An assessment of emergency medicine residency graduates' perceptions of the adequacy of their residency training

Lethal means restriction for suicide prevention: beliefs and behaviors of emergency department providers

BACKGROUND

We sought to examine the beliefs and behaviors of emergency department (ED) providers related to preventing suicide by reducing suicidal patients' access to lethal methods (means restriction) and identify characteristics associated with asking patients about firearm access.

METHODS

Physicians and nurses at eight EDs completed a confidential, voluntary survey.

RESULTS

The response rate was 79% (n = 631); 57% of respondents were females and 49% were nurses. Less than half believed, "most" or "all" suicides are preventable. More nurses (67%) than physicians (44%) thought "most" or "all" firearm suicide decedents would have died by another method had a firearm been unavailable (P < .001). The proportion of providers who reported they "almost always" ask suicidal patients about firearm access varied across five patient scenarios: suicidal with firearm suicide plan (64%), suicidal with no suicide plan (22%), suicidal with nonfirearm plan (21%), suicidal in past month but not today (16%), and overdosed but no longer suicidal (9%). In multivariable logistic regression, physicians were more likely than nurses to "almost always" or "often" ask about a firearm across all five scenarios, as were older providers and those who believed their own provider type was responsible for assessing firearm access.

CONCLUSIONS

Many ED providers are skeptical about the preventability of suicide and the effectiveness of means restriction, and most do not assess suicidal patients' firearm access except when a patient has a firearm suicide plan. These findings suggest the need for targeted staff education concerning means restriction for suicide prevention.

The business of emergency medicine: a nonclinical curriculum proposal for emergency medicine residency programs

Over the course of their postgraduate medical education, physicians are expected not only to acquire an extensive knowledge of clinical medicine and sound procedural skills, but also to develop competence in their other professional roles as communicator, collaborator, mediator, manager, teacher, and patient advocate. Although the need for physicians to develop stronger service delivery skills is well recognized, residency programs may underemphasize formal training in nonclinical proficiencies. As a result, graduates can begin their professional careers with an incomplete understanding of the operation of health care systems and how to utilize system resources in the manner best suited to their patients' needs. This article proposes the content, educational strategy, and needs assessment for an academic program entitled The Business of Emergency Medicine (BOEM). Developed as an adjunct to the (predominantly) clinical content of traditional emergency medicine (EM) training programs, BOEM is designed to enhance the existing academic curricula with additional learning opportunities by which EM residents can acquire a fundamental understanding of the nonclinical skills of their specialty.

Are Army-trained surgeons satisfied with their residencies?

OBJECTIVE

To evaluate the perceptions of training adequacy among surgeons educated in Army general surgical residencies as a tool for surgical program directors and students considering a military surgical career.

DESIGN

A questionnaire was sent to all general surgeons practicing in the Army during years 1999-2003 (n = 182). In addition to providing basic demographic information, subjects rated their perceptions of training experience in 13 areas on a 5-point Likert scale (1 = very dissatisfied, 2 = somewhat dissatisfied, 3 = neither satisfied nor dissatisfied, 4 = somewhat satisfied, 5 = very satisfied). Respondents were split into 3 groups based on graduation year (1968-1992, 1993-1998, 1999-2003) and thereby roughly on status of military obligation at the time of survey. Scores were compared with analysis of variance.

RESULTS

A total of 96 (52.7%) questionnaires were returned, 84 of which were included in this study. The average score for all graduation groups and satisfaction areas was 4.37 +/- 0.91. No differences occurred among the 3 graduation groups in any of the 13 satisfaction areas evaluated, except for pediatric surgery experience, where the most recent graduates rated their satisfaction lower than the other 2 groups (1968-1992, 4.00 +/- 0.61; 1993-1998, 3.96 +/- 1.14; 1999-2003, 3.21 +/- 1.27, p < 0.05). With respect to comparison among the 13 satisfaction areas, several areas of note are present. Satisfaction with training in care for basic surgical problems and the ability to make correct decisions are both higher than 5 other areas (p < 0.01). By contrast, satisfaction with number of cases performed, research training, and pediatric surgery training are lower than at least 3 of the other 12 areas (p < 0.01).

CONCLUSION

Army trained general surgeons, from the most distant to recent graduates, are satisfied with their residencies. Lower satisfaction scores in the areas of number of cases performed, research experience, and pediatric surgery training do, however, highlight aspects for continued research and improvement.

Sexual abuse knowledge base among residents in family practice, obstetrics/gynecology, and pediatrics

STUDY OBJECTIVE

To investigate resident physician knowledge about sexual abuse prevalence and understanding about potential perpetrators.

DESIGN

Questionnaires were mailed to program directors in family practice, obstetrics and gynecology, and pediatric residency programs.

PARTICIPANTS

The questionnaires were distributed to senior residents in their final months prior to graduation.

INTERVENTIONS

Residents were asked to fill out the questionnaire anonymously and return it to our institution in the prepaid envelope provided.

MAIN OUTCOME MEASURES

Demographic characteristics and knowledge of sexual abuse prevalence and perpetrator characteristics were assessed. Chi-square contingency table analysis was used to compare responses of the three specialties.

RESULTS

The overwhelming majority (98.8%) of residents correctly identified a family member as the individual most likely to sexually abuse a child. Approximately half of the residents knew the correct prevalence of sexual abuse among females and among males. There was a weak understanding of the potential youthfulness of juvenile offenders.

CONCLUSION

We believe that resident understanding of sexual abuse prevalence and about the youthfulness of juvenile offenders can be improved in all three specialties.

An evaluation of a logbook for trainees in accident & emergency medicine in the United Kingdom: senior consultant opinion

A previous paper from the Merseyside Group of Senior Registrars in Accident & Emergency Medicine examined the desirability of a logbook for Higher Specialist Training (HST) in accident & emergency medicine in the United Kingdom and its principal ingredients (Luke et al., 1991). A survey of 100 senior registrars and recently appointed consultants in the specialty identified the main issues of importance to the majority of respondents e.g. certification in advanced cardiac and trauma life support, a minimum of three years in the specialty before appointment as senior registrar and certain key secondments. In this paper, more senior consultants in the specialty were surveyed and a resounding majority concurred with the preferences of their junior colleagues. The findings are discussed and the implications for a future curriculum for postgraduate training in A&E medicine are explored.

Descriptive analysis of residency-trained emergency medicine physicians

The purpose of this study was to analyze the demographics, practice characteristics, and job satisfaction of physicians who completed emergency medicine residencies. A questionnaire was mailed to 858 physicians who graduated from residencies between 1978 and 1982. A 62.8% response rate (n = 539) was achieved. The majority of respondents were satisfied or very satisfied with their choice of a career in emergency medicine and with the quality of their residency training. Over 22% of respondents cited lack of preparation to perform administrative tasks as a significant weakness of their residency training. The results of survey indicate that emergency medicine physicians are engaged primarily in clinical practice, but that administrative duties increase rapidly in the years following residency graduation. Emergency medicine physicians are still highly concentrated in states in which emergency medicine residencies are located. The percentage of graduates choosing academic careers is smaller than reported in studies of earlier graduates.