Bio

Clinical Focus


  • Emergency Medicine

Academic Appointments


Administrative Appointments


  • Director of Emergency Medicine Simulation, Stanford University (2011 - Present)
  • Standing Appeals Panel, Accreditation Council of Graduate Medical Eductaion (ACGME) (2008 - Present)
  • Residency Review Committee (RRC)- Emergency Medicine, Acreditation Council for Graduate Medical Education (ACGME) (2002 - 2008)
  • Board of Directors, American Board of Emergency Medicine (ABEM) (2007 - Present)
  • Associate Dean for Medical Student Life Advising, Dean's Office, School of Medicine (2006 - Present)
  • Professor of Surgery/EMed, Stanford University (1998 - Present)

Honors & Awards


  • Advanced Stanford Leadership Development Program, Stanford University (2012-2013)
  • Stanford School of Medicine Teaching Excellence Award, Stanford University (2010)
  • Faculty Fellows Program, Stanford University (2009)
  • Stanford Leadership Development Program, Stanford University (2008-2009)
  • Education award, CAL/American College of Emergency Physicians (2008)
  • 1995 International Fellowship, The Ronald Reagan Institute of Emergency Medicine (1995)
  • 1994 International Fellowship, The Ronald Reagan Institute of Emergency Medicine (1994)
  • Best Poster of 1993 Award for "Effect of Schedule on Physician Sleep, Work Performance and Mood"., Society for Academic Emergency Medicine (1993)

Professional Education


  • Board Certification: Emergency Medicine, American Board of Emergency Medicine (1989)
  • Board Certification: Internal Medicine, American Board of Internal Medicine (1988)
  • Residency:Northwestern Memorial Hospital (1987) IL
  • Internship:Northwestern Memorial Hospital (1984) IL
  • Medical Education:University of Pennsylvania (1983) PA
  • MD, University of Pennsylvania, Medicine (1983)
  • BA, Cornell University (1979)

Community and International Work


  • 2010 Katmandu Ambulance Project, Katmandu, Nepal

    Location

    International

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    No

  • Every 15 Minutes

    Topic

    Teen driving and alcohol

    Partnering Organization(s)

    California Highway Patrol

    Populations Served

    high school students

    Location

    Bay Area

    Ongoing Project

    No

    Opportunities for Student Involvement

    Yes

Research & Scholarship

Current Research and Scholarly Interests


Effect of work schedule on work performance, mood and, sleep architecture in attending emergency medicine physicians,residents.

Teaching

2013-14 Courses


Graduate and Fellowship Programs


Publications

Journal Articles


  • LIFELONG LEARNING AND SELF-ASSESSMENT IS RELEVANT TO EMERGENCY PHYSICIANS JOURNAL OF EMERGENCY MEDICINE Jones, J. H., Smith-Coggins, R., Meredith, J. M., Korte, R. C., Reisdorff, E. J., Russ, C. M. 2013; 45 (6): 935-940

    Abstract

    The Lifelong Learning and Self-assessment (LLSA) component of the American Board of Emergency Medicine (ABEM) Maintenance of Certification (MOC) program is a self-assessment exercise for physicians. Beginning in 2011, an optional continuing medical education (CME) activity was added.As a part of a CME activity option for the LLSA, a survey was used to determine the relevancy of the LLSA readings and the degree to which medical knowledge garnered by the LLSA activity would modify clinical care.Survey results from the 2011 LLSA CME activity were reviewed. This survey was composed of seven items, including questions about the relevancy of the readings and the impact on the physician's clinical practice. The questions used a 5-point Likert scale and data underwent descriptive analyses.There were 2841 physicians who took the LLSA test during the study period, of whom 1354 (47.7%) opted to participate in the 2011 LLSA CME activity. All participants completed surveys. The LLSA readings were reported to be relevant to the overall clinical practice of Emergency Medicine (69.6% strongly relevant, 28.1% some relevance, and 2.3% little or no relevance), and provided information that would likely help them change their clinical practices (high likelihood 38.8%, some likelihood 53.0%, little or no change 8.2%).The LLSA component of the ABEM MOC program is relevant to the clinical practice of Emergency Medicine. Through this program, physicians gain new knowledge about the practice of Emergency Medicine, some of which is reported to change physicians' clinical practices.

