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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.

Author(s): Chan, MD, MHPE, Teresa M.; Gottlieb, MD, Michael; Fant, MD, MS, Abra L.; Messman, MD, Anne; Robinson, MD, Daniel W.; Cooney, MD, Robert R.; Papanagnou, MD, MPH, Dimitri; Yarris, MD, MCR, Lalena M. | Abstract: Introduction: Scholarship is an essential part of academic success. Junior faculty members are often unfamiliar with the grounding literature that defines educational scholarship. In this article, the authors aim to summarize five key papers outlining scholarship in the setting of academic contributions for emerging clinician educators. Methods: The authors conducted a consensus-building process to generate a list of key papers that describe the importance and significance of academic scholarship, informed by social media sources. We then used a three-round voting methodology, akin to a Delphi study, to determine the papers with the most impact. Results: A summary of the five most important papers on the topic domain of academic scholarship, as determined by this mixed group of junior faculty members and faculty developers, is presented in this paper. We subsequently wrote a summary of these five papers and their relevance to junior faculty members and faculty developers, as well. Conclusion: Five papers on educational scholarship, deemed essential by the authors’ consensus process, are presented in this paper. These papers may help provide the foundational background to help junior faculty members gain a grasp of the academic scholarly environment. This list may also inform senior faculty and faculty developers on the needs of junior faculty members in the nascent stages of their careers. [West JEmerg Med. 2016;17(5)519-526.]

Telesimulation is a new and innovative concept and process that has been used to provide education, training, and assessment in health-related fields such as medicine. This new area of simulation, and its terminology, has its origins within the past decade. The face validity and ability to provide the benefits of simulation education to learners at off-site locations has allowed the wide and rapid adoption of telesimulation in the field of medical education. Telesimulation has been implemented in areas such as pediatric resuscitation, surgery, emergency medicine, ultrasound-guided regional anesthesia in anesthesiology, nursing, and neurosurgery. However, its rapid expansion and current use has outgrown its recent description less than a decade ago. To date, there is no unifying definition of telesimulation that encompasses all the areas where it has been used while simultaneously allowing for growth and expansion in this field of study. This article has two main objectives. The first objective is to provide a comprehensive and unifying definition of telesimulation that encompasses all the areas where it has been used while allowing for growth and expansion in the field of study. The secondary objective is to describe the utility of telesimulation for emergency medicine educators in the context of the current evidence to serve as a background and framework that educators may use when considering creating educational programs that incorporate telecommunication and simulation resources. This article is complementary to the large group presentation where this new comprehensive and unifying definition was introduced to the simulation community at the International Meeting on Simulation in Healthcare in January 2016.

Background Residency applicants often have difficulty coordinating interviews with multiple programs. An online scheduling system might improve this process. Objective The authors sought to determine applicant mean time to schedule interviews and satisfaction using online scheduling compared with manual scheduling. Methods An electronic survey was sent to US graduates applying to any of 6 emergency medicine programs in the 2014–2015 application cycle. Of the participant programs, 3 used an online system and 3 did not. Applicants were asked to report estimated time to schedule with the online system compared to their average time using other methods, and to rate their satisfaction with the scheduling process. Results Of 1720 applicants to at least 1 of the 6 programs, 856 completed the survey (49.8%). Respondents reported spending less time scheduling interviews using the online system compared to other systems (median of 5 minutes [IQR 3–10] versus 60 minutes [IQR 15–240], respectively, P < .0001). In addition, applicants preferred using the online system (93.6% versus 1.4%, P < .0001.) Applicants were also more satisfied with the ease of scheduling their interviews using the online system (91.5% versus 11.0%, P < .0001) and felt that the online system aided them in coordinating travel arrangements (74.7% versus 41.5%, P < .01.) Conclusions An online interview scheduling system is associated with time savings for applicants as well as higher satisfaction among applicants, both in ease of scheduling and in coordinating travel arrangements. The results likely are generalizable to other medical and surgical specialties.

