Creation of a National Emergency Medicine Medical Education Journal Club.

Background There are a relatively limited number of emergency medicine (EM) medical education (MedEd) fellowships with few trainees at each program, creating barriers to local collaboration and networking. While best practices for developing MedEd journal clubs exist, there has not been an established national EM MedEd journal club. To address this need, we created a national journal club, the Council of Residency Directors (CORD) MedEd Journal Club (MEJC), to facilitate collaboration and networking opportunities by providing a synchronous online journal club. Objectives Our primary objective was to create a network for collaboration across geographical barriers to form a virtual community of practice (CoP) around the shared domain of evidence-based MedEd. Our secondary objective was to improve MedEd fellows' knowledge, skills, and attitudes surrounding MedEd research. Tertiary objectives included (1) broadening fellow exposure to key topics within MedEd, (2) describing how to develop scholarly work within MedEd, and (3) filling a perceived need for building a national MedEd virtual CoP. Curricular design The concept and objectives of the CORD MEJC were introduced to fellows and fellowship directors through a national listserv in March of 2022. Fellows volunteered to lead virtual sessions via Zoom on a monthly basis. Session fellow leaders independently chose the topics and were asked to submit two to three journal club articles discussing the topic at least two weeks in advance of each session. No topics were repeated throughout the academic year.  Impact/effectiveness Our quality improvement survey results indicated that the CORD MEJC is meeting its primary and secondary objectives. Survey results will be utilized as part of a continuous quality improvement initiative to enhance our program structure and curricula for the 2023-2024 academic year.

Development of entrustable professional activities for emergency medicine medical education fellowships: A modified Delphi study.

Background: It is essential that medical education (MedEd) fellows achieve desired outcomes prior to graduation. Despite the increase in postgraduate MedEd fellowships in emergency medicine (EM), there is no consistently applied competency framework. We sought to develop entrustable professional activities (EPAs) for EM MedEd fellows. Methods: From 2021 to 2022, we used a modified Delphi method to achieve consensus for EPAs. EM education experts generated an initial list of 173 EPAs after literature review. In each Delphi round, panelists were asked to make a binary choice of whether to include the EPA. We determined an inclusion threshold of 70% agreement a priori. After the first round, given the large number of EPAs meeting inclusion threshold, panelists were instructed to vote whether each EPA should be included in the "20 most important" EPAs for a MedEd fellowship. Modifications were made between rounds based on expert feedback. We calculated descriptive statistics. Results: Seventeen experts completed four Delphi rounds each with 100% response. After Round 1, 87 EPAs were eliminated and two were combined. Following Round 2, 46 EPAs were eliminated, seven were combined, and three were included in the final list. After the third round, one EPA was eliminated and 13 were included. After the fourth round, 11 EPAs were eliminated. The final list consisted of 16 EPAs in domains of career development, education theory and methods, research and scholarship, and educational program administration. Conclusions: We developed a list of 16 EPAs for EM MedEd fellowships, the first step in implementing competency-based MedEd.

Narrative medicine workshops for emergency medicine residents: Effects on empathy and burnout.

Background: Emergency medicine (EM) residents face unique affective challenges and barriers to interpersonal connection in their clinical environment which may contribute to decreased empathy and increased burnout. Narrative medicine (NM) might address these barriers and has had beneficial impacts in various populations but has never been studied in EM residents. In this study, we sought to evaluate the effect of NM workshops on burnout and empathy and to assess resident perceptions of the workshops. Methods: We performed a quasi-experimental study at two EM residencies from June to October 2020. Residents at the intervention site participated in two NM workshops led by EM faculty that were composed of a close reading of a literary text, reflective writing, and group discussion. Residents were asked to complete the abbreviated Interpersonal Reactivity Index (IRI) and a single-item burnout measure pre- and postintervention. We fitted linear regression models to IRI subscores; we treated burnout as an ordinal variable and fitted a conditional logistic regression model. Residents completed a postintervention survey that we analyzed using summary statistics. Results: A total of 46.7% of control (28/60) and 100% of intervention (48/48) residents responded (n = 76). While all respondents demonstrated worsening burnout with time (p = 0.001), residents at the intervention site exhibited less severe increases (interaction p < 0.001). Empathy remained unchanged. A total of 50% of intervention residents (24/48) responded to the postintervention survey; most (n = 20, 83.3%) agreed that the workshops should be a standard part of EM didactics. Conclusions: These findings establish the feasibility and desirability of NM in residency education and offers a model for EM-centered narrative workshops. Additionally, while our outcomes are limited, we found that exposure to an NM curriculum may be protective against worsening burnout.

