Innovations report: A grading committee for a required fourth-year emergency medicine clerkship.

Background: Assessment of medical students in the clinical learning environment is fraught with challenges. Seemingly small variations in clinical clerkship evaluation can significantly impact a student's future. As such, the integrity of the grade selection process must be heavily scrutinized. Group decision making in the form of a clerkship grading committee may be part of a solution to address this complex problem. Methods: We conducted a retrospective observational study to describe grading committee decisions for a required fourth-year EM clerkship from August 2021 to April 2022. Literature on best practices for group decision making and assessment were reviewed. This informed the development and implementation of the committee process. Each committee meeting was video recorded and coded for discussion time per student, times the committee grade differed from historical-grade cutoffs with reasoning, and the frequency a committee member voiced a first-hand account of student performance. Results: Data from nine meetings was reviewed (86 students). The mean discussion time per student was 2 min 13 s (range 11 s to 9 min 22 s). The final committee decision differed from historical-grade cutoffs for nine students (10%), six were adjusted above and three below. In 64% (55/86) of student reviews a committee member voiced a first-hand experience of working with the student. Positive grade adjustments were made due to outlier evaluations and negative adjustments were made for professionalism concerns. Conclusions: Grading committees are a means to conduct a comprehensive review of student performance and offer shared ownership of the grade decision among committee members. More study is needed to directly determine their potential benefit and role in clerkship grading.

Institution of a difficult airway response team for emergency department patients with anticipated or encountered difficult airways: Descriptive analysis of a 5-year experience at an academic teaching hospital.

Objectives: This study aimed to describe characteristics and outcomes associated with difficult airway response team (DART) encounters in the emergency department (ED). Methods: We performed a descriptive analysis of a prospective, single-center database of DART encounters in the ED from April 1, 2016 to March 31, 2021 cross-referenced with retrospective chart review. Adult ED patients ≥18 years old for whom a DART was activated were eligible. We prospectively collected activation characteristics, intubation indications, operator characteristics, and intubation methods used for DART encounters. Retrospective chart review was conducted to obtain patient demographics and outcome variables. Descriptive analyses were computed for all outcomes. Results: We analyzed 89 DART encounters. No intubation attempts were made prior to DART activation in 52 cases (58.4%). The most common indications for intubation were angioedema (n = 17, 19.1%) or other airway obstruction (n = 15, 16.9%). A definitive airway was established by anesthesiology (n = 46, 51.7%), emergency medicine (n = 25, 28.1%), trauma surgery (n = 9, 10.1%), and ENT (n = 5, 5.6%). The most common method of intubation used to establish a definitive airway was video laryngoscopy with a bougie or D-blade (n = 29, 32.6%) followed by flexible fiberoptic intubation (n = 19, 21.3%). A surgical airway was required in eight encounters (cricothyrotomy [n = 4, 4.5%]; tracheostomy [n = 4, 4.5%]). Cases were managed in the ED (n = 73, 82%), operating room (OR) (n = 10, 11.2%), and intensive care unit (ICU) (n = 1, 1.1%). All patients requiring intubation had an endotracheal or surgical airway established. Conclusion: Our findings provide important insights regarding ED DART utilization and have implications when considering institution of a DART in the ED.

Trainee burnout: Are there modifiable factors?

BACKGROUND: Burnout is a complex phenomenon and a major concern in graduate medical education as it directly impacts trainee well-being. Identifying modifiable lifestyle factors over which trainees have immediate control could support timely, actionable, individual and programme-level interventions to combat it. OBJECTIVE: The objective of this pilot study is to describe modifiable lifestyle factors that may limit the development of burnout in medical residents and fellows. METHODS: We performed a cross-sectional survey of residents and fellows at academic medical centre from September 2017 to October 2017. Participants completed the Maslach Burnout Inventory and a questionnaire designed to identify factors hypothesised to be protective against burnout. FINDINGS: A total of 205/805 (25%) trainees completed the survey with a mean (SD) age of 29.7 (2.6) years. 52% (n = 107) were female. Averaging at least 7 h of sleep per night was found to have a significant association with lower scores for the emotional exhaustion (24.8 [11, p = 0.04]) and depersonalisation (11.1 [6.4, p = 0.02]) dimensions of burnout. Additionally, self-identifying as a healthy eater was found to have a significant association with lower scores for emotional exhaustion (25 [11.5, p = 0.03]) and depersonalisation (11.5 [6.6, p = 0.04]) as well. Workouts, hobbies, identifying with organised religion, praying, meditation and mindfulness activities were not associated with a difference. CONCLUSIONS: Adequate sleep (7 or more hours per night) and healthy eating are modifiable individual-level lifestyle factors associated with lower burnout scores in trainees. These items could be a target for trainee education and programme level support initiatives.