Underrecognized Tickborne Illnesses: Borrelia Miyamotoi and Powassan Virus.

Over the past 2 decades, tickborne disease has been increasingly recognized as a threat to humans as a result of the growing geographic range of ticks. This review describes 2 tickborne diseases, Borrelia miyamotoi and Powassan virus, that likely have a significant impact on humans, yet are underdiagnosed compared to most other tickborne diseases. We performed a literature search from 2015 to 2020. Borrelia miyamotoi is a tickborne pathogen that infects and co-infects ticks along with other pathogens, including Borrelia burgdorferi. Because B miyamotoi infects the same Ixodes ticks as B burgdorferi, B miyamotoi may cover a similar geographic range. B miyamotoi infection may be underdiagnosed for 2 reasons. First, a presumptive treatment approach to Lyme disease may result in B miyamotoi infection treatment without identification of the actual cause. Second, the absence of readily available testing and diagnostic criteria makes it difficult to diagnose B miyamotoi infection. Powassan virus is a tickborne flavivirus similar to the dengue virus. Powassan virus disease appears to have an asymptomatic or minimally symptomatic presentation in most people but can cause devastating and fatal encephalitis. The Powassan virus may be transmitted in less than 15 min of tick feeding. Powassan virus disease is a difficult diagnosis because testing capabilities are limited and because there may be co-infection with other tickborne pathogens.

A National Survey of Wilderness Medicine Curricula in United States Emergency Medicine Residencies.

INTRODUCTION: Wilderness medicine (WM) is a growing subspecialty of emergency medicine. In 2018, we surveyed all 240 emergency medicine residencies in the United States to assess the scope of WM education in emergency medicine training programs in light of the nearly 30% increase in the number of residencies since 2015. METHODS: A survey was e-mailed to the Council of Residency Directors in Emergency Medicine listserv and individual program directors of each of the 240 residencies. The survey included questions on educational content, format, number of hours taught, availability of conference credit, offering of an elective or fellowship, and several predefined WM curricula. We evaluated differences between 3-y and 4-y residencies using the χ2 test, where P<0.05 was considered significant. RESULTS: We had a response rate of 57% for completed surveys. Analysis showed 63% of respondent programs teach WM material. The majority (86%) partially or completely developed their curriculum, with 33% offering at least 1 of the predefined curricula. Thirteen percent taught with lecture only, 2% taught by hands-on only, and 85% used a combination of the 2. WM electives were significantly more likely to be offered by 4-y than 3-y residencies (P=0.009). CONCLUSIONS: Almost two-thirds of respondent residency programs teach WM material. Of these, only one-third teach any of the predefined curricula. Four-year residencies are more likely to offer WM electives but are otherwise comparable to 3-y programs.

Emergency Ultrasound: A Survey Study of Fellowship Graduate Characteristics and Career Paths.

OBJECTIVES: There are sparse data on the career pathways of graduates of emergency ultrasound fellowships. The authors sought to define the characteristics of graduates and their reported career paths after training through this survey study. METHODS: A 26-question anonymous survey was emailed to 597 graduates of 70 fellowships over a 4-week period. No incentives were provided for completion of the questionnaire. Descriptive statistics are reported. For qualitative data, open- and axial-coding methods were used. RESULTS: A total of 336 participants completed the study for a response rate of 56%. The average age of respondents was 36.4 years, and 58% were male. Most graduates had MD degrees (89%) or DO degrees (10%). Sixty percent of graduates attended a 3-year emergency medicine residency, and 29% attended a 4-year residency. Only 11% pursued additional fellowship training, most commonly pediatric emergency medicine (n = 14). After fellowship, 63% (95% confidence interval [CI], 62.9, 63.1) of graduates began working full-time in an academic setting, whereas 24% (95% CI, 23.9, 24.1) worked full-time in a community setting. Thirty-three percent (95% CI, 32.7, 33.3) took an immediate position as ultrasound division director, whereas 4% (95% CI, 3.7, 4.3) became fellowship directors and 3% (95% CI, 2.7, 3.3) became ultrasound medical student directors. Currently, 67% (95% CI, 66-68%) identify ultrasound as their leading academic focus. CONCLUSIONS: Although not all fellowship graduates pursue academic positions, most note the impact of fellowship on their career paths. Graduates hold a variety of leadership positions. Approximately two thirds still consider ultrasound as their academic focus.

