"ContraceptED": A Multidisciplinary Framework for Emergency Department-Initiated Contraception

Emergency departments (EDs) are common access points for patients who are at high risk for unintended pregnancy. Low-barrier access to effective contraception represents a crucial and low-cost intervention to address this public health need. Same-day initiation of contraception during an ED visit is a unique opportunity to provide reproductive health care for high-risk patients with otherwise limited health care access. We collaborated with our obstetrics and gynecology (OB/GYN) department, pharmacists, and a team of community health advocates to support emergency clinicians (namely, emergency physicians and advanced practice providers) in assessing pregnancy and contraceptive readiness, increasing proficiency in contraception counseling, prescribing hormonal contraception, counseling on barrier and emergency contraception, and inserting (and removing) the Nexplanon implant, a form of long-acting reversible contraception. With this novel approach, we found that emergency clinicians voluntarily participated in trainings on contraception, including low-threshold long-acting reversible contraception initiation; and, after completing these trainings, clinicians integrated these skills into their workflow in the ED. We report our results after screening 38 patients during our current Pilot Phase of implementing this program.

A Structured Curriculum for Interprofessional Training of Emergency Medicine Interns

Interprofessional education (IPE) has been shown to improve health outcomes and patient satisfaction. IPE is now represented in the Accreditation Council for Graduate Medical Education’s emergency medicine (EM) milestones given the team-based nature of EM. The Highland Allied Health Rotation Program (H-AHRP) was developed by residents to enhance and standardize IPE for EM residents in a single hospital setting. H-AHRP was incorporated into the orientation month for interns starting in the summer of 2016. EM interns were paired with emergency department preceptors in registered nursing (RN), respiratory therapy (RT), pharmacy (PH), laboratory (LAB), and social work (SW) in either a four-hour shadowing experience (RN, RT, PH) or lecture-based overview (LAB, SW). We conducted a survey before and after the program. Overall, the EM interns reported an improved understanding of the scope of practice and day-to-day logistics after working with the preceptors. They found the program helpful to their future as physicians and would recommend it to other residencies. The H-AHRP program allows for the early incorporation of IPE into EM training, enhances interns’ understanding of both the scope and logistics of their colleagues, and is a well-received effort at improving team-based care.

Identifying the Emergency Medicine Personality: A Multisite Exploratory Pilot Study

OBJECTIVES

This study aimed to understand the personality characteristics of emergency medicine (EM) residents and assess consistency and variations among residency programs.

METHODS

In this cross-sectional study, a convenience sample of residents (N = 140) at five EM residency programs in the United States completed three personality assessments: the Hogan Personality Inventory (HPI)-describing usual tendencies; the Hogan Development Survey (HDS)-describing tendencies under stress or fatigue; and the Motives, Values, and Preferences Inventory (MVPI)-describing motivators. Differences between EM residents and a normative population of U.S. physicians were examined with one-sample t-tests. Differences between EM residents by program were analyzed using one-way analysis of variance tests.

RESULTS

One-hundred forty (100%), 124 (88.6%), and 121 (86.4%) residents completed the HPI, HDS, and MVPI, respectively. For the HPI, residents scored lower than the norms on the adjustment, ambition, learning approach, inquisitive, and prudence scales. For the HDS, residents scored higher than the norms on the cautious, excitable, reserved, and leisurely scales, but lower on bold, diligent, and imaginative scales. For the MVPI, residents scored higher than the physician population norms on altruistic, hedonistic, and aesthetics scales, although lower on the security and tradition scales. Residents at the five programs were similar on 22 of 28 scales, differing on one of 11 scales of the HPI (interpersonal sensitivity), two of 11 scales of the HDS (leisurely, bold), and three of 10 scales of the MVPI (aesthetics, commerce, and recognition).

CONCLUSIONS

Our findings suggest that the personality characteristics of EM residents differ considerably from the norm for physicians, which may have implications for medical students' choice of specialty. Additionally, results indicated that EM residents at different programs are comparable in many areas, but moderate variation in personality characteristics exists. These results may help to inform future research incorporating personality assessment into the resident selection process and the training environment.

Do Emergency Medicine Residency Graduates Feel Prepared to Manage Closed Fractures After Training?

OBJECTIVES

Fractures comprise 3% of all emergency department (ED) visits. Although emergency physicians are often responsible for managing most of the initial care of these patients, many report a lack of proficiency and comfort with these skills. The primary objective was to assess how prepared recent emergency medicine (EM) residency graduates felt managing closed fractures upon completion of residency. Secondary objectives included whether residency training or independent practice contributed most to the current level of comfort with these procedures and which fractures were most commonly reduced without orthopedic consultation.

METHODS

An anonymous online survey was sent to graduates from seven EM residency programs over a 3-month period to evaluate closed fracture reduction training, practice, and comfort level. Each site primary investigator invited graduates from 2010 to 2014 to participate and followed a set schedule of reminders.

