Acute stress impairs physician decision-making and clinical performance in resuscitations. Mental skills training, a component of the multistep, cognitive-behavioral technique of stress inoculation, modulates stress response in high-performance fields.
Acute patellar dislocation is a painful condition that can be effectively managed with prompt reduction. Successful reduction requires confidence, which comes with experience. Patellar dislocation is not prevalent enough for every emergency physician to encounter it in a live patient during residency training. Although the reduction maneuver is straightforward, trainees are often initially unsure of hand positioning and attempt to reduce the patella primarily with medial pressure. Simultaneous knee extension is an important component of the reduction, creating patellar and quadriceps tendon laxity and making for a smoother, less painful reduction. Many available videos demonstrate extension poorly and show the difficulty with which the reduction is performed when primarily medial patella pressure is used.1,2
The number of applications to individual emergency medicine (EM) residency programs has markedly increased over the past decade.1-3 As a result, residency programs have difficulty reviewing applications holistically and struggle to identify applicants who are truly interested in their program. These challenges were exacerbated by the COVID-19 pandemic: programs received more applications; and away-rotation restrictions limited EM applicants’ ability to express, and programs to identify, interest in a residency program or geographic region.2 Additionally, the Association of American Medical Colleges reported a concern for maldistribution of interview offers to the highest tier applicants, leaving other well-qualified students with a paucity of interviews – a trend that would threaten the success of the Match for all stakeholders.4
Improving the recruitment, retention, and leadership advancement of faculty who are under-represented in medicine is a priority at many academic institutions to ensure excellence in patient care, research, and health equity. Here we provide a critical review of the literature and offer evidence-based guidelines for faculty recruitment, retention, and representation in leadership. Recommendations for recruitment include targeted recruitment to expand the candidate pool with diverse candidates, holistic review of applications, and incentivizing stakeholders for success with diversity efforts. Retention efforts should establish a culture of inclusivity, promote faculty development, and evaluate for biases in the promotion and tenure process. We believe this guide will be valuable for all leaders and faculty members seeking to advance diversity, equity, and inclusion in their institutions.
This special issue of the Western Journal of Emergency Medicine, co-sponsored by the Council of Emergency Medicine Residency Directors (CORD) and the Clerkship Directors in Emergency Medicine (CDEM), serves as a snapshot of the current state of emergency medicine (EM) education research and focuses on relevant topics published by a diverse group of education scholars. Our field has seen marked increases in scholarship, publication venues, funding, and training opportunities for EM education research over the past decade.1-3 However, a lack of expertise in education research is still one of the main perceived barriers to educators reaching their scholarship goals.4-6 Educators who are new to research may not be aware of avenues to access the training, collaboration, and mentorship they need to achieve their scholarship goals. These avenues are now myriad and include everything from do-it-yourself episodic training, either in the digital space or in person, to longitudinal doctorate degree programs. Our aim in this piece is to describe available options for faculty development in education research, presented in the below table, along with references for exemplar programs. This table may be used by educators, mentors, and department leaders to determine the best fit for individual faculty development needs.
Learning is critical to developing and maintaining competence. Learning is slow at the beginning, accelerates rapidly as we gain skills and knowledge, and then slows again as we achieve competence and approach expertise. Rapid periods of expansion of ability and understanding alternate with stages of relative inertia. We may at times focus on routinization, the repetitive effort by which we standardize aspects of our practice, producing a steady practice state that is efficient and systematic. At other times, however, patients and systems demand a more dynamic approach to learning.
We appreciate the opportunity to respond to the letter to the editor in reference to our prior publications1,2 and to clarify the concerns raised. It seems that we, the authors of the original article, and the author(s) of the most recent letter to the editor have common ground on many of the issues presented. We believe that all emergency patients should be cared for by emergency physician-led teams. We agree that the training of our physician residents cannot be compromised.
We believe the letter to the editor by Tsyrulnik et al1 clarifying the initial manuscript “Implementation of a Physician Assistant Emergency Medicine Residency Within a Physician Residency” from December 2020 is an important marker and acknowledgment of a deep-rooted workforce issue that will plague emergency medicine (EM) for the entirety of its future. It also only scratches the surface. Indeed, in the aftermath of the EM workforce reports by the American Academy of Emergency Medicine (AAEM), and more recently the American College of Emergency Physicians, the AAEM Resident and Student Association is now advocating for an end to all postgraduate training programs for non-physician practitioners (NPP).2
Head computed tomography (CT) interpretation is a vital skill for emergency physicians. Existing literature shows poor concordance between emergency physicians and radiologists in head CT interpretation. Prior studies have used passive learning methods to address this knowledge gap. We created an active learning curriculum for teaching head CT interpretation to emergency medicine (EM) residents and compared its effectiveness to a passive learning strategy.
The COVID-19 pandemic has revealed the importance of teaching medical students pandemic preparedness and COVID-19 related clinical knowledge. To fill the gap of COVID-19 instruction backed by evaluation data, we present a comprehensive COVID-19 pilot curriculum with multiple levels of evaluation data.
Safety concerns surrounding the coronavirus 2019 pandemic led to the prohibition of student rotations outside their home institutions. This resulted in emergency medicine (EM)-bound students having less specialty experience and exposure to outside programs and practice environments, and fewer opportunities to gain additional Standardized Letters of Evaluation, a cornerstone of the EM residency application. We filled this void by implementing a virtual clerkship.
The Covid-19 pandemic limited educational and career development opportunities for medical students, requiring innovative programs to accelerate professional identity formation and clinical skills acquisition.
