BMC Emergency Medicine Journal Club

1
BMC Emergency MedicineJournal Club

• Enlightenment through resident scholarship
• June 2009 The FINAL Session for 2008-2009

2
Todays Agenda

• Paper Review
• Thomas Horesji
• Alison Sullivan
• Senior Resident Scholars Forum

BMC EM Journal Club
BMC EM Journal Club
3
2008-2009 JClub Curriculum

• To make us experts in our own literature
• To translate Dowling JClub lessons to ED
• To link primary literature to monthly topic
• To master new scientific vocabulary
• To inform our own research endeavors
• To remind ourselves daily reading can be fun

4
2008-2009 JClub Curriculum

• Retrospective case series
• Prospective observational trial
• Secondary analysis of prospective cohort
• Review article
• Survey study
• Critical appraisal
• Poem
• Commentary
• Cochrane review
• Research letter
• Consensus report

5
BMC Emergency MedicineJournal Club

• Enlightenment through resident scholarship
• Tom Horejsi, MD

BMC EM Journal Club
6
ACADEMIC EMERGENCY MEDICINE FEB 1997 VOL 4/NO 2

• M. Andrew Levitt, DO
• Alameda County Medical Center
• Highland Campus, Oakland, CA
• Department of Emergency Medicine
• University of California, San Francisco, CA

BMC EM Journal Club
7
Background

• Much opinion regarding resident research
• Little data describing resident research in the
  field of EM
• One argument used against resident research
  lesser quality

BMC EM Journal Club
8
Objective

• To determine whether the research done by
  residents has the same SAEM annual acceptance
  rate as research done by others
• Null hypothesis There is no difference between
  Resident acceptance rate and Other acceptance
  rate

BMC EM Journal Club
9
Methods

• Retrospective, Descriptive, Cohort Analysis
• Enrollment Computerized database of submitted
  abstracts for SAEM annual meeting. 1994/1995
• Grouped submissions into 2 categories
• Resident Authors
• Other Authors
• Also analyzed subcategories
• Example Clinical Practice

BMC EM Journal Club
10
Methods II

• Calculated raw acceptance rates for each group (
  accepted)
• 2x2 contingency tables analyzed using
  chi-square with Yates correction
• Statistical significance for p-value lt0.05
• Power analysis was performed

BMC EM Journal Club
11
Key Results

• Overall acceptance for 2 years combined
• Resident 45.9 (95 CI 40.8 - 51.1)
• Other 51.5 (95 CI 48.5 - 54.5)
• No statistically significant difference between
  the 2 groups for the 2 years combined

BMC EM Journal Club
12
(No Transcript)
13
Authors Conclusion

• EM resident acceptance rate to SAEM annual
  meetings is similar to that of other authors
• This suggests that research authored by residents
  is of similar quality to that of research
  authored by others

BMC EM Journal Club
14
Strengths of Article

• Tries to answer a question in academic EM that
  many have debated but few have studied
• Tries to lend support to resident research in EM
• Attempts to raise doubt about the argument that
  residents do not perform quality research

BMC EM Journal Club
15
Limitations of Article

• Study does not represent every attempt at
  research by residents/others (Isolated to SAEM)
• Principal author was determined by information
  in the abstract submission form only
• 1994/1995
• Study published in 1997

BMC EM Journal Club
16
Further Questions

• Why only 2 years?
• What would you find if you looked at a 10 year
  time span?
• Why was this published as a Letter?
• What is quality resident research?
• Does statistical insignificance similar
  quality?
• Are there other yardsticks for measuring quality?

BMC EM Journal Club
17
Final Comments

• This article was a nice attempt to support EM
  research and address a challenging question
• Unfortunately it fails to prove quality and
  given more time would possibly fail to prove the
  null hypothesis
• We (faculty and residents) should put our efforts
  into identifying ways of making research more
  interesting and attractive

BMC EM Journal Club
18
BMC Emergency MedicineJournal Club

• Enlightenment through resident scholarship
• Alison Sullivan, MD

BMC EM Journal Club
19
Acad Emerg Med 1999 61160
20
Background

• RRC requires that EM residents engage in
  scholarly activity
• Interpretation of requirement varied from program
  to program

21
Objective

• To develop a statement concerning the scope and
  definition of the scholarly project requirement

BMC EM Journal Club
22
Methods

• Consensus statement
• NIH model of consensus building
• Pre-workshop debate
• Invitation of participants
• Workshop
• Post-workshop document creation

23

• Overview of the presented viewpoints
• Goals of the scholarly project
• Definition of the scholarly project
• Examples
• Endpoints and measures of success

BMC EM Journal Club
24
Overview of presented viewpoints

• Whose views?
• AACEM, CORD, RRC, EMRA
• Members selected because of previous work
  concerning resident education and research
• Not designated by their respective groups

25
Goals of the scholarly project

• To instruct residents in the process of
  scientific inquiry.

26
Definition of the scholarly project

• Elements of the scientific method
• Focus on process not product

27
Examples

• Almost any submitted work can potentially be
  found to be acceptable
• Case report
• Community project
• Development of medical software

28
Endpoints

• Contains the elements in the definition of the
  scholarly project
• Documented in a written form
• Literature review

29
Authors Conclusion

• Process over product
• Open to interpretation by each residency program

BMC EM Journal Club
30
Strengths of Article

• Accomplishes stated goal
• Definition incorporates a variety of projects
• Offers a model to monitor progress

BMC EM Journal Club
31
Limitations of Article

• Unclear whether presented viewpoints
  representative of their respective groups
• Had to rely on expert opinion
• No plan for how to assess progress and need for
  change

BMC EM Journal Club
32
Final Comments

• Consensus statements are difficult to read
• Format detracted from content
• Importance of process in education

33
(No Transcript)
34
RRC Requirements
35
Senior Resident Scholars Forum
Enlightenment through resident scholarship