Management of pneumothoraces detected on chest computed tomography: can anatomical location identify patients who can be managed expectantly?

BACKGROUND: Pneumothorax (PTX) can be readily detected by computed tomography (CT) or ultrasound. However, management of PTX in hemodynamically stable patients remains controversial. STUDY OBJECTIVES: We sought to investigate whether a distinct anatomical distribution of PTX along prespecified chest zones as detected by CT can be described in patients with or without subsequent chest tube thoracotomy (CTT), thus potentially allowing the extended focused assessment with sonography for trauma (EFAST) ultrasound examination to guide PTX management. METHODS: We performed a retrospective review of chest CT scans performed in the emergency department (ED) of a Level I trauma center. CT scans were analyzed for PTX distribution according to a chest zone model. Medical records of subjects with PTX were reviewed for subsequent CTT. RESULTS: Of 3636 chest CT scans performed, 183 PTX (156 patients) were detected without CTT at the time of CT scan (69% male, mean age 42 years). Of these, 66 subjects (40%) underwent CTT; 43 chest tubes (63%) were placed in the ED, 9 (13%) during hospitalization and 9 (13%) in the operating room. Median time to CTT was 140 min (interquartile range 52-199). Initial hemodynamic parameters, need for surgery, and need for mechanical ventilation were similar in both groups (p > 0.05 for all). Anatomical distribution and size of PTX were similar in the two groups. CONCLUSION: Although the majority of patients with traumatic PTX could be managed conservatively, we did not identify a characteristic anatomical PTX pattern, which could identify subjects who may not require CTT.

Patient perceptions of ultrasound educational scans in the emergency department.

BACKGROUND: Emergency medicine residents may perform bedside ultrasound (BUS) scans that are carried out solely for educational purposes. This may lead to confusion on the part of patients, as the implications in the context of their medical care may be unclear. STUDY OBJECTIVES: We hypothesized that a scripted introduction would improve understanding of the objectives and limitations of educational BUS. METHODS: A perceptual survey was completed by a prospectively enrolled convenience sample of patients in two emergency departments. In phase 1, fifty patients completed the survey after their educational BUS. During phase 2, sonographers were provided with a one-paragraph scripted introduction to use and 50 additional patients were recruited. Group data were analyzed using chi-squared tests, Kruskal-Wallis, and t-test. RESULTS: There were no statistical differences in demographics between the two groups. The scripted introduction changed several survey responses by a statistically significant amount for questions including whether their clinician ordered the study, whether it was part of their medical care, and whether it would be part of their medical record (p < 0.01). The responses as to whether they would tell their doctor that they had an ultrasound done were not significantly changed by the script (p = 0.86). CONCLUSION: This study demonstrates that the use of a scripted introduction regarding the purpose of educational BUS improved patient understanding of the objectives and limitations of such scans. There were still areas where the scripted introduction did not change patient's perception of the educational BUS scan.

Is boarding compromising our residents' education? A national survey of emergency medicine program directors.

