The test developer's dilemma: Evaluating the balance of feasibility and empiric performance of test development techniques for repeated written assessments.

PURPOSE: Written assessments face challenges when administered repeatedly, including resource-intensive item development and the potential for performance improvement secondary to item recall as opposed to understanding. This study examines the efficacy of three-item development techniques in addressing these challenges. METHODS: Learners at five training programs completed two 60-item repeated assessments. Items from the first test were randomized to one of three treatments for the second assessment: (1) Verbatim repetition, (2) Isomorphic changes, or (3) Total revisions. Primary outcomes were the stability of item psychometrics across test versions and evidence of item recall influencing performance as measured by the rate of items answered correctly and then incorrectly (correct-to-incorrect rate), which suggests guessing. RESULTS: Forty-six learners completed both tests. Item psychometrics were comparable across test versions. Correct-to-incorrect rates differed significantly between groups with the highest guessing rate (lowest recall effect) in the Total Revision group (0.15) and the lowest guessing rate (highest recall effect) in the Verbatim group (0.05), p = 0.01. CONCLUSIONS: Isomorphic and total revisions demonstrated superior performance in mitigating the effect of recall on repeated assessments. Given the high costs of total item revisions, there is promise in exploring isomorphic items as an efficient and effective approach to repeated written assessments.[Box: see text].

PINCER: improved CRISPR/Cas9 screening by efficient cleavage at conserved residues.

CRISPR/Cas9 functional genomic screens have emerged as essential tools in drug target discovery. However, the sensitivity of available genome-wide CRISPR libraries is impaired by guides which inefficiently abrogate gene function. While Cas9 cleavage efficiency optimization and essential domain targeting have been developed as independent guide design rationales, no library has yet combined these into a single cohesive strategy to knock out gene function. Here, in a massive reanalysis of CRISPR tiling data using the most comprehensive feature database assembled, we determine which features of guides and their targets best predict activity and how to best combine them into a single guide design algorithm. We present the ProteIN ConsERvation (PINCER) genome-wide CRISPR library, which for the first time combines enzymatic efficiency optimization with conserved length protein region targeting, and also incorporates domains, coding sequence position, U6 termination (TTT), restriction sites, polymorphisms and specificity. Finally, we demonstrate superior performance of the PINCER library compared to alternative genome-wide CRISPR libraries in head-to-head validation. PINCER is available for individual gene knockout and genome-wide screening for both the human and mouse genomes.

Natural Product-Derived Treatments for Attention-Deficit/Hyperactivity Disorder: Safety, Efficacy, and Therapeutic Potential of Combination Therapy.

Typical treatment plans for attention-deficit/hyperactivity disorder (ADHD) utilize nonpharmacological (behavioral/psychosocial) and/or pharmacological interventions. Limited accessibility to behavioral therapies and concerns over adverse effects of pharmacological treatments prompted research for alternative ADHD therapies such as natural product-derived treatments and nutritional supplements. In this study, we reviewed the herbal preparations and nutritional supplements evaluated in clinical studies as potential ADHD treatments and discussed their performance with regard to safety and efficacy in clinical trials. We also discussed some evidence suggesting that adjunct treatment of these agents (with another botanical agent or pharmacological ADHD treatments) may be a promising approach to treat ADHD. The analysis indicated mixed findings with regard to efficacy of natural product-derived ADHD interventions. Nevertheless, these treatments were considered as a "safer" approach than conventional ADHD medications. More comprehensive and appropriately controlled clinical studies are required to fully ascertain efficacy and safety of natural product-derived ADHD treatments. Studies that replicate encouraging findings on the efficacy of combining botanical agents and nutritional supplements with other natural product-derived therapies and widely used ADHD medications are also warranted. In conclusion, the risk-benefit balance of natural product-derived ADHD treatments should be carefully monitored when used as standalone treatment or when combined with other conventional ADHD treatments.

The 4-aminopiperidine series has limited anti-tubercular and anti-staphylococcus aureus activity.

