Gender differences in emergency medicine resident assessment: A scoping review.

Background: Growing literature within postgraduate medical education demonstrates that female resident physicians experience gender bias throughout their training and future careers. This scoping review aims to describe the current body of literature on gender differences in emergency medicine (EM) resident assessment. Methods: We conducted a scoping review which adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. We included research involving resident physicians or fellows in EM (population and context), which focused on the impact of gender on assessments (concept). We searched seven databases from the databases' inception to April 4, 2022. Two reviewers independently screened citations, completed full-text review, and abstracted data. A third reviewer resolved any discrepancies. Results: A total of 667 unique citations were identified; 10 studies were included, and all were conducted within the United States. Four studies reported differences in EM resident assessments attributable to gender within workplace-based assessments (qualitative comments and quantitative scores) by both attending physicians and nonphysicians. Six studies investigating clinical competency committee scores, procedural scores, and simulation-based assessments did not report any significant differences attributable to gender. Conclusions: This scoping review found that gender bias exists within EM resident assessment most notably at the level of narrative comments typically received via workplace-based assessments. As female EM residents receive higher rates of negative or critical comments and discordant feedback documented on assessment, these findings raise concern about added barriers female EM residents may face while progressing through residency and the impact on their clinical and professional development.

Experiences, perspectives, and advice for using virtual interviews in post-graduate trainee selection: a national survey of CCFP (EM) program directors.

OBJECTIVE: Due to the COVID pandemic, restrictions were put in place mandating that all residency interviews be transitioned to a virtual format. Canadian CCFP(EM) programs were among the first to embark on this universal virtual interview process for resident selection. Although there have been several recent publications suggesting best practice guidelines for virtual interviews in trainee selection, pragmatic experiences and opinions from Program Directors (PDs) are lacking. This study aimed to elicit the experiences and perspectives of CCFP(EM) PDs after being amongst the first to conduct universal virtual interviews in Canada. METHODS: A 17-item online survey was created and distributed to all CCFP(EM) PDs (n = 17). It explored the virtual interview format employed, perceived advantages and disadvantages of a virtual configuration, confidence in determining a candidate's rank order, and PD preference for employing a virtual interview format in the future. It also elicited practical advice to conduct a smooth and successful virtual interview day. RESULTS: The survey response rate was 76.5% (13/17). Nine respondents (69.2%) agreed that the virtual interview format enabled them to confidently determine a candidate's rank order. With respect to preference for future use of virtual interviews, 23.1% agreed, 38.5% disagreed and 38.5% neither agreed nor disagreed. Inductive thematic analysis of free text responses revealed themes related to virtual interview advantages (time, financial, and resource costs), disadvantages (difficulty promoting smaller programs, getting a 'feel' for candidates and assessing their interpersonal skills), and practical tips to facilitate virtual interview processes. CONCLUSION: Once restrictions are lifted, cost-saving advantages must be weighed against suggested disadvantages such as showcasing program strengths and assessing interpersonal skills in choosing between traditional and virtual formats. Should virtual interviews become a routine part of resident selection, the advice suggested in this study may be considered to help optimize a successful virtual interview process.

RéSUMé: OBJECTIF: En raison de la pandémie de COVID-19, des restrictions ont été mises en place pour obliger toutes les entrevues de résidence à passer à un format virtuel. Les programmes canadiens CCMF(MU) ont été parmi les premiers à se lancer dans ce processus universel d'entrevue virtuelle pour la sélection des résidents. Bien qu'il y ait eu plusieurs publications récentes suggérant des lignes directrices de pratiques exemplaires pour les entrevues virtuelles dans la sélection des stagiaires, les expériences et les opinions pragmatiques des directeurs de programme (DP) font défaut. Cette étude visait à recueillir les expériences et les points de vue des DP du CCMF(MU) après avoir été parmi les premiers à mener des entrevues virtuelles universelles au Canada. MéTHODES: Une enquête en ligne de 17 questions a été créée et distribuée à tous les DP du CCMF(MU) (n=17). Elle a exploré le format d'entretien virtuel employé, les avantages et inconvénients perçus d'une configuration virtuelle, la confiance dans la détermination de l'ordre de classement d'un candidat, et la préférence des DP pour l'emploi d'un format d'entretien virtuel à l'avenir. Elle a également permis de recueillir des conseils pratiques pour mener à bien une journée d'entretiens virtuels. RéSULTATS: Le taux de réponse à l'enquête a été de 76,5 % (13/17). Neuf répondants (69,2 %) ont convenu que le format d'entretien virtuel leur a permis de déterminer avec confiance l'ordre de classement d'un candidat. En ce qui concerne la préférence pour l'utilisation future des entrevues virtuelles, 23,1 % étaient d'accord, 38,5 % étaient en désaccord et 38,5 % n'étaient ni d'accord ni en désaccord. L'analyse thématique inductive des réponses en texte libre a révélé des thèmes liés aux avantages des entretiens virtuels (coûts en temps, en argent et en ressources), aux inconvénients (difficulté à promouvoir les petits programmes, à se faire une idée des candidats et à évaluer leurs compétences interpersonnelles) et aux conseils pratiques pour faciliter les processus d'entretien virtuel. CONCLUSION: Une fois les restrictions levées, les avantages liés à la réduction des coûts doivent être mis en balance avec les inconvénients suggérés, tels que la mise en valeur des points forts du programme et l'évaluation des compétences interpersonnelles, lors du choix entre les formats traditionnels et virtuels. Si les entretiens virtuels devaient devenir un élément de routine dans la sélection des résidents, les conseils suggérés dans cette étude pourraient être pris en compte pour aider à optimiser un processus d'entretien virtuel réussi.

