The 2016 Model of The Clinical Practice of Emergency Medicine

Emergency medicine (EM) has a scientifically derived and commonly accepted description of the domain of its clinical practice. That document, “The Model of the Clinical Practice of Emergency Medicine” (EM Model), was developed through the collaboration of six organizations: the American Board of Emergency Medicine (ABEM), the administrative organization for the project, the American College of Emergency Physicians (ACEP), the Council of Emergency Medicine Residency Directors (CORD), the Emergency Medicine Residents\u27 Association (EMRA), the Residency Review Committee for Emergency Medicine (RRC-EM), and the Society for Academic Emergency Medicine (SAEM). Development of the EM Model was based on an extensive practice analysis of the specialty. The practice analysis relied on both empiric data gathered from actual emergency department visits and several expert panels (1). The resulting product was first published in 2001, and has successfully served as the common source document for all EM organizations (2,3). One of its strengths is incorporating the reality that EM is a specialty driven by symptoms not diagnoses, requiring simultaneous therapeutic and diagnostic interventions

Teaching Emotional Intelligence: A Control Group Study of a Brief Educational Intervention for Emergency Medicine Residents

Introduction: Emotional Intelligence (EI) is defined as an ability to perceive another’s emotional state combined with an ability to modify one’s own. Physicians with this ability are at a distinct advantage, both in fostering teams and in making sound decisions. Studies have shown that higher physician EI’s are associated with lower incidence of burn-out, longer careers, more positive patient-physician interactions, increased empathy, and improved communication skills. We explored the potential for EI to be learned as a skill (as opposed to being an innate ability) through a brief educational intervention with emergency medicine (EM) residents. Methods: This study was conducted at a large urban EM residency program. Residents were randomized to either EI intervention or control groups. The intervention was a two-hour session focused on improving the skill of social perspective taking (SPT), a skill related to social awareness. Due to time limitations, we used a 10-item sample of the Hay 360 Emotional Competence Inventory to measure EI at three time points for the training group: before (pre) and after (post) training, and at six-months post training (follow up); and at two time points for the control group: pre- and follow up. The preliminary analysis was a four-way analysis of variance with one repeated measure: Group x Gender x Program Year over Time. We also completed post-hoc tests. Results: Thirty-three EM residents participated in the study (33 of 36, 92%), 19 in the EI intervention group and 14 in the control group. We found a significant interaction effect between Group and Time (p<0.05). Post-hoc tests revealed a significant increase in EI scores from Time 1 to 3 for the EI intervention group (62.6% to 74.2%), but no statistical change was observed for the controls (66.8% to 66.1%, p=0.77). We observed no main effects involving gender or level of training. Conclusion: Our brief EI training showed a delayed but statistically significant positive impact on EM residents six months after the intervention involving SPT. One possible explanation for this finding is that residents required time to process and apply the EI skills training in order for us to detect measurable change. More rigorous measurement will be needed in future studies to aid in the interpretation of our findings

Development of a Head and Neck Regional Anesthesia Task Trainer for Emergency Medicine Learners

Audience: This innovation is designed for medical students through senior residents. Introduction: Regional anesthesia increases the EM physician’s ability to provide effective pain relief and to complete procedures within the Emergency Department (ED). Studies consistently demonstrate that emergency physicians undertreat pain when performing basic procedures such as suturing lacerations.1,2 Regional anesthesia allows for effective pain relief, while avoiding the risks associated with systemic analgesia/anesthesia or the tissue distortion of local anesthesia.3 Knowledge of the anatomy involved in various nerve blocks is crucial to the development of proper technique and successful performance of this skill. Three dimensional (3-D) model simulation-based mastery of procedural skills has been demonstrated to decrease resident anxiety, improve success rates, and decrease complications during the resident’s transition into the clinical setting.5,6 Similarly, use of a 3-D head and neck model to practice application of facial regional anesthesia is hypothesized to improve provider confidence and competence which will in turn provide an improved patient experience. Objectives: In participating in the educational session associated with this task trainer, the learner will: 1) Identify landmarks for the following nerve blocks: Infraorbital, Supraorbital (V1), Mental, Periauricular 2) Demonstrate the appropriate technique for anesthetic injection for each of these nerve blocks 3) Map the distribution of regional anesthesia expected from each nerve block 4) Apply the indications and contraindications for each regional nerve block Method: This low-fidelity task trainer allows residents and medical students to practice various nerve blocks on the face in order to improve learner confidence and proficiency in performing facial regional anesthesia

