A comparison of emergency medicine resident clinical experience in a rural versus urban emergency department.

Michael Charles Wadman, Benjamin Fago, Lance H. Hoffman, T. Paul Tran, Robert Leo Muelleman

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

INTRODUCTION: Strategies for increasing the numbers of American Board of Emergency Medicine certified/emergency medicine (EM) residency trained physicians practicing in rural emergency departments (EDs) include providing rural EM experiences during residency training. However, no studies to date describe the clinical work of EM residents rotating in a rural ED. The objective of the study was to compare the clinical experience of EM residents participating in a rural ED rotation with that on an urban university-based ED rotation. METHODS: Second-year EM residents completing both urban and rural clinical ED rotations self-reported the number of patients evaluated, number of patients admitted and admitting bed type, and the number and type of procedures performed over a 6 month period. Total admission rates, telemetry admission rates, and intensive care unit (ICU) admission rates were calculated and compared by z-test for two proportions. Total numbers for central venous access, conscious sedation, dislocation or fracture relocation/reduction endotracheal intubation, laceration repair, lumbar puncture, tube thoracostomy adult medical resuscitation, adult trauma resuscitation, pediatric medical resuscitation, pediatric trauma resuscitation, and the total number of ED hours completed at each clinical site were collected and procedure/resuscitation numbers calculated per 100 resident-hours in the ED. RESULTS: Five of six residents completed the patient data forms requested. Patients evaluated per hour in the rural versus urban EDs were 1.22 and 1.21, respectively. Rural versus urban ED total admission rates were 21.74% (95% CI, 28.19.01-24.47) versus 33.35% (31.50-35.20), telemetry admission rates were 3.40% (2.28-4.52) versus 14.24% (12.87-15.61), and ICU admission rates were 0.9% (0.31-1.49) versus 4.38% (3.58-5.18), with the differences in all admission rates determined to be statistically significant. Rural versus urban procedures/100 resident-hours in the ED were 0 versus 0.6 for central venous access (p = 0.087), 0.8 versus 0.3 for conscious sedation (p = 0.170), 1.3 versus 0.2 for dislocation or fracture relocation/reduction (p = 0.001), 0 versus 0.9 for endotracheal intubation (p = 0.026), 6.1 versus 2.7 for laceration repair (p < 0.001), 1.0 versus 1.0 for lumbar puncture (p = 0.845), 0.4 versus 0.2 for tube thoracostomy (p = 0.720), 2.4 versus 3.6 for adult medical resuscitation (p = 0.135), 0.7 versus 2.1 for adult trauma resuscitation (p = 0.023), 0.6 versus 0.3 for pediatric medical resuscitation (p = 0.642), and 0.8 versus 0.2 for pediatric trauma resuscitation (p = 0.034). The higher frequency of endotracheal intubations and adult trauma resuscitations per 100 resident-hours in the urban versus rural EDs was statistically significant by z-test, while laceration repair, dislocation/fracture relocation/reduction, and pediatric trauma resuscitations occurred more frequently in the rural ED by statistically significant margins. No other procedure or resuscitation type differed significantly. CONCLUSION: A rural ED rotation provides an active clinical experience, with patients per hour and most procedure frequencies being similar to those at urban sites, but with lower patient acuity as determined by admission rates.

Original languageEnglish (US)
Number of pages1
JournalRural and remote health
Volume10
Issue number2
StatePublished - Jan 1 2010

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Emergency Medicine
Resuscitation
Hospital Emergency Service
trauma
medicine
resident
move
experience
Fracture Fixation
Intratracheal Intubation
Pediatrics
Lacerations
Wounds and Injuries
Thoracostomy
Conscious Sedation
Telemetry
Spinal Puncture
Internship and Residency
Intensive Care Units
Patient Acuity

ASJC Scopus subject areas

  • Emergency Medical Services
  • Health(social science)
  • Medicine (miscellaneous)
  • Public Health, Environmental and Occupational Health

Cite this

A comparison of emergency medicine resident clinical experience in a rural versus urban emergency department. / Wadman, Michael Charles; Fago, Benjamin; Hoffman, Lance H.; Tran, T. Paul; Muelleman, Robert Leo.

In: Rural and remote health, Vol. 10, No. 2, 01.01.2010.

