Optimizing global health experiences in emergency medicine residency programs: A consensus statement from the Council of Emergency Medicine Residency Directors 2011 Academic Assembly global health specialty track

BACKGROUND: An increasing number of emergency medicine (EM) residency training programs have residents interested in participating in clinical rotations in other countries. However, the policies that each individual training program applies to this process are different. To our knowledge, little has been done in the standardization of these experiences to help EM residency programs with the evaluation, administration and implementation of a successful global health clinical elective experience. The objective of this project was to assess the current status of EM global health electives at residency training programs and to establish recommendations from educators in EM on the best methodology to implement successful global health electives. METHODS: During the 2011 Council of Emergency Medicine Residency Directors (CORD) Academic Assembly, participants met to address this issue in a mediated discussion session and working group. Session participants examined data previously obtained via the CORD online listserve, discussed best practices in global health applications, evaluations and partnerships, and explored possible solutions to some of the challenges. In addition a survey was sent to CORD members prior to the 2011 Academic Assembly to evaluate the resources and processes for EM residents’ global experiences. RESULTS: Recommendations included creating a global health working group within the organization, optimizing a clearinghouse of elective opportunities for residents and standardizing elective application materials, site evaluations and resident assessment/feedback methods. The survey showed that 71.4% of respondents have global health partnerships and electives. However, only 36.7% of programs require pre-departure training, and only 20% have formal competency requirements for these global health electives. CONCLUSIONS: A large number of EM training programs have global health experiences available, but these electives and the trainees may benefit from additional institutional support and formalized structure

A model for emergency medicine education in post-conflict Liberia

AbstractThe specialty of emergency medicine (EM) remains largely underdeveloped in many parts of the world including Africa. Within West Africa the Liberian health care system was presented with incredible challenges in the immediate post conflict years. One significant challenge facing the country was the paucity of health care providers. In 2006, only 122 physicians were practising in Liberia (one for every 26,782 citizens), only 87 of them Liberian national physicians. The public health indicators in post conflict Liberia suffered as a result of the overburdened system. Many indicators placed Liberia as having the worst health survivability in the world. Significantly, morbidity and mortality associated with unaddressed emergent presentations remained high.This article describes a unique paradigm for addressing the deficit in human capacity for emergency health care in the Republic of Liberia. This system was designed and supported by a consortium of academic medical centres in the United States working in conjunction with a local non-governmental organisation, Health Education and Relief Through Teaching (HEARTT). Since 2007, the consortium has delivered virtually uninterrupted emergency medical care and medical education at the largest teaching hospital in Liberia. The Liberian programme objectives included supervising and directing emergency medical care, providing a model for curriculum development, building capacity for medical education, and improving systems-based EM practice. The collaboration of multiple academic institutions in bringing emergency medical services and academic EM teaching to a post-conflict setting remains a unique model for introducing the development of acute care in a developing country

Exploration of Global Health Careers Across the Medical Fields

BackgroundDespite expansion of interest among American medical students in global health (GH), academic medical centers face multiple obstacles to the development of structured GH curricula and career guidance. To meet these demands we sought to provide a systematic analysis of the accounts of GH experts.MethodsWe developed a collaborative, interview-based, qualitative analysis of GH experiences across six career-related themes that are relevant to medical students interested in GH: justification, medical education, economics, research prospects, law and ethics, and work-life balance. Seven GH faculty members were interviewed for 30-90 minutes using sample questions as guidelines. We applied a grounded theory approach to analyze the interview transcripts to discover an emerging theory pertinent to GH trainees.FindingsRegarding 'justification,' 4 respondents defined GH as work with the underserved irrespective of geographic location; 5 respondents found sustainability imperative; and all respondents believe GH creates better physicians. Respondents identified many physician competencies developed through GH 'medical education,' with 5 respondents agreeing that work with underserved populations has transformative potential. Concerning 'economics', 3 respondents acknowledged GH's popularity among trainees, resulting in increased training opportunities, and 2 respondents emphasized an associated deficiency in program quality. All respondents described career models across specialties. Four respondents noted funding challenges when discussing 'research prospects'. Within the theme of 'laws and ethics', 4 respondents perceived inadequate accountability, and 6 respondents identified ways to create accountability. Finally, 6 respondents recognized family demands can compromise one's GH career and thus 'work-life balance'.ConclusionDespite diverse perspectives on the meaning and sustainability of GH work, this analysis provides a nascent framework that may inform curricular development for GH trainees. Suggestions are offered for elaborating this framework to fully exploit the transformative potential of GH training in medical education

