A guide to creating an educator's portfolio for the 21st century.

An educator's portfolio is (EP) a collection of materials for demonstrating and assessing a clinician educator's performance and perspective. Although not all academic institutions require faculty to maintain an EP, it can serve as a valuable tool for both personal reflection and professional advancement. With newer advancements in technology and social media, there are also opportunities to enhance the EP for the digital era. This educator's blueprint highlights eight strategies for creating an EP for the 21st century clinician educator: use your educator's philosophy to introduce and anchor your EP, apply broad definitions of scholarship, include pertinent metrics for all scholarly products, describe mentorship activities, incorporate self-assessment and the assessments from others, report comprehensive accounting of presentations, highlight leadership activities, and utilize technology to facilitate dissemination and sharing of your EP.

Exploring How House Staff Unions Impact the Program Director-Resident Educational Alliance.

ABSTRACT: In 1999, the National Labor Relations Board determined that residents function as employees, thereby allowing them to freely unionize. From 2020 to 2023, house staff (i.e., resident physicians and fellows) unions have significantly increased, and 8 physician training centers, representing nearly 4,000 house staff, have unionized since March 2021. While unions provide residents with an important tool in effecting change in their workplace, their introduction into the educational milieu has the potential to alter the program director (PD)-resident relationship. In this article, the authors use the educational alliance framework to detail 3 factors required to support a quality educational relationship between a resident and their PD. They also elaborate on how the introduction of unions may impact the PD-resident relationship and explore the potential unintended consequences of unionization as it pertains to this relationship. The authors then use 2 social psychology theories, naïve realism and motivated reasoning, to describe common framing dynamics that lead to conflict during collective bargaining processes. They conclude by offering strategies that PDs may use to mitigate tensions that arise in contract negotiations, even without a direct seat at the table. Ultimately, PDs should anticipate continued growth of resident unions and prepare themselves and their programs for the tensions that may arise from this action. The PD role as a neutral third party ought to be preserved, which is possible if all parties set reasonable expectations for the changes in the PD's role and responsibilities under a union. PDs should understand the 3 core aspects of the educational alliance and the importance of establishing credibility with their residents early on to build a strong foundation.

Differences in emergency medicine resident procedural reporting by race and ethnicity.

Background: The recruitment, retention, and training of physicians from groups underrepresented in medicine (UiM) is critically important to the practice of emergency medicine (EM). Studies across specialties have demonstrated disparities in operative experiences among UiM resident learners who are UiM; however, there are limited data on procedural disparities in EM. Objective: We sought to quantify the association between racial and ethnic identities that are UiM and the number of procedures reported among EM residents. Methods: We conducted a retrospective review of procedural differences by UiM status (using self-identified race and ethnicity) among graduating EM residents at nine training programs over a 10-year period. Sites were selected to ensure diversity of program length, program type, and geography. Data from residents in combined training programs, those who did not complete their full training at that institution, and those with missing data or electing not to report race/ethnicity were excluded. We calculated median and interquartile ranges for each procedure by UiM status. We conducted multivariable regression analyses accounting for UiM status, gender, and site as well as a sensitivity analysis excluding values >3 standard deviations from the mean for each procedure. Results: We collected data from 988 total residents, with 718 (73%) being non-UiM, 204 (21%) being UiM, 48 (5%) electing not to specific race/ethnicity, and 18 (2%) missing race/ethnicity data. While unadjusted data demonstrated a difference between UiM and non-UiM resident numbers across several procedures, there were no significant differences in procedures reported after accounting for gender and site in the primary or sensitivity analyses. Conclusions: We did not identify a statistically significant difference in reported procedures between UiM and non-UiM residents in EM. Future work should include qualitative investigations of UiM resident experience surrounding procedures as well as mixed-methods studies to examine how these data interact.

Education Theory Made Practical: Creating open educational resources via an apprenticeship model.

