Qualities Important in the Selection of Chief Residents.

Background Chief resident selection occurs by numerous methods. Chief residents also fulfill multiple roles, requiring a broad skill set. However, there is little literature on which qualities various stakeholders value in chief resident selection. The objective of this study was to identify the qualities that residents and faculty believe are important for chief residents. Methods Following a literature review, educational experts conducted a multi-institutional survey that asked participants to name the qualities they felt were most important in chief residents and to rank-order a predefined list of 10 qualities. Associations were calculated between rank-order and participant age, gender, institutional position, and history of serving as a chief resident. Results The response rate for the survey was 43.9% (385/877). Leadership, organization, and communication skills were named by all participants among the most common responses. Residents additionally named approachability, advocacy, and listening skills among their most valued qualities, whereas faculty named strong clinical skills and integrity. Dependability and trustworthiness were the most valued qualities in the rank-order list, whereas strong clinical skills and self-reflection were the least valued. Females valued the ability to manage multiple demands more whereas males valued dependability more. The faculty valued strong clinical skills more than residents. Conclusion A variety of qualities are seen as being valuable in chief residents. Additional research is needed to understand what qualities are associated with effective chief resident performance.

Universal Intimate-Partner Violence Assessment in the Pediatric Emergency Department and Urgent Care Setting: A Retrospective Review.

OBJECTIVE: The aim of this study was to examine universal intimate-partner violence (IPV) assessment in the pediatric acute care setting. METHODS: We reviewed universal IPV assessment over 1 year in 2 emergency departments and 3 urgent care centers within a children's hospital system. Written IPV assessment used 2 questions (ie, safety concerns at home, information desired); "yes" to either was considered positive. We identified positive assessments via preexisting quality report. We collected demographics, resource utilization, and reason for positive screen by chart review. Positive assessment for IPV was determined by chart documentation. RESULTS: Intimate-partner violence assessment was documented in 169,399 visits (96% of all visits); 511 (0.3%) were positive. Four hundred ninety cases were reviewed; 21 cases were excluded (incomplete data). One hundred twenty positive assessments were classified as misunderstood ("yes" marked in error); these were associated with nonwhite race (P < 0.001). We identified IPV in 169 (46%) of the remaining 370 positive assessments. Intimate-partner violence identification was associated with white race (P = 0.004), female caregiver (P < 0.001), and English as primary home language (P = 0.045). Non-IPV concerns triggered 239 positive assessments; concerns included child maltreatment (n = 125), mental/behavioral health (n = 46), other violence (n = 33), and parenting (n = 21). Intimate-partner violence was identified by social work in 82 cases triggered by non-IPV concerns. Resources utilized included social work (99%), non-IPV resources (59%), IPV advocate (21%), law enforcement (0.8%), and child protective services (1.6%). CONCLUSIONS: Universal IPV assessment in the pediatric acute care setting is feasible and may enable resource provision for IPV and non-IPV concerns.

Failure of an Educational Intervention to Improve Consultation and Implications for Healthcare Consultation.

INTRODUCTION: Consultation of another physician for his or her specialized expertise regarding a patient's care is a common occurrence in most physicians' daily practice, especially in the emergency department (ED). Therefore, the ability to communicate effectively with another physician during a patient consultation is an essential skill. However, there has been limited research on a standardized method for a physician to physician consultation with little guidance on teaching consultations to physicians in training. The objective of our study was to measure the effect of a structured consultation intervention on both content standardization and quality of medical student consultations. METHODS: Senior medical students were assessed on a required emergency medicine rotation with a physician phone consultation during a standardized, simulated chest pain case. The intervention groups received a standard consult checklist as part of their orientation to the rotation, followed by a video recording of a good consult call and a bad consult call with commentary from an emergency physician. The intervention was given to students every other month, alternating with a control group who received no additional education. Recordings were reviewed by three second-year internal medicine residents pursuing a fellowship in cardiology. Each recording was evaluated by two of the three reviewers and scored using a standardized checklist. RESULTS: Providing a standardized consultation intervention did not improve students' ability to communicate with consultants. In addition, there was variability between evaluators in regards to how they received the same information and how they perceived the quality of the same recorded consultation calls. Evaluator inter-rater reliability (IRR) was poor on the questions of 1) would you have any other questions of the student calling the consult and 2) did the student calling the consult provide an accurate account of information and case detail. The IRR was also poor on objective data such as whether the student stated their name. CONCLUSIONS: A brief intervention may not be enough to change complex behavior such as a physician to physician consultant communication. Importantly, despite consultants listening to the same audio recordings, the information was processed differently. Future investigations should focus on both those delivering as well as those receiving a consultation.

