Search

Introduction: Emergency medicine (EM) residents take the American Board of Emergency Medicine (ABEM) In-Training Examination (ITE) every year. This examination is based on the ABEM Model of Clinical Practice (Model). The purpose of this study was to determine whether a relationship exists between the number of patient encounters a resident sees within a specific clinical domain and their ITE performance on questions that are related to that domain. Methods: Chief complaint data for each patient encounter was taken from the electronic health record for EM residents graduating in three consecutive years between 2016-2021. We excluded patient encounters without an assigned resident or a listed chief complaint. Chief complaints were then categorized into one of 20 domains based on the 2016 Model. We calculated correlations between the total number of encounters seen by a resident for all clinical years and their ITE performance for the corresponding clinical domain from their third year of training.  Results: Available for analysis were a total of 232,625 patient encounters and 69 eligible residents who treated the patients. We found no statistically significant correlations following Bonferroni correction for multiple analyses. Conclusion: There was no correlation between the number of patient encounters a resident has within a clinical domain and their ITE performance on questions corresponding to that domain. This suggests the need for separate but parallel educational missions to achieve success in both the clinical environment and standardized testing.

Introduction: Belief in a just world is the cognitive bias that “one gets what they deserve.” Stronger belief in a just world for others (BJW-O) has been associated with discrimination against individuals with low socioeconomic status (SES) or poor health status, as they may be perceived to have “deserved” their situation. Emergency medicine (EM) residents have been shown to “cherry pick” patients; in this study we sought to determine whether BJW-O is associated with a biased case mix seen in residency. Methods: We assessed EM residents on their BJW-O using a scale with previous validity evidence and behavioral correlates. We identified chief complaints that residents may associate with low SES or poor health status, including psychiatric disease, substance use disorder (SUD); and patients with multidisciplinary care plans due to frequent ED visits. We then calculated the percentage of each of these patient types seen by each resident as well as correlations and a multiple linear regression. Results: 38 of 48 (79%) residents completed the BJW-O, representing 98,825 total patient encounters. The median BJW-O score was 3.25 (interquartile range 2.81–3.75). There were no significant correlations observed between BJW-O and the percentage of patients with multidisciplinary care plans who were seen, or patients with psychiatric, SUD, dental or sickle cell chief complaints seen; and a multiple linear regression showed no significant association. Conclusion: Higher BJW-O scores in EM residents are not significantly associated with a biased case mix of patients seen in residency.

Learning Objectives: To quantify individual differences in resident clinical exposure during training at a 3-year academic emergency medicine residency.Background: Experiential learning theory suggests that clinical exposures during residency are critical to developing expertise. Research in other specialties has shown significant individual differences in resident clinical exposures during training, but this has not been recently evaluated in emergency medicine (EM).Objective: To quantify individual differences in resident clinical exposure during training at a 3-year academic emergency medicine residency.Methods: We performed a retrospective review of electronic health records from 2013-2021 at our main clinical site (of four) to quantify the number and type of clinical encounters seen by each resident. Visits were attributed to the first assigned resident. We included data from residents who completed all three years of residency consecutively. We categorized primary patient chief complaints according to the 20 domains of the ABEM Model of Clinical Practice following a published consensus method with EM faculty. We calculated and reported descriptive statistics.Results: We collected data from 70 residents. Means and ranges of exposures in the top 10 most commonly identified domains are displayed in Figure 1.Conclusions: We found variability in resident clinical exposures at our primary training site. Residencies may benefit from examining resident clinical exposures to identify opportunities for individual resident improvements.

Learning Objectives: To examine the effect of increasing clinical exposure to common EM complaints had on in-service training exam scores, and provide some insight into how to further strengthen the relationship between these two pillars of training.Background: The in-service training exam (ITE) for Emergency Medicine (EM) residents has been shown to predict subsequent pass rate on the American Board of Emergency Medicine (ABEM) qualifying exam. Multimodal learning theory suggests that clinical exposures to common EM presentations would be beneficial for acquiring and retaining medical knowledge. It is unknown whether greater clinical exposure is associated with higher scores on the annual ITE.Objective: To determine whether a higher number of clinical patient encounters in a given domain correlates with higher ITE score across the corresponding ABEM domain.Methods: This is a retrospective review examining ITE scores and chief complaints seen by EM residents from 2013-2021 at our main clinical site. Visits were attributed to the first assigned resident. Patient encounters were categorized by chief complaint into one of 20 domains of the ABEM Model of Clinical Practice using a previously published consensus process. ITE scores during the third year of training were broken down into percentages by domain. Linear regressions were performed comparing clinical exposure within a domain to the ITE score.Results: Data were available for 70 residents. Correlation coefficients ranged between 0.01 and 0.29, indicating weak or no correlation (Table 1). Only 3 domains had significant correlations identified: Head, Ear, Eye, Nose, and Throat (multiple R=0.25, p