Research output: Contribution to journalArticle

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title = "A comparison of emergency medicine resident clinical experience in a rural versus urban emergency department.",
abstract = "INTRODUCTION: Strategies for increasing the numbers of American Board of Emergency Medicine certified/emergency medicine (EM) residency trained physicians practicing in rural emergency departments (EDs) include providing rural EM experiences during residency training. However, no studies to date describe the clinical work of EM residents rotating in a rural ED. The objective of the study was to compare the clinical experience of EM residents participating in a rural ED rotation with that on an urban university-based ED rotation. METHODS: Second-year EM residents completing both urban and rural clinical ED rotations self-reported the number of patients evaluated, number of patients admitted and admitting bed type, and the number and type of procedures performed over a 6 month period. Total admission rates, telemetry admission rates, and intensive care unit (ICU) admission rates were calculated and compared by z-test for two proportions. Total numbers for central venous access, conscious sedation, dislocation or fracture relocation/reduction endotracheal intubation, laceration repair, lumbar puncture, tube thoracostomy adult medical resuscitation, adult trauma resuscitation, pediatric medical resuscitation, pediatric trauma resuscitation, and the total number of ED hours completed at each clinical site were collected and procedure/resuscitation numbers calculated per 100 resident-hours in the ED. RESULTS: Five of six residents completed the patient data forms requested. Patients evaluated per hour in the rural versus urban EDs were 1.22 and 1.21, respectively. Rural versus urban ED total admission rates were 21.74{\%} (95{\%} CI, 28.19.01-24.47) versus 33.35{\%} (31.50-35.20), telemetry admission rates were 3.40{\%} (2.28-4.52) versus 14.24{\%} (12.87-15.61), and ICU admission rates were 0.9{\%} (0.31-1.49) versus 4.38{\%} (3.58-5.18), with the differences in all admission rates determined to be statistically significant. Rural versus urban procedures/100 resident-hours in the ED were 0 versus 0.6 for central venous access (p = 0.087), 0.8 versus 0.3 for conscious sedation (p = 0.170), 1.3 versus 0.2 for dislocation or fracture relocation/reduction (p = 0.001), 0 versus 0.9 for endotracheal intubation (p = 0.026), 6.1 versus 2.7 for laceration repair (p < 0.001), 1.0 versus 1.0 for lumbar puncture (p = 0.845), 0.4 versus 0.2 for tube thoracostomy (p = 0.720), 2.4 versus 3.6 for adult medical resuscitation (p = 0.135), 0.7 versus 2.1 for adult trauma resuscitation (p = 0.023), 0.6 versus 0.3 for pediatric medical resuscitation (p = 0.642), and 0.8 versus 0.2 for pediatric trauma resuscitation (p = 0.034). The higher frequency of endotracheal intubations and adult trauma resuscitations per 100 resident-hours in the urban versus rural EDs was statistically significant by z-test, while laceration repair, dislocation/fracture relocation/reduction, and pediatric trauma resuscitations occurred more frequently in the rural ED by statistically significant margins. No other procedure or resuscitation type differed significantly. CONCLUSION: A rural ED rotation provides an active clinical experience, with patients per hour and most procedure frequencies being similar to those at urban sites, but with lower patient acuity as determined by admission rates.",
author = "Wadman, {Michael Charles} and Benjamin Fago and Hoffman, {Lance H.} and Tran, {T. Paul} and Muelleman, {Robert Leo}",
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T1 - A comparison of emergency medicine resident clinical experience in a rural versus urban emergency department.

AU - Wadman, Michael Charles

AU - Fago, Benjamin

AU - Hoffman, Lance H.

