Sally A. Santen

Burnout in medical students: examining the prevalence and associated factors.

Objective: Burnout has been described as a syndrome of emotional exhaustion, depersonalization, and decreased personal accomplishment, and may originate during medical school. The objective of this study is to determine the prevalence of burnout and contributing factors in medical students. Methods: A survey was administered to 249 medical students using a modified Maslach Burnout Inventory Human Services Survey (MBI-HSS) and scales of stressors, assessment of workload, relaxation, control, accomplishment, support systems, and demographics. Results: Moderate or high degree of burnout was seen in 21% of the first year class, 41% of the second year class, 43% of the third year class, and 31% of the fourth year class (P < 0.05). Lower support, higher stress, and lack of control over ones life were significantly related to burnout using multivariate analysis. Conclusions: Burnout progressively develops over the course of medical education, while a high level of support and low stress decreased burnout.

Do Patients Understand Their Physician's Level of Training? A Survey of Emergency Department Patients

Purpose To assess patients’ understanding of levels of training and responsibilities for residents, medical students, and attendings in the emergency department as well as their degree of comfort in being cared for by a physician-in-training. Method In 1999, a questionnaire was administered to a convenience sample of 430 adult patients and family members in a university emergency department. The questionnaire asked for demographic information and contained 17 questions addressing the different levels of medical training and seven opinion-based questions on patients’ willingness to have physicians-in-training care for them. Results Respondents answered 65% of the knowledge-based questions about physicians’ training correctly. Only 43% understood that residents are always supervised when caring for patients, and 30% thought attendings required supervision by a resident. Respondents with education greater than a high school diploma answered more questions correctly (71% versus 59%; p < .05). A total of 80% felt it was very important to know their physicians level of training, but only 58% reported actually knowing the level of training. Only 62% felt comfortable knowing that their physician might be a supervised physician-in-training. In addition, despite the fact that this survey took place at a teaching hospital, 22% of respondents prefer not to be treated in a teaching hospital. Conclusions Patients and their families do not fully understand the roles and responsibilities of the physicians-in-training that may be caring for them despite feeling it is important to know their physicians’ level of training.

Patients' willingness to allow residents to learn to practice medical procedures.

Purpose Consent for teaching procedures has been the focus of ethical discussion recently. Patients may consent to a procedure but be unaware that the procedure is to be performed by a resident, perhaps for the first time. In such cases, patients have not specifically consented to the practice of teaching medical procedures. The authors studied patients’ awareness of resident training and willingness to allow residents to perform procedures on them. Method A survey was administered to a convenience sample of 202 Vanderbilt University Medical Center emergency department patients from February to April 2000. Three procedures (intubation, lumbar puncture, and sutures) were demonstrated. Patients were asked about their awareness of residents’ training and willingness to allow a resident to perform the procedures for the first time versus the tenth time. Results In all, 60% of patients did not realize they could be the first person a resident performs a procedure on. Only 49% of the patients were completely comfortable being the first patient for sutures, 29% for intubation, and 15% for a lumbar puncture. Most patients felt they should be informed if it was the residents first time performing procedures (66% for sutures, 69% for intubation, and 82% for lumbar puncture). Conclusion Not only do the majority of patients not know that they might be the first patient on whom a resident performs a procedure, more than two thirds believed they should be told if they are the first patient. Particularly for intubation and lumbar puncture, patients indicated that they would be uncomfortable being the first patient on whom these procedures were performed. These data raise ethical questions regarding physicians’ obligations to inform patients about resident-performed procedures.

Not Another Boring Lecture: Engaging Learners with Active Learning Techniques

BACKGROUND Core content in Emergency Medicine Residency Programs is traditionally covered in didactic sessions, despite evidence suggesting that learners do not retain a significant portion of what is taught during lectures. DISCUSSION We describe techniques that medical educators can use when leading teaching sessions to foster engagement and encourage self-directed learning, based on current literature and evidence about learning. CONCLUSIONS When these techniques are incorporated, sessions can be effective in delivering core knowledge, contextualizing content, and explaining difficult concepts, leading to increased learning.

Factors That Influence Medical Student Selection of an Emergency Medicine Residency Program: Implications for Training Programs

OBJECTIVES An understanding of student decision-making when selecting an emergency medicine (EM) training program is essential for program directors as they enter interview season. To build upon preexisting knowledge, a survey was created to identify and prioritize the factors influencing candidate decision-making of U.S. medical graduates. METHODS This was a cross-sectional, multi-institutional study that anonymously surveyed U.S. allopathic applicants to EM training programs. It took place in the 3-week period between the 2011 National Residency Matching Program (NRMP) rank list submission deadline and the announcement of match results. RESULTS Of 1,525 invitations to participate, 870 candidates (57%) completed the survey. Overall, 96% of respondents stated that both geographic location and individual program characteristics were important to decision-making, with approximately equal numbers favoring location when compared to those who favored program characteristics. The most important factors in this regard were preference for a particular geographic location (74.9%, 95% confidence interval [CI] = 72% to 78%) and to be close to spouse, significant other, or family (59.7%, 95% CI = 56% to 63%). Factors pertaining to geographic location tend to be out of the control of the program leadership. The most important program factors include the interview experience (48.9%, 95% CI = 46% to 52%), personal experience with the residents (48.5%, 95% CI = 45% to 52%), and academic reputation (44.9%, 95% CI = 42% to 48%). Unlike location, individual program factors are often either directly or somewhat under the control of the program leadership. Several other factors were ranked as the most important factor a disproportionate number of times, including a rotation in that emergency department (ED), orientation (academic vs. community), and duration of training (3-year vs. 4-year programs). For a subset of applicants, these factors had particular importance in overall decision-making. CONCLUSIONS The vast majority of applicants to EM residency programs employed a balance of geographic location factors with individual program factors in selecting a residency program. Specific program characteristics represent the greatest opportunity to maximize the success of the immediate interview experience/season, while others provide potential for strategic planning over time. A working knowledge of these results empowers program directors to make informed decisions while providing an appreciation for the limitations in attracting applicants.

