Second- and third-year medical students' clinical encounters in the emergency department.

Background: Experiential learning theory suggests that direct clinical experiences facilitate learning. Previous literature has focused primarily on the experiences of fourth-year medical students. As more students gain early clinical exposure, it is important to understand the types of patients seen by junior students. Objectives: This study aims to categorize the clinical experiences of early (M2 and M3) students in the emergency department (ED). Methods: A retrospective review of the electronic health record of patients seen by M2s and M3s on a 2-week emergency medicine rotation at a single urban academic ED in the Midwest was performed. Data elements extracted included total number of patients seen, Emergency Severity Index (ESI), disposition, and chief complaint. Students were not mandated to see any particular patients. Results: Medical students (248) saw 2994 total patients from 2018 to 2022. The median number of patients seen by each student was 12.0 (range 1-32). Pediatric patients made up 6.5% (n = 194) of total patients. Encounters were primarily ESI 2 or 3, which accounted for 89.4% of all patients (n = 2676). The most encountered complaints were abdominal pain, chest pain, and dyspnea, making up 15.6% (n = 467), 8.7% (n = 260), and 5.5% (n = 165), respectively, of total cases. Obstetrics/gynecology, hematologic, and environmental disorders were the least frequently encountered domains. No students saw all Clerkship Directors in Emergency Medicine (CDEM)-recommended complaints. Conclusions: There is significant variability in the ED encounters of M2s and M3s, with wide ranges of patient volume and presentations. This study provides some evidence that early students may not be meeting CDEM recommendations.

What You Didn't Learn in Residency: A Collective Curriculum for New Academic EM Faculty and Fellows.

Audience and Type of Curriculum: This curriculum is designed for emergency medicine fellows and first-year junior faculty. The curriculum covers core topics related to academic and professional success for an early career faculty member. Length of Curriculum: The curriculum is designed as quarterly sessions over the course of one academic year. Introduction: An increasing number of emergency medicine graduates are pursuing fellowship after completion of residency.1 Fellowship can be challenging as newly minted graduates begin to explore their academic niche, refine their clinical practice, and define their personal and professional spheres. We propose a structured curriculum to help guide fellows and new faculty to mitigate these challenges. Educational Goals: The aim of this curriculum is to develop relevant skills to promote academic success for fellows and first-year faculty at the start of their academic career and which could be completed during a one-year training timeline. We included topics relevant to all fellow and new faculty's expected personal and professional journey during this first year, including time management, academic productivity, resilience/wellness, and developing a national reputation. Educational Methods: The educational strategies used in this curriculum consist primarily of lecture seminars. There is one short individual activity associated with the lectures and one small group discussion. Research Methods: The course was assessed with pre- and post-test surveys following each lecture. Surveys assessed participants' reaction, learning, and behavior for each session. Evaluations were completed based on a 5-point Likert scale (1=strongly disagree, 5=strongly agree). Results: Fifteen participants attended the seminar series encompassing fellows and first-year faculty/post-fellows from ten different fellowship subspecialities. Average pre-assessment scores were low for many of the self-reported skills and confidence throughout the seminar series. Overall, participants reported increased confidence on the post-test for each of the seminar topics. In addition, participants reported that they learned new skills and planned to use the new ideas presented. All participants reported they would recommend these seminars to someone else on their same career path. Discussion: Overall, participants reported increased confidence, new skills, and plans to use the ideas presented in the seminar series. The content appears applicable to this learner set since all reported they would recommend the series to others on their career path. In conclusion, we believe our seminar series will build skills for fellows and first-year faculty which will promote academic success. Topics: Academic success, professional development, early career development.

Applying the master adaptive learner framework to just-in-time training of procedures.

