- Email: [email protected]
Survey of emergency medicine residents who completed a separate internship
RESEARCH FORUM ABSTRACTS
examination cases and provided the unexpected opportunity for direct observation of the residents’ clinical competency, which the team perceived to be evident. Conclusion: The certification process used in the United States may be successfully applied in developing and rebuilding regions, provided that process is flexibly adapted to local realities. The resumption of ethnic hostilities exemplified why emergency medicine is necessary in such regions, just as the disparity between oral case simulation and actual clinical performance serves as a warning. Examination methods that are valid in the United States may be insensitive in discerning competency in other settings, particularly in the absence of extensive experience with those methods. Emergency medicine in the developing world is fragile and often unfamiliar or even threatening to other specialty physicians. A rigid approach to preconceived performance standards, without sensitivity to the limitations of those standards, risks crippling a nascent emergency medicine specialty. However, by including other specialists in a credible certification process and by flexibly demonstrating firm standards, US emergency physicians can lend invaluable credibility and support to the introduction of emergency medicine to developing or rebuilding regions.
158
Differences in Emergency Physician and Nursing Tobacco and Alcohol Screening Patterns
Methods: A team of 10 US health care providers and support staff traveled to Tocoa, Honduras, and surrounding communities on 3 occasions during 2002 to 2004 to provide basic health education and emergency medicine training to all levels of health care providers during a 3-day period. Course participants included physicians, nurses, midwives, first responders, administrative staff, and community health workers. Each year, a written survey was conducted to ascertain the health concerns and needs of the community. Subsequent curricula were adjusted according to the survey results. Topics included triage, splinting and immobilization, cardiopulmonary resuscitation, prenatal care and childbirth, cardiovascular emergencies, respiratory illnesses, hypertension, diabetes, HIV, malaria, and preventative medicine. Hands-on sessions for physicians included ECG training, intubation skills, and intravenous access. A woodworker taught the local firefighters how to make their own backboards. Geographically isolated community health workers were provided with Where There Is No Doctor books and instruction in basic health care. Results: Approximately 750 participants were trained during a 3-year period. They were provided with resources to train others in their community with the hope of instituting a ‘‘train the trainer’’ program. The major health concerns in the communities include HIV (especially among the Afro-Honduran Garı´funa population), malaria, diabetes, hypertension, diarrhea, and respiratory illnesses. Conclusion: Emergency medicine skills can be taught in developing nations incorporating out-of-community and local educators and resources.
Greenberg MR, Love A, Li J, Sierzega GM, Buckenmyer C, Brice M, Weinstock M/ Lehigh Valley Hospital and Health Network, Allentown, PA Study objectives: We describe emergency department (ED) nursing and physician staff tobacco and alcohol screening behaviors before educational program implementation. Methods: This study was conducted in the ED at 1 site of a 3-site, tertiary care, community teaching hospital. We conducted a structured retrospective medical record review of 326 charts during a 3-month period during spring 2003. Patients aged 14 years and older who were alert, cooperative, not critically ill, and were discharged from the ED were included in the study. Patient tobacco and alcohol use patterns of this ED population were calculated. Screening frequency (by nurses and physicians) of patient tobacco and alcohol use was reviewed. The differences between nurse and physician screening rates were compared using the x2 test of association. Significance was determined by P values less than .05. Results: The median patient age range was 35 to 44 years. Smoking frequency in this population was 107 (32.8%) of 326. One hundred eighty-three patients (56.1%) out of 326 were identified as nonsmokers and 36 (11.0%) of 326 as either previous smokers or ‘‘unknown.’’ Alcohol use was self-reported in 106 (32.5%) of 326 of the patients. One hundred ninety-seven patients (60.4%) out of 326 identified themselves as nondrinkers and in 23 (7.0%) of 326 of the patients, alcohol usage was unknown. Two hundred eighty-six (87.7%) of 326 charts were screened by nurses for patient tobacco use, which was similar to the 280 (85.9%) of 326 screening rate for alcohol use. Fewer charts, 245 (75.2%) of 326, were screened by physicians for tobacco use. Comparatively, only 208 (63.8%) of 326 patients were screened by physicians for alcohol use. The differences between screening for tobacco (87.7% for nurses and 75.2% for physicians) was statistically significant (x2=17.06, P\.001). The difference between screening rates for alcohol (85.9% for nurses and 63.8% for physicians) was statistically significant (x2=42.0, P\.001). Conclusion: In this study, nursing staff had high rates of screening patients for tobacco and alcohol use. Physician screening rates were lower than that of nurses in both categories, more substantially so in alcohol screening.
