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Promotion and tenure (P&T) letters are a key component of the academic advancement portfolio. Despite their importance, many faculty are not trained to write these letters and there is limited literature describing the approach and key components. This paper reviews the role of P&T letters and provides general guidelines for writers. We present a step-by-step guide, which includes how to respond to requests, the role of institutional guidelines, providing context to the letter, evaluating candidates, and delivering an overall recommendation. Finally, we discuss current controversies in P&T letters. This paper is intended to help novice and more experienced writers to enhance their P&T letters, while also helping applicants for promotion understand what is being asked of their letter writers.

Racism in medicine affects patients, trainees, and practitioners and contributes to health care inequities. An effective strategy to actively oppose the structural racism ingrained in the fabric of medicine is to intentionally and systematically address diversity, equity, and inclusion (DEI) in medical education and research. As part of ARMED MedEd, a new longitudinal cohort course in advanced research methods in medical education, sponsored by the Society for Academic Emergency Medicine, the leadership team deliberately included a nested DEI curriculum. The goal of the DEI curriculum is to reduce bias in development, recruitment, and implementation of education research studies to promote equity and inclusion in medical education, research, and ultimately, patient care. A team of medical educators with expertise in DEI developed curricular elements focusing on DEI in education research. The two major components are a didactic curriculum (including implicit bias training) to teach researchers to consider equity as they design studies and a consultative service to refine research protocols to address lingering unintended bias. A dedicated focus on DEI can be incorporated into an advanced education research methodology course to raise awareness and provide tools to avoid bias in research design and implementation of interventions. Over time, the network of education researchers who are trained in DEI awareness will grow and provide equitable offerings to their learners to mitigate health inequities.

Purpose A previous study found that milestone ratings at the end of training were higher for male than for female residents in emergency medicine (EM). However, that study was restricted to a sample of 8 EM residency programs and used individual faculty ratings from milestone reporting forms that were designed for use by the program's Clinical Competency Committee (CCC). The objective of this study was to investigate whether similar results would be found when examining the entire national cohort of EM milestone ratings reported by programs after CCC consensus review. Method This study examined longitudinal milestone ratings for all EM residents (n = 1,363; 125 programs) reported to the Accreditation Council for Graduate Medical Education every 6 months from 2014 to 2017. A multilevel linear regression model was used to estimate differences in slope for all subcompetencies, and predicted marginal means between genders were compared at time of graduation. Results There were small but statistically significant differences between males' and females' increase in ratings from initial rating to graduation on 6 of the 22 subcompetencies. Marginal mean comparisons at time of graduation demonstrated gender effects for 4 patient care subcompetencies. For these subcompetencies, males were rated as performing better than females; differences ranged from 0.048 to 0.074 milestone ratings. Conclusions In this national dataset of EM resident milestone assessments by CCCs, males and females were rated similarly at the end of their training for the majority of subcompetencies. Statistically significant but small absolute differences were noted in 4 patient care subcompetencies.

Study objective Research in basic, translational, and clinical emergency medicine has made great strides since the formalization of emergency medicine as a specialty. Our objective is to identify and analyze strategies used by emergency medicine research pioneers to inform further advancement of research in emergency medicine, particularly for aspiring researchers and those in emerging areas, using emergency medicine medical education as one example. Methods This was a prospective, grounded-theory, qualitative study, using a constructivist/interpretivist paradigm. Leading basic science, translational, and clinical emergency medicine researchers who completed residency before 1995 were eligible for structured interviews. Thematic coding followed an iterative process until saturation was reached. A theoretic model was developed and analyzed. Results Research pioneers valued advanced methodological training and mentorship. Barriers to funding were lack of recognition of emergency medicine as a specialty, absence of a research history, and lack of training and funding resources. Deliberate interventions to improve emergency medicine research included educational sessions at national meetings, external (to emergency medicine) mentor pairings, targeted funding by emergency medicine organizations, and involvement with funding agencies. Pioneers facilitate research excellence by serving as mentors and allocating funds or protected time to develop researchers. To advance emerging subfields of research in emergency medicine, pioneers recommend advanced methodological training that is specific to the area, deliberate mentorship, and the formation of research consortia to conduct generalizable outcomes-based studies. Conclusion Research pioneers in emergency medicine cite mentorship, advanced skills obtained through fellowship or graduate degrees, deliberate collaboration with experienced researchers, support from emergency medicine organizations, and forming networks as the cornerstones of success.

