Predicting American Board of Emergency Medicine Qualifying Examination Passage Using United States Medical Licensing Examination Step Scores

BACKGROUND: The objective of the current study was to determine whether emergency medicine residents\u27 United States Medical Licensing Examination (USMLE) scores are significantly associated with first-attempt passage of the American Board of Emergency Medicine (ABEM) qualifying (written) examination. We hypothesized that USMLE Step 2 Clinical Knowledge (CK) scores would be useful in predicting students who passed the ABEM qualifying examination on their first attempt. METHODS: For this retrospective cohort study, we examined the data of residents who successfully completed training at two emergency medicine residency programs between the years 2002-2013. Because scores on the USMLE Step examinations varied greatly across years, we obtained means and standard deviations from the National Board of Medical Examiners. We subtracted the mean score for the year each resident took the examination from the resident\u27s examination score, creating centered Step 1 and centered Step 2 CK scores. RESULTS: A multivariate logistic regression analysis indicated that centered Step 2 CK scores could be used to predict the odds of passing the ABEM qualifying examination (odds ratio = 1.05 [95% confidence interval 1.02 to 1.08, \u3c 0.001]). Using a Step 2 CK score cutoff of 7 points lower than the mean yielded 64% sensitivity and 81% specificity for predicting passage of the ABEM written examination on the first attempt. CONCLUSION: Program directors and selection committees may wish to consider whether applicants\u27 Step 2 CK scores are near the national average when making ranking decisions, as this variable is highly predictive of passing the ABEM qualifying examination on the initial attempt

Impact on an Urgent Care Clinic of a New Freestanding Emergency Department in a Resource-Scarce Area

Convenience clinics-such as urgent care centers (UCCs), retail clinics, and freestanding emergency departments (FSEDs)-where patients can receive treatment for a variety of medical conditions have increased in number and popularity. We quantify the impact an FSED had on UCC visits in an underserved area in North Baton Rouge, Louisiana. All FSED and UCC visits were abstracted from 2015 to 2020. Visits were classified using codes. We used a time series analysis to evaluate the association of nonemergent and emergent visits to the UCC after the opening of the FSED. Visits were also aggregated at the census block group (neighborhood) level. Demographic characteristics and the neighborhood Area Deprivation Index were used to compare UCC utilization before and after the FSED opened and to describe the visits to the UCC and the FSED. We found a difference in the demographic composition of patients presenting to the UCC after the FSED opened. Emergent visits decreased at the UCC, but nonemergent visits did not change after the FSED opened. The majority of visits to the FSED were nonemergent, and the proportion of nonemergent visits to the FSED increased during the hours that the UCC was closed. The majority of visits to the FSED came from neighborhoods with a high Area Deprivation Index. The opening of an FSED resulted in a reduction of emergent visits to the UCC without impacting the number of nonemergent visits. The opening of an FSED in a poor, healthcare-resource-scarce area resulted in significantly more patients from deprived neighborhoods being treated at the FSED and UCC

Suicide attempts presenting to trauma centers: trends across age groups using the National Trauma Data Bank

BACKGROUND: This study sought to examine the epidemiology and mortality of violent suicide attempts presenting to trauma centers and to describe differences in male and female suicide attempters presenting to trauma centers by decade of age. METHOD: Data from the National Trauma Data Bank (American College of Surgeons) years 2010-2012 were used for this study. E-codes indicative of self-inflicted injury (e950-e959) were used to identify violent suicide attempts. Incidents were categorized by decade of age at admission. We examined the effects of age and sex on rates of violent suicide attempts, mechanism used, and mortality. RESULTS: In all, 36035 violent suicide attempts were identified in the National Trauma Data Bank. Proportion of in-hospital mortality differed significantly with age (P\u3c .001). Individuals aged 20 to 29 years had a significantly higher number of attempts with 15.6% mortality, whereas individuals aged 80 plus year had fewer attempts but with 45.9% mortality. There were significant interactions between sex and age on lethality of suicide attempts (P\u3c .01) and mechanism chosen (P\u3c .01), with men being more likely to use firearms across age groups. CONCLUSION: This study highlights the importance of examining the epidemiology of suicide attempts across sex and age. There are significant differences in rate of attempts, lethality of mechanism, and in-hospital mortality. Future studies should continue to investigate violent suicide attempts to design and implement effective treatment strategies targeted toward specific populations

Using the NAART to estimate WRAT-4 reading grade level in a predominantly African American sample

Tests of word-reading ability, such as the North American Adult Reading Test (NAART) and Wide Range Achievement Test (WRAT) Word Reading subtest, are often used by neuropsychologists to estimate premorbid intelligence. However, despite the fundamental basis in reading, little work has been done to calculate or estimate literacy level from NAART performance. Additionally, few prior studies have evaluated the use of word-reading tests in underrepresented populations such as African Americans or individuals with lower socioeconomic status and educational attainment. Finally, while the correlations between the NAART and older editions of the WRAT are known, no study has yet examined the relationship between the NAART and WRAT-Fourth Edition (WRAT-4). The purpose of the current study, then, was to replicate and extend prior research in these areas. NAART and WRAT-4 Word Reading (WRAT4WR) performances were examined in a sample of 173 primarily African American individuals who were HIV-positive and who had an average of fewer than 12 years of education. Analyses revealed a strong correlation between NAART error scores and WRAT4WR raw scores (r = -.866, p \u3c .001). Linear regression was used to establish the predictive equation to estimate WRAT4WR scores from NAART errors. This information allows for determining reading grade-level equivalents based on NAART error scores