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2.
J Empir Res Hum Res Ethics ; 14(2): 117-125, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30866723

RESUMO

Residents serve as both trainees and employees and can be considered potentially vulnerable research participants. This can lead to variation in the institutional review board (IRB) review. We studied sites participating in the Assessment of Professional Behaviors Study sponsored by the National Board of Medical Examiners (2009-2011). Of the 19 sites, all but one were university affiliated. IRB review varied; 2/19 did not submit to a local IRB, 4/17 (23%) were exempt, 11/17 (65%) were expedited, and 2/17 (12%) required full Board review; 12/17 (71%) required written informed consent. The interval from submission to approval was 1 to 2 months (8/17); the range was 1 to 7 months. Although most stated there were no major barriers to approval, the most common concern was resident coercion and loss of confidentiality. Local IRB review of this educational research study varied.

3.
Acad Emerg Med ; 26(3): 303-316, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30667132

RESUMO

OBJECTIVES: Organizations to promote career networking and mentorship among women are recommended as a best practice to support the recruitment and retention of women physicians; however, the impact of such organizations is unknown. Our primary objective is to describe the impact of a national woman-focused organization for academic emergency physicians on retention and advancement. METHODS: We conducted semistructured interviews of past and present organization leaders, as well as members at varying stages in their careers. Physicians with experience in qualitative methods conducted interviews and coded all transcripts using inductive content analysis techniques. Themes were reviewed and discussed to ensure consensus. RESULTS: We performed 17 interviews lasting 20 to 30 minutes each, resulting in 476 total minutes of transcript. Participants represented varying stages of career experience, ranging from 2 to 35 years since residency completion (median = 9.5 years). Median years of participation in the woman-focused organization was 10 years. Over half (53%) of participants were past presidents of the organization. The dominant themes encompassed facilitating academic advancement through scholarly productivity, leadership experiences, awards, and promotions; mentorship and sponsorship; peer support and collaborations; reduced professional isolation; and initiatives to address systemic gender inequities and challenges, including strategies to navigate bias, promote pay equity, and advocate for family-friendly workplace policies. DISCUSSION: Active participation in a woman-focused professional organization enhances members' career retention and advancement by creating opportunities and relationships that facilitate leadership, enabling scholarly work to advance equity and inclusion, and cultivating a sense of belonging. While challenges and barriers persist, the myriad benefits of a women-focused professional organization reported by members and leaders represent important steps toward greater equity for women and other underrepresented groups in academic medicine.


Assuntos
Medicina de Emergência/organização & administração , Liderança , Médicas/organização & administração , Sociedades Médicas/organização & administração , Mobilidade Ocupacional , Docentes de Medicina/organização & administração , Feminino , Humanos , Mentores , Pesquisa Qualitativa
5.
AEM Educ Train ; 2(2): 91-99, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30051075

RESUMO

Objectives: This study aimed to understand the personality characteristics of emergency medicine (EM) residents and assess consistency and variations among residency programs. Methods: In this cross-sectional study, a convenience sample of residents (N = 140) at five EM residency programs in the United States completed three personality assessments: the Hogan Personality Inventory (HPI)-describing usual tendencies; the Hogan Development Survey (HDS)-describing tendencies under stress or fatigue; and the Motives, Values, and Preferences Inventory (MVPI)-describing motivators. Differences between EM residents and a normative population of U.S. physicians were examined with one-sample t-tests. Differences between EM residents by program were analyzed using one-way analysis of variance tests. Results: One-hundred forty (100%), 124 (88.6%), and 121 (86.4%) residents completed the HPI, HDS, and MVPI, respectively. For the HPI, residents scored lower than the norms on the adjustment, ambition, learning approach, inquisitive, and prudence scales. For the HDS, residents scored higher than the norms on the cautious, excitable, reserved, and leisurely scales, but lower on bold, diligent, and imaginative scales. For the MVPI, residents scored higher than the physician population norms on altruistic, hedonistic, and aesthetics scales, although lower on the security and tradition scales. Residents at the five programs were similar on 22 of 28 scales, differing on one of 11 scales of the HPI (interpersonal sensitivity), two of 11 scales of the HDS (leisurely, bold), and three of 10 scales of the MVPI (aesthetics, commerce, and recognition). Conclusions: Our findings suggest that the personality characteristics of EM residents differ considerably from the norm for physicians, which may have implications for medical students' choice of specialty. Additionally, results indicated that EM residents at different programs are comparable in many areas, but moderate variation in personality characteristics exists. These results may help to inform future research incorporating personality assessment into the resident selection process and the training environment.

