The relationship between empathy and the quality of the educational environment in Canadian emergency medicine residents.

PURPOSE: Empathy and quality of educational environment appear to be inversely correlated with burnout but the relationship between the two is largely unknown. Our primary objective was to examine the relationship between postgraduate educational environment and empathy. Secondary objectives included impact of gender, residency year and on- versus off-service context on levels of empathy and educational environment. METHODS: A modified Dillman approach was used to conduct an email survey of Canadian Royal College Emergency Medicine residents in June 2020. The survey instrument included: demographic data, Toronto Empathy Questionnaire (TEQ) and Scan of Postgraduate Educational Environment Domains (SPEED). Logistic and linear regressions evaluated the association between TEQ and SPEED, and mean SPEED scores and covariates, respectively. RESULTS: Response rate was 38% (138/363) with representation from all programs. Respondents were mean 30 years of age, 59% men and 25%, 20%, 18%, 24%, and 13% in postgraduate year (PGY) 1-5, respectively. There was no statistically significant association between high/low TEQ scores and mean SPEED score (p = 0.97). There were no statistically significant associations between any of the covariates and high/low TEQ scores (gender, p = 0.21; PGY, p = 0.58; on-versus off-service, p = 0.46) or mean SPEED score (gender, p = 0.95; PGY, p = 0.48; on- versus off-service, p = 0.07). Emergency medicine residents rated their educational environment on average 3.44 (+/- 0.43) out of four. 39 of 134 residents were found to have low empathy. CONCLUSION: There was no association between empathy and educational environment. Further research is needed to elucidate modifiable factors contributing to the development of low empathy in emergency medicine residents.

RéSUMé: OBJECTIF: L'empathie et la qualite de l'environnement educatif semblent etre inversement correlees a l'epuisement professionnel, mais la relation entre les deux est largement inconnue. Notre objectif principal etait d'examiner la relation entre l'environnement educatif de troisieme cycle et l'empathie. Les objectifs secondaires comprenaient l'impact du sexe, de l'annee de residence et du contexte en service ou hors service sur les niveaux d'empathie et l'environnement educatif. MéTHODES: Une approche Dillman modiiee a ete utilisee pour mener une enquete par courriel aupres des residents du College royal canadien de medecine d'urgence en juin 2020. L'instrument d'enquete comprenait : des donnees demographiques, le Toronto Empathy Questionnaire (TEQ) et le Scan of Postgraduate Educational Environment Domains (SPEED). Des regressions logistiques et lineaires ont evalue l'association entre TEQ et SPEED, et les scores SPEED moyens et les covariables, respectivement. RéSULTATS: Le taux de reponse etait de 38 % (138/363) avec une representation de tous les programmes. Les repondants etaient ages en moyenne de 30 ans, 59 % d'hommes et 25%, 20%, 18%, 24% et 13% de la 1re a la 5e annee de troisieme cycle, respectivement. Il n'y avait pas d'association statistiquement signiicative entre les scores TEQ eleves/bas et le score SPEED moyen (p = 0.97). Il n'y avait pas d'association statistiquement signiicative entre l'une des covariables et les scores TEQ eleves/faibles (sexe, p = 0,21 ; annee de troisieme cycle, p = 0.58 ; en service contre hors service, p = 0.46) ou le score SPEED moyen (sexe, p = 0.95 ; annee de troisieme cycle, p = 0.48 ; en service contre hors service, p = 0.07). Les residents en medecine d'urgence ont evalue leur environnement educatif a une moyenne de 3.44 ± 0.43. 4.39 des 134 residents se sont averes avoir une faible empathie. CONCLUSION: Il n'y avait pas d'association entre l'empathie et l'environnement educatif. Des recherches supplementaires sont necessaires pour elucider les facteurs modiiables contribuant au developpement d'une faible empathie chez les residents en medecine d'urgence.

Role of Creatine Kinase in the Troponin Era: A Systematic Review.

INTRODUCTION: The diagnosis of non-ST-elevated myocardial infarction (NSTEMI) depends on a combination of history, electrocardiogram, and cardiac biomarkers. The most sensitive and specific biomarkers for cardiac injury are the troponin assays. Many hospitals continue to automatically order less sensitive and less specific biomarkers such as creatine kinase (CK) alongside cardiac troponin (cTn) for workup of patients with chest pain. The objective of this systematic review was to identify whether CK testing is useful in the workup of patients with NSTEMI symptoms. METHODS: We undertook a systematic review to ascertain whether CK ordered as part of the workup for NSTEMI was useful in screening patients with cardiac chest pain. The MEDLINE, Embase, and Cochrane databases were searched from January 1995-September 2020. Additional papers were added after consultation with experts. We screened a total of 2,865 papers, of which eight were included in the final analysis. These papers all compared CK and cTn for NSTEMI diagnosis. RESULTS: In each of the eight papers included in the analysis, cTn showed a greater sensitivity and specificity than CK in the diagnosis of NSTEMI. Furthermore, none of the articles published reliable evidence that CK is useful in NSTEMI diagnosis when troponin was negative. CONCLUSION: There is no evidence to continue to use CK as part of the workup of NSTEMI acute coronary syndrome in undifferentiated chest pain patients. We conclude that CK should not be used to screen patients presenting to the emergency department with chest pain.

Effect of Implementing Community of Practice Modified Thyroid Imaging Reporting and Data System on Reporting Adherence and Number of Thyroid Biopsies.

RATIONALE AND OBJECTIVES: Thyroid nodules are common in the population, although the rate of malignancy is relatively low (5%-15%). The purpose of this study was to determine if introducing a modified standardized reporting format and management algorithm (Thyroid Imaging Reporting and Data System [TI-RADS]) affects radiologist reporting adherence, number of thyroid biopsies, and other measurable outcomes. MATERIALS AND METHODS: All thyroid biopsies performed over two 6-month periods were evaluated at a tertiary care hospital with Research Ethics Board approval. The first period was before implementation of TI-RADS and the second was several months after implementation of TI-RADS (using a modified version made through a multidisciplinary collaboration). The number of biopsies performed was determined in each of the two periods as well as the percent of positive malignancy, wait times, and rates of non-diagnostic/unsatisfactory and inconclusive biopsies, which included atypia of undetermined significance (AUS) and follicular lesion of undetermined significance (FLUS). RESULTS: The average number of biopsies performed prior to implementing modified Kwak's TI-RADS was 74 thyroid biopsies per month and the average number of diagnostic ultrasounds was 271. After the introduction of modified Kwak's TI-RADS, the average number of thyroid biopsies decreased to 60 per month (an 18.9% reduction, P < .05), and the number of diagnostic ultrasound increased to 287 per month (a 5.9% increase from 2016 to 2017). The average wait time for a thyroid biopsy decreased from 5 to 3 weeks (P < .05). There was a slight increase in the rate of positive malignancy results (from 15% to 18%), although it was not statistically significant. The rate of non-diagnostic/unsatisfactory and inconclusive results (including AUS and FLUS) remained unchanged (18% AUS/FLUS/15% non-diagnostic/unsatisfactory before and 17% AUS/FLUS/15% non-diagnostic/unsatisfactory after TI-RADS introduction, P > .05). CONCLUSIONS: Introduction of a multidisciplinary-approved standardized reporting system with evidence-based management recommendations led to no statistically significant change in the number of diagnostic ultrasounds but a statistically significant reduction in the number of monthly thyroid biopsies and associated reduction in wait times.