    View details for DOI 10.1016/j.jemermed.2013.05.050

    View details for Web of Science ID 000327535800038

    View details for PubMedID 23937810

  • Lifelong Learning and Self-assessment is Relevant to Emergency Physicians J Emerg Med Jones, J. H., Smith-Coggins, R., Meredith, J. M., korte, R. C., Reisdorff, E. J., Russ, C. M. 2013; 45 (6): 935-41
  • American Board of Emergency Medicine Report on Residency Training (2012-2013) Annals of Emergency Medicine Smith-Coggins R, Baren JM, Counselman FL, Kowalenko T, Marco CA, Muelleman RL, Wahl RP, Korte RC 2013; 61 (5): 584-592
  • Report on residency training information (2011-2012) Annals of Emergency Medicine Smith-Coggins R, Carius ML, Collier RE, Counselman FL, Kowalenko T, Marco CA, Muelleman RL, Korte RC 2012; 59 (5): 416-24
  • Generational Influences in Academic Emergency Medicine: Structure, Function, and Culture (Part II) ACADEMIC EMERGENCY MEDICINE Mohr, N. M., Smith-Coggins, R., Larrabee, H., Dyne, P. L., Promes, S. B. 2011; 18 (2): 200-207

    Abstract

    Strategies for approaching generational issues that affect teaching and learning, mentoring, and technology in emergency medicine (EM) have been reported. Tactics to address generational influences involving the structure and function of the academic emergency department (ED), organizational culture, and EM schedule have not been published. Through a review of the literature and consensus by modified Delphi methodology of the Society for Academic Emergency Medicine Aging and Generational Issues Task Force, the authors have developed this two-part series to address generational issues present in academic EM. Understanding generational characteristics and mitigating strategies can address some common issues encountered in academic EM. By understanding the differences and strengths of each of the cohorts in academic EM departments and considering simple mitigating strategies, faculty leaders can maximize their cooperative effectiveness and face the challenges of a new millennium.

    View details for DOI 10.1111/j.1553-2712.2010.00986.x

    View details for Web of Science ID 000287248200015

    View details for PubMedID 21314780

  • DUTY HOURS IN EMERGENCY MEDICINE: BALANCING PATIENT SAFETY, RESIDENT WELLNESS, AND THE RESIDENT TRAINING EXPERIENCE: A CONSENSUS RESPONSE TO THE 2008 INSTITUTE OF MEDICINE RESIDENT DUTY HOURS RECOMMENDATIONS JOURNAL OF EMERGENCY MEDICINE Wagner, M. J., Wolf, S., Promes, S., McGee, D., Hobgood, C., Doty, C., McErlean, M. A., Janssen, A., Smith-Coggins, R., Ling, L., Mattu, A., Tantama, S., Beeson, M., Brabson, T., Christiansen, G., King, B., Luerssen, E., Muelleman, R. 2010; 39 (3): 348-355

    Abstract

    Representatives of emergency medicine (EM) were asked to develop a consensus report that provided a review of the past and potential future effects of duty hour requirements for EM residency training. In addition to the restrictions made in 2003 by the Accreditation Council for Graduate Medical Education, the potential effects of the 2008 Institute of Medicine (IOM) report on resident duty hours were postulated.The elements highlighted include patient safety, resident wellness, and the resident training experience. Many of the changes and recommendations did not affect EM as significantly as other specialties. Current training standards in EM have already emphasized patient safety by requiring continuous onsite supervision of residents. Resident fatigue has been addressed with restrictions of shift lengths and limitation of consecutive days worked.One recommendation from the IOM was a required 5-h rest period for residents on call. Emergency department (ED) patient safety becomes an important concern with the decrease in the availability and in the patient load of a resident consultant that may result from this recommendation. Of greater concern is the already observed slower throughput time for admitted patients waiting for resident care, which will increase ED crowding and decrease patient safety in academic institutions. A balance between being overly prescriptive with duty hour restrictions and trying to improve resident wellness was recommended. Discussion is included regarding the appropriate length of EM training programs if clinical experiences were limited by new duty hour regulations. Finally, this report presents a review of the financing issues associated with any changes.