Introduction: While patient throughput and emergency department (ED) length of stay (LOS) are recognized as important metrics in the delivery of efficient care, they must be balanced with the educational mission of academic centers. Prior studies examining the impact of learners on throughput and LOS when staffing directly with attending physicians have yielded mixed results. Herein we sought to examine the impact of a staffing model involving a supervisory resident “pre-attending” (PAT) on ED throughput and LOS, as this model offers a valuable educational experience for residents, but may do so at the expense of operational efficiency.Methods: We retrospectively analyzed 26,702 unique patient encounters at a university-affiliated community ED between July 1, 2017–January 1,2019. The experimental group was comprised of patients seen primarily by midlevel providers, who staffed with a PAT, who subsequently staffed with an attending physician. The control group was comprised of patients seen by midlevel providers and staffed directly with attendings without a PAT. We used a parametric hazard model to analyze the effect of the presence of a PAT on service time, controlling for potential confounders including timing of presentation and patient demographics.Results: The presence of a PAT is associated with a statistically significant increase in service time of five minutes (p = 0.006). Holding other variables equal, predicted service time in the experimental group was 173 minutes (95% confidence interval (CI), 171-176), while that for controls was 168 minutes (95% CI, 165-171).Conclusion: The presence of a PAT is associated with a statistically significant increase in service time, but the magnitude (five minutes) is likely operationally insignificant. The negligible increase in service time is offset by the benefit to residents’ training. The results of this study may be helpful for residency programs considering the addition of a PAT shift structure.

Recommendations from the Council of Residency Directors Application Process Improvement Committee (CORD-APIC)The coronavirus disease (COVID-19) pandemic has had a significant impact on undergraduate medical education with limitation of patient care activities and disruption to medical licensing examinations. In an effort to promote both safety and equity, the emergency medicine (EM) community has recommended no away rotations for EM applicants and entirely virtual interviews during this year’s residency application cycle. These changes affect the components of the EM residency application most highly regarded by program directors – Standardized Letters of Evaluation from EM rotations, board scores, and interactions during the interview. The Council of Residency Directors in Emergency Medicine Application Process Improvement Committee suggests solutions not only for the upcoming year but also to address longstanding difficulties within the process, encouraging residency programs to leverage these challenges as an opportunity for disruptive innovation.

Introduction: The Association of American Medical Colleges has introduced the Standardized Video Interview (SVI) to assess the communication and professionalism skills of residency applicants to allow a more holistic view of applicants beyond academic performance. Initial data suggests scores are not correlated with academic performance and provide a new measure of applicant attributes. It is not currently known how the SVI compares to existing metrics for assessing communication and professionalism during the interview process.Methods: Applicants to the University of Wisconsin Emergency Medicine Residency program were invited and interviewed without use of the SVI scores or videos. All faculty interviewers were blinded to applicants’ SVI information and asked to rate each applicant on their communication and professionalism on a scale from 1-25 (faculty gestalt score), analogous to the 6-30 scoring used by the SVI. We transformed SVI scores to our 1-25 system (transformed SVI score) for ease of comparison and compared them to faculty gestalt scores as well as applicants’ overall score for all components of their interview day (interview score).Results: We collected data for 125 residency candidates. Each applicant received a faculty gestalt score from up to four faculty interviewers. There was no significant correlation of SVI scores with faculty gestalt scores (Spearman’s rank correlation coefficient [rs] (123)=0.09, p=0.30) and no correlation with the overall interview score (rs(123)=0.01, p=0.93). Faculty gestalt scores were correlated positively with interview scores (rs(123)=0.65, p

