Emergency Medicine Residency

Research
Emergency Medicine Resident Research Advances

Welcome!

Research is a key component of Maine Medical Center’s three-pronged mission: Caring for our Community, Educating Tomorrow’s Caregivers, and Researching New Ways to Provide Care. Since 1996, clinical researchers from the Department of Emergency Medicine have been contributing to the growth of the specialty, the advancement of patient care, and the fulfillment of the MMC mission through their scholarly endeavors.

Our mission is as follows:

The Maine Medical Center Department of Emergency Medicine shall maintain a Division of Research and Quality with commitments to academic progress, achievement, and to clinical care that is safe, effective, patient-centered, timely, efficient, and equitable. The Division of Research and Quality shall strive to maintain a standard of excellence, ethics, and peer recognition as a contributor to Emergency Medicine research, quality, and academics. Our vision is to become a nationally recognized center for excellence in Emergency Medicine academics, including research and healthcare quality.

Members of the Division of Research and Quality Include:

Tania D. Strout, PhD, RN, MS
Director of Research
22 Bramhall Street
Portland, ME  04102
(207) 662-7049 phone
(207) 662-7054 fax
strout@mmc.org

Samir A. Haydar, DO, MPH
Director of Quality Improvement
Associate Director of Research
22 Bramhall Street
Portland, ME  04102
(207) 662-7010 phone
(207) 662-7054 fax
haydas@mmc.org

Lori A. O’Donnell
Administrative Support Person
Medical Student Coordinator
22 Bramhall Street
Portland, ME  04102
(207) 662-7024 phone
(207) 662-7054 fax
odonnl@mmc.org

Resident Research

The ACGME program requirements for Graduate Medical Education in Emergency Medicine state: "The curriculum should include resident experience in scholarly activity prior to completion of the program. Some examples of suitable resident scholarly activities are the preparation of a scholarly paper such as a collective review or case report, active participation in a research project or formulation and implementation of an original research project. Residents must be taught an understanding of basic research methodologies, statistical analysis and critical analysis of current medical literature."

In addition to the ACGME’s scholarly activity requirement, we believe that there are important skills emergency medicine residents should acquire during post-graduate training. These include tools for life-long learning, an understanding of how to use medical research and basic research concepts, an awareness of the importance of information management in healthcare, integration of the knowledge and skills required to participate in scholarly activities while maintaining scientific integrity, and the application of evidence-based medicine (EBM) skills. EBM skills include formulating questions, searching for answers, critically analyzing research to weigh the evidence, and applying the evidence to the care of patients or populations. These skills are taught during clinical care at the bedside, in didactic sessions, through Journal Club, during research and quality elective rotations, and during the completion of a scholarly project.

Resident Scholarly Activity

To fulfill the scholarly activity requirement, each resident must participate in or complete an approved scholarly project by the end of his or her residency. Some examples include:

• Original Research Project: The resident serves as principle investigator, co-investigator, or a sub-investigator on a project. Presentation of the protocol and/or completed project to the Director of Research and faculty at the departmental Emergency Medicine Research Committee meeting is required. A written manuscript is required. Close communication with the Director of Research is necessary to be certain the level of participation is sufficient to meet the requirement.

• Evidence-Based Medicine Critically Appraised Topic: The resident chooses a clinical question, searches the literature for pertinent articles, and writes approximately ten one-page critiques in the style of ACP Journal Club. These articles and reviews are assembled in a notebook and filed for future use by our training program. The Director of Research will determine if the review is of sufficient quality to meet the graduation requirement. 

• Case Report: A publication-ready manuscript is required. The Director of Research will determine if the end product is of sufficient quality to meet the graduation requirement. 

• Review Article: The resident prepares a publication-quality review based on the medical literature and submits it for publication. The Director of Research will determine if the paper meets the graduation requirement.  

• Departmental Practice Guideline: After selecting a clinical question, the resident searches the literature for pertinent articles or previously published guidelines and uses an evidence-based medicine approach to assess their validity and develop a departmental practice guideline. The Director of Research and Jeff Holmes, MD will determine if the work is sufficient to meet the graduation requirement.  

