A Positive Depression Screen Is Associated with Emergency Medicine Resident Burnout and Is not Affected by the Implementation of a Wellness Curriculum

Introduction: While burnout is occupation-specific, depression affects individuals comprehensively. Research on interventions for depression in emergency medicine (EM) residents is limited. Objectives: We sought to obtain longitudinal data on positive depression screens in EM residents, assess their association with burnout, and determine whether implementation of a wellness curriculum affected the rate of positive screens. Methods: In February 2017, we administered the Maslach Burnout Inventory and the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire two-question depression screen at 10 EM residencies. At five intervention sites, a year-long wellness curriculum was then introduced while five control sites agreed not to introduce new wellness initiatives during the study period. Study instruments were re-administered in August 2017 and February 2018. Results: Of 382 residents, 285 participated in February 2017; 40% screened positive for depression. In August 2017, 247/386 residents participated; 27.9% screened positive for depression. In February 2018, 228/386 residents participated; 36.2% screened positive. A positive depression screen was associated with higher burnout. There were similar rates of positive screens at the intervention and control sites. Conclusion: Rates of positive depression screens in EM residents ranged between 27.9% and 40%. Residents with a positive screen reported higher levels of burnout. Rates of a positive screen were unaffected by introduction of a wellness curriculum.

Computer-Based Simulation by Emergency Medicine Resident-Educator for Medical Students during the COVID-19 Pandemic

Today, residents in all disciplines are expected to be involved in not just educating themselves but in the education of others and peers as well. They are involved in a wide spectrum of teaching and instruction techniques such as case presentations, lectures, practical hands-on teaching, bedside clinical tutorials, informal discussions and simulation-based training. Simulation-based teaching has been playing an increasingly important role in both residency training as well as medical school curricula. In particular, it appeals to adult learners as it very task-driven and task-oriented, it allows for constant active engagement during role-playing in simulated scenarios and enables repetitive practice until a certain level of mastery or competency is achieved. The SingHealth residents training in emergency medicine have been collaborating with and engaging medical students from the Duke-NUS Graduate Medical School, as the two entities for a common Academic Medical Center. They share many collaborative projects and activities, research as well as educational training programmes. However, with the recent COVID-19 pandemic, both face-to-face medical teaching as well as simulation-based teaching proved to be challenging. One alternative is to move these teaching collaborations and programmes onto the online platform. This study describes the experience of emergency medicine resident-educators who conducted emergency medicine computer-based simulations (CBS) in collaboration with a group of medical students from the Duke-NUS Emergency Medicine Student Interest Group during the COVID-19 pandemic.

Excessive Daytime Sleepiness and Its Associated Factors among Emergency Medicine Residents in South Korea: A Nationwide Survey

Objective. Excessive daytime sleepiness (EDS) in emergency medicine (EM) residents is associated with patient safety. However, studies regarding EDS in EM residents are limited. The objective of this study was to identify the prevalence of EDS and its associated factors among EM residents. Methods. Epworth sleepiness scale scores, working hours per week (WHW), night working days per month, working environment, and depression were analyzed using data from the 2019 Korean Emergency Medicine Resident Survey. Results. The survey response rate was 63.8% (384/601). Among 241 respondents, the prevalence rate of EDS was 32.4%. Multivariable logistic regression analysis demonstrated that WHW (odds ratio [OR] = 1.03, 95% confidence interval [CI] = 1.01–1.06) and depression (OR = 3.64, 95% CI = 1.91–6.96) had increased ORs for EDS. Conclusions. Approximately one-third of EM residents had EDS. Depression and WHW were the associated factors.

Effects of Emergency Department Crowding and Time to Antibiotics in Pneumonia

Objective: To evaluate the relationship between emergency department (ED) crowding and time to antibiotic treatment in pneumonia patients. The secondary objective was to look for other factors related to delayed antibiotic treatment. Materials and Methods: The present study was a retrospective medical chart review between February 1 and June 30, 2015 of the patients aged 18 years and older with the ED diagnoses of pneumonia. The present study was performed in the ED of a tertiary care teaching hospital. One hundred seventy patients met the enrollment criteria. The patients were divided into ED crowded or non-crowded using the National Emergency Department Overcrowding Study tool for the main outcome of ED crowding and time to antibiotic treatment in pneumonia. Results: In the 170 pneumonia patients, 117 patients (68.8%) came to the ED during a crowded shift. The characteristics of the patients were similar in both the crowded and non-crowded shifts. Of the 170 pneumonia patients, 51.8% had CURB-65 scores of 1 or 2. Patients who came to the ED during the crowded shift and non-crowded shift received antibiotics at the median times of 125 and 110 minutes, respectively (p=0.125). Delayed antibiotic treatments of more than four hours occurred in 19 patients (16.2%) during the crowded shift and in three patients (5.7%) in the non-crowded shift (p=0.098). Other factors related to time to antibiotics were the first doctor to see the patient (p=0.05), severity of disease (p<0.01), and admission type (p=0.01). Conclusion: ED crowding was not related to time to antibiotic treatment in pneumonia patients. However, if the clinical conditions of the patients looked severe or the doctor who cared for the patients was an emergency medicine resident, the patients received early administration of antibiotics. Keywords: Emergency department crowding, Pneumonia, Time to antibiotics