A Guide to the Medical School Curriculum Vitae.

Audience: Although this lecture is aimed at medical students, it can also be utilized for residents, fellows, and junior faculty. Background: The topic of teaching medical students about the fundamentals of creating a curriculum vitae (CV) is important because a CV serves as a record of scholastic and professional experiences.1 Thus, their CV will undoubtedly play a vital role in residency applications.2,3 Intentional instruction about the elements to incorporate in a CV are especially important for first-generation and underrepresented students in the medical field because they may not have had as much exposure to both the requirements of a residency application nor qualities of an effective CV. Educational Objectives: After this lecture, learners should be able to: 1) elaborate on the significance of a CV for medical students and discuss its purpose, 2) outline the elements that should and should not be included on a CV, 3) integrate knowledge gleaned from basic principles with provided examples to establish the foundation of their own CV. Educational Methods: A PowerPoint lecture was used to explain the purpose of a CV and the elements to include in a personal CV for medical students. The lecture took place via Zoom and was provided at no cost to all UCISOM medical students. Research Methods: Students were given a short survey after the session to assess their understanding of why it is important to create and maintain a CV, including an evaluation of their overall satisfaction with the lecture presentation. Results: All the respondents (n=10) found the workshop to be useful and enjoyed the ability to see student examples while 80% of the respondents (n=8) found their knowledge of CVs increased because of the session. On a Likert scale from 1-5, with a 1 indicating "very unconfident" and 5 indicating "very confident," 90% of respondents (n=9) indicated they are now confident or very confident in building or updating their CV after this session. Discussion: Overall, the educational content was found to be effective. Although the sample size from the survey was modest at best, we feel the survey data and comments from attendees during and after the session indicate the effectiveness of the content. From its initial implementation, we learned that this lecture can be given by any level of medical education professional (student, administrator, etc) due to the comprehensiveness of the presentation. We also learned that using video conferencing such as Zoom was an effective administration method but could also be replaced by in-person learning without much difficulty. Overall, we deem this presentation to be easy to administer, thorough, full of examples, and educationally effective. Topics: Curriculum vitae, CV, medical student, residency application, electronic residency application service, ERAS.

Trauma by Couch: A Case Report of a Massive Traumatic Retroperitoneal Hematoma.

The authors present the case of a 42-year-old male who was evaluated in a community hospital emergency department (ED) with right upper quadrant and flank pain after falling onto his couch. His evaluation included computed tomography (CT) of his abdomen with intravenous contrast that identified a large right retroperitoneal hematoma measuring an impressive 17 centimeters (cm) in length. The patient was transferred to a receiving trauma center. Upon arrival a focused assessment with sonography in trauma (FAST) ultrasound was obtained. The interpretation of the findings was complicated by distortion of his anatomy by the hematoma. The patient remained hemodynamically stable and was admitted for continued observation. He was ultimately discharged home in stable condition. This case report provides a concise overview of the approach to evaluating blunt abdominal trauma, imaging considerations, and a brief review of the management of retroperitoneal hematomas. Topics: Trauma, retroperitoneal hemorrhage, ultrasound, FAST, computed tomography, hepatorenal recess, Morrison's pouch.

The Consequences of Step 2 Clinical Skills Examination Discontinuation for Medical Schools and Sustainability Plans for Clinical Skills Assessment.