BACKGROUND: Tuberculosis (TB) caused by Mycobacterium tuberculosis is the leading cause of death from a bacterial infection. The 4-aminopiperidine (PIP) series has been reported as having anti-bacterial activity against M. tuberculosis. We explored this series for its potential to inhibit aerobic growth of M. tuberculosis. We examined substitution at the N-1 position and C-4 position of the piperidine and modifications of the piperidine moiety systematically to delineate structure-activity relationships influencing potency. Compounds were tested for growth-inhibitory activity against virulent M. tuberculosis. A selected set of compounds were also tested for its activity against Staphylococcus aureus. RESULTS: The compound with a norbornenylmethyl substituent at the N-1 position and N-benzyl-N-phenethylamine at the C-4 position of the piperidine (1) was the only active compound with a minimum inhibitory concentration (MIC) of 10 µM against M. tuberculosis. Compounds were not active against S. aureus. CONCLUSIONS: We were unable to derive any other analogs with MIC < 20 µM against M. tuberculosis. Therefore we conclude that the lack of activity is a liability in this series precluding it from further development.

Cerebral venous sinus thrombophlebitis as a complication of acute otitis media.

BACKGROUND: While headache is a common emergency department chief complaint, cerebral venous sinus thrombosis (CVST) is an infrequently encountered cause of headache and is often not included in emergency physicians' differential diagnoses for headache. Our objective is to review the latest data on epidemiology, presenting symptoms, diagnosis, and treatment of CVST. CASE REPORT: A 27-year-old female presented to our emergency department with headache, blurred vision, and vomiting a day after being diagnosed with acute otitis media. Computed tomography scan of the brain without contrast in the emergency department was suggestive of CVST. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although a rare cause of headache, CVST should be considered for a subset of patients presenting to the emergency department with the common complaint of headache. CVST is diagnosed by magnetic resonance venogram or computed tomography venogram of the brain. Anticoagulation with close monitoring in consultation with appropriate experts is a safe first-line therapy for CVST, even in patients with hemorrhage on initial imaging.

A swollen hand with blisters: a case of compartment syndrome in a child.

The accurate identification of compartment syndrome in the emergency department is essential to timely treatment and prevention of long-term sequela. Recognizing compartment syndrome is not straightforward, especially in the pediatric population. In addition to communication barriers that exist with children, the classic signs of pain, pallor, paresthesia, paralysis, and pulselessness are not always present, making its diagnosis a challenge. We report a case of a child with compartment syndrome to the left hand due to compression from an ACE wrap. The existing literature on compartment syndrome in children is reviewed.

Creation of a National Emergency Medicine Medical Education Journal Club.

Background There are a relatively limited number of emergency medicine (EM) medical education (MedEd) fellowships with few trainees at each program, creating barriers to local collaboration and networking. While best practices for developing MedEd journal clubs exist, there has not been an established national EM MedEd journal club. To address this need, we created a national journal club, the Council of Residency Directors (CORD) MedEd Journal Club (MEJC), to facilitate collaboration and networking opportunities by providing a synchronous online journal club. Objectives Our primary objective was to create a network for collaboration across geographical barriers to form a virtual community of practice (CoP) around the shared domain of evidence-based MedEd. Our secondary objective was to improve MedEd fellows' knowledge, skills, and attitudes surrounding MedEd research. Tertiary objectives included (1) broadening fellow exposure to key topics within MedEd, (2) describing how to develop scholarly work within MedEd, and (3) filling a perceived need for building a national MedEd virtual CoP. Curricular design The concept and objectives of the CORD MEJC were introduced to fellows and fellowship directors through a national listserv in March of 2022. Fellows volunteered to lead virtual sessions via Zoom on a monthly basis. Session fellow leaders independently chose the topics and were asked to submit two to three journal club articles discussing the topic at least two weeks in advance of each session. No topics were repeated throughout the academic year.  Impact/effectiveness Our quality improvement survey results indicated that the CORD MEJC is meeting its primary and secondary objectives. Survey results will be utilized as part of a continuous quality improvement initiative to enhance our program structure and curricula for the 2023-2024 academic year.

Development of entrustable professional activities for emergency medicine medical education fellowships: A modified Delphi study.

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.

Affinity-based proteomics reveal cancer-specific networks coordinated by Hsp90.

Most cancers are characterized by multiple molecular alterations, but identification of the key proteins involved in these signaling pathways is currently beyond reach. We show that the inhibitor PU-H71 preferentially targets tumor-enriched Hsp90 complexes and affinity captures Hsp90-dependent oncogenic client proteins. We have used PU-H71 affinity capture to design a proteomic approach that, when combined with bioinformatic pathway analysis, identifies dysregulated signaling networks and key oncoproteins in chronic myeloid leukemia. The identified interactome overlaps with the well-characterized altered proteome in this cancer, indicating that this method can provide global insights into the biology of individual tumors, including primary patient specimens. In addition, we show that this approach can be used to identify previously uncharacterized oncoproteins and mechanisms, potentially leading to new targeted therapies. We further show that the abundance of the PU-H71-enriched Hsp90 species, which is not dictated by Hsp90 expression alone, is predictive of the cell's sensitivity to Hsp90 inhibition.

