Janicki Adam James, MacKuen Courteney, Hauspurg Alisse, Cohn Jamieson
Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA;
Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA.
Med Educ Online. 2016 Jun 28;21:28930. doi: 10.3402/meo.v21.28930. eCollection 2016.
Identification and management of obstetric emergencies is essential in emergency medicine (EM), but exposure to pregnant patients during EM residency training is frequently limited. To date, there is little data describing effective ways to teach residents this material. Current guidelines require completion of 2 weeks of obstetrics or 10 vaginal deliveries, but it is unclear whether this instills competency.
We created a 15-item survey evaluating resident confidence and knowledge related to obstetric emergencies. To assess confidence, we asked residents about their exposure and comfort level regarding obstetric emergencies and eight common presentations and procedures. We assessed knowledge via multiple-choice questions addressing common obstetric presentations, pelvic ultrasound image, and cardiotocography interpretation. The survey was distributed to residency programs utilizing the Council of Emergency Medicine Residency Directors (CORD) listserv.
The survey was completed by 212 residents, representing 55 of 204 (27%) programs belonging to CORD and 11.2% of 1,896 eligible residents. Fifty-six percent felt they had adequate exposure to obstetric emergencies. The overall comfort level was 2.99 (1-5 scale) and comfort levels of specific presentations and procedures ranged from 2.58 to 3.97; all increased moderately with postgraduate year (PGY) level. Mean overall percentage of items answered correctly on the multiple-choice questions was 58% with no statistical difference by PGY level. Performance on individual questions did not differ by PGY level.
The identification and management of obstetric emergencies is the cornerstone of EM. We found preliminary evidence of a concerning lack of resident comfort regarding obstetric conditions and knowledge deficits on core obstetrics topics. EM residents may benefit from educational interventions to increase exposure to these topics.
产科急症的识别与处理在急诊医学中至关重要，但急诊住院医师培训期间接触孕妇的机会通常有限。迄今为止，几乎没有数据描述向住院医师传授这些内容的有效方法。现行指南要求完成两周的产科培训或10次阴道分娩，但尚不清楚这是否能培养出相应能力。
我们设计了一项包含15个项目的调查问卷，评估住院医师对产科急症的信心和知识。为评估信心，我们询问住院医师关于他们对产科急症以及八种常见表现和操作的接触情况与舒适度。我们通过多项选择题评估知识，这些题目涉及常见的产科表现、盆腔超声图像以及胎心监护解读。该调查问卷通过急诊医学住院医师主任委员会（CORD）的邮件列表分发给各住院医师培训项目。
212名住院医师完成了调查，他们代表了CORD所属204个项目中的55个（27%），以及1896名符合条件住院医师中的11.2%。56%的人认为他们有足够的机会接触产科急症。总体舒适度为2.99（1 - 5分制），特定表现和操作的舒适度范围为2.58至3.97；所有这些随着研究生年级（PGY）水平适度增加。多项选择题的平均总体正确回答率为58%，不同PGY水平之间无统计学差异。各单项问题的表现也不因PGY水平而异。
产科急症的识别与处理是急诊医学的基石。我们发现了初步证据，表明住院医师对产科情况缺乏信心，且在核心产科主题方面存在知识缺陷。急诊住院医师可能会从增加这些主题接触机会的教育干预中受益。