PURPOSE: Comprehensive clinical skills examinations using standardized patients are widely used to assess multiple physician competencies. However, these exams are resource intensive. With the discontinuation of the Step 2 Clinical Skills (CS) exam in 2021, how medical schools will change their approaches to comprehensive clinical skills exams is unknown. This study explores school responses to this change and future directions of comprehensive clinical skills exams using the program sustainability framework. METHOD: This cross-sectional, descriptive study surveyed medical school curriculum deans at 150 Liaison Committee on Medical Education-accredited U.S. medical schools from September to October 2021. The 30-question survey included questions about medical school and participant role, current comprehensive clinical skills exams, sustainability dimensions, and challenges and future directions. Descriptive statistics were used to characterize responses, and content analysis was used to identify themes in the open-ended responses. RESULTS: Educators at 75 of 150 institutions (50%) responded. Sixty-three respondents (84%) reported conducting a comprehensive clinical skills exam. The comprehensive clinical skills exam assessed readiness for graduation (51 [81%]), provided feedback for students (49 [78%]), evaluated curricula (38 [60%]), provided information for medical student performance evaluation or communication with residency (10 [16%]), and assessed other factors (6 [10%]), including preparation for Step 2 CS in the past and readiness for advancement to fourth year of medical school (multiple responses were allowed). Factors facilitating sustainability included sufficient funding to continue the exam (55 [87%]) and the belief that clinical skills assessment in medical school is now more important after discontinuation of the Step 2 CS exam (55 [87%]). Challenges to sustainability included organizational capacity and limited interinstitutional collaboration. CONCLUSIONS: Educators remain committed to the purpose of comprehensive clinical skills exams. Adapting to changed licensing requirements while sustaining clinical skills exams enables innovation and improvement in assessment of clinical competence.

The impact of a mindfulness bracelet on emotional affect in medical students: a prospective cohort study.

BACKGROUND: There is concern that negative changes in emotional outlook among medical students may impair the behavior of students, diminish learning, and ultimately affect patient care. Although most medical students begin their professional education with idealism, enthusiasm, and attention to humanity, they often have difficulty balancing their happiness with social and professional responsibilities. The following study aimed to determine if a simple mindfulness reminder (in the form of a bracelet) will impact emotional affect in first-year medical students. The second aim is to better understand the changes in emotional affect as students start medical school. METHODS: First year medical students were invited to participate at the start of the academic year. Baseline survey data and demographic data were obtained prior to participants being given the mindfulness bracelet and a standardized presentation explaining its purpose. Follow-up surveys were obtained at one- and two-month intervals. Statistical analysis was based on sum score of the survey. Change of sum score over time was tested by using repeated measurement analysis. RESULTS: Data collection included 104 students at the initial distribution of the survey. Follow-up surveys were obtained from 78 and 69 students at the first- and second-month mark, respectively. No significant associations were detected between frequency of mindfulness bracelet usage and emotional affect. However, there was a significant decrease in positive affect over the first month of medical school (p < 0.01), followed by a significant recovery in positive affect in the second month of medical school (p < 0.01). Demographic data did not reveal statistically significant differences among demographic groups and progression of emotional affect. CONCLUSIONS: Although the mindfulness bracelet intervention did not yield significant improvement in emotional affect, our results are consistent with other studies demonstrating that the first year of medical school negatively impacts the emotional outlook of students. Future studies are needed to explore practical interventions and to better understand and address the negative effect that early medical school education has on student's emotional state.

Gender Evaluation and Numeric Distribution in Emergency Medicine Residencies (GENDER): A Retrospective Analysis of Gender Ratios Among Residents and Residency Directors from 2014-2017.

INTRODUCTION: While females make up more than half of medical school matriculants, they only comprise about one third of emergency medicine (EM) residents. We examined EM residency cohorts with entering years of 2014-2017 to estimate the ratio of males to females among residents and program leadership to determine what correlation existed, if any, between program leadership and residency gender distributions. METHODS: We identified 171 accredited EM residency programs in the United States with resident cohorts entering between 2014-2017 with publicly available data that were included in the study. The number of male and female residents and program directors were counted. We then confirmed the counts by contacting the programs directly to confirm accuracy of the data collected from program websites. RESULTS: Within the included 171 programs, the overall male to female EM resident ratio was 1.78:1. Individual program ratios ranged from 0.85-8.0. Only eight programs (5.6%) had a female-predominant ratio. Among program directors, the overall male to female ratio was 2.17:1. TThe gender of the program director did not have a statistically significant correlation with the male to female ratio among its residents (P = .93). CONCLUSION: Within 171 residency programs across the US with entering cohorts between 2014-2017, the average male to female ratio among residents is nearly 2:1. No significant correlation exists between the gender distribution among a program's leadership and its residents.

