Holes in the FOAM: An Analysis of Curricular Comprehensiveness in Online Educational Resources.

IntroductionPodcasts are used broadly for learning in emergency medicine (EM); however, there is concern about the potential for knowledge gaps for learners who rely on podcasts for their learning. The extent to which EM podcasts cover the core curriculum of EM is not known; thus, we sought to quantify the extent to which podcasts represent the core content of our specialty.MethodsWe performed a retrospective review of all EM podcast episodes published in 2019. All podcasts were given credit for the content they covered as it related to the 2016 American Board of Emergency Medicine (ABEM) Model of Clinical Practice in Emergency Medicine (EM Model). The primary outcome was a description of how podcasts represented the ABEM EM Model content topics compared to the topic representation of the ABEM Qualifying Exam.ResultsWe included 54 unique EM podcast programs and 1,193 podcast episodes. They covered 2,965 total EM Model core content topics. The topics most covered were “other” (which includes interpersonal skills and professionalism), procedures, and signs and symptoms. Musculoskeletal, hematology, and environmental each accounted for less than 1% of all topics covered. Almost three-quarters of podcast episodes covered other core competencies of the practice of EM.ConclusionPodcasts had a broad yet imbalanced coverage of the ABEM EM Model core content subtopics in 2019, with a notable coverage of other core competencies of the practice of EM. Learners, educators, and scholars should be mindful of these gaps and focus future work on exploring how podcasts should best be used in EM education.

Textbooks are often considered the criterion standard in medical education, but there is a growing preference for free open-access medical education (FOAM) content among learners. Despite FOAM's appeal, these resources often fall short in covering core content as comprehensively as the American Board of Emergency Medicine's 2019 Model of the Clinical Practice of Emergency Medicine (MCPEM), thereby sustaining the recommendation for textbook use. However, textbooks have limitations, such as how quickly content can become outdated. Notably, there is no evaluation of the comprehensiveness of emergency medicine (EM) textbooks in the literature. This observational cross-sectional study compared Rosen's Emergency Medicine: Concepts and Clinical Practice 10th Edition (Rosen's) and Tintinalli's Emergency Medicine: A Comprehensive Study Guide 9th Edition (Tintinalli's) with the MCPEM subtopics. Each textbook chapter was reviewed for content alignment with MCPEM subtopics. The primary outcome was the proportion of MCPEM subtopics covered by each textbook. Secondary outcomes included the count of chapters covering each topic and their distribution relative to the core content weighting in the ABEM National Qualifying Examination (NQE). Rosen's covered 95.3% of MCPEM subtopics (837 unique subtopics), and Tintinalli's covered 94.5% (826 unique subtopics). Both textbooks overrepresented topics like toxicology and psychobehavioral disorders compared to their weighting in the NQE. Relatively underrepresented topics included environmental disorders, cardiovascular disorders, renal and urogenital disorders, and traumatic disorders in Rosen's and other core competencies and cardiovascular disorders in Tintinalli's. The textbooks varied significantly in coverage of certain topics. Both Rosen's and Tintinalli's comprehensively cover MCPEM subtopics, with some discrepancies in topic representation compared to the NQE. While textbooks offer depth and breadth, they may not fully align with the NQE content distribution. A diversified approach to EM education, combining traditional textbooks and FOAM resources may be required for comprehensive learning.

This task trainer is designed to instruct emergency medicine (EM) resident physicians, senior medical students, and advanced practice providers. While orthopedic emergencies are common, exposure to fracture management may vary depending on one's training environment. Given that extremity bony trauma and fracture reduction techniques are listed as core content topics in the American Board of Emergency Medicine's (ABEM) 2022 Model of the Clinical Practice of Emergency Medicine,1 it is beneficial to practice their management in a simulated environment. Fracture reduction is particularly difficult to practice without any task trainers. Commercial fracture models are available and cost thousands of dollars which limits universal availability. This wrist fracture task trainer was developed to be a low-cost, reusable, transportable, and storable model with similar haptics to human bone and soft tissue. Utilizing this task trainer, learners will be able to 1) identify key anatomic structures, 2) distinguish a Colles from a Smith fracture of the radius, 3) understand fracture reduction technique using traction, translation and angulation, 4) appreciate the amount of force required for manipulation of the distal fracture fragment, and 5) gain hands-on practice using a model with similar haptics to bone and soft tissue. This task trainer is designed for practicing fracture reduction techniques in a simulated environment. Using materials that mimic similar haptics to bone and soft tissue, such as taut rubber bands for tendons and layers of socks for soft tissue, learners will need to use force to apply traction and reduce the distal fracture fragment through translation and angulation. This task trainer can be used for procedural education at the bedside or as part of small group sessions. This task trainer was used during a small group session at a training institution's medical simulation conference. Using a Likert scale, an anonymous survey assessed learner's confidence in the ability to reduce a fracture pre- and post-session. Free-text boxes were also provided to obtain feedback. This task trainer was also presented as a table-top innovation in an EM national conference where attendees provided verbal feedback. This task trainer was utilized by 32 participants during a medical simulation conference (10 PGY-1 (Post Graduate Year-1), 7 PGY-2, 5 PGY-3, 3 PGY-4, 5 medical students, 1 fellow, 1 attending physician). Of these individuals, 23 participated in the anonymous survey (8 PGY-1, 6 PGY-2, 4 PGY-3, 3 PGY-4, 2 medical students). Using a Likert scale of 1 to 5 assessing learner's confidence in fracture reduction technique before and after using this task trainer, the total mean score of the pre-session survey was 2.6 and the total mean score of the post-session survey results was 3.9. Attendees of an EM national conference who used the task trainer for hands-on practice provided verbal feedback. It was stated that its design was simple enough to replicate, it could be used for bedside teaching during a shift, and that the feel of the fracture line and technique required to reduce the fragment was realistic. It was noted that although the amount of force required was less for this model than in human practice, it was conceptually accurate. The utilization of this task trainer allows learners to understand and practice the maneuvers and force needed for successful fracture reduction. The materials used in its design require the learner to manipulate the distal fracture fragment in a realistic manner. This model is a low cost, reusable, transportable, and easily storable alternative to commercial trainers and can be used in a simulated environment to improve procedural competency and confidence. Fracture reduction, orthopedic emergencies, distal wrist fracture, distal radius fracture, Colles fracture, Smith fracture, radius, ulna.