    View details for DOI 10.1016/j.jemermed.2010.05.058

    View details for Web of Science ID 000282072800019

    View details for PubMedID 20634017

  • Duty Hours in Emergency Medicine: Balancing Patient Safety, Resident Wellness, and the Resident Training Experience: A Consensus Response to the 2008 Institute of Medicine Resident Duty Hours Recommendations ACADEMIC EMERGENCY MEDICINE Wagner, M. J., Wolf, S., Promes, S., McGee, D., Hobgood, C., Doty, C., McErlean, M. A., Janssen, A., Smith-Coggins, R., Ling, L., Mattu, A., Tantama, S., Beeson, M., Brabson, T., Christiansen, G., King, B., Luerssen, E., Muelleman, R. 2010; 17 (9): 1004-1011

    Abstract

    Representatives of emergency medicine (EM) were asked to develop a consensus report that provided a review of the past and potential future effects of duty hour requirements for EM residency training. In addition to the restrictions made in 2003 by the Accreditation Council for Graduate Medical Education (ACGME), the potential effects of the 2008 Institute of Medicine (IOM) report on resident duty hours were postulated. The elements highlighted include patient safety, resident wellness, and the resident training experience. Many of the changes and recommendations did not affect EM as significantly as other specialties. Current training standards in EM have already emphasized patient safety by requiring continuous on-site supervision of residents. Resident fatigue has been addressed with restrictions of shift lengths and limitation of consecutive days worked. One recommendation from the IOM was a required 5-hour rest period for residents on call. Emergency department (ED) patient safety becomes an important concern with the decrease in the availability and in the patient load of a resident consultant that may result from this recommendation. Of greater concern is the already observed slower throughput time for admitted patients waiting for resident care, which will increase ED crowding and decrease patient safety in academic institutions. A balance between being overly prescriptive with duty hour restrictions and trying to improve resident wellness was recommended. Discussion is included regarding the appropriate length of EM training programs if clinical experiences were limited by new duty hour regulations. Finally, this report presents a review of the financing issues associated with any changes.

    View details for DOI 10.1111/j.1553-2712.2010.00789.x

    View details for Web of Science ID 000281632000016

    View details for PubMedID 20836785

  • The Assessment of Individual Cognitive Expertise and Clinical Competency: A Research Agenda ACADEMIC EMERGENCY MEDICINE Spillane, L., Hayden, E., Fernandez, R., Adler, M., Beeson, M., Goyal, D., Smith-Coggins, R., Boulet, J. 2008; 15 (11): 1071-1078

    Abstract

    There is a large push to utilize evidence-based practices in medical education. At the same time, credentialing bodies are evaluating the use of simulation technologies to assess the competency and safety of its practitioners. At the 2008 Academic Emergency Medicine Consensus Conference on "The Science of Simulation in Healthcare," our breakout session critically evaluated several issues important to the use of simulation in emergency physician (EP) assessment. In this article, we discuss five topics felt to be most critical to simulation-based assessment (SBA). We then offer more specific research questions that would help to define and implement a SBA program in emergency medicine (EM).

    View details for DOI 10.1111/j.1553-2712.2008.00271.x

    View details for Web of Science ID 000261051700014

    View details for PubMedID 19032553

  • The Assessment of Individual Cognitive Expertise and Clinical Competency: A Research Agenda Acad Emerg Med Spillane L, Hayden E, Fernandez R, Adler M, Beeson M, Goyal D, Smith-Coggins R, Boulet J 2008; 15 (11): 1071-1078
  • Using patient care quality measures to assess educational outcomes ACADEMIC EMERGENCY MEDICINE Swing, S. R., Schneider, S., Bizovi, K., Chapman, D., Graff, L. G., Hobgood, C., Lukens, T., Radford, M. J., Sanders, A., Smith-Coggins, R., Spillane, L., Hruska, L., Wears, R. L. 2007; 14 (5): 463-473