Introduction: Clinical faculty may have limited knowledge of education theories and best practices in health professions education. Many faculty development programs focus on passive learning with limited application to practice. There is a need for more active engagement for early career educators. Methods: We created an apprenticeship-based electronic book series focused on translating education theories into practical applications for clinician educators. Chapters were authored by teams of two to four geographically separated early career educators, who were tasked with explaining an education theory and relating it to their educational practice. The chapters underwent internal peer review, followed by open peer review as a blog post and eventual publication. Usage data were collected, and surveys were sent to authors and end-users. Results: Six volumes (60 total chapters) have been created to date by 180 unique authors and 17 editors over a 6-year period. There have been 65,571 total blog page views and 17,180 total book downloads across the five published volumes. Authors reported an increase in their perceived knowledge (pre 2.6 ± 1.7 vs. post 7.2 ± 1.1, mean difference 4.5/9.0, 95% confidence interval [CI] 4.0-5.0, p < 0.001) after writing their chapter. Authors also reported career benefits including authorship for academic advancement/promotion and developing an area of education theory expertise. End-users also reported a mean increase in their perceived knowledge (pre 4.4 ± 2.5 vs. post 7.3 ± 1.4, mean difference 2.9/9.0, 95% CI 2.1-3.8, p < 0.001) after reading a chapter. Conclusion: The Education Theory Made Practical electronic book series represents a proof of concept for an apprenticeship-based model to teach education theory, while also creating scholarship and open access resources for the broader community.

Ethnic and Racial Differences in Ratings in the Medical Student Standardized Letters of Evaluation (SLOE).

Background: The Standardized Letter of Evaluation (SLOE) stratifies the assessment of emergency medicine (EM) bound medical applicants. However, bias in SLOE, particularly regarding race and ethnicity, is an underexplored area. Objective: This study aims to assess whether underrepresented in medicine (UIM) and non-UIM applicants are rated differently in SLOE components. Methods: This was a cross-section study of EM-bound applicants across 3 geographically distinct US training programs during the 2019-2020 application cycle. Using descriptive and regression analyses, we examine the differences between UIM applicants and non-UIM applicants for each of the SLOE components: 7 qualifications of an EM physician (7QEM), global assessment (GA) rating, and projected rank list (RL) position. Results: Out of a combined total of 3759, 2002 (53.3%) unique EM-bound applicants were included. UIM applicants had lower ratings for each of the 7QEM questions, GA, and RL positions. Compared to non-UIM applicants, only some of the 7QEM components: "Work ethic and ability to assume responsibility," "Ability to work in a team, and "Ability to communicate a caring nature," were associated with their SLOE. "Commitment to EM" correlated more with GA for UIM than for non-UIM applicants. Conclusions: This study shows a difference in SLOE rating, with UIM applicants receiving lower ratings than non-UIM applicants.

Gender differences in emergency medicine standardized letters of evaluation.

Objectives: The Standardized Letter of Evaluation (SLOE) is a vital portion of any medical student's emergency medicine (EM) residency application. Prior literature suggests gender bias in EM SLOE comparative ranking, but there is limited understanding of the impact of gender on other SLOE components. The study objective was to evaluate the presence of gender differences in the 7 Qualifications for EM (7QEM), Global Assessment (GA), and anticipated Rank List (RL) position. A secondary objective was to evaluate the gender differences in 7QEM scores and their link to GA and anticipated RL position. Methods: We performed a cross-sectional study using SLOEs from a subset of United States applicants to three EM residency programs during the 2019-2020 application cycle. We collected self-reported demographics, 7QEM scores, GA, and anticipated RL position. We utilized linear regression analyses and repeated measures ANOVA to evaluate if the relationship between the 7QEM scores, GA score, and anticipated RL position was different for men and women. Results: 2103 unique applicants were included (38.6% women, 61.4% men), with 4952 SLOEs meeting inclusion criteria. The average QEM (2.51 vs. 2.39; p < 0.001), GA (2.68 vs. 2.48; p < 0.001), and RL (2.68 vs. 2.47; p < 0.001) scores were statistically higher for women than men. When exploring the relationship between the 7QEM and GA, Ability to communicate a caring nature to patients was not found to be a statistically significant predictor for men, but it was for women. When exploring the relationship between 7QEM and RL, Commitment to EM was not a significant predictor for men, but it was for women. Conclusions: Women scored higher than men on the 7QEM, GA, and anticipated RL position on SLOEs. The 7QEM scores factored differently for men and women.

