Search

Background: Interviews for emergency medicine (EM) residency positions largely transitioned to a virtual‐only format in 2020–2021. The impact of virtual interview factors on applicants' rank of programs is unknown. Objective: We sought to assess the impact of modifiable factors in virtual interviews on applicants' rank of EM residency programs. Methods: We conducted a cross‐sectional mixed‐methods survey of students applying to at least one of seven study authors' EM residency programs in the United States during the 2020–2021 application cycle. The survey was developed using an interactive Delphi process and piloted prior to implementation. The survey was administered from May to June 2021 with up to four email reminders. Quantitative analysis included descriptive statistics. Three authors performed a thematic qualitative analysis of free‐text responses. Results: A total of 664 of 2281 (29.1%) students completed the survey, including 335 (50.5%) male, 316 (47.7%) female, and six (0.9%) nonbinary. A total of 143 (21.6%) respondents identified as underrepresented in medicine and 84 (12.7%) identified as LGBTQIA+. Respondents participated in a median of 14 interviews and ranked a median of 14 programs. Most respondents (335, 50.6%) preferred a choice of in‐person or virtual, while 183 (27.6%) preferred all in‐person, and 144 (21.8%) preferred all virtual. The program website and interview social were the most important factors influencing respondent ranking. Qualitative analysis revealed several positive aspects of virtual interviews including logistical ease and comfort. Negative aspects include technical issues, perceived interview hoarding, and barriers to applicant assessment and performance. Demonstrated effort by the program, effective information delivery, communication of resident culture, and a well‐implemented interview day positively influenced respondents' rank of programs. Conclusions: This study identified characteristics of the virtual interview format that impact applicants' rank of programs. These results can inform future recruitment practices. [ABSTRACT FROM AUTHOR]

Background: Women comprise 28% of faculty in academic departments of emergency medicine (EM) and 11% of academic chairs. Professional development programs for women are key to career success and to prevent pipeline attrition. Within emergency medicine, there is a paucity of outcomes‐level data for such programs. Objectives: We aim to measure the impact of a novel structured professional development curriculum and mentorship group (Resident and Faculty Female Tribe, or RAFFT) within an academic department of EM. Methods: This prospective single‐center curriculum implementation and evaluation was conducted in the academic year 2020–2021. A planning group identified potential curricular topics using an iterative Delphi process. We developed a 10‐session longitudinal curriculum; a postcurriculum survey was conducted to assess the perceived benefit of the program in four domains. Results: A total of 76% of 51 eligible women attended at least one session; for this project we analyzed the 24 participants (47%) who attended at least one session and completed both the pre‐ and the postsurvey. The majority of participants reported a positive benefit, which aligned with their expectations in the following areas: professional development (79.2%), job satisfaction (83.3%), professional well‐being (70.8%), and personal well‐being (79.2%). Resident physicians more often reported less benefit than expected compared to fellow/faculty physicians. Median perceived impact on career choice and trajectory was positive for all respondents. Conclusions: Success of this professional development program was measured through a perceived benefit aligning with participant expectations, a positive impact on career choice and career trajectory for participants in each career stage, and a high level of engagement in this voluntary program. Recommendations for the successful implementation of professional development programs include early engagement of stakeholders, the application of data from a program‐specific needs assessment, early dissemination of session dates to allow for protected time off, and structured discussions with appropriate identification of presession resources. [ABSTRACT FROM AUTHOR]

Background: In 2017, the Accreditation Council for Graduate Medical Education (ACGME) revised its Common Program Requirements to support trainees and faculty by mandating programs to provide dedicated wellness resources and education. Emergency medicine may benefit from this change due to high burnout rates within the specialty. However, the current state of wellness interventions in emergency medicine (EM) residency programs has not yet been well described. Understanding current practices is necessary to assess unmet needs and inform the development and evaluation of future interventions that aim to improve trainee wellness. Objectives: The goal of this study was to describe currently implemented wellness interventions in EM residency programs. Methods: This descriptive study surveyed 250 ACGME‐accredited EM residency programs between March 1 and June 1, 2020, regarding wellness interventions. The survey included demographic questions; structured multiple‐choice questions about cost, frequency, and champions; and free‐text response options to briefly describe interventions. Respondents were also asked to classify the interventions according to the seven factors described in the National Academy of Medicine Model of Clinician Well‐Being and Resilience. Results: Ninety of 250 (36% response rate) residency programs participated, describing 162 unique wellness interventions. Respondents classified the majority of interventions (n = 136) as targeting personal factors according to the National Academy of Medicine model. Qualitative analysis revealed five major themes describing the interventions: program culture, program factors, environmental and clinical factors, wellness activities and practices, and wellness resources. Conclusions: Results of this survey may help to inform a national needs assessment addressing the current state of wellness interventions in EM residency programs. Our results highlight the need for more interventions targeting external factors impacting resident wellness. [ABSTRACT FROM AUTHOR]

