EMERGENCY PROCEDURES IMPORTANT TO THE TRAINING OF EMERGENCY-MEDICINE RESIDENTS - WHO PERFORMS THEM IN THE EMERGENCY DEPARTMENT

Objective: To quantify one aspect of emergency medicine (EM) training by determining the proportion of emergency procedures performed by eme rgency physicians (EPs) in EDs with EM residency programs (EMRPs). Met hods: Cross-sectional descriptive survey of all allopathic EMRPs accre dited by the EM Residency Review Committee (RRC-EM) as of July 1, 1993 . Using a modified visual analog scale, program directors indicated th e proportion of ten index procedures performed in the ED by EPs vs all other physicians. Results: All 98 EMRPs meeting entry criteria respon ded to the survey. The medians for the percentage of times index proce dures were performed in the ED by an EP were as follows (parentheses f ollowing percentages enclose 95% CIs): endotracheal intubation, 97% (9 5%, 100%); reduction of anterior shoulder dislocation, 93% (88%, 97%); thoracostomy, 63% (50%, 75%); transvenous pacer insertion, 60% (50%, 75%); cricothyrotomy, 50% (50%, 75%); thoracotomy, 50% (25%, 50%); dia gnostic peritoneal lavage, 50% (25%, 50%); fiberoptic laryngoscopy, 22 % (6%, 25%); sigmoidoscopy, 0% (0%, 6%); and pelvic sonography, 0% (0% , 0%). Conclusion: EPs in EDs of institutions that have EMRPs perform, on average, 50% of all index procedures (95% CI 47%, 52%). This infor mation may assist EM programs experiencing difficulty in ensuring that their residents receive an equitable share of those procedures that a re critical to their training.