United States 2020 Emergency Medicine Resident Workforce Analysis.

STUDY OBJECTIVE: To characterize the emergency medicine resident physician workforce and the residency programs training them. METHODS: We identified emergency medicine residents in the 2020 American Medical Association (AMA) Physician Masterfile, analyzed demographic information, mapped both county-level population-adjusted and hospital referral region densities, and compared 2020 versus 2008 resident physician densities. We also analyzed all Accreditation Council for Graduate Medical Education (ACGME)-accredited emergency medicine residency programs from 2013 to 2020, mapped state-level population-adjusted densities, and identified temporal trends in program location and state-level program densities. All population-adjusted densities were calculated using the US Census Bureau resident population estimates. RESULTS: There were 6,993 emergency medicine residents in the 2020 AMA dataset with complete information. Most of them (98%) were in urban areas. Compared with 2008, per 100,000 US population, this represents disproportionate increases in urban areas (total [0.5], urban [0.5], large rural [0.2] and small rural [0.05]). We further identified 160 (2013) to 265 (2020) residency programs using the ACGME data. The new programs were 3-year training programs that were disproportionately added to states with an already higher number of programs (Florida [5 to 19], Michigan [11 to 25], New York [21 to 31], Ohio [9 to 18], Pennsylvania [12 to 21], California [14 to 22]). CONCLUSION: The number of emergency medicine residency programs has increased; most new programs were added to the states that already had emergency medicine residency programs. There is an emergency physician "desert" in the rural United States, lacking both residents and residency training programs. This analysis provides essential context to the ongoing conversation about the future of the emergency physician workforce.

Unheard Voices: A Qualitative Study of Resident Perspectives on Remediation.

BACKGROUND: Remediation is an important component of residency training that ensures residents are progressing toward competency and unsupervised practice. There is literature describing educators' attitudes about remediation; however, little is known about residents' perspectives regarding peers who are struggling and remediation. Understanding this perspective is critical to supporting struggling residents and developing successful remediation programs. OBJECTIVE: The objective of this study was to describe residents' perspectives on peers who are struggling and remediation processes within graduate medical education programs. METHODS: In 2015, we conducted focus groups of residents in a multi-institutional exploratory qualitative study designed to investigate resident perspectives on remediation. Focus groups included questions on identification of residents who are struggling, reasons residents face difficulty in training, attitudes toward remediation, and understanding of the remediation process. Using conventional content analysis, we analyzed the focus group data to discover common themes. RESULTS: Eight focus groups were performed at 3 geographically distinct institutions. A total of 68 residents participated, representing 12 distinct medical specialties. Four major themes emerged from the participants' discussion: lack of transparency, negative stigma, overwhelming emotions, and a need for change. CONCLUSIONS: Resident perspectives on remediation are affected by communication, culture, and emotions. The resident participants called for change, seeking greater understanding and transparency about what it means to struggle and the process of remediation. The residents also believed that remediation can be embraced and normalized.

Faculty development using a virtual community of practice: Three-year outcomes of the Academic Life in Emergency Medicine Faculty Incubator program.

INTRODUCTION: The Academic Life in Emergency Medicine (ALiEM) Faculty Incubator program is a longitudinal, 1-year, virtual faculty development program for early- and mid-career faculty members that crosses specialties and institutions. This study sought to evaluate the outcomes among 3 years of participants. METHODS: This cross-sectional survey study evaluated postcourse and 1-year outcomes from three graduated classes of the ALiEM Faculty Incubator program. The program evaluation survey was designed to collect outcomes across multiple Kirkpatrick levels using pre/post surveys and tracking of abstracts, publications, speaking opportunities, new leadership positions, and new curricula. RESULTS: Over 3 years, 89 clinician educators participated in the program. Of those, 59 (66%) completed the initial survey and 33 (37%) completed the 1-year survey. Participants reported a significant increase in knowledge (4.1/9.0 vs. 7.0/9.0). The number of abstracts, publications, and invited presentations significantly increased after course completion and continued postcourse. A total of 37 of 59 (62.7%) developed a new curriculum during the course and 19 of 33 (57.6%) developed another new curriculum after the course. A total of 29 of 59 (49.2%) began a new leadership position upon course completion with 15 of 33 (45.5%) beginning another new leadership position 1 year later. DISCUSSION: The ALiEM Faculty Incubator program demonstrated an increase in perceived knowledge and documented academic productivity among early- and mid-career medical educators.