Exploring the Relationship Between the American Board of Emergency Medicine In-Training Exam Scores and Mandatory Didactic Attendance for Emergency Medicine Residents

The American Board of Emergency Medicine Maintenance of Certification Summit

Report of the Task Force on Residency Training Information (1999-2000), American Board of Emergency Medicine

Piloting a certification process for emergency medicine residency graduates in Kosovo

IntroductionThere are no existing data on whether performance on the United States Medical Licensing Examination (USMLE) predicts success in American Board of Emergency Medicine (ABEM) certification. The aim of this study was to determine the presence of any association between USMLE scores and first-time success on the ABEM qualifying and oral certification examinations.MethodsWe retrospectively collected USMLE Step 1, Step 2 Clinical Knowledge (CK) scores and pass/fail results from the first attempt at ABEM qualifying and oral examinations from residents graduating between 2009 and 2011 from nine EM programs. A composite score was defined as the sum of USMLE Step 1 and Step 2 CK scores.ResultsSample was composed of 197 residents. Median Step 1, Step 2 CK and composite scores were 218 ([IQR] 207–232), 228 (IQR 217–239) and 444 (IQR 427–468). First-time pass rates were 95% for the qualifying examination and 93% for both parts of the examination. Step 2 CK and composite scores were better predictors of achieving ABEM initial certification compared to Step 1 score (area under the curve 0.800, 0.759 and 0.656). Step 1 score of 227, Step 2 CK score of 225 and composite score of 444 predicted a 95% chance of passing both boards.ConclusionHigher USMLE Step 1, Step 2 CK and composite scores are associated with better performance on ABEM examinations, with Step 2 CK being the strongest predictor. Cutoff scores for USMLE Step 1, Step 2 CK and composite score were established to predict first-time success on ABEM initial certification.

IntroductionIn 2024, the American Board of Emergency Medicine (ABEM) announced the launch of a new certifying exam that emergency medicine (EM) residency graduates must pass to achieve specialty certification. To date, there are no comprehensive curricula published in the available literature to aid residents in exam preparation.MethodsIn this pre-post pilot study, 44% (24/55) of postgraduate year 1 (PGY-1) through PGY-4 EM residents at a single site participated in a four-hour simulated certifying exam curriculum. Learners were asked to complete a four-point Likert scale survey rating self-reported preparedness (very unlikely – very likely) to take the ABEM Certifying Exam, as well as comfort with the ABEM tested competencies, preceding and following the simulation session.ResultsSurvey respondents (n = 21; 87.5%) reported an improvement in overall preparedness to take the ABEM Certifying Exam, yielding a pre-post mean difference score of +1.2 (1.9 [unlikely] pre to 3.1 [likely] post, P < .001). Additionally, there was an improvement in all ABEM-tested competencies; pre-post mean difference score ranged from +0.5 (3.0 pre to 3.5 post) for patient-centered communication to +1.1 (2.2 pre to 3.3 post) for clinical decision-making (P < .001 for all competencies).ConclusionGiven the critical need, and self-reported improvement in preparedness, EM training programs nationwide could consider incorporating a similar simulation curriculum into their didactic experience to help better prepare their learners for the new ABEM Certifying Exam.

Past Performance Probably IS Indicative of Future Results.