BACKGROUND: Research abstracts are submitted for presentation at scientific conferences; however, criteria for judging abstracts are variable. We sought to develop two rigorous abstract scoring rubrics for education research submissions reporting (1) quantitative data and (2) qualitative data and then to collect validity evidence to support score interpretation. METHODS: We used a modified Delphi method to achieve expert consensus for scoring rubric items to optimize content validity. Eight education research experts participated in two separate modified Delphi processes, one to generate quantitative research items and one for qualitative. Modifications were made between rounds based on item scores and expert feedback. Homogeneity of ratings in the Delphi process was calculated using Cronbach's alpha, with increasing homogeneity considered an indication of consensus. Rubrics were piloted by scoring abstracts from 22 quantitative publications from AEM Education and Training “Critical Appraisal of Emergency Medicine Education Research” (11 highlighted for excellent methodology and 11 that were not) and 10 qualitative publications (five highlighted for excellent methodology and five that were not). Intraclass correlation coefficient (ICC) estimates of reliability were calculated. RESULTS: Each rubric required three rounds of a modified Delphi process. The resulting quantitative rubric contained nine items: quality of objectives, appropriateness of methods, outcomes, data analysis, generalizability, importance to medical education, innovation, quality of writing, and strength of conclusions (Cronbach's α for the third round = 0.922, ICC for total scores during piloting = 0.893). The resulting qualitative rubric contained seven items: quality of study aims, general methods, data collection, sampling, data analysis, writing quality, and strength of conclusions (Cronbach's α for the third round = 0.913, ICC for the total scores during piloting = 0.788). CONCLUSION: We developed scoring rubrics to assess quality in quantitative and qualitative medical education research abstracts to aid in selection for presentation at scientific meetings. Our tools demonstrated high reliability.

Learning critical care medicine in the pediatric intensive care unit (PICU) can be stressful. Through semistructured interviews (n = 16), this study explored the emotions, perceptions, and motivations of pediatric medicine (PM) and emergency medicine (EM) residents, as they prepared for their first PICU rotation. Qualitative data were collected and analyzed using the grounded theory method. Three resultant themes emerged: (1) residents entered the PICU with a range of intense emotions and heightened expectations; (2) they experienced prior history of psychologically traumatic learning events (adverse learning experiences or ALEs); and (3) informed by ALEs, residents prepared for their rotation by focusing heavily on their most basic level of physiological needs and adopting a survival mindset prior to the start of the rotation. These three themes led to a substantive, or working, theory that ALE-associated events may affect how residents approach upcoming learning opportunities. Consequently, adapting a trauma-informed approach as a component of medical education may improve resident learning experiences in the PICU and beyond.

Introduction The Academic Life in Emergency Medicine (ALiEM) Faculty Incubator program is a longitudinal, 1-year, virtual faculty development program for early- and mid-career faculty members that crosses specialties and institutions. This study sought to evaluate the outcomes among 3 years of participants. Methods This cross-sectional survey study evaluated postcourse and 1-year outcomes from three graduated classes of the ALiEM Faculty Incubator program. The program evaluation survey was designed to collect outcomes across multiple Kirkpatrick levels using pre/post surveys and tracking of abstracts, publications, speaking opportunities, new leadership positions, and new curricula. Results Over 3 years, 89 clinician educators participated in the program. Of those, 59 (66%) completed the initial survey and 33 (37%) completed the 1-year survey. Participants reported a significant increase in knowledge (4.1/9.0 vs. 7.0/9.0). The number of abstracts, publications, and invited presentations significantly increased after course completion and continued postcourse. A total of 37 of 59 (62.7%) developed a new curriculum during the course and 19 of 33 (57.6%) developed another new curriculum after the course. A total of 29 of 59 (49.2%) began a new leadership position upon course completion with 15 of 33 (45.5%) beginning another new leadership position 1 year later. Discussion The ALiEM Faculty Incubator program demonstrated an increase in perceived knowledge and documented academic productivity among early- and mid-career medical educators.