AU - Tran, T. Paul

AU - Muelleman, Robert Leo

PY - 2010/1/1

Y1 - 2010/1/1

N2 - INTRODUCTION: Strategies for increasing the numbers of American Board of Emergency Medicine certified/emergency medicine (EM) residency trained physicians practicing in rural emergency departments (EDs) include providing rural EM experiences during residency training. However, no studies to date describe the clinical work of EM residents rotating in a rural ED. The objective of the study was to compare the clinical experience of EM residents participating in a rural ED rotation with that on an urban university-based ED rotation. METHODS: Second-year EM residents completing both urban and rural clinical ED rotations self-reported the number of patients evaluated, number of patients admitted and admitting bed type, and the number and type of procedures performed over a 6 month period. Total admission rates, telemetry admission rates, and intensive care unit (ICU) admission rates were calculated and compared by z-test for two proportions. Total numbers for central venous access, conscious sedation, dislocation or fracture relocation/reduction endotracheal intubation, laceration repair, lumbar puncture, tube thoracostomy adult medical resuscitation, adult trauma resuscitation, pediatric medical resuscitation, pediatric trauma resuscitation, and the total number of ED hours completed at each clinical site were collected and procedure/resuscitation numbers calculated per 100 resident-hours in the ED. RESULTS: Five of six residents completed the patient data forms requested. Patients evaluated per hour in the rural versus urban EDs were 1.22 and 1.21, respectively. Rural versus urban ED total admission rates were 21.74% (95% CI, 28.19.01-24.47) versus 33.35% (31.50-35.20), telemetry admission rates were 3.40% (2.28-4.52) versus 14.24% (12.87-15.61), and ICU admission rates were 0.9% (0.31-1.49) versus 4.38% (3.58-5.18), with the differences in all admission rates determined to be statistically significant. Rural versus urban procedures/100 resident-hours in the ED were 0 versus 0.6 for central venous access (p = 0.087), 0.8 versus 0.3 for conscious sedation (p = 0.170), 1.3 versus 0.2 for dislocation or fracture relocation/reduction (p = 0.001), 0 versus 0.9 for endotracheal intubation (p = 0.026), 6.1 versus 2.7 for laceration repair (p < 0.001), 1.0 versus 1.0 for lumbar puncture (p = 0.845), 0.4 versus 0.2 for tube thoracostomy (p = 0.720), 2.4 versus 3.6 for adult medical resuscitation (p = 0.135), 0.7 versus 2.1 for adult trauma resuscitation (p = 0.023), 0.6 versus 0.3 for pediatric medical resuscitation (p = 0.642), and 0.8 versus 0.2 for pediatric trauma resuscitation (p = 0.034). The higher frequency of endotracheal intubations and adult trauma resuscitations per 100 resident-hours in the urban versus rural EDs was statistically significant by z-test, while laceration repair, dislocation/fracture relocation/reduction, and pediatric trauma resuscitations occurred more frequently in the rural ED by statistically significant margins. No other procedure or resuscitation type differed significantly. CONCLUSION: A rural ED rotation provides an active clinical experience, with patients per hour and most procedure frequencies being similar to those at urban sites, but with lower patient acuity as determined by admission rates.

AB - INTRODUCTION: Strategies for increasing the numbers of American Board of Emergency Medicine certified/emergency medicine (EM) residency trained physicians practicing in rural emergency departments (EDs) include providing rural EM experiences during residency training. However, no studies to date describe the clinical work of EM residents rotating in a rural ED. The objective of the study was to compare the clinical experience of EM residents participating in a rural ED rotation with that on an urban university-based ED rotation. METHODS: Second-year EM residents completing both urban and rural clinical ED rotations self-reported the number of patients evaluated, number of patients admitted and admitting bed type, and the number and type of procedures performed over a 6 month period. Total admission rates, telemetry admission rates, and intensive care unit (ICU) admission rates were calculated and compared by z-test for two proportions. Total numbers for central venous access, conscious sedation, dislocation or fracture relocation/reduction endotracheal intubation, laceration repair, lumbar puncture, tube thoracostomy adult medical resuscitation, adult trauma resuscitation, pediatric medical resuscitation, pediatric trauma resuscitation, and the total number of ED hours completed at each clinical site were collected and procedure/resuscitation numbers calculated per 100 resident-hours in the ED. RESULTS: Five of six residents completed the patient data forms requested. Patients evaluated per hour in the rural versus urban EDs were 1.22 and 1.21, respectively. Rural versus urban ED total admission rates were 21.74% (95% CI, 28.19.01-24.47) versus 33.35% (31.50-35.20), telemetry admission rates were 3.40% (2.28-4.52) versus 14.24% (12.87-15.61), and ICU admission rates were 0.9% (0.31-1.49) versus 4.38% (3.58-5.18), with the differences in all admission rates determined to be statistically significant. Rural versus urban procedures/100 resident-hours in the ED were 0 versus 0.6 for central venous access (p = 0.087), 0.8 versus 0.3 for conscious sedation (p = 0.170), 1.3 versus 0.2 for dislocation or fracture relocation/reduction (p = 0.001), 0 versus 0.9 for endotracheal intubation (p = 0.026), 6.1 versus 2.7 for laceration repair (p < 0.001), 1.0 versus 1.0 for lumbar puncture (p = 0.845), 0.4 versus 0.2 for tube thoracostomy (p = 0.720), 2.4 versus 3.6 for adult medical resuscitation (p = 0.135), 0.7 versus 2.1 for adult trauma resuscitation (p = 0.023), 0.6 versus 0.3 for pediatric medical resuscitation (p = 0.642), and 0.8 versus 0.2 for pediatric trauma resuscitation (p = 0.034). The higher frequency of endotracheal intubations and adult trauma resuscitations per 100 resident-hours in the urban versus rural EDs was statistically significant by z-test, while laceration repair, dislocation/fracture relocation/reduction, and pediatric trauma resuscitations occurred more frequently in the rural ED by statistically significant margins. No other procedure or resuscitation type differed significantly. CONCLUSION: A rural ED rotation provides an active clinical experience, with patients per hour and most procedure frequencies being similar to those at urban sites, but with lower patient acuity as determined by admission rates.

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