Structural competency in emergency medical education: A scoping review and operational framework.

Objectives: Existing curricula and recommendations on the incorporation of structural competency and vulnerability into medical education have not provided clear guidance on how best to do so within emergency medicine (EM). The goal of this scoping review and consensus building process was to provide a comprehensive overview of structural competency, link structural competency to educational and patient care outcomes, and identify existing gaps in the literature to inform curricular implementation and future research in EM. Methods: A scoping review focused on structural competency and vulnerability following Arksey and O'Malley's six-step framework was performed in concurrence with a multistep consensus process culminating in the 2021 SAEM Consensus Conference. Feedback was incorporated in developing a framework for a national structural competency curriculum in EM. Results: A literature search identified 291 articles that underwent initial screening. Of these, 51 were determined to be relevant to EM education. The papers consistently conceptualized structural competency as an interdisciplinary framework that requires learners and educators to consider historical power and privilege to develop a professional commitment to justice. However, the papers varied in their operationalization, and no consensus existed on how to observe or measure the effects of structural competency on learners or patients. None of the studies examined the structural constraints of the learners studied. Conclusions: Findings emphasize the need for training structurally competent physicians via national structural competency curricula focusing on standardized core competency proficiencies. Moreover, the findings highlight the need to assess the impact of such curricula on patient outcomes and learners' knowledge, attitudes, and clinical care delivery. The framework aims to standardize EM education while highlighting the need for further research in how structural competency interventions would translate to an ED setting and affect patient outcomes and experiences.

Implementation of holistic review into emergency medicine residency application screening to improve recruitment of underrepresented in medicine applicants.

INTRODUCTION: Increasing the diversity of the emergency medicine (EM) workforce is imperative, with more diverse teams showing improved patient care and increased innovation. Holistic review, adapted from the Association of American Medical Colleges (AAMC), focuses on screening applicants with a balanced method, valuing their experiences, attributes, and academic metrics equally. A core tenet to holistic review is that diversity is essential to excellence. OBJECTIVE: Implementation of holistic review into the residency application screening process is effective at improving exposure to underrepresented in medicine (URiM) applicants. METHODS: After adjustment of our residency application screening rubric, improving our balance across the experience, attributes, and metrics domains, we conducted a retrospective cohort study comparing the representation of URiM applicants invited to interview, interviewed, and ranked by composite score compared to our previous primarily metric-based process. RESULTS: A total of 8,343 applicants were included in the study. Following implementation of holistic review, we saw an increase in the absolute percent of URiM applicants invited to interview (+11%, 95% confidence interview [CI] = 6.9% to 15.4%, p < 0.01), interviewed (+7.9%, 95% CI = 3.6% to 12.2%, p < 0.01), and represented in the top 75 through top 200 cutpoints based on composite score rank. The mean composite score for URiM applicants increased significantly compared to non-URiM applicants (+9.7, 95% CI = 8.2 to 11.2, p < 0.01 vs. +4.7, 95% CI = 3.5 to 5.9, p < 0.01). CONCLUSION: Holistic review can be used as a systematic and equitable tool to increase the exposure and recruitment of URiM applicants in EM training programs.

Impact of a Dedicated Teaching Attending Experience on a Required Emergency Medicine Clerkship.

INTRODUCTION: One published strategy for improving educational experiences for medical students in the emergency department (ED) while maintaining patient care has been the implementation of dedicated teaching attending shifts. To leverage the advantages of the ED as an exceptional clinical educational environment and to address the challenges posed by the rapid pace and high volume of the ED, our institution developed a clerkship curriculum that incorporates a dedicated clinical educator role - the teaching attending - to deliver quality bedside teaching experiences for students in a required third-year clerkship. The purpose of this educational innovation was to determine whether a dedicated teaching attending experience on a third-year required emergency medicine (EM) clerkship would improve student-reported clinical teaching evaluations and student-reported satisfaction with the overall quality of the EM clerkship. METHODS: Using a five-point Likert-type scale (1 - poor to 5 - excellent), student-reported evaluation ratings and the numbers of graduating students matching into EM were trended for 10 years retrospectively from the inception of the clerkship for the graduating class of 2009 through and including the graduating class of 2019. We used multinomial logistic regression to evaluate whether the presence of a teaching attending during the EM clerkship improved student-reported evaluation ratings for the EM clerkship. We used sample proportion tests to assess the differences between top-box (4 or 5 rating) proportions between years when the teaching attending experience was present and when it was not. RESULTS: For clinical teaching quality, when the teaching attending is present the estimated odds of receiving a rating of 5 is 77.2 times greater (p <0.001) than when the teaching attending is not present and a rating of 4 is 27.5 times greater (p =0.0017). For overall clerkship quality, when the teaching attending is present, the estimated odds of receiving a rating of 5 is 13 times greater (p <0.001) and a rating of 4 is 5.2 times greater (p=0.0086) than when the teaching attending is not present. CONCLUSION: The use of a dedicated teaching attending shift is a successful educational innovation for improving student self-reported evaluation items in a third-year required EM clerkship.

Subarachnoid Mirage: A Case of Pseudosubarachnoid Hemorrhage.

A 22-year-old man with a history of intravenous methamphetamine use presented with severe headache for 5 days, was afebrile, and had nuchal rigidity. Computed tomography and magnetic resonance imaging results were interpreted as revealing acute subarachnoid hemorrhage. Twenty-four hours later, he developed acute neurologic deterioration. A lumbar puncture was performed, revealing the presence of Staphylococcus aureus. The false-positive image mimicking blood was potentially a result of an extremely high protein concentration present in the cerebrospinal fluid, provoked by an intense inflammatory reaction leading to disruption of the blood-brain barrier. Pyogenic meningitis is one of the causes of pseudosubarachnoid hemorrhage, or a false diagnosis of subarachnoid hemorrhage, when one does not actually exist.

The 3-minute emergency medicine medical student presentation: a variation on a theme.

Oral presentations are a critical element in the communication of medical knowledge between students and faculty, but in most locations, the amount of time spent on teaching the oral presentation is minimal. Furthermore, the standard oral presentation does not work well within the emergency medicine (EM) setting, due to time constraints and the different principles that make EM a unique specialty. This article provides a suggested approach on how to educate students on optimal oral presentations in EM, as well as providing a link to an online guide instructing medical students how to give oral presentations.