Characteristics of the first two years of applicants to a new emergency medicine residency program.

BACKGROUND: To the best of our knowledge, no study has compared the effect of using the Electronic Residency Application Service (ERAS) on applicant pool characteristics for a new emergency medicine (EM) residency program. OBJECTIVE: We sought to compare applicants in an EM residency program's first year, in which the ERAS is not typically used, to applicants in year 2 (using ERAS). METHODS: We reviewed the applications to the new University of Utah EM residency program for the entering classes of 2005 (year 1) and 2006 (year 2). RESULTS: In total, 130 and 458 prospective residents applied during year 1 and year 2, respectively. Applicants using and not using ERAS were similar in average Step 1 score (211.8 vs. 212.4, respectively; p = 0.791), previously failed Step 1 or Step 2 attempt (12.1% vs. 11.0%, respectively; p = 0.729), previous failure to match in a residency program (8.6% vs. 4.6%, respectively; p = 0.083), previous residency training (18.8% vs. 14.9%, respectively; p = 0.288), and the percent who had completed an EM clerkship (95.3% vs. 93.0%, respectively; p = 0.342). Applicants not using ERAS were more likely to have been remediated in medical school (13.2% vs. 4.2%; p < 0.001) and to have a Standardized Letter of Recommendation (SLOR) (87% vs. 78%; p = 0.024). Applicants using ERAS were more likely to have a SLOR match estimate of "very competitive" (38.2% vs. 54.1%; p = 0.004). Applicants were similar in having attended a "top tier" medical school (44.5% vs. 41.3%, p = 0.508). CONCLUSION: Despite significantly fewer applicants, those applying without the use of ERAS to a new EM residency program were generally comparable to the applicant pool that did permit the use of ERAS. The larger number of applicants the second year likely reflects the use of ERAS.

Folic acid use in pregnant patients presenting to the emergency department.

BACKGROUND: The US Preventive Services Task Force has recommended daily folic acid supplementation for women planning on becoming pregnant in an effort to prevent fetal neural tube defects. We evaluated pregnant patients presenting to the emergency department to determine rates of folic acid supplementation. METHODS: We surveyed a convenience sample of pregnant patients who presented to the University of Utah Emergency Department (ED) between 1 January 2008, and 30 April 2009, regarding pregnancy history and prior medical care. RESULTS: One hundred thirty-five patients participated in the study. Eighty-four patients (62.2%) reported current folic acid supplementation. Sixty-six patients identified themselves as Caucasian and 69 as non-Caucasian race. There was a significant difference in folic acid use between Caucasian and non-Caucasian women (p = 0.035). The majority of Caucasian women (71.2%) reported daily folic acid use versus approximately one-half of non-Caucasian women (53.6%). Both groups were similar in accessing a primary care provider (PCP) for pregnancy care prior to the ED visit (53% vs. 49.3%, p = 0.663), and rates of folic acid use were similar in those who had seen a PCP (85.7% vs. 76.5%, p = 0.326). Language did not have a significant association with folic acid use. CONCLUSION: A large percentage of pregnant ED patients did not report current folic use, and there was a significant difference between Caucasian and non-Caucasian women in rates of folic acid supplementation. This study highlights the potential role of the ED in screening patients for folic acid supplementation.

Evaluating applicants to a new emergency medicine residency program: subjective assessment of applicant characteristics.

BACKGROUND: Because of the Accreditation Council for Graduate Medical Education (ACGME) and the Residency Review Committee (RRC) approval timelines, new residency programs cannot use Electronic Residency Application Service (ERAS) during their first year of applicants. AIM: We sought to identify differences between program directors' subjective ratings of applicants from an emergency medicine (EM) residency program's first year (in which ERAS was not used) to their ratings of applicants the following year in which ERAS was used. METHOD: The University of Utah Emergency Medicine Residency Program received approval from the ACGME in 2004. Applicants for the entering class of 2005 (year 1) did not use ERAS, submitting a separate application, while those applying for the following year (year 2) used ERAS. Residency program directors rated applicants using subjective components of their applications, assigning scores on scales from 0-10 or 0-5 (10 or 5 = highest score) for select components of the application. We retrospectively reviewed and compared these ratings between the 2 years of applicants. RESULTS: A total of 130 and 458 prospective residents applied during year 1 and year 2, respectively. Applicants were similar in average scores for research (1.65 vs. 1.81, scale 0-5, p = 0.329) and volunteer work (5.31 vs. 5.56, scale 0-10, p = 0.357). Year 1 applicants received higher scores for their personal statement (3.21 vs. 2.22, scale 0-5, p < 0.001), letters of recommendation (7.0 vs. 5.94, scale 0-10, p < 0.001), dean's letter (3.5 vs. 2.7, scale 1-5, p < 0.001), and in their potential contribution to class characteristics (4.64 vs. 3.34, scale 0-10, p < 0.001). CONCLUSION: While the number of applicants increased, the use of ERAS in a new residency program did not improve the overall subjective ratings of residency applicants. Year 1 applicants received higher scores for the written components of their applications and in their potential contributions to class characteristics.

Emergency department patients with psychiatric complaints return at higher rates than controls.

STUDY OBJECTIVE: At our 35,000 visit/year emergency department (ED), we studied whether patients presenting to the ED with psychiatric complaints were admitted to the hospital at a higher rate than non-psychiatric patients, and whether these patients had a higher rate of reevaluation in the ED within 30 days following the index visit. METHODS: We reviewed the electronic records of all ED patients receiving a psychiatric evaluation from January to February 2007 and compared these patients to 300 randomly selected patients presenting during the study period for non-psychiatric complaints. Patients were followed for 30 days, and admission rates and return visits were compared. RESULTS: Two hundred thirty-four patients presented to the ED and were evaluated for psychiatric complaints during the study period. Twenty-four point seven percent of psychiatric patients were admitted upon initial presentation versus 20.7% of non-psychiatric patients (p = 0.258). Twenty-one percent of discharged psychiatric patients returned to the ED within 30 days versus 13.4% of discharged non-psychiatric patients (p=0.041). Patients returning to the ED within 30 days had a 17.1% versus 21.6% admission rate for the psychiatric and non-psychiatric groups, respectively (p=0.485). CONCLUSION: Patients presenting to this ED with psychiatric complaints were not admitted at a significantly higher rate than non-psychiatric patients. These psychiatric patients did, however, have a significantly higher return rate to the ED when compared to non-psychiatric patients.