Background: Boarding patients in the emergency department (ED) potentially affects resident education. Program director (PD) perceptions of the impact of boarding on their trainees have not been previously described. Methods: We surveyed a cross-sectional convenience sample of emergency medicine PDs using a mixed-methods approach to explore their perceptions of how boarding has affected their residents' training. Descriptive data were reported as percentages and differences were calculated using Pearson's chi-square test, with p < 0.05 considered significant. A framework model was used to qualitatively analyze free-text responses. Results: A total of 170 responses were collected, for a response rate of 63%. Most respondents felt that boarding had at least some effect on resident education with 29%, 35%, 18%, and 12% noting "a little," "a moderate amount," "a lot," and "a great deal," respectively, and 5% noting "no effect at all." Respondents perceived a negative impact of boarding on resident education and training, with 80% reporting a "somewhat" or "extremely negative" effect, 18% feeling neutral, and 2% noting a "somewhat positive" effect. Most noted a "somewhat" or "extremely negative" effect on resident education in managing ED throughput (70%) and high patient volumes (66%). Fifty-four percent noted a "somewhat" or "extremely negative" impact on being involved in the initial workup of undifferentiated patients. Thirty-two percent saw a "somewhat" or "extremely positive" effect on learning the management of critically ill patients. Qualitative analysis of challenges, mitigation strategies, and resident feedback emphasized the lack of exposure to managing departmental patient flow, impact on bedside teaching, and need for flexibility in resident staffing. Conclusions: Most PDs agree that boarding negatively affects resident education and identify several strategies to mitigate the impact. These findings can help inform future interventions to optimize resident learning in the complex educational landscape of high ED boarding.

LGBTQ+ individuals are not explicitly represented in emergency medicine simulation curricula.

Background: Medical educational societies have emphasized the inclusion of marginalized populations, including the lesbian, gay, bisexual, transgender and queer (LGBTQ+) population, in educational curricula. Lack of inclusion can contribute to health inequality and mistreatment due to unconscious bias. Little didactic time is spent on the care of LGBTQ+ individuals in emergency medicine (EM) curricula. Simulation based medical education can be a helpful pedagogy in teaching cross-cultural care and communication skills. In this study, we sought to determine the representation of the LGBTQ+ population in EM simulation curricula. We also sought to determine if representations of the LGBTQ+ population depicted stigmatized behavior. Methods: We reviewed 971 scenarios from six simulation case banks for LGBTQ+ representation. Frequency distributions were determined for major demographic variables. Chi-Squared or Fisher's Exact Test, depending on the cell counts, were used to determine if relationships existed between LGBTQ+ representation and bank type, author type, and stigmatized behavior. Results: Of the 971 scenarios reviewed, eight (0.82%) scenarios explicitly represented LGBTQ+ patients, 319 (32.85%) represented heterosexual patients, and the remaining 644 (66.32%) did not specify these patient characteristics. All cases representing LGBTQ+ patients were found in institutional case banks. Three of the eight cases depicted stigmatized behavior. Conclusions: LGBTQ+ individuals are not typically explicitly represented in EM simulation curricula. LGBTQ+ individuals should be more explicitly represented to reduce stigma, allow EM trainees to practice using gender affirming language, address health conditions affecting the LGBTQ+ population, and address possible bias when treating LGBTQ+ patients.

Trends in nursing feedback for emergency medicine residents: A mixed-methods survey analysis of national practices.

Background: Feedback is critical for physician development. Multisource feedback is especially important in a team-based specialty such as emergency medicine (EM) and is required by the Accreditation Council for Graduate Medical Education. Nursing assessments provide a unique perspective, but little is known about the current national patterns of their collection and use in EM. Methods: We surveyed EM program directors using a mixed-methods approach to explore the use of nursing assessment of EM residents. Descriptive data were reported as absolute numbers and percentages. An adjunct analysis of free-text responses was done using the framework method. Results: The response rate for our survey was 63% (190 responses), of which 84% currently collect nursing feedback. Respondents from 94% of programs agreed that nursing feedback is useful in assessing professionalism and respondents from 92% of programs agreed that nursing feedback is useful in assessing communication and interpersonal skills, while 44% agreed that it is useful in informing resident medical knowledge. Forty-two percent reported that nursing feedback did not directly influence residents' progression through their training, while 2% indicated that such feedback played a significant role in leading to dismissal or probation. The majority of programs (64%) that do not collect feedback from nurses have done so in the past and hope to do so in the future. Qualitative analysis revealed themes of logistic challenges with data collection, concern regarding quality of feedback, and retributive or gender-disparate feedback. Conclusions: Nursing assessments of EM residents were collected by most responding programs and majority of those who do not collect them presently wish to do so in the future. They were considered particularly useful in the assessment of interpersonal skills, communication, and professionalism. However, lack of uniform methods for collecting assessment that meaningfully informs resident development and progression represents a challenge and direction for future inquiry.