Introduction: The “stable marriage” algorithm underlying the National Residency Match Program (NRMP) has been shown to create optimal outcomes when students submit true preference lists. Previous research has shown students may allow external information to affect their rank lists. The objective of this study was to determine whether medical students consistently make rank lists that reflect their true preferences.Methods: A voluntary online survey was sent to third-year students at a single midwestern medical school. Students were given hypothetical scenarios that either should or should not affect their true residency preferences and rated the importance of six factors to their final rank list. The survey was edited by a group of education scholars and revised based on feedback from a pilot with current postgraduate year 1 residents.Results: Of 175 students surveyed, 140 (80%) responded; 63% (88/140) reported that their “perceived competitiveness” would influence their rank list at least a “moderate amount. Of 135 students, 31 (23%) moved a program lower on their list if they learned they were ranked “low” by that program, while 6% (8/135) of respondents moved a program higher if they learned they were ranked “at the top of the list.” Participants responded similarly (κ = 0.71) when presented with scenarios asking what they would do vs what a classmate should do.Conclusion: Students’ hypothetical rank lists did not consistently match their true residency preferences. These results may stem from a misunderstanding of the Match algorithm. Medical schools should consider augmenting explicit education related to the NRMP Match algorithm to ensure optimal outcomes for students.

Introduction: Emergency physicians encounter scenarios daily that many would consider “disgusting,” including exposure to blood, pus, and stool. Physicians in procedural specialties such as surgery and emergency medicine (EM) have lower disgust sensitivity overall, but the role this plays in clinical practice is unclear. The objective of this study was to determine whether emergency physicians with higher disgust sensitivity see fewer “disgusting” cases during training.Methods: All EM residents at a midsize urban EM program were eligible to complete the Disgust Scale Revised (DS-R). We preidentified cases as “disgust elicitors” based on diagnoses likely to induce disgust due to physician exposure to bodily fluids, anogenital anatomy, or gross deformity. The “disgust elicitor” case percent was determined by “disgust elicitor” cases seen as the primary resident divided by the number of cases seen thus far in residency. We calculated Pearson’s r, t-tests and descriptive statistics on resident and population DS-R scores and “disgust elicitor” casesper month.Results: Mean DS-R for EM residents (n = 40) was 1.20 (standard deviation [SD] 1.24), significantly less than the population mean of 1.67 (SD 0.61, p

Introduction: The National Residency Matching Program (NRMP) allows post-interview contactbetween residency applicants and residency programs. Thank-you communications representone of the most common forms, but data on their value to applicants and program directors (PD)are limited. The objective of this study was to assess the effect of thank-you communications onapplicant- and residency-program rank lists.Methods: Two anonymous, voluntary surveys were sent after the 2018 NRMP Match, one toapplicants who were offered an interview at a single academic site in the 2017-2018 Match cycle,and one to EM PDs nationwide. The surveys were designed in conjunction with a nationallyrecognizedsurvey center and piloted and revised based on feedback from residents and faculty.Results: Of 196 residency applicants, 97 (49.5%) responded to the survey. Of these, 73/95 (76.8%)reported sending thank-you communications. Twenty-two of 73 (30%) stated that they sent thank-youcommunications to improve their spot on a program’s rank list; and 16 of 73 (21.9%) reported that theychanged their rank list based upon the responses they received to their thank-you communications. Of 163 PDs, 99 (60.7%) responded to the survey. Of those PDs surveyed, 22.6% reported that anapplicant could be moved up their program’s rank list and 10.8% reported that an applicant could movedown a program’s rank list based on their thank-you communications (or lack thereof).Conclusion: The majority of applicants to EM are sending thank-you communications. Asignificant minority of applicants and PDs changed their rank list due to post-interview thank-youcommunications.