6.
AEM Educ Train ; 2(2): 162-168, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30051083

RESUMO

Objectives: The objective was to examine emergency medicine (EM) residents' perceptions of gender as it intersects with resuscitation team dynamics and the experience of acquiring resuscitation leadership skills. Methods: This was an exploratory, qualitative study using grounded theory and a purposive sample of postgraduate year (PGY) 2-4 EM residents who function as resuscitation team leaders in two urban EM programs. One-on-one interviews were conducted by a single experienced researcher. Audiotaped interviews were transcribed and deidentified by two research assistants. A research team composed of a PhD educational researcher, a research nurse, an MPH research assistant, and an EM resident reviewed the transcripts and coded and analyzed data using MAXQDA v12. Themes and coding schema were discussed until consensus was reached. We used member checking to assess the accuracy of our report and to confirm that the interpretations were fair and representative. Results: Theme saturation was reached after interviewing 16 participants: 10 males and 6 females. The three major themes related to gender that emerged included leadership style, gender inequality, and relationship building. Both male and female residents reported that a directive style was more effective when functioning in the resuscitation leadership role. Female residents more often expressed discomfort with a directive style of leadership, preferring a more communicative and collaborative style. Both female and male residents identified several challenges as disproportionately affecting female residents, including negotiating interactions with nurses more and "earning the respect" of the team members. Conclusions: Residents acknowledged that additional challenges exist for female residents in becoming resuscitation team leaders. Increasing awareness in residency program leadership is key to affecting change to ensure all residents are trained in a similar manner, while also addressing gender-specific needs of residents where appropriate. We present suggestions for addressing these barriers and incorporating discussion of leadership styles into residency training.

7.
Ann Emerg Med ; 70(6): 825-834, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28935285

RESUMO

STUDY OBJECTIVE: We determine whether omitting the pelvic examination in emergency department (ED) evaluation of vaginal bleeding or lower abdominal pain in ultrasonographically confirmed early intrauterine pregnancy is equivalent to performing the examination. METHODS: We conducted a prospective, open-label, randomized, equivalence trial in pregnant patients presenting to the ED from February 2011 to November 2015. Patients were randomized to no pelvic examination versus pelvic examination. Inclusion criteria were aged 18 years or older, English speaking, vaginal bleeding or lower abdominal pain, positive ß-human chorionic gonadotropin result, and less than 16-week intrauterine pregnancy by ultrasonography. Thirty-day record review and follow-up call assessed for composite morbidity endpoints (unscheduled return, subsequent admission, emergency procedure, transfusion, infection, and alternate source of symptoms). Wilcoxon rank sum tests were used to assess patient satisfaction and throughput times. RESULTS: Only 202 (of a planned 720) patients were enrolled, despite extension of the study enrollment period. The composite morbidity outcome was experienced at similar rates in the intervention (no pelvic examination) and control (pelvic examination) groups (19.6% versus 22.0%; difference -2.4%; 90% confidence interval [CI] -11.8% to 7.1%). Patients in the intervention group were less likely to report feeling uncomfortable or very uncomfortable during the visit (11.2% versus 23.7%; difference -12.5; 95% CI -23.0% to -2.0%). CONCLUSION: Although there was only a small difference between the percentage of patients experiencing the composite morbidity endpoint in the 2 study groups (2.4%), the resulting 90% CI was too wide to conclude equivalence. This may have been due to insufficient power. Patients assigned to the pelvic examination group reported feeling uncomfortable more frequently.


