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.

Resident Supervision and Patient Care: A Comparative Time Study in a Community-Academic Versus a Community Emergency Department.

OBJECTIVE: The objective was to compare attending emergency physician (EP) time spent on direct and indirect patient care activities in emergency departments (EDs) with and without emergency medicine (EM) residents. METHODS: We performed an observational, time-motion study on 25 EPs who worked in a community-academic ED and a nonacademic community ED. Two observations of each EP were performed at each site. Average time spent per 240-minute observation on main-category activities are illustrated in percentages. We report descriptive statistics (median and interquartile ranges) for the number of minutes EPs spent per subcategory activity, in total and per patient. We performed a Wilcoxon two-sample test to assess differences between time spent across two EDs. RESULTS: The 25 observed EPs executed 34,358 tasks in the two EDs. At the community-academic ED, EPs spent 14.2% of their time supervising EM residents. Supervision activities included data presentation, medical decision making, and treatment. The time spent on supervision was offset by a decrease in time spent by EPs on indirect patient care (specifically communication and electronic health record work) at the community academic ED compared to the nonacademic community ED. There was no statistical difference with respect to direct patient care time expenditure between the two EDs. There was a nonstatistically significant difference in attending patient load between sites. CONCLUSIONS: EPs in our study spent 14.2% of their time (8.5 minutes/hour) supervising residents. The time spent supervising residents was largely offset by time savings related to indirect patient care activities rather than compromising direct patient care.

Residency Applicant Preferences of Online Systems for Scheduling Interviews.

BACKGROUND: Residency applicants often have difficulty coordinating interviews with multiple programs. An online scheduling system might improve this process. OBJECTIVE: The authors sought to determine applicant mean time to schedule interviews and satisfaction using online scheduling compared with manual scheduling. METHODS: An electronic survey was sent to US graduates applying to any of 6 emergency medicine programs in the 2014-2015 application cycle. Of the participant programs, 3 used an online system and 3 did not. Applicants were asked to report estimated time to schedule with the online system compared to their average time using other methods, and to rate their satisfaction with the scheduling process. RESULTS: Of 1720 applicants to at least 1 of the 6 programs, 856 completed the survey (49.8%). Respondents reported spending less time scheduling interviews using the online system compared to other systems (median of 5 minutes [IQR 3-10] versus 60 minutes [IQR 15-240], respectively, P < .0001). In addition, applicants preferred using the online system (93.6% versus 1.4%, P < .0001.) Applicants were also more satisfied with the ease of scheduling their interviews using the online system (91.5% versus 11.0%, P < .0001) and felt that the online system aided them in coordinating travel arrangements (74.7% versus 41.5%, P < .01.). CONCLUSIONS: An online interview scheduling system is associated with time savings for applicants as well as higher satisfaction among applicants, both in ease of scheduling and in coordinating travel arrangements. The results likely are generalizable to other medical and surgical specialties.

Addressing barriers to emergency anaphylaxis care: from emergency medical services to emergency department to outpatient follow-up.

BACKGROUND: Anaphylaxis is a systemic life-threatening allergic reaction that presents unique challenges for emergency care practitioners. Allergists and emergency physicians have a history of collaborating to promote an evidence-based, multidisciplinary approach to improve the emergency management and follow-up of patients with or at risk of anaphylaxis. OBJECTIVES: To review recent scientific literature about anaphylaxis, discuss barriers to care, and recommend strategies to support improvement in emergency anaphylaxis care. METHODS: An expert panel of allergists and emergency physicians was convened by the American College of Allergy, Asthma and Immunology in November 2014 to discuss current knowledge about anaphylaxis, identify opportunities for emergency practitioners and allergists to partner to address barriers to care, and recommend strategies to improve medical management of anaphylaxis along the continuum of care: from emergency medical systems and emergency department practitioners for acute management through appropriate outpatient follow-up with allergists to confirm diagnosis, identify triggers, and plan long-term care. RESULTS: The panel identified key barriers to anaphylaxis care, including difficulties in making an accurate diagnosis, low rates of epinephrine administration during acute management, and inadequate follow-up. Strategies to overcome these barriers were discussed and recommendations made for future allergist/emergency physician collaborations, and key messages to be communicated to emergency practitioners were proposed. CONCLUSION: The panel recommended that allergists and emergency physicians continue to work in partnership, that allergists be proactive in outreach to emergency care practitioners, and that easy-to-access educational programs and materials be developed for use by emergency medical systems and emergency department practitioners in the training environment and in practice.