The test developer's dilemma: Evaluating the balance of feasibility and empiric performance of test development techniques for repeated written assessments.

PURPOSE: Written assessments face challenges when administered repeatedly, including resource-intensive item development and the potential for performance improvement secondary to item recall as opposed to understanding. This study examines the efficacy of three-item development techniques in addressing these challenges. METHODS: Learners at five training programs completed two 60-item repeated assessments. Items from the first test were randomized to one of three treatments for the second assessment: (1) Verbatim repetition, (2) Isomorphic changes, or (3) Total revisions. Primary outcomes were the stability of item psychometrics across test versions and evidence of item recall influencing performance as measured by the rate of items answered correctly and then incorrectly (correct-to-incorrect rate), which suggests guessing. RESULTS: Forty-six learners completed both tests. Item psychometrics were comparable across test versions. Correct-to-incorrect rates differed significantly between groups with the highest guessing rate (lowest recall effect) in the Total Revision group (0.15) and the lowest guessing rate (highest recall effect) in the Verbatim group (0.05), p = 0.01. CONCLUSIONS: Isomorphic and total revisions demonstrated superior performance in mitigating the effect of recall on repeated assessments. Given the high costs of total item revisions, there is promise in exploring isomorphic items as an efficient and effective approach to repeated written assessments.[Box: see text].

Is it worth it? A qualitative analysis of the impact of medical education fellowships on careers.

Objectives: Medical education fellowships provide training in teaching, assessment, educational program administration, and scholarship. The longitudinal impact of this training is unknown. The objective of this study was to explore the impact of medical education fellowships on the careers of graduates. Methods: The authors performed a qualitative study with a constructivist-interpretivist paradigm using semistructured interviews in 2021. The authors used a purposeful randomized stratified sampling strategy of graduates to ensure diversity of representation (gender, region, fellowship duration, and career stage). Two researchers independently analyzed interview transcriptions using a modified grounded theory approach. Results: The authors interviewed 10 graduates and identified three overarching concepts: motivations for pursuing fellowship, benefits of training, and drivers of career development. Graduates sought training because of their desire for growth and career preparation and at the advice of mentors. Fellowships provided knowledge and skills in a structured learning environment, supported by mentors and a collaborative community. Fellowship training shaped the careers of graduates by increasing their self-efficacy, enhancing their outcome expectations, refining their goals, and influencing their professional identity formation. They acquired expertise that prepared them for jobs, developed credibility, felt competitive in the job market, anticipated successful promotion, reached for greater goals, broadened their educational worldview, and evolved their professional identity as a result of fellowship training. Conclusions: Fellowship training in medical education provides knowledge and skills, a structured learning environment, and important relationships that shape the careers of graduates by impacting their self-efficacy, outcome expectations, goal creation, and professional identity formation.

A workforce study of emergency medicine medical education fellowship directors: Describing roles, responsibilities, support, and priorities.

Introduction: Despite emergency medicine (EM) medical education fellowships increasing in number, the position of the medical education fellowship director (FD) remains incompletely defined. The goal of this study was to characterize the roles, responsibilities, support, and priorities for medical education FDs. Methods: We adapted and piloted an anonymous electronic survey consisting of 31 single-answer, multiple-answer, and free-response items. The survey was distributed to FDs via listserv and individual emails from a directory compiled from multiple online resources. We used descriptive statistics to analyze data from items with discrete answer choices. Using a constructivist paradigm, we performed a thematic analysis of free-response data. Results: Thirty-four medical education FDs completed the survey, resulting in a response rate of 77%. Thirty-eight percent of respondents were female. Fifty-three percent earned master's degrees in education and 35% completed a medical education fellowship. Most respondents held other education leadership roles including program director (28%), associate/assistant program director (28%), and vice chair (25%). Sixty-three percent received support in their role, including clinical buy-down (90%), administrative assistants (55%), and salary (5%). There was no difference (χ2 [2, n = 32] = 1.77, p = 0.41) between availability of support and type of hospital (community, university, or public hospital). Medical education FDs dedicated a median of 12 h per month to fellowship responsibilities, include education (median 35% of time), program administration (25%), research mentorship (15%), and recruitment (10%). Medical education FDs describe priorities that can be categorized into three themes related to fellows, fellowship, and institution. Conclusion: This study provides insight into the current position and experience of medical education FDs. The results can clarify the role and responsibilities of FDs as the demand for medical education FDs increases.