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.

Cognitive bias permeates almost every learner assessment in medical education. Assessment bias has the potential to affect a learner's education, future career and sense of self-worth. Decades of data show that there is little educators can do to overcome bias in learner assessments. Using in-group favouritism as an example, we offer an evidence-based, three-step solution to understand and move forward with cognitive bias in assessment: (1) Name: a simple admission about the presence of inherent bias in assessment, (2) Reframe: a rephrasing of assessment language to shed light on the assessor's subjectivity and (3) Check-in: a chance to ensure learner understanding and open lines of bidirectional communication. This process is theory-informed and based on decades of educational, sociological and psychological literature; we offer it as a logical first step towards a much-needed paradigm shift towards addressing bias in learner assessment.

BackgroundDidactic lectures remain common in medical education. Many faculty physicians do not receive formal training on public presentations or leading instructional sessions. Coaching has emerged in medical education with the potential to positively impact skills. We sought to evaluate a novel, national faculty peer-coaching program created to improve lecture presentation skills and foster career development.MethodsThis was a mixed-methods study of participant and faculty perceptions after completing the Council of Residency Directors in Emergency Medicine Academy Coaching Program. Participants completed an online evaluative survey consisting of multiple choice and Likert-type items. Program coaches participated in semistructured interviews. Descriptive statistics were reported for survey data. Thematic qualitative analysis by two independent reviewers was performed on interview data.ResultsDuring 2012 to 2017, a total of 30 participants and 11 coaches from 37 residency programs across the United States engaged in the program. Twenty-four (80%) participants completed the survey. Eight (73%) coaches participated in semistructured interviews. Data were collected between October and December 2018. The mean± SD numbers of national presentations participants had given before and after the coaching program were 6.92±7.68 and 16.42±15.43, respectively. Since their coaching, most participants (87.5%) have been invited to give a lecture at another institution. Many participants felt that the program improved their lecture evaluations, public speaking, ability to engage an audience, and professional development. Almost all (92%) would recommend the program to a colleague. The coaches perceived multiple benefits including improved skills, self-reflection, networking, career advancement, and personal fulfillment. Suggestions for improvement included improved administrative processes, more clear expectations, increased marketing, and increased participant and coach engagement.ConclusionParticipants and coaches perceived multiple benefits from this novel, national faculty coaching program. With identification of the success, challenges, and suggestions for improvement, others may benefit as they develop coaching programs in medical education.

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.

ProblemEarly- and midcareer clinician educators often lack a local discipline-specific community of practice (CoP) that encourages scholarly activity. As a result, these faculty members may feel disconnected from other scholars.ApproachAcademic Life in Emergency Medicine (ALiEM) piloted the Faculty

In this issue of Academic Medicine, Lundsgaard and colleagues present "Embracing Multiple Stakeholder Perspectives in Defining Trainee Competence," a qualitative exploration of how various stakeholders contribute to the understanding of trainee competence. Drawing on stakeholder theory from business management, the authors of that report explore how the perceptions of key stakeholders (leaders/administrators, nurses/nurse practitioners, trainees, and patients) either confirm, enhance, or complicate the picture of competence that emerges from the perspectives of senior physician supervisors.In this Invited Commentary, the author considers the potential effects of applying stakeholder theory to educational assessment and elaborates on Lundsgaard and colleagues' findings that additional stakeholder perceptions may be redundant in some instances and present conflicting understandings of competence in others. She also emphasizes the importance of a process of defining competence, and ultimately developing assessment programs, that includes measuring and illuminating conflicting perceptions of what constitutes competence. Finally, the author considers potential applications of Lundsgaard and colleagues' results for educators and assessors with comprehensive assessment programs already in place.There are limitations and risks to applying a conceptual framework that aims to increase value for a company to the training of physicians. However, with thoughtful application, incorporating multiple stakeholders into instrument development and workplace-based assessment may provide educators with a more nuanced picture of competence that incorporates the values of those ultimately impacted by trainee performance.

