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Benefits of post-simulation debriefings as an educational and feedback tool have been widely accepted for nearly a decade. Real-time, non-critical incident debriefing is similar to post-simulation debriefing; however, data on its practice in academic emergency departments (ED), is limited. Although tools such as TeamSTEPPS® (Team Strategies and Tools to Enhance Performance and Patient Safety) suggest debriefing after complicated medical situations, they do not teach debriefing skills suited to this purpose. Anecdotal evidence suggests that real-time debriefings (or non-critical incident debriefings) do in fact occur in academic EDs;, however, limited research has been performed on this subject. The objective of this study was to characterize real-time, non-critical incident debriefing practices in emergency medicine (EM). We conducted this multicenter cross-sectional study of EM attendings and residents at four large, high-volume, academic EM residency programs in New York City. Questionnaire design was based on a Delphi panel and pilot testing with expert panel. We sought a convenience sample from a potential pool of approximately 300 physicians across the four sites with the goal of obtaining >100 responses. The survey was sent electronically to the four residency list-serves with a total of six monthly completion reminder emails. We collected all data electronically and anonymously using SurveyMonkey.com; the data were then entered into and analyzed with Microsoft Excel. The data elucidate various characteristics of current real-time debriefing trends in EM, including its definition, perceived benefits and barriers, as well as the variety of formats of debriefings currently being conducted. This survey regarding the practice of real-time, non-critical incident debriefings in four major academic EM programs within New York City sheds light on three major, pertinent points: 1) real-time, non-critical incident debriefing definitely occurs in academic emergency practice; 2) in general, realtime debriefing is perceived to be of some value with respect to education, systems and performance improvement; 3) although it is practiced by clinicians, most report no formal training in actual debriefing techniques. Further study is needed to clarify actual benefits of real-time/non-critical incident debriefing as well as details on potential pitfalls of this practice and recommendations for best practices for use.

Background Pediatric sedation is a low-frequency, high-stakes procedure. This study aimed to train emergency medicine (EM) residents in pediatric procedural sedation through a sedation checklist, enhancing patient safety. Methods EM residents completed a pre-test and a survey on their knowledge and experiences with sedation protocols. Residents were subdivided into four groups: two control groups underwent a pediatric sedation simulation without the aid of a procedural checklist, while two intervention groups were given the procedural checklist to guide their management of the procedure. Following the simulations, a simulation faculty member reviewed sedation management and safety with residents for all groups and answered questions. An improvement analysis was performed via a post-intervention examination among all residents. Results Residents in the intervention group demonstrated an improvement in obtaining more critical actions during the simulation (intervention group critical actions 14, 13 vs non-intervention critical actions 10, 12) and confidence with the procedure (via a Likert scale survey across multiple arenas of pediatric sedation), with only moderately increased scores on the post-test examination (pre-simulation score of 6.28±2.14; post-simulation score of 6.75±1.88). Conclusion The data suggest that a checklist, combined with dedicated training through simulation, improves knowledge, confidence, and skill with regard to pediatric sedations. Further study is required to examine the longitudinal impact of our program on resident performance and patient outcomes., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Thomas Jefferson University Institutional Review Board issued approval N/A. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Lau et al.)