Racial Bias on the Emergency Medicine Standardized Letter of Evaluation.

Background: Studies on components of residency applications have shown evidence of racial bias. The Standardized Letter of Evaluation (SLOE) is an assessment measure for emergency medicine (EM) residency applications and, as more specialties opt to use SLOEs in place of narrative letters of recommendation, understanding bias on standardized assessments is essential. Objective: To determine whether there is a difference in rankings on the EM SLOE between underrepresented in medicine (UIM) and non-UIM applicants, White and non-White applicants, and to examine whether differences persist after controlling for other characteristics. Methods: The sample was drawn from medical students who applied to EM residency at the study institution in 2019. We compared rankings between UIM and non-UIM students and between students of each individual race/ethnicity and White students, after controlling for United States Medical Licensing Examination Step scores, Alpha Omega Alpha status, type of school (US MD, US DO, internation medical graduate), Medical Student Performance Evaluation class percentile, affiliated program vs visiting clerkship SLOE, gender and the interaction of race/ethnicity and gender, and adjusted for students submitting multiple SLOEs, using ordinal regression. Results: There were 1555 applicants to the study institution in 2019; 1418 (91.2%) had a SLOE and self-identified race/ethnicity. After controlling for applicant characteristics, non-UIM students were significantly more likely to be ranked higher than UIM students on "Rank Against Peers," (OR 1.46, 95% CI 1.03-2.07) and Grade (OR 1.46, 95% CI 1.05-2.04). Conclusions: Analysis of EM SLOEs submitted to our institution demonstrates racial bias on this standardized assessment tool, which persists after controlling for other performance predictors.

Growth of for-profit involvement in emergency medicine graduate medical education and association between for-profit affiliation and resident salary.

Background: Following projections of an emergency medicine (EM) physician oversupply, the growth of EM residency programs affiliated with for-profit hospitals has been subject to increased attention and speculation. However, essentially no literature exists regarding these programs. Resident pay is one area where these programs could differ from nonprofit-affiliated programs, as investor obligations could make for-profit corporations more likely to reduce resident salaries to increase profit margins. Here, we aim to quantify the growth of EM for-profit affiliated residency programs from 2001-2021 and determine if PGY1 salaries differ between these program types. Methods: Medicare and ACGME accreditation data were used to determine the profit status of hospitals affiliated with EM residency programs. ACGME new accreditation data from 2001-2021 were used to quantify the growth of both for-profit and nonprofit affiliated programs over this period. We searched program websites and called programs to determine 2021-2022 PGY1 salary. Multiple regression was used to model the relationship between profit status and salary using program characteristic covariates to control for confounding variables. Results: The number of EM programs increased from 117 to 276 from 2001-2021 while the number of for-profit affiliated EM residency programs increased from 1 to 29 during this period. Most (85.7%, [24/29]) for-profit affiliated programs were accredited from 2016-2021. Mean for-profit affiliated program salary ($55,658, n  = 24) was $3840 lower than mean nonprofit affiliated program salary ($59,498, n  = 203). For-profit affiliation was a significant predictor of lower 2021-2022 PGY1 salary after controlling for other program characteristics using multiple regression ( ß  = -1919.88, P = 0.010). Conclusions: We found a substantial growth of newly ACGME accredited for-profit affiliated EM residency programs from 2016-2021. We also found for-profit affiliated programs pay lower PGY1 salaries than nonprofit-affiliated programs after controlling for potential confounding variables, which suggests more oversight over the salary determination process could be necessary to prevent resident underpayment.

Quantifying For-Profit Outcomes in GME: A Multispecialty Analysis of Board Certifying Examination Pass Rates in For-Profit Affiliated Residency Programs.