Diversity in emergency medicine education: expanding the horizon.

An emergency medicine (EM)-based curriculum on diversity, inclusion, and cultural competency can also serve as a mechanism to introduce topics on health care disparities. Although the objectives of such curricula and the potential benefits to EM trainees are apparent, there are relatively few resources available for EM program directors to use to develop these specialized curricula. The object of this article is to 1) broadly discuss the current state of curricula of diversity, inclusion, and cultural competency in EM training programs; 2) identify tools and disseminate strategies to embed issues of disparities in health care in the creation of the curriculum; and 3) provide resources for program directors to develop their own curricula. A group of EM program directors with an interest in cultural competency distributed a preworkshop survey through the Council of Emergency Medicine Residency Directors (CORD) e-mail list to EM program directors to assess the current state of diversity and cultural competency training in EM programs. Approximately 50 members attended a workshop during the 2011 CORD Academic Assembly as part of the Best Practices track, where the results of the survey were disseminated and discussed. In addition to the objectives listed above, the presenters reviewed the literature regarding the rationale for a cultural competency curriculum and its relationship to addressing health care disparities, the relationship to unconscious physician bias, and the Tool for Assessing Cultural Competence Training (TACCT) model for curriculum development.

Promoting diversity in emergency medicine: summary recommendations from the 2008 Council of Emergency Medicine Residency Directors (CORD) Academic Assembly Diversity Workgroup.

Although the U.S. population continues to become more diverse, ethnic and racial health care disparities persist. The benefits of a diverse medical workforce have been well described, but the percentage of emergency medicine (EM) residents from underrepresented groups (URGs) is small and has not significantly increased over the past 10 years. The Council of Emergency Medicine Resident Directors (CORD) requested that a panel of CORD members review the current state of ethnic and racial diversity in EM training programs. The objective of the discussion was to develop strategies to help EM residency programs examine and improve diversity in their respective institutions. Specific recommendations focus on URG applicant selection and recruitment strategies, cultural competence curriculum development, involvement of URG faculty, and the availability of institutional and national resources to improve and maintain diversity in EM training programs.

Conference attendance does not correlate with emergency medicine residency in-training examination scores.

OBJECTIVES: The residency review committee for emergency medicine (EM) requires residents to have greater than 70% attendance of educational conferences during residency training, but it is unknown whether attendance improves clinical competence or scores on the American Board of Emergency Medicine (ABEM) in-training examination (ITE). This study examined the relationship between conference attendance and ITE scores. The hypothesis was that greater attendance would correlate to a higher examination score. METHODS: This was a multi-center retrospective cohort study using conference attendance data and examination results from residents in four large county EM residency training programs. Longitudinal multi-level models, adjusting for training site, U.S. Medical Licensing Examination (USMLE) Step 1 score, and sex were used to explore the relationship between conference attendance and in-training examination scores according to year of training. Each year of training was studied, as well as the overall effect of mean attendance as it related to examination score. RESULTS: Four training sites reported data on 405 residents during 2002 to 2008; 386 residents had sufficient data to analyze. In the multi-level longitudinal models, attendance at conference was not a significant predictor of in-training percentile score (coefficient = 0.005, 95% confidence interval [CI] = -0.053 to 0.063, p = 0.87). Score on the USMLE Step 1 examination was a strong predictor of ITE score (coefficient = 0.186, 95% CI = 0.155 to 0.217; p < 0.001), as was female sex (coefficient = 2.117, 95% CI = 0.987 to 3.25; p < 0.001). CONCLUSIONS: Greater conference attendance does not correlate with performance on an individual's ITE scores. Conference attendance may represent an important part of EM residency training but perhaps not of ITE performance.