Background: Just-in-time training (JITT) occurs in the clinical context when learners need immediate guidance for procedures due to a lack of proficiency or the need for knowledge refreshment. The master adaptive learner (MAL) framework presents a comprehensive model of transforming learners into adaptive experts, proficient not only in their current tasks but also in the ongoing development of lifelong skills. With the evolving landscape of procedural competence in emergency medicine (EM), trainees must develop the capacity to acquire and master new techniques consistently. This concept paper will discuss using JITT to support the development of MALs in the emergency department. Methods: In May 2023, an expert panel from the Society for Academic Emergency Medicine (SAEM) Medical Educator's Boot Camp delivered a comprehensive half-day preconference session entitled "Be the Best Teacher" at the society's annual meeting. A subgroup within this panel focused on applying the MAL framework to JITT. This subgroup collaboratively developed a practical guide that underwent iterative review and refinement. Results: The MAL-JITT framework integrates the learner's past experiences with the educator's proficiency, allowing the educational experience to address the unique requirements of each case. We outline a structured five-step process for applying JITT, utilizing the lumbar puncture procedure as an example of integrating the MAL stages of planning, learning, assessing, and adjusting. This innovative approach facilitates prompt procedural competence and cultivates a positive learning environment that fosters acquiring adaptable learning skills with enduring benefits throughout the learner's career trajectory. Conclusions: JITT for procedures holds the potential to cultivate a dynamic learning environment conducive to nurturing the development of MALs in EM.

PGY-2 emergency medicine residents are more efficient when paired with an early clinical medical student.

Objectives: There is a concern that provide increased extraneous cognitive load when paired with residents on shift. However, this may be offset by the decrease in extraneous load they may provide to the residents they are paired with by offloading basic patient care tasks. We hypothesized that these forces may not be balanced. Methods: We conducted a retrospective observational analysis of PGY-2 emergency medicine residents and junior medical students at a single academic emergency department (ED) in the Midwest. A series of efficiency metrics (relative value unit [RVUs], patients per hour [PPH], time to note completion, and resident assignment to disposition [RATD]) as well as one quality metric (number of return ED visits; "bouncebacks") were compared for resident shifts in which a student was paired with the resident as well those in which no student was paired utilizing a regression model. Results: A total of 1844 records met the inclusion criteria (214 shifts with a paired medical student and 1630 without). After covariates were adjusted for, medical student shift status was a statistically significant predictor of increases in PPH (p < 0.0001) and RVUs (p = 0.0161) but was not significantly associated with RATD (p = 0.6941), log-time to note completion (p = 0.1604), or bounceback status (p = 0.9840). Shifts where residents were paired with medical students were predicted to see an additional 1.131 (95% confidence interval [CI] 0.660-1.602) PPH and produce an additional 1.923 RVUs (95% CI 1.130-3.273) per shift relative to shifts without medical students. Conclusions: When junior medical students were paired with a PGY-2 resident on ED shifts, there was a significant increase in the PPH and RVUs generated when compared with shifts in which no medical student was paired with them.

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.

Better together: A multistakeholder approach to developing specialty-wide entrustable professional activities in emergency medicine.

Purpose: Entrustable professional activities (EPAs) are a widely used framework for curriculum and assessment, yet the variability in emergency medicine (EM) training programs mandates the development of EPAs that meet the needs of the specialty as a whole. This requires eliciting and incorporating the perspectives of multiple stakeholders (i.e., faculty, residents, and patients) in the development of EPAs. Without a shared understanding of what a resident must be able to do upon graduation, we run the risk of advancing ill-prepared residents that may provide inconsistent care. Methods: In an effort to address these challenges, beginning in February 2020, the authors assembled an advisory board of 25 EM faculty to draft and reach consensus on a final list of EPAs that can be used across all training programs within the specialty of EM. Using modified Delphi methodology, the authors came to consensus on an initial list of 22 EPAs. The authors presented these EPAs to faculty supervisors, residents, and patients for refinement. The authors collated and analyzed feedback from focus groups of residents and patients using thematic analysis. The EPAs were subsequently refined based on this feedback. Results: Stakeholders in EM residency training endorsed a final revised list of 22 EPAs. Stakeholder focus groups highlighted two main thematic considerations that helped shape the finalized list of EM EPAs: attention to the meaningful nuances of EPA language and contextualizing the EPAs and viewing them developmentally. Conclusions: To foreground all key stakeholders within the EPA process for EM, the authors chose within the development process to draft; come to consensus; and refine EPAs for EM in collaboration with relevant faculty, patient, and resident stakeholders. Each stakeholder group contributed meaningfully to the content and intended implementation of the EPAs. This process may serve as a model for others in developing stakeholder-responsive EPAs.

