This article reflects the proceedings of a workshop session, Postgraduate Education and Knowledge Translation, at the 2007 Academic Emergency Medicine Consensus Conference on knowledge translation (KT) in emergency medicine (EM). The objective was to develop a research strategy that incorporates KT into EM graduate medical education (GME). To bridge the gap between the best evidence and optimal patient care, Pathman et al. suggested a multistage model for moving from evidence to action. Using this theoretical knowledge-to-action framework, the KT consensus conference group focused on four key components: acceptance, application, ability, and remembering to act on the existing evidence. The possibility that basic familiarity, along with the pipeline by Pathman et al., may improve KT uptake may be an initial starting point for research on GME and KT. Current residents are limited by faculty GME role models to demonstrate bedside KT principles. The rapid uptake of KT theory will depend on developing KT champions locally and internationally for resident physicians to emulate. The consensus participants combined published evidence with expert opinion to outline recommendations for identifying the barriers to KT by asking four specific questions: 1) What are the barriers that influence a resident's ability to act on valid health care evidence? 2) How do we break down these barriers? 3) How do we incorporate this into residency training? 4) How do we monitor the longevity of this intervention? Research in the fields of GME and KT is currently limited. GME educators assume that if we teach residents, they will learn and apply what they have been taught. This is a bold assumption with very little supporting evidence. This article is not an attempt to provide a complete overview of KT and GME, but, instead, aims to create a starting point for future work and discussions in the realm of KT and GM. ACADEMIC EMERGENCY MEDICINE 2007; 14:1008-1014 ª 2007 by the Society for Academic Emergency MedicineKeywords: graduate medical education, residents, emergency medicine, knowledge translation, core competency T he task of theme IIIa of this consensus conference on knowledge translation (KT) was to develop a research framework describing how medical education strategies can promote evidence implementation by emergency medicine (EM) resident physicians.KT skills should be appreciated and utilized by medical students, residents, and postgraduate physicians. Yet, each of these groups has a unique baseline skill set and appreciation for the capacity of KT to enhance EM clinical practice. Accordingly, KT education will need to be
Using the DSM-IV criteria for personality disorders, prevalence rates for these disorders were evaluated among methadone maintenance patients, with a psychometric test--the Millon Clinical Multiaxial Inventory (MCMI-III). We found that 77% of patients met the study criteria for at least one personality disorder. Of those who had a personality disorder, 20% had two personality disorders, 14% had three personality disorders, and 6% had four personality disorders. Rates of specific personality disorders are reported. Consistencies and divergence from existing research literature are noted. It is suggested that future research compare psychometrically based self-report questionnaires to a structured clinical interview format, within the same clinical population.
Teaching ability and efficiency of clinical operations are important aspects of physician performance. In order to promote excellence in education and clinical efficiency, it would be important to determine physician qualities that contribute to both. We sought to evaluate the relationship between teaching performance and patient throughput times. Methods: The setting is an urban, academic emergency department with an annual census of 65,000 patient visits. Previous analysis of an 18-question emergency medicine faculty survey at this institution identified 5 prevailing domains of faculty instructional performance. The 5 statistically significant domains identified were: Competency and Professionalism, Commitment to Knowledge and Instruction, Inclusion and Interaction, Patient Focus, and Openness and Enthusiasm. We fit a multivariate, random effects model using each of the 5 instructional domains for emergency medicine faculty as independent predictors and throughput time (in minutes) as the continuous outcome. Faculty that were absent for any portion of the research period were excluded as were patient encounters without direct resident involvement. Results: Two of the 5 instructional domains were found to significantly correlate with a change in patient treatment times within both datasets. The greater a physician's Commitment to Knowledge and Instruction, the longer their throughput time, with each interval increase on the domain scale associated with a 7.38-minute increase in throughput time (90% confidence interval [CI]: 1.89 to 12.88 minutes). Conversely, increased Openness and Enthusiasm was associated with a 4.45-minute decrease in throughput (90% CI: À8.83 to À0.07 minutes). Conclusion: Some aspects of teaching aptitude are associated with increased throughput times (Openness and Enthusiasm), while others are associated with decreased throughput times (Commitment to Knowledge and Instruction). Our findings suggest that a tradeoff may exist between operational and instructional performance. [
World Bank Working Papers are published to communicate the results of the Bank's work to the development community with the least possible delay. The manuscript of this paper therefore has not been prepared in accordance with the procedures appropriate to formally-edited texts. Some sources cited in this paper may be informal documents that are not readily available. The findings, interpretations, and conclusions expressed herein are those of the author(s) and do not necessarily reflect the views of the International Bank for Reconstruction and Development/The World Bank and its affiliated organizations, or those of the Executive Directors of The World Bank or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of The World Bank of the legal status of any territory or the endorsement or acceptance of such boundaries. The material in this publication is copyrighted. Copying and/or transmitting portions or all of this work without permission may be a violation of applicable law. The International Bank for Reconstruction and Development/The World Bank encourages dissemination of its work and will normally grant permission promptly to reproduce portions of the work. Fontani (UNESCO Caribbean), Domenec Ruiz Devesa (World Bank LCSHE), Tara E. O'Connell (World Bank HDNED), Jenelle Babb (UNESCO Caribbean), Lesley Drake (PCD) and Anthi E. Patrikios (PCD). We gratefully acknowledge the support of CARICOM, especially Myrna Bernard and Edward Greene, throughout the processes described in this report. The document was peer reviewed by Alexandria Valerio (World Bank LCSHE) and Andy Chi Tembon (World Bank AFTH3). Feedback was provided by Eduardo Velez Bustillo (LCSHE), Mary T. Mulusa (World Bank LCSHH), John S. Osika (World Bank LCSHH), Cynthia Hobbs (World Bank LCSHE) and Angela Demas (World Bank LCSHE).
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