Introduction: There is a high prevalence of burnout among emergency medicine (EM) residents. The Maslach Burnout Inventory - Human Services Survey (MBI-HSS) is a widely used tool to measure burnout. The objective of this study was to compare the MBI-HSS and a two-question tool to determine burnout in the EM resident population. Methods: Based on data from the 2017 National Emergency Medicine Resident Wellness Survey study, we determined the correlation between two single-item questions with their respective MBI subscales and the full MBI-HSS. We then compared a 2-Question Summative Score to the full MBIHSS with respect to primary, more restrictive, and more inclusive definitions of burnout previously reported in the literature. Results: Of 1,522 residents who completed the survey 37.0% reported "I feel burned out from my work," and 47.1% reported "I have become more callous toward people since I took this job" once a week or more (each item >3 on a scale of 0-6). A 2-Question Summative Score totaling >3 correlated most closely with the primary definition of burnout (Spearman's rho 0.65 [95% confidence interval 0.62-0.68]). Using the summative score, 77.7% of residents were identified as burned out, compared to 76.1% using the full MBI-HSS, with a sensitivity and specificity of 93.6% and 73.0%, respectively. Conclusion: An abbreviated 2-Question Summative Score correlates well with the full MBI-HSS tool in assessing EM resident physician burnout and could be considered a rapid screening tool to identify at-risk residents experiencing burnout. [ABSTRACT FROM AUTHOR]

Introduction: It is unclear how emergency medicine (EM) programs educate core faculty about the use of milestones in competency-based evaluations. We conducted a national survey to profile how programs educate core faculty regarding their use and to assess core faculty's understanding of the milestones. Methods: Our survey tool was distributed over six months in 2017 via the Council of Emergency Medicine Residency Directors (CORD) listserv. Responses, which were de-identified, were solicited from program directors (PDs), assistant/associate program directors (APDs), and core faculty. A single response from a program was considered sufficient. Results: Our survey had a 69.7% response rate (n=140/201). 62.9% of programs reported educating core faculty about the EM Milestones via the distribution of physical or electronic media. Although 82.6% of respondents indicated that it was important for core faculty to understand how the EM Milestones are used in competency-based evaluations, respondents estimated that 48.6% of core faculty possess "fair or poor" understanding of the milestones. Furthermore, only 50.7% of respondents felt that the EM Milestones were a valuable tool. Conclusion: These data suggest there is sub-optimal understanding of the EM Milestones among core faculty and disagreement as to whether the milestones are a valuable tool. [ABSTRACT FROM AUTHOR]

Background: Drivers of physician burnout include an intricate interplay between health care organizational structures, societal influences, and individual‐level factors. In the traditional workforce, peer‐to‐peer recognition programs (PRPs) have reduced burnout by building a sense of community and effectively creating a "wellness culture." We implemented a PRP in an emergency medicine (EM) residency and determined its impact on subjective symptoms of burnout and wellness. Methods: This was a prospective, pre‐ and postintervention study conducted in a single residency over a 6‐month period. All 84 EM residents of the program were sent a voluntary anonymized survey that included a validated instrument on wellness and burnout. A PRP was initiated. After 6 months, a second survey was distributed. The outcome of the study was to examine whether the addition of a PRP reduced burnout and improved wellness. Results: There were 84 respondents to the pre‐PRP survey and 72 to the post‐PRP survey. Respondents reported an improvement after the inception of the use of the PRP in two factors that contribute to a physician's wellness: feeling recognized for accomplishments at work, which improved from 45% (38/84) affirmative to 63% (45/72; 95% confidence interval [CI] 2.3%–32.4%, p = 0.025) and a comfortable and supportive work environment, which improved from 68% (57/84) to 85% (61/72; 95% CI 3.5%–29.3%, p = 0.014). There was no significant effect in the Stanford Professional Fulfillment Index (PFI) as a result of this intervention over the 6 months. Conclusions: A PRP initiative resulted in improvements in several factors that drive physician wellness but overall burnout measured by the Stanford PFI did not show any improvement over the 6‐month period. A future longitudinal study examining the continuous assessment of PRP on the EM residents throughout the entire course of 4 years of residency training would be beneficial to determine if it could change burnout from year to year. [ABSTRACT FROM AUTHOR]