Development of a Head and Neck Regional Anesthesia Task Trainer for Emergency Medicine Learners

Audience: This innovation is designed for medical students through senior residents. Introduction: Regional anesthesia increases the EM physician’s ability to provide effective pain relief and to complete procedures within the Emergency Department (ED). Studies consistently demonstrate that emergency physicians undertreat pain when performing basic procedures such as suturing lacerations.1,2 Regional anesthesia allows for effective pain relief, while avoiding the risks associated with systemic analgesia/anesthesia or the tissue distortion of local anesthesia.3 Knowledge of the anatomy involved in various nerve blocks is crucial to the development of proper technique and successful performance of this skill. Three dimensional (3-D) model simulation-based mastery of procedural skills has been demonstrated to decrease resident anxiety, improve success rates, and decrease complications during the resident’s transition into the clinical setting.5,6 Similarly, use of a 3-D head and neck model to practice application of facial regional anesthesia is hypothesized to improve provider confidence and competence which will in turn provide an improved patient experience. Objectives: In participating in the educational session associated with this task trainer, the learner will: 1) Identify landmarks for the following nerve blocks: Infraorbital, Supraorbital (V1), Mental, Periauricular 2) Demonstrate the appropriate technique for anesthetic injection for each of these nerve blocks 3) Map the distribution of regional anesthesia expected from each nerve block 4) Apply the indications and contraindications for each regional nerve block Method: This low-fidelity task trainer allows residents and medical students to practice various nerve blocks on the face in order to improve learner confidence and proficiency in performing facial regional anesthesia

THE 2016 MODEL OF THE CLINICAL PRACTICE OF EMERGENCY MEDICINE

Emergency medicine (EM) has a scientifically derived and commonly accepted description of the domain of its clinical practice. That document, "The Model of the Clinical Practice of Emergency Medicine" (EM Model), was developed through the collaboration of six organizations: the American Board of Emergency Medicine (ABEM), the administrative organization for the project, the American College of Emergency Physicians (ACEP), the Council of Emergency Medicine Residency Directors (CORD), the Emergency Medicine Residents' Association (EMRA), the Residency Review Committee for Emergency Medicine (RRC-EM), and the Society for Academic Emergency Medicine (SAEM). Development of the EM Model was based on an extensive practice analysis of the specialty. The practice analysis relied on both empiric data gathered from actual emergency department visits and several expert panels (1). The resulting product was first published in 2001, and has successfully served as the common source document for all EM organizations 2, 3. One of its strengths is incorporating the reality that EM is a specialty driven by symptoms not diagnoses, requiring simultaneous therapeutic and diagnostic interventions.The task force that developed the EM Model recommended that a new task force, composed of representatives from all six organizations, be formed every 2 years to assess the success of the document in accomplishing its objective of supporting the ongoing development of the specialty of emergency medicine; to consider alterations to the EM Model suggested by the collaborating organizations; and to recommend changes to the six sponsoring organizations.The initial 2-year review occurred in 2003, with representatives from each of the six organizations suggesting changes and reporting how their respective organizations had used the document. The initial 2-year update was published in Annals of Emergency Medicine and Academic Emergency Medicine in 2005 4, 5. Subsequently, a task force met every 2 years to review the EM Model and recommend changes 6, 7, 8, 9, 10, 11, 12, 13. In 2013, a seventh organization, the American Academy of Emergency Medicine (AAEM), was added as a collaborating organization. In 2014, the collaborating organizations made the decision to review the EM Model on a 3-year review cycle. This article provides a brief review of the original EM Model, along with the changes to the EM Model as recommended by the 2016 EM Model Review Task Force. Significant changes occurred with the 2016 review, including extensive revision of Category 17, Toxicologic Disorders. A summary of all 2016 changes and an update on current uses of the EM Model by the seven collaborating EM organizations are also included in this article

Integrating Hospice and Palliative Medicine Education Within the American Board of Emergency Medicine Model

