Medical Simulation in Emergency Medicine Continued from Page 11 those from the online resource www.emedu.org.[5] While these and other unnamed barriers may seem insurmountable, program directors and residents need to remember that simulation-based training can even result in improved outcomes on traditional multiple choice exams, and to utilize this fact to leverage time and money to implement or expand simulation training in EM residency education.[16] Simulation places the knowledge, skills, and attitudes needed to become an effective emergency physician at our fingertips, offering an expansion of traditional teaching methods favored by current residency trainees.[16] Every year, as students graduate from medical school and enter residency training, they take some form of the Hippocratic Oath at graduation. One key tenet of all of these oaths is primum non nocere – first, do no harm – and utilizing simulation in EM residency education is one way to uphold that oath. We have a technology that engages and educates without placing patients in harm’s way. As it continues to become less expensive, we expect to see a continued expansion of simulation throughout all residency training, not just EM. For those programs that have yet to take the opportunity to expand their curricula to include simulation modalities, we challenge residents or faculty who are interested to start small and think big. It is your education – make the most of it. Go to www.emedu.org and www.medsim.org to get involved.
References 1. Xiao, Y., et al., Task complexity in emergency medical care and its implications for team coordination. LOTAS Group. Level One Trauma Anesthesia Simulation. Hum Factors, 1996. 38(4): p. 636-45. 2. ACGME, A.C.f.G.M.E. Emergency Medicine Guidelines - Guidelines for procedures and resuscitations. 2010 [cited 2010 11/29/2010]; Available from: http://www.acgme.org/acWebsite/RRC_110/110_guidelines.asp. 3. Vozenilek, J., et al., See one, do one, teach one: advanced technology in medical education. Acad Emerg Med, 2004. 11(11): p. 1149-54. 4. Gordon, J.A., Vozenilek, J. A., On Behalf of the SAEM Simulation Task Force and Interest Group, and the Technology in Medical and E. Committee, The science of simulation in healthcare: defining and developing clinical expertise. . Acad Emerg Med, 2008. 15(11): p. 971-977. 5. Okuda, Y., et al., National growth in simulation training within emergency medicine residency programs, 20032008. Acad Emerg Med, 2008. 15(11): p. 1113-6. 6. Gaba, D.M., The future vision of simulation in health care. Qual Saf Health Care, 2004. 13 Suppl 1: p. i2-10. 7. Binstadt, E.S., et al., A comprehensive medical simulation education curriculum for emergency medicine residents. Ann Emerg Med, 2007. 49(4): p. 495-504, 504 e1-11. 8. Rosen, M.A., et al., A measurement tool for simulation-based training in emergency medicine: the simulation module for assessment of resident targeted event responses (SMARTER) approach. Simul Healthc, 2008. 3(3): p. 170-9. 9. Rosen, M.A., et al., Promoting teamwork: an event-based approach to simulation-based teamwork training for emergency medicine residents. Acad Emerg Med, 2008. 15(11): p. 1190-8. 10. Maran, N.J. and R.J. Glavin, Low- to high-fidelity simulation - a continuum of medical education? Med Educ, 2003. 37 Suppl 1: p. 22-8. 11. McGraw, R.C. and H.M. O’Connor, Standardized patients in the early acquisition of clinical skills. Med Educ, 1999. 33(8): p. 572-8. 12. Zabar, S., et al., Can unannounced standardized patients assess professionalism and communication skills in the emergency department? Acad Emerg Med, 2009. 16(9): p. 915-8. 13. Laack, T.A., et al., A 1-week simulated internship course helps prepare medical students for transition to residency. Simul Healthc, 2010. 5(3): p. 127-32. 14. Havighurst LC, F.L., Fields CL, High versus low fidelity simulations: does the type of format affect candidates performance or perceptions?, in 27th Annual IPMA-HR Assessment Council Conference on Personnel Assessment. 2003, Fields Consulting Group: Baltimore, Maryland. 15. Shilkofski, N., Hunt, E. Use of In Situ Simulations to Identify Barriers to Patient Care for Ad Hoc Multicultural and Multidisciplinary Teams in Developing Countries. 2010 [cited 2010 11/29/2010]; Available from: http:// www.hopkinsmedicine.org/simulation_center/downloads/Nics%20abstract. 16. Ten Eyck, R.P., M. Tews, and J.M. Ballester, Improved medical student satisfaction and test performance with a simulation-based emergency medicine curriculum: a randomized controlled trial. Ann Emerg Med, 2009. 54(5): p. 684-91.
Is Being Selected as Chief Resident a Detriment to a Career in Academics? Gabrielle Jacquet MD, Michael Barra MD, Ilona Barash MD, Mathieu De Clerck MD, Josh Flanagan MD, Eric Katz MD, John Nicolet MD, Jordan Sax MD, Jeff Soderman MD, Michael Ward MD, Jeff Druck MD Abstract: In the United States alone, there are 149 Emergency Medicine residency programs, most of which have Chief Residents chosen to lead the residents in their final year. After graduation, EM-trained physicians can work in a variety of clinical settings, ranging from community hospitals to academic institutions. There are some who believe that the Chief position is of value for developing academicians, while others believe being appointed Chief is a detriment to development of an academic career. Objective: This study was conducted to determine whether being a Chief Resident is associated with an increased likelihood of entering a career in academics as compared with non-Chief Residents. Methods: In this retrospective study, the career choices of graduates from a convenience sample of 10 nationally-accredited Emergency Medicine residencies selected over a 5-year period were collected. The data were then analyzed with respect to Chief status during residency. The data were then further analyzed in subgroups with respect to time since graduation, and with respect to 3- vs. 4-year residency program. Further statistical analysis was performed using SPSS (IBM, Armonk, NY) to derive confidence intervals and assess the absence of differences in program duration. Results: A total of 557 graduate career choices were assessed, of which 153 were Chief Residents. Overall, 34% of graduates pursued a career in academics. Of former Chief Residents, 52% pursued a career in academics. Of the graduates who were not Chief Residents, 27% pursued a career in academics (Figure 1). This resulted in an Odds Ratio of 2.853 with 95% confidence intervals from 2.80-
2.91. Conclusion: Chief Residents in our convenience sample were almost three times as likely to pursue a career in academics as non-Chiefs. Introduction: Little is known about the Chief Resident role in Emergency Medicine. A recent article surveyed Chief Residents and program directors as to the roles and responsibilities of a Chief Resident, with the career plans of Chief Residents predicted to be either a mixed community/academic practice (approx. 33%), community medicine (approx. 29%) or academic practice (approx. 19%). However, these results were from a prospective study. Other disciplines have shown that being chosen as a Chief Resident affects career choice, with Chief Residents feeling that being selected for the position influenced them to preferentially choose an academic career, but this preference has not been shown in Emergency Medicine. Some postulate that the Chief Resident role, with an increased administrative duty, serves as an introduction to academic medicine; others posit that this introduction may serve as a detriment to future involvement in academic medicine. Often, the Chief Resident role is poorly defined, and one study in family medicine found a significant discrepancy in expectations for the position. It is not currently known if Chief Residents in emergency medicine go into academic positions more frequently than their non-Chief counterparts. Career in Academics Continued on Page 13
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