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Learning Objective: To better understand the nature of support offered through residency peer support programs and to explore trainee perceptions of the benefits, potential harms, and optimal characteristics of peer support.Background: Though peer support groups are often utilized during residency training, the dynamics, content, and impact of social support offered through peer support are poorly understood.Objective: To explore trainee perceptions of the benefits, drawbacks, and optimal membership and facilitation of peer support groups.Methods: After engaging in a peer support program at an emergency medicine residency program, fifteen residents and four group facilitators participated in four focus groups in 2018. Interview questions explored the dynamics of group interactions, types of support offered, and psychological impacts of participation. The authors conducted a reflexive thematic analysis of data, performing iterative coding and organization of interview transcripts.Results: Discussions with experienced senior residents and alumni normalized residents’ workplace struggles and provided them with insights into the trajectory of their residency experiences. Vulnerable group dialogue was enhanced by the use of “insider” participants, however participants acknowledged the potential contributions of mental health professionals. Though groups occasionally utilized maladaptive coping strategies and lacked actual solutions, they also enhanced residents’ sense of belonging, willingness to share personal struggles, and ability to “reset” in the clinical environment. Results of our reflexive thematic analysis are described with representative quotes in Table 1.Conclusions: Participants offered insights into the benefits and drawbacks of peer support as well as optimal peer group composition and facilitation. Support groups may be more effective if they engage a complementary model of alumni and psychologist facilitators, avoid fatalism, and aim to foster intimate connections among residents. These findings can inform the development of future initiatives aiming to create a safe space for trainees to discuss workplace stressors.

Learning Objectives: To implement a peer mentorship program and assess its impact on the levels of stress and self-esteem of fourth year medical students.Background: Residents and medical students often face significant stress during their training which negatively impacts their wellbeing and job satisfaction. Peer mentoring is a dynamic social construct shown to have a positive effect on psychosocial wellbeing, stress reduction, and job satisfaction. We hypothesize that implementing a buddy system between emergency medicine (EM) residents and fourth year medical students will have a beneficial effect towards decreasing stress levels and improving self-esteem during their EM rotation.Objectives: To implement a peer mentorship program and assess its impact on the perceived levels of stress and self-esteem of fourth year students.Curriculum design: We implemented a 5-week 1:1 peer-mentoring program between 27 students and current EM residents at a Level I Trauma center over three rotation months. Prior to the rotation, they each received an email introducing the buddy system and outlining suggested topics and a meeting frequency of three times. Students completed surveys incorporating the 10 item Perceived Stress Scale and the Rosenberg Self-Esteem Scale both one week prior and on the last day of the rotation. Random numbers were assigned for anonymity.Impact: In total, 25 of 27 pre and post surveys were collected. Preliminary data shows that 84% of buddy pairs met at least three times, 92% of students perceived the intervention positively, and 84% believed it contributed to their overall wellbeing. This is an easy platform to implement with no cost or constraints on a residency program. By implementing peer-mentorship early it can have a rapid positive effect, foster a larger network of mentorship, and improve the psychological safety of trainees.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has been shown to increase levels of psychological distress among healthcare workers. Little is known, however, about specific positive and negative individual and organizational factors that affect the mental health of emergency physicians (EP) during COVID-19. Our objective was to assess these factors in a broad geographic sample of EPs in the United States.  Methods: We conducted an electronic, prospective, cross-sectional national survey of EPs from October 6–December 29, 2020. Measures assessed negative mental health outcomes (depression, anxiety, post-traumatic stress, and insomnia), positive work-related outcomes, and strategies used to cope with COVID-19. After preliminary analyses and internal reliability testing, we performed four separate three-stage hierarchical multiple regression analyses to examine individual and organizational predictive factors for psychological distress.  Results: Response rate was 50%, with 517 EPs completing the survey from 11 different sites. Overall, 85% of respondents reported negative psychological effects due to COVID-19. Participants reported feeling more stressed (31%), lonelier (26%), more anxious (25%), more irritable (24%) and sadder (17.5%). Prevalence of mental health conditions was 17% for depression, 13% for anxiety, 7.5% for post-traumatic stress disorder (PTSD), and 18% for insomnia. Regular exercise decreased from 69% to 56%, while daily alcohol use increased from 8% to 15%. Coping strategies of behavioral disengagement, self-blame, and venting were significant predictors of psychological distress, while humor and positive reframing were negatively associated with psychological distress.  Conclusion: Emergency physicians have experienced high levels of psychological distress during the COVID-19 pandemic. Those using avoidant coping strategies were most likely to experience depression, anxiety, insomnia, and PTSD, while humor and positive reframing were effective coping strategies.

