Simulation for diversity, equity and inclusion in emergency medicine residency training: A qualitative study.

Background: The last few years have seen an increased focus on diversity, equity, and inclusion (DEI) initiatives across organizations. Simulation has been used in varying degrees for teaching about DEI topics with emergency medicine; however, there are no established best practices or guidelines on this subject. To further examine the use of simulation for DEI teachings, the DEISIM work group was created as a collaboration between the Society of Academic Emergency Medicine (SAEM) Simulation Academy and the Academy for Diversity and Inclusion in Emergency Medicine (ADIEM). This study represents their findings. Method: This qualitative study was conducted using a three-pronged approach. Initial literature search was conducted followed by a call for submission of simulation curricula. These were then followed by five focus groups. Focus groups were recorded, transcribed by a professional transcription service, and then subjected to thematic analysis. Results: Data were analyzed and organized into four broad categories including Learners, Facilitators, Organizational/Leadership, and Technical Issues. Challenges within each of these were identified, as were potential solutions. Select pertinent findings included focused faculty development, a carefully planned approach that utilized DEI content experts and the use of simulation for workplace microaggressions or discriminations. Conclusions: There appears to be a clear role for simulation in DEI teachings. Such curricula, however, should be undertaken with careful planning and input from appropriate and representative parties. More research is needed on optimizing and standardizing simulation-based DEI curricula.

Mock Oral Board Examinations via Web-based Video Teleconferencing in the Era of COVID-19.

Owing to infection control measures necessitated by the COVID-19 pandemic, many educational didactic components within residency programs have needed to adapt to virtual formats. We describe and evaluate the transition of an in-person mock oral board certification examination to an entirely virtual format. Oral board cases consisting of two single cases and one triple case were adapted to a virtual format using a Web-based video teleconferencing platform. Faculty examiners underwent 20-minute training sessions prior to the examination. Both resident examinees and faculty examiners completed postexamination surveys. The system usability scale (SUS) was used to assess the usability of the new format by the faculty examiners. Fifteen resident examinees completed the mock virtual oral board examination with eight faculty examiners. All faculty members completed the postexamination survey. The mean (±SD) SUS score was 90.6 (±11.5) out of a maximum of 100. Eleven of 15 (73%) resident examinees completed the postexamination survey. All respondents agreed or strongly agreed that examiner instructions were easy to understand and that examiners were adept at using the Web-based platform. Some technical issues were encountered including audio difficulties for some examiners. Respondents were split regarding personal preference for virtual or in-person mock oral board formats. Utilizing video teleconferencing software to provide a virtual, Web-based alternative to in-person mock oral board examination was feasible, and the virtual format was shown to have high usability despite minimal training time for experienced faculty examiners.

Sympathomimetic-Induced Hyperthermia and Hyponatremia: A Simulation Case for Emergency Medicine Residents.

Introduction: MDMA (3,4-methylenedioxymethamphetamine) is a popular drug of abuse associated with a variety of clinical manifestations. There are a number of life-threatening sequelae, including, but not limited to, agitated delirium, cardiac dysrhythmias, and hyperthermia. Similar to other substances that cause sympathomimetic toxidromes, MDMA also induces a syndrome of inappropriate antidiuretic hormone secretion-like state resulting in hyponatremia. The management of hyperthermia is of particular importance, as time to correction, particularly at temperatures greater than 106 °F, is directly associated with increased risk of morbidity and mortality. Methods: We created a simulation-based intervention to address and improve clinical skills relating to the management of MDMA intoxication. The scenario used a simulated patient to teach emergency medicine residents how to properly diagnose sympathomimetic toxicity and manage resultant hyperthermia and hyponatremia with cooling measures and appropriate fluid administration. Learners participated in a debrief session and were given an anonymous survey to assess their perceived knowledge. The case was performed as part of monthly emergency medicine resident didactics. Results: Eighteen learners took part in the case, with a 100% response rate. All participants agreed that the scenario increased their knowledge of cooling methods in severe hyperthermia, particularly whole-body packing. Eighty-nine percent (n = 16) reported that the scenario changed their practice patterns. Discussion: This simulated scenario requires minimal resources and can be instituted with emergency medicine residents from all levels of training. The scenario achieved its primary goal of improving residents' perceived knowledge of cooling measures in severe hyperthermia.

Applicant Attitudes Toward the Association of American Medical Colleges' Standardized Video Interview.

BACKGROUND: The Standardized Video Interview (SVI) was developed by the American Association of Medical Colleges to allow applicants to include objective data about professional behaviors and interpersonal and communication skills. Although the SVI pilot was administered to individuals applying to emergency medicine (EM) residency programs during the 2018 Electronic Residency Application Service (ERAS) cycle, little data have been published evaluating the applicant's perceptions. This survey aims to assess EM residency applicant attitudes toward the SVI. METHODS: During the 2018 ERAS application season an anonymous survey was administered to interviewees at one urban Accreditation Council for Graduate Medical Education-approved EM residency. Respondents were asked questions regarding the production of their video interviews, thoughts regarding the additive value of the SVI, and individual demographic data such as ethnicity and sex. Participation was optional. RESULTS: A total of 219 of 238 candidates completed the survey representing a 92% response rate. While the majority of applicants did not feel that their ethnicity impacted their application, 58.1% of those who did self-identified as African American or Asian. A total of 8.7% of respondents felt the SVI added information about their professional behaviors and 11% felt that it added information about interpersonal and communication skills. Only 2.8% of survey respondents felt the SVI should remain a portion of the ERAS application. CONCLUSIONS: Most respondents felt that the SVI was not an accurate representation of their interpersonal and communication skills or their professionalism and that it did not add value to their applications. While most cohorts were not concerned about bias regarding sex, ethnicity, sex, or age, a small subset felt that there was a potential for the SVI to bias the party reviewing their applications. Very few applicants felt the SVI should remain a part of the ERAS application. Applicant attitudes toward the SVI are largely negative and require further investigation prior to becoming a standard part of applicants' ERAS files.