Ectopic pregnancy is a high-risk diagnosis that is increasing in frequency and is still commonly missed in the emergency department. The emergency physician needs a high index of suspicion and must understand that the history, physical examination, and a single quantitative beta-hCG level cannot reliably rule out an ectopic pregnancy. Most pregnant patients who present to the emergency department during the first trimester with abdominal or pelvic pain, regardless of the presence of vaginal bleeding, should undergo further evaluation with ultrasonography. Ultrasound findings in conjunction with quantitative beta-hCG levels guide the management of the patient.

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IntroductionIn 2012 the Accreditation Council for Graduate Medical Education (ACGME) introduced the Next Accreditation System (NAS), which implemented milestones to assess the competency of residents and fellows. While attending evaluation and feedback is crucial for resident development, perhaps equally important is a resident’s self-assessment. If a resident does not accurately self-assess, clinical and professional progress may be compromised. The objective of our study was to compare emergency medicine (EM) resident milestone evaluation by EM faculty with the same resident’s self-assessment.MethodsThis is an observational, cross-sectional study that was performed at an academic, four-year EM residency program. Twenty-five randomly chosen residents completed milestone self-assessment using eight ACGME sub-competencies deemed by residency leadership as representative of core EM principles. These residents were also evaluated by 20 faculty members. The milestone levels were evaluated on a nine-point scale. We calculated the average difference between resident self-ratings and faculty ratings, and used sample t-tests to determine statistical significance of the difference in scores.ResultsEighteen residents evaluated themselves. Each resident was assessed by an average of 16 attendings (min=10, max=20). Residents gave themselves statistically significant higher milestone ratings than attendings did for each sub-competency examined (p<0.0001).ConclusionResidents over-estimated their abilities in every sub-competency assessed. This underscores the importance of feedback and assessment transparency. More attention needs to be paid to methods by which residency leadership can make residents’ self-perception of their clinical ability more congruent with that of their teachers and evaluators. The major limitation of our study is small sample size of both residents and attendings.

Background: During the COVID-19 pandemic, emergency medicine (EM) residency programs have transitioned from traditional in-person to virtual synchronous didactics to comply with social distancing guidelines. This study explores the perceptions of EM residents and faculty regarding this new virtual format.Methods: This was a multicenter, cross-sectional study at five EM residencies using a mixed-methods approach to investigate resident and faculty perceptions of virtual didactics. Institutions selected reflect different program lengths and geographic locations. Quantitative data measured on a Likert scale were summarized as percentages.Differences were calculated using Welch's t-test and chi-square, where p < 0.05 was significant. Open-ended responses were analyzed qualitatively.Results: Our response rate was 64% (n = 141) for residents and 48% (n = 108) for faculty. Fifty-one percent of faculty and 54% of residents felt that they were more likely to attend virtually than in person. Among residents, 77% felt that they were more likely to attend virtual conferences during vacation or elective rotations. Perceived retention of information from virtual sessions was perceived to be the same or better for 69% of residents and 58% of faculty. Residents felt that they paid more attention in the virtual format (29% vs. 26%, p = 0.037). Both groups missed the social interactions of in-person conference (86% of faculty, 75% of residents). Respondents from both groups felt that < 20% of total didactic time should remain virtual once social distancing recommendations are lifted. Qualitative analysis revealed recommendations from residents and faculty to optimize lecture style and interactivity. Decreased commute time and ability to multitask at home increased wellness for both groups.Conclusions: While benefits of virtual didactics were acknowledged, residents and faculty missed the social interaction of in-person conference and preferred < 20% of future didactics to be virtual. Further research should assess the difference in knowledge acquisition and retention between conference models.