Best Educational Practices in Pediatric Emergency Medicine During Emergency Medicine Residency Training: Guiding Principles and Expert Recommendations

The state of pediatric emergency medicine (PEM) education within emergency medicine (EM) residency programs is reviewed and discussed in the context of shifting practice environments and new demands for a greater focus on the availability and quality of PEM services. The rapid growth of PEM within pediatrics has altered the EM practice landscape with regard to PEM. The authors evaluate the composition, quantity, and quality of PEM training in EM residency programs, with close attention paid to the challenges facing programs. A set of best practices is presented as a framework for discussion of future PEM training that would increase the yield and relevance of knowledge and experiences within the constraints of 3- and 4-year residencies. Innovative educational modalities are discussed, as well as the role of simulation and pediatric-specific patient safety education. Finally, barriers to PEM fellowship training among EM residency graduates are discussed in light of the shortage of practitioners from this training pathway and in recognition of the ongoing importance of the EM voice in PEM.ACADEMIC EMERGENCY MEDICINE 2010; 17:S104–S113 © 2010 by the Society for Academic Emergency MedicinePeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79391/1/j.1553-2712.2010.00893.x.pd

Industry Relations With Emergency Medicine Graduate Medical Education Programs

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72174/1/j.1553-2712.2009.00539.x.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/72174/2/ACEM_539_sm_DataSupplementS1.pd

Uncharted Paths: Hospital Networks in Critical Care

Wide variation between hospitals in the quality of critical care lead to many potentially avoidable deaths. Regionalization of critical care is a possible solution; regionalization has been implemented for trauma and neonatal intensive care, and it is under active discussion for medical and cardiac critical care. However, regionalization is only one possible approach to reorganizing critical care services. This commentary introduces the technique of network analysis as a framework for the following: (1) understanding how critically ill patients move between hospitals, (2) defining the roles hospitals play in regional care delivery, and (3) suggesting systematic improvements that may benefit population health. We examined transfers of critically ill Medicare patients in Connecticut in 2005 as a model system. We found that patients are systematically transferred to more capable hospitals. However, we find the standard distinction of hospitals into either “secondary hospitals” or “tertiary hospitals” poorly explains observed transfer patterns; instead, hospitals show a continuum of roles. We further examine the implications of the network pattern in a simulation of quarantine of a hospital to incoming transfers, as occurred during the severe acute respiratory syndrome epidemic. Network perspectives offer new ways to study systems to care for critically ill patients and provide additional tools for addressing pragmatic problems in triage and bed management, regionalization, quality improvement, and disaster preparedness. (CHEST 2009; 135:827– 833)his analysis was supported in part by a Fellows Career Development Award from the American Thoracic Society, National Institutes of Health (NIH)/National Heart, Lung, and Blood Institute (NHLBI) Cardiopulmonary Epidemiology Training Grant No. 5T32HL007891 and NIH/NHLBI No. 1K08HL091249-01.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/61909/1/09.I.Christie.Asch.Kahn.09.Chest.pd