Correlation Between Scores on Weekly Quizzes and Performance on the Annual Resident In-Service Examination.

CONTEXT: Medical residency education relies heavily on the use of written and oral testing as a means of assessing a learner's knowledge acquisition. In the United States, osteopathic emergency medicine residents take an annual specialty-based resident in-service examination (RISE) for this purpose. Their performance on the RISE helps direct educators' approach to teaching and training. OBJECTIVES: To determine the correlative strength of residents' cumulative performance on a series of weekly in-house quizzes with their performance on the RISE. METHODS: In this prospective study, emergency medicine residents took a series of 15 quizzes between August 2013 and January 2014. The quizzes were administered using slides integrated with an audience-response system. Quizzes comprised questions gathered from various question banks and commercial test review resources specific to the specialty of emergency medicine. Effort was made to select questions covering topics tested on the RISE. Scores from each of the quizzes were recorded, and these data were analyzed for correlation with residents' scores on the RISE. RESULTS: Sixteen emergency medicine residents from all 4 postgraduate years participated in the study. For various reasons (vacation, illness, away rotations), not all 16 residents participated in each quiz. The mean participation rate over all 15 quizzes was 76.7%, with a mean quiz score of 57.8%. A correlation analysis was conducted between the achieved RISE score and the mean quiz score (excluding any quizzes not taken). Graphical analysis revealed a sufficiently linear relationship between the 2 variables, with no outliers. Both variables were normally distributed, as assessed by the Shapiro-Wilks test (P>.05). A strong positive correlation was found between RISE score and mean quiz score (r[14]=0.75; P=.001), with the mean quiz score over the quizzes taken explaining about 57% of the variance in the achieved RISE score. CONCLUSIONS: The results of this study imply that performance on weekly didactic quizzes may be strongly predictive of RISE performance and as such tracking these data may provide insight to educators and learners as to the most effective direction of their educational efforts.

Osteopathic Physicians on the Editorial Boards of Major Medical Journals Over the Past 30 Years.

CONTEXT: With the recent merger of the American Osteopathic Association and the Accreditation Council for Graduate Medical Education, new standards may be established for scholarly activity criteria and designation for each specialty. OBJECTIVE: To determine the percentage of osteopathic physicians on editorial boards in general and specialty medical journals and to compare the participation of osteopathic vs allopathic physicians and other health care researchers in editorial activities. METHODS: The number of osteopathic and allopathic physicians and other health care professionals serving as editor in chief, associate editor, editorial board member, emeritus editor, or in other editorial positions was examined in 8 major medical journals (New England Journal of Medicine, JAMA, Annals of Internal Medicine, Annals of Surgery, Annals of Emergency Medicine, Annals of Family Medicine, Obstetrics and Gynecology, and Pediatrics) published during the past 30 years. RESULTS: The number of editorial board positions increased during the past 30 years, with Annals of Surgery adding the most positions (64). When compared with allopathic physicians in all fields of medicine, the number of osteopathic physicians serving on an editorial board of a medical journal was significantly less (P<.001). When all editorial positions were combined, osteopathic physicians occupied 0.15% of all positions. CONCLUSION: A disparity exists between the numbers of osteopathic vs allopathic physicians in editorial positions in the core disciplines of medicine. Further investigation into the reasons why few osteopathic physicians serve in editorial roles is needed.

Quincke's disease.

Marijuana smoke can cause thermal injury, and since legalization and increased use of marijuana in our society, differentiating, diagnosing, and managing this condition have become mandatory. A case of a 28-year-old male with Quincke's disease secondary to marijuana inhalation is presented.

Emergency Medicine Gender-specific Education.

The 2014 Academic Emergency Medicine consensus conference has taken the first step in identifying gender-specific care as an area of importance to both emergency medicine (EM) and research. To improve patient care, we need to address educational gaps in this area concurrent with research gaps. In this article, the authors highlight the need for sex- and gender-specific education in EM and propose guidelines for medical student, resident, and faculty education. Specific examples of incorporating this content into grand rounds, simulation, bedside teaching, and journal club sessions are reviewed. Future challenges and strategies to fill the gaps in the current education model are also described.

Effect of triage-based use of the Ottawa foot and ankle rules on the number of orders for radiographic imaging.