Narrative medicine workshops for emergency medicine residents: Effects on empathy and burnout.

Background: Emergency medicine (EM) residents face unique affective challenges and barriers to interpersonal connection in their clinical environment which may contribute to decreased empathy and increased burnout. Narrative medicine (NM) might address these barriers and has had beneficial impacts in various populations but has never been studied in EM residents. In this study, we sought to evaluate the effect of NM workshops on burnout and empathy and to assess resident perceptions of the workshops. Methods: We performed a quasi-experimental study at two EM residencies from June to October 2020. Residents at the intervention site participated in two NM workshops led by EM faculty that were composed of a close reading of a literary text, reflective writing, and group discussion. Residents were asked to complete the abbreviated Interpersonal Reactivity Index (IRI) and a single-item burnout measure pre- and postintervention. We fitted linear regression models to IRI subscores; we treated burnout as an ordinal variable and fitted a conditional logistic regression model. Residents completed a postintervention survey that we analyzed using summary statistics. Results: A total of 46.7% of control (28/60) and 100% of intervention (48/48) residents responded (n = 76). While all respondents demonstrated worsening burnout with time (p = 0.001), residents at the intervention site exhibited less severe increases (interaction p < 0.001). Empathy remained unchanged. A total of 50% of intervention residents (24/48) responded to the postintervention survey; most (n = 20, 83.3%) agreed that the workshops should be a standard part of EM didactics. Conclusions: These findings establish the feasibility and desirability of NM in residency education and offers a model for EM-centered narrative workshops. Additionally, while our outcomes are limited, we found that exposure to an NM curriculum may be protective against worsening burnout.

Hsp90 inhibitor PU-H71, a multimodal inhibitor of malignancy, induces complete responses in triple-negative breast cancer models.

Triple-negative breast cancers (TNBCs) are defined by a lack of expression of estrogen, progesterone, and HER2 receptors. Because of the absence of identified targets and targeted therapies, and due to a heterogeneous molecular presentation, treatment guidelines for patients with TNBC include only conventional chemotherapy. Such treatment, while effective for some, leaves others with high rates of early relapse and is not curative for any patient with metastatic disease. Here, we demonstrate that these tumors are sensitive to the heat shock protein 90 (Hsp90) inhibitor PU-H71. Potent and durable anti-tumor effects in TNBC xenografts, including complete response and tumor regression, without toxicity to the host are achieved with this agent. Notably, TNBC tumors respond to retreatment with PU-H71 for several cycles extending for over 5 months without evidence of resistance or toxicity. Through a proteomics approach, we show that multiple oncoproteins involved in tumor proliferation, survival, and invasive potential are in complex with PU-H71-bound Hsp90 in TNBC. PU-H71 induces efficient and sustained downregulation and inactivation, both in vitro and in vivo, of these proteins. Among them, we identify downregulation of components of the Ras/Raf/MAPK pathway and G(2)-M phase to contribute to its anti-proliferative effect, degradation of activated Akt and Bcl-xL to induce apoptosis, and inhibition of activated NF-kappaB, Akt, ERK2, Tyk2, and PKC to reduce TNBC invasive potential. The results identify Hsp90 as a critical and multimodal target in this most difficult to treat breast cancer subtype and support the use of the Hsp90 inhibitor PU-H71 for clinical trials involving patients with TNBC.

A Systematic Review of Pain Management Education in Graduate Medical Education.

