Rate of Programs Affected by Resident Attrition and Program Factors Associated With Attrition in Emergency Medicine

ABSTRACT Background Resident attrition negatively affects residents and programs. The incidence of attrition in emergency medicine (EM) and program-specific factors associated with attrition remain unclear. Objective We quantified the percentage of EM residencies affected by attrition between 2007 and 2016 and identified program-specific factors associated with attrition. Methods We performed a retrospective analysis of data derived from the American Medical Association National Graduate Medical Education Census. We defined attrition as any postgraduate who left their residency training program prior to completion. We calculated the percentage of residency programs that experienced attrition and the overall incidence of attrition. We used Fisher's exact tests, Wilcoxon rank sum tests, and t tests, as well as multivariable logistic regression, to identify program-specific factors associated with attrition. Results Between 2007 and 2016, 139 EM residency programs (82%) experienced attrition of at least 1 resident. An average of 23% of EM training programs experienced attrition annually. The incidence of EM resident attrition averaged 0.85% per year. Program-specific factors associated with attrition include 4-year residencies (P = .031), programs with medium class size (P = .0003), more female residents (P = .002), and more female faculty (P = .003). After analysis, only medium class size (compared to small) was associated with attrition (odds ratio = 4.96, 95% confidence interval 1.65–14.91). Conclusions Between 2007 and 2016, while the incidence of resident attrition in EM was low (< 1%), the majority of programs experienced resident attrition. Medium class size (7 to 12 residents) was the only program-specific factor associated with increased attrition.

NE-CAT Crystallography Beamlines for Challenging Structural Biology Research

The NorthEastern Collaborative Access Team (NE-CAT) focuses on the design and operation of synchrotron X-ray beamlines for the solution of technically challenging structural biology problems and provides an important resource for the national and international research community. Currently NE-CAT operates two undulator beamlines: 24ID-C - tunable in the energy range from 6 to 22keV and 24ID-E - not-tunable, but optimized for Se SAD experiments. Both beamlines are equipped with state-of-the-art instrumentation. MD2 microdiffractometers installed at both beamlines provide very clean beams down to 5 microns in diameter and are capable of visualizing micron-sized crystals. Large area detectors (ADSC Quantum 315 at 24ID-E beamline and Pilatus-6MF at 24ID-C beamline), not only provide the best diffraction data, but also make possible to resolve large unit cells. Both beamlines are equipped with ALS style automatic sample mounters. Locally developed software suite RAPD provides data collection strategies, quasi-real time data integration and scaling and simple automated MR/SAD pipeline through 384 core computing cluster. Users of the beamlines are supported by experienced resident crystallographers. To meet the needs of technically challenging crystallographic projects, cutting-edge hardware and software ideas are implemented. A summary of beamline capabilities, technology, scientific highlights and details of availability will be presented. Funding for NE-CAT is provided through P41 grant from the NIGMS and from the NE-CAT member institutions.

Washing of Gloved Hands in Antiseptic Solution Prior to Central Venous Line Insertion Reduces Contamination

Glove contamination at the time a central venous catheter is handled is highly undesirable and likely to increase the risk of subsequent line infection. This study was designed to determine how frequently gloves become contaminated during central venous line insertion and to demonstrate the value of glove decontamination immediately prior to handling of the central venous catheter. During twenty routine internal jugular catheter insertions the sterility of the operator's gloved fingertips (just prior to handling the intravenous catheter) was assessed by touching the fingertips onto blood agar plates. The gloved hands were then rinsed in chlorhexidine/alcohol and after drying were placed onto a further plate. Contamination was detected in 55% of the prewash plates but in none of the postwash plates. Procedures performed by less experienced resident staff had a higher contamination rate despite there being no evident breach of sterile technique. It is likely that glove contamination results from the persistance of bacteria within the deeper layers of the skin, despite surface disinfection. These bacteria may be released by manipulation of the skin when identifying landmarks. This hypothesis was supported by a subsequent observation that gloves were more highly contaminated after firm touching of the skin rather than light touching. Glove contamination during central line insertion is frequent. Catheter contamination rates could be reduced (without risk or additional cost) by rinsing gloved hands in a solution of chlorhexidine (0.5%) in alcohol (70%) prior to handling the catheter.