159
Global Emergency Medicine Initiative: Advancing Emergency Medical Care in the Developing Nation of Honduras
Galletta GM/University of Massachusetts, Worcester, MA Study objectives: Honduras is a Spanish-speaking country located in Central America, with a population of approximately 6.5 million. It is one of the poorest countries in the western hemisphere and was severely affected by Hurricane Mitch in 1998, which killed approximately 5,600 people and cost $1 billion in damage. Shortly thereafter, Global Emergency Medicine Initiative (GEMINI), sponsored by Rotary International, developed a program to advance emergency medicine and disaster response in Honduras. I describe 3 years of emergency medical training experience in the developing nation of Honduras.
S 5 0
160
Survey of Emergency Medicine Residents Who Completed a Separate Internship
Ray AM, Dula DJ/Geisinger Health System, Danville, PA Study objectives: We determine the opinion of emergency medicine residents about the value of completing a separate 1-year rotating or transitional internship before starting an emergency medicine residency that does not require a separate internship. Methods: All Accreditation Council for Graduate Medical Education–accredited emergency medicine residency programs not requiring a separate internship (postgraduate year [PGY] 1 to 3, PGY 1 to 4, PGY 1 to 5 combined emergency medicine/pediatrics or emergency medicine/internal medicine) were contacted to determine the number of current emergency medicine residents who completed a separate internship before starting their residency. A Web-based survey was distributed to applicable residents in November 2003, with a follow-up reminder sent to nonrespondents in December 2003. Results: One hundred thirteen residents from 30 emergency medicine residencies were identified as having completed a separate internship; 46 surveys were returned (41% response rate). Fifty-nine percent (n=27) of residents are DOs, 41% (n=19) are MDs. Most respondents are residents in PGY 1 to 3 programs (83%, n=38), the remainder in PGY 1 to 4 (15%, n=7) and combined emergency medicine/pediatrics (2%, n=1). Reasons for completing a separate internship included DO licensure requirements in certain states (70% of DOs, 41% of total respondents, n=19); failing to match into emergency medicine directly from medical school (15%, n=7); military obligations or requirements (11%, n=5); change of career plans (11%, n=5); desiring additional time after medical school (11%, n=5); and other reasons (11%, n=5). A majority perceived themselves to be more comfortable with medical histories and physical examinations during the first year of their emergency medicine residency compared with their colleagues who did not complete a separate internship (83%, n=38). Most also perceived themselves to be more comfortable with procedures during the first year of their emergency medicine residency (74%, n=34). This difference in comfort decreased with each subsequent year of emergency medicine residency training, with an increasing number of residents believing their colleagues’ proficiency about the same as theirs. Most residents (72%, n=33) were glad they completed their internship, with 65% (n=30) indicating they would repeat the internship again ‘‘if they had to do it all over again.’’ However, the majority of DOs who completed the internship because of licensure requirements would not have done so if it were not required (67%, n=18). Conclusion: A small number of residents in emergency medicine residencies that do not require a separate internship have completed a separate 1-year rotating or transitional internship. The reasons for internship completion are varied, with the majority being related to licensure or military requirements. In general, respondents indicated this year to be a valuable experience.
