Introduction

Since 1978, the NRMP has published data demonstrating characteristics of applicants that have matched into their preferred specialty in the NRMP main residency match. This data has been published approximately every two years. There is limited information about trends within this published data for students matching into emergency medicine (EM). Our objective was to investigate and describe trends in NRMP data to include the ratio of applicants to available EM positions, USMLE Step 1 and Step 2 scores (compared to the national means), number of programs ranked, and AOA membership among US seniors matching into EM.

Methods

This was a retrospective observational review of NRMP data published between 2007 and 2016. The data was analyzed using ANOVA and Fischer’s exact to determine statistical significance.

Results

The ratio of applicants to available EM positions remained essentially stable from 2007 to 2014, but did increase slightly in 2016. A net upward trend in overall Step 1 and Step 2 scores for EM applicants was observed. However, this did not outpace the national trend increase in Step 1 and 2 scores overall. There was no statistical difference in the mean number of programs ranked by EM applicants among the years studied (p=0.93). Among time intervals, there was a difference in the number of EM applicants with AOA membership (p=0.043) due to a drop in the number of AOA students in 2011. No sustained statistical trend was identified over the 7-year period studied.

Conclusion

NRMP data demonstrate trends among EM applicants that are similar to national trends in other specialties for USMLE board scores, and stability in number of programs ranked and AOA membership. EM does not appear to have become more competitive relative to other specialties or previous years in these categories.

Introduction: Increased out-of-hospital time is associated with worse outcomes in trauma. Sparse literature exists comparing prehospital scene and transport time management intervals between adult and pediatric trauma patients. National Emergency Medical Services guidelines recommend that trauma scene time be less than 10 minutes. The objective of this study was to examine prehospital time intervals in adult and pediatric trauma patients.

Methods: We performed a retrospective cohort study of blunt and penetrating trauma patients in a five-county region in North Carolina using prehospital records. We included patients who were transported emergency traffic directly from the scene by ground ambulance to a Level I or Level II trauma center between 2013-2018. We defined pediatric patients as those less than 16 years old. Urbanicity was controlled for using the Centers for Medicare and Medicaid’s Ambulance Fee Schedule. We performed descriptive statistics and linear mixed-effects regression modeling.

Results: A total of 2179 records met the study criteria, of which 2077 were used in the analysis. Mean scene time was 14.2 minutes (95% confidence interval [CI], 13.9-14.5) and 35.3% (n = 733) of encounters had a scene time of 10 minutes or less. Mean transport time was 17.5 minutes (95% CI, 17.0-17.9). Linear mixed-effects regression revealed that scene times were shorter for pediatric patients (p<0.0001), males (p=0.0016), penetrating injury (p<0.0001), and patients with blunt trauma in rural settings (p=0.005), and that transport times were shorter for males (p = 0.02), non-White patients (p<0.0001), and patients in urban areas (p<0.0001).

Conclusion: This study population largely missed the 10-minute scene time goal. Demographic and patient factors were associated with scene and transport times. Shorter scene times occurred with pediatric patients, males, and among those with penetrating trauma. Additionally, suffering blunt trauma while in a rural environment was associated with shorter scene time. Males, non-White patients, and patients in urban environments tended to have shorter transport times. Future studies with outcomes data are needed to identify factors that prolong out-of-hospital time and to assess the impact of out-of-hospital time on patient outcomes.