Faculty Bibliography

Background: The complexity of healthcare demands physicians develop their skills as both clinicians and leaders, but traditional medical education has not embraced a comprehensive leadership curriculum. To meet this need, the NYU School of Medicine developed a "Physician as Leaders" workshop for its students. Education Objectives: The workshop's goal is to provide students with the attitude & behavioral skills necessary to function as members and leaders of highly effective teams. Its objectives are 1. Begin to develop leadership skills, specifically in effective communication and conflict management, 2. Recognize the impact effective communication has on patient care, and 3. Reflect on personal strengths and begin to produce a personal development plan. Curriculum: The 90-min workshop was presented to 172 third year students in groups of 18. Four physicians (this included 3 medical directors and 3 other leaders within the medical school) led the course. Role play scenarios featured physicians in confrontational roles and a medical student mediating the conflict. Students also role played scenarios in small groups. A communication and conflict management didactic was given after the simulations. Results: A post-workshop survey with a 64% response rate revealed that 71% of students felt the workshop met objective 1, 67% objective 2, and 66% objective 3 (see table). Conclusion: Medical schools under prepare students for leadership positions. Conflict management and communication skills are essential to prepare medical students for daily professional interactions. This workshop was well received, and lays the groundwork for an approved 20-hr, 4-year longitudinal curriculum to teach core principles of leadership including time management, teamwork, operational improvement, and others. (Table Presented)

BACKGROUND: Medical knowledge (MK) in residents is commonly assessed by the in-training examination (ITE) and faculty evaluations of resident performance. OBJECTIVE: We assessed the reliability of clinical evaluations of residents by faculty and the relationship between faculty assessments of resident performance and ITE scores. METHODS: We conducted a cross-sectional, observational study at an academic emergency department with a postgraduate year (PGY)-1 to PGY-3 emergency medicine residency program, comparing summative, quarterly, faculty evaluation data for MK and overall clinical competency (OC) with annual ITE scores, accounting for PGY level. We also assessed the reliability of faculty evaluations using a random effects, intraclass correlation analysis. RESULTS: We analyzed data for 59 emergency medicine residents during a 6-year period. Faculty evaluations of MK and OC were highly reliable (kappa = 0.99) and remained reliable after stratification by year of training (mean kappa = 0.68-0.84). Assessments of resident performance (MK and OC) and the ITE increased with PGY level. The MK and OC results had high correlations with PGY level, and ITE scores correlated moderately with PGY. The OC and MK results had a moderate correlation with ITE score. When residents were grouped by PGY level, there was no significant correlation between MK as assessed by the faculty and the ITE score. CONCLUSIONS: Resident clinical performance and ITE scores both increase with resident PGY level, but ITE scores do not predict resident clinical performance compared with peers at their PGY level.

OBJECTIVES: The purpose of this study was to compare quarterly global evaluations with direct observation evaluations to determine if direct observation evaluations provide unique data compared to those obtained from quarterly global evaluations. METHODS: This observational, cohort study was performed at a 3-year emergency medicine (EM) residency program with 10 residents per year. Faculty used an online Web-based evaluation system to complete quarterly global evaluations and patient-specific direct observation evaluations. Two scores were collected for each resident within each quarterly evaluation period: 1) the quarterly evaluation score was the mean score across all faculty who performed a quarterly evaluation and, 2) the direct observation score was the mean score across all faculty who performed a direct observation evaluation. Pearson correlation coefficients were performed across these two groups of evaluations. RESULTS: Over the 4-year period of the study 296 complete data sets were available for the analysis. When the quarterly evaluation score was correlated with the direct observation score for each resident at the same evaluation period, we found a very high correlation for each of the eight evaluation questions (r = 0.95-0.96, p < 0.0001). When these evaluations were stratified based on the number of direct observation evaluations that were performed during the evaluation period of interest, the correlation between the quarterly evaluation and the direct observation scores increased as the number of direct observations in the evaluation period increased. The evaluation scores from the faculty who had performed both direct observation and quarterly evaluation methods during the same resident evaluation period were highly correlated even with small numbers of evaluators. CONCLUSIONS: Direct observations are highly correlated with quarterly evaluations when there are greater than three direct observation evaluations completed; however, this correlation drops significantly when the number of direct observations is lower. Direct observation evaluations provide similar data when compared with data obtained from quarterly global evaluations.

