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A study of the workforce in emergency medicine: 1999

ANNALS OF EMERGENCY MEDICINE 2002年第1期40卷 3-15页

作者： Moorhead, JC Gallery, ME Hirshkorn, C Barnaby, DP Barsan, WG Conrad, LC Dalsey, WC Fried, M Herman, SH Hogan, P Mannle, TE Packard, DC Perina, DG Pollack, CV Rapp, MT Rorrie, CC Schafermeyer, RW Oregon Hlth Sci Univ Dept Emergency Med Portland OR 97201 USA Amer Coll Emergency Phys Irvine CA USA Lewin Grp Falls Church VA USA Mt Sinai Sch Med Dept Emergency Med New York NY USA Univ Michigan Dept Emergency Med Ann Arbor MI 48109 USA St Joseph Hosp Dept Emergency Med Denver CO USA Robert Wood Johnson Univ Hosp Dept Emergency Med New Brunswick NJ USA Amer Coll Emergency Phys Washington DC USA Wesley Long Moses Cone Hosp Dept Emergency Med Greensboro NC USA Baylor Univ Med Ctr Dept Emergency Med Dallas TX USA Univ Virginia Hlth Sci Ctr Dept Emergency Med Charlottesville VA USA Penn Hosp Dept Emergency Med Philadelphia PA 19107 USA Washington Univ Sch Med & Hlth Dept Emergency Med Washington DC USA Carolinas Med Ctr Dept Emergency Med Charlotte NC 28203 USA

Study objective: We estimate the total number of physicians practicing clinical emergency medicine during a specified period, describe certain characteristics of those individuals to estimate the total number of full-time equivalents (FTEs) and the total number of individuals needed to staff those FTEs, and compare the data collected with those data collected in 1997. Methods: Data were gathered from a survey of a random sample of 2,153 hospitals drawn from a population of 5,329 hospitals reported by the American Hospital Association as having, or potentially having, an emergency department. The survey instrument addressed items such as descriptive data on the institution, enumeration of physicians in the ED, and the total number of physicians working during the period from June 6 to June 9, 1999. Demographic data on the individuals were also collected. Results: A total of 940 hospitals responded (a 44% return rate). These hospitals reported that a total of 6,719 physicians were working during the specified period, or an average of 7.85 persons scheduled per institution. The physicians were scheduled for a total of 347,702 hours. The average standard for FrE was 40 clinical hours per week. This equates to 4,346 FTEs or 5.29 FTEs per institution. The ratio of persons to FrEs was 1.48:1. With regard to demographics, 83% of the physicians were men, and 82% were white. Their average age was 42.6 years. As for professional credentials, 42% were emergency medicine residency trained, and 58% were board certified in emergency medicine;50% were certified by the American Board of Emergency Medicine. Conclusion: Given that there are 5,064 hospitals with EDs and given that the data indicate that there are 5.35 FTEs per ED, the total number of FTEs is projected to be 27,067 (SE=500). Given further that the data indicate a physician/FTE ratio of 1.47:1, we conclude that there are 39,746 persons (SE=806) needed to staff those FTEs. When adjusted for persons working at more than on

关键词：美国医院协会证明/统计学和数值数据急救医学/教育急诊室医院实习医师和住院医师职务/统计学和数值数据医务人员医院/标准医务人员医院/供应和分配人员配备和时间安排/统计学和数值数据专业场所/统计学和数值数据前瞻性研究薪金和附加福利/统计学和数值数据美国工作负荷量/统计学和数值数据成年人女(雌)性人类男(雄)性中年人

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Residents' medical information needs in clinic: Are they being met?

