Faculty consensus on competitiveness for the new competency-based emergency medicine standardized letter of evaluation.

Background: Emergency medicine (EM) has introduced a new, competency-based standardized letter of evaluation (SLOE) template. While a previous version of the SLOE has been shown to promote a high degree of faculty consensus regarding competitiveness, this has not been shown for the new SLOE template. Objective: The objective was to evaluate faculty consensus on competitiveness for the new EM SLOE 2.0. Methods: Fifty mock SLOE 2.0 letters using the new template were drafted and sent to a group of experienced EM educators. The 50 letters were ranked by the experienced faculty as well as a point-based prediction model and a regression model and the results were compared. Results: Faculty consensus on competitiveness remained strong when using the new SLOE 2.0 format. The points-based prediction model and regression model both demonstrated a high level of agreement with faculty consensus rankings for the SLOE 2.0. Conclusions: Introduction of the new, competency-based SLOE 2.0 format did not have a deleterious effect on faculty consensus rankings of competitiveness.

Decoding competitiveness: Exploring how emergency medicine faculty interpret standardized letters of evaluation.

Background: Given the importance of the standardized letter of evaluation (SLOE) for application to emergency medicine (EM) residency, it is important that SLOE developers and authors understand how reviewers determine SLOE competitiveness. To inform SLOE design and authorship, the authors set out to build a novel theory to explain how faculty holistically interpret SLOE competitiveness. Methods: The authors used constructivist grounded theory to explore how EM faculty determine SLOE competitiveness. They used purposive sampling to recruit EM faculty participants with at least 1 year of experience in scoring SLOEs. One author conducted hour-long, semistructured interviews over Zoom between August 2023 and March 2024. Two authors iteratively coded the data to develop the initial codebook, organize codes into categories, and build connections to construct the resulting theory. Results: The authors interviewed 11 EM faculty from throughout the United States. Participants described a complex process to determine SLOE competitiveness. They began by contextualizing the SLOE to determine its trustworthiness and value before using various components of the SLOE to stratify and refine their understanding of competitiveness. Finally, when participants noted the inconsistency between different aspects of the SLOE, they used various methods to reconcile discordances and determine competitiveness. Conclusions: This study illuminates the framework used by EM faculty to determine applicant competitiveness based on the SLOE and highlights several factors that SLOE authors should consider to ensure the accurate and efficient transfer of information.

Measuring and Predicting Faculty Consensus Rankings of Standardized Letters of Evaluation.

Background Standardized letters of evaluation (SLOE) are becoming more widely incorporated into the residency application process to make the letter of recommendation, an already critical component in a residency application packet, more objective. However, it is not currently known if the reviewers of these letters share consensus regarding the strength of an applicant determined by their SLOE. Objective We measured the level of faculty agreement regarding applicant competitiveness as determined by SLOEs and the ability of 2 algorithms to predict faculty consensus rankings. Methods Using data from the 2021-2022 Match cycle from the Council of Residency Directors in Emergency Medicine SLOE Database as a blueprint, authors created 50 fictional SLOEs representative of the national data. Seven faculty then rated these SLOEs in order of applicant competitiveness, defined as suggested rank position. Consensus was evaluated using cutoffs established a priori, and 2 prediction models, a point-based system and a linear regression model, were tested to determine their ability to predict consensus rankings. Results There was strong faculty consensus regarding the interpretation of SLOEs. Within narrow windows of agreement, faculty demonstrated similar ranking patterns with 83% and 93% agreement for "close" and "loose" agreement, respectively. Predictive models yielded a strong correlation with the consensus ranking (point-based system r=0.97, linear regression r=0.97). Conclusions Faculty displayed strong consensus regarding the competitiveness of applicants via SLOEs, adding further support to the use of SLOEs for selection and advising. Two models predicted consensus competitiveness rankings with a high degree of accuracy.

A Primer for Developing Chalk Talks.

