Through a joint collaboration involving Academic Life in Emergency Medicine’s (ALiEM) Wellness Think Tank, Essentials of Emergency Medicine (EEM), and the Emergency Medicine Residents’ Association (EMRA), a one-day Resident Wellness Consensus Summit (RWCS) was organized.
Physicians are at much higher risk for burnout, depression, and suicide than their non-medical peers. One of the working groups from the May 2017 Resident Wellness Consensus Summit (RWCS) addressed this issue through the development of a longitudinal residency curriculum to address resident wellness and burnout.
In 2017 the Accreditation Council for Graduate Medical Education (ACGME) updated the Common Program Requirements to focus more on resident wellbeing. To address this issue, one working group from the 2017 Resident Wellness Consensus Summit (RWCS) focused on wellness program innovations and initiatives in emergency medicine (EM) residency programs.
The WestJEM Blog and Podcast Watch presents high-quality open-access educational blogs and podcasts in emergency medicine based on the ongoing Academic Life in Emergency Medicine (ALiEM) Approved Instructional Resources (AIR) and AIR-Professional (Pro) series. Both series critically appraise open-access educational blogs and podcasts in EM using an objective scoring instrument. This installment of the blog and podcast watch series curated and scored relevant posts in the specific topic of toxicology emergencies from the AIR-Pro Series.
Emergency medicine (EM) is in different stages of development around the world. Colombia has made significant strides in EM development in the last two decades and recognized it as a medical specialty in 2005. The country now has seven EM residency programs: three in the capital city of Bogotá, two in Medellin, one in Manizales, and one in Cali. The objective of this study was to characterize these seven residency programs.
The WestJEM Blog and Podcast Watch presents high-quality, open-access educational blogs and podcasts in emergency medicine (EM) based on the ongoing Academic Life in EM (ALiEM) Approved Instructional Resources (AIR) and AIR-Professional series. Both series critically appraise resources using an objective scoring rubric. This installment of the Blog and Podcast Watch highlights the topic of procedure emergencies from the AIR Series.
Transesophageal echocardiography (TEE) is a well-established method of evaluating cardiac pathology. It has many advantages over transthoracic echocardiography (TTE), including the ability to image the heart during active cardiopulmonary resuscitation. This prospective simulation study aims to evaluate the ability of emergency medicine (EM) residents to learn TEE image acquisition techniques and demonstrate those techniques to identify common pathologic causes of cardiac arrest.
Emergency department (ED) crowding is associated with detrimental effects on ED quality of care. Triage liaison providers (TLP) have been used to mitigate the effects of crowding. Prior studies have evaluated attending physicians and advanced practice providers as TLPs, with limited data evaluating resident physicians as TLPs. This study compares operational performance outcomes between resident and attending physicians as TLPs.
End-of-shift evaluation (ESE) forms, also known as daily encounter cards, represent a subset of encounter-based assessment forms. Encounter cards have become prevalent for formative evaluation, with some suggesting a potential for summative evaluation.
Author Affiliation Eric Shappell, MD University of Chicago, Department of Medicine, Section of Emergency Medicine, Chicago, Illinois Abra Fant, MD, MS Northwestern University Feinberg School of Medicine, Department of Emergency Medicine, Chicago, Illinois Benjamin Schnapp, MD Northwestern University Feinberg School of Medicine, Department of Emergency Medicine, Chicago, Illinois Jill P. Craig, BA Northwestern University Feinberg […]
There are no existing data on whether performance on the United States Medical Licensing Examination (USMLE) predicts success in American Board of Emergency Medicine (ABEM) certification.
The objective of this study was to analyze the content and volume of literature that has been written on cultural competency in emergency medicine (EM) since its educational imperative was first described by the Institute of Medicine in 2002.
The WestJEM Blog and Podcast Watch presents high quality open-access educational blogs and podcasts in emergency medicine (EM) based on the ongoing ALiEM Approved Instructional Resources (AIR) and AIR-Professional series. Both series critically appraise resources using an objective scoring rubric. This installment of the Blog and Podcast Watch highlights the topic of neurologic emergencies from the AIR series.
