Incorporating Evidence-Based Medicine into Resident Education: A CORD Survey of Faculty and Resident Expectations

BACKGROUND: The Accreditation Council for Graduate Medical Education (ACGME) invokes evidence-based medicine (EBM) principles through the practice-based learning core competency. The authors hypothesized that among a representative sample of emergency medicine (EM) residency programs, a wide variability in EBM resident training priorities, faculty expertise expectations, and curricula exists. OBJECTIVES: The primary objective was to obtain descriptive data regarding EBM practices and expectations from EM physician educators. Our secondary objective was to assess differences in EBM educational priorities among journal club directors compared with non-journal club directors. METHODS: A 19-question survey was developed by a group of recognized EBM curriculum innovators and then disseminated to Council of Emergency Medicine Residency Directors (CORD) conference participants, assessing their opinions regarding essential EBM skill sets and EBM curricular expectations for residents and faculty at their home institutions. The survey instrument also identified the degree of interest respondents had in receiving a free monthly EBM journal club curriculum. RESULTS: A total of 157 individuals registered for the conference, and 98 completed the survey. Seventy-seven (77% of respondents) were either residency program directors or assistant/associate program directors. The majority of participants were from university-based programs and in practice at least 5 years. Respondents reported the ability to identify flawed research (45%), apply research findings to patient care (43%), and comprehend research methodology (33%) as the most important resident skill sets. The majority of respondents reported no formal journal club or EBM curricula (75%) and do not utilize structured critical appraisal instruments (71%) when reviewing the literature. While journal club directors believed that resident learners\u27 most important EBM skill is to identify secondary peer-reviewed resources, non-journal club directors identified residents\u27 ability to distinguish significantly flawed research as the key skill to develop. Interest in receiving a free monthly EBM journal club curriculum was widely accepted (89%). CONCLUSIONS: Attaining EBM proficiency is an expected outcome of graduate medical education (GME) training, although the specific domains of anticipated expertise differ between faculty and residents. Few respondents currently use a formalized curriculum to guide the development of EBM skill sets. There appears to be a high level of interest in obtaining EBM journal club educational content in a structured format. Measuring the effects of providing journal club curriculum content in conjunction with other EBM interventions may warrant further investigation

A Survey of Delirium Self-Reported Knowledge and Practices among Emergency Physicians in the United States

Objective: This study aimed to evaluate United States emergency physicians’ self-reported knowledge and practices regarding the detection, prevention, and management of delirium, a common and deadly syndrome that disproportionately affects older emergency department (ED) patients. Knowledge and practices of the broader emergency physician community about these priority topics in geriatric emergency medicine are understudied. Design: Electronic self-administered online survey Setting: United States Participants: One-hundred ninety-seven emergency physicians of the American College of Emergency Physicians Emergency Medicine Practice Research Network Measures: Descriptive statistics were generated from survey responses. Results: Of 734 physicians in the research network who were sent the survey, 197 (27%) responded. Most respondents reported intermediate (46%) or advanced (46%) knowledge of delirium detection and management and intermediate (61%) or advanced (21%) knowledge of delirium prevention. Forty percent reported low concern or neutrality over discharging a patient with delirium from the ED. There was high variability in respondents’ perception about the prioritization of delirium in their EDs, and only 14% reported the ED where they worked had a protocol addressing delirium. Participants identified multiple challenges in diagnosing, preventing, and managing delirium, including the physical space and logistics of the emergency care environment (82%), challenges identifying delirium in patients with dementia (75%), and time constraints (64%). Most (69%) perceived utility in increased clinician education on delirium. Conclusions: Surveyed emergency physicians self-report a high knowledge of delirium detection and management, in contrast to prior research demonstrating low ED delirium detection rates. The variable institutional prioritization of delirium reported also does not align with that of geriatric emergency medicine experts and associations, suggesting a need for strategies to bridge this gap

Dissemination and Implementation of Shared Decision Making Into Clinical Practice: A Research Agenda.

Shared decision making (SDM) is essential to advancing patient-centered care in emergency medicine. Despite many documented benefits of SDM, prior research has demonstrated persistently low levels of patient engagement by clinicians across many disciplines, including emergency medicine. An effective dissemination and implementation (D&I) framework could be used to alter the process of delivering care and to facilitate SDM in routine clinical emergency medicine practice. Here we outline a research and policy agenda to support the D&I strategy needed to integrate SDM into emergency care

Emergency Department Policies to Improve Care Experiences for Older Adults during the COVID-19 Pandemic

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