    Abstract

    To report the results of a project designed to develop and implement a prototype methodology for identifying candidate patient care quality measures for potential use in assessing the outcomes and effectiveness of graduate medical education in emergency medicine.A workgroup composed of experts in emergency medicine residency education and patient care quality measurement was convened. Workgroup members performed a modified Delphi process that included iterative review of potential measures; individual expert rating of the measures on four dimensions, including measures quality of care and educational effectiveness; development of consensus on measures to be retained; external stakeholder rating of measures followed by a final workgroup review; and a post hoc stratification of measures. The workgroup completed a structured exercise to examine the linkage of patient care process and outcome measures to educational effectiveness.The workgroup selected 62 measures for inclusion in its final set, including 43 measures for 21 clinical conditions, eight medication measures, seven measures for procedures, and four measures for department efficiency. Twenty-six measures met the more stringent criteria applied post hoc to further stratify and prioritize measures for development. Nineteen of these measures received high ratings from 75% of the workgroup and external stakeholder raters on importance for care in the ED, measures quality of care, and measures educational effectiveness; the majority of the raters considered these indicators feasible to measure. The workgroup utilized a simple framework for exploring the relationship of residency program educational activities, competencies from the six Accreditation Council for Graduate Medical Education general competency domains, patient care quality measures, and external factors that could intervene to affect care quality.Numerous patient care quality measures have potential for use in assessing the educational effectiveness and performance of graduate medical education programs in emergency medicine. The measures identified in this report can be used as a starter set for further development, implementation, and study. Implementation of the measures, especially for high-stakes use, will require resolution of significant measurement issues.

    View details for DOI 10.1197/j.aem.2006.12.011

    View details for Web of Science ID 000245960100013

    View details for PubMedID 17395960

  • The use of simulation in emergency medicine: A research agenda ACADEMIC EMERGENCY MEDICINE Bond, W. F., Lammers, R. L., Spillane, L. L., Smith-Coggins, R., Fernandez, R., Reznek, M. A., Vozenilek, J. A., Gordon, J. A. 2007; 14 (4): 353-363

    Abstract

    Medical simulation is a rapidly expanding area within medical education. In 2005, the Society for Academic Emergency Medicine Simulation Task Force was created to ensure that the Society and its members had adequate access to information and resources regarding this new and important topic. One of the objectives of the task force was to create a research agenda for the use of simulation in emergency medical education. The authors present here the consensus document from the task force regarding suggested areas for research. These include opportunities to study reflective experiential learning, behavioral and team training, procedural simulation, computer screen-based simulation, the use of simulation for evaluation and testing, and special topics in emergency medicine. The challenges of research in the field of simulation are discussed, including the impact of simulation on patient safety. Outcomes-based research and multicenter efforts will serve to advance simulation techniques and encourage their adoption.

    View details for DOI 10.1197/j.aem.2006.11.021

    View details for Web of Science ID 000245579300010

    View details for PubMedID 17303646

  • Improving alertness and performance in emergency department physicians and nurses: The use of planned naps ANNALS OF EMERGENCY MEDICINE Smith-Coggins, R., Howard, S. K., Mac, D. T., Wang, C., Kwan, S., Rosekind, M. R., Sowb, Y., Ballise, R., Levis, J., Gaba, D. M. 2006; 48 (5): 596-604

    Abstract

    We examine whether a 40-minute nap opportunity at 3 AM can improve cognitive and psychomotor performance in physicians and nurses working 12-hour night shifts.This is a randomized controlled trial of 49 physicians and nurses working 3 consecutive night shifts in an academic emergency department. Subjects were randomized to a control group (no-nap condition=NONE) or nap intervention group (40-minute nap opportunity at 3 AM=NAP). The main outcome measures were Psychomotor Vigilance Task, Probe Recall Memory Task, CathSim intravenous insertion virtual reality simulation, and Profile of Mood States, which were administered before (6:30 PM), during (4 AM), and after (7:30 AM) night shifts. A 40-minute driving simulation was administered at 8 AM and videotaped for behavioral signs of sleepiness and driving accuracy. During the nap period, standard polysomnographic data were recorded.Polysomnographic data revealed that 90% of nap subjects were able to sleep for an average of 24.8 minutes (SD 11.1). At 7:30 AM, the nap group had fewer performance lapses (NAP 3.13, NONE 4.12; p<0.03; mean difference 0.99; 95% CI: -0.1-2.08), reported more vigor (NAP 4.44, NONE 2.39; p<0.03; mean difference 2.05; 95% CI: 0.63-3.47), less fatigue (NAP 7.4, NONE 10.43; p<0.05; mean difference 3.03; 95% CI: 1.11-4.95), and less sleepiness (NAP 5.36, NONE 6.48; p<0.03; mean difference 1.12; 95% CI: 0.41-1.83). They tended to more quickly complete the intravenous insertion (NAP 66.40 sec, NONE 86.48 sec; p=0.10; mean difference 20.08; 95% CI: 4.64-35.52), exhibit less dangerous driving and display fewer behavioral signs of sleepiness during the driving simulation. Immediately after the nap (4 AM), the subjects scored more poorly on Probed Recall Memory (NAP 2.76, NONE 3.7; p<0.05; mean difference 0.94; 95% CI: 0.20-1.68).A nap at 3 AM improved performance and subjective report in physicians and nurses at 7:30 AM compared to a no-nap condition. Immediately after the nap, memory temporarily worsened. The nap group did not perform any better than the no-nap group during a simulated drive home after the night shift.