Chalk talks are a ubiquitous teaching strategy in both pulmonary, critical care, and sleep medicine and medicine in general; yet, trainees and early career faculty are rarely taught how to design, prepare, and present a chalk talk. Skills necessary to deliver a chalk talk are transferable to other settings, such as the bedside, wards during rounds, and virtual classrooms. As a teaching strategy, the chalk talk can involve learners at multiple levels, foster practical knowledge, stimulate self-assessment, encourage the generation of broad differential diagnoses, and promote an interactive learning environment. Suited for both formal and informal learning, the chalk talk can be prepared well in advance or, after some practice, can be presented "on the fly." Furthermore, often on the wards or in the intensive care unit, team members are asked to "teach the rest of the team" at some point during rounds. There is little guidance in medical education for students and trainees to prepare for how to do this, and the chalk talk can serve as an excellent format and teaching strategy to "teach the team" when tasked to do so. To highlight our perspectives on best practices in using the chalk talk format effectively, we first briefly review the literature surrounding this very common yet understudied teaching strategy. We then provide a primer on how to design, develop, and deliver a chalk talk as a resource for how we teach residents, fellows, and early career attendings to deliver their own chalk talks.

Demystifying Acute Pain Management in the Emergency Department: A Case-Based Approach.

Introduction: Acute pain is one of the most common complaints that presents to the emergency department. Despite its ubiquity, oligoanalgesia, or the undertreatment of pain, remains a problem in medicine, possibly due to minimal dedicated pain teaching for senior medical students transitioning to residency. Methods: We designed a 2.5-hour interactive seminar for senior medical students transitioning into residency. The seminar included a chalk talk and case-based discussion, reviewed pain physiology, revisited pain assessment, and introduced pain management strategies using a novel acute pain plan to organize an analgesic approach from presentation through disposition from the emergency department. The didactic chalk talk was interwoven with a case of acute pain. Seminar materials promoted a near-peer teaching opportunity for future facilitators. Learners completed open-ended pre-/postsession knowledge assessments. Results: Data were obtained from 19 fourth-year medical students enrolled in three iterations of a preinternship course at Harvard Medical School. Prior to the seminar, learners scored an average of 23.0 out of 53.0 points (SD = 9.0) on the knowledge assessment, which improved to 36.6 out of 53.0 points (SD = 6.7) following the seminar (paired t test p < .001). Learner satisfaction data revealed a positive response to the seminar: Learners felt more confident managing pain and highly recommended the seminar's continuation in the future. Discussion: Initial data from this seminar suggest a need for and benefit of targeted pain education for senior medical students. Seminar materials can easily be adapted for learners in other departments or in early graduate medical education.

Addressing Equity in Global Medical Education During the COVID-19 Pandemic: The Global Medical Education Collaborative.

PROBLEM: The COVID-19 pandemic has presented a unique set of challenges to medical education globally. Low- and middle-income countries (LMICs) have faced unique barriers in transitioning to virtual modalities, and many medical students in LMICs experienced dramatically reduced educational time. The authors created the Global Medical Education Collaborative (GMEC) to address this problem by providing free, online, case-based tutorials to medical students in LMICs during the pandemic. APPROACH: The authors developed a needs assessment to gauge students' educational requirements, which informed GMEC's 2 primary goals: to provide free access to interactive online tutorials for students in LMICs and to bridge the physical distance between educators and learners via an online platform. A pilot program in Nigeria (April 26-May 26, 2020) helped inform the current strategy and logistics. Tutors and students were recruited via social media and medical education networks at the authors' home institutions. OUTCOMES: Within the first 2 months (April 26-June 26, 2020), 324 students representing 12 countries and 20+ medical schools joined GMEC. Additionally, 95 physicians and trainees joined as tutors and, collectively, delivered 52 tutorials. Students responded to a needs assessment querying confidence in various clinical domains, interest in covering clinical topics, barriers to virtual learning, and the effect of the pandemic on their education. Tutors held 1-hour, interactive tutorials over Zoom covering a variety of clinical topics. According to surveys, 91% of students (71 of 78) felt more confident in the material related to the tutorial's topic after participating. NEXT STEPS: GMEC will continue to engage students, tutors, and collaborators to facilitate the delivery of innovative, high-quality tutorials to students affected by COVID-19 in LMICs. To ensure that the platform is sustainable and aligned with GMEC's mission to promote equity in global medical education, the collaborative will need to be agile and responsive.

Twelve tips for public health education using social media.