Purpose: During the third-year emergency medicine (EM) clerkship, medical students are immersed in traumatic incidents with their patients and clinical teams. Trauma-informed medical education (TIME) applies trauma-informed care (TIC) principles to help students manage trauma. We aimed to qualitatively describe the extent to which students perceived the six TIME domains as they navigated critical incidents during their EM clerkship., Methods: We employed a constructivist, modified grounded theory approach to explore medical students' experiences. We used the critical incident technique to elicit narratives to better understand the six TIME domains as they naturally appear in the clerkship. Participants were asked to describe a traumatic incident they experienced during the clerkship, followed by the clerkship's role in helping them manage the incident. Using the framework method, transcripts were analyzed 1) deductively by matching transcript excerpts to relevant TIME domains and 2) inductively by generating de novo themes to capture factors that affected students' handling of trauma during critical incidents., Results: Twelve participants were enrolled and interviewed in July 2022. "Safety" was the most frequently described TIME domain, whereas "Gender, Cultural, and Historical issues" and "Peer Support" were discussed least. Inductive analysis revealed themes that hindered or supported their ability to manage traumatic experiences, which were grouped into three categories: 1) student interactions with the learning environment: complex social determinants of health, inequalities in care, and overt discrimination; 2) student interactions with patients: ethically ambiguous care, witnessing acute patient presentations, and reactivation of past trauma; and 3) student interactions with supervisors: power dynamics, invalidation of contributions, role-modeling, and student empowerment., Conclusion: The six TIME domains are represented in students' perceptions of immediate, stressful critical incidents during their EM clerkship, with "Safety" being the most commonly described; however, the degree to which these domains are supported in students' experiences of the EM clerkship differ, and instances of inadequately experienced domains may contribute to student distress. Understanding the EM clerkship through the specific lens of students' experiences of trauma may be an effective strategy to guide curricular changes that promote a supportive learning environment for students in the emergency department., Competing Interests: Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. Funding for this study was provided through the Society for Academic Emergency Medicine (SAEM) Foundation through the SAEMF/RAMS Medical Student Research Grant, which was awarded to Ms. Giselle Appel (mentor, D. Papanagnou). There are no other conflicts of interest or sources of funding to declare.

Background: Healthcare spending represents a large portion of the GDP of the United States. Value-based care (VBC) seeks to decrease waste in health care spending, yet this concept is insufficiently taught to medical students. The Choosing Wisely Students and Trainees Advocating for Resource Stewardship (STARS) campaign promotes initiatives that integrate knowledge of VBC into undergraduate medical education (UME). This study sought to determine the most effective strategy to educate medical students on key principles of VBC as taught by the STARS campaign., Methods: Choosing Wisely principles were incorporated into the UME curriculum of an academic medical institution via the creation of eight new learning objectives (LOs) for case-based learning (CBL) sessions and lectures. Medical students completed an annual 10-question survey from 2019 to 2022 and 10 formal examination questions during the preclinical (years 1 and 2) curriculum after exposure to varying quantities of LOs. Pearson correlation, chi-square, and logistic regression were employed to determine the association between increased LOs in the curriculum and (1) campaign awareness and (2) knowledge of VBC principles., Results: A total of 700 survey responses over a four-year period (2019 to 2022) were analyzed. Student awareness of the campaign and knowledge of VBC principles increased year over year during the survey period (39% to 92% and 64% to 74%, respectively). There were significant associations between increased LOs in the curriculum and (1) campaign awareness (0.828, p<0.0001) and (2) knowledge of VBC principles (0.934, p<0.001). Students also performed well on formal examination questions related to VBC principles (mean: 81.5% and mean discrimination index: 0.18)., Conclusion: Integration of VBC-focused LOs is significantly associated with awareness of the Choosing Wisely STARS campaign and knowledge of VBC principles taught by the campaign. Collaborative initiatives to increase exposure to VBC education may improve students' knowledge of these principles during medical school., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, El Fadel et al.)

Background: It is essential that medical education (MedEd) fellows achieve desired outcomes prior to graduation. Despite the increase in postgraduate MedEd fellowships in emergency medicine (EM), there is no consistently applied competency framework. We sought to develop entrustable professional activities (EPAs) for EM MedEd fellows., Methods: From 2021 to 2022, we used a modified Delphi method to achieve consensus for EPAs. EM education experts generated an initial list of 173 EPAs after literature review. In each Delphi round, panelists were asked to make a binary choice of whether to include the EPA. We determined an inclusion threshold of 70% agreement a priori. After the first round, given the large number of EPAs meeting inclusion threshold, panelists were instructed to vote whether each EPA should be included in the "20 most important" EPAs for a MedEd fellowship. Modifications were made between rounds based on expert feedback. We calculated descriptive statistics., Results: Seventeen experts completed four Delphi rounds each with 100% response. After Round 1, 87 EPAs were eliminated and two were combined. Following Round 2, 46 EPAs were eliminated, seven were combined, and three were included in the final list. After the third round, one EPA was eliminated and 13 were included. After the fourth round, 11 EPAs were eliminated. The final list consisted of 16 EPAs in domains of career development, education theory and methods, research and scholarship, and educational program administration., Conclusions: We developed a list of 16 EPAs for EM MedEd fellowships, the first step in implementing competency-based MedEd., Competing Interests: The authors declare no conflicts of interest., (© 2024 The Authors. AEM Education and Training published by Wiley Periodicals LLC on behalf of Society for Academic Emergency Medicine.)