Optimizing efficiency of a custom clinical decision support tool improves adult congenital heart disease care.

Study objective: Improve the efficiency of an inpatient clinical decision support tool (CDS) for patients with adult congenital heart disease (ACHD). Design: The efficiency of a CDS was evaluated across two time periods and compared. Setting: An academic, tertiary care center. Participants: ACHD patients roomed in an inpatient setting. Intervention: Plan-Do-Study-Act (PDSA) methods were applied starting in 2021 and included refinement of diagnostic codes and the addition of department encounter codes. Main outcome measures: True positive and false positive CDS alerts. Results: Baseline data from 2017 had a median (IQR) of 38 (17) and 2019 baseline data had 65 (19) total alerts per month. Combining both baseline data years, the median true positive CDS alerts was 47.3 %. There were 71 (6) total alerts per month for the 2021-2022 time period and with ongoing PDSA cycles and optimization in the CDS the true positive alerts improved substantially resulting in a shifting of the median to 78.9 % within 9 months. Conclusion: CDS can efficiently notify providers when an ACHD patient is encountered. The use of ICD 10 codes alone to identify ACHD patients has limited accuracy with a high proportion of false positives. Ongoing revision of the CDS system methods is important to improving efficiency and minimizing provider alert fatigue.

Emergency Medicine Obstetrics and Gynecology: A Case-Based Curriculum for Residents.

Introduction: Millions of patients present to US emergency departments every year with OB/GYN concerns. Emergency medicine trainees must be adequately prepared to care for this population, regardless of how commonly they appear in the training environment. We used active learning and gamification principles in this curriculum to increase learner engagement and participation in the material. Methods: We chose OB/GYN topics based on review of Tintinalli's OB/GYN content and the American Board of Emergency Medicine's Model of Clinical Practice. Each session comprised a case-based lecture and review questions using the game-based Kahoot! online software. Pre- and postcurriculum surveys assessed residents' confidence in caring for emergent OB/GYN pathologies on a 5-point Likert scale. We designed survey questions assessing the first level of Kirkpatrick's levels of training evaluation; these questions were reviewed and revised by the department's Medical Education Scholarship Committee for validity. Results: A mean of 18 residents attended each session. Seventy-six percent of residents (26 of 34) completed the precurriculum survey, 67% (23 of 34) completed the postcurriculum survey, and 44% (15 of 34) completed both. For all respondents, mean reported confidence with curriculum topics increased from 3.5 to 4.0 (p < .05). For residents completing both surveys, confidence increased from 3.4 to 4.0 (p < .01). Discussion: Application of this curriculum significantly improved learner confidence in targeted OB/GYN topics. Future directions could include evaluating curricular impact at higher levels in the Kirkpatrick model, extending sessions to include more time for interaction, and adding suggested readings.

Deployment of Real-time Natural Language Processing and Deep Learning Clinical Decision Support in the Electronic Health Record: Pipeline Implementation for an Opioid Misuse Screener in Hospitalized Adults.