Sex Distribution of Editorial Board Members Among Emergency Medicine Journals.

STUDY OBJECTIVE: Previous studies have demonstrated that a sex disparity exists in the editorial boards of select specialties. However, there are limited data with respect to emergency medicine. We seek to determine the sex distribution of editors in chief and editorial board members among emergency medicine journals. METHODS: In this cross-sectional survey, we compiled a list of all emergency medicine journals, using the Scimago Journal & Country Rank on August 13, 2019. We excluded journals that were no longer published, were not emergency medicine journals, had rotating editorial boards for each issue, or had no first names listed. We obtained the sex and editorial board role by using publicly available data on the journal Web sites. We assigned sex according to knowledge of the member or his or her online faculty profile and used the Genderize program (Genderize.io, Roskilde, Denmark) when sex could not be determined with the above-mentioned approach. We report descriptive statistics for the categoric data, stratified by position (editor in chief, editorial board member, social media editor, resident/fellow member) and country. RESULTS: We identified 73 journals in Scimago; 37 met inclusion criteria, with data available to determine the sex in 99.5% of cases. There were 46 total editors in chief, with only 4 (8.7%) being women. Of 1,477 total editorial board members, only 241 were women (16.3%), with a range of 0% to 33.3% per journal. We found that 28.6% of social media editors (2/7) at 4 journals and 70% of resident or fellow editors (7/10) at 5 journals were women. CONCLUSION: There is a notable sex disparity among emergency medicine journals' editors in chief and editorial board members. Efforts should be made to improve sex distribution among editorial boards.

Emergency Medicine Gender in Resident Leadership Study (EM GIRLS): The Gender Distribution Among Chief Residents.

OBJECTIVES: The goal of this research was to determine the gender distribution of chief residents in emergency medicine (EM) residencies in the United States to explore whether the gender leadership gap is present at the resident level in EM. METHODS: The investigators compiled a list of EM residency programs accredited by the Accreditation Council for Graduate Medical Education. Investigators reached out to the programs using established best practices in survey distribution collecting the following: program name, program location, program length, total number of residents, total number of female residents, total number of chief residents, and the total number of female chief residents. RESULTS: Of the 223 programs contacted 194 programs responded and 182 programs were included in the study (a response rate of 82%). As of the 2019 to 2020 academic year, female EM residents account for 37.0% (2,459/6,718) of all EM residents and female EM chief residents account for 42.2% (250/593) of EM chief residents. The proportion of female EM chief residents was significantly higher than the proportion of both female EM residents (42.2% vs. 37%, p = 0.007) and female EM attending physicians (42.2% vs. 27.5%, p < 0.001). When comparing proportions of female residents based on duration of program, female physicians comprised 35.0% (1,652/4,720) of residents at 3-year programs and 40.4% (807/1998) of residents at 4-year programs (p < 0.01). CONCLUSIONS: While the proportion of female EM residents remains significantly lower than the proportion of male residents, females and males are similarly represented at the chief resident role.

Rethinking the Approach to Continuing Professional Development Conferences in the Era of COVID-19.

The COVID-19 pandemic has required a substantial change to the approach used for traditional, in-person continuing professional development (CPD) conferences. Running a virtual CPD conference will necessitate consideration of digital platforms and conversion of large group and small group sessions, abstract presentations, and networking events to a digital medium. This paper will discuss these challenges and present strategies to address them for CPD conference planning in the era of COVID-19.

Clinical Teaching: An Evidence-based Guide to Best Practices from the Council of Emergency Medicine Residency Directors.

