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Introduction: The coronavirus disease 2019 (COVID-19) pandemic presents unique challenges to frontline healthcare workers. In order to safely care for patients new processes, such as a plan for the airway management of a patient with COVID-19, must be implemented and disseminated in a rapid fashion. The use of in-situ simulation has been used to assist in latent problem identification as part of a Plan-Do-Study-Act cycle. Additionally, simulation is an effective means for training teams to perform high-risk procedures before engaging in the actual procedure. This educational advance seeks to use and study in-situ simulation as a means to rapidly implement a process for airway management in patients with COVID-19.Methods: Using an airway algorithm developed by the authors, we designed an in-situ simulation scenario to train physicians, nurses, and respiratory therapists in best practices for airway management of patients with COVID-19. Physician participants were surveyed using a five-point Likert scale with regard to their comfort level with various aspects of the airway algorithm both before and after the simulation in a retrospective fashion. Additionally, we obtained feedback from all participants and used it to refine the airway algorithm.Results: Over a two-week period, 93 physicians participated in the simulation. We received 81 responses to the survey (87%), which showed that the average level of comfort with personal protective equipment procedures increased significantly from 2.94 (95% confidence interval, 2.71-3.17) to 4.36 (4.24-4.48), a difference of 1.42 (1.20-1.63, p < 0.001). There was a significant increase in average comfort level in understanding the physician role with scores increasing from 3.51 (3.26-3.77) to 4.55 (2.71-3.17), a difference of 1.04 (0.82-1.25, p < 0.001). There was also increased comfort in performing procedural tasks such as intubation, from 3.08 (2.80-3.35) to 4.38 (4.23-4.52) after the simulation, a difference of 1.30 points (1.06-1.54, p < 0.001). Feedback from the participants also led to refinement of the airway algorithm.Conclusion: We successfully implemented a new airway management guideline for patients with suspected COVID-19. In-situ simulation is an essential tool for both dissemination and onboarding, as well as process improvement, in the context of an epidemic or pandemic.

Introduction: Scholarship and academic networking are essential for promotion and productivity. To develop education scholarship, the Council of Emergency Medicine Directors (CORD) and Clerkship Directors of Emergency Medicine (CDEM) created an annual Special Issue in Educational Research and Practice of the Western Journal of Emergency Medicine. The objective of this study was to evaluate the network created by the special Issue, and explore changes within the network over time.Methods: Researchers used bibliometric data from Web of Science to create a social network analysis of institutions publishing in the first four years of the special issue using UCINET software. We analyzed whole-network and node-level metrics to describe variations and changes within the network.Results: One hundred and three (56%) Accreditation Council for Graduate Medical Education-accredited emergency medicine programs were involved in 136 articles. The majority of institutions published in one or two issues. Nearly 25% published in three or four issues. The network analysis demonstrated that the mean number of connections per institution increased over the four years (mean of 5.34; standard deviation [SD] 1.27). Mean degree centralization was low at 0.28 (SD 0.05). Network density was low (mean of 0.09; SD 0.01) with little change across four issues. Five institutions scored consistently high in betweenness centrality, demonstrating a role as connectors between institutions within the network and the potential to connect new members to the network.Conclusion: Network-wide metrics describe a consistently low-density network with decreasing degree centralization over four years. A small number of institutions within the network were persistently key players in the network. These data indicate that, aside from core institutions that publish together, the network is not widely connected. There is evidence that new institutions are coming into the network, but they are not necessarily connected to the core publishing groups. There may be opportunities to intentionally increase connections across the network and create new connections between traditionally high-performing institutions and newer members of the network. Through informal discussions with authors from high-performing institutions, there are specific behaviors that departments may use to promote education scholarship and forge these new connections.