Point-of-care ultrasound (POCUS) is expanding across all medical specialties. As the benefits of US technology are becoming apparent, efforts to integrate US into pre-clinical medical education are growing. Our objective was to describe our process of integrating POCUS as an educational tool into the medical school curriculum and how such efforts are perceived by students.
Derivation of Two Critical Appraisal Scores for Trainees to Evaluate Online Educational Resources: A METRIQ Study
Teresa M. Chan, MD, MHPE, et al.
Online education resources (OERs), like blogs and podcasts, increasingly augment or replace traditional medical education resources such as textbooks and lectures. Trainees’ ability to evaluate these resources is poor, and few quality assessment aids have been developed to assist them. This study aimed to derive a quality evaluation instrument for this purpose.
Volume 17, Issue 4, July 2016
Matthew C. Tews, DO, MS et al.
Medical students on an emergency medicine rotation are traditionally evaluated at the end of each shift with paper-based forms, and data are often missing due to forms not being turned in or completed. Because students’ grades depend on these evaluations, change was needed to increase form rate of return. We analyzed a new electronic evaluation form and modified completion process to determine if it would increase the completion rate without altering how faculty scored student performance.
Volume 17, Issue 3, May 2016
Shannon Toohey, MD et al.
Introduction
Millennial learners are changing the face of residency education because they place emphasis on technology with new styles and means of learning. While research on the most effective way to teach the millennial learner is lacking, programs should consider incorporating educational theories and multimedia design principles to update the curriculum for these new learners. The purpose of the study is to discuss strategies for updating an emergency medicine (EM) residency program’s curriculum to accommodate the modern learner.
Discussion
These 10 tips provide detailed examples and approaches to incorporate technology and learning theories into an EM curriculum to potentially enhance learning and engagement by residents.
Conclusion
While it is unclear whether technologies actually promote or enhance learning, millennials use these technologies. Identifying best practice, grounded by theory and active learning principles, may help learners receive quality, high-yield education. Future studies will need to evaluate the efficacy of these techniques to fully delineate best practices
Volume 17, Issue 3, May 2016
Manish Garg, MD, et al.
Introduction: Residents and faculty in emergency medicine (EM) residency programs might
be unaware of the professional and legal risks associated with the use of social media (SM).
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The objective of this study was to identify and characterize the types and reported incidence of
unprofessional SM behavior by EM residents, faculty, and nurses and the concomitant personal
and institutional risks.
Methods: This multi-site study used an 18-question survey tool that was distributed electronically
to the leaders of multiple EM residency programs, members of the Council of Emergency Medicine
Residency Directors (CORD), and the residents of 14 EM programs during the study period May
to June 2013.
Results: We received 1,314 responses: 772 from residents and 542 from faculty. Both
groups reported encountering high-risk-to-professionalism events (HRTPE) related to SM use
by residents and non-resident providers (NRPs), i.e., faculty members and nurses. Residents
reported posting of one of the following by a resident peer or nursing colleague: identifiable
patient information (26%); or a radiograph, clinical picture or other image (52%). Residents
reported posting of images of intoxicated colleagues (84%), inappropriate photographs (66%),
and inappropriate posts (73%). Program directors (PDs) reported posting one of the following by
NRPs and residents respectively: identifiable patient information (46% and 45%); a radiograph,
clinical picture or other image (63% and 58%). PDs reported that NRPs and residents posted
images of intoxicated colleagues (64% and 57%), inappropriate photographs (63% and 57%), or
inappropriate posts (76% and 67%). The directors also reported that they were aware of or issued
reprimands or terminations at least once a year (30% NRPs and 22% residents). Residents were
more likely to post photos of their resident peers or nursing colleagues in an intoxicated state
than were NRPs (p=0.0004). NRPs were more likely to post inappropriate content (p=0.04) and
identifiable patient information (p=0.0004) than were residents.
Conclusion: EM residents and faculty members cause and encounter HRTPE frequently while
using SM; these events present significant risks to the individuals responsible and their associated
institution. Awareness of these risks should prompt responsible SM use and consideration of
CORD’s Social Media Task Force recommendations.
Volume 17, Issue 3, May 2016
William J. Peterson, MD, et al.