As the complexity ofmedical knowledge and clinical practice continues to grow, physicians and physicians-intrainingmust learn to identify gaps in their knowledge and understand and engage in self-directed learning (SDL) in pursuit of academic goals and improved clinical performance. There is a lack of consensus, however, on the precise definition of SDL and how it relates to self-regulated learning (SRL) and co-regulated learning (CRL). We propose a conceptual framework for understanding the progression of a self-directed learner in the health professions and describe the interplay of SRL and CRL., (Copyright © 2023 the Association of American Medical Colleges.)

Emergency medicine clerkships have become more prevalent in the third year of medical school, a time when students are immersed in the core clinical training of their undergraduate medical education. There is little guidance for clinician educators, however, on how to effectively scaffold learning for third-year medical students when rotating in the emergency department (ED) during core clerkships. The authors sought to provide best practices in teaching to leverage the rich learning environment of the ED - regardless of their specialty selections. Based on an extensive review of the literature spanning on-shift teaching, feedback, clinical medicine, and bedside teaching, the following twelve tips are offered to guide the instruction of the undifferentiated third-year medical student in the ED., Competing Interests: No competing interests were disclosed., (Copyright: © 2023 Winger AD and Papanagnou D.)

Purpose: The purpose of this study was to explore how decision making and informal and incidental learning (IIL) emerged in the clinical learning environment (CLE) during the height of the Covid-19 pandemic. The authors' specific interest was to better understand the IIL that took place among frontline physicians who had to navigate a CLE replete with uncertainty and complexity with the future goal of creating experiences for medical students that would simulate IIL and use uncertainty as a catalyst for learning., Method: Using a modified constructivist, grounded theory approach, we describe physicians' IIL while working during times of heightened uncertainty. Using the critical incident technique, we conducted 45-min virtual interviews with seven emergency department (ED) and five intensive care unit (ICU) physicians, who worked during the height of the pandemic. The authors transcribed and restoried each interview before applying inductive, comparative analysis to identify patterns, assertions, and organizing themes., Results: Findings showed that the burden of decision making for physicians was influenced by the physical, emotional, relational, and situational context of the CLE. The themes that emerged for decision making and IIL were interdependent. Prominent among the patterns for decision making were ways to simplify the problem by applying prior knowledge, using pattern recognition, and cross-checking with team members. Patterns for IIL emerged through trial and error, which included thoughtful experimentation, consulting alternative sources of information, accumulating knowledge, and "poking at the periphery" of clinical practice., Conclusions: Complexity and uncertainty are rife in clinical practice and this study made visible decision-making patterns and IIL approaches that can be built into formal curricula. Making implicit uncertainty explicit by recognizing it, naming it, and practicing navigating it may better prepare learners for the uncertainty posed by the clinical practice environment., Competing Interests: The authors declare no conflicts of interest., (© 2023 The Authors. AEM Education and Training published by Wiley Periodicals LLC on behalf of Society for Academic Emergency Medicine.)

Introduction: Uncertainty is an inherent part of medicine. Prior work has trained medical students to better communicate diagnostic uncertainty; however, this work touches on only one aspect of the uncertainty students will face in practice. We developed a session to provide them with a taxonomy for categorizing the various types of uncertainty, as well as a framework to apply when navigating uncertainty during clinical challenges. These tools can help students make sense of uncertainty and determine actions in a complex health system., Methods: We designed a virtual workshop for third-year medical students at the end of their core clerkships. It included a didactic session followed by a small-group immersive unfolding case experience with several challenge points during which we tasked students with applying the framework, classifying the uncertainty domain, and discussing how they would problem-solve each scenario., Results: We conducted the workshop with 128 third-year medical students. We collected data through an anonymous postsession survey (86% response rate; 110 of 128 students). Most found the workshop useful (64%; 54 of 85), and a large number found the framework helpful in appraising uncertainty (47%; 42 of 89). A majority felt their perspectives on uncertainty changed after the workshop (66%; 73 of 110). Students integrated prior health systems science knowledge in their strategies to problem-solve each challenge., Discussion: This session provides a novel application of a sense-making framework and taxonomy for medical students to classify uncertainty. It offers a simple, low-cost, interactive, virtual activity that can be implemented at other institutions., (© 2023 Rusnack et al.)