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AMERICAN JOURNAL OF MEDICINE 2000年第3期109卷 218-223页

作者： Green, ML Ciampi, MA Ellis, PJ Waterbury Hosp Yale Primary Care Residency Program Waterbury CT 06721 USA St Marys Hosp Waterbury CT USA Yale Univ Sch Med Yale Primary Care Residency Program Dept Internal Med New Haven CT USA

PURPOSE: Little is known about how often residents encounter unanswered clinical questions in their training. This knowledge would facilitate the development of curricula to help residents practice evidence-based medicine. This study was conducted to determine the frequency, characteristics, and pursuit of residents' clinical questions. SUBJECTS AND METHODS: Residents in a university-based primary care internal medicine program were observed in two hospital-based teaching clinics. Residents were interviewed after each patient encounter to determine whether they had any remaining clinical questions. At the end of each clinic session, they recorded their level of agreement with a series of statements about factors that were expected to motivate residents to seek the answers to each question. One week later, residents were contacted to determine if they had pursued these questions. RESULTS: Sixty-four residents were interviewed after 401 (99%) of 404 patient encounters. They identified 280 new questions, approximately 2 questions for every 3 patients. The most common types of questions were related to therapy (38%) or diagnosis (27%). The residents were subsequently contacted about 277 (99%) of their questions. Of these, only 80 (29%) were pursued, most commonly by consulting textbooks (31%), original articles (21%), or attending physicians (17%). In a multivariable analysis, belief that the patient expected the answer (odds ratio [OR] = 2.3, 95% confidence interval [CI]: 1.3 to 4.0, P = 0.004) and fear of malpractice exposure (OR = 2.1, 95% CI: 1.0 to 4.3, P = 0.05) were associated with information pursuit. Lack of time (60%) and forgetting the question (29%) were the most frequent reasons for failing to pursue a question. CONCLUSION: Residents frequently encountered new clinical questions in the outpatient clinic, but infrequently answered them. Efforts to demonstrate the feasibility of timely searches, remind them of their questions, and reinforce the exigency (educ

关键词：康涅狄格循证医学内科学/教育实习医师和住院医师职务/统计学和数值数据知识学习动机多元分析比值比初级卫生保健问卷调查成年人女(雌)性人类男(雄)性

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Improving emergency medicine residents' approach to patients with alcohol problems: A controlled educational trial

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ANNALS OF EMERGENCY MEDICINE 2002年第1期40卷 52-64页

作者： D'Onofrio, G Nadel, ES Degutis, LC Sullivan, LM Casper, K Bernstein, E Samet, JH Yale Univ Sch Med Sect Emergency Med New Haven CT 06519 USA Harvard Univ Dept Emergency Med Boston MA 02115 USA Boston Univ Sch Med Stat & Consulting Unit Boston MA 02118 USA Boston Univ Sch Med Dept Emergency Med Boston MA 02118 USA Boston Univ Sch Med Gen Internal Med Sect Clin Addict Res & Educ Unit Boston MA 02118 USA

Study objective: We determine whether training using a structured skills-based intervention would improve emergency medicine residents' knowledge and practice in screening and intervening with patients presenting to the emergency department with alcohol problems. Methods: In a controlled trial conducted at 2 similar emergency medicine residency programs associated with urban, Level I trauma centers, a 4-hour didactic, video, and skills-based workshop was conducted. Main outcome measures included (1) scores on changes in self-reported knowledge, current practice, self-efficacy, roleresponsibility, attitudes and beliefs, and provider readiness to change from baseline to 1 year after intervention and (2) change in practice as measured by record review before and after intervention. Results: The intervention group (n=17) had a significant increase in knowledge scores (P<.001) and practice with regard to percent of medical records with evidence of screening and intervention (17% before versus 58% after;95% confidence interval [CI] 31 to 50;P<.001);no change was observed in the control group (n=19). These increases were significantly different between groups (95% Cl 30 to 54;P<.001). There were no significant differences within or between groups for composite scores derived for current practice, self-efficacy, role responsibility, or readiness to change. Conclusion: A brief, structured, educational intervention for residents contributed to significant improvement in knowledge and practice with regard to patients with alcohol problems.