ANNALS OF EMERGENCY MEDICINE
44:4
OCTOBER 2004
examination cases and provided the unexpected opportunity for direct observation of the residents’ clinical competency, which the team perceived to be evident. Conclusion: The certification process used in the United States may be successfully applied in developing and rebuilding regions, provided that process is flexibly adapted to local realities. The resumption of ethnic hostilities exemplified why emergency medicine is necessary in such regions, just as the disparity between oral case simulation and actual clinical performance serves as a warning. Examination methods that are valid in the United States may be insensitive in discerning competency in other settings, particularly in the absence of extensive experience with those methods. Emergency medicine in the developing world is fragile and often unfamiliar or even threatening to other specialty physicians. A rigid approach to preconceived performance standards, without sensitivity to the limitations of those standards, risks crippling a nascent emergency medicine specialty. However, by including other specialists in a credible certification process and by flexibly demonstrating firm standards, US emergency physicians can lend invaluable credibility and support to the introduction of emergency medicine to developing or rebuilding regions.
158
Differences in Emergency Physician and Nursing Tobacco and Alcohol Screening Patterns
Methods: A team of 10 US health care providers and support staff traveled to Tocoa, Honduras, and surrounding communities on 3 occasions during 2002 to 2004 to provide basic health education and emergency medicine training to all levels of health care providers during a 3-day period. Course participants included physicians, nurses, midwives, first responders, administrative staff, and community health workers. Each year, a written survey was conducted to ascertain the health concerns and needs of the community. Subsequent curricula were adjusted according to the survey results. Topics included triage, splinting and immobilization, cardiopulmonary resuscitation, prenatal care and childbirth, cardiovascular emergencies, respiratory illnesses, hypertension, diabetes, HIV, malaria, and preventative medicine. Hands-on sessions for physicians included ECG training, intubation skills, and intravenous access. A woodworker taught the local firefighters how to make their own backboards. Geographically isolated community health workers were provided with Where There Is No Doctor books and instruction in basic health care. Results: Approximately 750 participants were trained during a 3-year period. They were provided with resources to train others in their community with the hope of instituting a ‘‘train the trainer’’ program. The major health concerns in the communities include HIV (especially among the Afro-Honduran Garı´funa population), malaria, diabetes, hypertension, diarrhea, and respiratory illnesses. Conclusion: Emergency medicine skills can be taught in developing nations incorporating out-of-community and local educators and resources.
Greenberg MR, Love A, Li J, Sierzega GM, Buckenmyer C, Brice M, Weinstock M/ Lehigh Valley Hospital and Health Network, Allentown, PA Study objectives: We describe emergency department (ED) nursing and physician staff tobacco and alcohol screening behaviors before educational program implementation. Methods: This study was conducted in the ED at 1 site of a 3-site, tertiary care, community teaching hospital. We conducted a structured retrospective medical record review of 326 charts during a 3-month period during spring 2003. Patients aged 14 years and older who were alert, cooperative, not critically ill, and were discharged from the ED were included in the study. Patient tobacco and alcohol use patterns of this ED population were calculated. Screening frequency (by nurses and physicians) of patient tobacco and alcohol use was reviewed. The differences between nurse and physician screening rates were compared using the x2 test of association. Significance was determined by P values less than .05. Results: The median patient age range was 35 to 44 years. Smoking frequency in this population was 107 (32.8%) of 326. One hundred eighty-three patients (56.1%) out of 326 were identified as nonsmokers and 36 (11.0%) of 326 as either previous smokers or ‘‘unknown.’’ Alcohol use was self-reported in 106 (32.5%) of 326 of the patients. One hundred ninety-seven patients (60.4%) out of 326 identified themselves as nondrinkers and in 23 (7.0%) of 326 of the patients, alcohol usage was unknown. Two hundred eighty-six (87.7%) of 326 charts were screened by nurses for patient tobacco use, which was similar to the 280 (85.9%) of 326 screening rate for alcohol use. Fewer charts, 245 (75.2%) of 326, were screened by physicians for tobacco use. Comparatively, only 208 (63.8%) of 326 patients were screened by physicians for alcohol use. The differences between screening for tobacco (87.7% for nurses and 75.2% for physicians) was statistically significant (x2=17.06, P\.001). The difference between screening rates for alcohol (85.9% for nurses and 63.8% for physicians) was statistically significant (x2=42.0, P\.001). Conclusion: In this study, nursing staff had high rates of screening patients for tobacco and alcohol use. Physician screening rates were lower than that of nurses in both categories, more substantially so in alcohol screening.