Comparing the Psychological Effects of Manikin-Based and Augmented Reality-Based Simulation Training: Within-Subjects Crossover Study.

BACKGROUND: Patient simulators are an increasingly important part of medical training. They have been shown to be effective in teaching procedural skills, medical knowledge, and clinical decision-making. Recently, virtual and augmented reality simulators are being produced, but there is no research on whether these more realistic experiences cause problematic and greater stress responses as compared to standard manikin simulators. OBJECTIVE: The purpose of this research is to examine the psychological and physiological effects of augmented reality (AR) in medical simulation training as compared to traditional manikin simulations. METHODS: A within-subjects experimental design was used to assess the responses of medical students (N=89) as they completed simulated (using either manikin or AR) pediatric resuscitations. Baseline measures of psychological well-being, salivary cortisol, and galvanic skin response (GSR) were taken before the simulations began. Continuous GSR assessments throughout and after the simulations were captured along with follow-up measures of emotion and cortisol. Participants also wrote freely about their experience with each simulation, and narratives were coded for emotional word use. RESULTS: Of the total 86 medical students who participated, 37 (43%) were male and 49 (57%) were female, with a mean age of 25.2 (SD 2.09, range 22-30) years and 24.7 (SD 2.08, range 23-36) years, respectively. GSR was higher in the manikin group adjusted for day, sex, and medications taken by the participants (AR-manikin: -0.11, 95% CI -0.18 to -0.03; P=.009). The difference in negative affect between simulation types was not statistically significant (AR-manikin: 0.41, 95% CI -0.72 to 1.53; P=.48). There was no statistically significant difference between simulation types in self-reported stress (AR-manikin: 0.53, 95% CI -2.35 to 3.42; P=.71) or simulation stress (AR-manikin: -2.17, 95% CI -6.94 to 2.59; P=.37). The difference in percentage of positive emotion words used to describe the experience was not statistically significant between simulation types, which were adjusted for day of experiment, sex of the participants, and total number of words used (AR-manikin: -4.0, 95% CI -0.91 to 0.10; P=.12). There was no statistically significant difference between simulation types in terms of the percentage of negative emotion words used to describe the experience (AR-manikin: -0.33, 95% CI -1.12 to 0.46; P=.41), simulation sickness (AR-manikin: 0.17, 95% CI -0.29 to 0.62; P=.47), or salivary cortisol (AR-manikin: 0.04, 95% CI -0.05 to 0.13; P=.41). Finally, preexisting levels of posttraumatic stress disorder, perceived stress, and reported depression were not tied to physiological responses to AR. CONCLUSIONS: AR simulators elicited similar stress responses to currently used manikin-based simulators, and we did not find any evidence of AR simulators causing excessive stress to participants. Therefore, AR simulators are a promising tool to be used in medical training, which can provide more emotionally realistic scenarios without the risk of additional harm.

The Applied Weighted Slide Metric (AWSM) Tool: Creation of a Standard Slide Design Rubric.

Introduction: Lectures are a standard aspect across all realms of medical education. Previous studies have shown that visual design of presentation slides can affect learner outcomes. The purpose of this study was to develop a slide design rubric grounded in evidence-based, multimedia principles to enable objective evaluation of slide design. Method: Using the principles described in Mayers' Principles of Multimedia Learning and Duarte's Slide:ology, the authors extracted nineteen items important for slide design. We developed an online, rank-item, survey tool to identify the importance of each item among medical educators. Respondents selected which slide design principles they felt were important when attending a lecture/didactic session and ranked their relative importance. Results: We received 225 responses to the survey. When asked to specifically rank elements from most important to least important, participants gave the most weight to "readability of figures and data" and "[lack of] busy-ness of slide." The lowest ranked elements were "transitions and animations" and "color schemes". Using the results of the survey, including the free response, we developed a rubric with relative weighting that followed our survey data. Conclusion: With this information we have applied values to the various aspects of the rubric for a total score of 100. We hope that this rubric can be used for self-assessment or to evaluate and improve slides for educators. Future research will be focused on implementing and validating the slide design survey and ensuring it is easily usable with a high inter-rater reliability and whether self-assessment with the rubric improves presentation design and education quality.