Assuntos
Dor Abdominal/etiologia , Serviço Hospitalar de Emergência , Exame Ginecológico , Hemorragia Uterina/etiologia , Dor Abdominal/diagnóstico , Dor Abdominal/diagnóstico por imagem , Adulto , Feminino , Humanos , Satisfação do Paciente , Gravidez , Ultrassonografia , Hemorragia Uterina/diagnóstico , Hemorragia Uterina/diagnóstico por imagem
8.
Acad Emerg Med ; 24(10): 1182-1192, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28779488

RESUMO

OBJECTIVE: A 2010 survey identified disparities in salaries by gender and underrepresented minorities (URM). With an increase in the emergency medicine (EM) workforce since, we aimed to 1) describe the current status of academic EM workforce by gender, race, and rank and 2) evaluate if disparities still exist in salary or rank by gender. METHODS: Information on demographics, rank, clinical commitment, and base and total annual salary for full-time faculty members in U.S. academic emergency departments were collected in 2015 via the Academy of Administrators in Academic Emergency Medicine (AAAEM) Salary Survey. Multiple linear regression was used to compare salary by gender while controlling for confounders. RESULTS: Response rate was 47% (47/101), yielding data on 1,371 full-time faculty: 33% women, 78% white, 4% black, 5% Asian, 3% Asian Indian, 4% other, and 7% unknown race. Comparing white race to nonwhite, 62% versus 69% were instructor/assistant, 23% versus 20% were associate, and 15% versus 10% were full professors. Comparing women to men, 74% versus 59% were instructor/assistant, 19% versus 24% were associate, and 7% versus 17% were full professors. Of 113 chair/vice-chair positions, only 15% were women, and 18% were nonwhite. Women were more often fellowship trained (37% vs. 31%), less often core faculty (59% vs. 64%), with fewer administrative roles (47% vs. 57%; all p < 0.05) but worked similar clinical hours (mean ± SD = 1,069 ± 371 hours vs. 1,051 ± 393 hours). Mean overall salary was $278,631 (SD ± $68,003). The mean (±SD) salary of women was $19,418 (±$3,736) less than men (p < 0.001), even after adjusting for race, region, rank, years of experience, clinical hours, core faculty status, administrative roles, board certification, and fellowship training. CONCLUSIONS: In 2015, disparities in salary and rank persist among full-time U.S. academic EM faculty. There were gender and URM disparities in rank and leadership positions. Women earned less than men regardless of rank, clinical hours, or training. Future efforts should focus on evaluating salary data by race and developing systemwide practices to eliminate disparities.


Assuntos
Grupos de Populações Continentais/estatística & dados numéricos , Diversidade Cultural , Medicina de Emergência/organização & administração , Docentes de Medicina/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Masculino , Salários e Benefícios , Distribuição por Sexo , Inquéritos e Questionários , Estados Unidos , Recursos Humanos
9.
Curr Probl Diagn Radiol ; 45(4): 258-64, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26657346

RESUMO

Physician awareness of the risks of ionizing radiation exposure related to medical imaging is poor. Effective educational interventions informing physicians of such risk, especially in emergency medicine (EM), are lacking. The SIEVERT (Suboptimal Ionizing Radiation Exposure Education - A Void in Emergency Medicine Residency Training) learning module was designed to improve provider knowledge of the risks of radiation exposure from medical imaging and comfort in communicating these risks to patients. The 1-hour module consists of introductory lecture, interactive discussion, and role-playing scenarios. In this pilot study, we assessed the educational effect using unmatched, anonymous preintervention and postintervention questionnaires that assessed fund of knowledge, participant self-reported imaging ordering practices in several clinical scenarios, and trainee comfort level in discussing radiation risks with patients. All 25 EM resident participants completed the preintervention questionnaire, and 22 completed the postintervention questionnaire within 4 hours after participation. Correct responses on the 14-question learning assessment increased from 6.32 (standard deviation = 2.36) preintervention to 12.23 (standard deviation = 1.85) post-intervention. Overall, 24% of residents were comfortable with discussing the risks of ionizing radiation exposure with patients preintervention, whereas 41% felt comfortable postintervention. Participants ordered fewer computed tomography scans in 2 of the 4 clinical scenarios after attending the educational intervention. There was improvement in EM residents' knowledge regarding the risks of ionizing radiation exposure from medical imaging, and increased participant self-reported comfort levels in the discussion of these risks with patients after the 1-hour SIEVERT learning module.