Clinical teaching is the primary educational tool use to train learners from day one of medical school all the way to the completion of fellowship. However, concerns over time constraints and patient census have led to a decline in bedside teaching. This paper provides a critical review of the literature on clinical teaching with a focus on instructor teaching strategies, clinical teaching models, and suggestions for incorporating technology. Recommendations for instructor-related teaching factors include adequate preparation, awareness of effective teacher attributes, using evidence-based-knowledge dissemination strategies, ensuring good communication, and consideration of environmental factors. Proposed recommendations for potential teaching strategies include the Socratic method, the One-Minute Preceptor model, SNAPPS, ED STAT, teaching scripts, and bedside presentation rounds. Additionally, this article will suggest approaches to incorporating technology into clinical teaching, including just-in-time training, simulation, and telemedical teaching. This paper provides readers with strategies and techniques for improving clinical teaching effectiveness.

Curated Collections for Educators: Five Key Papers about Receiving Feedback in Medical Education.

Introduction Feedback is a complex, multi-component interaction that is essential for academic development and advancement. Successful feedback requires active involvement from both the giver and receiver. However, research and guidance on the subject mostly center on the role of the provider of feedback. But the receiver of feedback holds the true power in this interaction, choosing how to interpret the information and deciding whether or not to incorporate the feedback to instill behavioral change. In this article, the authors aim to summarize five key papers related to receiving feedback, in order to outline both relevant information for emerging clinician-educators and discern ways to use this information for faculty development. Methods In order to generate a list of key papers that describe the importance of receiving feedback, the authors conducted a consensus-building process informed by social media sources. Key articles on receiving feedback were aggregated through a literature search. This list was further augmented via an open call on Twitter for important papers regarding receiving feedback. Through these processes, a list of 43 papers was created on the topic of receiving feedback in medical education. After compiling this preliminary list, the authorship group engaged in a modified Delphi approach to build consensus on selecting papers that best described the process of receiving feedback. Results We present the group's five most highly rated papers on the topic of receiving feedback in medical education. These papers were deemed essential and have also been summarized based on their relevance to junior faculty members and faculty developers. Conclusion While giving and receiving feedback are both vital for growth and development, much of the research focuses solely on giving feedback. However, receiving feedback is equally, if not more, important for instilling change in the learner. We explore the power of receiving feedback in medical education through five key papers that analyze the subject. We believe these papers can serve as great learning resources for both junior faculty members and faculty developers. They can assist the junior faculty to cultivate the ability to receive feedback and also serve as resources to aid senior faculty in building faculty-development sessions.

What Emergency Medicine Rewards: Is There Implicit Gender Bias in National Awards?

STUDY OBJECTIVE: Multiple studies have demonstrated a gender gap in the percentage of women recognized in national awards, but to our knowledge this gap has not been studied within emergency medicine. This study is designed to evaluate the presence of a gender gap in female representation in awards from national emergency medicine organizations in the United States and Canada. METHODS: The awards from 5 national organizations during the past 5 years were reviewed. We developed a data extraction tool to identify and categorize the awards and recipients. Data were grouped according to gender distribution and assessed with respect to emergency medicine organization, year of award, category of award, and career phase specified by award. RESULTS: The overall percentage of female awardees across all 5 organizations from 2014 to 2018 was 28%. Only 16% of all named awards were named after women, and female awardees were more likely to be recognized early in their career for advocacy and work pertaining to the advancement of women, whereas men were favored for awards recognizing mentorship and organizational contributions. CONCLUSION: Emergency medicine is unique among other specialties in that the percentage of women represented in national awards (28%) closely mirrors the overall representation of women in emergency medicine (27.6% in the United States, 31% in Canada). This is in contrast to the documented leadership gap in academic medicine and emergency medicine, which may reflect a lag time between receiving national awards and earning academic and professional promotion. Although some organizations had significantly lower representation of female awardees, the overall trends indicate that women have closed the gender gap in award representation. This may signal a forthcoming change in other domains with established gaps in emergency medicine; specifically, in leadership and pay.

Curated Collections for Educators: Eight Key Papers about Feedback in Medical Education.

