Changes in Residency Applicant Cancellation Patterns with Virtual Interviews: A Single-site Analysis.

Background: Residency programs transitioned to primarily virtual interviews due to the COVID-19 pandemic. This shift raised questions regarding expectations and patterns of applicant cancellation timeliness. The purpose of this study was to examine changes in applicant cancellations after transitioning to virtual interviews. Methods: This was a retrospective cohort study of interview data from a three-year emergency medicine residency at a tertiary-care academic medical center. Using archived data from Interview Broker, we examined scheduling patterns between one in-person (2019-2020) and two virtual interview cohorts (2020-2021 and 2021-2022). Our outcomes were the overall cancellation rates relative to interview slots as well as the proportion of cancellations that occurred within 7 or 14 days of the interview date. Results: There were 453 interview slots and 568 applicants invited. Overall, applicants canceled 17.1% of scheduled interviews. Compared with in-person interviews, applicants canceled significantly fewer virtual interviews (in person: 40/128 (31.3%), virtual year 1: 22/178 (12.4%), virtual year 2: 15/143 (10.5%), P = 0.001). Conversely, applicants canceled significantly more virtual interviews within both the 14-day threshold (in person: 8/40 (20%), virtual year 1: 12/22 (55.5%), virtual year 2: 12/15 (80%), P < 0.001) and the 7-day threshold (in person: 0/40 (0%), virtual year 1: 3/22 (13.6%), virtual year 2: 4/15 (26.7%), P = 0.004). Conclusion: While limited, at our site, changing to a virtual interview format correlated with fewer cancellations overall. The proportion of cancellations within 14 days was much higher during virtual interview seasons, with most cancellations occurring during that time frame. Additional studies are needed to determine the effects of cancellation patterns on emergency medicine recruitment.

Improvement in Resident Scholarly Output with Implementation of a Scholarly Activity Guideline and Point System.

Introduction: Ensuring high-quality scholarly output by graduate medical trainees can be a challenge. Within many specialties, including emergency medicine (EM), it is unclear what constitutes appropriate resident scholarly activity. We hypothesized that the quantity and quality of scholarly activity would improve with a clearer guideline, including a point system for eligible scholarly activities. Methods: A resident Scholarly Activity Guideline was implemented for EM residents in a university setting. The guideline consists of a point system in which point values, ranging from 1-10, are assigned to various types of scholarly activities. Residents must earn at least 10 points and present their work to meet their scholarly graduation requirement. We tracked scholarly activities for graduates from the classes of 2014-2020, with the guideline being implemented for the class of 2016. In a blind analysis, we compared median total points per resident, mean counts of the Boyer model of scholarship components per resident, and mean counts of significant scholarly output per resident before vs after the guideline was implemented. Significant scholarly output was defined as an implemented protocol, a research project with data collection and analysis, a research abstract presentation, or an oral abstract presentation. Results: Among 64 residents analyzed, 48 residents used the guideline. We found that median points per resident increased after the guideline was implemented (median, interquartile range: before 7 [7], after 11 [10, 13], P = 0.002). Post-guideline scholarly activities were found to represent more of Boyer's components of scholarship [mean before 0.81 [SD 0.40], mean after 1.52 [SD 0.71], mean difference 0.71, 95% confidence interval [CI] 0.332 ± 1.09, P < 0.001. There was no difference in the mean significant scholarly output per resident (mean before 1.38 [SD 1.02], mean after 1.02 [SD 1.00], mean difference 0.35, 95% CI 0.93 ± 0.23, P = 0.23). Conclusion: Implementation of a Scholarly Activity Guideline point system significantly increased the quantity and, by one of two measures, increased the quality of scholarly output in our program. Our point-based guideline successfully incorporated traditional and modern forms of scholarship that can be tailored to resident interests.

Socially distanced, virtually connected: Faculty and resident perceptions of virtual didactics.

BACKGROUND: During the COVID-19 pandemic, emergency medicine (EM) residency programs have transitioned from traditional in-person to virtual synchronous didactics to comply with social distancing guidelines. This study explores the perceptions of EM residents and faculty regarding this new virtual format. METHODS: This was a multicenter, cross-sectional study at five EM residencies using a mixed-methods approach to investigate resident and faculty perceptions of virtual didactics. Institutions selected reflect different program lengths and geographic locations. Quantitative data measured on a Likert scale were summarized as percentages. Differences were calculated using Welch's t-test and chi-square, where p < 0.05 was significant. Open-ended responses were analyzed qualitatively. RESULTS: Our response rate was 64% (n = 141) for residents and 48% (n = 108) for faculty. Fifty-one percent of faculty and 54% of residents felt that they were more likely to attend virtually than in person. Among residents, 77% felt that they were more likely to attend virtual conferences during vacation or elective rotations. Perceived retention of information from virtual sessions was perceived to be the same or better for 69% of residents and 58% of faculty. Residents felt that they paid more attention in the virtual format (29% vs. 26%, p = 0.037). Both groups missed the social interactions of in-person conference (86% of faculty, 75% of residents). Respondents from both groups felt that < 20% of total didactic time should remain virtual once social distancing recommendations are lifted. Qualitative analysis revealed recommendations from residents and faculty to optimize lecture style and interactivity. Decreased commute time and ability to multitask at home increased wellness for both groups. CONCLUSIONS: While benefits of virtual didactics were acknowledged, residents and faculty missed the social interaction of in-person conference and preferred < 20% of future didactics to be virtual. Further research should assess the difference in knowledge acquisition and retention between conference models.