RESULTS

The response rate was 287/384 (74.7%) and included 3-year (198/287, 69%) and 4-year (89/287, 31%) programs. Practice in community, academic, and hybrid ED settings was reported by 150/287 (52.3%), 64/287 (22.3%), and 73/287 (25.4%), respectively. It was indicated by 137/287 (47.7%) that they reduce closed fractures without a bedside orthopedic consultation greater than 75% of the time. The majority of graduates felt not at all prepared (35/287, 12.2%) or somewhat prepared (126/287, 43.9%) upon residency graduation. Postresidency independent practice contributed most to the current level of comfort for 156/287 (54.4%). The most common fractures requiring reduction were wrist/distal radius and/or ulna, next finger/hand, and finally, ankle/distal tibia and/or fibula.

CONCLUSIONS

Although most recent graduates feel at least "somewhat" prepared to manage closed fractures in the ED, most felt that independent practice was a greater contributor to their current level of comfort than residency training. Recent graduates indicate that fracture reduction without orthopedic consultation is common in today's clinical practice. This survey identifies common fractures requiring reduction which EM residencies may wish to consider prioritizing in their emergency orthopedic curricula to better prepare their residents for independent clinical practice.

Residency Applicant Preferences of Online Systems for Scheduling Interviews

BACKGROUND

Residency applicants often have difficulty coordinating interviews with multiple programs. An online scheduling system might improve this process.

OBJECTIVE

The authors sought to determine applicant mean time to schedule interviews and satisfaction using online scheduling compared with manual scheduling.

METHODS

An electronic survey was sent to US graduates applying to any of 6 emergency medicine programs in the 2014-2015 application cycle. Of the participant programs, 3 used an online system and 3 did not. Applicants were asked to report estimated time to schedule with the online system compared to their average time using other methods, and to rate their satisfaction with the scheduling process.

RESULTS

Of 1720 applicants to at least 1 of the 6 programs, 856 completed the survey (49.8%). Respondents reported spending less time scheduling interviews using the online system compared to other systems (median of 5 minutes [IQR 3-10] versus 60 minutes [IQR 15-240], respectively, P < .0001). In addition, applicants preferred using the online system (93.6% versus 1.4%, P < .0001.) Applicants were also more satisfied with the ease of scheduling their interviews using the online system (91.5% versus 11.0%, P < .0001) and felt that the online system aided them in coordinating travel arrangements (74.7% versus 41.5%, P < .01.).

CONCLUSIONS

An online interview scheduling system is associated with time savings for applicants as well as higher satisfaction among applicants, both in ease of scheduling and in coordinating travel arrangements. The results likely are generalizable to other medical and surgical specialties.

How Prevalent Are Potentially Illegal Questions During Residency Interviews? A Follow-up Study of Applicants to All Specialties in the National Resident Matching Program

PURPOSE

To describe the prevalence and effects on applicants of being asked potentially illegal questions during the residency interview process by surveying all residency applicants to all specialties.

METHOD

The authors surveyed all applicants from U.S. medical schools to residency programs in all specialties in 2012-2013. The survey included questions about the prevalence of potentially illegal questions, applicants' level of comfort with such questions, and whether such questions affected how applicants ranked programs. Descriptive statistics, tests of proportions, t tests, and logistic regression modeling were used to analyze the data.

RESULTS

Of 21,457 eligible applicants, 10,976 (51.1%) responded to the survey. Overall, 65.9% (7,219/10,967) reported receiving at least one potentially illegal question. More female respondents reported being asked questions about gender (513/5,357 [9.6%] vs. 148/5,098 [2.9%]), marital status (2,895/5,283 [54.8%] vs. 2,592/4,990 [51.9%]), or plans for having children (889/5,241 [17.0%] vs. 521/4,931 [10.6%]) than male respondents (P < .001). Those in surgical specialties were more likely to have received a potentially illegal question than those in nonsurgical specialties (1,908/2,330 [81.9%] vs. 5,311/8,281 [64.1%]). Questions regarding their commitment to the program were reported by 15.5% (1,608/10,378) of respondents. Such potentially illegal questions negatively affected how respondents ranked programs.

CONCLUSIONS

Two-thirds of applicants reported being asked potentially illegal questions. More women than men reported receiving questions about marital status or family planning. Potentially illegal questions negatively influence how applicants perceive and rank programs. A formal interview code of conduct or interviewer training could help to address these issues.

Asking for a commitment: violations during the 2007 match and the effect on applicant rank lists

INTRODUCTION

Applicants to residency face a number of difficult questions during the interview process, one of which is when a program asks for a commitment to rank the program highly. The regulations governing the National Resident Matching Program (NRMP) match explicitly forbid any residency programs asking for a commitment.

METHODS

We conducted a cross-sectional survey of applicants from U.S. medical schools to five specialties during the 2006-2007 interview season using the Electronic Residency Application Service of the Association of American Medical Colleges. Applicants were asked to recall being asked to provide any sort of commitment (verbal or otherwise) to rank a program highly. Surveys were sent after rank lists were submitted, but before match day. We analyzed data using descriptive statistics and logistic regression.