This article was migrated. The article was marked as recommended. With nearly half the world's population using social media, platforms like Instagram, Twitter, and Facebook have become popular sources of information gathering and sharing for the general public. In medicine, social media is increasingly used to educate patients due its wide reach and interactive nature. Early studies showed that these social media-based initiatives can even promote behavioral change by increasing public knowledge and self-efficacy. Several barriers such as time and technical skills, however, prevent healthcare workers from using social media platforms to promote public health education. The following twelve tips may help reduce these barriers and create more opportunities for patients to easily access quality medical information on social media. Creating an effective public health education platform on social media involves identifying clear goals, understanding the social context of all messaging, recruiting a motivated team, creating a style guide, vetting content for accuracy, and interacting with social media followers. These tips will help build an accurate and quality social media public health education campaign.

Fluorescent Calcium Imaging and Subsequent In Situ Hybridization for Neuronal Precursor Characterization in Xenopus laevis.

Spontaneous intracellular calcium activity can be observed in a variety of cell types and is proposed to play critical roles in a variety of physiological processes. In particular, appropriate regulation of calcium activity patterns during embryogenesis is necessary for many aspects of vertebrate neural development, including proper neural tube closure, synaptogenesis, and neurotransmitter phenotype specification. While the observation that calcium activity patterns can differ in both frequency and amplitude suggests a compelling mechanism by which these fluxes might transmit encoded signals to downstream effectors and regulate gene expression, existing population-level approaches have lacked the precision necessary to further explore this possibility. Furthermore, these approaches limit studies of the role of cell-cell interactions by precluding the ability to assay the state of neuronal determination in the absence of cell-cell contact. Therefore, we have established an experimental workflow that pairs time-lapse calcium imaging of dissociated neuronal explants with a fluorescence in situ hybridization assay, allowing the unambiguous correlation of calcium activity pattern with molecular phenotype on a single-cell level. We were successfully able to use this approach to distinguish and characterize specific calcium activity patterns associated with differentiating neural cells and neural progenitor cells, respectively; beyond this, however, the experimental framework described in this article could be readily adapted to investigate correlations between any time-series activity profile and expression of a gene or genes of interest.

Calcium Activity Dynamics Correlate with Neuronal Phenotype at a Single Cell Level and in a Threshold-Dependent Manner.

Calcium is a ubiquitous signaling molecule that plays a vital role in many physiological processes. Recent work has shown that calcium activity is especially critical in vertebrate neural development. Here, we investigated if calcium activity and neuronal phenotype are correlated only on a population level or on the level of single cells. Using Xenopus primary cell culture in which individual cells can be unambiguously identified and associated with a molecular phenotype, we correlated calcium activity with neuronal phenotype on the single-cell level. This analysis revealed that, at the neural plate stage, a high frequency of low-amplitude spiking activity correlates with an excitatory, glutamatergic phenotype, while high-amplitude spiking activity correlates with an inhibitory, GABAergic phenotype. Surprisingly, we also found that high-frequency, low-amplitude spiking activity correlates with neural progenitor cells and that differentiating cells exhibit higher spike amplitude. Additional methods of analysis suggested that differentiating marker tubb2b-expressing cells exhibit relatively persistent and predictable calcium activity compared to the irregular activity of neural progenitor cells. Our study highlights the value of using a range of thresholds for analyzing calcium activity data and underscores the importance of employing multiple methods to characterize the often irregular, complex patterns of calcium activity during early neural development.

Characterization of tweety gene (ttyh1-3) expression in Xenopus laevis during embryonic development.

The tweety family of genes encodes large-conductance chloride channels and has been implicated in a wide array of cellular processes including cell division, cell adhesion, regulation of calcium activity, and tumorigenesis, particularly in neuronal cells. However, their expression patterns during early development remain largely unknown. Here, we describe the spatial and temporal patterning of ttyh1, ttyh2, and ttyh3 in Xenopus laevis during early embryonic development. Ttyh1 and ttyh3 are initially expressed at the late neurula stage are and primarily localized to the developing nervous system; however ttyh1 and ttyh3 both show transient expression in the somites. By swimming tadpole stages, all three genes are expressed in the brain, spinal cord, eye, and cranial ganglia. While ttyh1 is restricted to proliferative, ventricular zones, ttyh3 is primarily localized to postmitotic regions of the developing nervous system. Ttyh2, however, is strongly expressed in cranial ganglia V, VII, IX and X. The differing temporal and spatial expression patterns of ttyh1, ttyh2, and ttyh3 suggest that they may play distinct roles throughout embryonic development.