An Asynchronous Curriculum: Learner Perspectives on Incorporating Asynchronous Learning Into In-Person and Virtual Emergency Residency Didactics.

Background  Didactic education in emergency medicine (EM) residencies has been impacted both by the advent of asynchronous learning and by the shift toward virtual, web-based conference education due to coronavirus disease 2019 (COVID-19). Studies have demonstrated the efficacy of asynchronous education, but few have explored resident opinions about how asynchronous and virtual modifications on conference impact their educational experience.  Objective This study aimed to evaluate resident perceptions of both asynchronous and virtual modifications to a historically in-person didactic curriculum. Methods This was a cross-sectional study of residents of a three-year EM program at a large academic center where a 20% asynchronous curriculum was implemented in January 2020. A questionnaire was administered online with questions assessing how residents perceived their didactic curriculum with regard to convenience, retention of information, work/life balance, enjoyability, and overall preference. Questions compared resident opinions of in-person vs. virtual learning, as well as how the substitution of one hour of asynchronous learning impacted residents' perception of their didactics. Responses were reported on a five-point Likert-type scale.  Results A total of 32 out of 48 residents (67%) completed the questionnaire. When virtual conference was compared to in-person conference, residents favored virtual conference with regard to convenience (78.1%), work-life balance (78.1%), and overall preference (68.8%). They favored in-person conference (40.6%) or felt that the modalities were equivalent (40.6%) with regard to retention of information and favored in-person conference with regard to enjoyability (53.1%). Residents felt that the addition of asynchronous learning to their curriculum increased subjective convenience, work-life balance, enjoyability, retention of information, and overall preference, regardless of whether synchronous conference was virtual or in-person. All 32 responding residents were interested in seeing the asynchronous curriculum continue. Conclusion EM residents value the addition of asynchronous learning to both in-person and virtual didactic curricula. Additionally, virtual conference was favored over in-person conference with regard to work/life balance, convenience, and overall preference. As social distancing restrictions continue to ease post-COVID-19 pandemic, EM residencies may consider adding or maintaining asynchronous or virtual components to their synchronous conference schedule as a means to support resident wellness.

Experiential Learning in Patient Safety: A Multi-Center Study Examining Emergency Medicine Residents' Situational Awareness of Hazards via Simulation.

Introduction The 2016 Clinical Learning Environment Review established that experiential patient safety curricula for residents are uncommon. Moreover, these curricula do not incorporate non-technical skills linked to safety, such as situational awareness (SA). We developed an in-situ patient safety simulation exercise incorporating core SA concepts and subsequently assessed exercise feasibility and acceptability, and measured residents' safety SA. Methods A simulation scenario and mock chart were designed, incorporating 16 patient safety hazards. Residents at two institutions reviewed the chart and had 10 minutes in an emergency department room with the simulated scenario to document identified hazards, followed by a facilitated debriefing. Pre- and post-exercise surveys were completed. We used regression analyses to compare exercise performance and survey responses by training year, and measures of proportional difference and association for survey responses. Results This study included 76 of 104 eligible residents (73.1%). Around 56.5% initially reported being comfortable identifying hazards. During the exercise, hazards requiring higher SA were identified less frequently. Senior residents identified more hazards (OR 2.26; 95%CI 1.56-3.28) (mean 8.28, SD1.45); 93.4% expressed satisfaction with the session, and residents reporting comfort increased significantly (89.5%, p<0.001). Conclusion In-situ simulation incorporating SA concepts feasibly provides experiential safety education and enhances resident comfort with safety issues. Visible hazards were often identified; those requiring information synthesis were usually missed, suggesting a need for developing more robust resident SA. While interns demonstrated the poorest performance, senior residents only identified 50% of errors, indicating that patient safety education enhancing SA should begin early and continue longitudinally.

Evaluation of a Hands-On Wrist Fracture Simulator for Fracture Management Training in Emergency Medicine Residents.