• Computer-Based Project: The resident designs a computer application or educational project. A written description and completed prototype or products are expected endpoints. The resident will review the process for protecting intellectual properties. The Director of Research will determine if the project meets the graduation requirement. 

• Product/Device Development: The resident designs a medical product/device. A written description and prototype or products are required. In addition, the resident will review the process for protecting intellectual properties. The Director of Research will determine if the product or device meets the graduation requirement. 

• Quality Project: The resident participates in a significant quality-focused investigation or project. In order to ensure the ability to disseminate quality findings outside of the institution, quality projects are handled as research projects and require submission to our Institutional Review Board. A written manuscript is required. The Director of Research and Director of Emergency Medicine Quality will determine if the work meets the graduation requirement. 

• Other: Residents are encouraged to present ideas for alternative projects to the Director of Research. With approval, these may meet the academic requirement for graduation. Scholarly writing is required for all projects.

Research Elective for Medical and Health Professions Students

The Department of Emergency Medicine is committed to the education of medical and health professions students in addition to resident physicians and offers a unique Emergency Medicine Research Rotation for third and fourth year students. The goal of the rotation is to allow students an opportunity to receive an intensive, four-week educational experience in Emergency Medicine research. The research topic will generally focus on clinically relevant projects that enhance or complement the student’s understanding of EM practice and research.  For more information, please contact the Department of Emergency Medicine Division of Research and Quality.

Recent Scholarly Publications and Presentations

American College of Emergency Medicine Accepted Abstracts, 2012

Retention Of ST-elevation Myocardial Infarction ECG Interpretation Competency By Paramedics: Urban Versus Rural Differences. Michael Roehlk, MD; George L. Higgins, III, MD; Kevin M. Kendall, MD; Tania D. Strout, PhD, RN, MS.  
Computed Tomography Usage For ED Patients With Suspected Appendicitis Following Implementation Of A Multidisciplinary Scoring-System Based Protocol. Christopher T. Bowe, MD; Cecelia Trydestam, MD; Douglas Gregory, MD; Tania D. Strout, PhD, RN, MS; Jonathan Dreifus, MD.

Cases in Geriatric Emergency Medicine: An Integrated Simulation Experience. Robert Anderson, MD.

Performance-Based Compensation For Emergency Physicians Improves Adherence To Interventions Focused On Reducing ED Length Of Stay. Samir A. Haydar, DO, MPH; Tania D. Strout, PhD, RN, MS; Michael R. Baumann, MD. 

Society for Academic Emergency Medicine Presented Abstracts, 2012

Strout TD, Baumann MR. Rasch Analysis of the Agitation Severity Scale when Used with Emergency Department Acute Psychiatry Patients.

Gibbs MA, Baumann MR, Lyden J, Strout TD, Knowles D. Effect of the Implementation of an Electronic Clinical Decision Support Tool on Adherence to Joint Commission Pneumonia Core Measures in an Academic Emergency Department.

Sledge A, Germann CA, Strout TD. Impact of Emergency Physicians Board Certification on Patient Perceptions of ED Care Quality.

Haydar SA, Botler J, Strout TD. Emergency Department Holding Orders Reduce ED Length of Stay by Decreasing Time to Bed Order.

Strout TD, Baumann MR, Pelletier J, Dolbec K. Reliability of the Revised Professional Practice Environment Scale when Used with Emergency Physicians.
Periyanayagam U, Dreifuss B, Hammerstedt H, Chamberlain S, Nelson S, Kamugisha J, Bisanzo, M.  Feasibility of Emergency Care in Rural Uganda: A Pilot Study.
Periyanayagam U, Bisanzo M, Chamberlain S, Hammerstedt H, Nelson S, Koshaba P, Dreifuss B.  Emergency Care Training Needs in Sub-Saharan Africa: A Pilot Study from Rural Uganda. 