159
Global Emergency Medicine Initiative: Advancing Emergency Medical Care in the Developing Nation of Honduras
Galletta GM/University of Massachusetts, Worcester, MA Study objectives: Honduras is a Spanish-speaking country located in Central America, with a population of approximately 6.5 million. It is one of the poorest countries in the western hemisphere and was severely affected by Hurricane Mitch in 1998, which killed approximately 5,600 people and cost $1 billion in damage. Shortly thereafter, Global Emergency Medicine Initiative (GEMINI), sponsored by Rotary International, developed a program to advance emergency medicine and disaster response in Honduras. I describe 3 years of emergency medical training experience in the developing nation of Honduras.
S 5 0
160
Survey of Emergency Medicine Residents Who Completed a Separate Internship
Ray AM, Dula DJ/Geisinger Health System, Danville, PA Study objectives: We determine the opinion of emergency medicine residents about the value of completing a separate 1-year rotating or transitional internship before starting an emergency medicine residency that does not require a separate internship. Methods: All Accreditation Council for Graduate Medical Education–accredited emergency medicine residency programs not requiring a separate internship (postgraduate year [PGY] 1 to 3, PGY 1 to 4, PGY 1 to 5 combined emergency medicine/pediatrics or emergency medicine/internal medicine) were contacted to determine the number of current emergency medicine residents who completed a separate internship before starting their residency. A Web-based survey was distributed to applicable residents in November 2003, with a follow-up reminder sent to nonrespondents in December 2003. Results: One hundred thirteen residents from 30 emergency medicine residencies were identified as having completed a separate internship; 46 surveys were returned (41% response rate). Fifty-nine percent (n=27) of residents are DOs, 41% (n=19) are MDs. Most respondents are residents in PGY 1 to 3 programs (83%, n=38), the remainder in PGY 1 to 4 (15%, n=7) and combined emergency medicine/pediatrics (2%, n=1). Reasons for completing a separate internship included DO licensure requirements in certain states (70% of DOs, 41% of total respondents, n=19); failing to match into emergency medicine directly from medical school (15%, n=7); military obligations or requirements (11%, n=5); change of career plans (11%, n=5); desiring additional time after medical school (11%, n=5); and other reasons (11%, n=5). A majority perceived themselves to be more comfortable with medical histories and physical examinations during the first year of their emergency medicine residency compared with their colleagues who did not complete a separate internship (83%, n=38). Most also perceived themselves to be more comfortable with procedures during the first year of their emergency medicine residency (74%, n=34). This difference in comfort decreased with each subsequent year of emergency medicine residency training, with an increasing number of residents believing their colleagues’ proficiency about the same as theirs. Most residents (72%, n=33) were glad they completed their internship, with 65% (n=30) indicating they would repeat the internship again ‘‘if they had to do it all over again.’’ However, the majority of DOs who completed the internship because of licensure requirements would not have done so if it were not required (67%, n=18). Conclusion: A small number of residents in emergency medicine residencies that do not require a separate internship have completed a separate 1-year rotating or transitional internship. The reasons for internship completion are varied, with the majority being related to licensure or military requirements. In general, respondents indicated this year to be a valuable experience.
ANNALS OF EMERGENCY MEDICINE
44:4
OCTOBER 2004