关键词：慢性酒精中毒/诊断慢性酒精中毒/治疗医务工作者的态度临床工作能力康涅狄格急救医学/教育健康知识态度实践实习医师和住院医师职务/方法实习医师和住院医师职务/统计学和数值数据马萨诸塞医师的作用人群监测自我效验教学/方法成年人女(雌)性人类男(雄)性

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Report of the task force on residency training information (2000-2001), American Board of Emergency Medicine

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ANNALS OF EMERGENCY MEDICINE 2001年第5期37卷 515-532页

作者： Hoffman, GL Bock, BF Gallagher, EJ Ham, HP Reinhart, MA Amer Board Emergency Med Task Force Residency Training Informat E Lansing MI 48823 USA

The American Board of Emergency Medicine gathers extensive background information on emergency medicine residents and the programs in which they train. We present the fourth annual report on the status of US emergency... 详细信息

关键词：聘任鉴定/统计学和数值数据年龄分布课程教育医学研究生/统计学和数值数据教育医学研究生/发展趋势急救医学/教育人种群/统计学和数值数据助学金和奖学金/组织和管理实习医师和住院医师职务/统计学和数值数据实习医师和住院医师职务/发展趋势许可证医学居住特征/统计学和数值数据时间因素美国成年人女(雌)性人类男(雄)性中年人

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Attrition in graduate surgical education: An analysis of the 1993 entering cohort of surgical residents

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JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS 1999年第6期189卷 602-610页

作者： Kwakwa, F Jonasson, O Amer Coll Surg Chicago IL 60611 USA

Background: Pyramidal surgical residency programs, in which more residents are enrolled than can complete the program, have gradually declined in number in recent years. In 1996, the Residency Review Committee for Surgery established a policy that the number of residents appointed to a program must be consistent with the number who will complete the program. Even so, there is still attrition in the ranks of surgical residents, some of whom hold undesignated preliminary positions and have no guarantee of a position that will lead to completion of the program. This study examined the 1993 entering cohort of surgical residents to determine the rate of attrition as of 1998. Study Design: Data were collected from the AMA's Medical Education Research Information Database, the American College of Surgeons Resident Masterfile, and the Association of American Medical Colleges GME Tracking Census database. The data were examined by specialty, gender, ethnic background, and type of medical school attended. Results: The overall attrition rate from surgical GME was 12%;the rate for international medical graduates was 33%;and the rate for osteopathic residents was 28%. African-American United States and Canadian graduates had attrition rates of 16% for men and 8% for women, and Hispanic United States and Canadian graduates had attrition rates of 14% for men and 15% for women. General surgery residents had an attrition rate of 26%, which included residents in undesignated preliminary positions. Gender was not a risk factor except for the significantly higher attrition rate of African-American men. Most (81%) of the residents who dropped out of surgical GME enrolled in GME in other specialties. Conclusions: The attrition rate from surgical GME is low, and most residents who drop out reenter GME in another specialty. Of concern is the high rate of attrition of African-American men who are United States or Canadian graduates. The highest rate of attrition, by far, is in the group of

关键词：职业选择队列研究人种群/统计学和数值数据实习医师和住院医师职务/人力实习医师和住院医师职务/统计学和数值数据退学/统计学和数值数据外科学/教育外科学/人力美国女(雌)性人类男(雄)性

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Comparison of the objective structured clinical examination with the performance of third year medical students in surgery

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AMERICAN JOURNAL OF SURGERY 2000年第4期179卷 286-288页

作者： Merrick, HW Nowacek, G Boyer, J Robertson, J Med Coll Ohio Dept Surg Toledo OH 43699 USA Med Coll Ohio Off Educ Resources & Res Toledo OH 43699 USA