Does academic practice protect emergency physicians against burnout?

Burnout is a complex syndrome thought to result from long-term exposure to career-related stressors. Physicians are at higher risk for burnout than the general United States (US) working population, and emergency medicine has some of the highest burnout rates of any medical specialty. Burnout impacts physicians' quality of life, but it can also increase medical errors and negatively affect patient safety. Several studies have reported lower burnout rates and higher job satisfaction in academic medicine as compared with private practice. However, researchers have only begun to explore the factors that underlie this protective effect. This paper aims to review existing literature to identify specific aspects of academic practice in emergency medicine that may be associated with lower physician burnout rates and greater career satisfaction. Broadly, it appears that spending time in the area of emergency medicine one finds most meaningful has been associated with reduced physician burnout. Certain non-clinical academic work, including involvement in research, leadership, teaching, and mentorship, have been identified as specific activities that may protect against burnout and contribute to higher job satisfaction. Given the epidemic of physician burnout, hospitals and practice groups have a responsibility to address burnout, both by prevention and by early recognition and support. We discuss methods by which organizations can actively foster physician well-being and provide examples of 2 leading academic institutions that have developed comprehensive programs to promote physician wellness and prevent burnout.

Changes to the ACGME Common Program Requirements and Their Potential Impact on Emergency Medicine Core Faculty Protected Time.

The Accreditation Council for Graduate Medical Education (ACGME), which regulates residency and fellowship training in the United States, recently revised the minimum standards for all training programs. These standards are codified and published as the Common Program Requirements. Recent specific revisions, particularly removing the requirement ensuring protected time for core faculty, are poised to have a substantial impact on emergency medicine training programs. A group of representatives and relevant stakeholders from national emergency medicine (EM) organizations was convened to assess the potential effects of these changes on core faculty and the training of emergency physicians. We reviewed the literature and results of surveys conducted by EM organizations to examine the role of core faculty protected time. Faculty nonclinical activities contribute greatly to the academic missions of EM training programs. Protected time and reduced clinical hours allow core faculty to engage in education and research, which are two of the three core pillars of academic EM. Loss of core faculty protected time is expected to have detrimental impacts on training programs and on EM generally. We provide consensus recommendations regarding EM core faculty clinical work hour limitations to maintain protected time for educational activities and scholarship and preserve the quality of academic EM.

A Randomized Comparison of In-hospital Rescuer Positions for Endotracheal Intubation in a Difficult Airway.

INTRODUCTION: Emergency endotracheal intubation (ETI) is a common and critical procedure performed in both prehospital and in-hospital settings. Studies of prehospital providers have demonstrated that rescuer position influences ETI outcomes. However, studies of in-hospital rescuer position for ETI are limited. While we adhere to strict standards for the administration of ETI, we posited that perhaps requiring in-hospital rescuers to stand for ETI is an obstacle to effectiveness. Our objective was to compare in-hospital emergency medicine (EM) trainees' performance on ETI delivered from both the seated and standing positions. METHODS: EM residents performed ETI on a difficult airway mannequin from both a seated and standing position. They were randomized to the position from which they performed ETI first. All ETIs were recorded and then scored using a modified version of the Airway Management Proficiency Checklist. Residents also rated the laryngeal view and the difficulty of the procedure. We analyzed comparisons between ETI positions with paired t-tests. RESULTS: Forty-two of our 49 residents (85.7%) participated. Fifteen (35.7%) were female, and all three levels of training were represented. The average number of prior ETI experiences among our subjects was 44 (standard deviation=34). All scores related to ETI performance were statistically equivalent across the two positions (performance score, number of attempts, time to intubation success, and ratings of difficulty and laryngeal view). We also observed no differences across levels of training. CONCLUSION: The position of the in-hospital provider, whether seated or standing, had no effect on the provider's ETI performance. Since environmental circumstances sometimes necessitate alternative positioning for effective ETI administration, our findings suggest that there may be value in training residents to perform ETI from both positions.