    View details for DOI 10.1016/j.annemergmed.2006.02.005

    View details for Web of Science ID 000241749400017

    View details for PubMedID 17052562

  • : Measuring Sleep Onset: Comparing The Standard Versus An Experimental Montage Sleep Howard SK, Smith-Coggins R, Nevarez M, Sohoni A, Gaba D, Rosekind M 2005; 28: A1324-325
  • : Sleep Propensity and Performance: Evaluating A Brief Protocol In Health Care Providers Sleep Howard SK, Smith-Coggins R, Nevarez M, Sohoni A, Gaba D, Rosekind M 2005; 28: A133
  • Assessment of resident professionalism using high-fidelity simulation of ethical dilemmas ACADEMIC EMERGENCY MEDICINE Gisondi, M. A., Smith-Coggins, R., Harter, P. M., Soltysik, R. C., Yarnold, P. R. 2004; 11 (9): 931-937

    Abstract

    To examine the responses of emergency medicine residents (EMRs) to ethical dilemmas in high-fidelity patient simulations as a means of assessing resident professionalism.This cross-sectional observational study included all EMRs at a three-year training program. Subjects were excluded if they were unable or unwilling to participate. Each resident subject participated in a simulated critical patient encounter during an Emergency Medicine Crisis Resource Management course. An ethical dilemma was introduced before the end of each simulated encounter. Resident responses to that dilemma were compared with a professional performance checklist evaluation. Multi-response permutation procedure analysis was used to compare performance measures between resident classes, with the a priori hypothesis that mean performance should increase as experience increases.Of the 30 potential subjects, 90% (27) participated. The remaining three residents were unavailable due to scheduling conflicts. It was observed that senior residents (second and third year) performed more checklist items than did first-year residents (p < 0.028 for each senior class). Omnibus comparison of mean critical actions completed across all three years was not statistically significant (p < 0.13). Residents performed a critical action with 100% uniformity across training years in only one ethical scenario ("Practicing Procedures on the Recently Dead"). Residents performed the fewest critical actions and overall checklist items for the "Patient Confidentiality" case.Senior residents had better overall performance than incoming interns, suggesting that professional behaviors are learned through some facet of residency training. Although limited by small sample size, the application of this performance-assessment tool showed the ability to discriminate between experienced and inexperienced EMRs with respect to a variety of aspects of professional competency. These findings suggest a need for improved resident education in areas of professionalism and ethics.

    View details for DOI 10.1197/j.aem.2004.04.005

    View details for Web of Science ID 000223732700005

    View details for PubMedID 15347542

  • Integrating the Accreditation Council for Graduate Medical Education core competencies into the Model of the Clinical Practice of Emergency Medicine ACADEMIC EMERGENCY MEDICINE Chapman, D. M., Hayden, S., Sanders, A. B., Binder, L. S., Chinnis, A., Corrigan, K., LaDuca, T., Dyne, P., Perina, D. G., Smith-Coggins, R., Sulton, L., Swing, S. 2004; 11 (6): 674-685

