Learning Objective: Using previously validated methodology, to analyze the EBM content of clinical questions generated by EM residents while on shift.

Background: Evidence Based Medicine (EBM) skills allow EM physicians to obtain new information while on shift. There is little documentation EM resident clinical questioning skills.

Objective: Using previously validated methodology, to analyze the EBM content of clinical questions generated by EM residents while on shift.

Methods: With IRB approval, residents (PGY 1-4) were required to submit logs of on-shift EBM activity in the program’s procedure software system New InnovationsTM. The logs are a convenience sample, with an N of 3-5 per 28-day EM rotation. The logs include a patient description, clinical question, search strategy, information found, and subsequent application. The questions were analyzed through the lens of Patient-Intervention-Comparison-Outcome (PICO) using a rubric previously described by Ramos et al, BMJ, 2003. Anchor words/phrases were established for each of the PICO elements, with exemplars in Table 1. Data was analyzed descriptively.

Results: From 6/2013 until 5/2020, 10,450 discrete completed logs were identified for inclusion. A total of 49 were excluded (45 logs because they were intentionally left blank or only contained a punctuation mark and 4 were exact copies of the previous log) leaving 10,401 for analysis. These were submitted by 143 residents, of which 51 were female (35.7%). Table 2 demonstrates analysis of the questions via the PICO framework using the Fresno rubric. The average score each of the 4 PICO categories for all logs was 1.20. When excluding zero scores the average was 2.33.

Conclusions: In this single site cohort, resident description of P was most detailed, followed by I. C was the most excluded clinical question element. Having more patient oriented O would strengthen that category. When residents include a PICO category in clinical questions, their ability to do so appears strong, so educational interventions to encourage the use of all 4 PICO elements may yield the most improvement.

Learning Objectives: This project seeks to describe how on shift EBM activity by EM residents impacts clinical patient care.

Background: Evidence Based Medicine (EBM) skills allow EM providers to obtain and apply new information while on shift in the ED. The impact of using EBM on shift to patient care has not previously been described.

Objective: This project seeks to describe how EBM activity by EM residents impacts clinical patient care.

Methods: This IRB approved study was conducted by a PGY 1-4 EM residency. Residents are required to complete logs of on-shift EBM activity in the program’s procedure software system New InnovationsTM. The logs are a convenience sample, with an N of 3-5 per 28-day EM rotation. The logs include a patient description, clinical question, search strategy, information found, and subsequent application. Using qualitative methodology described by MacQueen (CAM 1998), a codebook was created to analyze resident free text to the prompt: “Based on your research, would you have done anything differently”. The coding framework is shown in Table One. Results are analyzed descriptively.

Results: From June 2013 to May 2020, 11,145 discrete logs were identified. Of these, 571 were excluded (298 incomplete and 273 duplicate), leaving 10,574 logs for analysis. These logs were completed by 137 residents, of which 46 were female (34%). The 10 most utilized log codes (97.5%) are in Table One. The remaining 29 codes were 2.5% of the dataset. A total of 1977 (18.7%) logs affirmed that evidence researched will change their future practices. Of those, 392 (3.7%) explicitly stated their research influenced care while the patient was in the ED.

Conclusions: In this single site cohort, residents were able to successfully link EBM activity to individual patients using the program’s procedure recording software. In almost one fifth of this convenience sample, residents described how the activity changed their individual clinical practice of EM, with one in 27 changing patient care in real time. Logging EBM activity appears to generate ACGME outcomes data.