Introduction Entrustable professional activities (EPAs) are units of professional practice defined as tasks or responsibilities that trainees are entrusted to perform unsupervised. AAMC Core EPA 10 is defined as the ability to “recognize a patient who requires emergent care and initiate evaluation and management.” We designed a simulation scenario to elicit EPA 10–related behaviors for learner assessment to guide entrustment decisions. Methods This case presents a 61-year-old male with a complaint of feeling ill. The students need to diagnose an ST segment elevation myocardial infarction that leads to a pulseless ventricular tachycardia arrest. A simulation manikin is used, and students are assessed using a checklist. The tool is a set of critical actions that were proposed by a group of content experts, based on the following EPA 10 functions: recognizing unstable vital signs, asking for help, and determining appropriate disposition. In addition to case-specific behavioral items, an overall entrustment item was added to inform the entrustment decision. Results This case was implemented in a mandatory fourth-year clerkship for 7 years prior to its adaptation for entrustment on EPA 10. In recent experience from one institution, about 14% of students failed to meet entrustment. Students rated the experience as valuable (average 5.0, on a 5-point Likert scale) and thought that it would change their performance in a clinical setting (average 4.95, on a 5-point Likert scale). Discussion Faculty raters noted challenges regarding entrustment based on a single simulation and the implications that team role (supporting role vs. leader role) has on entrustment.

Introduction This simulation case was designed to evaluate the ability of third- and fourth-year emergency medicine clerkship students and acting interns to perform the tasks outlined in the Association of American Medical College's Core Entrustable Professional Activity 10, to “recognize a patient requiring urgent or emergent care and initiate evaluation and management.” The overarching goal is to assess medical students’ ability to recognize and take steps to stabilize a sick patient. Methods In this case, students encounter a physician, simulated with a high-fidelity manikin, who has suddenly become confused. Students are expected to recognize that he is acutely ill, call for help, and begin the initial steps of resuscitation. Bedside testing reveals hypoglycemia, which students are expected to treat. Further examination, history gathering, and diagnostic tests reveal that the patient is suffering from gram-negative sepsis. Students are evaluated on their ability to recognize signs of serious illness, call for appropriate help, perform critical assessment and treatment tasks, communicate their findings to an attending physician, and determine the appropriate patient disposition. Outcomes are measured using critical action checklists. Results Initial trials of this case demonstrated its feasibility. All 13 students who have participated in this session have identified all five critical actions. Discussion In later iterations, the number of roles was streamlined in order to reduce how many personnel were required. As a result of the very high critical-actions success rates of the first two groups of students tested, our case-specific checklist was revised with the goal of improving its discriminatory power.

Peer feedback is increasingly being used by residency programs to provide an added dimension to the assessment process. Studies show that peer feedback is useful, uniquely informative, and reliable compared to other types of assessments. Potential barriers to implementation include insufficient training/preparation, negative consequences for working relationships, and a perceived lack of benefit.We explored the perceptions of residents involved in peer-to-peer feedback, focusing on factors that influence accuracy, usefulness, and application of the information.Family medicine residents at the University of Michigan who were piloting an online peer assessment tool completed a brief survey to offer researchers insight into the peer feedback process. Focus groups were conducted to explore residents' perceptions that are most likely to affect giving and receiving peer feedback.Survey responses were provided by 28 of 30 residents (93%). Responses showed that peer feedback provided useful (89%, 25 of 28) and unique (89%, 24 of 27) information, yet only 59% (16 of 27) reported that it benefited their training. Focus group participants included 21 of 29 eligible residents (72%). Approaches to improve residents' ability to give and accept feedback included preparatory training, clearly defined goals, standardization, fewer and more qualitatively oriented encounters, 1-on-1 delivery, immediacy of timing, and cultivation of a feedback culture.Residents perceived feedback as important and offered actionable suggestions to enhance accuracy, usefulness, and application of the information shared. The findings can be used to inform residency programs that are interested in creating a meaningful peer feedback process.

