Medical Student Perception of Resident Versus Attending Contributions to Education on Co-Supervised Shifts During the Emergency Medicine Clerkship.

OBJECTIVE: The objective was to assess medical student perception of resident and attending contributions to nine Accreditation Council for Graduate Medical Education educational objectives during their emergency medicine (EM) clerkship. METHODS: This was a prospective survey study of fourth-year medical students during their EM clerkship in a single academic emergency department. Students anonymously completed end-of-shift surveys if supervised by both resident and attending physicians. Students estimated the relative educational contribution from resident and attending on a 100-point visual analog scale (-50 to 50) with -50 = 100% resident contribution, +50 = 100% attending contribution, and 0 = equal contributions by resident and attendings. Nine educational objectives were surveyed: evidence-based medicine (EBM), clinical knowledge, chart documentation, bedside teaching, patient throughput, interpersonal communication, oral patient presentations, efficiency, and procedural instruction. RESULTS: We collected 274 surveys from 65 students. Of the nine objectives, students perceived that residents contributed more than attendings in eight of nine (results reported as mean values with 95% confidence intervals): clinical knowledge -4.5 (-7.3 to -1.7), chart documentation -8.0 (-12.0 to -4.0), bedside teaching -8.6 (-12.0 to -5.2), throughput -13.0 (-16.4 to -9.6), oral presentations -14.2 (-17.3 to -11), efficiency -14.4 (-17.6 to -11.3), procedural instruction -20.2 (-24.0 to -16.5), and interpersonal communication -13.5 (-17.7 to -9.4). The sole outlier favoring attendings was EBM: 5.5 (1.9 to 9.1). CONCLUSIONS: Medical students perceive resident physicians to contribute more than attendings for most of their EM educational objectives, with faculty providing the greatest contribution to their EBM training.

Multicenter study of cigarette smoking among patients presenting to the emergency department with acute asthma.

BACKGROUND: Many studies have focused on smoking and chronic asthma severity. However, research on the relationship between smoking and acute asthma severity in an acute care setting is sparse. OBJECTIVES: To determine the smoking prevalence among emergency department (ED) patients with acute asthma and to investigate the relationships between smoking and acute asthma severity. METHODS: A 63-site medical record review study of ED patients, ages 14 to 54 years, with a principal diagnosis of acute asthma was performed. Patients with chronic obstructive pulmonary disease were excluded. Measurements for acute asthma severity included sociodemographic factors, asthma medical history, ED presentation, clinical course, medications administered, and return visit within 48 hours. RESULTS: A total of 4,052 patient medical records were reviewed. A total of 1,332 patients (33%; 95% confidence interval, 31%-34%) were documented as smokers. No statistically significant differences were found between smokers and nonsmokers in vital signs, oxygen saturation, peak expiratory flow, and administration of asthma medications. By contrast, smokers were more likely than nonsmokers to receive antibiotics in the ED (12% vs 9%, P < .001) or at discharge (23% vs 14%, P < .001). A multivariate analysis confirmed that smoking status was independently associated with antibiotic administration (odds ratio, 1.6; 95% confidence interval, 1.3-1.8). CONCLUSIONS: One-third of ED patients with acute asthma smoked cigarettes. Smokers and nonsmokers did not differ in their acute asthma severity. Asthmatic smokers, however, were more likely to receive antibiotics, even when adjusting for other possible confounders.

A rare incidental finding in a case of painless jaundice.

Portal vein thrombosis secondary to protein C deficiency is a rare finding. Diagnosing a portal vein thrombosis itself is difficult due to nonspecific symptoms such as nausea, vomiting, anorexia, and weight loss. Proving that a protein C deficiency is the cause of a portal vein thrombosis is even more difficult as an extensive and thorough workup is required to rule out malignancies, myeloproliferative disorders, and hypercoaguable states which can all lead to thromboses. Patients require anticoagulation to prevent two dangerous complications of portal vein thrombosis; portal hypertension leading to esophageal varices with massive hemetemesis and extension of thrombus from the portal vein into the mesenteric veins leading to intestinal ischemia and death. In this case report, we present a patient with the complaint of painless jaundice who was found to have an incidental finding of portal vein thrombosis secondary to protein C deficiency. The different etiologies of portal vein thrombosis, along with diagnosis and treatment options will be discussed and highlighted.