Background: Emergency medicine (EM) has introduced a new, competency‐based standardized letter of evaluation (SLOE) template. While a previous version of the SLOE has been shown to promote a high degree of faculty consensus regarding competitiveness, this has not been shown for the new SLOE template. Objective: The objective was to evaluate faculty consensus on competitiveness for the new EM SLOE 2.0. Methods: Fifty mock SLOE 2.0 letters using the new template were drafted and sent to a group of experienced EM educators. The 50 letters were ranked by the experienced faculty as well as a point‐based prediction model and a regression model and the results were compared. Results: Faculty consensus on competitiveness remained strong when using the new SLOE 2.0 format. The points‐based prediction model and regression model both demonstrated a high level of agreement with faculty consensus rankings for the SLOE 2.0. Conclusions: Introduction of the new, competency‐based SLOE 2.0 format did not have a deleterious effect on faculty consensus rankings of competitiveness. [ABSTRACT FROM AUTHOR]

Objectives: There is a concern that provide increased extraneous cognitive load when paired with residents on shift. However, this may be offset by the decrease in extraneous load they may provide to the residents they are paired with by offloading basic patient care tasks. We hypothesized that these forces may not be balanced. Methods: We conducted a retrospective observational analysis of PGY‐2 emergency medicine residents and junior medical students at a single academic emergency department (ED) in the Midwest. A series of efficiency metrics (relative value unit [RVUs], patients per hour [PPH], time to note completion, and resident assignment to disposition [RATD]) as well as one quality metric (number of return ED visits; "bouncebacks") were compared for resident shifts in which a student was paired with the resident as well those in which no student was paired utilizing a regression model. Results: A total of 1844 records met the inclusion criteria (214 shifts with a paired medical student and 1630 without). After covariates were adjusted for, medical student shift status was a statistically significant predictor of increases in PPH (p < 0.0001) and RVUs (p = 0.0161) but was not significantly associated with RATD (p = 0.6941), log‐time to note completion (p = 0.1604), or bounceback status (p = 0.9840). Shifts where residents were paired with medical students were predicted to see an additional 1.131 (95% confidence interval [CI] 0.660–1.602) PPH and produce an additional 1.923 RVUs (95% CI 1.130–3.273) per shift relative to shifts without medical students. Conclusions: When junior medical students were paired with a PGY‐2 resident on ED shifts, there was a significant increase in the PPH and RVUs generated when compared with shifts in which no medical student was paired with them. [ABSTRACT FROM AUTHOR]

ALiEM EM Match Advice is a web series hosted on the Academic Life in Emergency Medicinewebsite. The intended audience includes senior medical students seeking a residency inemergency medicine (EM) and the faculty members who advise them. Each episode featuresa panel of three EM program directors who discuss a critical step in the residency applicationprocess. This article serves as a user’s guide to the series, including a timeline for viewingeach episode, brief summaries of the panel discussions, and reflection questions for discussionbetween students and their faculty advisors.

Introduction: Interviewing for residency is a complicated and often expensive endeavor. Literature has estimated interview costs of $4,000 to $15,000 per applicant, mostly attributable to travel and lodging. The authors sought to reduce these costs and improve the applicant interview experience by coordinating interview dates between two residency programs in .Methods: Two emergency medicine residency programs scheduled contiguous interview dates for the 2015-2016 interview season. A survey was used to assess applicant experiences interviewing in and attitudes regarding coordinated scheduling. Data on utilization of coordinated dates were obtained from interview scheduling software. The target group for this intervention consisted of applicants from medical schools outside that completed interviews at both programs.Results: Of the 158 applicants invited to both programs, 84 (53%) responded to the survey. Scheduling data was available for all applicants. The total estimated cost savings for target applicants coordinating interview dates was $18,600. The majority of target applicants reported that this intervention increased the ease of scheduling (84%), made them less likely to cancel the interview (82%) and saved them money (71%).Conclusions: Coordinated scheduling of interview dates was associated with significant estimated cost savings and was reviewed favorably by applicants across all measures of experience. Expanding use of this practice geographically and across specialties may further reduce the cost of interviewing for applicants.

Background: Given the importance of the standardized letter of evaluation (SLOE) for application to emergency medicine (EM) residency, it is important that SLOE developers and authors understand how reviewers determine SLOE competitiveness. To inform SLOE design and authorship, the authors set out to build a novel theory to explain how faculty holistically interpret SLOE competitiveness. Methods: The authors used constructivist grounded theory to explore how EM faculty determine SLOE competitiveness. They used purposive sampling to recruit EM faculty participants with at least 1 year of experience in scoring SLOEs. One author conducted hour‐long, semistructured interviews over Zoom between August 2023 and March 2024. Two authors iteratively coded the data to develop the initial codebook, organize codes into categories, and build connections to construct the resulting theory. Results: The authors interviewed 11 EM faculty from throughout the United States. Participants described a complex process to determine SLOE competitiveness. They began by contextualizing the SLOE to determine its trustworthiness and value before using various components of the SLOE to stratify and refine their understanding of competitiveness. Finally, when participants noted the inconsistency between different aspects of the SLOE, they used various methods to reconcile discordances and determine competitiveness. Conclusions: This study illuminates the framework used by EM faculty to determine applicant competitiveness based on the SLOE and highlights several factors that SLOE authors should consider to ensure the accurate and efficient transfer of information. [ABSTRACT FROM AUTHOR]