Competing Interests: The authors declare no conflicts of interest.

Background Disaster triage training equips learners with the critical skills to rapidly evaluate patients, yet few medical schools include formal triage training in their curriculum. Simulation exercises can successfully teach triage skills, but few studies have specifically evaluated online simulation to teach these skills to medical students. Aims We sought to develop and evaluate a largely asynchronous activity for senior medical students to practice their triage skills in an online format. Methods We developed an online, interactive triage exercise for fourth-year medical students. For the exercise, the student participants acted as triage officers for an emergency department (ED) at a large tertiary care center during an outbreak of a severe respiratory illness. Following the exercise, a faculty member led a debriefing session using a structured debriefing guide. Pre- and post-test educational assessments used a five-point Likert scale to capture the helpfulness of the exercise and their self-reported pre- and post-competency in triage. Change in self-reported competency was analyzed for statistical significance and effect size. Results Since May 2021, 33 senior medical students have completed this simulation and pre- and post-test educational assessments. Most students found the exercise "very" or "extremely" helpful for learning, with a mean of 4.61 (SD: ±0.67). Most students rated their pre-exercise competency as "beginner" or "developing" and their post-exercise competency as "developing" or "proficient" on a four-point rubric. The average increase in self-reported competency was 1.17 points (SD: ±0.62), yielding a statistically significant difference (p < 0.001) and large effect size (Hedges' g: 1.94). Conclusions We conclude that a virtual simulation can increase students' sense of competence in triage skills, using fewer resources than in-person simulation of disaster triage. As a next step, the simulation and the source code are publicly available for anyone to engage with the simulation or adapt it for their respective learners., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Pandit et al.)

Introduction: Patients living with a disability experience an illness trajectory that may be uncertain. While navigating clinical uncertainty has been well-researched, health professionals' intolerance of uncertainty for patients living with disabilities has yet to be explored. We examined the relationship between medical students' intolerance of uncertainty with their attitudes towards people living with disabilities to better inform curricular efforts., Methods: We employed a survey-based design consisting of the Intolerance of Uncertainty Scale (IUS) and Disability Attitudes in Healthcare (DAHC) Scale to medical students upon completion of core clerkships (end of third-year of training). Data were de-identified. Mean DAHC and IUS scores were compared with published values via t -test. Linear regression was used to examine IUS/DAHC scores for anonymized students. Pearson correlation coefficient was calculated to assess correlation between IUS and DAHC scores., Results: Response rate was 97% (268/275 students). Mean IUS score did not differ from previously cited medical student scores, but mean DAHC score was significantly higher than previously cited scores. We observed a statistically-significant relationship between IUS and DAHC scores. Students with greater intolerance of uncertainty had lower scores for disability attitudes [ F (1,243) = 8.05, value of p  < 0.01], with an R 2 -value of 0.032, suggesting that 3% of DAHC score variance can be explained by IUS score changes., Conclusion: We identified a weak negative correlation between IUS and DAHC scores in medical students. Further research is needed to clarify findings and identify best practices that equip trainees with skills to care for patients with uncertain illness trajectories and patients living with disabilities., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Ogle, Papanagnou, Reopelle, Rusnack, Feingold-Link, Poluch and Ankam.)

Patient panels are an inspiring, highly rated educational tool to complement course goals and objectives for students in medical education programs. The COVID-19 pandemic brought challenges on the ability to successfully host in-person patient panels. These challenges resulted in the need to pivot in-person patient panels to online platforms, while still ensuring the quality and intimacy of patient narratives. In this 12 tips article, we share lessons learned in transitioning patient panels in our health systems science curriculum to an online experience for students enrolled in a pre-clinical medical education program., Competing Interests: No competing interests were disclosed., (Copyright: © 2023 Papanagnou D et al.)