BACKGROUND: The purpose of this study was to investigate the validity of the Objective Structured Clinical Examination (OSCE) as an evaluation technique by comparing medical student performance on the OSCE with traditional forms of evaluation. SUBJECTS AND METHODS: We analyzed the performance of 129 third-year medical students in the 1997-1998 academic year on clinical evaluations, oral examinations, and NBME subject examinations, and on OSCE, which was not included in the final grade. RESULTS: The OSCE showed high correlation with the final grades received for the clerkship. Seventy-one percent of students receiving High Pass or Honors had high OSCE scores whereas 67% of students with low OSCE scores received poor or Defer grades. Pearson product-moment correlations demonstrated significant bivariate correlations with the other test parameters. CONCLUSIONS: This study demonstrates that the OSCE is similar to the traditional methods in evaluating general ability and is also able to evaluate clinical ability in a standardized manner. Am J Surg. 2000;179:286-288. (C) 2000 by Excerpta Medica, Inc.

关键词：方差分析教育考核/方法教育考核/标准教育考核/统计学和数值数据实习医师和住院医师职务/方法实习医师和住院医师职务/统计学和数值数据学生医科/统计学和数值数据外科学/教育外科学/统计学和数值数据人类

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The longitudinal study of surgical residents, 1994 to 1996

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JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS 1999年第6期188卷 575-585页

作者： Kwakwa, F Jonasson, O Amer Coll Surg Chicago IL 60611 USA

Background: The American College of Surgeons (ACS) has conducted a detailed annual survey of residents enrolled in surgical graduate medical education (GME) programs since 1982 and has regularly published the resulting data as the Longitudinal Study of Surgical Residents. This report documents surgical resident enrollment and graduation for the academic years 1994-95 and 1995-96. Study Design: The Medical Education Research and Information Database of the American Medical Association was supplemented by the existing ACS Resident Masterfile and by personal contact with program directors and their staffs to verify accuracy and completeness of reporting. Each resident was tracked individually through surgical GME. Results: The total number of surgical residents graduating from surgical GME in 1995 and 1996 has not changed since 1982. Most graduates of surgical residency programs are in obstetrics and gynecology, followed by general surgery;demographic analysis of the graduating cohort shows that most are Caucasian male graduates of US or Canadian medical schools, and that their age at graduation is 33 to 35 years. International medical graduates (IMG) make up 8.9% of entering surgical residents and 6% of graduates. Osteopathic medical school graduates account for 1.2% to 1.3% of entering and graduating surgical residents. Women represent 27% of entering and 23% to 24% of graduates of surgical GME. The largest number and proportion of women in surgical GME are enrolled in obstetrics and gynecology residency programs, where they make up the majority of entering and graduating classes. When all other surgical residency program enrollments are considered together, women make up 17% and 16% of entering residents in 1994 and 1995 respectively, and 13% and 14% of graduates in those years. Conclusions: Surgical GME enrollment and graduation is stable. Few women and ethnic minorities are enrolled in surgical residency programs. IMG enrollment and graduation in surgical GME is l

关键词：数据收集教育医学研究生/统计学和数值数据人种群/统计学和数值数据实习医师和住院医师职务/统计学和数值数据纵向研究性别因素专业外科/教育专业外科/统计学和数值数据美国成年人女(雌)性人类男(雄)性

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The emergency medicine workforce study: More questions than answers

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ANNALS OF EMERGENCY MEDICINE 2002年第1期40卷 16-18页

作者： Augustine, JJ Kellermann, AL Emory Univ Sch Med Dept Emergency Med Atlanta GA 30322 USA

[Augustine JJ, Kellermann AL. The emergency medicine workforce study: more questions than answers. Ann Emerg Med . July 2002;40:16-18.]