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Differences in Self-expression Reflect Formal Evaluation in a Fourth-year Emergency Medicine Clerkship

Introduction: Medical schools have begun to incorporate self-reflection exercises into their curricula, with the belief that these exercises help students master the material more deeply and perform better. Reflection may be a potential learning tool for Emergency Medicine, but there are few data supporting this hypothesis. The authors evaluated the relationship between a linguistic marker of the degree of reflection after a student’s shift in an emergency department and that student’s clerkship performance.Methods: The authors conducted a retrospective case series by analyzing the performance and reflective statements of 116 students from a single medical school who participated in a required emergency medicine clerkship at one or two of four clinical sites from 2013-14. After each shift, an attending emergency medicine physician evaluated the student according to the RIME (Reporter-Interpreter-Manager-Educator) scheme. The authors developed software to extract the text from those comments, remove uninformative words and standardize the remaining words. The authors determined the most common words and two-word phrases that students used to describe their shift.  The correlation between students’ final clerkship grades and the fraction of student comments with at least one content word was analyzed.Results: Of the 145 possible records, 116 were included for analysis. The other 29 were excluded as they were visiting students who did not receive a final numeric grade. The correlation between final grade and the number of completed self-reflections was 0.32. The correlation between final grade and the average number of words in each self-reflection was 0.21. The first correlation is significantly greater than 0 (p=0.03, t-test), but the second correlation is not (p=0.16, t-test). The median final grade of those who wrote reflections on more than half of their shifts was significantly greater than those who wrote reflections half of the time, 83.675 versus 79.23 (p=0.05, 2-sample Kolmogorov-Smirnov test).Conclusions: Students who reflected more frequently received a higher grade in an emergency medicine clerkship for fourth year medical students. The number of words in each reflection was not significantly correlated with grade performance. The most common words and phrases students wrote were associated with learning and managing patients

Differences in Self-expression Reflect Formal Evaluation in a Fourth-year Emergency Medicine Clerkship

Introduction: Medical schools have begun to incorporate self-reflection exercises into their curricula, with the belief that these exercises help students master the material more deeply and perform better. Reflection may be a potential learning tool for emergency medicine (EM), but there are few data supporting this hypothesis. The authors evaluated the relationship between a linguistic marker of the degree of reflection after a student’s shift in an emergency department and that student’s clerkship performance. Methods: The authors conducted a retrospective case series by analyzing the performance and reflective statements of 116 students from a single medical school who participated in a required EM clerkship at one or two of four clinical sites from 2013-14. After each shift, an attending emergency physician evaluated the student according to the RIME (Reporter-Interpreter-Manager- Educator) scheme. The authors developed software to extract the text from those comments, remove uninformative words and standardize the remaining words. The authors determined the most common words and two-word phrases that students used to describe their shift. The correlation between students’ final clerkship grades and the fraction of student comments with at least one content word was analyzed. Results: Of the 145 possible students, 116 were included for analysis. The other 29 were excluded as they were visiting students who did not receive a fi nal numeric grade. The correlation between final grade and the number of completed self-reflections was 0.32. The correlation between final grade and the average number of words in each self -reflection was 0.21. The first correlation is significantly greater than 0 (p=0.03, t-test), but the second correlation is not (p=0.16, t-test). The median final grade of those who wrote reflections on more tha n half of their shifts was significantly greater than those who wrote reflections half of the time, 83.675 versus 79.23 (p=0.05, 2-sample Kolmogorov-Smirnov test). Conclusion: Students who reflected more frequently received a higher grade in an EM clerkship for fourth-year medical students. The number of words in each reflection was not significantly correlated with grade performance. The most common words and phrases students wrote were associated with learning and managing patients