The impact of a rural emergency department rotation on applicant ranking of a US emergency medicine residency program.

INTRODUCTION: Few US emergency medicine (EM) residency programs have been located in rural states due to program requirements for emergency department (ED) patient volume. Recent revision to the program requirements now permits 'educationally justifiable exceptions' to the patient population requirement, 'such as clinical sites in a rural setting', and some EM residency programs now plan to offer rural ED clinical experiences as a required curricular component. The impact of a required rural EM rotation on the ranking decisions of applicants is important to residency programs seeking to attract the most desirable applicants. OBJECTIVE: To assess the impact of a required rural ED rotation on applicant ranking of an EM residency program in the US National Resident Matching Program (NMRP). METHODS: All applicants to the study's EM residency program completing the interview portion of the application process received a mailed and emailed survey following the release of the 2004 NMRP results. The survey included questions addressing the rural/non-rural classification of the location of the applicants' childhood home, medical school, and anticipated future practice. RESULTS: Of 46 eligible subjects, 32 (69.6%) completed the survey. Of subjects with a rural childhood, 73.3% reported a positive impact on rank order (95% CI 50.9-95.7%) and 26.7% reported no impact (CI 4.3-49.1%); 81.3% of subjects with non-rural backgrounds reported no impact (CI 62.2-100%), 12.5% higher rank (CI 0-28.7%), and 6.3% lower (CI 0-18.2%). If planning a future practice in a rural community, 83.3% reported positive impact (CI 62.2-100%) and 16.7% no impact (CI 0-37.8%); 78.9% of subjects anticipating future practice in non-rural communities reported no impact (CI 60.6-97.3%), 15.8% higher rank (CI 0-32.2%), and 5.3% lower (CI 0-15.4). Of the subjects attending medical school in rural states, 52.2% reported a positive impact (CI 31.8-72.6%) and 47.8% no impact (CI 27.4-68.2%), while 75% of graduates of medical schools in non-rural states reported no impact (CI 32.6-100%) and 25% (CI 0-67.4%) a negative impact. CONCLUSION: The presence of a rural ED rotation did not adversely impact EM residency applicants' ranking of the program.

Domestic violence homicides: ED use before victimization.

The purpose of this study was to document prior emergency department (ED) use and injuries presented by victims of domestic violence (DV) homicides. We identified all female DV homicide cases investigated by Kansas City, Missouri, Police Department (KCPD) officials over 5 years. Medical Records from 12 hospitals were searched to determine how many homicide victims were in the ED within the 2 years preceding their homicide. The records were reviewed and classified according to the Flitcraft Criteria. KCPD documented 139 female homicides victims, with 34 (24.5%) of these ruled DV-related. Of these 34 victims, 15 (44%) presented to an ED within 2 years of homicide. The 15 subjects made 48 total visits, which included 20 (42%) injury-related visits. Fourteen (93%) of the victims seen in the ED presented with injuries on at least 1 encounter. Eight patients had head injuries (53.3%), 2 had perineal lacerations (13.3%), 2 had rapes (13.3%), and 1 had a suicide attempt (6.7%). The medical records of 8 (53.3%) of the 15 victims yielded at least suggestive evidence of battering. There was documented domestic violence in 2 cases and intervention in none. Because nearly half of all women who were victims of a DV-related homicide had been in the ED within 2 years before their deaths, the ED could play an important role in prevention. Approximately one half had documentation at least suggestive of battering. These results suggest the potential for universal screening, and documented safety assessments.