Assuntos
Competência Clínica/estatística & dados numéricos , Medicina de Emergência/educação , Internato e Residência/métodos , Lesões por Radiação/prevenção & controle , Treinamento por Simulação/métodos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Medicina de Emergência/métodos , Medicina de Emergência/estatística & dados numéricos , Humanos , Segurança do Paciente , Projetos Piloto , Doses de Radiação , Radiação Ionizante , Risco , Inquéritos e Questionários
11.
Teach Learn Med ; 26(2): 168-73, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24702554

RESUMO

BACKGROUND: The purpose of our study was to evaluate the educational value of an annual Senior Scholars Forum (SSF) of graduating Emergency Medicine resident participants and attendees. DESCRIPTION: This study was conducted at an urban academic medical center with a PGY1-4 year residency program. After completion of the 2nd annual SSF, a web-based survey instrument was sent to all resident and faculty attendees. The instrument was a 3-part tool adapted from previous studies on postgraduate scholarship. Data were analyzed using descriptive statistics. EVALUATION: Forty-two of the 44 (95%) attendees completed the survey, including 100% of the PGY4 resident presenters. Prior to the SSF, 52% of respondents did not have a full understanding of senior scholarly activities. After the SSF, 67% reported an improved understanding and 88% had a better understanding of the scope of potential scholarly projects. Sixty-four percent reported the SSF introduced them to departmental resources available for completion of their own scholarly projects, and 69% would have liked to have heard the lessons communicated earlier in residency. Most (79%) agreed the SSF demonstrated the value of communal scholarly activities. Most senior residents (67%) felt most of the department would not know about their scholarship if they had not participated in the SSF. CONCLUSIONS: Our innovative SSF enhanced the scholarship process by allowing graduating senior residents an opportunity to share their scholarly productivity with a larger audience, provided attendees critical insights into the process of scholarship, and encouraged communal learning. Because the Accreditation Council for Graduate Medical Education and Residency Review Committee require all residents to participate in scholarly activity, other training programs may benefit from a similar educational experience.


Assuntos
Medicina de Emergência/educação , Bolsas de Estudo , Internato e Residência , Centros Médicos Acadêmicos , Boston , Educação de Pós-Graduação em Medicina/economia , Feminino , Humanos , Masculino , Inquéritos e Questionários
12.
J Emerg Med ; 43(2): e125-8, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21903354

RESUMO

BACKGROUND: Evisceration of bowel contents through the vagina is a rare event that may be complicated by bowel obstruction. OBJECTIVE: We report a case of vaginal evisceration with small bowel obstruction which, in contrast to previous, more dramatic case reports in the literature, is a more subtle and, in fact, characteristic clinical presentation for this unusual occurrence. CASE REPORT: A 72-year-old woman with a previous history of pelvic surgery presented to the Emergency Department with lower abdominal discomfort and a prolapsing mass from her vagina. She was initially discharged home after bedside reduction of the mass, but returned 48 h later with worsening symptoms. A computed tomography scan on her repeat visit confirmed evisceration of bowel into the vaginal vault with obstruction of distal bowel loops. Surgical and gynecologic services were consulted and the patient underwent partial small bowel resection and vaginal cuff repair in the operating room. CONCLUSION: Early recognition of subtle presentations of vaginal evisceration is crucial for preserving bowel viability and preventing morbidity from bowel ischemia or infarction. Risk factors for this rare condition include postmenopausal status, previous pelvic surgery, and presence of an enterocele.