Introduction: Leading change effectively is critical to advancing medical education. Residency didactics often require change in order to meet stakeholder’s needs. Kotter’s change management model (KCMM) is an 8-step method for implementing change that can be applied to educational initiatives. This innovation improved an emergency medicine residency didactics curriculum through application of KCMM.Methods: An initiative to improve residency didactics curriculum was titled the “Didactics Revolution” and implemented according to KCMM: establish a sense of urgency, form a powerful guiding coalition, create a vision, communicate the vision, empower others to act on the vision, plan for and create short-term wins, consolidate improvements and produce still more change, and institutionalize new approaches. Data from the Annual Program Review was utilized to assess the impact of the KCMM strategy.Results: The percentage of residents who agreed or strongly agreed that lectures provide a valuable learning experience increased from 39.1% in the year prior to 88.0% in the year during the implementation (p < .001), and remained relatively high at 73.5% in the year following. The percentage of residents who agreed or strongly agreed that they felt well-prepared for the written boards increased from 60.9% in the year prior to 92.0% in the year during the implementation (p = .01) and remained high at 73.5% in the year following.Conclusion: Residency didactics can be improved through the use of KCMM, a change management model originally developed in the corporate context.

Introduction: Forming effective networks is important for personal productivity and career development. Although critical for success, these networks are not well understood. The objective of this study was to usze a social network analysis tool to demonstrate the growth of institutional publication networks for education researchers and show how a single institution has expanded its publication network over time.Methods: Publications from a single institution’s medical education research group (MERG) were pulled since its inception in 2010 to 2019 using Web of Science to collect publication information. Using VOSViewer software, we formed and plotted a network sociogram comparing the first five years to the most recent 4.25 years to compare the institutions of authors from peer reviewed manuscripts published by this group.Results: We found 104 peer-reviewed research articles, editorials, abstracts, and reviews for the MERG authors between 2010 and 2019 involving 134 unique institutions. During 2010-2014, there were 26 publications involving 56 institutions. From 2015- 2019, there were 78 publications involving 116 unique institutions.Conclusion: This brief report correlates successful research productivity in medical education with the presence of increased inter-institutional collaborations as demonstrated by network sociograms.  Programs to intentionally expand collaborative networks may prove to be an important element of facilitating successful careers in medical education scholarship.

The 20-year US GLOBEC (Global Ocean Ecosystem Dynamics) program examined zooplankton populations and their predators in four coastal marine ecosystems. Program scientists learned that environmental controls on zooplankton vital rates, especially the timing and magnitude of reproduction, growth, life-cycle progression, and mortality, determine species population dynamics, seasonal and spatial distributions, and abundances. Improved knowledge of spatialtemporal abundance and distribution of individual zooplankton taxa coupled with new information linking higher trophic level predators (salmon, cod, haddock, penguins, seals) to their prey yielded mechanistic descriptions of how climate variation impacts regionally important marine resources. Coupled ecological models driven by improved regional-scale climate scenario models developed during GLOBEC enable forecasts of plausible future conditions in coastal ecosystems, and will aid and inform decision makers and communities as they assess, respond, and adapt to the effects of environmental change. Multi-region synthesis revealed that conditions in winter, before upwelling, or seasonal stratification, or ice melt (depending on region) had significant and important effects that primed the systems for greater zooplankton population abundance and productivity the following spring summer, with effects that propagated to higher trophic levels. © 2013 by The Oceanography Society. All rights reserved.

