Intern Orthopedic Rotation Versus Emergency Medicine Procedure Month: Which one Derives More Opportunity?

Abstract

INTRODUCTION The American College of Graduate Medical Education (ACGME) defines 18 “key procedures” as requirements in emergency medicine (EM) residency programs. The post-graduate year-1 (PGY-1) curriculum provides an early foundation for EM trainees to gain procedural experience, but traditional PGY-1 rotations may not provide robust procedural opportunities. Our objective was to replace a traditional orthopedic rotation with a 4-week rotation that emphasized EM procedure acquisition and comprehension. Although all residents met ACGME procedural requirements before the curricular modification, the purpose of this month was to increase overall procedure numbers. The block contained dedicated procedure shifts in the emergency department as well as an asynchronous, self-directed learning course. We sought to compare the number of procedures performed by PGY-1 residents during their orthopedic rotation (the year before implementation), to the number of procedures performed during their procedure rotation (the year after implementation). METHODS The total number of procedures performed and logged by PGY-1 residents during the traditional orthopedic rotation (during the year prior to implementation of the new procedure rotation) were compared to the total number of procedures by the first class to undergo the new procedure rotation the following year. Thirty resident logs were reviewed (15 per class). Data were analyzed using SAS NPAR1WAY; Z < 0.05 was considered significant. RESULTS When compared to the orthopedic rotation, the procedure rotation had statistically significant higher numbers of procedures per resident (22, standard deviation [SD] 12, vs 11.4, SD 7.6; Z = 0.0177). A wide variety of nonorthopedic procedures accounted for the increased numbers, (13.6, SD 10.3, vs 0.9, SD 0.9; Z < 0.001). While the average number of orthopedic procedures was slightly less on the procedure rotation, there was no statistical difference (orthopedic rotation 10.13, procedure rotation 8.26; Z = 0.4605). Notably, fewer procedures were performed when 2 residents were on the procedure rotation at the same time (21 vs 10.1). CONCLUSION This analysis demonstrated a larger number and a wider variety of procedures performed by PGY-1 residents during a dedicated procedure rotation compared to a traditional orthopedic rotation. Furthermore, exposure to orthopedic procedures did not decline significantly. Limitations of the study include a modest number of subjects. Data may be limited by the consistency of procedure logging by individual residents. Further studies may assess procedural competency after PGY-1 year of training.

A Profile of Orthopedic Education in Emergency Medicine Residency Programs in the United States

“…Complicating standardization further are findings by others, such as Schmitz et al, who found key differences between the ortho education received by EM residents based on the time of day, components of the rotation, amount of resident autonomy, and patient volumes [9]. Another study that compared rotation structure by Briggs et al found that both dedicated ortho rotations in the ED and primary care sports medicine rotations provided experiences comparable to rotations in an ortho department for EM residents [10]. Despite the potential for these alternative structures to be feasible options for EM residency programs to utilize for their trainees' clinical ortho experiences, we believe that specific guidelines written in the form of both educational and clinical expectations are required to ensure that EM residents graduate with the competence to manage all orthopedic related complaints effectively.…”

“…While several attempts have been made to define content better or build standardized curricula for musculoskeletal/orthopedic topics, these efforts have not generalized well across programs since offerings of orthopedic content and training are contingent upon the unique set of resources available to a program or institution [9][10][11][14][15]25]. Chow et al proposed a standard ortho curriculum that included goals, objectives, and educational strategies that could be adapted to any educational setting [25].…”

“…Prior studies have proposed various methods for incorporating orthopedic content into the EM curriculum, including but not limited to the provision of clinical rotations dedicated to caring for patients with ortho injuries or musculoskeletal complaints. Although some researchers have attempted to shed light on the effectiveness of clinical orthopedic supplements in EM education, there is limited knowledge of precisely how orthopedics is taught in EM [9][10][11][12][13][14][15]. The purpose of this study was to profile how ortho education is provided in EM residency programs across the United States.…”