Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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The authors propose a three-year curriculum for emergency medicine residents using human simulation both to teach and to assess the Accreditation Council for Graduate Medical Education (ACGME) core competencies. Human simulation refers to a variety of technologies that allow residents to work through realistic patient problems so as to allow them to make mistakes, learn, and be evaluated without exposing a real patient to risk. ⋯ Because of the limitations of current assessment tools, the demonstration of resident competence is used only for formative evaluations. Limitations of this proposal and difficulties in implementation are discussed, along with a description of the organization and initiation of the simulation program.
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Systems-Based Practice (SBP) is the sixth competency defined by the Accreditation Council for Graduate Medical Education (ACGME) Outcome Project. Specifically, SBP requires "Residents [to] demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value." This competency can be divided into four subcompetencies, all of which are integral to training emergency medicine (EM) physicians: resources, providers, and systems; cost-appropriate care; delivery systems; and patient advocacy. In March 2002, the Council of Emergency Medicine Residency Directors (CORD-EM) convened a consensus conference to assist residency directors in modifying the SBP competency specific for EM. ⋯ Suggested EM residency curriculum components for SBP are already in place in most residency programs, so no additional resources would be required for their implementation. These include: emergency medical services and administrative rotations, directed reading, various interdisciplinary and hospital committee participation, continuous quality improvement project participation, evidence-based medicine instruction, and various didactic experiences, including follow-up, interdisciplinary, and case conferences. With appropriate integration and evaluation of this competency into training programs, it is likely that future generations of physicians and patients will reap the benefits of an educational system that is based on well-defined outcomes and a more systemic view of health care.
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To develop and apply a systematic approach to identify and define valid, relevant, and feasible measures of emergency department (ED) clinical performance. ⋯ Using a Modified-Delphi process, it was possible to identify a series of condition-outcome pairs that panelists felt were potentially related to ED quality of care, then define specific indicators for many of these condition-outcome pairs. Some indicators could be measured using an existing data set. The development of sound clinical performance indicators for the ED is possible, but the feasibility of measuring them will be dependent on the availability and accessibility of high-quality data.
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Excellent communication and interpersonal (C-IP) skills are a universal requirement for a well-rounded emergency physician. This requirement for C-IP skill excellence is a direct outgrowth of the expectations of our patients and a prerequisite to working in the increasingly complex emergency department environment. Directed education and assessment of C-IP skills are critical components of all emergency medicine (EM) training programs and now are a requirement of the Accreditation Council for Graduate Medical Education (ACGME) Outcome Project. ⋯ Ten specific communication competencies are defined for EM. Assessment techniques for evaluation of these C-IP competencies and a timeline for implementation are also defined. Standardized patients and direct observation were identified as the criterion standard assessment methods of C-IP skills; however, other methods for assessment are also discussed.