    View details for DOI 10.1197/j.aem.2004.02.008

    View details for Web of Science ID 000221905700012

    View details for PubMedID 15175209

  • Use of High-Fidelity Simulation to Evaluate Resident Professionalism During Critical Patient Encounters Acad Emerg Med Gisondi M, Smith-Coggins R, Harter P 2004; 11 (9): 931-937
  • Integrating the Accreditation Council for Graduate Medical Education Core Competencies Into the Model o f the Clinical Practice of Emergency Medicine Acad Emerg Med Chapman D, Hayden S, Sanders A, Binder L, Chinnis A, Corrigan K, LaDuca, Dyne P, Perina D, Smith-Coggins R, Sulton L, Swing S 2004; 11 (6): 674-685
  • Integrating the Accreditation Council for Graduate Medical Education Core Competencies Into the Model of the Clinical Practice of Emergency Medicine Ann Emerg Med, Chapman D, Hayden S, Sanders A, Binder L, Chinnis A, Corrigan K, LaDuca T, Dyne P, Perina D, Smith-Coggins R, Sulton L, Swing S 2004; 43 (6): 756-769
  • Global Assessment Tool for Emergency Medicine-Specific Core Competency Evaluation Academic Emergency Medicine Wang E, Chapman D, Hayden S, Sanders A, Binder L, Chinnis A, Corrigan K, LaDuca R, Dyne P, Perina D, Smith-Coggins R, Sulton L, Swing S 2004; 11 (12): 1370-1
  • Emergency medicine crisis resource management (EMCRM): Pilot study of a simulation-based crisis management course for emergency medicine ACADEMIC EMERGENCY MEDICINE Reznek, M., Smith-Coggins, R., Howard, S., Kiran, K., Harter, P., Sowb, Y., Gaba, D., Krummel, T. 2003; 10 (4): 386-389

    Abstract

    To determine participant perceptions of Emergency Medicine Crisis Resource Management (EMCRM), a simulation-based crisis management course for emergency medicine.EMCRM was created using Anesthesia Crisis Resource Management (ACRM) as a template. Thirteen residents participated in one of three pilot courses of EMCRM; following a didactic session on principles of human error and crisis management, the residents participated in simulated emergency department crisis scenarios and instructor-facilitated debriefing. The crisis simulations involved a computer-enhanced mannequin simulator and standardized patients. After finishing the course, study subjects completed a horizontal numerical scale survey (1 = worst rating to 5 = best rating) of their perceptions of EMCRM. Descriptive statistics were calculated to evaluate the data.The study subjects found EMCRM to be enjoyable (4.9 +/- 0.3) (mean +/- SD) and reported that the knowledge gained from the course would be helpful in their practices (4.5 +/- 0.6). The subjects believed that the simulation environment prompted realistic responses (4.6 +/- 0.8) and that the scenarios were highly believable (4.8 +/- 0.4). The participants reported that EMCRM was best suited for residents (4.9 +/- 0.3) but could also benefit students and attending physicians. The subjects believed that the course should be repeated every 8.2 +/- 3.3 months.The EMCRM participants rated the course very favorably and believed that the knowledge gained would be beneficial in their practices. The extremely positive response to EMCRM found in this pilot study suggests that this training modality may be valuable in training emergency medicine residents.

    View details for Web of Science ID 000181995500016

    View details for PubMedID 12670855

  • Development of a Three-Level Curriculum for Crisis Resource management Training in Emergency Medicine International Meeting on Medical Simulation Sowb Y, Kiran K, Reznec M, Smith-Coggins R, Harter P, Stafford-Cecil S, Howard S, Gaba D 2003: 47
  • Use of High-fidelity simulation to Evaluate Resident Professionalism during Critical Patient Encounters ACGME/ABMS Conference, Fostering Professionalism: Challenges and Opportunities Gisondi M, Smith-Coggins R, Harter P 2003: 12
  • Do Naps During the Night Shift Improve Performance in the Emergency Department Sleep Smith-Coggins R, Howard S, Kwan S, Wang C, Mac DT, Rosekind M, Sowb Y, Balise R, Gaba D 2002: A116-A117
  • Development of a Standard Crisis Management Curriculum for Emergency Medicine Academic Emergency Medicine Reznek M, Smith-Coggins R, Howard S, Harter P, Sowb Y, Gaba D, Krummel T 2002; 9 (5): 430
  • Do Naps During the Night Shift Improve Performance in the Emergency Department Annals of Emergency Medicine Smith-Coggins R, Howard S, Kwan S, Wang C, Mac DT, Rosekind M, Sowb Y, Balise R, Gaba D 2002; 9 (5): 466
  • Morningness-eveningness preferences of emergency medicine residents are skewed toward eveningness ACADEMIC EMERGENCY MEDICINE Steele, M. T., McNamara, R. M., SMITHCOGGINS, R., Watson, W. A. 1997; 4 (7): 699-705