BACKGROUND: The clinical narrative in electronic health records (EHRs) carries valuable information for predictive analytics; however, its free-text form is difficult to mine and analyze for clinical decision support (CDS). Large-scale clinical natural language processing (NLP) pipelines have focused on data warehouse applications for retrospective research efforts. There remains a paucity of evidence for implementing NLP pipelines at the bedside for health care delivery. OBJECTIVE: We aimed to detail a hospital-wide, operational pipeline to implement a real-time NLP-driven CDS tool and describe a protocol for an implementation framework with a user-centered design of the CDS tool. METHODS: The pipeline integrated a previously trained open-source convolutional neural network model for screening opioid misuse that leveraged EHR notes mapped to standardized medical vocabularies in the Unified Medical Language System. A sample of 100 adult encounters were reviewed by a physician informaticist for silent testing of the deep learning algorithm before deployment. An end user interview survey was developed to examine the user acceptability of a best practice alert (BPA) to provide the screening results with recommendations. The planned implementation also included a human-centered design with user feedback on the BPA, an implementation framework with cost-effectiveness, and a noninferiority patient outcome analysis plan. RESULTS: The pipeline was a reproducible workflow with a shared pseudocode for a cloud service to ingest, process, and store clinical notes as Health Level 7 messages from a major EHR vendor in an elastic cloud computing environment. Feature engineering of the notes used an open-source NLP engine, and the features were fed into the deep learning algorithm, with the results returned as a BPA in the EHR. On-site silent testing of the deep learning algorithm demonstrated a sensitivity of 93% (95% CI 66%-99%) and specificity of 92% (95% CI 84%-96%), similar to published validation studies. Before deployment, approvals were received across hospital committees for inpatient operations. Five interviews were conducted; they informed the development of an educational flyer and further modified the BPA to exclude certain patients and allow the refusal of recommendations. The longest delay in pipeline development was because of cybersecurity approvals, especially because of the exchange of protected health information between the Microsoft (Microsoft Corp) and Epic (Epic Systems Corp) cloud vendors. In silent testing, the resultant pipeline provided a BPA to the bedside within minutes of a provider entering a note in the EHR. CONCLUSIONS: The components of the real-time NLP pipeline were detailed with open-source tools and pseudocode for other health systems to benchmark. The deployment of medical artificial intelligence systems in routine clinical care presents an important yet unfulfilled opportunity, and our protocol aimed to close the gap in the implementation of artificial intelligence-driven CDS. TRIAL REGISTRATION: ClinicalTrials.gov NCT05745480; https://www.clinicaltrials.gov/ct2/show/NCT05745480.

Emergency Medicine Residents' "Just World" Bias Is Not Associated with a Biased Case Mix.

INTRODUCTION: Belief in a just world is the cognitive bias that "one gets what they deserve." Stronger belief in a just world for others (BJW-O) has been associated with discrimination against individuals with low socioeconomic status (SES) or poor health status, as they may be perceived to have "deserved" their situation. Emergency medicine (EM) residents have been shown to "cherry pick" patients; in this study we sought to determine whether BJW-O is associated with a biased case mix seen in residency. METHODS: We assessed EM residents on their BJW-O using a scale with previous validity evidence and behavioral correlates. We identified chief complaints that residents may associate with low SES or poor health status, including psychiatric disease, substance use disorder (SUD); and patients with multidisciplinary care plans due to frequent ED visits. We then calculated the percentage of each of these patient types seen by each resident as well as correlations and a multiple linear regression. RESULTS: 38 of 48 (79%) residents completed the BJW-O, representing 98,825 total patient encounters. The median BJW-O score was 3.25 (interquartile range 2.81-3.75). There were no significant correlations observed between BJW-O and the percentage of patients with multidisciplinary care plans who were seen, or patients with psychiatric, SUD, dental or sickle cell chief complaints seen; and a multiple linear regression showed no significant association. CONCLUSION: Higher BJW-O scores in EM residents are not significantly associated with a biased case mix of patients seen in residency.

Number of Patient Encounters in Emergency Medicine Residency Does Not Correlate with In-Training Exam Domain Scores.

INTRODUCTION: Emergency medicine (EM) residents take the American Board of Emergency Medicine (ABEM) In-Training Examination (ITE) every year. This examination is based on the ABEM Model of Clinical Practice (Model). The purpose of this study was to determine whether a relationship exists between the number of patient encounters a resident sees within a specific clinical domain and their ITE performance on questions that are related to that domain. METHODS: Chief complaint data for each patient encounter was taken from the electronic health record for EM residents graduating in three consecutive years between 2016-2021. We excluded patient encounters without an assigned resident or a listed chief complaint. Chief complaints were then categorized into one of 20 domains based on the 2016 Model. We calculated correlations between the total number of encounters seen by a resident for all clinical years and their ITE performance for the corresponding clinical domain from their third year of training. RESULTS: Available for analysis were a total of 232,625 patient encounters and 69 eligible residents who treated the patients. We found no statistically significant correlations following Bonferroni correction for multiple analyses. CONCLUSION: There was no correlation between the number of patient encounters a resident has within a clinical domain and their ITE performance on questions corresponding to that domain. This suggests the need for separate but parallel educational missions to achieve success in both the clinical environment and standardized testing.