Background Fractures are common in the emergency department, and fracture management training poses certain challenges. Recent emergency medicine (EM) residency graduates feel only somewhat prepared to manage fractures. In this study, our objectives were to determine the effect of introducing a wrist fracture simulator (Sawbones®) to traditional EM fracture management education and to assess resident attitudes, comfort with fracture management, and perceptions of the simulator. Methodology This six-month prospective study involved postgraduate year one residents at two academic EM programs. For convenience, each residency was considered as one test group. One residency group was deemed the traditional group (n = 10), while the other was the intervention simulator group (n = 16). Identical traditional lectures and buddy splinting workshops were provided. The simulator group received supplemental training with the Sawbones® simulator. Groups were filmed using this simulator for fracture management before the teaching sessions and at six months. Grading utilized a 27-point scale, with a subscale covering reduction. Data were collected regarding attitudes, comfort with fracture management, and perceptions of the simulator. Results In total, 26 residents participated in the study. There was no significant difference between groups at six months in overall fracture management scores (traditional group: 15.8 ± 3.1; simulator group: 15.4 ± 3.9; p = 0.92). On the subscale of fracture reduction skills, the simulator group showed significant improvement (p = 0.0078), while the traditional training group did not (p = 0.065). Both groups reported satisfaction with the simulator, improved comfort, and knowledge of fracture management. Conclusions Fracture management is an essential competency, and prior research has shown that most graduating EM residents do not feel comfortable with these skills. All participating residents in this study struggled with adequate fracture management, even after the teaching session. Our study suggests that there is a benefit to supplementing traditional training with a fracture simulator.

"A sorely neglected field": A multisite study of self-reported humanities exposure among emergency medicine residents.

Background: The Association of American Medical Colleges has identified the humanities as fundamental to medical education across all specialties. Evidence from undergraduate medical education (UME) demonstrates the humanities' positive impacts on outcomes that could be relevant to patient care and trainee well-being in emergency medicine (EM) residency training. However, less is known about the humanities' role in graduate medical education (GME). Objectives: The objectives were to describe EM residents' self-reported exposure to the humanities and its relationship with their empathy, tolerance of ambiguity, and patient-centeredness, and to assess their attitudes toward the humanities in GME. Methods: This cross-sectional survey-based study was conducted at six U.S. EM residency programs in 2018-2019. Quantitative analyses included linear regressions testing for trends between humanities exposures and outcomes, adjusted for sex, year in training, and clustering within programs; adjunct analysis of free-text responses was performed using an exploratory constructivist approach to identify themes about views on the humanities' role in medicine. Results: Response rate was 54.8% (153/279). A total of 65% of respondents were male and 28.1% of respondents had a preceding humanities degree. Preceding humanities degree and current self-reported humanities exposure were positively associated with performance on empathy subscales (p = 0.02). Seventy-five percent (n = 114) of respondents agreed humanities are important in GME; free-text responses revealed perceived positive impacts of humanities on generating well-rounded clinicians and enhancing patient care. Conclusions: Engagement with the humanities may be associated with empathy among EM residents. Although the magnitude of associations was smaller than that seen in UME, this study demonstrates resident interest in humanities and suggests that extracurricular engagement with the humanities may be insufficient to prolong positive impacts seen in UME. Further research is needed to explore how to sustain these benefits through integration or addition of the humanities in existing GME curricula.

Medical student self-assessment as emergency medicine residency applicants.

BACKGROUND: Emergency medicine (EM) applicants are encouraged to consider their own "competitiveness" when deciding on the number of applications to submit. Program directors rank the Standardized Letter of Evaluation (SLOE) as the most important factor when reviewing an applicant. Accurate insight into how clinical performance is reflected on the SLOE could improve medical students' ability to gauge their own competitiveness. OBJECTIVE: This study aims to determine the accuracy of students' self-assessment by SLOE evaluation measures when compared to the SLOE completed by faculty after their EM clerkship. METHODS: Participants of this multicenter study included fourth-year medical students who had completed their EM clerkship and were applying to EM residency. Students completed a modified SLOE to reflect rankings they believed they would receive on their official SLOE. Additionally, students completed a survey assessing their knowledge of the SLOE, their perception of feedback during the clerkship, and their self-perceived competitiveness as an EM applicant. Correlation between the rankings on the student-completed SLOE and the official SLOE was analyzed using the Kendall correlation. RESULTS: Of the 49 eligible students, 42 (85.7%) completed the study. The correlation between scores on the student-completed and official SLOE were significantly low (r < 0.68) for each item. The majority of students agreed that they were satisfied by the quantity and quality of feedback they received (31/42, 73.8%). Few students agreed that they knew how many applications to submit to ensure a match in EM (7/42, 16.7%). CONCLUSION: This study demonstrates that students did not accurately predict their rankings on the official SLOE at the end of an EM rotation and had little insight into their competitiveness as an applicant. These findings highlight opportunities to mitigate the burden on students and programs caused by the increasing number of applications per applicant. Further research is needed as to whether strategies to increase insight into competitiveness are effective.