RESULTS

There were 7,028 unique responses out of 11,983 surveys sent for a response rate of 58.6%. Of those who identified their specialty (emergency medicine, internal medicine, obstetrics and gynecology [OBGYN], general surgery and orthopedics), there were 6,303 unique responders. Overall 19.6% (1380/7028) of all respondents were asked to commit to a program. Orthopedics had the highest overall prevalence at 28.9% (372/474), followed by OBGYN (23.7%; 180/759), general surgery (21.7%; 190/876), internal medicine (18.3%; 601/3278), and finally, emergency medicine (15.4%; 141/916). Of those responding, 38.4% stated such questions made them less likely to rank the program.

CONCLUSION

Applicants to residencies are being asked questions expressly forbidden by the NRMP. Among the five specialties surveyed, orthopedics and OBGYN had the highest incidence of this violation. Asking for a commitment makes applicants less likely to rank a program highly.

Change to an informal interview dress code improves residency applicant perceptions

Introduction

Residency interview apparel has traditionally been the dark business suit. We changed the interview dress code from a traditionally established unwritten ‘formal’ attire to an explicitly described ‘informal’ attire. We sought to assess if the change in dress code attire changed applicants’ perceptions of the residency program or decreased costs.

Methods

The authors conducted an anonymous survey of applicants applying to one emergency medicine residency program during two application cycles ending in 2012 and 2013. Applicants were asked if the change in dress code affected their perception of the program, comfort level, overall costs and how it affected their rank lists.

Results

We sent the survey to 308 interviewed applicants over two years. Of those, 236 applicants completed the survey for a combined response rate of 76.6% (236/308). Among respondents, 85.1% (200 of 235) stated they appreciated the change; 66.7% (154 of 231) stated the change caused them to worry more about what to wear. Males were more uncomfortable than females due to the lack of uniformity on the interview day (18.5% of males [25/135] vs. 7.4% of females [7/95], collapsed results p-value 0.008). A total of 27.7% (64/231) agreed that the costs were less overall. The change caused 50 of 230 (21.7%) applicants to rank the program higher on their rank list and only one applicant to rank the program lower.

Conclusion

A change to a more informal dress code resulted in more comfort and fewer costs for applicants to a single residency program. The change also resulted in some applicants placing the program higher on their rank order list.

Comparison of the multiple mini-interview with the traditional interview for U.S. emergency medicine residency applicants: a single-institution experience

PURPOSE

The multiple mini-interview (MMI) is a validated interview technique used primarily to evaluate medical school applicants. No study has compared MMIs with traditional interviews (TIs) in the evaluation of U.S. emergency medicine residency (EMR) applicants.

METHOD

During the 2011-2012 interview season, a four-station MMI was incorporated into the interview process for EMR applicants at Alameda Health System-Highland Hospital (AHS). A postinterview anonymous questionnaire was offered to all applicants after they submitted their rank lists but prior to release of National Residency Matching Program results. Respondents rated their perceptions of the MMI and TI on a five-point Likert scale. McNemar chi-square test was used to explore differences in respondents' perceptions of interview styles.

RESULTS

One hundred ten interviewees completed the survey (73%). Overall, applicants found the TI more enjoyable than the MMI process (98 [89%] compared with 48 [44%], McNemar chi-square=28.66, P<.01) and preferred the TI process to the MMI (66 [60%] compared with 9 [10%], McNemar chi-square=40.81, P<.01). Sixteen applicants (14%) indicated that the use of the MMI would negatively affect their ranking of the program.

CONCLUSIONS

In contrast to prior studies, U.S. EMR applicants to AHS preferred the TI to the MMI. Further investigation into the use of the MMI for selecting U.S. EMR applicants is warranted.

How prevalent are potentially illegal questions during residency interviews?

PURPOSE

To study the prevalence of potentially illegal questions in residency interviews and to identify the impact of such questions on applicants' decisions to rank programs.

METHOD

Using an Electronic Residency Application Service-supported survey, the authors surveyed all applicants from U.S. medical schools to residency programs in five specialties (internal medicine, general surgery, orthopedic surgery, obstetrics-gynecology [OB/GYN], and emergency medicine) in 2006-2007. The survey included questions about the frequency with which respondents were asked about gender, age, marital status, couples matching, current children, intent to have children, ethnicity, religion, or sexual orientation, and the effect that such questions had on their decision to rank programs.

RESULTS

Of 11,983 eligible applicants, 7,028 (58.6%) completed a survey. Of respondents, 4,557 (64.8%) reported that they were asked at least one potentially illegal question. Questions related to marital status (3,816; 54.3%) and whether the applicant currently had children (1,923; 27.4%) were most common. Regardless of specialty, women were more likely than men to receive questions about their gender, marital status, and family planning (P < .001). Among those respondents who indicated their specialty, those in OB/GYN (162/756; 21.4%) and general surgery (214/876; 24.4%) reported the highest prevalence of potentially illegal questions about gender. Being asked a potentially illegal question negatively affected how respondents ranked that program.

CONCLUSIONS

Many residency applicants were asked potentially illegal questions. Developing a formal interview code of conduct targeting both applicants and programs may be necessary to address the potential flaws in the resident selection process.