Clerkships in Emergency Medicine.

Planning for clerkships in emergency medicine (EM) can be stressful, prolonged, and challenging. Therefore, medical students should start planning for them early. In this article, we offer guidance regarding several issues pertinent to the EM clerkship, such as the best time to schedule one (or more) during medical school, the most appropriate institution or program to schedule it, the process of selecting and applying for the clerkship, and the number of EM clerkships to consider. We will explain why an EM clerkship should be scheduled between June and October and the reason that 2 EM clerkships at different sites are sufficient for the majority of students. Additionally, we emphasize that clerkships in emergency departments associated with EM residency programs or with reputations for outstanding student teaching tend to be most beneficial. Above all, students interested in EM should attempt to leave a great impression after completing their clerkships by providing stellar patient care, demonstrating enthusiasm at all times, and maintaining professionalism. In turn, they will gain knowledge and clinical experiences that should prove valuable in their future.

Program Visits and Residency Interviews.

Interviews and program visits play a major role in the National Resident Matching Program application process. They are a great opportunity for programs to assess applicants and vice versa. Irrespective of all other elements in the application profile, these can make it or break it for an applicant. In this article, we assist applicants in planning their residency interviews and program visits. We elaborate on the keys to success, including planning of the interviews in a proper and timely fashion, searching programs individually, conducting mock interviews, following interview and program visit etiquette, and carefully scheduling and making travel arrangements. We also guide applicants through what to expect and is expected of them during their interview and visit.

Selecting a Medical School Advisor.

Having an advisor offers medical students many advantages, including increased likelihood of matching into their top choices. Interestingly, students who choose emergency medicine (EM) as a specialty are more likely to seek advising. However, finding and optimally utilizing an EM faculty advisor is often challenging for the medical student. In this article, we tackle the different ways to seek advising, including the 'virtual advisor program' implemented by the Society for Academic Emergency Medicine, the 'e-Advisor Program' instigated by the Clerkship Director in EM Group, the 'member exclusive mentorship program' of the Emergency Medicine Residency Association, as well as peer-based mentoring. More so, we discuss the consensus recommendations developed by the Student Advising Task Force to guide both students planning to apply to EM and their advisors to ensure high-caliber advising.

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.

Louisiana motorcycle fatalities linked to statewide helmet law repeal.

BACKGROUND: On August 15, 1999, Louisiana's mandatory motorcycle helmet law was repealed. Our primary objective was to determine if the repeal resulted in an increase in motorcyclist morbidity and mortality. METHODS: We retrospectively evaluated the frequency of helmet use and morbidity and mortality before and after the repeal of the law. Fatality statistics for Louisiana were obtained through the National Highway Safety Traffic Association between 1994 and 2002. Injury statistics were totaled for motorcyclists admitted to Medical Center of Louisiana New Orleans during the same period of time. RESULTS: Statewide, helmet use decreased 21.2% (p < 0.001, chi-square) after repeal of the helmet law, while locally, helmet use decreased 34.7% (p < 0.001). Fatalities significantly increased after the repeal, both statewide (3.0%-3.9%, p < 0.05) and locally (3.8%-5.8%, p < 0.0001). CONCLUSION: Motorcycle helmet use decreased significantly and motorcyclist fatality rates increased significantly after repeal of the Louisiana mandatory helmet law.

Prediction of intracranial injury in children aged five years and older with loss of consciousness after minor head injury due to nontrivial mechanisms.

STUDY OBJECTIVE: Indications for computed tomography (CT) in children with minor head injury remain controversial. The objective of this preliminary study is to determine whether a clinical decision rule developed for adults could be used in children aged 5 years and older. METHODS: A prospective questionnaire was completed on all patients who were aged 5 to 17 years with major mechanisms of injury resulting in minor head injury (defined as normal Glasgow Coma Scale or modified coma scale in infants, plus normal brief neurologic examination) and loss of consciousness. The questionnaire documented 6 clinical variables: headache, emesis, intoxication, seizure, short-term memory deficits, and physical evidence of trauma above the clavicles. CT was obtained for all patients, findings were compared with the results of the questionnaires, and the sensitivity and specificity of the decision rule were determined. RESULTS: Throughout a 30-month period, 175 patients were enrolled, with a mean age of 12.8 years. Fourteen (8%) patients had intracranial injury or depressed skull fracture on CT. The presence of any of the 6 criteria was significantly associated with an abnormal CT scan result (P<.05) and was 100% (95% confidence interval 73% to 100%) sensitive for identifying patients with intracranial injury. CONCLUSION: In this preliminary study, CT use in pediatric patients with minor head injury could have been safely reduced by 23% by using a clinical decision rule previously validated in adults.