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December 2005 Issue

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New ER Docs Put Skills to the Test

Published December 2005

Doctors are accustomed to doing assessments and tests to diagnose patients, but in UC's emergency medicine residency training program, it's the physicians who are being tested.

The program, the oldest in the United States, celebrates its 35th anniversary this year--plus a lot of progress in the way emergency residents treat patients.

"In the past, residents weren't necessarily actively taught how to do procedures," says Andra Blomkalns, MD, program director and assistant professor of emergency medicine. "They learned by simply doing them on real patients. At UC we really focus on orientation, formal instruction and competency.

"During my residency," says Dr. Blomkalns, "I wasn't formally trained how to put a line in someone's chest. I learned by watching one done, and then just did it.

"Today, as part of our overall training and patient-care quality initiative, our attending physicians watch and grade residents the first several times they perform a procedure before they're permitted to do it by themselves. The reason for this is simple--we're committed to patient safety."

This initiative, called the Committee on Procedural Quality and Evidence-Based Medicine, is headed by emergency medicine faculty members Alexander Trott, MD, and Stewart Wright, MD.

To increase the quality of patient care and residents' ability to learn, most programs now restrict duty hours. Residents are not allowed to work more than 80 hours a week or more than 30 hours in a row, and are off one in every seven days. At one time there were no restrictions on hours.

An aspect of UC's program that's different from most is the orientation that participants undergo a month prior to officially beginning their residency.

Orientation includes dealing with patient emergencies, interviewing and handling displeased or violent patients, as well as an overview of commonly prescribed medications and common medical errors.

"People are concerned about medical errors, so we also ensure that recent medical school graduates are not plopped into an environment where they make life-or-death decisions on their first day, without having been taught any practical skills for doing that," explains Dr. Blomkalns.

"The patients we're treating have greatly changed as well," she says. "We're seeing more patients and sicker patients, because they're coming to the emergency department for treatment instead of going to their primary-care physician's office."

In response to the changing patient mix, UC's emergency medicine physicians are developing new skill sets, such as the use of ultrasound. Previously patients were sent to radiology for imaging, which can take longer and isn't generally available in the middle of the night.

"Emergency medicine physicians are like chameleons--we change to adapt to the needs of the patient, and that's not always easy," says Dr. Blomkalns. "We're being more selective in admitting patients.

"People who used to be admitted to the hospital for days, such as those with pneumonia or other infections, are now being taken care of in our department in 23 hours. We're rapidly moving them through their workup and treatment, which takes some of the inpatient burden away from providers and saves inpatient costs.

"Everyone will come to an emergency department at some point in their lives," says Dr. Blomkalns. "Medicine moves fast, and emergency physicians are often at the forefront of new discoveries and treatments leading to quality care for patients."

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