Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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In emergency medicine, there is an ongoing debate regarding patients who use the emergency department (ED) as their usual source of medical care-an arguably costly and inefficient pattern of utilization. However, there are few accurate national data on the prevalence of such usage. This analysis uses the 1998 National Health Interview Survey to estimate the number of Americans who name the ED as their usual source of care, and compares their characteristics with those who have a usual source of care other than the ED. Poverty, lack of insurance, younger age, male gender, and minority race or ethnicity predicted identifying the ED as the usual source of care.
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Portfolios are an innovative approach to evaluate the competency of emergency medicine residents. Three key characteristics add to their attractiveness. First, portfolios draw from the resident's actual work. ⋯ The portfolios can enhance the relationship between faculty and residents since faculty will suggest cases, discuss anomalies, and interact with the residents around the portfolio. The authors believe that in general portfolios can cover many of the general competencies specified by the ACGME while still focusing on issues important to emergency medicine. The authors believe that portfolios provide an approach to evaluation commensurate with the self-evaluation skills they would like to develop in their residents.
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Simulations are exercises designed to mimic real-life situations in which learners are given the opportunity to reason through a clinical problem and make critical decisions without the potential of harming actual patients. Simulation, using a variety of formats, is useful for assessing the core competencies-particularly patient care (decision making, prioritizing, procedural skills), interpersonal skills (team leadership, communication), and systems-based practice (team structure and utilization, resource use). High-fidelity computerized human simulators are a relatively new tool for use in medical simulation. ⋯ The use of human simulators to reproduce life-threatening situations will be especially useful in assessing the clinical competence of emergency medicine physicians. Operational definitions of competence and tools with which to evaluate performance must first be developed. Standardization of scenarios and evaluation tools will permit assessment of the reproducibility of scenarios and the reliability and validity of the tools used to measure competence.