Biostatistics are ubiquitous in medicine, providing quantitative insights into trials and experiments that shape the healthcare field. Despite training in evidence-based medicine, medical students and residents struggle to master biostatistical concepts and apply biostatistics to appraise research. There are limited resources available for students to quickly and cost-effectively learn biostatistical tests. From this problem, a two-part biostatistical educational module was created using Rise Articulate 360® software, an interactive module platform. The study aimed to assess the effectiveness of an educational biostatistics module's ability to improve learners' knowledge and application of commonly used biostatistical tests, as well as their confidence in biostatistics. Each part of the module contained five biostatistical test tutorials. Each biostatistical test was explained, as well as how the test was typically applied in healthcare. Knowledge acquisition, test application, and confidence regarding biostatistical tests were assessed using a pretest and a posttest. The module was completed by 33 first- and second-year medical students.  Knowledge acquisition improved from a mean of 2.41 to 3.53 ( P <= 0.001). Participants expressed that the biostatistical educational module was easy to use and improved both their confidence and knowledge of specific biostatistical tests. Most students found that the biostatistical educational module applied to their future work. In summary, our module was successful in exposing learners in the health professions to commonly used biostatistical tests and tests' applications to the medical literature and their future research. Biostatistics is a pillar of medical research and education, and students' mastery of the concept will prove to be of longitudinal valuable, whether they pursue careers as clinicians and/or researchers., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Hayes et al.)

Purpose: There are no standardized approaches for communicating with patients discharged from the emergency department with diagnostic uncertainty. This trial tested efficacy of the Uncertainty Communication Education Module, a simulation-based mastery learning curriculum designed to establish competency in communicating diagnostic uncertainty., Method: Resident physicians at 2 sites participated in a 2-arm waitlist randomized controlled trial from September 2019 to June 2020. After baseline (T1) assessment of all participants via a standardized patient encounter using the Uncertainty Communication Checklist (UCC), immediate access physicians received training in the Uncertainty Communication Education Module, which included immediate feedback, online educational modules, a smartphone-based application, and telehealth deliberate practice with standardized patients. All physicians were retested 16-19 weeks later (T2) via in-person standardized patient encounters; delayed access physicians then received the intervention. A final test of all physicians occurred 11-15 weeks after T2 (T3). The primary outcome measured the percentage of physicians in the immediate versus delayed access groups meeting or exceeding the UCC minimum passing standard at T2., Results: Overall, 109 physicians were randomized, with mean age 29 years (range 25-46). The majority were male (n = 69, 63%), non-Hispanic/Latino (n = 99, 91%), and White (n = 78, 72%). At T2, when only immediate access participants had received the curriculum, immediate access physicians demonstrated increased mastery (n = 29, 52.7%) compared with delayed access physicians (n = 2, 3.7%, P < .001; estimated adjusted odds ratio of mastery for the immediate access participants, 31.1 [95% CI, 6.8-143.1]). There were no significant differences when adjusting for training site or stage of training., Conclusions: The Uncertainty Communication Education Module significantly increased mastery in communicating diagnostic uncertainty at the first postintervention test among emergency physicians in standardized patient encounters. Further work should assess the impact of clinical implementation of these communication skills., (Copyright © 2022 by the Association of American Medical Colleges.)

Introduction: In a challenging time for the healthcare workforce responding to the coronavirus disease 2019 (COVID-19) pandemic, it is critical to identify factors contributing to team members' feelings of "belonging" in the workplace. The Institute for Healthcare Improvement's Quintuple Aim's principle of improving healthcare worker well-being could be applied to explore the implications of the increased turnover and stress, which connect to components of belonging. This study applies a qualitative approach to the organizational issues impacting healthcare teams, particularly during a complex and uncertain time., Methods: To elucidate factors contributing to belonging, we conducted a series of semi-structured interviews with an interdisciplinary cross-sectional sample of healthcare workers. Interviews were conducted with 23 total staff members in two clinical settings, the emergency department and hospital medicine groups at a large urban teaching hospital, to evaluate team members' perspectives of the work environment., Results: Participants discuss their degree of inclusion, excitement, challenges, and respective needs from the organization. Perspectives of workers representing varied professional roles of the healthcare team were gathered to provide robust and unique insights into initiatives that can enhance belonging in the clinical workplace., Conclusion: Our findings provide a preliminary framework to identify strategies that can potentially reinforce collective team member belonging and consequently improve staff well-being, morale, and retention., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Gordon et al.)