In May 2014, Annals of Emergency Medicine continued a successful collaboration with an academic Web site, Academic Life in Emergency Medicine (ALiEM) to host an online discussion session featuring the 2014 Annals Residents' Perspective article "Does the Multiple Mini-Interview Address Stakeholder Needs? An Applicant's Perspective" by Phillips and Garmel. This dialogue included Twitter conversations, a live videocast with the authors and other experts, and detailed discussions on the ALiEM Web site's comment section. This summary article serves the dual purpose of reporting the qualitative thematic analysis from a global online discussion and the Web analytics for our novel multimodal approach. Social media technologies provide a unique opportunity to engage with a diverse audience to detect existing and new emerging themes. Such technologies allow rapid hypothesis generation for future research and enable more accelerated knowledge translation. © 2014 by the American College of Emergency Physicians.

Merriam-Webster defines quality as a degree of excellence.1 What is left unstated is how degree and excellence are defined. Does this suggest that the quality of medical education research, like beauty, lies in “the eye of the beholder?” Can we measure quality objectively and consistently or is it subjective and contextual, varying with the type of research question, reviewers' judgments, or quality indices applied? Do these factors capture the aspects of quality that you, our readers, value? We pose these questions for your consideration as you read the following review papers published in this issue of the Journal of Graduate Medical Education (JGME). Locke and colleagues2 reviewed graduate medical education (GME) research papers published in 2011 and selected the 12 articles they considered to be of the greatest importance to internal medicine teachers. With a similar target audience, Eaton et al3 used the Medical Education Research Study Quality Index (MERSQI)4,5 to score internal medicine residency quantitative research papers over a 2-year period. The authors then reviewed the papers ranking in the top 25th percentile for common themes. Examining papers in the surgical education literature published over a decade, Wohlauer and colleagues6 identified common themes and research methods through reviewing the most frequently cited articles in Web of Science, as a surrogate for relevance and quality. Each review aims to identify notable medical education papers for a specific audience and time period, but each takes a different approach. Despite overlapping themes (common topics were simulation, duty hours, resident well-being or distress, resident assessment, and career choices), these 3 reviews achieved different results. Of note, the reviews by Locke et al3 and Eaton et al2 had comparable target audiences, search techniques, and journals reviewed, yet they identified only 2 common papers. The differences may be explained by the use of dissimilar quality criteria, exclusion of qualitative papers for 1 review and only a 50% overlap in review periods. However, the finding that 2 selection processes with a similar aim resulted in almost mutually exclusive results remains striking. The lack of a common definition of quality for medical education research does not stem from a lack of prior efforts to both define and improve the quality of our studies. In addition to the MERSQI, other instruments exist to measure quality in quantitative studies, such as the Best Evidence in Medical Education Global Scale and the Modified Newcastle-Ottawa Scale.7,8 These instruments vary in their (1) incorporation of items that address methodological rigor, (2) reliance on outcome quality based on Kirkpatrick's hierarchy of outcomes of educational interventions, and (3) their association with quality based on a systematic review of method and reporting quality in education research.9–,11 Although methodological rigor is the foundation of quality, attempts to boost quality by focusing on rigor at the expense of other aspects of quality can sometimes diminish the value of the results for consumers. Even the emphasis on outcomes research, a well-intentioned effort to encourage studies that address the highest tier outcomes (patient care or physician behavior outcomes) may result in the unintended consequences of dilution, diminished feasibility, failure to establish a causal link, biased outcome selection, and “teaching to the test.” 12 In addition, we understand that consumers of education research may place value on factors that are not captured by available instruments and that may be neglected by a myopic focus on only the pinnacle of Kirkpatrick's pyramid. The definition of quality for a given product is usually informed by the consumers of that product. Readers of JGME may value elements of quality that are not currently captured by available instruments or methods; we are seeking your input to guide us in future efforts to identify notable medical education papers and help redefine quality in our research.