Objective: Little is known about the factors important to applicants when selecting an emergency medicine residency. We sought to identify which residency-specific criteria applicants value in selecting a training program.

Methods: We conducted an anonymous survey of emergency medicine interviewees at our residency. Applicants were asked to rate each of 18 factors on a four-point scale from 1 (“not at all important”) to 4 (“very important”) in their selection of a residency.

Results: Of 82 interviewees, 73 (89%) completed the survey. The factors with the top six mean scores were: how happy the residents seemed (3.9), program personality (3.8), faculty enthusiasm (3.7), geographic location (3.6), experience during interview day (3.5), and pediatrics training (3.5).

Conclusion: The top three factors deemed most important to emergency medicine applicants are primarily intangibles, while programs have no control over the fourth most important factor, location.

[WestJEM. 2009;10:159-162.]

Objective: We sought to characterize the experiences and preferences of applicants to emergency medicine (EM) residency programs about being contacted by programs after their interview day but before the rank list submission deadline.

Methods: This cross-sectional study surveyed all applicants to an academic EM residency during the 2006-2007 interview cycle. Participation was anonymous and voluntary. We used a Web-based survey software program to administer the survey in February 2007, after rank lists were submitted. Two additional invitations to participate were sent over the next month. The instrument contained multiple-choice and free-text items. This study was submitted to our Institutional Review Board and was exempt from formal review.

Results: 240/706 (34%) of applicants completed the survey. 89% (214/240) of respondents reported being contacted by a residency program after their interview but before rank lists were due. Of those contacted, 91% report being contacted by e-mail; 67% by mail; and 55% by phone. 51% of subjects reported that being contacted changed the order of their rank list in at least one case. A majority of contacted applicants felt “happy” (58%) or “excited” (56%) about being contacted, but significant numbers reported feeling “put on the spot” (21%) or “uncomfortable” (17%). A majority felt that it is appropriate for programs to contact applicants after interview day but before the rank lists are submitted, but 39% of contacted subjects responded that contact by phone is either “always inappropriate” or “usually inappropriate.” Regarding perceptions regarding the rules of the match, 80% (165/206) of respondents felt it was appropriate to tell programs where they would be ranked, and 41% (85/206) felt it was appropriate for programs to notify applicants of their place on the program’s rank list.

Conclusion: Most EM residency applicants report being contacted by programs after the interview day but before rank lists are submitted. Although applicants feel this practice is appropriate in general, over a third of subjects feel that contact by phone is inappropriate. These findings suggest that residency programs can expect a majority of their applicants to be contacted after an interview at another program, and shed light on how applicants perceive this practice. [West J Emerg Med. 2010; 11(5):474-478.]

Introduction: The Accreditation Council for Graduate Medical Education requires that residency programs ensure resident competency in performing safe, effective handoffs. Understanding resident, attending, and nurse perceptions of the key elements of a safe and effective emergency department (ED) handoff is a crucial step to developing feasible, acceptable educational interventions to teach and assess this fundamental competency. The aim of our study was to identify the essential themes of ED-based handoffs and to explore the key cultural and interprofessional themes that may be barriers to developing and implementing successful ED-based educational handoff interventions.

Methods: Using a grounded theory approach and constructivist/interpretivist research paradigm, we analyzed data from three primary and one confirmatory focus groups (FGs) at an urban, academic ED. FG protocols were developed using open-ended questions that sought to understand what participants felt were the crucial elements of ED handoffs. ED residents, attendings, a physician assistant, and nurses participated in the FGs. FGs were observed, hand-transcribed, audio-recorded and subsequently transcribed. We analyzed data using an iterative process of theme and subtheme identification. Saturation was reached during the third FG, and the fourth confirmatory group reinforced the identified themes. Two team members analyzed the transcripts separately and identified the same major themes. 

Results: ED providers identified that crucial elements of ED handoff include the following: 1) Culture (provider buy-in, openness to change, shared expectations of sign-out goals); 2) Time (brevity, interruptions, waiting); 3) Environment (physical location, ED factors); 4) Process (standardization, information order, tools). 

Conclusion: Key participants in the ED handoff process perceive that the crucial elements of intershift handoffs involve the themes of culture, time, environment, and process. Attention to these themes may improve the feasibility and acceptance of educational interventions that aim to teach and assess handoff competency.

ABSTRACT

Introduction

Academic Emergency Department (ED) handoffs are high-risk transfer of care events. Emergency medicine residents are inadequately trained to handle these vital transitions.

We aimed to explore what modifications the I-PASS (Illness severity, Patient summary, Action list, Situation awareness and contingency plans, and Synthesis by receiver) handoff system requires to be effectively modified for use in ED inter-shift handoffs.

Methods

This mixed-method needs assessment conducted at an academic ED explored the suitability of the I-PASS system for ED handoffs. We conducted a literature review, focus groups, and then a survey. We sought to identify the distinctive elements of ED handoffs and discern how these could be incorporated into the I-PASS system.

Results

Focus group participants agreed the Patient summary should be adapted to include anticipated disposition of patient. Participants generally endorsed the order and content of the other elements of the I-PASS tool. The survey yielded several wording changes to reflect contextual differences. Themes from all qualitative sources converged to suggest changes for brevity and clarity (Figure 1). Most participants agreed that the I-PASS tool would be well suited to the emergency department setting.

Conclusion

With modifications for context, brevity, and clarity, the I-PASS system may be well suited for application to the ED setting. This study provides qualitative data in support of utilizing the I-PASS tool and concrete suggestions for how to modify the I-PASS tool for the ED. Implementation and outcome research is needed to investigate if the I-PASS tool is feasible and improves patient outcomes in the ED environment.