关键词：文化多样性急救医学/组织和管理急救医学/发展趋势急诊室医院卫生政策实习医师和住院医师职务/统计学和数值数据职业满意医务人员医院/组织和管理医务人员医院/供应和分配诊疗工作管理医学/组织和管理美国工作负荷量/统计学和数值数据女(雌)性人类男(雄)性

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Lack of correlation of residents' academic performance and teaching skills

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AMERICAN JOURNAL OF MEDICINE 2000年第3期109卷 238-240页

作者： Morrison, EH Rucker, L Prislin, MD Castro, CS Univ Calif Irvine Dept Family Med Orange CA 92868 USA Univ Calif Irvine Dept Internal Med Orange CA 92868 USA Univ Calif Irvine Off Med Educ Orange CA 92868 USA

Recent studies have identified several teaching practices that characterize skilled clinical faculty, including actively involving learners, teaching at the bedside, and giving frequent feedback (1–4). It has also become clear that resident physicians provide a great deal of teaching for medical students (5), particularly in the informal curriculum” (6). Yet, little is known about residents as teachers (7), including the relation between residents□ academic performance and teaching skills. The purpose of this study was to compare the observed academic performance of second-year internal medicine residents with their specific teaching behaviors and with howstudents evaluated them as teachers.

关键词：加利福尼亚临床工作能力内科学/教育实习医师和住院医师职务/统计学和数值数据学生医科教学/标准成年人女(雌)性人类男(雄)性

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Are physicians aware of which of their patients have indwelling urinary catheters?

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AMERICAN JOURNAL OF MEDICINE 2000年第6期109卷 476-480页

作者： Saint, S Wiese, J Amory, JK Bernstein, ML Patel, UD Zemencuk, JK Bernstein, SJ Lipsky, BA Hofer, TP Univ Michigan Sch Med Dept Internal Med Ann Arbor MI USA Univ Calif San Francisco Sch Med Dept Med San Francisco CA 94143 USA Univ Washington Sch Med Dept Med Seattle WA 98195 USA Vet Affairs Ann Arbor Healthcare Syst Vet Affairs Ctr Practice Management & Outcomes Ann Arbor MI USA Vet Affairs Puget Sound Hlth Care Syst Primary & Specialty Med Care Seattle WA USA

PURPOSE: Although infections associated with indwelling urinary catheters are common, costly, and morbid, the use of these catheters is unnecessary in more than one-third of patients. We sought to assess whether attending physicians, medical residents, and medical students are aware if their hospitalized patients have an indwelling urinary catheter, and whether physician awareness is associated with appropriate use of these catheters. METHODS: The physicians and medical students responsible for patients admitted to the medical services at four university-affiliated hospitals were given a list of the patients on their service. For each patient, the provider was asked: "As of yesterday afternoon, did this patient have an indwelling urethral catheter?" Respondents' answers were compared with the results of examining the patient. RESULTS: Among 288 physicians and students on 56 medical teams, 256 (89%) completed the survey. Of 469 patients, 117 (25%) had an indwelling catheter. There were a total of 319 provider-patient observations among these 117 patients. Over all, providers were unaware of catheterization for 88 (28%) of the 319 provider-patient observations. Unawareness rates by level of training were 21% for students, 22% for interns, 27% for residents, and 38% for attending physicians (P = 0.06). Catheter use was inappropriate in 36 (31%) of the 117 patients with a catheter. Providers were unaware of catheter use for 44 (41%) of the 108 provider-patient observations of patients who were inappropriately catheterized. Catheterization was more Likely to be appropriate if respondents were aware of the catheter (odds ratio = 3.7;95% confidence interval, 2.1 to 6.7, P<0.001). CONCLUSION: Physicians are commonly unaware that their patients have an indwelling urinary catheter. Inappropriate catheters are more often "forgotten" than appropriate ones. System-wide interventions aimed at discontinuing unnecessary catheterization seem warranted. Am J Med. 2000;109: 476-480. (

关键词：觉知导管留置临床工作能力卫生设施管理人员/统计学和数值数据医院大学/统计学和数值数据医院退伍军人/统计学和数值数据感染控制实习医师和住院医师职务/统计学和数值数据医学审核医师/统计学和数值数据前瞻性研究学生医科/统计学和数值数据导尿管插入术/方法导尿管插入术/利用老年人女(雌)性人类男(雄)性中年人

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