No difference in factual or conceptual recall comprehension for tablet, laptop, and handwritten note-taking by medical students in the United States: a survey-based observational study

PURPOSE: Technological advances are changing how students approach learning. The traditional note-taking methods of longhand writing have been supplemented and replaced by tablets, smartphones, and laptop note-taking. It has been theorized that writing notes by hand requires more complex cognitive processes and may lead to better retention. However, few studies have investigated the use of tablet-based note-taking, which allows the incorporation of typing, drawing, highlights, and media. We therefore sought to confirm the hypothesis that tablet-based note-taking would lead to equivalent or better recall as compared to written note-taking. METHODS: We allocated 68 students into longhand, laptop, or tablet note-taking groups, and they watched and took notes on a presentation on which they were assessed for factual and conceptual recall. A second short distractor video was shown, followed by a 30-minute assessment at the University of California, Irvine campus, over a single day period in August 2018. Notes were analyzed for content, supplemental drawings, and other media sources. RESULTS: No significant difference was found in the factual or conceptual recall scores for tablet, laptop, and handwritten note-taking (P=0.61). The median word count was 131.5 for tablets, 121.0 for handwriting, and 297.0 for laptops (P=0.01). The tablet group had the highest presence of drawing, highlighting, and other media/tools. CONCLUSION: In light of conflicting research regarding the best note-taking method, our study showed that longhand note-taking is not superior to tablet or laptop note-taking. This suggests students should be encouraged to pick the note-taking method that appeals most to them. In the future, traditional note-taking may be replaced or supplemented with digital technologies that provide similar efficacy with more convenience.

Influence of Factors Relating to Sex and Gender on Rank List Decisions and Perceptions of Residency Training: Survey Study.

BACKGROUND: Females make up more than half of medical school matriculants but only one-third of emergency medicine (EM) residents. Various factors may contribute to why fewer females choose the field of EM, such as the existing presence of females in the specialty. OBJECTIVE: This study is a follow-up to previous work, and a survey is used to assess current residents' attitudes and perceptions on various factors, including those relating to sex and gender on creating rank lists as medical students and in perceived effects on residency education. METHODS: A web-based survey consisting of Likert scale questions regarding a variety of factors influencing a student's decision to create a rank list and in perceived effects on residency education was sent to current EM residents in 2020. RESULTS: Residents from 17 programs participated in the survey with an 18.2% (138/758) response rate. The most important factors in creating a rank list were the personality of residents in the program, location, and facility type. For factors specifically related to gender, respondents who answered affirmatively to whether the gender composition of residents affected the selection of a program in making a rank list were more likely to also answer affirmatively to subsequent questions related to the gender of program leadership (P<.001) and gender composition of attending physicians (P<.001). The personality of residents was also the most important factor perceived to affect residency education. For factors influencing rank list and residency education, female respondents placed higher importance on subcategories related to gender (ie, gender composition of the residents, of the program leadership, and of the attending physicians) to a significant degree compared with their male counterparts. CONCLUSIONS: Although factors such as location and resident personality show the most importance in influencing residency selection, when stratifying based on respondent sex, females tend to indicate that factors relating to gender have more influence on rank list and residency education compared with males.

A Call to Action From the California Consortium for the Assessment of Clinical Competence: Making the Case for Regional Collaboration.