Recent Publications, 2012

Higgins GL, III; Baumann MR, Kendall KM. Red Blood Cell Transfusion: Experience in a Rural Aero-Medical Transport Service. Prehospital and Disaster Medicine (Research Based, Accepted, in press)

Emergency Medicine Quality Council. Guideline for the Management of Bleeding on Dabigatran (Pradaxa). Portland (ME): Maine Medical Center, Departments of Emergency Medicine & Pharmacy; 2012. National Guideline Clearinghouse (Systematic Review, Evidence-based Guideline; Accepted, in press).

Vessey JA, DiFazio R, Strout TD. Increasing Meaning in Measurement: A Rasch Analysis of the CATS. Nursing Research (Research Based, accepted, in press).

Irish CB, Carden LO. Emergency ultrasound in patients with respiratory distress. EM Critical Care. 2012; 2(1): 1-24.

Bisanzo M, Nichols K, Hammerstedt H, Dreifuss B, Nelson SW, Chamberlain S, Kyomugisha F, Noble A, Arthur A, Thomas S. Nurse-Administered Ketamine Sedation in an Emergency Department in Rural Uganda. Annals of Emergency Medicine 2012; 59: 268-275. (Research Based).

Buschhorn H, Strout TD, Baumann MR, Sholl M. Emergency Medical Services Triage Using the Emergency Severity Index: Is It Reliable and Valid? Journal of Emergency Nursing (Research Based, accepted, in press).

MacVane C, Irish CB, Owens WB, Strout TD. Accuracy of Transvaginal Ultrasound in an Emergency Department Residency Program. Journal of Emergency Medicine (Research Based, accepted, in press).

Clark A, Bloch R, Gibbs M. Trauma in Pregnancy. Trauma Reports (Accepted, in press).

Haydar SA, Moore ET, Higgins GL III, Irish CB, Owens WB, Strout TD. Effect of Bedside Ultrasonography on the Certainty of Physician Clinical Decision Making for Septic Patients in the Emergency Department. Annals of Emergency Medicine (Accepted, in press).

Foianini A & Weigand T. What is the role of lidocaine and phenytoin in tricyclic antidepressant-induced cardiotoxicity? Clinical Toxicology (Accepted, in press).

Higgins GL III, Wells H, Baumann MR. Implementing an Electronic Point-of-Care Medical Record at an Organized Athletic Event: Challenges, Pitfalls, and Lessons Learned. Clinical Journal of Sports Medicine (Accepted, in press).

Dachs RJ, Kulkarni D, Higgins III GL. The pulmonary embolism rule-out criteria rule in a community hospital ED: a retrospective study of its potential utility. American Journal of Emergency Medicine 2010 (Accepted, in press).

Recent Publications: Images and Cases, 2012 

Crispo, M., Fix, M., & Higgins, GL III. A Case of Superior Vena Cava Syndrome Demonstrating Pemberton’s Sign. Journal of Emergency Medicine (Accepted, in press).

Salib TB, Higgins GL III. A Case of Spontaneous Intracranial Hypotension. Journal of Emergency Medicine (Accepted, in press).

Pelletier J, Haydar S, Higgins GL III. Quinoa proctophytobezoar causing severe fecal impaction. Journal of Family Practice (Accepted, in press).

Higgins, GL III. A Case of Human Lightning Strike Demonstrating  Lichtenberg Figures and Keraunoparalysis. Annals of Emergency Medicine (Accepted, in press).

Moore E, Strout TD, Saucier J. A Crying Infant with Painful Toes. Journal of Family Practice. (Accepted, in press).

Ward N, MacVane C. Blistering Rash in an Elderly Male. Journal of Family Practice. (Accepted, in press).

Ward N, Little J, Higgins GL III. Man with confusion and resolved paralysis. Annals of Emergency Medicine 2012: 59; 335.

Higgins GL III. A Case of Acute Long-head Biceps Tendon Rupture. Journal of Emergency Medicine. (Accepted, in press).

Angles E, Nelson S, Higgins GL III. A Women with Facial Weakness: A Classic Case of Ramsay Hunt Syndrome. Journal of Emergency Medicine (Case Report and Images, accepted, in press).