Limited data to support improved outcomes after community paramedicine intervention: A systematic review.

BACKGROUND: Community paramedicine (CP) leverages trained emergency medical services personnel outside of emergency response as an innovative model of health care delivery. Often used to bridge local gaps in healthcare delivery, the CP model has existed for decades. Recently, the number of programs has increased. However, the level of robust data to support this model is less well known. OBJECTIVE: To describe the evidence supporting community paramedicine practice. DATA SOURCES: OVID, PubMed, SCOPUS, EMBASE, Google Scholar-WorldCat, OpenGrey. STUDY APPRAISAL AND SYNTHESIS METHODS: Three people independently reviewed each abstract and subsequently eligible manuscript using prespecified criteria. A narrative synthesis of the findings from the included studies, structured around the type of intervention, target population characteristics, type of outcome and intervention content is presented. RESULTS: A total of 1098 titles/abstracts were identified. Of these 21 manuscripts met our eligibility criteria for full manuscript review. After full manuscript review, only 6 ultimately met all eligibility criteria. Given the heterogeneity of study design and outcomes, we report a description of each study. Overall, this review suggests CP is effective at reducing acute care utilization. LIMITATIONS: The small number of available manuscripts, combined with the lack of robust study designs (only one randomized controlled trial) limits our findings. CONCLUSIONS: Initial studies suggest benefits of the CP model; however, notable evidence gaps remain.

Obtaining History with a Language Barrier in the Emergency Department: Perhaps not a Barrier After All.

INTRODUCTION: Patients with limited English proficiency may be at risk for incomplete history collection, potentially a patient safety issue. While federal law requires qualified medical interpreters be provided for these patients, little is known about the quality of information obtained in these encounters. Our study compared the medical histories obtained by physicians in the emergency department (ED) based on whether the patients primarily spoke English or Spanish. METHODS: This was a prospective, observational study conducted at a single, urban, academic ED during a six-month time period. Resident and faculty physicians caring for adult patients with a chief complaint of chest or abdominal pain were eligible for participation. Patient encounters were directly observed by medical students who had been trained using simulated encounters. Observers documented which key historical data points were obtained by providers, including descriptions of pain (location, quality, severity, radiation, alleviating/aggravating factors), past medical/family/surgical history, and social history, in addition to the patient's language in providing history. Providers, interpreters, and observers were blinded to the nature of the study. We used chi-square analyses to examine differences in whether specific elements were collected based on the primary language of the patient. RESULTS: Encounters with 753 patients were observed: 105 Spanish speaking and 648 English speaking. Chi-square analyses found no statistically significant differences in any history questions between Spanish-speaking and English-speaking patients, with the exception that questions regarding alleviating factors were asked more often with Spanish-speaking patients (45%) than English-speaking patients (30%, p=.003). The average percentages of targeted history elements obtained in Spanish and English encounters were 60% and 57%, respectively. CONCLUSION: In this study at a large, urban, academic ED, the medical histories obtained by physicians were similar between English-speaking and Spanish-speaking patients. This suggests that the physicians sought to obtain medical histories at the same level of detail despite the language barrier. One limitation to consider is the Hawthorne effect; however, providers and observers were blinded to the nature of the study in an attempt to minimize the effect.

Emergency Medicine Interest Group Procedural Simulation Conference: An Experience for Multiple Learner Levels.

Prior research has identified knowledge gaps between the verbalization of procedures and performance in simulations. Against this background, we designed a procedural simulation conference to enhance our students' procedural skills development using instruction and deliberate practice. The conference had six procedure stations, each focusing on specific learning objectives. Sixty medical students and 20 instructors from University of Missouri-Kansas City's Emergency Medicine Interest Group participated. A majority rated the conference as helpful in enhancing students' procedural skills.