The Accreditation Council for Graduate Medical Education (ACGME) requires programs to develop research curricula regarding how research is “conducted, evaluated, explained to patients, and applied to patient care.”1 Specific to fellowship, the ACGME requires fellows to participate in and complete scholarly work aligned with their subspecialty requirements.2 The American Board of Pediatrics (ABP) subspecialty in pediatric emergency medicine (PEM) further requires that each PEM fellow have a strong core knowledge in scholarly activities and complete meaningful scholarly work; the ABP tests research knowledge as part of the in-training exam (ITE), board certification exam, and maintenance of certification. The ITE and board exams’ proportion of research questions is not trivial (7% of questions overall).2,3
Over the last several decades simulation, in both graduate and undergraduate emergency medicine education, has continued to develop as a leading and highly effective teaching modality. Limited research exists to evaluate the efficacy of low-fidelity (table-top) simulation, as compared to high-fidelity standards, as it relates to medical knowledge learning outcomes. We sought to assess the efficacy of a low-fidelity simulation modality in undergraduate emergency medicine education, based on quantitative medical knowledge learning outcomes.
The United States Medical Licensing Examination (USMLE) Step 1 score is one of the few standardized metrics used to objectively review applicants for residency. In February 2020 the USMLE program announced that the numerical Step 1 scoring would be changed to a binary (Pass/Fail) system. In this study we sought to characterize how this change in score reporting will impact the application review process for emergency medicine (EM) program directors (PD).
Residency didactic conferences transitioned to a virtual format during the COVID-19 pandemic. This format creates questions about effective educational practices, which depend on learner engagement. In this study we sought to characterize the competitive demands for learner attention during virtual didactics and to pilot methodology for future studies.
The Accreditation Council for Graduate Medical Education (ACGME) lists “educating patients, families, students, residents, and other health professionals” as a common core requirement for residency programs in every medical specialty.1 Residents often play a crucial role in peer and medical student education. Teaching others can solidify resident knowledge, enhance students’ knowledge, and influence career choices.2,3,4,5
The United States Medical Licensing Examination (USMLE) Step 1 score is one of the few standardized metrics used to objectively review applicants for residency. In February 2020 the USMLE program announced that the numerical Step 1 scoring would be changed to a binary (Pass/Fail) system. In this study we sought to characterize how this change in score reporting will impact the application review process for emergency medicine (EM) program directors (PD).
Emergency medicine residency programs around the country develop didactic conferences to prepare residents for board exams and independent practice. To our knowledge, there is not currently an evidence-based set of guidelines for programs to follow to ensure maximal benefit of didactics for learners. This paper offers expert guidelines for didactic instruction from members of the Council of Emergency Medicine Residency Directors Best Practices Subcommittee, based on best available evidence. Programs can use these recommendations to further optimize their resident conference structure and content. Recommendations in this manuscript include best practices in formatting didactics, selection of facilitators and instructors, and duration of individual sessions. Authors also recommend following the Model of Clinical Practice of Emergency Medicine when developing content, while incorporating sessions dedicated to morbidity and mortality, research methodology, journal article review, administration, wellness, and professionalism.
Clinical teaching is the primary educational tool use to train learners from day one of medical school all the way to the completion of fellowship. However, concerns over time constraints and patient census have led to a decline in bedside teaching. This paper provides a critical review of the literature on clinical teaching with a focus on instructor teaching strategies, clinical teaching models, and suggestions for incorporating technology. Recommendations for instructor-related teaching factors include adequate preparation, awareness of effective teacher attributes, using evidence-based-knowledge dissemination strategies, ensuring good communication, and consideration of environmental factors. Proposed recommendations for potential teaching strategies include the Socratic method, the One-Minute Preceptor model, SNAPPS, ED STAT, teaching scripts, and bedside presentation rounds. Additionally, this article will suggest approaches to incorporating technology into clinical teaching, including just-in-time training, simulation, and telemedical teaching. This paper provides readers with strategies and techniques for improving clinical teaching effectiveness.
A primary aim of residency training is to develop competence in clinical reasoning. However, there are few instruments that can accurately, reliably, and efficiently assess residents’ clinical decision-making ability. This study aimed to externally validate the script concordance test in emergency medicine (SCT-EM), an assessment tool designed for this purpose.
Adverse effects of administrative burden on emergency physicians have been described previously, but the impact of electronic health record documentation by academic emergency attendings on resident education is not known. In this observational study of a quaternary care, academic emergency department, we sought to assess whether the amount of time attending physicians spent on documentation affected the amount of time they spent teaching.
Social risks adversely affect health and are associated with increased healthcare utilization and costs. Emergency department (ED) patients have high rates of social risk; however, little is known about best practices for ED-based screening or linkage to community resources. We examined the perspectives of patients and community organizations regarding social risk screening and linkage from the ED.
The prevalence of food insecurity (FI) and insulin rationing among patients with diabetes who present to the emergency department (ED) is unclear. We examined the prevalence of food insecurity and subtherapeutic insulin use among patients who presented to the ED with a blood glucose level of greater than 250 milligrams per deciliter.
Hallway beds in the emergency department (ED) produce lower patient satisfaction and inferior care. We sought to determine whether socioeconomic factors influence which visits are assigned to hallway beds, independent of clinical characteristics at triage.
A small percentage of patients with skin infections later develop necrotizing fasciitis (NF). Diagnostic testing is needed to identify patients with skin infections at low risk of NF who could be discharged from the emergency department (ED) after antibiotic initiation. Elevated lactate has been associated with NF; existing estimates of the frequency of NF are based on retrospective reviews, and cases often lack testing for lactate. We present the incidence of patients with skin infections who developed NF and their baseline lactates.