Part One of this two-article series reviews assessment tools to measure burnout and other negative states. Physician well-being goes beyond merely the absence of burnout. Transient episodes of burnout are to be expected. Measuring burnout alone is shortsighted. Well-being includes being challenged, thriving, and achieving success in various aspects of personal and professional life. In this second part of the series, we identify and describe assessment tools related to wellness, quality of life, resilience, coping skills, and other positive states.

Introduction: There is significant variability in the preparedness of incoming interns at the start of residency training with regard to medical knowledge, procedural skills, and attitudes. Specialty-specific preparatory courses aimed at improving clinical skills exist; however, no preparatory courses targeting wellness promotion or burnout prevention have previously been described. Resident well-being has gained increasing attention from the Accreditation Council for Graduate Medical Education, and numerous studies have demonstrated high levels of burnout among resident physicians. The American Medical Association (AMA) divides resident well-being into the following six categories: nutrition, fitness, emotional health, financial health, preventative care, and mindset and behavioral adaptability. Using the AMA’s conceptual framework for well-being in residency, we performed a targeted needs assessment to support the development of a “pre-residency” well-being curriculum. Our aim was to discover what current residents and faculty felt were the perceived areas of under-preparedness, in relation to resident well-being, for incoming interns at the start of their residency training.Methods: Using a grounded theory approach, we conducted a series of semi-structured, focus group interviews. Focus groups consisted of junior residents (postgraduate years [PGY] 1-3), senior residents (PGY-4), and current faculty members. A standardized interview guide was used to prompt discussion and themes were identified from audio recording. We modified theories based on latent and manifest content analysis, and we performed member checking and an external audit to improve validity.Results: Participants noted variable exposure to both formal and informal well-being training prior to residency. Regardless, participants uniformly agreed that their past experiences did not adequately prepare them for the challenges, specific to burnout prevention, faced during residency training. Of the six domains of resident well-being described by the AMA, emotional health, mindset and behavioral adaptability, and financial health were the domains most cited for interns to be underprepared for at the start of residency training.Conclusion: Despite variability in prior medical school and life experiences, incoming interns were underprepared in several domains of well-being, including emotional health, mindset and behavioral adaptability, and financial health. Targeted interventions toward these areas of well-being should be piloted and studied further for their potential to mitigate effects of burnout among resident physicians.

Part One of this two-article series reviews assessment tools to measure burnout and other negative states. Physician well-being goes beyond merely the absence of burnout. Transient episodes of burnout are to be expected. Measuring burnout alone is shortsighted. Well-being includes being challenged, thriving, and achieving success in various aspects of personal and professional life. In this second part of the series, we identify and describe assessment tools related to wellness, quality of life, resilience, coping skills, and other positive states.

BackgroundThe flipped classroom model for didactic education has recently gained popularity in medical education; however, there is a paucity of performance data showing its effectiveness for knowledge gain in graduate medical education.ObjectiveWe assessed whether a flipped classroom module improves knowledge gain compared with a standard lecture.MethodsWe conducted a randomized crossover study in 3 emergency medicine residency programs. Participants were randomized to receive a 50-minute lecture from an expert educator on one subject and a flipped classroom module on the other. The flipped classroom included a 20-minute at-home video and 30 minutes of in-class case discussion. The 2 subjects addressed were headache and acute low back pain. A pretest, immediate posttest, and 90-day retention test were given for each subject.ResultsOf 82 eligible residents, 73 completed both modules. For the low back pain module, mean test scores were not significantly different between the lecture and flipped classroom formats. For the headache module, there were significant differences in performance for a given test date between the flipped classroom and the lecture format. However, differences between groups were less than 1 of 10 examination items, making it difficult to assign educational importance to the differences.ConclusionsIn this crossover study comparing a single flipped classroom module with a standard lecture, we found mixed statistical results for performance measured by multiple-choice questions. As the differences were small, the flipped classroom and lecture were essentially equivalent.

