ACGME and ABEM endorsed the emergency medicine milestones as a framework for developing and accessing trainees’ progress toward competence in each domain in 2012 [56 (link),57 (link)]. Milestones describe competencies and identify KSABs that can be used as outcome measures within the six core competencies. Individual milestones demonstrate the KSABs required for graduation via unsupervised practice. However, some behaviors are not fully encompassed within KSABs in different social cultures and are categorized as care services (CS). With the aspect of care services (CS), there are four evaluation criteria: teamwork (CS1), patient safety (CS2), system management (CS3), and technology applications (CS4).
Many studies investigate the relationship between teamwork and patient safety and find a positive impact on it [38 (link)] in ED. Teamwork is a competency integrated with common thoughts, behaviors, and feelings that help health providers work as a team to provide better patient safety and outcomes in the clinic [38 (link),42 (link)]. EM is considered a high-risk specialty in which inter-professional healthcare workers must engage to guarantee patient safety. Studies have shown that successful teamwork and communication training has improved patient outcomes [38 (link),39 (link),40 (link)]. However, Aouicha et al. described a worrying situation among those healthcare professionals in ED who lack a patient safety culture in their practice [41 (link)]. Therefore, teamwork training and building facilitate the cultivation of a patient safety culture and subsequently affect patient outcomes positively. The hospital can consider implementing effective teamwork and patient safety culture programs to reduce the incidence of unsafe care and adverse events.
System management focuses on both SBP and transition of care. SBP is the ACGME core competency that focuses on complex systems and physicians’ roles. SBP encompasses several topics, including multidisciplinary team-based care, healthcare quality improvements, cost containment, value consideration, and benefit/risk analysis to patient care. The definition of SBP does not easily translate into clinical observations and behaviors to assess in clinical practice. Gonzalo et al. developed five domains to evolve further SBP: comprehensive systems-based learning, the continuum of professional development, teaching and assessment methods, clinical learning environments of SBP, and professional identity [43 (link)]. A consensus conference on education research by Academic Emergency Medicine reviewed the literature on SBP assessment tools. It suggested multimodal assessment with direct observation by expert clinicians in the workplace [46 (link)]. In brief, EPs not only deliver effective, efficient, safe, timely, and patient-centered care, but also develop strategies to improve healthcare delivery within the ED, hospital system, and community. Care transitions occur when one healthcare provider transfers responsibility for a patient’s care to another. The evolution of patient care may happen between pre-hospital and ED providers, EPs at shift change, EPs and hospitalists, and ED and nursing homes [44 (link),45 (link),47 (link)]. All types of healthcare workers participate in the transition of a patient’s care. ED is considered a high-risk, unpredictable, and frequently interrupted environment, which may adversely impact patient care quality. The transition of care from the ED has significant risks for EPs and patients, and the competency of providing high-quality care is crucial to EPs. Unlike primary care, Rider et al. highlighted the importance of optimizing technology for an effective transition of care from the ED to the outpatient clinic [49 (link)].
The use of technology applications has increased in recent years, especially in the ED specialty, due to the utilization of artificial intelligence (AI). AI is considered the next major technological breakthrough in the healthcare system. EM has been at the forefront of disciplines using AI applications for patient care because of the uniqueness of the EM model. AI was adopted for clinical practice in numerous applications within EM, including in the interpretation of diagnostic imaging, interpretation of electrocardiography, and outcome prediction [51 (link)]. The intervention of AI can increase the speed and accuracy of clinical decisions and pose benefits to both EPs, ED, and healthcare systems [50 (link)]. The most established applications of AI in EM are within the ED itself. For example, AI has shown promise in interpreting diagnostic imaging, predicting patient outcomes, and monitoring patient vitals. However, facing the new technologies, EPs require careful vetting, legal regulations, patient safeguards, and user education. EPs should identify the limits and risks of AI while enjoying its potential benefits [48 (link)].
Many studies investigate the relationship between teamwork and patient safety and find a positive impact on it [38 (link)] in ED. Teamwork is a competency integrated with common thoughts, behaviors, and feelings that help health providers work as a team to provide better patient safety and outcomes in the clinic [38 (link),42 (link)]. EM is considered a high-risk specialty in which inter-professional healthcare workers must engage to guarantee patient safety. Studies have shown that successful teamwork and communication training has improved patient outcomes [38 (link),39 (link),40 (link)]. However, Aouicha et al. described a worrying situation among those healthcare professionals in ED who lack a patient safety culture in their practice [41 (link)]. Therefore, teamwork training and building facilitate the cultivation of a patient safety culture and subsequently affect patient outcomes positively. The hospital can consider implementing effective teamwork and patient safety culture programs to reduce the incidence of unsafe care and adverse events.
System management focuses on both SBP and transition of care. SBP is the ACGME core competency that focuses on complex systems and physicians’ roles. SBP encompasses several topics, including multidisciplinary team-based care, healthcare quality improvements, cost containment, value consideration, and benefit/risk analysis to patient care. The definition of SBP does not easily translate into clinical observations and behaviors to assess in clinical practice. Gonzalo et al. developed five domains to evolve further SBP: comprehensive systems-based learning, the continuum of professional development, teaching and assessment methods, clinical learning environments of SBP, and professional identity [43 (link)]. A consensus conference on education research by Academic Emergency Medicine reviewed the literature on SBP assessment tools. It suggested multimodal assessment with direct observation by expert clinicians in the workplace [46 (link)]. In brief, EPs not only deliver effective, efficient, safe, timely, and patient-centered care, but also develop strategies to improve healthcare delivery within the ED, hospital system, and community. Care transitions occur when one healthcare provider transfers responsibility for a patient’s care to another. The evolution of patient care may happen between pre-hospital and ED providers, EPs at shift change, EPs and hospitalists, and ED and nursing homes [44 (link),45 (link),47 (link)]. All types of healthcare workers participate in the transition of a patient’s care. ED is considered a high-risk, unpredictable, and frequently interrupted environment, which may adversely impact patient care quality. The transition of care from the ED has significant risks for EPs and patients, and the competency of providing high-quality care is crucial to EPs. Unlike primary care, Rider et al. highlighted the importance of optimizing technology for an effective transition of care from the ED to the outpatient clinic [49 (link)].
The use of technology applications has increased in recent years, especially in the ED specialty, due to the utilization of artificial intelligence (AI). AI is considered the next major technological breakthrough in the healthcare system. EM has been at the forefront of disciplines using AI applications for patient care because of the uniqueness of the EM model. AI was adopted for clinical practice in numerous applications within EM, including in the interpretation of diagnostic imaging, interpretation of electrocardiography, and outcome prediction [51 (link)]. The intervention of AI can increase the speed and accuracy of clinical decisions and pose benefits to both EPs, ED, and healthcare systems [50 (link)]. The most established applications of AI in EM are within the ED itself. For example, AI has shown promise in interpreting diagnostic imaging, predicting patient outcomes, and monitoring patient vitals. However, facing the new technologies, EPs require careful vetting, legal regulations, patient safeguards, and user education. EPs should identify the limits and risks of AI while enjoying its potential benefits [48 (link)].
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