Palliative and end-of-life care education in Canadian emergency medicine residency programs: A national cross-sectional survey.

OBJECTIVES: Emergency physicians play an important role in providing care at the end-of-life as well as identifying patients who may benefit from a palliative approach. Several studies have shown that emergency medicine (EM) residents desire further training in palliative care. We performed a national cross-sectional survey of EM program directors. Our primary objective was to describe the number of Canadian postgraduate EM training programs with palliative and end-of-life care curricula. METHODS: A 15-question survey in English and French was sent by email to all program directors of both the Canadian College of Family Physicians emergency medicine (CCFP(EM)) and the Royal College of Physicians and Surgeons of Canada emergency medicine (RCPSC-EM) postgraduate training programs countrywide using FluidSurveys™ with a modified Dillman approach. RESULTS: We received a total of 26 responses from the 36 (response rate = 72.2%) EM postgraduate programs in Canada. Ten out of 26 (38.5%) programs had a structured educational program pertaining to palliative and end-of-life care. Lectures or seminars were the exclusive choice to teach content. Clinical palliative medicine rotations were mandatory in one out of 26 (3.8%) programs. The top two barriers to implementation of palliative and end-of-life care curricula were lack of time (84.6%) and curriculum development concerns (80.8%). CONCLUSIONS: Palliative and end-of-life care training within EM has been identified as an area of need. This cross-sectional survey demonstrates that a minority of Canadian EM programs have palliative and end-of-life care curricula. It will be important for all EM training programs, RCPSC-EM and CCFP(EM), in Canada, to develop an agreed upon set of competencies and to structure their curricula around them.

Elevated liver enzymes as a predictor of liver injury in stable blunt abdominal trauma patients: case report and systematic review of the literature.

Liver injury secondary to blunt abdominal trauma is a well-defined entity in emergency medicine. A challenge exists in the diagnosis of liver trauma in the stable, wellappearing patient with a history of blunt abdominal trauma. In centres lacking advanced diagnostic modalities an elevation in hepatic transaminases may provide guidance for the rural emergency physician in seeking further imaging and/or surgical consultation. We present a case report and a discussion of the literature. The literature provided a broad spectrum of results. There appears to be a direct relationship between blunt liver trauma and elevation in liver transaminases. These results are especially evident in the pediatric population. Our findings may help guide the rural emergency physician in transfer and disposition decisions in patients in this situation.