Jeremy Branzetti

Impact of Burnout on Self-Reported Patient Care Among Emergency Physicians

Introduction Burnout is a syndrome of depersonalization, emotional exhaustion and sense of low personal accomplishment. Emergency physicians (EPs) experience the highest levels of burnout among all physicians. Burnout is associated with greater rates of self-reported suboptimal care among surgeons and internists. The association between burnout and suboptimal care among EPs is unknown. The objective of the study was to evaluate burnout rates among attending and resident EPs and examine their relationship with self-reported patient care practices. Methods In this cross-sectional study burnout was measured at two university-based emergency medicine residency programs with the Maslach Burnout Inventory. We also measured depression, quality of life (QOL) and career satisfaction using validated questionnaires. Six items assessed suboptimal care and the frequency with which they were performed. Results We included 77 out of 155 (49.7%) responses. The EP burnout rate was 57.1%, with no difference between attending and resident physicians. Residents were more likely to screen positive for depression (47.8% vs 18.5%, p=0.012) and report lower QOL scores (6.7 vs 7.4 out of 10, p=0.036) than attendings. Attendings and residents reported similar rates of career satisfaction (85.2% vs 87.0%, p=0.744). Burnout was associated with a positive screen for depression (38.6% vs 12.1%, p=0.011) and lower career satisfaction (77.3% vs 97.0%, p=0.02). EPs with high burnout were significantly more likely to report performing all six acts of suboptimal care. Conclusion A majority of EPs demonstrated high burnout. EP burnout was significantly associated with higher frequencies of self-reported suboptimal care. Future efforts to determine if provider burnout is associated with negative changes in actual patient care are necessary.

Emergency Medicine Faculty Are Poor at Predicting Burnout in Individual Trainees: An Exploratory Study

Burnout is common among emergency medicine (EM) physicians, and it is prevalent even among EM trainees. Recently proposed Accreditation Council for Graduate Medical Education requirements encourage faculty to alert residency leadership when trainees display signs of burnout. It remains uncertain how trainees experiencing burnout can be reliably identified. We examined if EM faculty advisers at one institution can accurately predict burnout in their EM resident advisees.

Supplemental Milestones for Emergency Medicine Residency Programs: A Validation Study

Introduction Emergency medicine (EM) residency programs may be 36 or 48 months in length. The Residency Review Committee for EM requires that 48-month programs provide educational justification for the additional 12 months. We developed additional milestones that EM training programs might use to assess outcomes in domains that meet this accreditation requirement. This study aims to assess for content validity of these supplemental milestones using a similar methodology to that of the original EM Milestones validation study. Methods A panel of EM program directors (PD) and content experts at two institutions identified domains of additional training not covered by the existing EM Milestones. This led to the development of six novel subcompetencies: “Operations and Administration,” “Critical Care,” “Leadership and Management,” “Research,” “Teaching and Learning,” and “Career Development.” Subject-matter experts at other 48-month EM residency programs refined the milestones for these subcompetencies. PDs of all 48-month EM programs were then asked to order the proposed milestones using the Dreyfus model of skill acquisition for each subcompetency. Data analysis mirrored that used in the original EM Milestones validation study, leading to the final version of our supplemental milestones. Results Twenty of 33 subjects (58.8%) completed the study. No subcompetency or individual milestone met deletion criteria. Of the 97 proposed milestones, 67 (69.1%) required no further editing and remained at the same level as proposed by the study authors. Thirty milestones underwent level changes: 15 (15.5%) were moved one level up and 13 (13.4%) were moved one level down. One milestone (1.0%) in “Leadership and Management” was moved two levels up, and one milestone in “Operations and Administration” was moved two levels down. One milestone in “Research” was ranked by the survey respondents at one level higher than that proposed by the authors; however, this milestone was kept at its original level assignment. Conclusion Six additional subcompetencies were generated and assessed for content validity using the same methodology as was used to validate the current EM Milestones. These optional milestones may serve as an additional set of assessment tools that will allow EM residency programs to report these additional educational outcomes using a familiar milestone rubric.

Faculty Prediction of In-Training Examination Scores of Emergency Medicine Residents: A Multicenter Study

BACKGROUND The Emergency Medicine In-Training Examination (EMITE) is one of the few validated instruments for medical knowledge assessment of emergency medicine (EM) residents. The EMITE is administered only once annually, with results available just 2 months before the end of the academic year. An earlier predictor of EMITE scores would be helpful for educators to institute timely remediation plans. A previous single-site study found that only 69% of faculty predictions of EMITE scores were accurate. OBJECTIVE The goal of this article was to measure the accuracy with which EM faculty at five residency programs could predict EMITE scores for resident physicians. METHODS We asked EM faculty at five different residency programs to predict the 2014 EMITE scores for all their respective resident physicians. The primary outcome was prediction accuracy, defined as the proportion of predictions within 6% of the actual scores. The secondary outcome was prediction precision, defined as the mean deviation of predictions from the actual scores. We assessed faculty background variables for correlation with the two outcomes. RESULTS One hundred and eleven faculty participated in the study (response rate 68.9%). Mean prediction accuracy for all faculty was 60.0%. Mean prediction precision was 6.3%. Participants were slightly more accurate at predicting scores of noninterns compared to interns. No faculty background variable correlated with the primary or secondary outcomes. Eight participants predicted scores with high accuracy (>80%). CONCLUSIONS In this multicenter study, EM faculty possessed only moderate accuracy at predicting resident EMITE scores. A very small subset of faculty members is highly accurate.

ALiEM Blog and Podcast Watch: Procedures in Emergency Medicine

Introduction The WestJEM Blog and Podcast Watch presents high-quality, open-access educational blogs and podcasts in emergency medicine (EM) based on the ongoing Academic Life in EM (ALiEM) Approved Instructional Resources (AIR) and AIR-Professional series. Both series critically appraise resources using an objective scoring rubric. This installment of the Blog and Podcast Watch highlights the topic of procedure emergencies from the AIR Series. Methods The AIR Series is a continuously building curriculum that follows the Council of Emergency Medicine Residency Directors’ (CORD) annual testing schedule. For each module, relevant content is collected from the top 50 Social Media Index sites published within the previous 12 months, and scored by eight AIR board members using five equally weighted measurement outcomes: Best Evidence in Emergency Medicine (BEEM) score, accuracy, educational utility, evidence based, and references. Resources scoring ≥30 out of 35 available points receive an AIR label. Resources scoring 27–29 receive an “honorable mention” label if the executive board agrees that the post is accurate and educationally valuable. Results A total of 85 blog posts and podcasts were evaluated in June 2016. This report summarizes key educational pearls from the three AIR posts and the 10 Honorable Mentions. Conclusion The WestJEM Blog and Podcast Watch series is based on the AIR and AIR-Pro series, which attempts to identify high-quality educational content on open-access blogs and podcasts. This series provides an expert-based, post-publication curation of educational social media content for EM clinicians, with this installment focusing on procedure emergencies within the AIR series.