CONTEXT: Reducing unnecessary testing lessens the cost burden of medical care, but decreasing use depends on consistently following evidence-based clinical decision rules. The Ottawa foot and ankle rules (OFARs) are validated, longstanding evidence-based guidelines to predict fractures. Frequently, radiography is automatically ordered for acute ankle injuries despite findings from OFARs suggesting no fracture. OBJECTIVES: First, to determine whether implementation of protocol-driven use of the OFARs at triage would decrease the number of radiography orders and length of stay (LOS) in the emergency department. Second, to quantify the incidence of OFARs use at triage and to assess patient expectations of radiography use and patient satisfaction as rated by both patients and clinicians. METHODS: In this prospective, 2-stage sequential pilot study, patients with acute ankle and foot injuries were screened in the emergency department between January 2013 and October 2013. In the first stage, clinicians (physician assistants, residents, and attending physicians) performed their usual practice habits for radiography use in the control group. For the second stage, they were educated to appropriately apply the OFARs before ordering radiography. For patients who were suspected of having a fracture at triage, nursing staff ordered radiography. For patients who were not suspected of having a fracture at triage, a clinician reassessed them using the OFARs after their triage assessment. Radiography was then ordered at the discretion of the clinician. Results gathered after training in the OFARs comprised the intervention group. After discharge, patients were surveyed regarding their expectations and satisfaction, and clinicians were surveyed on their perceptions of patient satisfaction. RESULTS: A total of 131 patients were screened, 62 patients were enrolled in the study after consent was obtained, and 2 patients withdrew from the study prematurely, leaving 30 patients in each group. Fifty-eight of the 60 patients (97%) underwent radiography. Emergency department LOS decreased from 103 minutes to 96.5 minutes (P=.297) after the OFARs were applied. There was also a decrease in LOS in patients with a fracture (137 minutes vs 103 minutes [P=.112]). Radiography was expected to be ordered by 27 of 30 patients in the control group (90%) and 24 of 30 in the intervention group (80%) (P=.472). Patients were equally satisfied among the groups (54 of 60 [90%]) (with no difference between groups), and 27 of 30 (90%) vs 30 of 30 (100%) clinicians in the control and intervention groups, respectively, perceived that patients were satisfied with their treatment. CONCLUSION: There was no statistical evidence that application of the OFARs decreases the number of imaging orders or decreases LOS. This observation suggests that even when clinicians are being observed and instructed to use clinical decision rules, their evaluation bias tends toward recommendations for testing.

Research priorities for the influence of gender on diagnostic imaging choices in the emergency department setting.

Diagnostic imaging is a cornerstone of patient evaluation in the acute care setting, but little effort has been devoted to understanding the appropriate influence of sex and gender on imaging choices. This article provides background on this issue and a description of the working group and consensus findings reached during the diagnostic imaging breakout session at the 2014 Academic Emergency Medicine consensus conference "Gender-specific Research in Emergency Care: Investigate, Understand, and Translate How Gender Affects Patient Outcomes." Our goal was to determine research priorities for how sex and gender may (or should) affect imaging choices in the acute care setting. Prior to the conference, the working group identified five areas for discussion regarding the research agenda in sex- and gender-based imaging using literature review and expert consensus. The nominal group technique was used to identify areas for discussion for common presenting complaints to the emergency department where ionizing radiation is often used for diagnosis: suspected pulmonary embolism, suspected kidney stone, lower abdominal pain with a concern for appendicitis, and chest pain concerning for coronary artery disease. The role of sex- and gender-based shared decision-making in diagnostic imaging decisions is also raised.

Carbon monoxide poisoning secondary to hookah smoking.

Hookah smoking, at one time confined to North Africa, the eastern Mediterranean region, the Arabian peninsula, and Southeast Asia, has begun to spread throughout the world. As some practices of eastern and Arab cultures reach the United States, the number of people using hookah on an experimental or regular basis has increased. Carbon monoxide poisoning can be a common adverse effect, possibly undetected by physicians, in hookah smokers. The authors report a case of carbon monoxide poisoning secondary to smoking tobacco through a hookah.

Developmental and persistent developmental stuttering: an overview for primary care physicians.

Stuttering is a speech disorder characterized by a disruption in the fluency, timing, and rhythm of normal speech. It affects approximately 5% of children at some point in their lives. Although dysfluency often resolves before adulthood, it may cause periods of extreme anxiety for patients, especially those who continue to stutter in adolescence and adulthood. Although these patients are unlikely to stop stuttering, treatment options are available to reduce anxiety and therefore the severity of symptoms. In the present review article, the authors discuss the pathophysiology, diagnosis, and management of developmental stuttering in children and adults.

Tenosynovitis caused by texting: an emerging disease.

De Quervain tenosynovitis is characterized by pain that overlies the radial aspect of the wrist and that is aggravated by ulnar deviation of the hand. The most common cause of de Quervain tenosynovitis is overuse of the thumb musculature. The authors report a case of bilateral de Quervain tenosynovitis observed in a woman aged 48 years at a rural outpatient primary care office. The condition was induced by the patient's excessive use of the text messaging feature on her cellular telephone. Treatment, including naproxen, cock-up wrist splints, and limitation of texting, resulted in complete recovery of the patient. The authors urge physicians to be aware of the potential association between a patient's tenosynovitis symptoms and excessive texting.

Pathophysiologic mechanisms, diagnosis, and management of dapsone-induced methemoglobinemia.

Dapsone is a leprostatic agent commonly prescribed for the treatment of patients with leprosy, malaria, and a variety of blistering skin diseases, including dermatitis herpetiformis. Methemoglobinemia, a potentially life-threatening condition in which the oxygen-carrying capacity of blood in body tissues is reduced, is a known adverse effect of dapsone use. The authors report a case of dapsone-induced methemoglobinemia observed in the emergency department during routine workup for contact dermatitis in a patient with celiac disease. The pathophysiologic mechanisms, diagnosis, and management of dapsone-induced methemoglobinemia are discussed.