Level of Comfort in Evaluating Older Patients Amongst Medical Students and Emergency Medicine Residents

Introduction As the population ages, emergency physicians must be better equipped to manage the complex needs of older patients. While geriatric core competencies have been developed for medical students and emergency medicine (EM) residents, little work has been done to evaluate EM trainees’ comfort with these competencies, or their interest in and barriers to learning more about Geriatric Emergency Medicine (GEM). Methods We conducted a cross-sectional study of EM residents and medical students in their clinical years of training with interest in EM. We used an online self-administered survey to evaluate trainees’ self-reported comfort with previously reported geriatric competency domains, in addition to exploring GEM education and interest. Results 169 trainees participated in the survey, 71% of which were medical students and 29% of which were residents. A majority of medical students (66%) and residents (92%) overall reported comfort evaluating and managing older patients in the ED, but comfort varied with each competency domain. Year of training within these groups was not reliably predictive of increased comfort across the various domains. Common barriers to learning more about GEM identified include exposure in medical education and training for medical students and residents, at 59% and 65% respectively. Medical students also noted that more exposure in preclinical and clinical training would increase interest in GEM, at 57% and 54%, respectively. For residents, learning more about what a career in GEM looks like would increase interest in GEM (51%). Common resources used to learn about older patients were society guidelines for medical students (56%) and UpToDate for residents (82%). Only 30% of medical students noted that their medical school offers a dedicated geriatric curriculum, and medical students whose medical school offered a geriatrics curriculum reported more comfort in evaluating and managing older patients in the ED. Conclusion While the majority of trainees surveyed felt comfortable in the geriatric core competencies, increased geriatrics exposure in preclinical and clinical training could increase interest in GEM. Such exposure may be best accomplished earlier in medical training and will be important in creating a future EM physician workforce that is competent in caring for this complex and important patient population

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

The Role of Gender in Nurse-Resident Interactions: A Mixed-methods Study

Introduction: The role of gender in interprofessional interactions is poorly understood. This mixed-methods study explored perceptions of gender bias in interactions between emergency medicine (EM) residents and nurses.Methods: We analyzed qualitative interviews and focus groups with residents and nurses from two hospitals for dominant themes. An electronic survey, developed through an inductive-deductive approach informed by qualitative data, was administered to EM residents and nurses. Quantitative analyses included descriptive statistics and between-group comparisons. Results: Six nurses and 14 residents participated in interviews and focus groups. Key qualitative themes included gender differences in interprofessional communication, specific examples of, and responses to, gender bias. Female nurses perceived female residents as more approachable and collaborative than male residents, while female residents perceived nurses’ questions as doubting their clinical judgment. A total of 134 individuals (32%) completed the survey. Females more frequently perceived interprofessional gender bias (mean 30.9; 95% confidence interval {CI}, 25.6, 36.2; vs 17.6 [95% CI, 10.3, 24.9). Residents reported witnessing interprofessional gender bias more frequently than nurses (58.7 (95% CI, 48.6, 68.7 vs 23.9 (95% CI, 19.4, 28.4). Residents reported that gender bias affected job satisfaction (P = 0.002), patient care (P = 0.001), wellness (P = 0.003), burnout (P = 0.002), and self-doubt (P = 0.017) more frequently than nurses. Conclusion: Perceived interprofessional gender bias negatively impacts personal wellbeing and workplace satisfaction, particularly among female residents. Key institutional stakeholders including residency, nursing, and hospital leadership should invest the resources necessary to develop and integrate evidence-based strategies to improve interprofessional relationships that will ultimately enhance residency training, work climate, and patient care