Introduction: This study investigates the impact of the Doximity rankings on the rank list choices
made by residency applicants in emergency medicine (EM).
Methods: We sent an 11-item survey by email to all students who applied to EM residency
programs at four different institutions representing diverse geographical regions. Students were
asked questions about their perception of Doximity rankings and how it may have impacted their
rank list decisions.
Results: Response rate was 58% of 1,372 opened electronic surveys. This study found that a
majority of medical students applying to residency in EM were aware of the Doximity rankings prior
to submitting rank lists (67%). One-quarter of these applicants changed the number of programs
and ranks of those programs when completing their rank list based on the Doximity rankings
(26%). Though the absolute number of programs changed on the rank lists was small, the results
demonstrate that the EM Doximity rankings impact applicant decision-making in ranking residency
programs.
Conclusion: While applicants do not find the Doximity rankings to be important compared to other
factors in the application process, the Doximity rankings result in a small change in residency
applicant ranking behavior. This unvalidated ranking, based principally on reputational data rather
than objective outcome criteria, thus has the potential to be detrimental to students, programs, and
the public. We feel it important for specialties to develop consensus around measurable training
outcomes and provide freely accessible metrics for candidate education.
Volume 17, Issue 3, May 2016
Joshua Jauregui, MD, et al.
Introduction: Medical professionalism is a core competency for emergency medicine (EM)
trainees; but defining professionalism remains challenging, leading to difficulties creating
objectives and performing assessment. Because professionalism is dynamic, culture-specific, and
often taught by modeling, an exploration of trainees’ perceptions can highlight their educational
baseline and elucidate the importance they place on general conventional professionalism
domains. To this end, our objective was to assess the relative value EM residents place on
traditional components of professionalism.
Methods: We performed a cross-sectional, multi-institutional survey of incoming and graduating
EM residents at four programs. The survey was developed using the American Board of Internal
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Medicine’s “Project Professionalism” and the Accreditation Council of Graduate Medical Education
definition of professionalism competency. We identified 27 attributes within seven domains: clinical
excellence, humanism, accountability, altruism, duty and service, honor and integrity, and respect
for others. Residents were asked to rate each attribute on a 10-point scale. We analyzed data
to assess variance across attributes as well as differences between residents at different training
levels or different institutions.
Results: Of the 114 residents eligible, 100 (88%) completed the survey. The relative value
assigned to different professional attributes varied considerably, with those in the altruism domain
valued significantly lower and those in the “respect for others” and “honor and integrity” valued
significantly higher (p<0.001). Significant differences were found between interns and seniors for
five attributes primarily in the “duty and service” domain (p<0.05). Among different residencies,
significant differences were found with attributes within the “altruism” and “duty and service”
domains (p<0.05).
Conclusion: Residents perceive differences in the relative importance of traditionally defined
professional attributes and this may be useful to educators. Explanations for these differences are
hypothesized, as are the potential implications for professionalism education. Because teaching
professional behavior is taught most effectively via behavior modeling, faculty awareness of
resident values and faculty development to address potential gaps may improve professionalism
education.
Volume 17, Issue 3, May 2016
Ryan Miller, BS et al.
Introduction: Over the past decade, medical students have witnessed a decline in the
opportunities to perform technical skills during their clinical years. Ultrasound-guided central
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venous access (USG-CVA) is a critical procedure commonly performed by emergency medicine,
anesthesia, and general surgery residents, often during their first month of residency. However, the
acquisition of skills required to safely perform this procedure is often deficient upon graduation from
medical school. To ameliorate this lack of technical proficiency, ultrasound simulation models have
been introduced into undergraduate medical education to train venous access skills. Criticisms of
simulation models are the innate lack of realistic tactile qualities, as well as the lack of anatomical
variances when compared to living patients. The purpose of our investigation was to design and
evaluate a life-like and reproducible training model for USG-CVA using a fresh cadaver.