A Model Curriculum for an Emergency Medicine Residency Rotation in Clinical Informatics.

Audience: This curriculum is designed for emergency medicine residents at all levels of training. The curriculum covers basic foundations in clinical informatics for improving patient care and outcomes, utilizing data, and leading improvements in emergency medicine. Length of Curriculum: The curriculum is designed for a four-week rotation. Introduction: The American College of Graduate Medical Education (ACGME) mandated that all Emergency Medicine (EM) residents receive specific training in the use of information technology.1,2 To our knowledge, a clinical informatics curriculum for EM residents does not exist. We propose the following standardized and reproducible educational curriculum for EM residents. Educational Goals: The aim of this curriculum is to teach informatics skills to emergency physicians to improve patient care and outcomes, utilize data, and develop projects to lead change.3 These goals will be achieved by providing a foundational informatics elective for EM residents that follows the delineation of practice for Clinical Informatics outlined by the American Medical Informatics Association (AMIA) and the American Board of Preventive Medicine (ABPM).4-6. Educational Methods: The educational strategies used in this curriculum include asynchronous learning via books, papers, videos, and websites. Residents attend administrative sessions (meetings), develop a project proposal, and participate in small group discussions.The rotation emphasizes the basic concepts surrounding clinical informatics with an emphasis on improving care delivery and outcomes, information systems, data governance and analytics, as well as leadership and professionalism. The course focuses on the practical application of these concepts, including implementation, clinical decision support, workflow analysis, privacy and security, information technology across the patient care continuum, health information exchange, data analytics, and leading change through stakeholder engagement. Research Methods: An initial version of the curriculum was introduced to two separate institutions and was completed by three rotating resident physicians and one rotating resident pharmacist. A brief course evaluation as well as qualitative feedback was solicited from elective participants by the course director, via email following the completion of the course, regarding the effectiveness of the course content. Learner feedback was used to influence the development of this complete curriculum. Results: The curriculum was graded by learners on a 5-point Likert scale (1=strongly disagree, 5 = strongly agree). The mean response to, "This course was a valuable use of my elective time," was 5 (sd=0). The mean response to, "I achieved the learning objectives," and "This rotation helped me understand Clinical Informatics," were both 4.75 (sd=0.5). Discussion: Overall, participants reported that the content was effective for achieving the learning objectives. During initial implementation, we found that the preliminary asynchronous learning component worked less effectively than we anticipated due to a lower volume of content. In response to this, as well as resident feedback, we added significantly more educational content.In conclusion, this model curriculum provides a structured process for an informatics rotation for the emergency medicine resident that utilizes the core competencies established by the governing bodies of the clinical informatics specialty and ACGME. Topics: Clinical informatics key concepts, including definitions, fundamental terminology, history, policy and regulations, ethical considerations, clinical decision support, health information systems, data governance and analytics, process improvement, stakeholder engagement and change management.

Documentation from trained medical students has a low rate of relative downcoding for emergency medicine encounters.

Background: Since 2018, the Centers for Medicare & Medicaid Services (CMS) guidelines have allowed teaching physicians to bill for evaluation and management services based on medical student documentation. Limited previous data suggest that medical student documentation suffers from a high rate of downcoding relative to faculty documentation. We sought to compare the coding outcomes of documentation performed by medical students, and not edited by faculty, with documentation edited and submitted by faculty. Methods: A total of 104 randomly selected notes from real patient encounters written by senior medical students were compared to the revised notes submitted by faculty. The note pairs were then split and reviewed by blinded professional coders and assigned level of service (LoS) codes 1-5 (corresponding to E&M CPT codes 99281-99285). Results: We found that the LoS agreement between student and faculty note versions was 63%, with 23% of all student notes receiving lower LoS compared to faculty notes (downcoded). This was found to be similar to baseline variability in professional coder LoS designations. Conclusions: Notes from medical students who have completed a focused documentation curriculum have less LoS downcoding than in previous reports.