Opioid-mediated contraction of the distal common bile duct (CBD) may delay tracer passage during nuclear hepatobiliary imaging (NHI), mimicking pathologic obstruction. We sought to determine if opioid administration before NHI delays CBD visualization and prolongs imaging. The records of 198 Emergency Department patients who underwent NHI were reviewed (after excluding those with evidence for pathologic CBD obstruction). Opioids were administered before NHI in 56 cases. Delayed CBD visualization occurred in 28.6% of subjects who had received opioids and in 12.0% of those who had not (p < 0.01). Delayed imaging was performed in 77.8% of those who had received opioids and in 53.5% of those who had not (p < 0.01). The relative risk of delayed CBD visualization was 1.46 [95%CI 0.65-3.28] for meperidine, 4.18 [95%CI 2.00-8.82] for morphine, and 2.38 [95%CI 1.29-4.39] for any opioid. We conclude that opioids given before NHI are associated with delayed CBD visualization and more imaging sessions

STUDY OBJECTIVE: The design and function of emergency departments may allow breaches of privacy that could adversely affect patient satisfaction and medical care. We sought to determine whether patients perceive less privacy in ED treatment areas with curtains than in rooms with solid walls. METHODS: Patients 18 years and older at a university hospital ED who received care in a room with solid walls and a door, a curtained area next to the nurses' station, or a curtained area away from the nurses' station were surveyed. Patients responded on a 5-point Likert scale to 11 questions regarding privacy. Differences between areas were determined by using the Kruskal-Wallis and Mann-Whitney tests and were considered significant at P values of less than.05. RESULTS: Structured interviews were conducted with 108 ED patients. Responses from those in the curtained areas were similar. Compared with those in the rooms with walls, these patients more often believed that they could overhear others and that others could hear them, view them, hear personal information, and view personal parts of their bodies (P < or =.04 for all). They also perceived a lower overall sense of privacy (P <.01). Of all those surveyed, 85.2% reported 'a lot of' or 'complete' respect for privacy by the staff, and 92.6% experienced at least as much privacy as they expected, with no difference between areas. CONCLUSION: Patients perceive significantly less auditory and visual privacy in ED treatment areas with curtains compared with a room with solid walls. Consideration of these findings in current practice and in future ED design and construction is suggested

STUDY OBJECTIVE: We sought to determine the follow-up rate of discharged emergency department patients who were instructed to obtain reevaluation within 48 hours at our ED, a clinic, or a private physician's office and to determine the reasons why patients do not obtain short-term follow-up when instructed. METHODS: Emergency physicians prospectively enrolled a convenience sample of patients discharged from a university hospital ED who were believed to be at risk for clinical deterioration. Patients were instructed to obtain reevaluation within 48 hours at a public clinic, private physician's office, or our ED (without charge). A telephone interview was conducted after 48 hours had elapsed. RESULTS: Three hundred twenty-five patients were enrolled, 300 were included in data analysis, and 203 (67.7%) of these obtained follow-up as instructed. Those referred to the ED had a higher follow-up rate (105/127 [82.7%]) than those referred to clinics (59/99 [59.6%]) or private physicians (39/74 [52.7%]). Inability to obtain an appointment was cited by 34.3% of those who did not obtain follow-up care as instructed. CONCLUSION: Many patients discharged from the ED who were believed to be at risk for clinical deterioration did not obtain medical follow-up within 48 hours when so instructed. Free ED follow-up resulted in a better rate of short-term follow-up than that for clinics and private physicians and may be especially useful if a patient's ability to obtain follow-up is uncertain or if timely reevaluation is particularly imperative

A study was undertaken to determine if use of a structured review instrument (SRI) increased the perceived overall satisfaction with a journal club in a group of emergency medicine residents. Before and 6 months after the introduction of a structured checklist format for article review, a 5-point Likert scale (1 = worst, 5 = best) was used to assess residents' satisfaction with the journal club, as well as the following subsidiary outcome parameters resident and leader workload, educational value in interpreting the medical literature, and application of the information to clinical practice. Additional measured outcome variables included resident attendance and number of articles read per attendee. Continuous and categorical data were compared using the Wilcoxon Rank Sum test and Fisher's exact test, respectively. Following introduction of the SRI, residents were more satisfied with the journal club (3.8 v 3.2, P < .05). There was no change in resident attendance (92% v 71%, P = .65), total articles read (75% v 70%, P = .33), or perceived workload (3.3 v 3.1; P = .3). The use of a SRI was found to increase resident satisfaction and improve the perceived educational value of a journal club without increasing residents' workload or decreasing attendance

STUDY OBJECTIVE: To compare the tissue-cooling efficiency of external cryotherapy with and without adjunctive compression. METHODS: We conducted an experimental repeated-measures study in which each of the 11 anesthetized subject dogs served as its own control. A chemical instant cold pack was applied to each subject's ventral thighs. One pack was held in position by gravity, and the other was compressed against the musculature with a tubular elastic wrap. Baseline and subsequent temperature measurements were taken every 10 minutes for 1 hour with the use of an IM temperature probe percutaneously inserted into each subject's hind legs. RESULTS: IM temperatures were not significantly different at baseline and were coldest at 20 minutes; they increased slowly thereafter. The recorded temperature was lower under the compressed cold pack (P = .003), and changes over time for both groups were also significant (P = .005). The instantaneous temperature difference at 10, 30, 40, 50, and 60 minutes was also significant. CONCLUSION: Externally applied instant cold packs in a dog model caused local tissue hypothermia that peaked by 20 minutes, persisted for at least 1 hour, and was significantly augmented by adjunctive compression. Further research is needed to evaluate the clinical efficacy and safety of these interventions in the management of acute soft-tissue injuries