Methods: This was a cross-sectional study at an urban academic medical center. An 18-point
procedural knowledge tool and an 18-point procedural skill evaluation tool were administered
during a cadaver lab at the beginning and end of the surgical clerkship. During the fresh cadaver
lab, procedure naïve third-year medical students were trained on how to perform ultrasoundguided
central venous access of the femoral and internal jugular vessels. Preparation of the fresh
cadaver model involved placement of a thin-walled latex tubing in the anatomic location of the
femoral and internal jugular vein respectively.
Results: Fifty-six third-year medical students participated in this study during their surgical
clerkship. The fresh cadaver model provided high quality and lifelike ultrasound images despite
numerous cannulation attempts. Technical skill scores improved from an average score of 3 to 12
(p<0.001) and procedural knowledge scores improved from an average score of 4 to 8 (p<0.001).
Conclusion: The use of this novel cadaver model prevented extravasation of fluid, maintained
ultrasound-imaging quality, and proved to be an effective educational model allowing third-year
medical students to improve and maintain their technical skills.
Volume 17, Issue 2, March 2016.
James Ahn, MD, et al.
Introduction: In the face of declining bedside teaching and increasing emergency department
(ED) crowding, balancing education and patient care is a challenge. Dedicated shifts by teaching
residents (TRs) in the ED represent an educational intervention to mitigate these difficulties. We
aimed to measure the perceived learning and departmental impact created by having TR.
Methods: TRs were present in the ED from 12pm-10pm daily, and their primary roles were to
provide the following: assist in teaching procedures, give brief “chalk talks,” instruct junior trainees
on interesting cases, and answer clinical questions in an evidence-based manner. This observational
study included a survey of fourth-year medical students (MSs), residents and faculty at an academic
ED. Surveys measured the perceived effect of the TR on teaching, patient flow, ease of procedures,
and clinical care.
Results: Survey response rates for medical students, residents, and faculty are 56%, 77%, and
75%, respectively. MSs perceived improved procedure performance with TR presence and the
majority agreed that the TR was a valuable educational experience. Residents perceived increased
patient flow, procedure performance, and MS learning with TR presence. The majority agreed that
the TR improved patient care. Faculty agreed that the TR increased resident and MS learning, as
well as improved patient care and procedure performance.
Conclusion: The presence of a TR increased MS and resident learning, improved patient care and
procedure performance as perceived by MSs, residents and faculty. A dedicated TR program can
provide a valuable resource in achieving a balance of clinical education and high quality healthcare.
Volume 17, Issue 2, March 2016.
Dustin Smith, MD, et al.
Introduction: Work interruptions during patient care have been correlated with error. Task-switching
is identified by the Accreditation Council for Graduate Medical Education (ACGME) as a core
competency for emergency medicine (EM). Simulation has been suggested as a means of assessing
EM core competencies. We assumed that senior EM residents had better task-switching abilities
than junior EM residents. We hypothesized that this difference could be measured by observing the
execution of patient care tasks in the simulation environment when a patient with a ST-elevation
myocardial infarction (STEMI) interrupted the ongoing management of a septic shock case.
Methods: This was a multi-site, prospective, observational, cohort study. The study population
consisted of a convenience sample of EM residents in their first three years of training. Each subject
performed a standardized simulated encounter by evaluating and treating a patient in septic shock.
At a predetermined point in every sepsis case, the subject was given a STEMI electrocardiogram
(ECG) for a separate chest pain patient in triage and required to verbalize an interpretation and
action. We scored learner performance using a dichotomous checklist of critical actions covering
sepsis care, ECG interpretation and triaging of the STEMI patient.
Results: Ninety-one subjects participated (30 postgraduate year [PGY]1s, 32 PGY2s, and 29
PGY3s). Of those, 87 properly managed the patient with septic shock (90.0% PGY1s, 100%
PGY2, 96.6% PGY 3s; p=0.22). Of the 87 who successfully managed the septic shock, 80 correctly
identified STEMI on the simulated STEMI patient (86.7% PGY1s, 96.9% PGY2s, 93.1% PGY3s;
p=0.35). Of the 80 who successfully managed the septic shock patient and correctly identified the
STEMI, 79 provided appropriate interventions for the STEMI patient (73.3% PGY1s, 93.8% PGY2s,
93.8% PGY3s; p=0.07).