IntroductionCurrent residency didactic schedules that are built upon hour-long, lecture-based presentations are incongruous with adult learning theory and the needs of millennial generation residents. An alternative to the traditional lecture, the flipped classroom involves viewing a short video lecture at home, followed by an active discussion during class time. This module was developed for emergency medicine residents and rotating medical students without previous training on the subject.MethodsThe at-home portion of the module was designed to be delivered at home, while the in-class discussion was designed to be carried out over 30-45 minutes during a regularly scheduled didactic time. Small-group size may be determined by faculty availability, though groups of five are optimal. There is no requirement for faculty preparation prior to the in-class session. Associated materials include objectives, the at-home video, a discussion guide for faculty facilitators, a case-based handout for students and residents, and assessment questions. We assessed our module with a pretest, immediate posttest, and the posttest again after 90 days.ResultsThe mean pretest score was 66%, mean posttest score 76%, and mean retention test score 66%. There was an immediate increase of 10%, which did not remain at 90 days.DiscussionWe developed a flipped classroom module that can be implemented in any emergency medicine residency or clerkship. It addresses the theoretical challenges posed to traditional conference didactics by increasing the focus on problem solving and self-directed learning.

Audience: This module is designed for emergency medicine trainees. Though it focuses on those early in their career (medical students and junior residents), it is applicable to all emergency medicine learners. Introduction: In the United States, headache is the fifth most-common primary complaint of patients presenting to the emergency department and can be the primary symptomatic manifestation of many life-threatening illnesses. The emergency physician plays a unique role in diagnosing and managing these patients. The emergency physician’s two major responsibilities are to relieve headache pain and to ensure that life-threatening causes are diagnosed and treated. Objectives: At the end of this module, the learner will be able to: 1) list the diagnoses critical to the emergency physician that may present with headache; 2) identify key historical and examination findings that help differentiate primary (benign) from secondary (serious) causes of headache; 3) discuss the indications for diagnostic imaging, lumbar puncture and laboratory testing in patients with headache; 4) recognize life-threatening diagnoses on CT imaging and CSF examination; 5) describe treatment strategies to relieve headache symptoms.  Methods: This module includes a complete flipped classroom module. Learners are responsible for viewing a 20-minute video prior to the 30-minute small-group, case-based didactic discussion portion. The learners are assessed with multiple-choice question assessments, for low stakes retrieval practice or spaced practice. This could alternatively be run as a team-based learning session, with the pre- and post-tests used as an individual or group readiness assessment test, and the small group exercises converted to a group application exercise. Topics: Headache, subarachnoid hemorrhage, migraine, occult trauma, meningitis, temporal arteritis, carbon monoxide toxicity, acute glaucoma, cervical artery dissection, space occupying lesion, idiopathic intracranial hypertension.

The article presents a case study of a man having pulmonary embolism in transit.

This corrects West J Emerg Med. 2019 March;20(2):291-304. Assessment of Physician Well-being, Part Two: Beyond Burnout Lall MD, Gaeta TJ, Chung AS, Chinai SA, Garg M, Husain A, Kanter C, Khandelwal S, Rublee CS, Tabatabai RR, Takayesu JK, Zaher M, Himelfarb NT. Erratum in West J Emerg Med. 2020 May;21(3):727. Author name misspellled. The sixth author, originally published as Abbas Hussain, MD is revised to Abbas Husain, MD. Abstract: Part One of this two-article series reviews assessment tools to measure burnout and other negative states. Physician well-being goes beyond merely the absence of burnout. Transient episodes of burnout are to be expected. Measuring burnout alone is shortsighted. Well-being includes being challenged, thriving, and achieving success in various aspects of personal and professional life. In this second part of the series, we identify and describe assessment tools related to wellness, quality of life, resilience, coping skills, and other positive states.