Unfilled in emergency medicine: An analysis of the 2022 and 2023 Match by program accreditation, ownership, and geography.

Background: The two most recent National Resident Matching Program (NRMP) Match cycles saw a high number of initially unfilled emergency medicine (EM) residency positions. We sought to identify the risk of EM residency program characteristics including accreditation duration, primary clinical site ownership status, and geography pertaining to not initially filling all positions. Methods: We performed a repeated cross-sectional observational study of EM residency programs participating in the 2022 and 2023 NRMP Match cycles and used publicly available data from the NRMP, the Accreditation Council for Graduate Medical Education, the Centers for Medicare & Medicaid Services, and the U.S. Department of Housing and Urban Development. Our primary outcome was the proportion of EM residency programs that did not initially fill positions, with analyses stratified by accreditation duration (>5 or ≤5 years), primary clinical site ownership status, and geographic core-based statistical areas (CBSAs). Results: A total of 219 of 2921 (7.5%) positions in the 2022 Match and 554 of 3010 (18.4%) positions in the 2023 Match were initially unfilled. Over the 2-year period, EM residency programs accredited within the past 5 years had more than double the risk (relative risk [RR] 2.08, 95% confidence interval [CI] 1.69-2.57, chi-square p < 0.001) of not filling all positions compared to those accredited more than 5 years previously. EM residency programs with a primary clinical site under for-profit ownership had a 50% greater risk of not filling all positions when compared to those under nonprofit or governmental ownership (RR 1.50, 95% CI 1.14-1.98, chi-square p = 0.009). In 2023, several CBSAs had a high number of both offered and unfilled positions. Conclusions: EM residency programs accredited within the past 5 years or those with a primary clinical site under for-profit ownership had a greater risk of not filling all positions within the past two Match cycles.

The impact of interviewer characteristics on residency candidate scores in Emergency Medicine: a brief report.

Background: At the conclusion of residency candidate interview days, faculty interviewers commonly meet as a group to reach conclusions about candidate evaluations based on shared information. These conclusions ultimately translate into rank list position for The Residency Match. The primary objective is to determine if the post-interview discussion influences the final scores assigned by each interviewer, and to investigate whether interviewer characteristics are significantly associated with the likelihood of changing their score. Based on Foucault's 'theory of discourse' and Bourdieu's 'social capital theory,' we hypothesized that interviewer characteristics, and the discourse itself, would contribute to score changes after a post-interview discussion regarding emergency medicine residency candidates. Methods: We conducted a cross-sectional observational study of candidate scores for all candidates to a four-year emergency medicine residency program affiliated with Yale University School of Medicine during a single application cycle. The magnitude and direction of score changes, if any, after group discussion were plotted and grouped by interviewer academic rank. We created a logistic regression model to determine the odds that candidate scores changed from pre- and post-discussion ratings related to specific interviewer factors. Results: A total of 24 interviewers and 211 candidates created 471 unique interviewer-candidate scoring interactions, with 216 (45.8%) changing post-discussion. All interviewers ranked junior to professor were significantly more likely to change their score compared to professors. Interviewers who were women had significantly lower odds of changing their individual scores following group discussion (p=0.020; OR 0.49, 95% CI 0.26-0.89). Conclusions: Interviewers with lower academic rank had higher odds of changing their post-discussion scores of residency candidates compared to professors. Future work is needed to further characterize the influencing factors and could help create more equitable decision processes during the residency candidate ranking process.

Anatomical distribution of traumatic pneumothoraces on chest computed tomography: implications for ultrasound screening in the ED.