Assuntos
Obstrução Intestinal/etiologia , Prolapso Uterino/complicações , Prolapso Visceral/etiologia , Idoso , Feminino , Humanos , Obstrução Intestinal/cirurgia , Intestino Delgado , Retocele/complicações , Fatores de Risco , Prolapso Uterino/cirurgia , Prolapso Visceral/diagnóstico , Prolapso Visceral/cirurgia
13.
Acad Emerg Med ; 19(12): 1468-75, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23279253

RESUMO

This project was developed from the research network track at the 2012 Academic Emergency Medicine consensus conference on education research in emergency medicine (EM). Using a combination of consensus techniques, the modified Delphi method, and qualitative research methods, the authors describe multiple aspects of developing, implementing, managing, and growing an EM education research network. A total of 175 conference attendees and 24 small-group participants contributed to discussions regarding an education research network; participants were experts in research networks, education, and education research. This article summarizes relevant conference discussions and expert opinion for recommendations on the structure of an education research network, basic operational framework, site selection, leadership, subcommittees, guidelines for authorship, logistics, and measuring success while growing and maintaining the network.


Assuntos
Pesquisa Biomédica/métodos , Educação Médica/métodos , Medicina de Emergência/educação , Pesquisa Biomédica/educação , Pesquisa Biomédica/normas , Consenso , Conferências de Consenso como Assunto , Educação Médica/normas , Humanos
15.
Acad Emerg Med ; 18(5): 504-12, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21569169

RESUMO

OBJECTIVES: Effective real-time feedback is critical to medical education. This study tested the hypothesis that an educational intervention related to feedback would improve emergency medicine (EM) faculty and resident physician satisfaction with feedback. METHODS: This was a cluster-randomized, controlled study of 15 EM residency programs in 2007-2008. An educational intervention was created that combined a feedback curriculum with a card system designed to promote timely, effective feedback. Sites were randomized either to receive the intervention or to continue their current feedback method. All participants completed a Web-based survey before and after the intervention period. The primary outcome was overall feedback satisfaction on a 10-point scale. Additional items addressed specific aspects of feedback. Responses were compared using a generalized estimating equations model, adjusting for confounders and baseline differences between groups. The study was designed to achieve at least 80% power to detect a one-point difference in overall satisfaction (α = 0.05). RESULTS: Response rates for pre- and postintervention surveys were 65.9 and 47.3% (faculty) and 64.7 and 56.9% (residents). Residents in the intervention group reported a mean overall increase in feedback satisfaction scores compared to those in the control group (mean increase 0.96 points, standard error [SE] ± 0.44, p = 0.03) and significantly higher satisfaction with the quality, amount, and timeliness of feedback. There were no significant differences in mean scores for overall and specific aspects of satisfaction between the faculty physician intervention and control groups. CONCLUSIONS: An intervention designed to improve real-time feedback in the ED resulted in higher resident satisfaction with feedback received, but did not affect faculty satisfaction with the feedback given.


Assuntos
Atitude do Pessoal de Saúde , Educação de Pós-Graduação em Medicina/métodos , Medicina de Emergência/educação , Conhecimento Psicológico de Resultados , Corpo Clínico Hospitalar/psicologia , Médicos/psicologia , Análise por Conglomerados , Currículo , Serviço Hospitalar de Emergência , Docentes , Feminino , Humanos , Internet , Internato e Residência , Modelos Lineares , Masculino
16.
Acad Emerg Med ; 16 Suppl 2: S76-81, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-20053217

RESUMO

OBJECTIVES: Effective feedback is critical to medical education. Little is known about emergency medicine (EM) attending and resident physician perceptions of feedback. The focus of this study was to examine perceptions of the educational feedback that attending physicians give to residents in the clinical environment of the emergency department (ED). The authors compared attending and resident satisfaction with real-time feedback and hypothesized that the two groups would report different overall satisfaction with the feedback they currently give and receive in the ED. METHODS: This observational study surveyed attending and resident physicians at 17 EM residency programs through web-based surveys. The primary outcome was overall satisfaction with feedback in the ED, ranked on a 10-point scale. Additional survey items addressed specific aspects of feedback. Responses were compared using a linear generalized estimating equation (GEE) model for overall satisfaction, a logistic GEE model for dichotomized responses, and an ordinal logistic GEE model for ordinal responses. RESULTS: Three hundred seventy-three of 525 (71%) attending physicians and 356 of 596 (60%) residents completed the survey. Attending physicians were more satisfied with overall feedback (mean score 5.97 vs. 5.29, p < 0.001) and with timeliness of feedback (odds ratio [OR] = 1.56, 95% confidence interval [CI] = 1.23 to 2.00; p < 0.001) than residents. Attending physicians were also more likely to rate the quality of feedback as very good or excellent for positive feedback, constructive feedback, feedback on procedures, documentation, management of ED flow, and evidence-based decision-making. Attending physicians reported time constraints as the top obstacle to giving feedback and were more likely than residents to report that feedback is usually attending initiated (OR = 7.09, 95% CI = 3.53 to 14.31; p < 0.001). CONCLUSIONS: Attending physician satisfaction with the quality, timeliness, and frequency of feedback given is higher than resident physician satisfaction with feedback received. Attending and resident physicians have differing perceptions of who initiates feedback and how long it takes to provide effective feedback. Knowledge of these differences in perceptions about feedback may be used to direct future educational efforts to improve feedback in the ED.