This article discusses strategies for emergency medicine educators to accomplish mission-driven work. The author emphasizes the importance of knowing one's mission and setting goals that align with personal values and institutional goals. Prioritization is also highlighted as a key factor in doing mission-driven work effectively. The article suggests conducting a time audit to identify time-wasting activities and optimize productivity. Additionally, the author recommends starting the day with the most important task, calendaring tasks to ensure focus, and making daily, weekly, and monthly plans. By implementing these strategies, emergency medicine educators can avoid feeling overwhelmed and stay focused on their mission-driven work. [Extracted from the article]

This article explores the use of technology-enhanced audience interaction in medical education to promote active learning. Active learning has been found to improve attentiveness, enjoyment, and knowledge retention, but it can also cause anxiety in large group settings. Technology-enhanced audience interaction provides a solution by allowing participation with anonymity, creating a supportive learning environment. The article discusses considerations for selecting software programs for audience interaction, such as presentation objectives, learner participation, and software characteristics. It also highlights virtual whiteboard platforms like Miro, Padlet, FigJam, and LucidSpark, as well as the integration of presentation tools like PowerPoint and Keynote. However, the article cautions about potential distractions, technology failures, and subscription costs. It emphasizes the importance of staying updated on evolving technology and considering whether technological solutions are suitable for effective learning environments. Overall, technology-enhanced audience interaction can offer active learning opportunities but should be carefully evaluated based on the audience, content, and environment. [Extracted from the article]

Background: Just‐in‐time training (JITT) occurs in the clinical context when learners need immediate guidance for procedures due to a lack of proficiency or the need for knowledge refreshment. The master adaptive learner (MAL) framework presents a comprehensive model of transforming learners into adaptive experts, proficient not only in their current tasks but also in the ongoing development of lifelong skills. With the evolving landscape of procedural competence in emergency medicine (EM), trainees must develop the capacity to acquire and master new techniques consistently. This concept paper will discuss using JITT to support the development of MALs in the emergency department. Methods: In May 2023, an expert panel from the Society for Academic Emergency Medicine (SAEM) Medical Educator's Boot Camp delivered a comprehensive half‐day preconference session entitled "Be the Best Teacher" at the society's annual meeting. A subgroup within this panel focused on applying the MAL framework to JITT. This subgroup collaboratively developed a practical guide that underwent iterative review and refinement. Results: The MAL‐JITT framework integrates the learner's past experiences with the educator's proficiency, allowing the educational experience to address the unique requirements of each case. We outline a structured five‐step process for applying JITT, utilizing the lumbar puncture procedure as an example of integrating the MAL stages of planning, learning, assessing, and adjusting. This innovative approach facilitates prompt procedural competence and cultivates a positive learning environment that fosters acquiring adaptable learning skills with enduring benefits throughout the learner's career trajectory. Conclusions: JITT for procedures holds the potential to cultivate a dynamic learning environment conducive to nurturing the development of MALs in EM. [ABSTRACT FROM AUTHOR]