In the time of the COVID-19 pandemic, where clinical environments are plagued by both uncertainty and complexity, the importance of the informal and social aspects of learning among health care teams cannot be exaggerated. While there have been attempts to better understand the nuances of informal learning in the clinical environment through descriptions of the tacit or hidden curriculum, incidental learning in medical education has only been partially captured in the research. Understood through concepts borrowed from the Cynefin conceptual framework for sensemaking, the early stages of the pandemic immersed clinical teams in complex and chaotic situations where there was no immediately apparent relationship between cause and effect. Health care teams had to act quickly amidst the chaos: they had to first act, make sense of, and respond with intentionality. Informal and incidental learning (IIL) emerged as a byproduct of acting with the tools and knowledge available in the moment. To integrate the informal, sometimes haphazard nature of emergence among health care teams, educators require an understanding of IIL. This understanding can help medical educators prepare health professions learners for the cognitive dissonance that accompanies uncertainty in clinical practice. The authors introduce IIL as an explanatory framework to describe how teams navigate complexity in the clinical learning environment and to better inform curricular development for health professions training that prepares learners for uncertainty. While further research in IIL is needed to illuminate tacit knowledge that makes learning explicit for all audiences in the health professions, there are opportunities to cultivate learners' skills in formal curricula through various learning interventions to prime them for IIL when they enter complex clinical learning environments., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Association of American Medical Colleges.)

Objective: To describe how emergency medicine resident physicians discuss diagnostic uncertainty during a simulated ED discharge discussion., Methods: A secondary content analysis of simulated clinical encounter audiotapes completed by emergency medicine residents across two sites., Results: When discussing lack of diagnosis, residents explained the evaluation revealed no cause for symptoms, noted concerning diagnoses that were excluded, and acknowledged both symptoms and patients' feelings. Residents used explicit and implicit language to discuss diagnostic uncertainty with similar frequency. Almost half of the residents discussed the ED role as focused on emergent illness to give patients context for their uncertain diagnoses. However, 28% of residents in this study did not discuss diagnostic uncertainty in any form. All residents provided reassurance., Conclusion: Residents use a range of approaches to discuss diagnostic uncertainty with patients at the time of a simulated ED discharge, with some residents omitting discussion of uncertainty entirely., Practice Implications: These findings represent the current state of communication, which needs improvement. These findings do not immediately transfer to clinical practice recommendations, but rather support a need for both further study and development of formal communication training on this topic., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: A methodical and evidence-based approach to the creation and implementation of fellowship programs is not well described in the graduate medical education literature. The Society for Academic Emergency Medicine (SAEM) convened an expert panel to promote standardization and excellence in fellowship training. The purpose of the expert panel was to develop a fellowship guide to give prospective fellowship directors the necessary skills to successfully implement and maintain a fellowship program., Methods: Under direction of the SAEM Board of Directors, SAEM Education Committee, and SAEM Fellowship Approval Committee, a panel of content experts convened to develop a fellowship guide using an evidence-based approach and best practices content method. The resource guide was iteratively reviewed by all panel members., Results: Utilizing Kern's six-step model as a conceptual framework, the fellowship guide summarizes the construction, implementation, evaluation, and dissemination of a novel fellowship curriculum to meet the needs of trainees, educators, and sponsoring institutions. Other key areas addressed include Accreditation Council for Graduate Medical Education and nonaccredited fellowships, programmatic assessment, finances, and recruitment., Conclusions: The fellowship guide summarizes the conceptual framework, best practices, and strategies to create and implement a new fellowship program., Competing Interests: The authors have no potential conflicts to disclose., (© 2022 by the Society for Academic Emergency Medicine.)

