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The purpose was to measure faculty members': (1) knowledge of quality improvement and patient safety (QIPS), (2) attitudes and beliefs about their own QI skills, and (3) self-efficacy toward participating in, leading, and teaching QIPS. Faculty completed an online survey. Questions assessed demographic and academic characteristics, knowledge, attitudes/beliefs, and self-efficacy. Knowledge was measured using the Quality Improvement Knowledge Assessment Tool-Revised (QIKAT-R). Participants provided free-text responses to questions about clinical scenarios. Almost half of participants (n = 236) self-reported that they were moderately or extremely comfortable with QIPS skills. Few were very (20%) or most (15%) comfortable teaching QIPS. Ninety-one participants attempted the QIKAT-R, and 78 participants completed it. The mean score was 16.6 (SD = 5.6). Despite positive attitudes and beliefs about their own QIPS skills, study results demonstrate a general lack of knowledge among surveyed faculty members. Faculty development efforts are needed to improve proficiency in participating, leading, and teaching QIPS projects.

Background With increasing rates of obesity and its link with cardiovascular disease, there is a need for better understanding of the obesity‐outcome relationship. This study explores the association between categories of obesity with treatment times and mortality for patients experiencing ST‐segment elevation myocardial infarction. Methods and Results We examined 8725 patients with ST‐segment elevation myocardial infarction who underwent primary percutaneous coronary intervention and used regression models to analyze the relationship between 6 categories of body mass index with key door‐to‐balloon time, total ischemic time, and in‐hospital mortality. We relied on data from the Mission: Lifeline North Texas program, consisting of 33 percutaneous coronary intervention–capable hospitals in 6 counties surrounding Dallas, Texas. Data were extracted from the National Cardiovascular Data Registry for each participating hospital. Of the samples, 76% were overweight or obese. Comparing the univariate differences between the normal‐weight group and the pooled sample, we observed a U‐shaped association between body mass index and both mortality and door‐to‐balloon times. The most underweight and severely obese had the highest mortality and median door‐to‐balloon time, respectively. These differences persisted after multivariate adjustments for door‐to‐balloon time, but not for mortality. Conclusions Extremely obese patients have longer treatment time delays than other body mass index categories. However, this did not extend to significant differences in mortality in the multivariate models. We conclude that clinicians should incorporate body mass assessments into their diagnosis and treatment plans to mitigate observed disparities.

Wilderness medicine is the practice of resource-limited medicine under austere conditions. In 2003, the first wilderness medicine fellowship was established, and as of March 2013, a total of 12 wilderness medicine fellowships exist. In 2009 the American College of Emergency Physicians Wilderness Medicine Section created a Fellowship Subcommittee and Taskforce to bring together fellowship directors, associate directors, and other interested stakeholders to research and develop a standardized curriculum and core content for emergency medicine (EM)-based wilderness medicine fellowships. This paper describes the process and results of what became a 4-year project to articulate a standardized curriculum for wilderness medicine fellowships. The final product specifies the minimum core content that should be covered during a 1-year wilderness medicine fellowship. It also describes the structure, length, site, and program requirements for a wilderness medicine fellowship.

The provision of emergency care in the United States, regionalized or not, depends on an adequate workforce. Adequate must be defined both qualitatively and quantitatively. There is currently a shortage of emergency care providers, one that will exist for the foreseeable future. This article discusses what is known about the current emergency medicine (EM) and non-EM workforce, future trends, and research opportunities.

Sandra M. Schneider, MD, Angela F. Gardner, MD, Larry D. Weiss, MD, JD, Joseph P. Wood, MD, JD,Michael Ybarra, MD, Dennis M. Beck, MD, Arlen R. Stauffer, MD, Dean Wilkerson, JD, MBA, ThomasBrabson, DO, MBA, Anthony Jennings, DO, Mark Mitchell, DO, Roland B. McGrath, MD, TheodoreA. Christopher, MD, Brent King, MD, Robert L. Muelleman, MD, Mary J. Wagner, MD, DouglasM. Char, MD, Douglas L. McGee, MD, Randy L. Pilgrim, MD, Joshua B. Moskovitz, MD, MPH, AndrewR. Zinkel, MD, Michele Byers, MBA, William T. Briggs, MSN, Cherri D. Hobgood, MD, DouglasF. Kupas, MD, Jennifer Kruger, PA-C, MBA, Cary J. Stratford, PA-C, and Nicholas Jouriles, MD

Background The specialty of emergency medicine (EM) continues to experience a significant workforce shortage in the face of increasing demand for emergency care. Summary In July 2009, representatives of the leading EM organizations met in Dallas for the Future of Emergency Medicine Summit. Attendees at the Future of Emergency Medicine Summit agreed on the following: 1) Emergency medical care is an essential community service that should be available to all; 2) An insufficient emergency physician workforce also represents a potential threat to patient safety; 3) Accreditation Council for Graduate Medical Education/American Osteopathic Association (AOA)-accredited EM residency training and American Board of Medical Specialties/AOA EM board certification is the recognized standard for physician providers currently entering a career in emergency care; 4) Physician supply shortages in all fields contribute to—and will continue to contribute to—a situation in which providers with other levels of training may be a necessary part of the workforce for the foreseeable future; 5) A maldistribution of EM residency-trained physicians persists, with few pursuing practice in small hospital or rural settings; 6) Assuring that the public receives high quality emergency care while continuing to produce highly skilled EM specialists through EM training programs is the challenge for EM's future; 7) It is important that all providers of emergency care receive continuing postgraduate education.