From intern to "accepted": A guide to preparing for fellowship in emergency medicine.

Introduction: The number of fellowship options for emergency medicine (EM) physicians continues to expand. While guides exist to help residents explore individual fellowship pathways, we aimed to create a comprehensive guide for all residents considering fellowship. Methods: At the direction of the Society for Academic Emergency Medicine (SAEM) Board, 9 members of the Fellowship Guide Workgroup, including members of the Fellowship Approval Committee, and 2 members of SAEM Residents and Medical Students (RAMS) group collaboratively developed the guide using available evidence and expert opinion when high-quality evidence was unavailable. The guide was reviewed and approved by all members. Results: The guide offers advice to EM residents on how to conceptualize key aspects of their training with respect to preparation for fellowship, including scholarship, teaching, leadership, and electives. Additionally, it offers perspective on selecting a fellowship that matches the resident's interests and goals and successfully applying. Conclusion: This fellowship guide for EM residents considering fellowship summarizes the best currently available advice for residents considering fellowship training after residency.

From the ground up: Creating and leading fellowship programs in emergency medicine.

Background: A methodical and evidence-based approach to the creation and implementation of fellowship programs is not well described in the graduate medical education literature. The Society for Academic Emergency Medicine (SAEM) convened an expert panel to promote standardization and excellence in fellowship training. The purpose of the expert panel was to develop a fellowship guide to give prospective fellowship directors the necessary skills to successfully implement and maintain a fellowship program. Methods: Under direction of the SAEM Board of Directors, SAEM Education Committee, and SAEM Fellowship Approval Committee, a panel of content experts convened to develop a fellowship guide using an evidence-based approach and best practices content method. The resource guide was iteratively reviewed by all panel members. Results: Utilizing Kern's six-step model as a conceptual framework, the fellowship guide summarizes the construction, implementation, evaluation, and dissemination of a novel fellowship curriculum to meet the needs of trainees, educators, and sponsoring institutions. Other key areas addressed include Accreditation Council for Graduate Medical Education and nonaccredited fellowships, programmatic assessment, finances, and recruitment. Conclusions: The fellowship guide summarizes the conceptual framework, best practices, and strategies to create and implement a new fellowship program.

A Novel Virtual Emergency Medicine Residents-as-Teachers (RAT) Curriculum.

Audience: The Residents-as-Teachers (RAT) curriculum is designed for emergency medicine (EM) residents of all years (PGY1-4). Length of Curriculum: The curriculum is divided into three hour-long sessions. The entire curriculum can be run as a single block or can be spread out over multiple days. Introduction: The Accreditation Council of Graduate Medical Education (ACGME) and the Liaison Committee on Medical Education (LCME) both require residents to receive training in teaching medical students and junior residents. They also require opportunities for residents to participate in teaching and be assessed on their effectiveness in this role.1,2 However, the ACGME does not provide guidance or require formal curricula on molding residents into effective teachers. Many programs and institutions have incorporated RAT curricula as a solution to provide residents with the skills necessary to create an excellent educational environment for junior learners. These curricula have been embraced by many specialties, including Emergency Medicine (EM).3-6 The effectiveness of the teaching received during the clinical rotations has important long-term effects on medical students, and may impact their future career choices in medicine.6The COVID-19 pandemic has also required education institutions to vastly alter the delivery of their didactics, including moving to a virtual platform. A completely online format has many benefits that extend beyond the pandemic, such as easier access to participants (including those off-service or at remote sites), no requirement for a physical space, and easier recording of sessions. Educational Goals: To provide residents with an introduction to teaching techniques that can be utilized on-shift to facilitate an excellent educational experience for junior learners while balancing the resident's patient care responsibilities. Educational Methods: The educational strategies used in this curriculum include PowerPoint (Redmond, WA) slideshows given by a live presenter via the telecommunications platform Zoom (San Jose, CA), viewing of videos demonstrating curriculum topics, simulation-based learning through role-play, and small-group discussions including simulation debriefing. Research Methods: A survey was distributed to residents before and following the completion of the three training sessions to assess resident satisfaction with the delivery of the content and comfort with the teaching tools discussed. Suggestions on potential improvements were also assessed to inform changes to future iterations of the curriculum. Comfort regarding the included teaching tools was assessed using a five-point Likert scale. After completion of the curriculum, rotating medical students were provided with an evaluation form to assess if residents were teaching using the techniques from the course. Results: Both the pre-curriculum and post-curriculum surveys had a response rate of 61.1%. Student's t-test showed a statistically significant increase in mean resident comfort level with the teaching strategies post-curriculum (3.05 to 3.83, p < 0.01). Medical student evaluations have shown, overall, that the majority of residents are utilizing the education techniques on-shift. There were no significant differences found in medical student perception of resident use of taught skills between those who had and had not attended the sessions. However, all but one assessed skill showed higher utilization in those who had attended the correlating session. Discussion: The educational content was effective in improving the residents' comfort with the teaching strategies presented, and residents are utilizing these techniques on-shift. Through implementation, we discovered that presenting a curriculum over video conferencing required additional administrative support to help ensure efficacy of break-out groups. Based on resident feedback after the first session, multiple changes were made, including providing residents with hand-out references for use during the role-playing sessions. The success of this curriculum demonstrated the feasibility and utility of running a RAT curriculum entirely in a virtual format. Topics: Residents-as-teachers, distance learning, role-playing, virtual curriculum, video conferencing, One Minute Preceptor, feedback, "What if?" game, Aunt Minnie, SPIT, activated demonstration, self-directed teaching tools, teaching scripts, Post-It Pearls.