Background: Clear communication is integral to good clinical care; however, communication training is cost and time intensive. Mobile applications (apps) may provide a useful adjunct to traditional simulation skills training., Objective: To evaluate (1) use of an app for teaching communication skills about diagnostic uncertainty, (2) feedback on app use, and (3) the association between use and skill mastery., Patient Involvement: The app under study is designed to improve doctor-patient communication., Methods: The study was a planned sub-analysis of a randomized controlled waitlist trial with emergency medicine resident physicians randomized to receive immediate or delayed access to an educational curriculum focused on diagnostic uncertainty. The curriculum included a web-based interactive module and the app. Metrics describing participants' use of the app, feedback on use, and association of use and achieving mastery in communicating diagnostic uncertainty are reported. Differences between groups utilizing the app were analyzed using Chi-squared test; logistic regression assessed the association between app use and achieving mastery of the communication skill., Results: Among 109 participants completing the trial, only 34 (31.2%) used the app. Most participants engaged with the app on one occasion for a median of 50 min (IQR 31, 87). Senior residents were more likely to use the app than junior residents (41.3% vs 23.8%, p=0.05). Overall reviews were positive; 76% reported the app helped them learn. There was no significant association between app use and achieving mastery of the communication skill in the trial [OR 2.1, 95% CI (0.91-4.84)]., Discussion: Despite positive reviews of app use, overall use was low and there was no association with achieving mastery., Practical Value: Offering an app as an auxiliary training opportunity may be beneficial to some residents, but shouldn't be planned for use as a primary didactic modality unless there is evidence for effectiveness and use is mandated., Availability of Data and Materials: The datasets generated and/or analyzed during the current study are not publicly available since some data may be identifiable but are available from the corresponding author on reasonable request., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Managing the uncertainty of clinical practice represents a significant source of stress for clinicians, including medical students transitioning into the clinical workplace. Self-compassion, a strategy to better cope with stress and burnout, may represent a skill that can be leveraged to better prepare learners for the uncertainty inherent in clinical practice. A negative correlation between intolerance of uncertainty and self-compassion has been demonstrated in undergraduate students and in the general population. An examination of this relationship in medical students may help inform future curricular development for addressing burnout in undergraduate medical education. We electronically administered the Intolerance of Uncertainty Short Scale and the Self-Compassion Short Form to 273 third-year medical students from a single institution and analyzed data via regression. A significant negative correlation was found between intolerance of uncertainty and self-compassion (p < 0.0001). Students with higher levels of self-compassion showed lower levels of intolerance of uncertainty. This is consistent with findings in other populations. Our findings offer a starting point for designing training experiences that strengthen student self-compassion to enhance their ability to reconcile the uncertainty they will encounter in clinical practice., (© The Author(s) 2022.)

Background: When it comes to scheduling interviews, medical students may wonder if they need a strategy to increase their likelihood of matching. Previous studies examined the temporal effects of the residency interview on overall match rate; however, there are additional factors that affect the match process, including board examination scores and letters of recommendation. Only few studies have examined the effect interview time of day has on match success. The current study examines the impact date and time of interview during the interview season have on candidates' respective interview scores., Methods: Interview data over a three-year period (i.e., three interview cycles) was examined at a PGY-1-3, ACGME-accredited EM residency program in Philadelphia. Date of interview and time of day of interview (i.e., morning versus afternoon) was examined. A linear regression analysis was performed to determine if there is a statistically-significant difference in overall interview scores based on date during the interview season and time of day., Results: There is no statistically-significant effect of time of day or date on residency interview scores., Conclusions: Our findings are congruent with other studies on the temporal effects of residency interviews on overall match rate. Findings should provide reassurance to students scheduling interviews, as time slots have not been found to have a significant relationship with overall interview score. Future studies should more holistically analyze the residency application process., (© 2022. The Author(s).)

Competing Interests: DP was a 2020 Macy Faculty Scholar through the Josiah Macy Jr. Foundation. REL serves on the medical advisory board of Echonous.