The goal of the Pacific Ocean Boundary Ecosystem and Climate Study (POBEX) was to diagnose the large-scale climate controls on regional transport dynamics and lower trophic marine ecosystem variability in Pacific Ocean boundary systems. An international team of collaborators shared observational and eddyresolving modeling data sets collected in the Northeast Pacific, including the Gulf of Alaska (GOA) and the California Current System (CCS), the Humboldt or Peru-Chile Current System (PCCS), and the Kuroshio-Oyashio Extension (KOE) region. POBEX investigators found that a dominant fraction of decadal variability in basin and regional-scale salinity, nutrients, chlorophyll, and zooplankton taxa is explained by a newly discovered pattern of ocean-climate variability dubbed the North Pacific Gyre Oscillation (NPGO) and the Pacific Decadal Oscillation (PDO). NPGO dynamics are driven by atmospheric variability in the North Pacific and capture the decadal expression of Central Pacific El Niños in the extratropics, much as the PDO captures the low-frequency expression of eastern Pacific El Niños. By combining hindcasts of eddy-resolving ocean models over the period 1950-2008 with model passive tracers and long-term observations (e.g., CalCOFI, Line-P, Newport Hydrographic Line, Odate Collection), POBEX showed that the PDO and the NPGO combine to control low-frequency upwelling and alongshore transport dynamics in the North Pacific sector, while the eastern Pacific El Niño dominates in the South Pacific. Although different climate modes have different regional expressions, changes in vertical transport (e.g., upwelling) were found to explain the dominant nutrient and phytoplankton variability in the CCS, GOA, and PCCS, while changes in alongshore transport forced much of the observed long-term change in zooplankton species composition in the KOE as well as in the northern and southern CCS. In contrast, cross-shelf transport dynamics were linked to mesoscale eddy activity, driven by regional-scale dynamics that are largely decoupled from variations associated with the large-scale climate modes. Preliminary findings suggest that mesoscale eddies play a key role in offshore transport of zooplankton and impact the life cycles of higher trophic levels (e.g., fish) in the CCS, PCCS, and GOA. Looking forward, POBEX results may guide the development of new modeling and observational strategies to establish mechanistic links among climate forcing, mesoscale circulation, and marine population dynamics. © 2013 by The Oceanography Society. All rights reserved.

This report reviews the state of the California Current System (CCS) between winter 2012 and spring 2013, and includes observations from Washington State to Baja California. During 2012, large-scale climate modes indicated the CCS remained in a cool, productive phase present since 2007. The upwelling season was delayed north of 42°N, but regions to the south, especially 33° to 36°N, experienced average to above average upwelling that persisted throughout the summer. Contrary to the indication of high production suggested by the climate indices, chlorophyll observed from surveys and remote sensing was below average along much of the coast. As well, some members of the forage assemblages along the coast experienced low abundances in 2012 surveys. Specifically, the concentrations of all lifestages observed directly or from egg densities of Pacific sardine, Sardinops sagax, and northern anchovy, Engraulis mordax, were less than previous years’ survey estimates. However, 2013 surveys and observations indicate an increase in abundance of northern anchovy. During winter 2011/2012, the increased presence of northern copepod species off northern California was consistent with stronger southward transport. Krill and small-fraction zooplankton abundances, where examined, were generally above average. North of 42°N, salps returned to typical abundances in 2012 after greater observed concentrations in 2010 and 2011. In contrast, salp abundance off central and southern California increased after a period of southward transport during winter 2011/2012. Reproductive success of piscivorous Brandt’s cormorant, Phalacrocorax penicillatus, was reduced while planktivorous Cassin’s auklet, Ptychoramphus aleuticus was elevated. Differences between the productivity of these two seabirds may be related to the available forage assemblage observed in the surveys. California sea lion pups from San Miguel Island were undernourished resulting in a pup mortality event perhaps in response to changes in forage availability. Limited biological data were available for spring 2013, but strong winter upwelling coastwide indicated an early spring transition, with the strong upwelling persisting into early summer.

Geophysical Research Letters (GRL) is the American Geophysical Union's premier journal of fast, groundbreaking communication. It rapidly publishes high-impact, letter-length articles, and it is the top-cited multidisciplinary geosciences journal over the past 10 years, with an impact factor that increased again in 2009, to 3.204. For manuscripts submitted to GRL, the median time to first and final decision is 23 and 27 days, respectivelya 35% improvement since 2007and the median time from submission to publication is 13 weeks for 90% of GRL papersa 25% improvement since 2007. Among high-impact publications in the geosciences, GRL has the fastest turnaround.