Resident recruitment in the COVID-19 era: factors influencing program ranking by residents applying to a family medicine-emergency medicine training program.

OBJECTIVE: The COVID-19 pandemic has created numerous unique challenges for the recruitment of prospective trainees. Cancellation of visiting electives and in-person interviews created challenges for programs to showcase elements that have been shown to influence applicants' program selection, including geographical considerations and program collegiality. Novel strategies have been recommended and employed to facilitate candidate recruitment, but it is unclear how influential such strategies are on candidates' program ranking. It is also unclear what factors influence program selection among CCFP(EM) candidates. We sought to evaluate the impact of novel recruitment strategies on applicants' ranking of the University of Ottawa CCFP(EM) program and determine factors which were most influential in applicants' first-choice program selection. METHODS: An online survey was distributed to all candidates (n = 127) who applied to the University of Ottawa CCFP(EM) program. The survey instrument included 33 items. Respondents were asked to rate on a 3-point scale how influential specific recruitment strategies were on their ranking of our program and the influence of different training factors on their selection of first-choice program. RESULTS: The survey response rate was 27% (34/127). Recruitment strategies rated as most positively influential included virtual one-on-one meetings with program directors (100%), virtual Q&A sessions (77.8%), virtual communication with chief residents (73.3%), and a mailed personalized recruitment package (72.2%). The top factors influencing applicants' first-choice program selection included: collegiality between faculty and residents (96.4%); level of responsibility given to residents (96.4%); support within the program (96.4%); and procedural opportunities within the program (96.3%). CONCLUSION: Facilitating virtual personal interaction with program leadership is highly influential in how CCFP(EM) candidates rank programs. CCFP(EM) candidates value characteristics of a training program over the geographical location and available amenities. Program leaders should consider these findings when recruiting prospective candidates.

RéSUMé: OBJECTIF: La pandémie de COVID-19 a créé de nombreux défis uniques pour le recrutement de stagiaires potentiels. L'annulation des stages optionnels et des entrevues en personne a créé des difficultés pour les programmes de présenter des éléments qui se sont avérés influer sur la sélection des programmes des candidats, y compris les considérations géographiques et la collégialité du programme. De nouvelles stratégies ont été recommandées et utilisées pour faciliter le recrutement des candidats, mais on ne sait pas dans quelle mesure ces stratégies influent sur le classement des programmes des candidats. On ne sait pas non plus quels facteurs influencent la sélection des programmes parmi les candidats au CCFP(EM). Nous avons cherché à évaluer l'impact de nouvelles stratégies de recrutement sur le classement des candidats du programme CCFP(EM) de l'Université d'Ottawa et à déterminer les facteurs qui ont eu le plus d'influence sur la sélection du programme de premier choix des candidats. MéTHODES: Un sondage en ligne a été distribué à tous les candidats (n = 127) qui ont postulé au programme CCFP(EM) de l'Université d'Ottawa. L'instrument d'enquête comprenait 43 points. Les répondants devaient évaluer sur une échelle de 3 points l'influence de stratégies de recrutement spécifiques sur leur classement de notre programme et l'influence de différents facteurs de formation sur leur choix du programme de premier choix. RéSULTATS: Le taux de réponse au sondage était de 27% (34/127). Les stratégies de recrutement jugées les plus influentes sont les réunions virtuelles en tête-à-tête avec les directeurs de programme (100%), les séances virtuelles de questions-réponses (77,8%), la communication virtuelle avec les chefs résidents (73,3%) et l'envoi par courrier d'un dossier de recrutement personnalisé (72,2%). Les principaux facteurs influençant le choix du programme de premier choix des candidats comprenaient: la collégialité entre le corps professoral et les résidents (96,4%); le niveau de responsabilité donné aux résidents (96,4%); le soutien au sein du programme (96,4%); et les possibilités de procédures au sein du programme (96,3%). CONCLUSION: Faciliter l'interaction virtuelle personnelle avec le leadership du programme a une grande influence sur la façon dont les candidats du CCFP(EM) classent les programmes. Les candidats CCFP(EM) valorisent les caractéristiques d'un programme de formation plutôt que à l'emplacement géographique et les commodités disponibles. Les chefs de programme devraient tenir compte de ces constatations lorsqu'ils recrutent des candidats éventuels.

