Gottlieb Michael, Jordan Jaime, Krzyzaniak Sara, Mannix Alexandra, King Andrew, Cooney Robert, Fix Megan, Shappell Eric
Department of Emergency Medicine Rush University Medical Center Chicago Illinois USA.
Department of Emergency Medicine David Geffen School of Medicine at UCLA Los Angeles California USA.
AEM Educ Train. 2023 Feb 5;7(1):e10841. doi: 10.1002/aet2.10841. eCollection 2023 Feb.
Procedural competency is expected of all emergency medicine (EM) residents upon graduation. The ACGME requires a minimum number of essential procedures to successfully complete training. However, data are limited on the actual number of procedures residents perform and prior studies are limited to single institutions over short time periods. This study sought to assess the number of Key Index Procedures completed during EM residency training and evaluate trends over time.
We conducted a retrospective review of graduating EM resident procedure logs across eight ACGME accredited residency programs over the last 10 years (2013-2022). Sites were selected to ensure diversity of program length, program type, and geography. All data from EM residents graduating in 2013-2022 were eligible for inclusion. Data from residents from combined training programs, those who did not complete their full training at that institution (i.e., transferred in/out), or those who did not have data available were excluded. We determined the list of procedures based upon the ACGME Key Index Procedures list. Sites obtained totals for each of the identified procedures for each resident upon graduation. We calculated the mean and 95% CI for each procedure.
We collected data from a total of 914 residents, with 881 (96.4%) meeting inclusion criteria. The most common procedures were point-of-care ultrasound, adult medical resuscitation, adult trauma resuscitation, and intubation. The least frequent procedures included pericardiocentesis, cricothyroidotomy, cardiac pacing, vaginal delivery, and chest tubes. Most procedures were stable over time with the exception of lumbar punctures (decreased) and point-of-care ultrasound (increased).
In a national sample of EM programs, procedural numbers remained stable except for lumbar puncture and ultrasound. This information can inform residency training curricula and accreditation requirements.
所有急诊医学（EM）住院医师毕业时都应具备程序操作能力。毕业后医学教育认证委员会（ACGME）要求完成一定数量的基本程序才能成功完成培训。然而，关于住院医师实际执行的程序数量的数据有限，先前的研究仅限于单个机构且时间较短。本研究旨在评估急诊医学住院医师培训期间完成的关键指标程序的数量，并评估随时间的趋势。
我们对过去10年（2013 - 2022年）八个经ACGME认证的住院医师培训项目中毕业的急诊医学住院医师的程序记录进行了回顾性研究。选择这些地点是为了确保项目时长、项目类型和地理位置的多样性。2013 - 2022年毕业的急诊医学住院医师的所有数据均符合纳入标准。联合培训项目的住院医师、未在该机构完成全部培训（即转入/转出）的住院医师或没有可用数据的住院医师的数据被排除。我们根据ACGME关键指标程序列表确定程序清单。各地点获取了每位住院医师毕业时每项确定程序的总数。我们计算了每项程序的平均值和95%置信区间。
我们共收集了914名住院医师的数据，其中881名（96.4%）符合纳入标准。最常见的程序是床旁超声、成人医疗复苏、成人创伤复苏和插管。最不常见的程序包括心包穿刺术、环甲膜切开术、心脏起搏、阴道分娩和胸管置入。除腰椎穿刺（减少）和床旁超声（增加）外，大多数程序随时间保持稳定。
在全国急诊医学项目样本中，除腰椎穿刺和超声外，程序数量保持稳定。这些信息可为住院医师培训课程和认证要求提供参考。
