Emergency Medicine Physicians’ Knowledge and Perceptions of Training, Education, and Resources in Eating Disorders

Abstract

Background: Eating disorders, specifically anorexia nervosa, have one of the highest mortality rates of all mental illnesses.(1) Knowledge and perceptions of patients with eating disorders (ED) in the Emergency Medicine (EM) specialty is not explored. EM physicians may be the first or only provider a patient interacts with. The purpose of this study is to explore previous training/education, perceptions of available resources, and educational needs in treating eating disorders in practicing Emergency Medicine (EM) physicians. Methods: A 36-question investigator-developed survey was used in this cross-sectional study. Data were extracted from Opinio for statistical analyses. SAS 9.4 was used to analyze data. The survey assessed EM physicians’ previous training, education, and confidence in treating and diagnosing eating disorders in adults and adolescents. The primary outcomes assessed were participants’ previous training/education in eating disorders, knowledge of resources for patients, and educational needs.Results: Of the 162 participants, just 1.9% completed a rotation on eating disorders during residency. Ninety-three percent were unfamiliar with the American Psychiatric Association’s Practice Guideline for the Treatment of Patients with Eating Disorders; 95% were unfamiliar with the publication, “ED [Emergency Department] management of patients with eating disorders”. At least 50% were unaware of seven of the ten resources for patients with eating disorders examined. At least 50% agreed additional education on 15 of the 19 topics examined would be useful; 85% agreed to education on assessment of patients with eating disorders in the ED.Conclusions: Providing EM physicians with comprehensive education and training and increasing awareness of eating disorder resources could result in identifying more patients with eating disorders to increase treatment post-discharge.

Considering a risk profile based on emergency department utilization in young people with eating disorders: Implications for early detection

“…Health service use before and immediately after diagnosis of an eating disorder has been found to be significantly elevated in adolescents and young adults, which is consistent with our findings (Dooley‐Hash, Lipson, Walton, & Cunningham, 2013; Striegel‐Moore et al, 2008). ED physicians may not have the training or knowledge of resources for eating disorder patients' post‐ED discharge (Ma, Gonzales‐Pacheco, Cerami, & Coakley, 2021). This suggests that eating disorder patients who are not documented as having an eating disorder may not be screened appropriately and may be discharged without support or resources.…”

“…The findings from the current study present an opportunity for learning and training for ED health care staff. Education and training surrounding eating disorders throughout medical school and residency has been reported as lacking by ED residents (Ma et al, 2021). Literature suggests that while ED residents may be aware of the medical signs, symptoms, and complications of eating disorders, they often feel unprepared to screen for an eating disorder, especially when the psychological, physical, and behavioral warning signs are unclear and ambiguous.…”

“…This screening protocol would not be used to diagnose but rather assist ED physicians and other health care staff in detecting signs of an eating disorder so that they can connect the patient with appropriate next steps for treatment. This would include a referral to a specialized eating disorder program, hospital‐based stabilization, consult with psychiatry, access to community resources (i.e., psychological and dietetic services), suggestion of support groups or non‐profit organizations (Hornberger & Lane, 2021; Ma et al, 2021). If the patient endorses an eating disorder when screened, further assessment from a psychiatric nurse team or psychiatrist could be completed.…”

A retrospective cohort study examining health care utilization patterns in individuals diagnosed with an eating disorder in childhood and/or adolescence

“…Furthermore, they suggested patients with EDs are not screened appropriately and often leave without follow‐up (Redekopp et al, 2021). These authors concluded that emergency department residents and medical students receive little training and feel apprehensive if signs for an ED are ambiguous (Ma et al, 2021). They also suggest there should be better screening in the emergency department, especially if signs suggestive of an ED are present such as, anxiety, depression, suicidality, cardiovascular and GI complications.…”