Fifteen Years After Katrina: Paving the Way for Health Care Transformation.

Following the devastation of the Greater New Orleans, Louisiana, region by Hurricane Katrina, 25 nonprofit health care organizations in partnership with public and private stakeholders worked to build a community-based primary care and behavioral health network. The work was made possible in large part by a $100 million federal award, the Primary Care Access Stabilization Grant, which paved the way for innovative and sustained public health and health care transformation across the Greater New Orleans area and the state of Louisiana.

Medical students' perceptions of an emergency medicine clerkship: an analysis of self-assessment surveys.

BACKGROUND: No studies have been performed that evaluate the perceptions of medical students completing an emergency medicine (EM) clerkship. Given the variability of exposure to EM in medical schools nationwide, assessment of the student rotation may inform the structure and content of new and existing clerkships, particularly in relation to student's acquisition of the core competencies. OBJECTIVES: To investigate whether undergraduate medical students rotating through an EM clerkship improved their understanding and abilities in core content areas and common procedural skills; to evaluate whether improvement was affected by rotation length. METHODS: All students participating in an EM clerkship over a 12-month period were asked to complete an anonymous voluntary pre- and post-rotation survey. Confidence with patient assessment, diagnosis, and management plans; trauma and medical resuscitations; formal and informal presentations; basic procedure skills and understanding of the modern practice of EM were self assessed using a Likert scale. Group mean scores on each question on the pre- and post-clerkship surveys were calculated and compared. The mean scores on each survey item, both pre- and post-clerkship, were compared between 2- and 4-week clerkship rotation groups. RESULTS: Two hundred thirty-nine students participated in the rotation during the 12 months of the study. One hundred sixty-one (161), or 67.4%, completed the pre-rotation survey, and 96 (40.2%) completed the post-rotation survey. Overall, students showed significant mean gains in confidence with initial patient assessment, diagnosis, and management plans (p < 0.01, 0.02, <0.01) and with basic procedure skills (p < 0.01 for all). Students completing a 2-week rotation did not differ significantly from f4week rotators in confidence levels, except in the area of formal presentation skills (p = 0.01), where the 4-week students demonstrated a statistically significant advantage. The 2-week clerkship participants were significantly less confident in all procedures except EKG interpretation, splinting, and venipuncture (p = 0.28, 0.22, 0.05). Regardless of rotation length, students generally felt they had sufficient exposure to patients and opportunities for hands-on learning and practice, and overwhelmingly would recommend the EM clerkship to a fellow student, regardless of their chosen specialty. CONCLUSIONS: Medical students show significant gains in confidence with acute care knowledge, disease management, and procedure skills after completion of an EM clerkship. Although a 4-week clerkship may be preferable to expose students to the widest variety of patients and procedures, all students can benefit and improve in core competencies after an EM undergraduate experience.

Male victims of partner violence: prevalence and accuracy of screening tools.

The objective of this study was to determine the accuracy of two brief surveys for detection of male victims of intimate partner violence (IPV) in the Emergency Department (ED). This study was conducted prospectively in an urban, teaching hospital over 6 weeks; all men triaged to the acute care portion of the ED were eligible for enrollment. Exclusion criteria included age less than 18 years, refusal, altered mental status, or condition requiring lifesaving intervention. Data included demographics, Revised Conflict Tactics Scale (CTS2) score, and scores on two brief surveys of IPV: the HITS ("Hurt/Insult/Threaten/Scream") scale and the Partner Violence Screen (PVS). The CTS2 uses previously validated population scores for female to male psychological aggression and physical assault. Neither the HITS nor the PVS has been validated for use in the ED for detecting male victims of IPV. There were 116 men approached for enrollment; nearly half completed all surveys. Mean age was 41.8 years, and the sample was 73% African-American and 20% white. Thirty-nine percent had positive scores on the psychological aggression portion of the CTS2, whereas 20% had positive scores on the physical assault subscale. Comparing the HITS and PVS to both the psychological and physical portions of the CTS2 resulted in sensitivities of 30-45% and specificities of 83-88%. False negative rates on the two brief surveys ranged from 14-33%, and negative predictive values and positive likelihood ratios were low. Neither the HITS nor the PVS accurately screens male victims of IPV in the ED. Further research is needed to develop a valid, brief screening test to identify male victims of IPV in an acute setting. (c) 2006 Elsevier Inc.