Emergency Medicine: An Integral Component of the Continuum of Critical Care That is Devalued by Fellowship Programs

Wessman, Brian; Fuller, Brian M.

doi:10.1016/j.jemermed.2015.03.026

Cited by 6 publications

(8 citation statements)

References 9 publications

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“…In addition to clinical obligations, the majority of emergency medicine/critical care physicians reported academic/administrative responsibilities. These findings illustrate that emergency medicine/critical care physicians are creating a multitude of employment experiences and demonstrates that there does not exist a classic phenotype of practice among emergency medicine/critical care physicians but rather reflects an undefined employment landscape and an inherent plasticity of emergency medicine/critical care physicians, which has been a trait identified and commented on in other studies 7,8,13 …”

Section: Discussionmentioning

confidence: 65%

“…To our knowledge, this is the first study to look at training, prac- and an inherent plasticity of emergency medicine/critical care physicians, which has been a trait identified and commented on in other studies. 7,8,13 Curiously, this study found that after critical care fellowship training, 63% of emergency medicine/critical care physicians surveyed described a practice inclusive of both emergency medicine and critical care. In the Mayglothling study, 7 52% of emergency medicine/critical care physicians engaged in a dual practice.…”

Section: Discussionmentioning

confidence: 95%

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Emergency physicians in critical care: where are we now?

et al. 2020

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Objective Prior to 2011, emergency physicians who completed critical care (CC) fellowship were unable to obtain board certification in the United States. Three pathways for CC board certification have since been established. This study explores the training, practice, and perceived challenges of emergency medicine/critical care fellows and emergency medicine/critical care physicians in the United States. Methods Anonymous institutional review board‐approved survey distributed via email through an online survey engine from April to December 2016. Participants were recruited through national organizations and independent interest groups. Emergency physicians who were in CC fellowship or had completed a CC fellowship and were in practice in the United States participated voluntarily. Results Of the 162 respondents, 152 were included (92 physicians, 60 fellows). Eighty‐nine percent ranged from 31–50 years old. Among fellows, 90% desired a dual discipline practice. Among physicians, 63% split their time between the emergency department and ICU. Seventy‐one percent of physicians reported working in academic institutions. Among physicians engaged in a dual practice, mean full‐time equivalent (±SD) devoted to the ED was 0.37 (±0.22), mean full‐time equivalent for ICU was 0.47 (±0.22), and mean full‐time equivalent for protected academic time was 0.28 (±0.19). Emergency medicine/critical care fellows and emergency medicine/critical care physicians identified numerous challenges associated with duality. Conclusions Since the advent of critical care board certification for emergency physicians in the United States, there has been an increasing number of emergency physicians pursuing CC fellowships and achieving CC board certification. Emergency medicine/critical care physicians are venturing into a variety of practice models, demonstrating that the employment landscape remains plastic. Not unexpectedly, emergency medicine/critical care fellows and emergency medicine/critical care physicians are encountering challenges intrinsic to their duality.

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 95%

Emergency physicians in critical care: where are we now?

et al. 2020

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“…One of the founding fathers of CCM, Peter Safar, stated that critical care is a continuum that initiates with the prehospital care, continues with the resuscitation and stabilization provided by EM physicians, and proceeds into the intensive care unit (ICU) 3,5 . EM graduates have been allowed to pursue CCM training since 1976 [5][6][7] .…”

Section: Resultsmentioning

confidence: 99%

“…This discordance between patient needs and physician supply has been more evident during the present pandemic. Patient outcomes, safety, and health care costs were affected due to the lack of an adequate number of CCM physicians 3,4 . Despite recent strides in efforts to address this issue, there is still a lot of work to be done.…”

Section: Introductionmentioning

confidence: 99%

Challenges of critical care medicine: why does training in critical care emergency medicine make sense?

Velázquez-García,

Marín-García,

Rodríguez-Cintrón

2023

RECC

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Background: Critical care medicine (CCM) specialists' shortage is a well-known problem. In the past decade, emergency medicine (EM) physicians became trained in CCM through the internal medicine pathway. Objective: We point out the competence acquired by EM trainees, which makes them qualified to complete a CCM fellowship and the hurdles they faced to achieve it. Methods: This study reviews the Accreditation Council for Graduate Medical Education (ACGME) EM residency requisites and how they prepare for a CCM fellowship, discusses the requisites for the EM/CCM pathway, and reviews a recent retrospective analysis by comparing the scores obtained by EM/CCM on the Multidisciplinary Critical Care Knowledge Assessment Program (MCCKAP) as well as the American Board of Internal Medicine (ABIM) examination with Surgical Critical Care Medicine SCCM and Anesthesiology Critical Care Medicine (ACCM) fellows over a 10-year period. Results: During training, EM residents become proficient in the daily management of critically ill patients. They become certified in many procedures performed by CCM physicians. Despite this, pre-requisites of certain number of clinical rotations are required when they apply. A recent study compared scores obtained by EM/CCM on the MCCKAP examination with SCCM and ACCM over a 10-year period. EM/CCM fellows obtained higher scores (562.4, SD: 67.4 vs. 505.3, SD: 87.5; p < 0.001). ABIM board certification rate was similar between EM and IM candidates (91.2 vs. 93.2%; p = 0.22). Conclusions: The higher exposure and treatment of critically ill patients experienced by EM trainees and the procedural skills they acquired made them more than qualified for an IM-CCM fellowship. Acknowledging this, VA-Caribbean Healthcare System CCM department has become the main source of EM/CCM-IM pathway physicians in Puerto Rico.

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“…[6] The initial management of a critical illness occurs in the ED, which results in emergency care and critical care being considered as one in the continuum of acute care. [7] Families and critically ill patients often remain in the ED owing to access block and high bed occupancy in critical care units. [8] Families accompanying their loved ones to the ED are usually unprepared for the turmoil associated with the experience and depend on healthcare professionals to support them through this crisis.…”

mentioning

confidence: 99%

Family-centred practices of healthcare professionals in three emergency departments in KwaZulu-Natal, South Africa

Emmamally

Brysiewicz

2018

S Afr J Crit Care

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Background. Emergency healthcare professionals can practise family-centred care (FCC) by engaging in active partnerships with families. In a chaotic environment, which challenges communication and supportive behaviours, responding to and acknowledging families' individuality enhance positive family outcomes. Objective. To describe the adherence of emergency healthcare professionals to family-centred practices in some emergency departments in KwaZulu-Natal, South Africa. Methods. A quantitative survey was conducted among healthcare professionals in three emergency departments. A previously published checklist was used to collect data on adherence to relational and participatory family-centred practices. Results. A total of 77 completed questionnaires were received from the 79 participants surveyed, giving a response rate of 97.5%. Analysis showed that healthcare professionals endeavour to practise FCC, but that their implementation of practice indicators of family-centred care is inconsistent. Results suggested that healthcare professionals used relational practices to a larger extent than participatory practices. Conclusion. In the emergency department, collaboration and partnering with families should be emphasised to ensure that principles of FCC are practised as a standard.

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Emergency Medicine: An Integral Component of the Continuum of Critical Care That is Devalued by Fellowship Programs

Cited by 6 publications

References 9 publications

Emergency physicians in critical care: where are we now?

Emergency physicians in critical care: where are we now?

Challenges of critical care medicine: why does training in critical care emergency medicine make sense?

Family-centred practices of healthcare professionals in three emergency departments in KwaZulu-Natal, South Africa

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