Introduction: Evidence-based medicine (EBM) skills are fundamental to lifelong learning. These can be tracked the same way that procedural skills are tracked—via residency program logs. Review of the logs can inform faculty on the EBM activity of their trainees. An understanding of the topics residents query while on shift can provide insight into where they need further knowledge to provide optimal patient care. Our objective in this project was to categorize the relationship of the clinical questions posed by emergency medicine (EM) residents while working in the emergency department to the American Board of Emergency Medicine (ABEM) Model of Clinical Practice.
\nMethods: We conducted this institutional review board-approved study (deemed exempt research) in a postgraduate year (PGY) 1-4 EM residency. A toxicology rotation and fellowship were established during the study period. Residents were required to submit three to five descriptions of EBM activity per 28-day EM rotation block into the program’s management software. We analyzed each complete log submitted from June 2013–May 2020 using the 2019 ABEM Model of Clinical Practice. The clinical questions posed were mapped to the ABEM Model for content, including sub-categories and acuity level. Demographic information in the logs allowed for analysis for ABEM’s pediatric and geriatric modifiers. The primary outcome measure was the number of clinical questions mapped to each section of the Model.
\nResults: From June 2013–May 2020, 10,444 discrete completed logs were completed by 137 residents. “Procedures and Skills” (n = 1,110, 10.63%) and “Cardiovascular Disorders” (n = 991, 9.49%) were the most prevalent ABEM content areas. “Trauma” (n = 812, 7.77%) and “Drugs and Chemical Classes” (n = 749, 7.17%) were the most prevalent ABEM sub-categories. “Emergent” (n = 7,770, 74.3%) was the most commonly searched ABEM acuity, followed by “lower acuity” (n = 5,341, 51.1%) and “critical” (n = 5,192, 49.7%). Of note, not all conditions have ABEM acuity codes, and some have multiple. Clinical questions addressed issues regarding pediatric patients in 10.16% (n = 1,061) and geriatric patients in 8.05% (n = 841) of logs.
\nConclusion: In this single-site cohort, “Procedures and Skills” was the most common source of on-shift questions for EM residents, perhaps representing just-in-time training. “Trauma” was the most common sub-category, potentially the result of a large footprint in the ABEM Model of Clinical Practice. The residency program’s toxicology rotation and fellowship may have influenced the types of conditions treated by residents and the subsequent content of their logs. Furthermore, completing logs on shift may have impacted the mapping to ABEM acuity levels. Programmatic understanding of residents’ on-shift, evidence-based medicine questions could serve to identify educational gaps and opportunities.
","language":"eng","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"practice based learning"},{"word":"Evidence based medicine"},{"word":"Graduate Medical Education"}],"section":"Education","is_remote":true,"remote_url":"https://escholarship.org/uc/item/0f01v0kd","frozenauthors":[{"first_name":"Shreyas","middle_name":"","last_name":"Kudrimoti","name_suffix":"","institution":"Lehigh Valley Health Network, Department of Emergency and Hospital Medicine, Allentown, Pennsylvania","department":""},{"first_name":"Max","middle_name":"","last_name":"Needham","name_suffix":"","institution":"Lehigh Valley Health Network, Department of Emergency and Hospital Medicine, Allentown, Pennsylvania","department":""},{"first_name":"Jacob","middle_name":"R.","last_name":"Albers","name_suffix":"","institution":"Lehigh Valley Health Network, Department of Emergency and Hospital Medicine, Allentown, Pennsylvania; University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Allentown, Pennsylvania","department":""},{"first_name":"Jeffrey","middle_name":"B.","last_name":"Brown","name_suffix":"","institution":"Lehigh Valley Health Network, Department of Emergency and Hospital Medicine, Allentown, Pennsylvania; University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Allentown, Pennsylvania","department":""},{"first_name":"Estelle","middle_name":"","last_name":"Cervantes","name_suffix":"","institution":"Lehigh Valley Health Network, Department of Emergency and Hospital Medicine, Allentown, Pennsylvania; University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Allentown, Pennsylvania","department":""},{"first_name":"Phillip","middle_name":"","last_name":"Sgobba","name_suffix":"","institution":"Lehigh Valley Health Network, Department of Emergency and Hospital Medicine, Allentown, Pennsylvania; University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Allentown, Pennsylvania","department":""},{"first_name":"Ajay","middle_name":"K.","last_name":"Varadhan","name_suffix":"","institution":"Lehigh Valley Health Network, Department of Emergency and Hospital Medicine, Allentown, Pennsylvania; University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Allentown, Pennsylvania","department":""},{"first_name":"Dawn","middle_name":"M.","last_name":"Yenser","name_suffix":"","institution":"Lehigh Valley Health Network, Department of Emergency and Hospital Medicine, Allentown, Pennsylvania","department":""},{"first_name":"Bryan","middle_name":"G.","last_name":"Kane","name_suffix":"","institution":"Lehigh Valley Health Network, Department of Emergency and Hospital Medicine, Allentown, Pennsylvania; University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Allentown, Pennsylvania","department":""}],"date_submitted":"2025-09-19T16:32:38.531000Z","date_accepted":"2026-01-07T18:50:21.652000Z","date_published":"2026-05-13T16:47:00Z","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/52907/galley/50341/download/"}]}