both programs had significantly improved test scores after an orthopedic surgery rotation. Baselines scores of PGY-2 residents were higher than PGY-1 residents. CONCLUSIONS: EM residents can improve their competency in MSK education with a 4-week rotation in orthopedic surgery. Further studies are needed to determine knowledge retention and to identify components of an optimal orthopedic rotation.

Two Cases of Catastrophic AAA Rupture in Young Women with Systemic Lupus Erythematosus.

We present two cases of young women with a past medical history significant for systemic lupus erythematosus (SLE), who presented to the Emergency Department with a ruptured abdominal aortic aneurysm (AAA). These cases are of particular interest because the patients did not fit the typical demographic for patients who present with a ruptured AAA. Based on these cases and a review of the relevant literature, ED providers should maintain a higher index of suspicion for AAA rupture in patients with autoimmune diseases, especially SLE.