Background Social determinants of health (SDoH) have significant implications for health outcomes in the United States. Emergency departments (EDs) function as the safety nets of the American health care system, caring for many vulnerable populations. ED‐based interventions to assess social risk and mitigate social needs have been reported in the literature. However, the breadth and scope of these interventions have not been evaluated. As the field of social emergency medicine (SEM) expands, a mapping and categorization of previous interventions may help shape future research. We sought to identify, summarize, and characterize ED‐based interventions aimed at mitigating negative SDoH. Methods We conducted a scoping review to identify and characterize peer‐reviewed research articles that report ED‐based interventions to address or impact SDoH in the United States. We designed and conducted a search in Medline, CINAHL, and Cochrane CENTRAL databases. Abstracts and, subsequently, full articles were reviewed independently by two reviewers to identify potentially relevant articles. Included articles were categorized by type of intervention and primary SDoH domain. Reported outcomes were also categorized by type and efficacy. Results A total of 10,856 abstracts were identified and reviewed, and 596 potentially relevant studies were identified. Full article review identified 135 articles for inclusion. These articles were further subdivided into three intervention types: a) provider educational intervention (18%), b) disease modification with SDoH focus (26%), and c) direct SDoH intervention (60%), with 4% including two “types.” Articles were subsequently further grouped into seven SDoH domains: 1) access to care (33%), 2) discrimination/group disparities (7%), 3) exposure to violence/crime (34%), 4) food insecurity (2%), 5) housing issues/homelessness (3%), 6) language/literacy/health literacy (12%), 7) socioeconomic disparities/poverty (10%). The majority of articles reported that the intervention studied was effective for the primary outcome identified (78%). Conclusion Emergency department–based interventions that address seven different SDoH domains have been reported in the peer‐reviewed literature over the past 30 years, utilizing a variety of approaches including provider education and direct and indirect focus on social risk and need. Characterization and understanding of previous interventions may help identify opportunities for future interventions as well as guide a SEM research agenda.
The authors hope that these data will prove useful to the surgeon for both identifying the LSN and planning for potential neurotization procedures of the brachial plexus.
Background Beginning January 26th, 2022, the National Board of Medical Examiners transitioned scoring of the United States Medical Licensing Examination (USMLE) Step 1 from a 3-digit score to pass/fail. In the past, the Step 1 score has been weighted heavily by program directors (PDs) as one of the most important metrics when assessing medical student’s competitiveness. Objective The objective of this study was to evaluate the perceptions of emergency medicine (EM) PDs on the transition to a pass/fail USMLE Step 1 exam, and to elicit the opinions of EM PDs on the USMLE examinations’ ability to predict resident performance. Methods A survey consisting of ranking and multiple-choice questions was sent to EM PDs. The multiple-choice questions were asked to determine EM PDs level of confidence in the ability of Step 1 and Step 2 Clinical Knowledge (CK) to predict a student’s ability to succeed in residency. The ranking questions focused on assessing each program’s current resident selection practices in comparison to expected selection criteria changes following a transition to pass/fail Step 1. R studio and MATLAB were used for statistical analysis, and a P value <0.05 was considered significant. Results The survey was completed by 57 (20.21%) EM PDs. When asked if Step 1 and Step 2 CK are accurate predictors of a resident’s ability to perform clinically within EM, only 10.5% of PDs answered ‘yes’ to Step 1 being predictive, compared to 31.6% for Step 2 CK. Regarding selection criteria, the top quartile of attributes (standardized letters of evaluation [1st], away rotations [2nd], clerkship grades [3rd] and Step 2 CK score [4th]) remained the same following the transition. Conclusion Our results indicate that the top quartile of attributes might remain the same, despite most PDs agreeing that Step 2 CK is a better predictor of a resident’s performance.
Background: Performance on the annual in-training examination (ITE) for emergency medicine (EM) residents has been shown to correlate with performance on the American Board of Emergency Medicine (ABEM) qualifying examination. As such, significant planning is often committed to ITE preparation, from an individual resident and a residency program perspective. Online specialty-specific question banks (QBanks) represent a popular medium for ITE preparation; however, the impact of QBanks on ITE performance is unclear. We sought to assess the impact of QBank participation on EM resident ITE performance. Methods: ITE and QBank performance results were collated over 2 academic years, 2019 and 2020, from a 3-year EM residency program. The QBank was provided as a self-study option in 2019 and incorporated as a mandatory component of the curriculum in 2020. ITE raw scores and percentile rank for training level scores were compared with performance on the QBank, including QBank average performance score as well as number of QBank questions completed. The Pearson correlation coefficient was used to measure association between ITE performance and QBank correlates.Additional descriptive demographics, to include gender, PGY level, and USMLE step 1 and 2 scores were also considered.Results: Sixty-two sets (30 residents in 2019, 32 residents in 2020) of ITE performance data and QBank correlates were included. Overall, raw ITE scores and number of QBank questions completed were found to have a significant, positive correlation,
Objectives The coronavirus disease 2019 (COVID‐19) pandemic significantly affected the ability of residency programs and applicants to interact using traditional methods of in‐person interviews and visiting rotations. We examined the social media presence of emergency medicine (EM) residency training programs and how programs responded to the COVID‐19 pandemic. Methods The Electronic Residency Application Service (ERAS) identified EM residency programs that participated in the 2021 match. Programs were reviewed for the presence of a website and social media accounts on Twitter, Instagram, and Facebook, as well as foundation date. Data were collected after the ERAS application deadline. Results All programs, except one, had some sort of online presence. A total of 258 websites and 476 social media accounts were identified. The majority of programs maintained an account on Twitter (75%), Instagram (61%), or Facebook (38%). Most Twitter and Facebook accounts were established before the onset of the COVID‐19 pandemic. However, 46% of Instagram accounts were created after March 1, 2020. During 2020, there was a 34% increase in total social media account development, higher than in previous years. Conclusion EM residency training programs have a robust online presence. Account development continued to grow in 2020, after the onset of the COVID‐19 pandemic, and growth on Instagram was noted to be substantial. Interactions through online platforms may supplement the residency application process, but their efficacy is unclear.
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