Purpose: A disparity exists in cancer screening rates for the Sexual and Gender Minority (SGM) community. We sought to understand the perceptions and baseline knowledge of cancer screening among SGM community members., Methods: Survey administered via social media from June 2018 to October 2018. We asked 31 questions focused on cancer screening, human papillomavirus, emotional distress, and experience with the health care system. Those included were 18 years or older. Cancer screening attitudes and knowledge, as well as perceptions of the health care system were investigated., Results: There were 422 respondents analyzed: 24.6% identified as female, 25.5% as male, 40.1% transgender, and 9.6% as other. 65.4% of the SGM community is not certain what cancer screening to do for themselves. Only 27.3% and 55.7% knew that HPV was a risk factor associated with head and neck cancer and anal cancer, respectively. Half stated their emotional distress prevents them from getting cancer screening. It was identified that process changes in making appointments, comforts during the visit, and formal training for physicians and nurses could increase cancer screening compliance for this community. The transgender population had a trend in more gaps in knowledge of appropriate cancer screening and significant excess emotional distress., Conclusion: Gaps in cancer screening knowledge and emotional and financial distress may be responsible for the disparity of lower cancer screening rates for the SGM population and the transgender population may be most at risk. Appreciating the cancer screening concerns of the SGM population can help shape future clinical and institutional approaches to improve health care delivery., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Abstract: We live in a world where "just-in-time" (JiT) methodologies are increasingly used. Continuing professional development (CPD), including faculty development, has the opportunity to leverage online technologies in a JiT format to further support learner engagement and program sustainability. In this article, the authors propose a model that can serve as a taxonomy for defining and implementing JiT continuing education (JiTCE). The anatomy of JiTCE describes four mechanisms to address CPD needs and delivery procedures: perceived and unperceived, as well as pull and push (PUPP) taxonomy. JiTCE PUPP taxonomy defines four components for designing and developing a program with JiT: on-demand learning, subscription-based learning, performance feedback-driven learning, and data-driven learning. These methods, as backbones, use various online technologies, which offer fundamental support for JiTCE. Delivery systems and technologies are provided as specific examples for JiTCE throughout the article. JiTCE introduces a novel taxonomy to meet continuing education needs and provides an organized approach to design and deploy programming in a sustainable way. Online technologies are evolving everyday and are an indispensable part of both clinical practice and medical education. Pull-push and perceived-unperceived axes can help guide new opportunities for instructional designers and curriculum developers to leverage best practices to align with CPD offerings, which include cutting-edge technologies., (Copyright © 2021 The Alliance for Continuing Education in the Health Professions, the Association for Hospital Medical Education, and the Society for Academic Continuing Medical Education.)

Medical errors harm patients and increase costs. Engaging early clinicians in patient safety (PS) is critical but challenging. We evaluated the impact of a Patient Safety Escape Room (PSER) simulation on intern engagement in PS. During the PSER, learner teams identified PS hazards in a simulated hospital room, revealing clues that allow "escape" via event report entry. One-hundred twenty interns from 14 training programs completed 2 PSERs each. Before the PSER, 5% reported experience entering an event report. Following the PSER, all interns had participated in entering an event report. Mean learner-reported comfort in identifying PS hazards improved significantly (6.3 ± 1.57 to 8.0 ± 1.2; P < 0.001). Individual safety hazards were identified by between 6% and 100% of teams. Mean observer-rated teamwork was lower than learner-rated teamwork (41.5 ± 5.18 versus 45.92 ± 3.87; P = 0.01). Subsequent resident reporting rates did not increase compared with historic controls. The PSER engaged early learners, however, translating improvements into the clinical environment remains challenging., (Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Diagnostic uncertainty abounds in medicine, and communication of that uncertainty is critical to the delivery of high-quality patient care. While there has been training in communicating diagnostic uncertainty directed towards residents, a gap remains in preparing medical students to understand and communicate diagnostic uncertainty. We developed a session to introduce medical students to diagnostic uncertainty and to practice communicating uncertainty using a checklist during role-play patient conversations., Methods: This virtual session was conducted for third-year medical students at the conclusion of their core clerkships. It consisted of prework, didactic lecture, peer role-play, and debriefing. The prework included reflection prompts and an interactive online module. The role-play featured a patient complaining of abdominal pain being discharged from the emergency department without a confirmed diagnosis. Students participated in the role of patient, provider, or observer., Results: Data from an anonymous postsession survey (76% response rate; 202 of 265 students) indicated that most students (82%; 152 of 185) felt more comfortable communicating diagnostic uncertainty after the session. A majority (83%; 166 of 201) indicated the session was useful, and most (81%; 149 of 184) indicated it should be included in the curriculum., Discussion: This virtual session requires few facilitators; has peer role-play, eliminating the need for standardized patients; and is adaptable for in-person teaching. As its goal was to introduce an approach to communicating diagnostic uncertainty, not achieve mastery, students were not individually assessed for proficiency using the Uncertainty Communication Checklist. Students felt the session intervention was valuable., (© 2022 Poluch et al.)