Background: Despite the importance of pain management across specialties and the effect of poor management on patients, many physicians are uncomfortable managing pain. This may be related, in part, to deficits in graduate medical education (GME). Objective: We sought to evaluate the methodological rigor of and summarize findings from literature on GME interventions targeting acute and chronic non-cancer pain management. Methods: We conducted a systematic review by searching PubMed, MedEdPORTAL, and ERIC (Education Resources Information Center) to identify studies published before March 2019 that had a focus on non-cancer pain management, majority of GME learners, defined educational intervention, and reported outcome. Quality of design was assessed with the Medical Education Research Study Quality Instrument (MERSQI) and Newcastle-Ottawa Scale-Education (NOS-E). One author summarized educational foci and methods. Results: The original search yielded 6149 studies; 26 met inclusion criteria. Mean MERSQI score was 11.6 (SD 2.29) of a maximum 18; mean NOS-E score was 2.60 (SD 1.22) out of 6. Most studies employed a single group, pretest-posttest design (n=16, 64%). Outcomes varied: 6 (24%) evaluated reactions (Kirkpatrick level 1), 12 (48%) evaluated learner knowledge (level 2), 5 (20%) evaluated behavior (level 3), and 2 (8%) evaluated patient outcomes (level 4). Interventions commonly focused on chronic pain (n=18, 69%) and employed traditional lectures (n=16, 62%) and case-based learning (n=14, 54%). Conclusions: Pain management education research in GME largely evaluated chronic pain management interventions by assessing learner reactions or knowledge at single sites.

Growth of for-profit involvement in emergency medicine graduate medical education and association between for-profit affiliation and resident salary.

Background: Following projections of an emergency medicine (EM) physician oversupply, the growth of EM residency programs affiliated with for-profit hospitals has been subject to increased attention and speculation. However, essentially no literature exists regarding these programs. Resident pay is one area where these programs could differ from nonprofit-affiliated programs, as investor obligations could make for-profit corporations more likely to reduce resident salaries to increase profit margins. Here, we aim to quantify the growth of EM for-profit affiliated residency programs from 2001-2021 and determine if PGY1 salaries differ between these program types. Methods: Medicare and ACGME accreditation data were used to determine the profit status of hospitals affiliated with EM residency programs. ACGME new accreditation data from 2001-2021 were used to quantify the growth of both for-profit and nonprofit affiliated programs over this period. We searched program websites and called programs to determine 2021-2022 PGY1 salary. Multiple regression was used to model the relationship between profit status and salary using program characteristic covariates to control for confounding variables. Results: The number of EM programs increased from 117 to 276 from 2001-2021 while the number of for-profit affiliated EM residency programs increased from 1 to 29 during this period. Most (85.7%, [24/29]) for-profit affiliated programs were accredited from 2016-2021. Mean for-profit affiliated program salary ($55,658, n  = 24) was $3840 lower than mean nonprofit affiliated program salary ($59,498, n  = 203). For-profit affiliation was a significant predictor of lower 2021-2022 PGY1 salary after controlling for other program characteristics using multiple regression ( ß  = -1919.88, P = 0.010). Conclusions: We found a substantial growth of newly ACGME accredited for-profit affiliated EM residency programs from 2016-2021. We also found for-profit affiliated programs pay lower PGY1 salaries than nonprofit-affiliated programs after controlling for potential confounding variables, which suggests more oversight over the salary determination process could be necessary to prevent resident underpayment.

Racial Bias on the Emergency Medicine Standardized Letter of Evaluation.

Background: Studies on components of residency applications have shown evidence of racial bias. The Standardized Letter of Evaluation (SLOE) is an assessment measure for emergency medicine (EM) residency applications and, as more specialties opt to use SLOEs in place of narrative letters of recommendation, understanding bias on standardized assessments is essential. Objective: To determine whether there is a difference in rankings on the EM SLOE between underrepresented in medicine (UIM) and non-UIM applicants, White and non-White applicants, and to examine whether differences persist after controlling for other characteristics. Methods: The sample was drawn from medical students who applied to EM residency at the study institution in 2019. We compared rankings between UIM and non-UIM students and between students of each individual race/ethnicity and White students, after controlling for United States Medical Licensing Examination Step scores, Alpha Omega Alpha status, type of school (US MD, US DO, internation medical graduate), Medical Student Performance Evaluation class percentile, affiliated program vs visiting clerkship SLOE, gender and the interaction of race/ethnicity and gender, and adjusted for students submitting multiple SLOEs, using ordinal regression. Results: There were 1555 applicants to the study institution in 2019; 1418 (91.2%) had a SLOE and self-identified race/ethnicity. After controlling for applicant characteristics, non-UIM students were significantly more likely to be ranked higher than UIM students on "Rank Against Peers," (OR 1.46, 95% CI 1.03-2.07) and Grade (OR 1.46, 95% CI 1.05-2.04). Conclusions: Analysis of EM SLOEs submitted to our institution demonstrates racial bias on this standardized assessment tool, which persists after controlling for other performance predictors.