Introduction: Recent research demonstrates burnout prevalence rates as high as 76% in emergency medicine (EM) residents. In 2017 the Accreditation Council for Graduate Medical Education (ACGME) required that all training programs provide dedicated wellness education for their trainees as a requirement for accreditation. We aimed to conduct a systematic review of published wellness interventions conducted in EM residency programs following the implementation of the 2017 ACGME Common Program Requirements change in order to characterized published intervention and evaluate their effectiveness. Methods: We applied a published approach to conducting systematic reviews of the medical education literature. We performed a search of the literature from January 1, 2017-February 1, 2020. Studies were included for final review if they described a specific intervention and reported outcomes with the primary goal of improving EM resident wellness. Outcomes were characterized using the Kirkpatrick training evaluation model. Results: Eight of 35 identified studies met inclusion criteria. Most described small convenience samples of EM residents from single training programs and used the satisfaction rates of participants as primary outcome data. Only quantitative assessment methods were used. Studies addressed only a limited number of factors affecting resident wellness. The majority of interventions focused on personal factors, although a few also included sociocultural factors and the learning and practice environment. Conclusion: There is a relative dearth of literature in the area of research focused on interventions designed to improve EM resident wellness. Furthermore, the studies we identified are narrow in scope, involve relatively few participants, and describe programmatic changes of limited variety. Future directions include an increase and emphasis on multi-institutional studies, randomized controlled trials, qualitative methodology, and opportunities for funded research. [ABSTRACT FROM AUTHOR]

Introduction: Prior research demonstrates gender differences in language used in letters of recommendation. The emergency medicine (EM) Standardized Letter of Evaluation (SLOE) format limits word count and provides detailed instructions for writers. The objective of this study is to examine differences in language used to describe men and women applicants within the SLOE narrative. Methods: All applicants to a four-year academic EM residency program within a single application year with a first rotation SLOE available were included in the sample. We used the Linguistic Inquiry and Word Count (LIWC) program to analyze word frequency within 16 categories. Descriptive statistics, chi-squared, and t-tests were used to describe the sample; gender differences in word frequency were tested for using Mann-Whitney U tests. Results: Of 1117 applicants to the residency program, 822 (82%) first-rotation SLOEs were available; 64% were men, and 36% were women. We did not find a difference in baseline characteristics including age (mean 27 years), top 25 schools (22.5%), Alpha Omega Alpha Honor Medical Society rates (13%), and having earned advanced degrees (10%). The median word count per SLOE narrative for men was 171 and for women was 180 (p = 0.15). After adjusting for letter length, word frequency differences between genders were only present in two categories: social words (women: 23 words/letter; men: 21 words/letter, p = 0.02) and ability words (women: 2 words/letter; men: 1 word/letter, p = 0.04). We were unable to detect a statistical difference between men and women applicants in the remaining categories, including words representing communal traits, agentic traits, standout adjectives, grindstone traits, teaching words, and research words. Conclusion: The small wording differences between genders noted in two categories were statistically significant, but of unclear real-world significance. Future work is planned to evaluate how the SLOE format may contribute to this relative lack of bias compared to other fields and formats. [ABSTRACT FROM AUTHOR]

1. Examine the potential role of facilitated reflective writing as a tool for reducing burnout in healthcare workers. 2. Evaluate the feasibility and acceptability of a facilitated reflective writing program designed to reduce burnout in healthcare workers. High rates of burnout have been reported in healthcare workers. Evidence suggests that creative pursuits may reduce burnout among this group. To examine the feasibility and acceptability of an innovative, cross-disciplinary pilot program using facilitated poetry writing and discussion to mitigate burnout for healthcare providers in palliative and emergency medicine. An experienced teaching artist led a series of six virtual writing workshops. Participants were presented with a model poem, then encouraged to write and share their own poetry via discussion and posting to an interactive online platform. We collected data on recruitment, retention, satisfaction, intent to participate in future programming, and factors affecting participation. Of the 19 participants consented (13 palliative; six emergency), 16 attended at least one session. Of those who participated in at least one workshop, the median attendance was three sessions. Participant satisfaction, likelihood to recommend, and likelihood to engage in similar programming were measured using a 5-point Likert scale. Most respondents reported being at least "somewhat satisfied" with individual sessions (39/42; 92.8%) and the program overall (8/9; 88.9%). The majority reported being at least "somewhat likely" to recommend the program (47/51; 92.2%) and engage in similar programming (38/51; 74.5%). Barriers included clinical duties, conflicting meetings, and competing time commitments. While participant retention was lower than expected, individuals who engaged with the programming reported overall satisfaction with the sessions and program as a whole, indicating feasibility and acceptability of this type of program. We are examining the efficacy of this program in mitigating burnout and providing an effective space to process emotions and experiences. Burnout negatively impacts the well-being of healthcare workers and the quality of patient care, and it is essential to develop reliable tools to combat burnout in this group. [ABSTRACT FROM AUTHOR]