Report of the task force on residency training information (2002-2003), american board of emergency medicine

Introduction:Hazardous materials (HazMat) training is not a requirement for accreditation of US Emergency Medicine (EM) residencies, nor for EM board certification by the American Board of Emergency Medicine (ABEM). However, the US Occupational Safety and Health Administration (OSHA) requires hospitals train all personnel expected to deal with contaminated patients. This QI project aimed to develop an EM physician-specific HazMat course and evaluate the physician comfort level with HazMat personal protective equipment (PPE) donning and doffing, triage, procedural skills, and decontamination.Method:A four-hour “HazMat for Docs” course was designed at a large urban academic trauma center and offered to second-year EM residents. Additionally, we performed a quantitative survey of a cohort of 72 current and recently graduated EM residents (classes 2019-2024), some of whom had taken the course in person. Our primary outcome was to measure improvement in comfort level with essential HazMat tasks after completing the course. Our secondary outcome was to evaluate the current or recently graduated EM physician's overall comfort levels with managing a HazMat incident, as well as HazMat skills and knowledge retention.Results:A total of 53 responses (73.6%) were obtained. 45.3% of the respondents were male and 54.7% female. 37.8% of the respondents were recent EM graduates, with 20.8% PGY-4, 13.2% PGY-3, 15.1% PGY-2, 13.2% PGY-1. 16/53 (30.2%) had prior EMS experience. EM Physicians were most comfortable with donning and doffing PPE (4.92 on a 7-point scale) and least comfortable with decontamination procedures (2.98/7). After completing the HazMat course, EM physicians increased their comfort level with HazMat decontamination procedures by 8.6% and with organizing a multi-disciplinary ED HazMat response by 10.5%.Conclusion:EM Physician comfort levels with HazMat procedures are low. Increased training aimed at improving physician knowledge, preparedness, and comfort level for such events is necessary and can be accomplished through a short course.

Emergency Medicine Milestones: The Next Step.

Although the Accreditation Council for Graduate Medical Education and the American Board of Emergency Medicine require clinical ethics education in residency training, instruction varies widely. We assessed the educational preparedness of trainees in emergency medicine to address ethics challenges common to their field. The survey assessed two outcomes: 1) knowledge of specific ethical challenges and 2) perceived educational preparedness, across five ethics areas: 1) informed consent and decisional-capacity assessment, 2) surrogate decision making, 3) interpretation of advanced directives, 4) withdrawing and/or withholding life support, and 5) presumed consent for emergency treatment. Clinical vignettes, revised through expert panel review and pilot testing, were utilized to evaluate these areas. The final instrument was administered via Web link to emergency medicine residents and recent graduates through adverts within Emergency Medicine Residency Association and Society for Academic Emergency Medicine (SAEM) newsletters and social media platforms. Additionally, targeted e-mails through the Council of Residency Directors in Emergency Medicine, the Clerkship Directors of Emergency Medicine, and the SAEM Ethics Committee listservs encouraged survey distribution. Analyses involved one-way analysis of variance for overall knowledge scores and chi-square tests for categorical outcomes. Multivariable regression models tested associations between respondent characteristics and outcomes. There were 302 participants of which 34% reported having a dedicated ethics module within their residency curriculum. The mean (±SD) knowledge score was 59.7% (±12.8%); assessing decisional capacity was the most difficult topic for respondents as only 1% both correctly addressed the general issue and identified the correct plan of action. Participants having a dedicated ethics module perceived themselves better prepared, although there was no association between having a dedicated ethics module and knowledge scores. Gaps in clinical ethics knowledge appear prevalent among emergency medicine trainees, and few programs have dedicated ethics modules. Greater study is needed to understand and remedy clinical ethics knowledge shortfalls.

The Society for Academic Emergency Medicine (SAEM) commissioned an emergency medicine (EM) faculty salary and benefits survey for all 2001 residency review committee (RRC)-EM-accredited programs using the SAEM fifth-generation survey instrument. Responses were collected by SAEM and blinded from the investigators. Data represent compensation paid for the 2001-02 academic year. Seventy-six of 124 (61%) accredited programs responded, yielding usable data on 1,355 full-time faculty representing all four Association of American Medical Colleges (AAMC) regions. Blinded program and individual faculty data were entered into a customized version of Filemaker Pro, a relational database program with a built-in statistical package. Salary data were sorted by criteria such as program region, faculty title, American Board of Emergency Medicine (ABEM) certification, academic rank, years postresidency, program size, and whether data were reported to the AAMC. Demographic data were analyzed with regard to numerous criteria, including department staffing levels, emergency department (ED) volumes, ED length of stay, department income sources, salary incentive components, research funding, and specific type and value of fringe benefits offered. Data were compared with those from previous SAEM studies. Mean salaries were reported as follows: all faculty, $180,913; first-year faculty, $147,746; programs reporting data to the AAMC, $174,354; programs not reporting data to the AAMC, $191,397. Mean salaries as reported by AAMC region: northeast, $178,593; south, $176,314; midwest, $200,095; west, $166,779. Full-time emergency medicine residency program faculty work an average of 1,129 clinical hours per year. Reported salaries for full-time EM residency faculty have risen approximately 8.7% since the last survey. Up to approximately 1,200 clinical hours worked per year, salary varies inversely with clinical hours worked. Total per-faculty patient contact time (overall workload) has grown approximately 13% since the last survey. Patient wait times have increased approximately 27% since the last survey. Significant regional differences in salaries have been present in all five SAEM surveys. Emergency medicine residency faculty continue to work at the upper extremes of patient encounters per physician, patient acuity levels, and department lengths of stay.