Assuntos
Medicina de Emergência/educação , Internato e Residência , Conhecimento Psicológico de Resultados , Corpo Clínico Hospitalar , Ensino , Adulto , Estudos Transversais , Feminino , Humanos , Masculino
17.
Acad Emerg Med ; 12(7): 640-6, 2005 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-15995097

RESUMO

BACKGROUND: Although rare, HIV transmission is one of the most feared consequences of sexual assault. While availability of medications to prevent HIV transmission (HIV nonoccupational postexposure prophylaxis [HIV nPEP]) is increasing, little is known about emergency department (ED) prescribing practices and patient adherence to treatment recommendations. OBJECTIVES: To determine factors associated with offering, following up with, and adhering to treatment when HIV nPEP is initiated for sexual assault victims. METHODS: This was a retrospective chart review of female patients presenting with complaint of sexual assault to an urban ED from October 1, 1999, to September 30, 2002. HIV nPEP medications and/or follow-up were provided without charge. Chi-square analysis identified factors associated with being offered or referred for nPEP and follow-up. Variables significant at the p < 0.10 level were entered into logistic regression analysis. RESULTS: Two hundred twenty-nine charts were reviewed. The final sample size was 181. Mean age was 29.1 years; median time from assault to presentation was 10.1 hours; 51.5% of the assailants were known to the victims. HIV nPEP was offered to 89 (49%) patients, and 11 patients were referred to an HIV nurse. Eighty-five (85%) patients accepted, 38 of these 85 (45%) followed up, and 18 of the 85 (21%) completed treatment. In multivariate analysis, three variables were statistically significantly associated with increased likelihood of referral or being offered HIV nPEP: unknown assailant, having insurance, and younger age. Treatment was completed by 15 of 82 (18%) of ED-initiated patients, versus three of three (100%) referred for initiation. The authors were unable to identify factors associated with completing treatment. CONCLUSIONS: HIV nPEP was offered to less than half of sexual assault patients, and few completed treatment. Further studies are needed to evaluate and improve appropriateness of HIV nPEP administration and follow-up.


Assuntos
Serviços Médicos de Emergência/estatística & dados numéricos , Infecções por HIV/prevenção & controle , Hospitais de Ensino/estatística & dados numéricos , Hospitais Urbanos/estatística & dados numéricos , Cooperação do Paciente/estatística & dados numéricos , Prática Profissional/estatística & dados numéricos , Estupro/estatística & dados numéricos , Adulto , Distribuição por Idade , Boston , Intervalos de Confiança , Enfermagem em Emergência/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Seguimentos , Pesquisas sobre Serviços de Saúde , Humanos , Análise Multivariada , Razão de Chances , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Retrospectivos
18.
Emerg Med Clin North Am ; 22(4): 1117-32, 2004 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-15474785

RESUMO

DV encompasses a wide variety of actions that coerce, control, or demean the victim. Victims of DV suffer many physical and mental health consequences that cause emergency physicians to encounter them knowingly or unknowingly in the medical setting. Physicians who are aware of the prevalent problem of DV are able to help victims the most. A physician should be educated to recognize the physical and emotional presentations of victims, but, more importantly, the physician should be knowledgeable about the need for screening of all patients to reach the greatest number of victims. Victims often are not ready or able to disclose DV because of patient and physician barriers. Clinicians should work to overcome these barriers by initiating screening, ensuring patient comfort and safety, and understanding the many stages involved in behavioral change that a victim must traverse. The emergency physician would experience less frustration and more success if he or she would change their role from problem solver to listener and empowerer. This approach allows the survivor to make informed choices. Patients who are ready to make changes must be provided with protection,treatment, resources, and support. Informed, active physicians have great potential for improving DV victims' lives, reducing the effects of violence,and facilitating the patient's progression from victim to survivor.


