Audience Response System Facilitates Prediction of Scores on In-Training Examination.

INTRODUCTION: Audience response systems (ARS) are increasingly popular; however, their contribution to education is not completely clear. Our study found that scores from review quizzes delivered by an ARS correlate with in-training exam (ITE) scores and are viewed positively by residents. This information may be useful in identifying poor performers early so that targeted educational interventions can be made. The objective was to determine if scores on review quizzes delivered by an ARS correlate with ITE scores and to obtain participant feedback on use of the ARS for ITE preparation. METHODS: This was a prospective observational study of emergency medicine (EM) residents at six accredited EM residency programs. Subjects included residents who had taken previous ITEs. Subjects participated in bimonthly review sessions using an ARS. Twelve review quizzes were administered, each consisting of 10 multiple-choice questions. After the ITE, subjects completed an attitudinal survey consisting of six Likert-scale items and one "yes/no" item. We used a mixed linear model to analyze the data, accounting for prior 2012 ITE scores and nesting due to institution. RESULTS: Among 192 participants, 135 (70.3%) completed the ITE in both 2012 and 2013; we analyzed their data for the first objective. Results from the mixed linear model indicate that the total mean score on the review quizzes was a significant [t(127) = 6.68; p < 0.001] predictor of the 2013 ITE after controlling for the 2012 ITE score. One hundred forty-six (76.0%) participants completed the attitudinal survey; 96% of respondents stated that they would like ARS to be used more often in resident education. Respondents felt the sessions aided in learning (mean 7.7/10), assisted in preparation for the ITE (mean 6.7/10), and helped identify content areas of weakness (mean 7.6/10). CONCLUSION: Our results suggest that scores from review quizzes delivered by an audience response system correlate with in-training exam scores and is viewed positively by residents.

Imaging and laboratory testing in acute abdominal pain.

When discussing which laboratory tests or imaging to order in the setting of acute abdominal pain, it is practical to organize information by disease process (eg, acute appendicitis, cholecystitis). Because studies on the accuracy of diagnostic tests are of necessity related to the presence or absence of specific diagnoses, and because clinicians frequently look to tests to help them rule in or rule out specific conditions, this article is organized by region of pain and common abdominal diagnoses. It focuses on the contributions that laboratory testing and imaging make in the emergency management of abdominal complaints.

Performance of medical residents in sterile techniques during central vein catheterization: randomized trial of efficacy of simulation-based training.

BACKGROUND: Catheter-related bloodstream infection (CRBSI) is a preventable cause of a potentially lethal ICU infection. The optimal method to teach health-care providers correct sterile techniques during central vein catheterization (CVC) remains unclear. METHODS: We randomly assigned second- and third-year internal medicine residents trained by a traditional apprenticeship model to simulation-based plus video training or video training alone from December 2007 to January 2008, with a follow-up period to examine CRBSI ending in July 2009. During the follow-up period, a simulation-based training program in sterile techniques during CVC was implemented in the medical ICU (MICU). A surgical ICU (SICU) where no residents received study interventions was used for comparison. The primary outcome measures were median residents' scores in sterile techniques and rates of CRBSI per 1,000 catheter-days. RESULTS: Of the 47 enrolled residents, 24 were randomly assigned to the simulation-based plus video training group and 23 to the video training group. Median baseline scores in both groups were equally poor: 12.5 to 13 (52%-54%) out of maximum score of 24 (P = .95; median difference, 0; 95% CI, 0.2-2.0). After training, median score was significantly higher for the simulation-based plus video training group: 22 (92%) vs 18 (75%) for the video training group (P < .001; median difference, 4; 95% CI, 3-6). During the follow-up period, there was a significantly lower rate of CRBSI in the MICU (1.0 per 1,000 catheter-days) compared with the SICU (3.4 per 1,000 catheter-days) (P = .03). The incidence rate ratio derived from the Poisson regression (0.30; 95% CI, 0.10-0.91) indicated there was a 70% reduction in the incidence of CRBSI in the postintervention MICU compared with the preintervention MICU and the postintervention SICU. CONCLUSIONS: Simulation-based training in sterile techniques during CVC is superior to traditional training or video training alone and is associated with decreased rate of CRBSI. Simulation-based training in CVC should be routinely used to reduce iatrogenic risk. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT00612131; URL: clinicaltrials.gov.

Does reported funding differ by gender in the surgical literature?

BACKGROUND: It is commonly believed that women surgeons are less likely to be funded and to publish than their male counterparts. According to the American Board of Surgery, currently 13.5% of board-certified surgeons are women. OBJECTIVE: We compared first authorship and reported funding of original articles in the surgical literature by gender. METHODS: We conducted a structured review of all original articles during 2006 from 4 major surgical journals (Annals of Surgery, Archives of Surgery, Surgery, and Journal of the American College of Surgeons). For each article, the gender and academic degree of the first author was determined as well as the study design, type and country of the institution, and source of funding, if any. chi tests were used to compare the rates of reported funding, academic degrees, and type of research by gender of author. A multivariate logistic regression model was used to determine the association between gender, degree, country, institution, and study design with funding. RESULTS: Of the 664 original research reports evaluated, 118 (17.8% [95% confidence interval (CI), 15.0-20.9]) were first-authored by women and 522 (78.6% [95% CI, 75.3-81.6]) by men (in 24 [3.6%], the gender of the first author was unknown). Two hundred fifty-eight (38.9% [95% CI, 35.2-42.6]) of the articles reported funding. Funding rates among men and women were not quite significantly different (37.0% vs. 45.8%, difference 8.8%; 95% CI, -1%-19%; P = 0.08). The percentage of randomized clinical trials (RCTs) among men and women first authors was similar (13.4% vs. 13.6%, P = 0.92). Female first authors were less likely to have a medical degree than male first authors (93 of 118 [78.8%] vs. 486 of 519 [93.6%], P < 0.0010). On multivariate analysis, non-RCTs were less likely to be funded than RCTs (odds ratio, 0.25; 95% CI, 0.14-0.40). CONCLUSIONS: The percentage of original surgical articles first authored by women is greater than the percentage of female surgeons. Funding rates of original articles were similar among men and women.