Spontaneous subperiosteal orbital hematoma in a patient with chronic sinusitis.

Periorbital swelling is a common presentation to the emergency department (ED), and its etiology can range from benign to acutely vision-threatening. Orbital subperiosteal hematoma is a rare ED diagnosis that is typically associated with trauma, though can infrequently occur spontaneously in the setting of sudden elevations in cranial venous pressure, bleeding diathesis, and sinusitis. We present a case of a 55-year-old female with a history of chronic sinusitis who presented to the ED with a three-day history of left-sided periorbital swelling along with painful extraocular movements and markedly decreased visual acuity following a cross-country road trip through elevation. Contrast computed tomography scan of the orbits revealed a large extraconal collection in the subperiosteal space causing significant mass effect on the left globe, along with findings of diffuse sinonasal disease bilaterally. Intravenous antibiotics were started immediately and the patient underwent surgical incision and drainage of the subperiosteal space, where she was diagnosed with a spontaneous subperiosteal orbital hematoma secondary to chronic sinusitis. Within the literature, there are fewer than 20 case reports of orbital subperiosteal hematoma secondary to sinusitis. The purpose of this case report is to assist emergency physicians in considering the rare but potentially vision-threatening condition of spontaneous subperiosteal orbital hematoma within their differential diagnosis of patients with periorbital swelling and proptosis, as well as to provide an approach to management within the ED.

A novel transition to practice curriculum for CCFP(EM) programs.

We implemented a novel transition-to-practice curriculum incorporating four new processes to prepare CCFP(EM) residents for independent practice. These elements were: 1) explicit sequencing of competency progression; 2) establishment of coaching teams; 3) establishment of independent shifts; and 4) implementation of a transition-to-practice seminar series. Exit surveys of residents rated the new curriculum highly with 15/17 (88.2%) residents reporting they felt prepared for independent practice. All residents rated competency progression, coaching teams, independent shifts and transition-to-practice series favourably. This framework can be used by other 1-year enhanced skills or other fellowship programs to prepare their residents for independent practice.

RéSUMé: Nous avons mis en place un nouveau programme de transition vers la pratique qui intègre quatre nouveaux processus pour préparer les résidents du CCFP(EM) à la pratique indépendante. Ces éléments étaient : 1) l'enchaînement explicite de la progression des compétences ; 2) la mise en place d'équipes d'encadrement ; 3) la mise en place mise en place de quarts de travail indépendants ; et 4) la mise en œuvre d'une série de séminaires de transition vers la pratique. Les sondages de sortie des résidents ont donné une note élevée au nouveau programme avec 15/17 (88,2 %) les résidents déclarant qu'ils se sentaient prêts à pratiquer de façon indépendante. Tous les résidents ont accordé une note favorable à la progression des compétences, aux équipes d'encadrement, aux quarts de travail indépendants et à la transition vers la série de pratiques. Ce cadre peut être utilisé par d'autres programmes de perfectionnement des compétences d'un an ou d'autres programmes de bourses pour préparer leurs résidents à la pratique indépendante.

Exercise training improves myocardial tolerance to ischemia in male but not in female rats.

Acute exercise increases myocardial tolerance to ischemia-reperfusion (I-R) injury in male but not in female rat hearts, possibly due to a decreased heat shock protein 70 (Hsp70) response in the female hearts. This study examined whether repetitive exercise training would increase Hsp70 and myocardial tolerance to I-R injury in female rat hearts. Adaptations in myocardial manganese superoxide dismutase (MnSOD) and endothelial nitric oxide synthase (eNOS) were also assessed. Ten-week old male (M) and female (F) Sprague-Dawley rats (n = 40 total) exercise-trained for 14 wk; the last 8 wk consisted of running 1 h at 30 m/min (2% incline), 5 days/wk. Following training, left ventricle mechanical function (LVMF) was monitored for 30 min of reperfusion following 30 min of global ischemia (Langendorff procedure). Myocardial Hsp70 content was not different in M and F control groups, while increases were observed in both trained groups (M greater than F; P < 0.05). Although MnSOD content did not differ between groups, endothelial nitric oxide synthase (eNOS) levels were decreased in F, with no change in M, following training (P < 0.05). Hearts from control F demonstrated a greater recuperation of all indices of LVMF following I-R compared with control M hearts (P < 0.05). Hearts of trained M exhibited improved recovery of LVMF (left ventricular diastolic pressure, left ventricular end-diastolic pressure, +dP/dt, -dP/dt) during reperfusion compared with control M hearts (P < 0.05). In contrast, hearts of trained F did not show any change in recovery from I-R. Hence, exercise training is more beneficial to M than F in improving myocardial function following I-R injury.