Quantifying For-Profit Outcomes in GME: A Multispecialty Analysis of Board Certifying Examination Pass Rates in For-Profit Affiliated Residency Programs.

Background: The number of for-profit hospitals has increased in the United States, but their role in and outcomes for graduate medical education (GME) are unclear. Objectives: To describe for-profit involvement in internal medicine (IM), general surgery (GS), and pediatrics GME by quantifying change in for-profit affiliated residency programs and comparing for-profit and nonprofit affiliated program board certifying examination pass rates. Methods: We used Accreditation Council for Graduate Medical Education and Medicare data to quantify for-profit prevalence in IM, GS, and pediatrics GME from 2001 to 2021. We used public pass rate data from the American Board of Surgeons (2017-2019; n=242 programs; 6562 examinees), American Board of Internal Medicine (2018-2020; n=465 programs; 23 922 examinees), and American Board of Pediatrics (2018-2020; n=202 programs; 9819 examinees) to model the relationship between profit status and pass rate within each specialty and across specialties combined using linear regression. Results: The proportion of for-profit affiliated residency programs increased 400.0% in IM, 334.4% in GS, and 23.2% in pediatrics from 2001 to 2021. Bivariate linear regression revealed significantly lower pass rate in for-profit affiliated programs in IM ß =-7.73, P<.001), pediatrics (ß =-14.6, P<.001), and the 3 specialties combined (ß =-5.45, P<.001). Upon multiple regression with addition of program characteristic covariates, this relationship remained significant in pediatrics (ß =-10.04, P=.006). Conclusions: The proportion of for-profit affiliated residency programs has increased in IM, GS, and pediatrics from 2001 to 2021. After controlling for covariates, for-profit affiliated programs were associated with lower board examination pass rates in pediatrics with no association in IM, GS, or the combined measure.

Is it worth it? A qualitative analysis of the impact of medical education fellowships on careers.

Objectives: Medical education fellowships provide training in teaching, assessment, educational program administration, and scholarship. The longitudinal impact of this training is unknown. The objective of this study was to explore the impact of medical education fellowships on the careers of graduates. Methods: The authors performed a qualitative study with a constructivist-interpretivist paradigm using semistructured interviews in 2021. The authors used a purposeful randomized stratified sampling strategy of graduates to ensure diversity of representation (gender, region, fellowship duration, and career stage). Two researchers independently analyzed interview transcriptions using a modified grounded theory approach. Results: The authors interviewed 10 graduates and identified three overarching concepts: motivations for pursuing fellowship, benefits of training, and drivers of career development. Graduates sought training because of their desire for growth and career preparation and at the advice of mentors. Fellowships provided knowledge and skills in a structured learning environment, supported by mentors and a collaborative community. Fellowship training shaped the careers of graduates by increasing their self-efficacy, enhancing their outcome expectations, refining their goals, and influencing their professional identity formation. They acquired expertise that prepared them for jobs, developed credibility, felt competitive in the job market, anticipated successful promotion, reached for greater goals, broadened their educational worldview, and evolved their professional identity as a result of fellowship training. Conclusions: Fellowship training in medical education provides knowledge and skills, a structured learning environment, and important relationships that shape the careers of graduates by impacting their self-efficacy, outcome expectations, goal creation, and professional identity formation.

A workforce study of emergency medicine medical education fellowship directors: Describing roles, responsibilities, support, and priorities.

Introduction: Despite emergency medicine (EM) medical education fellowships increasing in number, the position of the medical education fellowship director (FD) remains incompletely defined. The goal of this study was to characterize the roles, responsibilities, support, and priorities for medical education FDs. Methods: We adapted and piloted an anonymous electronic survey consisting of 31 single-answer, multiple-answer, and free-response items. The survey was distributed to FDs via listserv and individual emails from a directory compiled from multiple online resources. We used descriptive statistics to analyze data from items with discrete answer choices. Using a constructivist paradigm, we performed a thematic analysis of free-response data. Results: Thirty-four medical education FDs completed the survey, resulting in a response rate of 77%. Thirty-eight percent of respondents were female. Fifty-three percent earned master's degrees in education and 35% completed a medical education fellowship. Most respondents held other education leadership roles including program director (28%), associate/assistant program director (28%), and vice chair (25%). Sixty-three percent received support in their role, including clinical buy-down (90%), administrative assistants (55%), and salary (5%). There was no difference (χ2 [2, n = 32] = 1.77, p = 0.41) between availability of support and type of hospital (community, university, or public hospital). Medical education FDs dedicated a median of 12 h per month to fellowship responsibilities, include education (median 35% of time), program administration (25%), research mentorship (15%), and recruitment (10%). Medical education FDs describe priorities that can be categorized into three themes related to fellows, fellowship, and institution. Conclusion: This study provides insight into the current position and experience of medical education FDs. The results can clarify the role and responsibilities of FDs as the demand for medical education FDs increases.

