Pena Margarita E, Wheatley Matthew A, Suri Pawan, Mace Sharon E, Kwan Elizabeth, Baugh Christopher W
Department of Emergency Medicine Ascension St. John Hospital Wayne State University School of Medicine Detroit MI.
Department of Emergency Medicine Grady Memorial Hospital Emory University School of Medicine Atlanta GA.
AEM Educ Train. 2019 Dec 19;4(Suppl 1):S47-S56. doi: 10.1002/aet2.10413. eCollection 2020 Feb.
Many hospitals have or will be opening an observation unit (OU), the majority managed by the emergency department (ED). Graduating emergency medicine (EM) residents will be expected to have the knowledge and skills necessary to appropriately identify and manage patients in this setting. Our objective is to examine the current state of observation medicine (OM) education and prevalence in EM training.
In a follow-up to the 2019 Society for Academic Emergency Medicine (SAEM) OM Interest Group meeting, we convened an expert panel of OM physicians who are members of both the SAEM OM Interest Group and the American College of Emergency Physicians Section of OM. The panel of six emergency physicians representing geographic diversity was formed. A structured literature review was performed yielding 16 educational publications and sources pertaining to OM education and training across all specialties.
Only a small number of EM residencies have a required or elective OM rotation in an OU. An OM rotation in a protocol-driven ED OU gives residents experience managing patients in this setting and improves skills integral to EM and part of the EM milestones and Accreditation Council for Graduate Medical Education (ACGME) core competencies: reassessment, disposition decision making, risk stratification, team management, and practicing cost-appropriate care. Even without a formal rotation, multiple OM educational resources can be incorporated into EM resident education and didactics. Education research opportunity exists.
This panel believes that OM is an important component of EM that should be incorporated into EM residency as the knowledge and skills learned such as risk stratification, disposition decision making, and team management augment those needed for the practice of EM. There is a distinct opportunity for EM educators to better equip their trainees for a career in EM by including OM education and experience in EM residency training.
许多医院已经或即将开设观察单元（OU），其中大多数由急诊科（ED）管理。预计即将毕业的急诊医学（EM）住院医师应具备在这种环境中正确识别和管理患者所需的知识和技能。我们的目标是研究观察医学（OM）教育的现状以及在急诊医学培训中的普及程度。
在2019年学术急诊医学协会（SAEM）观察医学兴趣小组会议之后，我们召集了一个由观察医学医生组成的专家小组，他们同时是SAEM观察医学兴趣小组和美国急诊医师学会观察医学分会的成员。组成了一个代表地域多样性的六名急诊医生小组。进行了结构化文献综述，得出了16篇关于所有专业的观察医学教育和培训的教育出版物和资料来源。
只有少数急诊医学住院医师培训项目在观察单元中有必修或选修的观察医学轮转。在协议驱动的急诊科观察单元进行观察医学轮转，能让住院医师在这种环境中积累管理患者的经验，并提高急诊医学不可或缺的技能，这些技能也是急诊医学里程碑和毕业后医学教育认证委员会（ACGME）核心能力的一部分：重新评估、处置决策、风险分层、团队管理以及实施成本合理的护理。即使没有正式轮转，也可以将多种观察医学教育资源纳入急诊医学住院医师教育和教学中。存在教育研究机会。
该专家小组认为，观察医学是急诊医学的重要组成部分，应纳入急诊医学住院医师培训，因为所学的风险分层、处置决策和团队管理等知识和技能可增强急诊医学实践所需的能力。急诊医学教育工作者有明显的机会通过在急诊医学住院医师培训中纳入观察医学教育和经验，更好地使他们的学员为急诊医学职业生涯做好准备。