Purpose: Entrustable professional activities (EPAs) are a widely used framework for curriculum and assessment, yet the variability in emergency medicine (EM) training programs mandates the development of EPAs that meet the needs of the specialty as a whole. This requires eliciting and incorporating the perspectives of multiple stakeholders (i.e., faculty, residents, and patients) in the development of EPAs. Without a shared understanding of what a resident must be able to do upon graduation, we run the risk of advancing ill‐prepared residents that may provide inconsistent care. Methods: In an effort to address these challenges, beginning in February 2020, the authors assembled an advisory board of 25 EM faculty to draft and reach consensus on a final list of EPAs that can be used across all training programs within the specialty of EM. Using modified Delphi methodology, the authors came to consensus on an initial list of 22 EPAs. The authors presented these EPAs to faculty supervisors, residents, and patients for refinement. The authors collated and analyzed feedback from focus groups of residents and patients using thematic analysis. The EPAs were subsequently refined based on this feedback. Results: Stakeholders in EM residency training endorsed a final revised list of 22 EPAs. Stakeholder focus groups highlighted two main thematic considerations that helped shape the finalized list of EM EPAs: attention to the meaningful nuances of EPA language and contextualizing the EPAs and viewing them developmentally. Conclusions: To foreground all key stakeholders within the EPA process for EM, the authors chose within the development process to draft; come to consensus; and refine EPAs for EM in collaboration with relevant faculty, patient, and resident stakeholders. Each stakeholder group contributed meaningfully to the content and intended implementation of the EPAs. This process may serve as a model for others in developing stakeholder‐responsive EPAs. [ABSTRACT FROM AUTHOR]

Background Standardized letters of evaluation (SLOE) are becoming more widely incorporated into the residency application process to make the letter of recommendation, an already critical component in a residency application packet, more objective. However, it is not currently known if the reviewers of these letters share consensus regarding the strength of an applicant determined by their SLOE. Objective We measured the level of faculty agreement regarding applicant competitiveness as determined by SLOEs and the ability of 2 algorithms to predict faculty consensus rankings. Methods Using data from the 2021-2022 Match cycle from the Council of Residency Directors in Emergency Medicine SLOE Database as a blueprint, authors created 50 fictional SLOEs representative of the national data. Seven faculty then rated these SLOEs in order of applicant competitiveness, defined as suggested rank position. Consensus was evaluated using cutoffs established a priori, and 2 prediction models, a point-based system and a linear regression model, were tested to determine their ability to predict consensus rankings. Results There was strong faculty consensus regarding the interpretation of SLOEs. Within narrow windows of agreement, faculty demonstrated similar ranking patterns with 83% and 93% agreement for "close" and "loose" agreement, respectively. Predictive models yielded a strong correlation with the consensus ranking (point-based system r=0.97, linear regression r=0.97). Conclusions Faculty displayed strong consensus regarding the competitiveness of applicants via SLOEs, adding further support to the use of SLOEs for selection and advising. Two models predicted consensus competitiveness rankings with a high degree of accuracy. [ABSTRACT FROM AUTHOR]

Audience and Type of Curriculum: This curriculum is designed for emergency medicine fellows and first-year junior faculty. The curriculum covers core topics related to academic and professional success for an early career faculty member. Length of Curriculum: The curriculum is designed as quarterly sessions over the course of one academic year. Introduction: An increasing number of emergency medicine graduates are pursuing fellowship after completion of residency.1 Fellowship can be challenging as newly minted graduates begin to explore their academic niche, refine their clinical practice, and define their personal and professional spheres. We propose a structured curriculum to help guide fellows and new faculty to mitigate these challenges. Educational Goals: The aim of this curriculum is to develop relevant skills to promote academic success for fellows and first-year faculty at the start of their academic career and which could be completed during a one-year training timeline. We included topics relevant to all fellow and new faculty's expected personal and professional journey during this first year, including time management, academic productivity, resilience/wellness, and developing a national reputation. Educational Methods: The educational strategies used in this curriculum consist primarily of lecture seminars. There is one short individual activity associated with the lectures and one small group discussion. Research Methods: The course was assessed with pre- and post-test surveys following each lecture. Surveys assessed participants' reaction, learning, and behavior for each session. Evaluations were completed based on a 5-point Likert scale (1=strongly disagree, 5=strongly agree). Results: Fifteen participants attended the seminar series encompassing fellows and first-year faculty/postfellows from ten different fellowship subspecialities. Average pre-assessment scores were low for many of the self-reported skills and confidence throughout the seminar series. Overall, participants reported increased confidence on the post-test for each of the seminar topics. In addition, participants reported that they learned new skills and planned to use the new ideas presented. All participants reported they would recommend these seminars to someone else on their same career path. Discussion: Overall, participants reported increased confidence, new skills, and plans to use the ideas presented in the seminar series. The content appears applicable to this learner set since all reported they would recommend the series to others on their career path. In conclusion, we believe our seminar series will build skills for fellows and first-year faculty which will promote academic success. [ABSTRACT FROM AUTHOR]