The discontinuation of the United States Medical Licensing Examination Step 2 Clinical Skills Examination emphasizes the need for other reliable standardized assessments of medical student clinical skills. For 30 years, the California Consortium for the Assessment of Clinical Competence (CCACC) has collaborated in the development of clinical skills assessments and has become a valuable resource for clinicians, standardized patient educators, psychometricians, and medical educators. There are many merits to strong multi-institutional partnerships, including the integration of data across multiple schools to provide feedback to both students and curricula, pooled test performance statistics for analysis and quality assurance, shared best practices and resources, individual professional development, and opportunities for research and scholarship. The infrastructure of the CCACC allows member schools to adapt to a changing medical landscape, from emerging trends in clinical medicine to the limitations imposed by a global pandemic. In the absence of a national examination, there is now a greater need for all medical schools to develop a comprehensive, dynamic, and psychometrically sound assessment that accurately evaluates clinical skills. Medical schools working together in regional consortia have the opportunity to create and implement innovative and robust assessments that evaluate a wide range of clinical skills, ensure that medical students have met an expected level of clinical competency before graduation, and provide a framework that contributes to ongoing efforts for the development of new national clinical skills standards.

Zombie Cruise Ship Virtual Escape Room for POCUS Pulmonary: Scan Your Way Out.

Audience: Targeted audience could be learners in medical field with basic knowledge of point-of-care ultrasound (POCUS), pulmonary and emergency medicine for example, medical students, emergency medicine residents (1st-3rd year), emergency physicians at all level of trainings, or emergency medicine physician's assistants. Introduction: Point-of-care ultrasound (POCUS) is rapidly becoming an essential part of emergency medicine and patient care .1,2 POCUS can provide more detailed clinical information when used in conjunction with a physical examination, overall aiding clinicians' decision-making capacity.3 POCUS also proves a cost-effective tool in reducing the number of advanced imaging studies ordered and unnecessary patient radiation exposure.3,4 Performing POCUS has also proved beneficial for patient satisfaction because it increases the amount of face-to-face time spent with the patient while also providing live imaging interpretation during the emergency department visits .3,5,6 POCUS-Pulmonary can also create a safer environment for both medical staff and patients during the COVID-19 pandemic.6 Performing POCUS-Pulmonary on suspected COVID-19 patients can limit the number of patients receiving thoracic CT studies to confirm COVID-19 related pneumonia.6,7 Performing POCUS-Pulmonary reduces the number of patients transferred between the radiology department and the emergency department, significantly reduces overall possible COVID-19 exposures, and reduces equipment cleaning time.6 Given the overall reduction of advanced imaging studies ordered, CT scanners would be more readily available for critical care patients, such as trauma or other hemodynamic instability.6 Emergency providers practicing in rural areas with limited resources may benefit from the use of POCUS -Pulmonary, facilitating better patient care at decreased exposure-rate, cleaning cost, and overall increase in patient satisfaction given more bedside patient-provider communication.6-8 POCUS-Pulmonary is a crucial clinical skill for emergency medicine providers everywhere.6,8 Clinicians should be able to perform POCUS-Pulmonary, interpret image findings, and develop a treatment plan promptly.9. Educational Objectives: By the end of performing the Zombie Cruise Ship Virtual Escape Room, learners will be able to: 1) recognize sonographic signs of A-line, B-line, Barcode sign, Bat sign, Seashore Sign, Plankton sign, Jellyfish Sign, Lung point, lung lockets, and Lung pulse; 2) differentiate sonographic findings of pneumothorax, hemothorax, pneumonia, COVID 19 pneumonia, pulmonary edema, and pleural effusion from normal lung findings; 3) distinguish pneumonia from atelectasis by recognizing dynamic air bronchogram; and 4) recognize indications for performing POCUS pulmonary such as dyspnea, blunt trauma, fall, cough and/or heart failure. Educational Methods: This group-based learning program was designed for use in virtual meetings, lectures, and in small-group learning activities, such as didactic and EM conferences. A Google form was used to create a virtual escape room for learners in which they had to take quizzes to advance to the next level. Learners may enact teamwork through discussion and group effort, or respond individually to ultrasound pulmonary questions. Research Methods: Learners will take pre and post-test assessment to compare the learners POCUS-Pulmonary knowledge before and after small group, virtual escape room learning. All participants in the virtual escape room game are given a pre and post-test assessment comprised of seventeen total questions: two questions asking the participant's training level, and fifteen POCUS-Pulmonary questions. Pre and Post-test questions are identical; however, the participants' answers to the pre-test assessment are not revealed to them on completion. Instead, participants receive a letter grade on completing the pre-test assessment. Participants complete the pre and post-test assessments over fifteen minutes allotted before and after the virtual escape room. Upon completing the post-test assessment, a letter grade and the correct answers were given to the participants. Results: Twenty-four emergency medicine resident physicians (PGY 1-3)) participated in the Zombie Cruise Ship Escape Room pre-test, while a total of twenty-three resident physicians participated in the post-test assessment. The pre-test data showed an average of 10.33 points, compared to post-test data, which showed 11.91 points. There was an improvement of two points on the median score with a median pre-test score of 10 vs. the post-test median of 12. Discussion: The virtual zombie cruise ship experience proved a practical and useful tool in increasing overall participants' interest in POCUS pulmonary during the COVID-19 pandemic. Participants had higher retention after actively discussing and researching the most up-to-date clinical information during the virtual and inperson small group meetings. The game encouraged participants to make decisions quickly. This pace created a fun competition between participants who genuinely enjoyed the learning experience even during the COVID-19 pandemic via Zoom/Google Meet virtual conferences. By creating a virtual escape learning tool, learners can experience teamwork-based learning without concern for group size limitations during the pandemic. Topics: Sonographic findings of pneumothorax, hemothorax, pneumonia, COVID-19 pneumonia, pulmonary edema, pleural effusion, normal lung, A-line, lack of A-line, presence of B-line, Lung sliding, M mode, dynamic air bronchogram, lung rockets, Bar code Sign, Bat Sign, lung pulse, lung point, hepatization, Seashore Sign, Plankton Sign, Jellyfish Sign, and subpleural pulmonary consolidation.