Conclusion: When management of a septic shock patient was interrupted with a STEMI ECG in a
simulated environment we were unable to measure a significant difference in the ability of EM residents
to successfully task-switch when compared across PGY levels of training. This study may help refine
the use of simulation to assess EM resident competencies.
Volume 16, Issue 7, December 2015.
Luan E. Lawson, MD, MAEd, et al.
Introduction: Assessment of medical students’ knowledge in clinical settings is complex yet
essential to the learning process. Clinical clerkships use various types of written examinations to
objectively test medical knowledge within a given discipline. Within emergency medicine (EM), a new
national standardized exam was developed to test medical knowledge in this specialty. Evaluation
of the psychometric properties of a new examination is an important issue to address during test
development and use. Studies have shown that student performance on selected standardized
exams will reveal students’ strengths and/or weaknesses, so that effective remedial efforts can be
implemented. Our study sought to address these issues by examining the association of scores on
the new EM national exam with other standardized exam scores.
Methods: From August 2011 to April 2013, average National EM M4 examination scores of fourthyear
medical students taken at the end of a required EM clerkship were compiled. We examined
the correlation of the National EM M4 examination with the scores of initial attempts of the United
States Medical Licensing Exam (USMLE) Step 1 and Step 2 Clinical Knowledge (CK) examinations.
Correlation coefficients and 95% confidence intervals of correlation coefficients are reported. We
also examined the association between the national EM M4 examination score, final grades for the
EM rotation, and USMLE Step 1 and Step 2 CK scores.
Results: 133 students were included in the study and achieved a mean score of 79.5 SD 8.0 on
the National EM M4 exam compared to a national mean of 79.7 SD 3.89. The mean USMLE Step
1 score was 226.8 SD 19.3. The mean USMLE Step 2 CK score was 238.5 SD 18.9. National EM
M4 examination scores showed moderate correlation with both USMLE Step 1 (mean score=226.8;
correlation coefficient=0.50; 95% CI [0.28-0.67]) and USMLE Step 2 CK (mean score=238.5;
correlation coefficient=0.47; 95% CI [0.25-0.65]). Students scoring below the median on the national
EM M4 exam also scored well below their colleagues on USMLE exams.
Conclusion: The moderate correlation of the national EM M4 examination and USMLE Step 1 and
Step 2 CK scores provides support for the utilization of the CDEM National EM M4 examination as
an effective means of assessing medical knowledge for fourth-year medical students. Identification of
students scoring lower on standardized exams allows for effective remedial efforts to be undertaken
throughout the medical education process.
Volume 16, Issue 7, December 2015.
Kevin R. Schwartz, MD, et al.
Introduction: Increasingly, pediatric and emergency medicine (EM) residents are pursuing clinical
rotations in low-income countries. Optimal pre-departure preparation for such rotations has not yet been
established. High-fidelity simulation represents a potentially effective modality for such preparation. This
study was designed to assess whether a pre-departure high-fidelity medical simulation curriculum is
effective in helping to prepare residents for clinical rotations in a low-income country.
Methods: 43 pediatric and EM residents planning clinical rotations in Liberia, West Africa, participated in a
simulation-based curriculum focused on severe pediatric malaria and malnutrition and were then assessed
by survey at three time points: pre-simulation, post-simulation, and after returning from work abroad.
Results: Prior to simulation, 1/43 (2%) participants reported they were comfortable with the diagnosis
and management of severe malnutrition; this increased to 30/42 (71%) after simulation and 24/31 (77%)
after working abroad. Prior to simulation, 1/43 (2%) of residents reported comfort with the diagnosis and
management of severe malaria; this increased to 26/42 (62%) after simulation and 28/31 (90%) after
working abroad; 36/42 (86%) of residents agreed that a simulation-based global health curriculum is more
useful than a didactic curriculum alone, and 41/42 (98%) felt a simulator-based curriculum should be
offered to all residents planning a clinical trip to a low-income country.
Conclusion: High-fidelity simulation is effective in increasing residents’ self-rated comfort in management
of pediatric malaria and malnutrition and a majority of participating residents feel it should be included as
a component of pre-departure training for all residents rotating clinically to low-income countries.