Assuntos
Medicina de Emergência/métodos , Tratamento de Emergência/métodos , Maus-Tratos Conjugais/diagnóstico , Maus-Tratos Conjugais/prevenção & controle , Atitude do Pessoal de Saúde , Atitude Frente a Saúde , Diagnóstico Diferencial , Feminino , Acesso aos Serviços de Saúde/normas , Humanos , Incidência , Programas de Rastreamento , Anamnese , Papel do Médico , Poder Psicológico , Prevalência , Fatores de Risco , Autocuidado , Autoimagem , Maus-Tratos Conjugais/legislação & jurisprudência , Maus-Tratos Conjugais/psicologia , Maus-Tratos Conjugais/estatística & dados numéricos , Estados Unidos/epidemiologia , Saúde da Mulher
19.
Ann Emerg Med ; 42(5): 651-6, 2003 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-14581917

RESUMO

STUDY OBJECTIVE: We surveyed emergency physicians to determine current practices, knowledge, attitudes, and beliefs regarding nonoccupational postexposure prevention practices. METHODS: Two thousand randomly selected practicing emergency physicians from the American College of Emergency Physicians' national database and all graduating emergency medicine residents in 2000 were surveyed. Knowledge, role responsibility, self-efficacy, and attitudes and beliefs were measured and composite scores developed. Differences in responses between supporters and nonsupporters were compared for each category. RESULTS: Eight hundred eighty-nine responded, representing 60% (67/113) of emergency medicine residencies, 32% (347/1095) of emergency medicine residents, and 27% (542/2000) of emergency physicians. Responders recommend nonoccupational postexposure prevention for sexual assault (35%), unintentional needle stick (25%), and, rarely (<15%), for unsafe sexual practices and injection drug use. Knowledge of Centers for Disease Control and Prevention recommendations or the time when treatment may be most beneficial is poor (15.5% and 13.7%, respectively). Most agree their role includes providing nonoccupational postexposure prevention drugs and referring patients for counseling (76.5% and 75.6%, respectively). Confidence in assessing need for nonoccupational postexposure prevention varied with exposure type (sexual assault [61.6%], unintentional needle stick [54.8%], unsafe sexual practices [40.4%], and injection drug use [49.7%]). Supporters of nonoccupational postexposure prevention (64.1%) are more likely to have nonoccupational postexposure prevention available (69.3% versus 42.9%; 95% confidence interval [CI] 19.7 to 33.1), written protocols (42.5% versus 33.0%; 95% CI 2.8 to 16.2), and higher mean composite scores than nonsupporters in all categories: knowledge, self-efficacy, role responsibility, and attitudes. CONCLUSION: Most emergency physicians surveyed agree that offering nonoccupational postexposure prevention is feasible and within their role responsibility. Establishing nonoccupational postexposure prevention protocols and providing educational programs are important first steps in changing practice.


Assuntos
Atitude do Pessoal de Saúde , Medicina de Emergência , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Corpo Clínico Hospitalar , Padrões de Prática Médica , Adulto , Fármacos Anti-HIV/uso terapêutico , Competência Clínica/normas , Aconselhamento , Medicina de Emergência/educação , Medicina de Emergência/métodos , Medicina de Emergência/normas , Exposição Ambiental/efeitos adversos , Feminino , Infecções por HIV/etiologia , Infecções por HIV/transmissão , Humanos , Masculino , Corpo Clínico Hospitalar/educação , Corpo Clínico Hospitalar/psicologia , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Papel do Médico , Padrões de Prática Médica/normas , Encaminhamento e Consulta , Autoeficácia , Inquéritos e Questionários , Estados Unidos
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