Initial Management and Recognition of Aortoiliac Occlusive Disease, A Case Report.

Aortoiliac occlusive disease (AOD) is a manifestation of peripheral arterial disease characterized by stenosis or occlusion of the distal aorta and iliac vessels. Advanced disease may present with symptoms of claudication to the buttock and thighs, erectile dysfunction, and absent or diminished femoral pulses bilaterally. Here, we discuss a case of a 71-year-old male who presented with acute bilateral lower extremity pain and weakness. Pulses were undetectable bilaterally at the groin prompting emergent imaging and vascular surgery consultation due to the suspected diagnosis of AOD. The patient was taken for bilateral femoral artery cut downs with embolectomy. The patient made an impressive recovery with preservation of motor function of lower extremities. In this case report we discuss pertinent workup and management of a patient suspected to be suffering from AOD. Topics: Vascular, arterial thrombosis, limb ischemia, aortoiliac arterial thrombosis, Leriche syndrome, peripheral arterial disease.

Frequency of Social Media and Digital Scholarship Keywords in U.S. Medical Schools' Promotion and Tenure Guidelines.

PURPOSE: Medical schools must have clear policies and procedures for promotion and tenure (P&T) of faculty. Social media and digital scholarship (SMDS) is an emerging form of scholarship capable of reaching audiences quickly, conveniently, and in a wide variety of formats. It is unclear how frequently SMDS is considered during P&T reviews. The authors sought to determine whether current P&T guidelines at medical schools consider SMDS. METHOD: The authors acquired P&T guidelines from any U.S. Liaison Committee on Medical Education-accredited medical school (or their governing university) that were available online between October and December 2020. Using an iterative process, they developed a bank of keywords that were specific to SMDS or that could include SMDS between October and December 2020. The authors searched each school's guidelines for each keyword and determined whether the word was being used in relation to crediting faculty for SMDS in the context of P&T procedures. The primary outcome measure was the dichotomous presence or absence of SMDS-specific keywords in each school's P&T guidelines. RESULTS: The authors acquired P&T guidelines from 145/154 (94%) medical schools. After removing duplicate documents, the authors considered 139 guidelines. The keyword bank included 59 terms, of which 49 were specific to SMDS and 10 were umbrella terms that could be inclusive of SMDS. Of the 139 guidelines, 121 (87%) contained at least 1 SMDS-specific keyword. Schools had a median of 3 SMDS-specific keywords in their P&T guidelines. CONCLUSIONS: As the presence and impact of SMDS increase, schools should provide guidance on its role in the P&T process. Faculty should receive clear guidance on how to document quality SMDS for their promotion file.