    Abstract

    To determine the morningness-eveningness (ME) distribution of emergency medicine (EM) residents.A voluntary, modified ME questionnaire was administered to all EM residents in the United States at the time of the 1995 American Board of Emergency Medicine's annual In-Training Examination.Seventy-eight percent (2,047/2,614) of the surveys were returned. ME scores ranged from 24 to 76, with a median score of 49 (interquartile range 44, 56). The scores were distributed differently from those of the normal population (p < 0.001), being skewed toward eveningness. There was a correlation (r = 0.13, p < 0.0001) between resident age and ME score, with older residents being more morning-oriented. Males were more morning-oriented than females (p = 0.005), and respondents with children living at home also were significantly more morning-oriented (p < 0.001). Stepwise logistic regression showed that the influence of age, gender, and children was cumulative (r = 0.19) but accounted for only 4% of the observed variability.EM residents are distributed differently from the normal population in terms of their ME preferences, tending slightly toward eveningness. The importance of this distribution in EM residents in unknown. A longitudinal follow-up of this cohort may help to determine the association of ME preference with overall practice satisfaction, tolerance of shift work, and career longevity.

    View details for Web of Science ID A1997XJ85200012

    View details for PubMedID 9223694

  • Morningness-Eveningness Preference of Emergency Medicine Residents are Skewed Toward Eveningness . Acad Emerg Med Steele MT, McNamara RM, Smith-Coggins R. Watson WA 1997; 4 (7): 699-705
  • RELATIONSHIP OF DAY VERSUS NIGHT SLEEP TO PHYSICIAN PERFORMANCE AND MOOD ANNALS OF EMERGENCY MEDICINE SMITHCOGGINS, R., Rosekind, M. R., Hurd, S., BUCCINO, K. R. 1994; 24 (5): 928-934

    Abstract

    To document and analyze the quality and quantity of emergency physicians' sleep as a function of day and night shift work, and to compare cognitive and motor performance and mood during day and night shifts.Six physicians were monitored for two 24-hour periods. One period consisted of daytime work and nocturnal sleep and the second consisted of daytime sleep and nighttime work.The emergency department of Stanford University Medical Center and physicians' homes.Six attending emergency physicians.Ambulatory polysomnographic recorders continuously gathered EEG, electro-oculogram, and electromyograph data throughout each observation period. Physicians filled out hourly mood ratings and completed a set of two performance tests five times throughout the day.Physicians had significantly less sleep (496.6 minutes versus 328.5 minutes, P = .02) when sleeping during the day as compared with sleeping at night. Significant performance decrements were also found. Physicians working nights were slower at intubating a mannequin (31.56 seconds versus 42.2 seconds, P = .04) and were more likely to commit errors as their shift progressed (P = .04). Physicians in both conditions were more likely to make errors during a simulated triage test toward the end of their shifts (P = .02). Subjects also rated themselves significantly less sleepy (P < .01), happier (P < .01), and more clear thinking (P < .01) when working day versus night shifts.Attending emergency physicians get less sleep and are less effective when performing manual and cognitive tests while working night shifts with day sleep compared with working day shifts with night sleep.

    View details for Web of Science ID A1994PP22500014

    View details for PubMedID 7978567

  • Gender-Associated Differences in Emergency Department Pain Management Academic Emergency Medicine Raftery KA, Smith-Coggins R, Chen AHM 1994; 1 (2): A52
  • Promoting Alertness and Performance on the Night Shift: An Intervention Study Annals of Emergency Medicine Smith-Coggins R, Rosekind MR, Buccino KR, Cole W 1993; 22 (5): 946
  • The Relationship of Day vs. Night Sleep to Physician Performance and Mood Annals of Emergency Medicine Smith-Coggins R, Rosekind M, Hurd S, Buccino K 1991; 20 (4): 455
  • A Technique for Producing Constant Plasma Drug Concentrations. Annals of Internal Medicine Ambre JJ, Smith-Coggins R, Belnap S, Nelson J 1987: 122
  • Mothball Composition: Three Simple Tests for Distinguishing Paradichlorobenzene From Naphthalene Annals of Emergency Medicine Ambre JJ, Smith-Coggins R 1986: 724-726
  • Local Anesthetics Annals of Emergency Medicine Altman RS, Smith-Coggins R, Ampel LL 1985: 1209-1217
  • Unsaturated Fatty Acids and Human Mononuclear Cell Function. Prog of Lipid Research Utermohlen V, Coniglio J, Mao D, sierra J, Smith R, Besner G, Hutchins S, Spitzer K, Tomasso J, Boyar A 1981: 739-741

