Emergency Medicine Summary Pdf

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The utility of point-of-care ultrasound is well supported by the medical literature. Consequently, pediatric emergency medicine providers have embraced this technology in everyday practice. Recently, the American Academy of Pediatrics published a policy statement endorsing the use of point-of-care ultrasound by pediatric emergency medicine providers. To date, there is no standard guideline for the practice of point-of-care ultrasound for this specialty. This document serves as an initial step in the detailed "how to" and description of individual point-of-care ultrasound examinations. Pediatric emergency medicine providers should refer to this paper as reference for published research, objectives for learners, and standardized reporting guidelines.

At the conclusion of the SVI for the 2020 ERAS season, the AAMC reviewed data from the last four years. The AAMC stands confidently behind the SVI as a reliable, valid assessment of behavioral competencies that does not disadvantage individuals or groups. However, there is a lack of interest among the emergency medicine community in continuing to use and research the SVI, as well as operational challenges scaling the SVI to the full applicant pool across multiple specialties. As such, the AAMC decided not to renew or expand the SVI pilot in emergency medicine for the 2021 ERAS application cycle.

The SVI evaluation plan included four broad areas: (1) psychometrics, (2) validity evidence, (3) fairness and preparation, and (3) program director and applicant reactions. Each broad area was composed of multiple research questions. As shown in the table below, data from multiple ERAS application cycles were used to evaluate the broad areas. We provided data in some areas (i.e., psychometrics) immediately following each SVI pilot year and are still waiting for data to accumulate in other areas (e.g., correlations with performance).

*While we have begun to collect performance data from participating applicants in the 2018 ERAS cycle, sample sizes are too small to draw any conclusions. Data from multiple years must be combined in order to report and interpret results.

Raters were trained to use a standardized rating process and scoring rubrics. They participated in several rounds of practice and were given feedback prior to making operational ratings. We estimated reliability by examining the extent to which raters agreed with each other at the conclusion of rater training and found that rater reliability met industry standards.1 Findings were consistent across all four years. We also examined score distributions after each SVI administration. Results showed that SVI total scores were relatively normally distributed and there was variance in the ratings.2

Validity refers to the extent to which evidence and theory support the inferences drawn from scores based on their intended uses. The process of providing evidence of validity is ongoing and involves accumulating multiple sources of evidence.3 We established the validity of SVI scores using evidence based on content and relations with other variables. This approach aligns with best practices in the professional testing literature and legal guidelines.4-6

To date we are not able to provide evidence of validity based on relationship to intern performance data due to methodological limitations associated with the local validity study. We partnered with 17 emergency medicine programs to examine the correlation between SVI scores, ACGME Milestone ratings, end-of-shift ratings, and ratings from a research-only performance evaluation tool. During this work, we learned that programs interpret and use ratings scales differently, so we need to conduct analyses at the program level. Sample sizes (n=5 to 25) are too small to have adequate power.8 Additional years of data are needed to have sufficient sample sizes and to analyze the relations between SVI scores and intern performance.

Unconscious bias training was provided to raters and made available to program directors. Across all four years of data, we consistently found that the average score differences between White, Black, Hispanic, and Asian applicants did not reach the threshold for a small effect. These group differences are substantially smaller than what is observed for standardized tests, which usually have large group differences for Black applicants and medium differences for Hispanic applicants.9 Group differences in SVI scores are also smaller than observed for the eSLOE, which has a small effect for Black applicants.10 The SVI is the only national assessment being used operationally in residency selection that does not result in group differences in scores by race/ethnicity. The inclusion of the SVI in the selection process has the potential to facilitate holistic review and broaden the pool of applicants invited to the in-person interview.

We surveyed program directors about their use and attitudes about the SVI in the 2018 and 2019 ERAS seasons.16,17 Results from both studies were largely consistent and showed that program directors used the SVI cautiously during the pilot. Only 42% of those surveyed in the 2019 ERAS season reported using SVI scores at some point in the process and most of whom reported that SVI scores were not important when deciding whom to invite to the in-person interview. Most program directors reported wanting more research on the value of SVI scores before incorporating it into their selection processes.17

During each season, we surveyed applicants immediately following their completion of the SVI. We also surveyed applicants after receiving their scores during the 2018 ERAS season. Results have consistently shown that applicants are satisfied with the instructions and policies that support the SVI. However, they are not satisfied with the SVI overall. They do not believe it will contribute to holistic review or that it is a good measure of their interpersonal and communications skills or professionalism.17,18

Given the large volume of residency applicants across all specialties, the AAMC has been studying computer scoring of interviews. After several years of research, we do not believe computer scoring is ready for operational use.

Emergency physicians representing 15 countries from all IFEM regions composed the Task Force. Monthly meetings were held via video-conferencing software to achieve consensus for report content. The report was submitted and approved by the IFEM Board on June 1, 2020.

The IFEM report is a comprehensive document intended to be used in whole or by section to inform and address aspects of ED crowding and access block. Overall, ED crowding is a multifactorial issue requiring systems-wide solutions applied at local, regional, and national levels. Access block is the predominant contributor of ED crowding in most parts of the world.

Emergency department (ED) crowding and access block represent potentially the greatest threats to the core mission of emergency care across the world. The problem is pervasive, massive in scale, and amounts to a public health emergency with potentially lethal consequences [1]. At its core, crowding and access block overwhelm ED resources and prevent the delivery of timely and effective care for patients. These are patients in need of necessary and immediate attention for the whole range of medical, trauma, and behavioral emergencies that can impact a person or community. The causes of ED crowding and access block are complex and multifactorial and can vary considerably not only between hospitals, jurisdictions, and countries, but also within the same setting during different periods of time [1, 2].

The International Federation of Emergency Medicine (IFEM) recognized that there was both an extreme need and a unique opportunity to provide EDs around the world with expert and evidence-based guidance. Recognizing crowding and access block were wicked problems (problems that are challenging to solve due to complexity, breadth, and/or contradictory elements) requiring adaptive solutions, the plan was to develop a resource that could be adapted to local circumstances. The ED Crowding and Access Block Task Force was constructed with this goal and endorsed by the IFEM Board and launched at the International Conference on Emergency Medicine conference in South Korea in 2019. Since that time, the ED Crowding and Access Block Task Force Terms of Reference were approved, and the task force has seen involvement from all IFEM regions. Over thirty emergency medicine (EM) physician experts and thought leaders, with a broad range of expertise, have been joining monthly video conferences and contributing to fourteen distinct dossiers and well-referenced synopses which constitute the basis for this report (Table 1).

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Extensive skill, knowledge, and experience are needed for these careers. Many require more than five years of experience. For example, surgeons must complete four years of college and an additional five to seven years of specialized medical training to be able to do their job.

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