Evaluating Applicant Perceptions of the Impact of Social Media on the 2020-2021 Residency Application Cycle Occurring During the COVID-19 Pandemic: Survey Study.

BACKGROUND: Due to challenges related to the COVID-19 pandemic, residency programs in the United States conducted virtual interviews during the 2020-2021 application season. As a result, programs and applicants may have relied more heavily on social media-based communication and dissemination of information. OBJECTIVE: We sought to determine social media's impact on residency applicants during an entirely virtual application cycle. METHODS: An anonymous electronic survey was distributed to 465 eligible 2021 Match applicants at 4 University of California Schools of Medicine in the United States. RESULTS: A total of 72 participants (15.5% of eligible respondents), applying to 16 specialties, responded. Of those who responded, 53% (n=38) reported following prospective residency accounts on social media, and 89% (n=34) of those respondents were positively or negatively influenced by these accounts. The top three digital methods by which applicants sought information about residency programs included the program website, digital conversations with residents and fellows of that program, and Instagram. Among respondents, 53% (n=38) attended virtual information sessions for prospective programs. A minority of applicants (n=19, 26%) adjusted the number of programs they applied to based on information found on social media, with most (n=14, 74%) increasing the number of programs to which they applied. Survey respondents ranked social media's effectiveness in allowing applicants to learn about programs at 6.7 (SD 2.1) on a visual analogue scale from 1-10. Most applicants (n=61, 86%) felt that programs should use social media in future application cycles even if they are nonvirtual. CONCLUSIONS: Social media appears to be an important tool for resident recruitment. Future studies should seek more information on its effect on later parts of the application cycle and the Match.

Accreditation Council for Graduate Medical Education Milestones for Emergency Medicine Residency Training Incorporated into First- and Second-Year Medical Student Elective.

INTRODUCTION: As part of its Next Accreditation System, the Accreditation Council for Graduate Medical Education and the American Board of Emergency Medicine describe 6 competencies containing 23 sub-competencies graded by milestones ranging from level 1 (expected of an incoming intern) to level 5 (demonstrates abilities of an attending) that are used to track resident training progression. To the best of our knowledge, there have been no studies introducing a milestones-based curriculum to medical students prior to their introduction to the wards, so we sought to determine the effects that a pre-clinical Emergency Medicine Interest Group (EMIG) Milestones Elective would have on preparing the students interested in Emergency Medicine (EM) as a specialty to meet the level 1 milestones prior to their intern year. METHODS: The elective hosted 15 events throughout the academic year, and pre- and post-curriculum surveys were administered. Thirteen first- and second-year medical students at our institution who completed the elective self-reported their perception of preparedness for each level 1 milestone in the 19 sub-competencies. A repeated measures design was used through identical pre- and post-curriculum surveys to determine any changes in self-reported preparedness for meeting level 1 milestones after completing the elective using Wilcoxon Signed Ranks Test. RESULTS: There was a significant increase in the median scoring from 1 to 2 (p=0.027) in overall self-reported preparedness for meeting the level 1 milestones included in the elective, as well as significant increases in subcategories across competencies 1-4 outlined by the ACGME. There was no significant increase in preparedness for professionalism or interpersonal communication competencies. There was no significant increase in interest in EM as a result of the elective. CONCLUSION: Implementing a milestones-based curriculum during the pre-clinical years shows improved self-reported preparedness of students interested in pursuing EM for meeting level 1 milestones prior to residency. Additionally, a specialty-based elective such as this one offered through EMIG may further increase interest in the field during pre-clinical years.

