Elsevier

The Journal of Emergency Medicine

Volume 16, Issue 1, January–February 1998, Pages 121-127
The Journal of Emergency Medicine

Education
Quantification of Procedures and Resuscitations in an Emergency Medicine Residency

Presented in part at the 1993 Society for Academic Emergency Medicine Meeting.
https://doi.org/10.1016/S0736-4679(97)00252-7Get rights and content

Abstract

Currently, there are no data that govern the number of procedures that are necessary to promote competence during emergency medicine (EM) training. Nonetheless, the Residency Review Committee requires each program to report the average number of procedures and resuscitations performed by its residents. For 7 years, we have used a computer database to track resuscitation and procedure experience for 42 residents. We have documented resident experience both in our 36,000-visit Level I Trauma Center emergency department and during off-service rotations in our 400-bed university teaching hospital. We report data from four graduating classes (n = 24). We estimate that residents have recorded 60% of the actual procedures performed. The 24 residents documented 11,947 procedures, averaging 498 per resident (range 264–1055), and participated in 3432 resuscitations, or 143 per resident (range 64–379). Mean and standard deviations are reported for 20 specific EM procedures and 4 types of resuscitations. EM residents perform a large number of procedures, but there is wide inter-resident variability. There is no documentation that some residents perform even one of some rare but critical procedures. This tracking system suggests, then, that procedure simulations, or cadaver and animal models, must be developed and used to enhance experience. This program can be modified to track resident experience in any specialty, as well as to document supervision by faculty and support credentialling inquiries.

Introduction

One component of optimal training in emergency medical procedures is the performance of a sufficient number to promote competence, but there are no data that govern how many are necessary 1, 2. An accurate catalogue of this experience is necessary for several reasons. First, for individual residents, paucity of experience may translate into inadequate skill, and documented experience during training supports credentialling for independent practice. Programmatically, because the Emergency Medicine Residency Review Committee (RRC-EM) requires each program to report the average number of procedures and resuscitations performed by its residents, such a catalog is mandatory [2]. Variability in skill and motivation between residents and between programs at different sites (urban vs. rural) and of different lengths should result in wide differences in procedural and resuscitation experience. Only one previous report [1]detailed these activities for a single class of residents in Texas. We report a larger sample across four residency classes, expanding on a preliminary report [3].

Section snippets

Materials and Methods

This study was conducted at the University of California, Irvine (UCI), Emergency Medicine Residency, in Orange, CA. Training in this emergency medicine resident year 1 (EM-1) through emergency medicine resident year 3 (EM-3) residency takes place predominantly at UCI Medical Center, an urban, 400-bed, Level I Trauma Center with an annual emergency department (ED) census of 36,000 patients, and an annual major trauma census of 1,800. The department admits 27% of its patients, with half of these

Results

Procedure and resuscitation experience for 24 EM residents are shown in Table 1. The 2-month audit of compliance in the ED shows that approximately 60% of the actual procedures performed were recorded in the system (Table 1). We did not find any procedures recorded on data sheets that were not present on the patient charts.

For 3 years, when there were 18 residents, recorded procedures by academic year were as follows: 1993–1994 (2561), 1994–1995 (1781), and 1995–1996 (2350). Procedures recorded

Discussion

The use of computerized databases for tracking EM resident experience has several advantages. The ease of data retrieval from a centralized database provides for a quick, ongoing analysis of resident performance in which weaknesses and deficiencies can be pinpointed and improved. Procedure experience has become a part of resident evaluation sessions. Residents and faculty subsequently pay special attention during clinical rotations to areas of inexperience, and supplement these under close

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    Education is coordinated by Stephen R. Hayden, md, of the University of California San Diego Medical Center, San Diego, California

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