CJEM
-
Prompt diagnosis of acute coronary syndrome (ACS) using a 12-lead electrocardiogram (ECG) is a critical task for emergency physicians. While computerized algorithms for ECG interpretation are limited in their accuracy, machine learning (ML) models have shown promise in several areas of clinical medicine. We performed a systematic review to compare the performance of ML-based ECG analysis to clinician or non-ML computerized ECG interpretation in the diagnosis of ACS for emergency department (ED) or prehospital patients. ⋯ ML models have overall higher discrimination and sensitivity but lower specificity than clinicians and non-ML software in ECG interpretation for the diagnosis of ACS. ML-based ECG interpretation could potentially serve a role as a "safety net", alerting emergency care providers to a missed acute MI when it has not been diagnosed. More rigorous primary research is needed to definitively demonstrate the ability of ML to outperform clinicians at ECG interpretation.
-
Health economic evaluations are used in decision-making regarding resource allocation and it is imperative that they are completed with rigor. The primary objectives were to describe the characteristics and assess the quality of economic evaluations published in emergency medicine journals. ⋯ The majority of health economic evaluations in the emergency medicine literature are cost-utility analyses and are of high quality. Decision analytic models and studies primarily designed as economic analyses were positively correlated with higher quality. To improve study quality, future EM economic evaluations should justify the choice of the perspective of the analysis and the selection of the primary outcome.
-
Review
Call to action: equity, diversity, and inclusion in emergency medicine resident physician selection.
This call to action seeks to improve emergency care in Canada for equity-deserving communities, enabled by equitable representation among emergency physicians nationally. Specifically, this work describes current resident selection processes and makes recommendations to enhance the equity, diversity, and inclusion (EDI) of resident physician selection in Canadian emergency medicine (EM) residency programs. ⋯ We call on Canadian EM training programs to implement these eight recommendations to strengthen EDI practices in EM resident physician selection and, in doing so, help to improve the care that patients from equity-deserving groups receive in Canada's emergency departments (EDs).
-
Transition from residency to unsupervised practice represents a critical stage in learning and professional identity formation, yet there is a paucity of literature to inform residency curricula and emergency department transition programming for new faculty. ⋯ The Canadian EM community used a structured process to develop 14 best practice recommendations to enhance the transition to practice phase of residency training as well as the transition period in the career of junior attending physicians.
-
The purpose of this study was to identify the learning needs of emergency physicians returning to Emergency Medicine (EM) practice after clinical leaves of less than 2 years, summarize existing return to practice programs, and propose recommendations regarding ideal educational and support structures for these physicians both during their practice gaps and upon return to EM. ⋯ We have developed a set of recommendations regarding ideal educational and support structures for physicians experiencing gaps in practice of less than 2 years. This set of recommendations was informed by review of existing and exemplar programs, policies and experience of regulatory bodies, interviews with EM Department Heads across Canada, and a subsequent process of consensus at the 2022 CAEP conference academic symposium. It is hoped that this set of recommendations will inform discussions and potential strategies employed by departments to facilitate the smooth and effective return to EM practice for individuals experiencing gaps.