OBJECTIVES: We sought to assess the anatomical distribution of traumatic pneumothoraces (PTXs) on chest computed tomography (CT) to develop an optimized protocol for PTX screening with ultrasound in the emergency department (ED). METHODS: We performed a retrospective review of all chest CTs performed in one ED between January 2005 and December 2008 according to presence, location, and size of PTX. Pneumothoraces were then measured and categorized into 14 anatomical regions for each hemithorax. RESULTS: A total of 277 (3.8%) PTXs were identified, with 26 bilateral PTX, on 3636 chest CTs performed during the study period. Etiology was blunt (85%) or penetrating trauma (15%). Eighty-three (45%) PTXs were radiographically occult on initial chest x-ray. One hundred eighty-three (66%) PTX had no chest tube at the time of CT. For both hemithoraces, the distribution demonstrated increasing PTX frequency and size from lateral to medial and from superior to inferior. Region 12 (parasternal, intercostal spaces [ICS] 7-8) was involved in 68% of PTX on either side; region 9 (parasternal, ICS 5-6), in 67% on the left and in 52% on the right; and region 11 (lateral to midclavicular line, ICS 7-8), in 46% on the left and in 53% on the right. The largest anterior-to-posterior PTX dimension was seen in region 12. CONCLUSIONS: Our results indicate that 80.4% of right- and 83.7% of left-sided traumatic PTXs would be identified by scanning regions 9, 11, and 12. These findings suggest that a standardized protocol for PTX screening with ultrasound should include these regions.

Exercise-induced anaphylaxis as a cause of syncope.

BACKGROUND: Exercise-induced anaphylaxis (EIA) is an under-recognized condition that is a distinct physical allergy. Triggers include varying amounts of exercise, alone or in combination with certain foods or medications (food-dependent EIA, or FDEIA). Therapy is identical to that of any immunoglobulin E-mediated allergic reaction. OBJECTIVES: This case is reported to increase awareness among emergency physicians of EIA and FDEIA. CASE REPORT: A 57-year-old man was found with a diffuse erythematous rash after eating a wheat bagel and walking up five flights of stairs. Emergency medical services found him hypotensive and combative. In the Emergency Department, the patient's blood pressure was 72/27 mm Hg, with an oxygen saturation of 97% on non-rebreather mask. The physical examination was notable for bilateral inspiratory crackles in the lower one-third of the lungs. He received intravenous (i.v.) diphenhydramine 25 mg, i.v. methylprednisolone 125 mg, and 1 L of normal saline, after which his blood pressure improved to 110/54 mm Hg. He was admitted to the hospital where his recovery was uneventful. CONCLUSION: EIA and FDEIA are uncommon forms of physical allergy, but they represent important entities for emergency physicians to consider. Recognition of the association with exercise is key, as recurrences can be prevented by avoiding triggers.

Resident Perceptions of a Publicly Disclosed Daily Productivity Dashboard.

INTRODUCTION: Following resident requests, we created a public metrics dashboard to inform residents of their daily productivity. Our goal was to iteratively improve the dashboard based on resident feedback and to measure the impact of reviewing aggregate data on self-perceived productivity. METHODS: A 10-question anonymous survey was completed by our postgraduate year 1-3 residents. Residents answered questions on the dashboard and rated their own productivity before and after reviewing aggregate peer-comparison data. Using the Wilcoxon signed-rank test we calculated summary statistics for survey questions and compared distributions of pre- and post-test, self-rated productivity scores. RESULTS: All 43 eligible residents completed the survey (response rate 100%). Thirteen (30%) residents "rarely" or "never" reviewed the dashboard. No respondents felt the dashboard measured their productivity or quality of care "extremely accurately" or "very accurately." Seven (16%) residents felt "very" or "extremely pressured" to change their practice patterns based on the metrics provided, and 28 (65%) would have preferred private over public feedback. Fifteen residents (35%) changed their self-perceived rank after viewing peer-comparison data, although not significantly in a particular direction (z = 0.71, P = 0.48). CONCLUSION: Residents did not view the presented metrics as reflective of their productivity or quality of care. Viewing the dashboard did not lead to statistically significant changes in resident self-perception of productivity. This finding highlights the need for expanding the resident conversation and education on metrics, given their frequent inclusion in attending physician workforce payment and incentive models.

Meeting expectations: An exploration of academic emergency medicine faculty experiences and preferences in the virtual meeting environment by age, gender and parental status.