Coping Strategies Utilized by Emergency Department Providers During the COVID-19 Pandemic.

INTRODUCTION: COVID-19 has exposed health care workers to new stressors; emergency department providers are at risk of increased stress. It is unknown how coping strategies are utilized by this group during a pandemic. METHODS: A cross-sectional survey incorporating the Brief COPE inventory was deployed to residents, fellows, faculty, and physician assistants at a single US academic emergency department in the spring (April 2020 - May 2020) and winter (December 2020 - January 2021). Scores for 14 individual coping strategies, as well as approach (positive) and avoidant (negative) coping categories, were measured, and utilization of these coping strategies was compared with respect to the provider's role, sex, the number of people living at home, presence of pets and/or children at home, and stress level. RESULTS: The response rate was 58/103 (56.3%) and 50/109 (45.9%) for the spring and winter distributions, respectively. In the spring, 70.6% of responders reported increased stress vs 66% in the winter. Overall utilization of coping strategies increased slightly between spring and winter for approach coping (32.22 to 32.64) and avoidant coping (20.95 to 21.73). Resident physicians utilized less approach coping and more avoidant coping when compared to faculty/fellows. Substance use overall had a relatively low score, which increased slightly between spring and winter distributions (2.93 to 3.04). CONCLUSIONS: Approach coping was frequently utilized among ED providers during the COVID-19 pandemic study period. Resident physicians had higher utilization of avoidant coping strategies compared to faculty/fellows and could benefit from targeted wellness interventions during times of increased stress.

Curated collection for clinician educators: Six key papers on residency recruitment.

INTRODUCTION: All emergency medicine (EM) residency programs must recruit new medical school graduates each year. The process is often overwhelming, with each program receiving far more applicants than available positions. We searched for evidence-based best practices to guide residency programs in screening, interviewing, and ranking applicants to ensure a high-performing and diverse residency class. METHODS: A literature search was conducted on the topic of residency recruitment, utilizing a call on social media as well as multiple databases. After identifying relevant articles, we performed a modified Delphi process in three rounds, utilizing junior educators as well as more senior faculty. RESULTS: We identified 51 relevant articles on the topic of residency recruitment. The Delphi process yielded six articles that were deemed most highly relevant over the three rounds. Transparency with selection criteria, holistic application review, standardized letters of evaluation, and blinding applicant files for interviewers were among noted best practices. CONCLUSIONS: Well-supported evidence-based practices exist for residency recruitment, and programs may benefit from understanding which common recruitment practices offer the most value. The articles discussed here provide a foundation for faculty looking to improve their program's recruiting practices.