Qualitative research is a focused and deliberate approach to understanding the human condition and can identify areas that warrant further investigation through hypothesis-testing (quantitative) research. In this overview article, we discuss reasons to undertake a qualitative study; introduce three research paradigms whose frameworks are commonly used by medical education researchers (grounded theory, ethnography, phenomenology); describe the four most commonly used data gathering techniques (interviews, focus groups, observation, document tracing); and discuss the nature of the sampling/data-gathering process. Examples of research questions that employ each paradigm and data gathering technique as well as a list of published sample articles to guide researchers are provided. This article is protected by copyright. All rights reserved.

Education leaders at the 2012 Academic Emergency Medicine Consensus Conference on education research proposed that dedicated postgraduate education scholarship fellowships (ESFs) might provide an effective model for developing future faculty as scholars. A formal needs assessment was performed to understand the training gap and inform the development of ESFs. A mixed-methods needs assessment was conducted of four emergency medicine national stakeholder groups in 2013: department chairs; faculty education/research leaders; existing education fellowship directors; and current education fellows/graduates. Descriptive statistics were reported for quantitative data. Qualitative data from semistructured interviews and free-text responses were analyzed using a thematic approach. Participants were 11/15 (73%) education fellowship directors, 13/20 (65%) fellows/graduates, 106/239 (44%) faculty education/research leaders, and a convenience sample of 26 department chairs. Department chairs expected new education faculty to design didactics (85%) and teach clinically (96%). Faculty education/research leaders thought new faculty were inadequately prepared for job tasks (83.7%) and that ESFs would improve the overall quality of education research (91.1%). Fellowship directors noted that ESFs provide skills, mentorship, and protected time for graduates to become productive academicians. Current fellows/graduates reported pursing an ESF to develop skills in teaching and research methodology. Stakeholder groups uniformly perceived a need for training in education theory, clinical teaching, and education research. These findings support dedicated, deliberate training in these areas. Establishment of a structure for scholarly pursuits prior to assuming a full-time position will effectively prepare new faculty. These findings may inform the development, implementation, and curricula of ESFs.

The authors’ curricular goal was to develop, pilot, and evaluate an educational intervention designed to train incoming medical students on entrustable professional activity (EPA) 10, the recognition, and evaluation of a patient requiring emergent care. The authors hypothesized that this intervention would be feasible and acceptable to learners and would increase self-reported comfort with the functions of EPA 10. This was an observational, cross-sectional study of first-year medical students. Students completed a group introduction to EPAs followed by four low-fidelity simulation stations, including the following: (1) a case-based vital signs module, (2) a standardized patient encounter involving altered mental status after syncope, (3) a simulated trauma patient evaluation, and (4) a team-based learning scenario designed to teach and assess closed-loop communication when caring for a pulseless patient. The primary outcomes were feasibility, learner acceptability, and pre- and post-intervention learner comfort and knowledge. Descriptive statistics were calculated; Wilcoxon rank-sum tests were used to test for a significant difference in pre- and post-intervention responses. 147/147 responses were collected (100% response rate). This innovative curriculum was feasible to develop and implement. Students reported improvement in comfort in all EPA 10-related functions. Free-text comments revealed that learners enjoyed the simulation experience, felt safe in the training environment, and reported increased awareness of their roles and limitations as providers. In conclusion, novice medical students who completed early simulated clinical cases reported increased comfort with functions directly related to entrustment for EPA 10. This type of workplace simulation training was feasible to implement and well-received by learners.