Background: The number of for-profit hospitals has increased in the United States, but their role in and outcomes for graduate medical education (GME) are unclear. Objectives: To describe for-profit involvement in internal medicine (IM), general surgery (GS), and pediatrics GME by quantifying change in for-profit affiliated residency programs and comparing for-profit and nonprofit affiliated program board certifying examination pass rates. Methods: We used Accreditation Council for Graduate Medical Education and Medicare data to quantify for-profit prevalence in IM, GS, and pediatrics GME from 2001 to 2021. We used public pass rate data from the American Board of Surgeons (2017-2019; n=242 programs; 6562 examinees), American Board of Internal Medicine (2018-2020; n=465 programs; 23 922 examinees), and American Board of Pediatrics (2018-2020; n=202 programs; 9819 examinees) to model the relationship between profit status and pass rate within each specialty and across specialties combined using linear regression. Results: The proportion of for-profit affiliated residency programs increased 400.0% in IM, 334.4% in GS, and 23.2% in pediatrics from 2001 to 2021. Bivariate linear regression revealed significantly lower pass rate in for-profit affiliated programs in IM ß =-7.73, P<.001), pediatrics (ß =-14.6, P<.001), and the 3 specialties combined (ß =-5.45, P<.001). Upon multiple regression with addition of program characteristic covariates, this relationship remained significant in pediatrics (ß =-10.04, P=.006). Conclusions: The proportion of for-profit affiliated residency programs has increased in IM, GS, and pediatrics from 2001 to 2021. After controlling for covariates, for-profit affiliated programs were associated with lower board examination pass rates in pediatrics with no association in IM, GS, or the combined measure.

The impact of COVID-19 restrictions on participant enrollment in the PREPARE trial.

Background: At the initiation of the COVID-19 pandemic, restrictions forced researchers to decide whether to continue their ongoing clinical trials. The PREPARE (Pragmatic Randomized Trial Evaluating Pre-Operative Alcohol Skin Solutions in Fractured Extremities) trial is a pragmatic cluster-randomized crossover trial in patients with open and closed fractures. PREPARE was enrolling over 200 participants per month at the initiation of the pandemic. We aim to describe how the COVID-19 research restrictions affected participant enrollment. Methods: The PREPARE protocol permitted telephone consent, however, sites were obtaining consent in-person. To continue enrollment after the initiation of the restrictions participating sites obtained ethics approval for telephone consent scripts and the waiver of a signature on the consent form. We recorded the number of sites that switched to telephone consent, paused enrollment, and the length of the pause. We used t-tests to compare the differences in monthly enrollment between July 2019 and November 2020. Results: All 19 sites quickly implement telephone consent. Fourteen out of nineteen (73.6%) sites paused enrollment due to COVID-19 restrictions. The median length of enrollment pause was 46.5 days (range, 7-121 days; interquartile range, 61 days). The months immediately following the implementation of restrictions had significantly lower enrollment. Conclusion: A pragmatic design allowed sites to quickly adapt their procedures for obtaining informed consent via telephone and allowed for minimal interruptions to enrollment during the pandemic.

A Systematic Review of Pain Management Education in Graduate Medical Education.

Background: Despite the importance of pain management across specialties and the effect of poor management on patients, many physicians are uncomfortable managing pain. This may be related, in part, to deficits in graduate medical education (GME). Objective: We sought to evaluate the methodological rigor of and summarize findings from literature on GME interventions targeting acute and chronic non-cancer pain management. Methods: We conducted a systematic review by searching PubMed, MedEdPORTAL, and ERIC (Education Resources Information Center) to identify studies published before March 2019 that had a focus on non-cancer pain management, majority of GME learners, defined educational intervention, and reported outcome. Quality of design was assessed with the Medical Education Research Study Quality Instrument (MERSQI) and Newcastle-Ottawa Scale-Education (NOS-E). One author summarized educational foci and methods. Results: The original search yielded 6149 studies; 26 met inclusion criteria. Mean MERSQI score was 11.6 (SD 2.29) of a maximum 18; mean NOS-E score was 2.60 (SD 1.22) out of 6. Most studies employed a single group, pretest-posttest design (n=16, 64%). Outcomes varied: 6 (24%) evaluated reactions (Kirkpatrick level 1), 12 (48%) evaluated learner knowledge (level 2), 5 (20%) evaluated behavior (level 3), and 2 (8%) evaluated patient outcomes (level 4). Interventions commonly focused on chronic pain (n=18, 69%) and employed traditional lectures (n=16, 62%) and case-based learning (n=14, 54%). Conclusions: Pain management education research in GME largely evaluated chronic pain management interventions by assessing learner reactions or knowledge at single sites.