Background: During the COVID-19 pandemic, virtual meetings became the norm in academic emergency medicine (EM) departments. This study explores the experiences of academic EM faculty within this environment. Methods: In 2021, authors surveyed a cross-sectional convenience sample of EM faculty using a mixed-methods approach to explore perceptions of the virtual meeting environment. Authors reported data on a five-point Likert scale, summarized as percentages, and calculated differences using Pearson's chi-squared test, where p < 0.05 was significant. Free text responses were analyzed qualitatively. Results: Two-hundred-fifty-nine responses were collected, (female [55.6%], ≤40 years old, [39.8%]) of which 33.2% had children ≤7 years old. Most respondents felt the total number of virtual meetings had increased and were more likely to happen outside of regular business hours compared to in-person meetings. Most faculty preferred meetings during regular hours and liked the virtual format overall. Younger faculty respondents were more polarized in their preferences of timing of meetings and reported more pressure to accept meetings outside of regular hours. Female respondents with young children were more likely to dislike meetings outside regular hours and to have declined them. Women faculty, younger faculty, and women faculty with young children were significantly more likely to agree that women had been "more impacted by the new virtual work environment." Qualitative themes highlighting the flexibility provided by the virtual work environment and decreased commuting time, though many felt communication was limited in virtual meetings. Conclusions: Academic EM faculty mostly preferred keeping meetings during regular business hours and in a virtual format. Experiences varied by age but not by gender overall. Women with young children reported greater challenges than women without. Men did not differ by parental status. The virtual format provided increased flexibility but limited communication and engagement. Academic EM departments may use this data to inform future meeting practices.

Differences in faculty feedback for high, expected, and below-expected clinically performing emergency medicine residents.

Objectives: A lifelong pursuit such as medicine is frequently paired with a framework of "deliberate practice" for improvement. It is unclear whether the quality of feedback varies across different learner levels. Our study aims to assess whether a difference exists in the quality of feedback delivered to high-, expected-, and below-expected performer emergency medicine (EM) residents based on their attending-identified performance level. Methods: We conducted a retrospective review of written EM resident feedback collected between November 2018 and March 2021. Clinical performance level was subjectively determined by attending faculty in their feedback. Feedback was coded on a scale from 0-5 based on the presence (1) or absence (0) of the items modified from the Ende's SMART criteria: Specific (S), Measurable (M), Achievable (A), Relevant (R), and Time-bound (T). The primary outcome was any total modified SMART criteria score difference concerning performance level using logistic regression with Generalized Estimating Equations (GEE). Secondary outcomes were differences for individual criteria. Results: We analyzed 1284 evaluations (311 high performers, 930 expected performers, and 43 below-expected performers) of 94 unique residents from 66 different evaluators. Mean total modified SMART scores were significantly higher in high and below-expected performers than those designated as expected performers by faculty evaluators. Achievable and Relevant written feedback was provided to high performers in a significantly larger proportion than expected and below-expected performers. Only 278 out of 1284 evaluations met criteria for Specific. Conclusions: Mean total modified SMART feedback scores were significantly greater in high performers and below-expected performers when compared to expected performers. Achievable and Relevant feedback was provided in greater proportions to high performer residents compared to expected and below-expected performers. These findings are a challenge to academic faculty to engage in quality feedback delivery for residents at all performance levels.

Socially distanced, virtually connected: Faculty and resident perceptions of virtual didactics.