ObjectiveEducation scholarship can be conducted using a variety of methods, from quantitative experiments to qualitative studies. Qualitative methods are less commonly used in emergency medicine (EM) education research but are well-suited to explore complex educational problems and generate hypotheses. We aimed to review the literature to provide resources to guide educators who wish to conduct qualitative research in EM education.MethodsWe conducted a scoping review to outline: 1) a list of journals that regularly publish qualitative educational papers; 2) an aggregate set of quality markers for qualitative educational research and scholarship; and 3) a list of quality checklists for qualitative educational research and scholarship.ResultsWe found nine journals that have published more than one qualitative educational research paper in EM. From the literature, we identified 39 quality markers that were grouped into 10 themes: Initial Grounding Work (preparation, background); Goals, Problem Statement, or Question; Methods (general considerations); Sampling Techniques; Data Collection Techniques; Data Interpretation and Theory Generation; Measures to Optimize Rigour and Trustworthiness; Relevance to the Field; Evidence of Reflective Practice; Dissemination and Reporting. Lastly, five quality checklists were found for guiding educators in reporting their qualitative work.ConclusionMany problems that EM educators face are well-suited to exploration using qualitative methods. The results of our scoping review provide publication venues, quality indicators, and checklists that may be useful to EM educators embarking on qualitative projects.

Clinician educators (CEs) are challenged to produce meaningful scholarship while balancing various clinical and administrative roles. The increasing availability of technology provides new opportunities for scholarly output and dissemination. This article proposes three strategies for utilizing technology to enhance scholarly output for the busy CE. The strategies are supported by real examples of these techniques, followed by a discussion of potential limitations and future directions.

Background Real-time feedback is crucial to improving physician performance. Emerging theory suggests that learner-initiated feedback may be more effective in changing performance than attending-initiated feedback, but little is known about how residents perceive resident- vs. attending-initiated feedback. Objectives The primary aim was to determine whether residents’ satisfaction varied by learner- vs. attending-initiated feedback encounters. We hypothesized that residents would be more satisfied with resident-initiated feedback. Methods This was a multicenter study of five EM residency programs. We developed a milestones-based, real-time feedback intervention that provided behavioral anchors for ED subcompetencies and prompted a feedback discussion. The intervention was implemented at all sites for a 3 month period from March to November 2014. Residents were asked to initiate 1 card per shift; attendings were also invited to initiate encounters, and in either instance, asked to provide one specific suggestion for improvement. Residents confidentially rated their satisfaction with feedback on a 10-point scale. Reported satisfaction was categorized as “very satisfied” (score of 10) vs. “less than very satisfied” (score

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.]

Emergency medicine (EM) residency programs can provide up to 20% of their planned didactic experiences asynchronously through the Individualized Interactive Instruction (III) initiative. Although blogs and podcasts provide potential material for III content, programs often struggle with identifying quality online content.Background To develop and implement a process to curate quality EM content on blogs and podcasts for resident education and III credit.Objective We developed the Approved Instructional Resources (AIR) Series on the Academic Life in Emergency Medicine website. Monthly, an editorial board identifies, peer reviews, and writes assessment questions for high-quality blog/podcast content. Eight educators rate each post using a standardized scoring instrument. Posts scoring ≥ 30 of 35 points are awarded an AIR badge and featured in the series. Enrolled residents can complete an assessment quiz for III credit. After 12 months of implementation, we report on program feasibility, enrollment rate, web analytics, and resident satisfaction scores.Methods As of June 2015, 65 EM residency programs are enrolled in the AIR Series, and 2140 AIR quizzes have been completed. A total of 96% (2064 of 2140) of participants agree or strongly agree that the activity would improve their clinical competency, 98% (2098 of 2140) plan to use the AIR Series for III credit, and 97% (2077 of 2140) plan to use it again in the future.Results The AIR Series is a national asynchronous EM curriculum featuring quality blogs and podcasts. It uses a national expert panel and novel scoring instrument to peer review web-based educational resources.Conclusions