Untold stories: Emergency medicine residents' experiences caring for diverse patient populations.

OBJECTIVES: The Accreditation Council for Graduate Medical Education expects specialties to teach and assess proficiency in culturally competent care. However, little guidance has emerged to achieve these goals. Clinical training within socioeconomically disparate settings may provide an experiential learning opportunity. We sought to qualitatively explore resident experiences working in the generic clinical learning environments (i.e., exposure to socioeconomically diverse patients across different training sites) and how it shapes cultural competency-related skill development. METHODS: Residents were recruited from emergency medicine (EM) programs. We used purposeful sampling across all postgraduate years and elicited experiences related to working at the different sites related to cultural identity, frustrating patient encounters, vulnerable populations, and development of health disparities/social determinants of health knowledge. Individual structured interviews were conducted via phone between May and December 2016. Interviews were audiotaped, transcribed, anonymized, and analyzed using systematic and iterative coding methods. RESULTS: Twenty-four interviews revealed three main themes. EM residents' experiences caring for patients across sites shaped their understanding of: (1) potential patient attributes that affected the clinical encounter, (2) difficulties in building rapport had adverse effect on the clinical evaluation, and (3) residency program and training experiences shaped their clinical preparedness and willingness to work in underserved areas. CONCLUSION: Assessing the impact disparate clinical setting exposures have on trainees' preparedness to care for socioeconomically diverse patients can provide valuable insight for medical educators into barriers and facilitators to delivering optimal learning and patient care. Participants provided a breadth of stories illuminating their real-world consciousness and competency with meeting the needs of diverse populations and their access to varied educational outlets to grapple with the disparities they observed. More research is needed to uncover effective strategies to help residents thrive and feel more prepared to care for diverse populations.

Outcome assessment of medical education fellowships in emergency medicine.

OBJECTIVES: Medical education fellowships in emergency medicine (EM) provide training in teaching, assessment, educational program administration, and scholarship. The longitudinal impact of this training is unknown. Our objective was to characterize the career outcomes of medical education fellowship graduates. METHODS: We solicited curriculum vitae (CV) from graduates of U.S. EM education fellowships by email. We abstracted data from CVs with a standard instrument that included program characteristics, employment history, leadership positions, awards, and scholarly productivity. We calculated and reported descriptive statistics. RESULTS: A total of 71 of 91 (78%) graduates participated. Thirty-three completed a 1-year fellowship and 38 completed a 2-year fellowship. Nineteen (27%) completed an advanced degree during fellowship. Median (range) graduation year was 2016 (1997-2020). The majority, 63 of 71 (89%), work in an academic setting. Graduates held leadership positions in continuing medical education, graduate medical education, and undergraduate medical education. Forty-eight (68%) served on national medical education committees. The mean ± SD number of national medical education awards was 1.27 ± 2.03. The mean ± SD number of national medical education presentations was 7.63 ± 10.83. Graduates authored a mean ± SD of 3.63 ± 5.81 book chapters and a mean ± SD of 4.99 ± 6.17 peer-reviewed medical education research publications. Ten (14%) served on journal editorial boards, 34 (48%) were journal reviewers, and 31 (44%) had received a medical education grant. CONCLUSION: EM medical education fellowship graduates are academically productive and hold education leadership positions.

Validity Evidence for the Emergency Medicine Standardized Letter of Evaluation.