A suggested core content for education scholarship fellowships in emergency medicine

A working group at the 2012 Academic Emergency Medicine consensus conference on education research in emergency medicine (EM) convened to develop a curriculum for dedicated postgraduate fellowships in EM education scholarship. This fellowship is intended to create future education scholars, equipped with the skills to thrive in academic careers. This proceedings article reports on the consensus of a breakout session subgroup tasked with defining a common core content for education scholarship fellowships. The authors propose that the core content of an EM education scholarship fellowship can be categorized in four distinct areas: career development, theories of learning and teaching methods, education research methods, and educational program administration. This core content can be incorporated into curricula for education scholarship fellowships in EM or other fields and can also be adapted for use in general medical education fellowships.

Can You Multitask? Evidence and Limitations of Task Switching and Multitasking in Emergency Medicine.

Emergency physicians work in a fast-paced environment that is characterized by frequent interruptions and the expectation that they will perform multiple tasks efficiently and without error while maintaining oversight of the entire emergency department. However, there is a lack of definition and understanding of the behaviors that constitute effective task switching and multitasking, as well as how to improve these skills. This article reviews the literature on task switching and multitasking in a variety of disciplines-including cognitive science, human factors engineering, business, and medicine-to define and describe the successful performance of task switching and multitasking in emergency medicine. Multitasking, defined as the performance of two tasks simultaneously, is not possible except when behaviors become completely automatic; instead, physicians rapidly switch between small tasks. This task switching causes disruption in the primary task and may contribute to error. A framework is described to enhance the understanding and practice of these behaviors.

Reporting Achievement of Medical Student Milestones to Residency Program Directors: An Educational Handover.

PROBLEM Competency-based education, including assessment of specialty-specific milestones, has become the dominant medical education paradigm; however, how to determine baseline competency of entering interns is unclear-as is to whom this responsibility falls. Medical schools should take responsibility for providing residency programs with accurate, competency-based assessments of their graduates. APPROACH A University of Michigan ad hoc committee developed (spring 2013) a post-Match, milestone-based medical student performance evaluation for seven students matched into emergency medicine (EM) residencies. The committee determined EM milestone levels for each student based on assessments from the EM clerkship, end-of-third-year multistation standardized patient exam, EM boot camp elective, and other medical school data. OUTCOMES In this feasibility study, the committee assessed nearly all 23 EM milestones for all seven graduates, shared these performance evaluations with the program director (PD) where each student matched, and subsequently surveyed the PDs regarding this pilot. Of the five responding PDs, none reported using the traditional medical student performance evaluation to customize training, four (80%) indicated that the proposed assessment provided novel information, and 100% answered that the assessment would be useful for all incoming trainees. NEXT STEPS An EM milestone-based, post-Match assessment that uses existing assessment data is feasible and may be effective for communicating competency-based information about medical school graduates to receiving residency programs. Next steps include further aligning assessments with competencies, determining the benefit of such an assessment for other specialties, and articulating the national need for an effective educational handover tool between undergraduate and graduate medical education institutions.

Competency-based education: programme design and challenges to implementation.

Competency‐based education (CBE) has been widely cited as an educational framework for medical students and residents, and provides a framework for designing educational programmes that reflect four critical features: a focus on outcomes, an emphasis on abilities, a reduction of emphasis on time‐based training, and promotion of learner centredness. Each of these features has implications and potential challenges for implementing CBE.

Chaperones for rectal and genital examinations in the emergency department: What do patients and physicians want?

Background: The objective of this study was to compare patients’ preferences and physicians’ practice for the presence of chaperones during genitourinary examinations. Methods: A survey of 163 emergency department patients and 52 physicians was used to evaluate patients’ preferences and physicians’ practices for the presence and gender of a chaperone during genital examinations. Results: Most male patients (88%) did not care about the presence of a chaperone. Only 47% of female patients preferred a chaperone when a pelvic examination was to be performed by a male physician and only 26% preferred a chaperone with a female physician. One hundred percent of male and most female physicians (92%) used a chaperone for pelvic examinations. Most physicians do not ask patients whether they want a chaperone; however, most patients would like to be asked. Conclusions: We conclude there is a discrepancy between what physicians do and what their patients desire.