The Intersection of Gender and Resuscitation Leadership Experience in Emergency Medicine Residents: A Qualitative Study.

OBJECTIVES: The objective was to examine emergency medicine (EM) residents' perceptions of gender as it intersects with resuscitation team dynamics and the experience of acquiring resuscitation leadership skills. METHODS: This was an exploratory, qualitative study using grounded theory and a purposive sample of postgraduate year (PGY) 2-4 EM residents who function as resuscitation team leaders in two urban EM programs. One-on-one interviews were conducted by a single experienced researcher. Audiotaped interviews were transcribed and deidentified by two research assistants. A research team composed of a PhD educational researcher, a research nurse, an MPH research assistant, and an EM resident reviewed the transcripts and coded and analyzed data using MAXQDA v12. Themes and coding schema were discussed until consensus was reached. We used member checking to assess the accuracy of our report and to confirm that the interpretations were fair and representative. RESULTS: Theme saturation was reached after interviewing 16 participants: 10 males and 6 females. The three major themes related to gender that emerged included leadership style, gender inequality, and relationship building. Both male and female residents reported that a directive style was more effective when functioning in the resuscitation leadership role. Female residents more often expressed discomfort with a directive style of leadership, preferring a more communicative and collaborative style. Both female and male residents identified several challenges as disproportionately affecting female residents, including negotiating interactions with nurses more and "earning the respect" of the team members. CONCLUSIONS: Residents acknowledged that additional challenges exist for female residents in becoming resuscitation team leaders. Increasing awareness in residency program leadership is key to affecting change to ensure all residents are trained in a similar manner, while also addressing gender-specific needs of residents where appropriate. We present suggestions for addressing these barriers and incorporating discussion of leadership styles into residency training.

Recognition and initial management of acute ischemic stroke.

This article addresses the recognition and management of acute ischemic stroke. It includes a discussion of cerebrovascular anatomy, common ischemic stroke syndromes, and central venous thrombosis. Extensive attention is paid to the initial emergency department management of stroke, addressing medical and systems issues, and treatment of ischemic stroke by thrombolysis.

An automated procedure logging system improves resident documentation compliance.

OBJECTIVES: The purpose of this study was to determine the effect of an automated procedure logging (APL) system on the number of procedures logged by emergency medicine (EM) residents. Secondary objectives were to assess the APL's effect on completeness and accuracy of procedure logging and to measure resident compliance with the system. METHODS: This was a before-and-after study conducted at a university-affiliated, urban medical center, with an annual emergency department census of >130,000. The EM residency is a 4-year, Residency Review Committee (RRC)-accredited program with 12 residents per year. We developed software to electronically search and abstract resident procedures documented in the electronic medical record (EMR) and automatically export them into a Web-based residency management system. We compared the mean daily number of procedures logged for two 6-month periods: October 1, 2009, to March 31, 2010 (pre-APL), and October 1, 2010, to March 31, 2011 (post-APL), using a two-sample t-test. We also generated a random sample of 231 logged procedures from both the pre- and post-APL time periods to assess for completeness and accuracy of data transfer. Completeness and accuracy in the pre- and post-APL periods were compared using Fisher's exact test. Aggregate resident compliance with the system was also measured. RESULTS: The mean daily number of procedures logged increased by 168% (10.0 vs. 26.8, mean difference = 16.8, 95% confidence interval [CI] = 15.4 to 18.2, p < 0.001) after the implementation of APL. Procedures logged with the APL system were more complete (76% vs. 100%, p < 0.001) and more accurate (87% vs. 99%, p < 0.001). Most residents (42/48, 88%) used APL to log at least 90% of procedures. Only 4% of procedures eligible for automation were logged manually in the post-APL period. CONCLUSIONS: There was a significant increase in the daily mean number of procedures logged after the implementation of APL. Recorded data were more complete and more accurate during this time frame. This innovative system improved resident logging of required procedures and helped our assessment of Accreditation Council for Graduate Medical Education (ACGME) Patient Care and Practice-Based Learning Competencies for individual residents.

HIV postexposure prophylaxis in sexual assault: current practice and patient adherence to treatment recommendations in a large urban teaching hospital.

BACKGROUND: Although rare, HIV transmission is one of the most feared consequences of sexual assault. While availability of medications to prevent HIV transmission (HIV nonoccupational postexposure prophylaxis [HIV nPEP]) is increasing, little is known about emergency department (ED) prescribing practices and patient adherence to treatment recommendations. OBJECTIVES: To determine factors associated with offering, following up with, and adhering to treatment when HIV nPEP is initiated for sexual assault victims. METHODS: This was a retrospective chart review of female patients presenting with complaint of sexual assault to an urban ED from October 1, 1999, to September 30, 2002. HIV nPEP medications and/or follow-up were provided without charge. Chi-square analysis identified factors associated with being offered or referred for nPEP and follow-up. Variables significant at the p < 0.10 level were entered into logistic regression analysis. RESULTS: Two hundred twenty-nine charts were reviewed. The final sample size was 181. Mean age was 29.1 years; median time from assault to presentation was 10.1 hours; 51.5% of the assailants were known to the victims. HIV nPEP was offered to 89 (49%) patients, and 11 patients were referred to an HIV nurse. Eighty-five (85%) patients accepted, 38 of these 85 (45%) followed up, and 18 of the 85 (21%) completed treatment. In multivariate analysis, three variables were statistically significantly associated with increased likelihood of referral or being offered HIV nPEP: unknown assailant, having insurance, and younger age. Treatment was completed by 15 of 82 (18%) of ED-initiated patients, versus three of three (100%) referred for initiation. The authors were unable to identify factors associated with completing treatment. CONCLUSIONS: HIV nPEP was offered to less than half of sexual assault patients, and few completed treatment. Further studies are needed to evaluate and improve appropriateness of HIV nPEP administration and follow-up.