BACKGROUND: During the COVID-19 pandemic, emergency medicine (EM) residency programs have transitioned from traditional in-person to virtual synchronous didactics to comply with social distancing guidelines. This study explores the perceptions of EM residents and faculty regarding this new virtual format. METHODS: This was a multicenter, cross-sectional study at five EM residencies using a mixed-methods approach to investigate resident and faculty perceptions of virtual didactics. Institutions selected reflect different program lengths and geographic locations. Quantitative data measured on a Likert scale were summarized as percentages. Differences were calculated using Welch's t-test and chi-square, where p < 0.05 was significant. Open-ended responses were analyzed qualitatively. RESULTS: Our response rate was 64% (n = 141) for residents and 48% (n = 108) for faculty. Fifty-one percent of faculty and 54% of residents felt that they were more likely to attend virtually than in person. Among residents, 77% felt that they were more likely to attend virtual conferences during vacation or elective rotations. Perceived retention of information from virtual sessions was perceived to be the same or better for 69% of residents and 58% of faculty. Residents felt that they paid more attention in the virtual format (29% vs. 26%, p = 0.037). Both groups missed the social interactions of in-person conference (86% of faculty, 75% of residents). Respondents from both groups felt that < 20% of total didactic time should remain virtual once social distancing recommendations are lifted. Qualitative analysis revealed recommendations from residents and faculty to optimize lecture style and interactivity. Decreased commute time and ability to multitask at home increased wellness for both groups. CONCLUSIONS: While benefits of virtual didactics were acknowledged, residents and faculty missed the social interaction of in-person conference and preferred < 20% of future didactics to be virtual. Further research should assess the difference in knowledge acquisition and retention between conference models.

Comparison of Web-versus classroom-based basic ultrasonographic and EFAST training in 2 European hospitals.

STUDY OBJECTIVE: Training physicians in new skills through classroom-based teaching has inherent cost and time constraints. We seek to evaluate whether Web-based didactics result in similar knowledge improvement and retention of basic ultrasonographic principles and the Extended Focused Assessment with Sonography for Trauma (EFAST) compared with the traditional method. METHODS: Physicians from 2 German emergency departments were randomized into a classroom group with traditional lectures and a Web group who watched narrated lectures online. All participants completed a pre- and posttest and a second posttest 8 weeks later. Both groups underwent hands-on training after the first posttest. A control group completed the 2 initial tests without didactic intervention. RESULTS: Fifty-five subjects participated in the study. Both the classroom and Web group showed significant improvement in pre- and posttest 1 scores (75.9% versus 93.9% and 77.8% versus 92.5%; P<.001 for both), with similar knowledge retention after 8 weeks (88.6% and 88.9%; P=.87). No statistically significant difference in mean test scores could be found between the 2 groups at each point: -1.9% (95% confidence interval [CI] -5.2% to 1.4%) for the pretest, 1.4% (95% CI -0.6% to 3.4%) for posttest 1, and -0.3% (95% CI -3.9% to 3.3%) for posttest 2. The control group showed no learning effect without intervention (83.3% versus 82.8%, ; P=.88). CONCLUSION: Web-based learning provides the potential to teach physicians with greater flexibility than classroom instruction. Our data suggest that Web-based ultrasonography and EFAST didactics are comparable to traditional classroom lectures and result in similar knowledge retention.

Resident Self-Assessment and the Deficiency of Individualized Learning Plans in Our Residencies.

INTRODUCTION: The focus of residency training is to ensure that graduates attain a minimum level of skills and knowledge in order to be able to practice independently. While there are multiple formal methods to evaluate a resident, there is a paucity of literature that describes whether programs have residents perform individual self-assessment (ISA) with the development of individualized learning plans (ILP) to better themselves. We sought to investigate the current state of emergency medicine (EM) residency programs using ISA and determine whether these assessments are used to develop an ILP for each resident. METHODS: An electronic survey was developed by educators at our institution and sent to all program leaders of United States EM residencies approved by the Accreditation Council for Graduate Medical Education. An individualized email request was sent to non-responders. Results were obtained from February-May 2019. RESULTS: Of 240 programs we contacted, 119 (49.5%) completed the survey. Seventy-nine percent of programs reported that they had all residents perform an ISA. These were completed semiannually in 69% of the programs surveyed, annually in 19%, less than annually in 8%, and quarterly or more frequently in 4%. Of those programs requiring a resident ISA, only 21% required that all residents develop an ILP; 79% had only those residents requiring additional help or no residents develop an ILP. CONCLUSION: Most programs that completed the survey reported having residents complete an individual self-assessment, but there was variation in the areas assessed. The majority of programs had only lower performing, or no residents, develop an ILP based on this.

Conference Didactic Planning and Structure: An Evidence-based Guide to Best Practices from the Council of Emergency Medicine Residency Directors.

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.