Background: Hospice and palliative medicine (HPM) is a board-certified subspecialty within emergency medicine (EM), but prior studies have shown that EM residents do not receive sufficient training in HPM. Experts in HPM-EM created a consensus list of competencies for HPM training in EM residency. We evaluated how the HPM competencies integrate within the American Board of Emergency Medicine Milestones, which include the Model of the Clinical Practice of Emergency Medicine (EM Model) and the knowledge, skills, and abilities (KSA) list.Methods: Three emergency physicians independently mapped the HPM-EM competencies onto the 2019 EM Model items and the 2021 KSAs. Discrepancies were resolved by a fourth independent reviewer, and the final mapping was reviewed by all team members.Results: The EM Model included 78% (18/23) of the HPM competencies as a direct match, and we identified recommended areas for incorporating the other five. The KSAs included 43% (10/23). Most HPM competencies included in the KSAs mapped onto at least one level B (minimal necessary for competency) KSA. Three HPM competencies were not clearly included in the EM Model or in the KSAs (treating end-of-life symptoms, caring for the imminently dying, and caring for patients under hospice care).Conclusion: The majority of HPM-EM competencies are included in the current EM Model and KSAs and correspond to knowledge needed to be competent in EM. Programs relying on the EM Milestones to plan their curriculums may miss training in symptom management and care for patients at the end of life or who are on hospice

Integration of Geriatric Education Within the American Board of Emergency Medicine Model

Background: Emergency medicine (EM) resident training is guided by the American Board of Emergency Medicine Model of the Clinical Practice of Emergency Medicine (EM Model) and the EM Milestones as developed based on the knowledge, skills, and abilities (KSA) list. These are consensus documents developed by a collaborative working group of seven national EM organizations. External experts in geriatric EM also developed competency recommendations for EM residency education in geriatrics, but these are not being taught in many residency programs. Our objective was to evaluate how the geriatric EM competencies integrate/overlap with the EM Model and KSAs to help residency programs include them in their educational curricula.Methods: Trained emergency physicians independently mapped the geriatric resident competencies onto the 2019 EM Model items and the 2021 KSAs using Excel spreadsheets. Discrepancies were resolved by an independent reviewer with experience with the EM Model development and resident education, and the final mapping was reviewed by all team members.Results: The EM Model included 77% (20/26) of the geriatric competencies. The KSAs included most of the geriatric competencies (81%, 21/26). All but one of the geriatric competencies mapped onto either the EM Model or the KSAs. Within the KSAs, most of the geriatric competencies mapped onto necessary level skills (ranked B, C, D, or E) with only five (8%) also mapping onto advanced skills (ranked A).Conclusion: All but one of the geriatric EM competencies mapped to the current EM Model and KSAs. The geriatric competencies correspond to knowledge at all levels of training within the KSAs, from beginner to expert in EM. Educators in EM can use this mapping to integrate the geriatric competencies within their curriculums

‘Speed advising’ for medical students applying to residency programs: an efficient supplement to traditional advising

Background: Over time, Residency Match dynamics fluctuate with some specialties experiencing increases in medical student popularity. Academic departments with limited resources must devise methods for coping with increased demand for their specialty. Students perceive traditional programs on Match mechanics as inadequate. Subsequently, faculty are confronted with demands for more personal attention from more students. Objectives: We developed a strategy for providing specialty-specific residency match advising to large numbers of students. Methods: The ‘speed-advising’ session (SAS) was developed to address the common questions and concerns that medical students pose during the Match process and to provide advisees with a breadth of faculty perspectives. Two SASs were offered over a 2-week period. After the sessions, students and faculty were surveyed regarding their experience. Results: Twenty-six students pursued our specialty in the 2015 Match (26 of 234, 11.1%). Twenty-three (89%) participated in the SAS. Seventy-four percent of students (17 of 23) and all faculty completed the post-session survey. Students found the SAS to be informative, helpful and an efficient use of time. Common discussion topics included: career goals, to which programs and how many to apply, and how academic record impacts their likelihood of matching in our specialty. Students would have preferred more time with each faculty; however, most (77%) conceded that their questions were adequately answered. Faculty-favored speed advising over traditional advising (86%), primarily due to estimated time savings of 7.3 h per faculty member. Conclusions: In preparing students for the Match, specialty-specific speed advising offers an efficient supplement to traditional advising