Feedback is an essential part of learning, growth, and academic success. Junior faculty members are often unfamiliar with the grounding literature that defines feedback. Many times they receive little education on providing and receiving feedback, resulting in unhelpful "feedback" for both learners and program leadership alike. This article aims to summarize eight key papers on feedback, to outline relevant information for emerging clinician educators, and identify ways to use these resources for the faculty development.  In order to generate a list of key papers that describes the importance and significance of feedback, the authors conducted a consensus-building process to identify the top papers. In August and September, 2018, the 2018-2019 Academic Life in Emergency Medicine (ALiEM) Faculty Incubator program discussed the topic of feedback in medical education. A number of papers on the topic was highlighted. This list of papers was further augmented using the suggestions and expertise of guest experts who are leaders in the field of medical education and feedback. The authors also used social media to conduct an open call on Twitter for important papers regarding feedback (utilizing #meded, #Feedback hashtags). Via this process, a list of 88 key papers was identified on the topic of feedback in medical education. After compiling these papers, the authorship group engaged in a modified Delphi approach to build consensus on the top eight papers on feedback. These papers were deemed essential by the authors and have been summarized with respect to their relevance to junior faculty members and to faculty developers. In this manuscript, we present eight key papers addressing feedback in medical education with discussions and applications for junior faculty members and faculty developers. This list of articles that can serve to help junior clinician educators grow in their ability to give effective feedback and also serve as resources upon which senior faculty can design the faculty development sessions.

Simulation-based Remediation in Emergency Medicine Residency Training: A Consensus Study.

INTRODUCTION: Resident remediation is a pressing topic in emergency medicine (EM) training programs. Simulation has become a prominent educational tool in EM training and been recommended for identification of learning gaps and resident remediation. Despite the ubiquitous need for formalized remediation, there is a dearth of literature regarding best practices for simulation-based remediation (SBR). METHODS: We conducted a literature search on SBR practices using the terms "simulation," "remediation," and "simulation based remediation." We identified relevant themes and used them to develop an open-ended questionnaire that was distributed to EM programs with experience in SBR. Thematic analysis was performed on all subsequent responses and used to develop survey instruments, which were then used in a modified two-round Delphi panel to derive a set of consensus statements on the use of SBR from an aggregate of 41 experts in simulation and remediation in EM. RESULTS: Faculty representing 30 programs across North America composed the consensus group with 66% of participants identifying themselves as simulation faculty, 32% as program directors, and 2% as core faculty. The results from our study highlight a strong agreement across many areas of SBR in EM training. SBR is appropriate for a range of deficits, including procedural, medical knowledge application, clinical reasoning/decision-making, communication, teamwork, and crisis resource management. Simulation can be used both diagnostically and therapeutically in remediation, although SBR should be part of a larger remediation plan constructed by the residency leadership team or a faculty expert in remediation, and not the only component. Although summative assessment can have a role in SBR, it needs to be very clearly delineated and transparent to everyone involved. CONCLUSION: Simulation may be used for remediation purposes for certain specific kinds of competencies as long as it is carried out in a transparent manner to all those involved.

Curated Collections for Educators: Five Key Papers about Residents as Teachers Curriculum Development.

The Accreditation Council for Graduate Medical Education (ACGME) requires residency programs to prepare residents to teach and assess medical students and other learners. In order to achieve this, many programs develop formal residents as teachers (RAT) curricula. Medical educators may seek the guidance of previously published literature during the development of RAT programs at their institutions. The authors sought to identify key articles published on the subject of RAT programs over the last 10 years. The authors utilized a formal literature search with the help of a medical librarian and identified additional articles from virtual discussions among the author group and an open call for articles on Twitter using the hashtag #MedEd. Virtual discussions occurred within an online community of practice, the Academic Life in Emergency Medicine (ALiEM) Faculty Incubator. The lead author conducted a four-round modified Delphi process among the author group in order to narrow the broad article list to five key articles on RAT programs. The authors summarize each article and provide considerations for junior faculty as well as faculty developers. Curriculum development and program evaluation should utilize established frameworks and evidence-based approaches. The papers identified by this Delphi process will help faculty use best practices when creating or revising new RAT curriculum. In addition, faculty tasked with guiding junior faculty in this process or creating faculty development programs around curriculum development will find these articles to be a great resource for building content.