BACKGROUND: The standardized letter of evaluation (SLOE) is the application component that program directors value most when evaluating candidates to interview and rank for emergency medicine (EM) residency. Given its successful implementation, other specialties, including otolaryngology, dermatology, and orthopedics, have adopted similar SLOEs of their own, and more specialties are considering creating one. Unfortunately, for such a significant assessment tool, no study to date has comprehensively examined the validity evidence for the EM SLOE. OBJECTIVE: We summarized the published evidence for validity for the EM SLOE using Messick's framework for validity evidence. METHODS: A scoping review of the validity evidence of the EM SLOE was performed in 2020. A scoping review was chosen to identify gaps and future directions, and because the heterogeneity of the literature makes a systematic review difficult. Included articles were assigned to an aspect of Messick's framework and determined to provide evidence for or against validity. RESULTS: There have been 22 articles published relating to validity evidence for the EM SLOE. There is evidence for content validity; however, there is a lack of evidence for internal structure, relation to other variables, and consequences. Additionally, the literature regarding response process demonstrates evidence against validity. CONCLUSIONS: Overall, there is little published evidence in support of validity for the EM SLOE. Stakeholders need to consider changing the ranking system, improving standardization of clerkships, and further studying relation to other variables to improve validity. This will be important across GME as more specialties adopt a standardized letter.

Affective, cognitive, and behavioral outcomes from a resident personal finance curriculum pilot project.

BACKGROUND: The transition to residency marks a significant shift in the financial circumstances of medical trainees. Despite existing resources, residents still cite uncertainty in this domain. A personal finance curriculum is needed to close this educational gap and improve the financial well-being of trainees. METHODS: The curriculum was developed using Kern's framework. Two needs assessments informed the consensus development of goals and objectives, educational strategies, and assessments. Course material was hosted online for asynchronous review and complemented by two 1-hour webinars. The curriculum was piloted at one institution. Participants completed (1) knowledge assessments before and after the intervention, (2) a survey of reactions to the curriculum, and (3) an assessment of financial behavioral changes after the intervention. RESULTS: Thirty-seven residents (37/49, 76%) enrolled in the curriculum. Among participants, 20 (20/37, 54%) completed the curriculum. Most participants agreed or strongly agreed that the content was relevant (20/20, 100%) and clearly presented (19/20, 95%) and that they would recommend the curriculum to other residents (20/20, 100%). Performance on the knowledge assessment improved 21% after the intervention (mean ± SD = pretest 57% ± 17%, posttest = 78% ± 12%; p < 0.001). Most residents (17/20, 85%) also reported behavioral changes including setting new financial goals (12/20, 60%), taking new action toward financial planning (11/20, 55%), and changing financial habits (6/20, 30%). There were no direct financial costs incurred in the implementation of this pilot. CONCLUSIONS: This is a successful pilot of a virtual personal finance curriculum with positive outcomes data. Addressing this problem at scale will require buy-in from educators around the country to deliver this information to residents that may not otherwise seek it out. Future study should assess curricular outcomes in other settings and the durability of acquired knowledge and behavioral changes over time.

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.

Identifying the Gaps: Needs Assessment to Guide Development of a Dedicated Toxicology Curriculum for Emergency Medicine Residents.

INTRODUCTION: The American Board of Emergency Medicine identifies medical toxicology as an essential curricular element for emergency medicine (EM) residencies; however, access to medical toxicology education varies widely by institution. We hypothesized that EM residents are uncomfortable with core toxicology content and would be interested in  a dedicated toxicology curriculum. METHODS: An electronic needs assessment survey developed by experts in EM and medical toxicology was sent to residents and program leadership at nine EM programs participating in the Emergency Medicine Education Research Alliance (EMERA), a geographically diverse sampling of academic EM residency programs. We queried the presence of a current toxicology curriculum, interest in a dedicated toxicology curriculum, and comfort with core toxicology concepts for board examinations and in clinical practice.  RESULTS: A total of 148 residents and 8 faculty leadership completed the survey.  Only 29% of resident respondents felt comfortable with toxicology concepts, and only 66% of respondents reported access to a toxicology curriculum. Of those without a known toxicology curriculum, most were interested in a formal curriculum. Faculty respondents reported 6/8 programs offered a toxicology curriculum. Faculty at the two programs without a formal curriculum expressed interest in a dedicated curriculum. CONCLUSIONS: Emergency medicine residents remain uncomfortable with the core toxicology content in clinical practice. The majority of residents without a known toxicology curriculum would be interested in a dedicated toxicology curriculum.