Triage physicians in an academic emergency department: Impact on resident education.

BACKGROUND: Overcrowding in emergency departments (EDs) in the United States has been linked to worse patient outcomes. Implementation of countermeasures such as a physician-in-triage (PIT) system have improved patient care and decreased wait times. The purpose of this study was to evaluate how a PIT system affects medical resident education in an academic ED. METHODS: This was a retrospective observational comparison of resident metrics at a single-site, urban, academic ED before and after implementing a PIT system. Resident metrics of average emergency severity index (ESI), patients-per-hour, and in-training-examination scores were measured before and six months after the implementation of the PIT system. RESULTS: In total, 18,231 patients were evaluated by all residents in the study period before PIT implementation compared to 17,008 in the study period following PIT implementation. The average ESI among patients evaluated by residents decreased from 3.00 to 2.68 (p < 0.01, 95% confidence interval [CI] = 0.31 to 0.33), while average resident patient-per-hour rate decreased from 1.41 to 1.32 (p < 0.01, 95% CI = 0.05 to 0.13] and ITE scores saw no statistically significant change of 76.11 to 78.26 (p = 0.26, 95% CI = -5.75 to 1.45). While these differences are statistically significant, they are likely not clinically significant. CONCLUSIONS: Our implementation of PIT system at one academic medical center minimally increased the acuity and minimally decreased the number of patients that residents see. This suggested that in our center, a PIT program did not detract from ED resident clinical education. However, further research with alternative markers in multiple centers is needed.

Utilization of Educational Videos to Improve Communication and Discharge Instructions.

INTRODUCTION: When discharging a patient from the emergency department (ED), it is crucial to make sure that they understand their disposition and aftercare instructions. However, numerous factors make it difficult to ensure that patients understand their next steps. Our objective was to determine whether patient understanding of ED discharge and aftercare instructions could be improved through instructional videos in addition to standard written discharge instructions. METHODS: This was a prospective pre- and post-intervention study conducted at a single-center, academic tertiary care ED. Patients presenting with the five selective chief complaints (closed head injury, vaginal bleeding, laceration care, splint care, and upper respiratory infection) were given questionnaires after their discharge instructions to test comprehension. Once video discharge instructions were implemented, patients received standard discharge instructions in addition to video discharge instructions and were given the same questionnaire. A total of 120 patients were enrolled in each group. RESULTS: There were significantly better survey scores after video discharge instructions (VDI) vs standard discharge instructions (SDI) for the closed head injury (27% SDI vs 46% VDI, P = 0.003); upper respiratory infection (28% SDI vs 64% VDI; P < 0.0001); and vaginal bleeding in early pregnancy groups (20% SDI vs 60% VDI, P < 0.0001). There were no significant differences in survey scores between the splint care (53% SDI vs 66% VDI; P = 0.08) and suture care groups (29% SDI vs 31% VDI; P = 0.40). CONCLUSION: Video discharge instructions supplementing standard written instructions can help improve patient comprehension and information retention. This better understanding of aftercare instructions is essential to patient follow-up and has been shown to improve patient outcomes.

Planning Engaging, Remote, Synchronous Didactics in the COVID-19 Pandemic Era.

As part of the Accreditation Council for Graduate Medical Education requirements, residents must participate in structured didactic activities. Traditional didactics include lectures, grand rounds, simulations, case discussions, and other forms of in-person synchronous learning. The COVID-19 pandemic has made in-person activities less feasible, as many programs have been forced to transition to remote didactics. Educators must still achieve the goals and objectives of their didactic curriculum despite the new limitations on instructional strategies. There are several strategies that may be useful for organizing and creating a remote residency didactic curriculum. Educators must master new technology, be flexible and creative, and set rules of engagement for instructors and learners. Establishing best practices for remote didactics will result in successful, remote, synchronous didactics; reduce the impact of transitioning to a remote learning environment; and keep educators and learners safe as shelter-at-home orders remain in place.