The impact of COVID-19 restrictions on participant enrollment in the PREPARE trial.

Background: At the initiation of the COVID-19 pandemic, restrictions forced researchers to decide whether to continue their ongoing clinical trials. The PREPARE (Pragmatic Randomized Trial Evaluating Pre-Operative Alcohol Skin Solutions in Fractured Extremities) trial is a pragmatic cluster-randomized crossover trial in patients with open and closed fractures. PREPARE was enrolling over 200 participants per month at the initiation of the pandemic. We aim to describe how the COVID-19 research restrictions affected participant enrollment. Methods: The PREPARE protocol permitted telephone consent, however, sites were obtaining consent in-person. To continue enrollment after the initiation of the restrictions participating sites obtained ethics approval for telephone consent scripts and the waiver of a signature on the consent form. We recorded the number of sites that switched to telephone consent, paused enrollment, and the length of the pause. We used t-tests to compare the differences in monthly enrollment between July 2019 and November 2020. Results: All 19 sites quickly implement telephone consent. Fourteen out of nineteen (73.6%) sites paused enrollment due to COVID-19 restrictions. The median length of enrollment pause was 46.5 days (range, 7-121 days; interquartile range, 61 days). The months immediately following the implementation of restrictions had significantly lower enrollment. Conclusion: A pragmatic design allowed sites to quickly adapt their procedures for obtaining informed consent via telephone and allowed for minimal interruptions to enrollment during the pandemic.

Design, synthesis, and evaluation of small molecule Hsp90 probes.

A number of compounds from different chemical classes are known to bind competitively to the ATP-pocket of Hsp90 and inhibit its chaperone function. The natural product geldanamycin was the first reported inhibitor of Hsp90 and since then synthetic inhibitors from purine, isoxazole and indazol-4-one chemical classes have been discovered and are currently or soon to be in clinical trials for the treatment of cancer. In spite of a similar binding mode to Hsp90, distinct biological profiles were demonstrated among these molecules, both in vitro and in vivo. To better understand the molecular basis for these dissimilarities, we report here the synthesis of chemical tools for three Hsp90 inhibitor classes. These agents will be useful for probing tumor-by-tumor the Hsp90 complexes isolated by specific inhibitors. Such information will lead to better understanding of tumor specific molecular markers to aid in their clinical development. It will also help to elucidate the molecular basis for the biological differences observed among Hsp90 inhibitors.

Validity Evidence for the Emergency Medicine Standardized Letter of Evaluation.

BACKGROUND: The standardized letter of evaluation (SLOE) is the application component that program directors value most when evaluating candidates to interview and rank for emergency medicine (EM) residency. Given its successful implementation, other specialties, including otolaryngology, dermatology, and orthopedics, have adopted similar SLOEs of their own, and more specialties are considering creating one. Unfortunately, for such a significant assessment tool, no study to date has comprehensively examined the validity evidence for the EM SLOE. OBJECTIVE: We summarized the published evidence for validity for the EM SLOE using Messick's framework for validity evidence. METHODS: A scoping review of the validity evidence of the EM SLOE was performed in 2020. A scoping review was chosen to identify gaps and future directions, and because the heterogeneity of the literature makes a systematic review difficult. Included articles were assigned to an aspect of Messick's framework and determined to provide evidence for or against validity. RESULTS: There have been 22 articles published relating to validity evidence for the EM SLOE. There is evidence for content validity; however, there is a lack of evidence for internal structure, relation to other variables, and consequences. Additionally, the literature regarding response process demonstrates evidence against validity. CONCLUSIONS: Overall, there is little published evidence in support of validity for the EM SLOE. Stakeholders need to consider changing the ranking system, improving standardization of clerkships, and further studying relation to other variables to improve validity. This will be important across GME as more specialties adopt a standardized letter.