Conference Proceedings


  • Rotating shiftwork schedules: Can we enhance physician adaptation to night shifts? SMITHCOGGINS, R., Rosekind, M. R., BUCCINO, K. R., Dinges, D. F., MOSER, R. P. HANLEY & BELFUS INC. 1997: 951-961

    Abstract

    To evaluate the effectiveness of a broad, literature-based night shiftwork intervention for enhancement of emergency physicians' (EPs') adaptation to night rotations.A prospective, double-blind, active placebo-controlled study was conducted on 6 attending physicians in a university hospital ED. Three data sets were collected under the following conditions: baseline, after active placebo intervention, and after experimental intervention. In each condition, data were collected when the physicians worked both night and day shifts. Measurements included ambulatory polysomnographic recordings of the main sleep periods, objective performance tests administered several times during the subjects' shifts, and daily subjective ratings of the subjects' sleep, moods, and intervention use.The subjects slept an average of 5 hr 42 min across all conditions. After night shifts, the subjects slept significantly less than they did after day shifts (5 hr 13 min vs 6 hr 20 min; p < 0.05). The physicians' vigilance reaction times and times for intubation of a mannequin were significantly slower during night shifts than they were during day shifts (p = 0.007 and p < 0.04, respectively), but performances on ECG analysis did not significantly differ between night and day shifts. Mood ratings were significantly more negative during night shifts than they were during day shifts (more sluggish p < 0.04, less motivated p < 0.03, and less clear thinking p < 0.04). The strategies in the experimental intervention were used 85% of the time according to logbook entries. The experimental and active placebo interventions did not significantly improve the physician's performance, or mood on the night shift, although the subjects slept more after both interventions.Although the experimental intervention was successfully implemented, it failed to significantly improve attending physicians' sleep, performance, or mood on night shifts. A decrease in speed of intubation, vigilance reaction times, and subjective alertness was evident each time the physicians rotated through the night shift. These findings plus the limited sleep across all conditions and shifts suggest that circadian-mediated disruptions of waking neurobehavioral functions and sleep deprivation are problems in EPs.

    View details for Web of Science ID A1997YA21000008

    View details for PubMedID 9332626

  • GENDER-ASSOCIATED DIFFERENCES IN EMERGENCY DEPARTMENT PAIN MANAGEMENT RAFTERY, K. A., SMITHCOGGINS, R., GHEN, A. H. MOSBY-YEAR BOOK INC. 1995: 414-421

    Abstract

    To determine whether patient or provider gender is associated with the number, type, and strength of medications received by emergency department patients with headache, neck pain, or back pain.Prospective cohort study.Stanford University Hospital ED PARTICIPANTS: Patients 18 years and older who arrived at the ED with a chief complaint of headache, neck pain, or back pain between February 1, 1993, and September 30, 1993. Provider participants included medical students, interns, residents, nurse practitioners, and attending physicians.ED administration of analgesic versus no analgesic, strength of analgesic administered, and administration of multiple medications. The study group consisted of 190 patients, 110 of them female. The patients were evaluated by 84 providers, 60 of them male. According to the providers surveyed, female patients described more pain than did male patients (P < .01) and were perceived by providers to experience more pain (P = .03). Female patients received more medications (P < .01) and were less likely to receive no medication (P = .01). Female patients also received more potent analgesics (P = .03). Linear and logistic regression analysis showed that patient perception of pain was the strongest predictor of the number and strength of medications given; patient gender was not a predictor.Female patients with headache, neck pain, or back pain describe more pain and are perceived by providers to have more pain than male patients in the ED. Female patients also receive more medications and stronger analgesics. In this study, severity of patient pain rather than gender stereotyping appeared to correlate most with pain-management practices.

    View details for Web of Science ID A1995RX46800002

    View details for PubMedID 7574121

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