Replacing Lectures with Small Groups: The Impact of Flipping the Residency Conference Day.

The flipped classroom, an educational alternative to the traditional lecture, has been widely adopted by educators at all levels of education and across many disciplines. In the flipped classroom, learners prepare in advance of the face-to-face meeting by learning content material on their own. Classroom time is reserved for application of the learned content to solving problems or discussing cases. Over the past year, we replaced most residency program lectures with small-group discussions using the flipped-classroom model, case-based learning, simulation and procedure labs. In the new model, residents prepared for conference by reviewing a patient case and studying suggested learning materials. Conference day was set aside for facilitated small-group discussions about the case. This is a cross-cohort study of emergency medicine residents who experienced the lecture-based curriculum to residents in the new flipped-classroom curriculum using paired comparisons (independent t-tests) on in-training exam scores while controlling for program year level. We also compared results of the evaluation of various program components. We observed no differences between cohorts on in-training examination scores. Small-group methods were rated the same across program years. Two program components in the new curriculum, an updated format of both adult and pediatric case conferences, were rated significantly higher on program quality. In preparation for didactics, residents in the new curriculum report spending more time on average with outside learning materials, including almost twice as much time reviewing textbooks. Residents found the new format of the case conferences to be of higher quality because of the inclusion of rapid-fire case discussions with targeted learning points.

'Speed advising' for medical students applying to residency programs: an efficient supplement to traditional advising.

BACKGROUND: Over time, Residency Match dynamics fluctuate with some specialties experiencing increases in medical student popularity. Academic departments with limited resources must devise methods for coping with increased demand for their specialty. Students perceive traditional programs on Match mechanics as inadequate. Subsequently, faculty are confronted with demands for more personal attention from more students. OBJECTIVES: We developed a strategy for providing specialty-specific residency match advising to large numbers of students. METHODS: The 'speed-advising' session (SAS) was developed to address the common questions and concerns that medical students pose during the Match process and to provide advisees with a breadth of faculty perspectives. Two SASs were offered over a 2-week period. After the sessions, students and faculty were surveyed regarding their experience. RESULTS: Twenty-six students pursued our specialty in the 2015 Match (26 of 234, 11.1%). Twenty-three (89%) participated in the SAS. Seventy-four percent of students (17 of 23) and all faculty completed the post-session survey. Students found the SAS to be informative, helpful and an efficient use of time. Common discussion topics included: career goals, to which programs and how many to apply, and how academic record impacts their likelihood of matching in our specialty. Students would have preferred more time with each faculty; however, most (77%) conceded that their questions were adequately answered. Faculty-favored speed advising over traditional advising (86%), primarily due to estimated time savings of 7.3 h per faculty member. CONCLUSIONS: In preparing students for the Match, specialty-specific speed advising offers an efficient supplement to traditional advising.

Teaching Emotional Intelligence: A Control Group Study of a Brief Educational Intervention for Emergency Medicine Residents.

INTRODUCTION: Emotional Intelligence (EI) is defined as an ability to perceive another's emotional state combined with an ability to modify one's own. Physicians with this ability are at a distinct advantage, both in fostering teams and in making sound decisions. Studies have shown that higher physician EI's are associated with lower incidence of burn-out, longer careers, more positive patient-physician interactions, increased empathy, and improved communication skills. We explored the potential for EI to be learned as a skill (as opposed to being an innate ability) through a brief educational intervention with emergency medicine (EM) residents. METHODS: This study was conducted at a large urban EM residency program. Residents were randomized to either EI intervention or control groups. The intervention was a two-hour session focused on improving the skill of social perspective taking (SPT), a skill related to social awareness. Due to time limitations, we used a 10-item sample of the Hay 360 Emotional Competence Inventory to measure EI at three time points for the training group: before (pre) and after (post) training, and at six-months post training (follow up); and at two time points for the control group: pre- and follow up. The preliminary analysis was a four-way analysis of variance with one repeated measure: Group x Gender x Program Year over Time. We also completed post-hoc tests. RESULTS: Thirty-three EM residents participated in the study (33 of 36, 92%), 19 in the EI intervention group and 14 in the control group. We found a significant interaction effect between Group and Time (p≤0.05). Post-hoc tests revealed a significant increase in EI scores from Time 1 to 3 for the EI intervention group (62.6% to 74.2%), but no statistical change was observed for the controls (66.8% to 66.1%, p=0.77). We observed no main effects involving gender or level of training. CONCLUSION: Our brief EI training showed a delayed but statistically significant positive impact on EM residents six months after the intervention involving SPT. One possible explanation for this finding is that residents required time to process and apply the EI skills training in order for us to detect measurable change. More rigorous measurement will be needed in future studies to aid in the interpretation of our findings.

The use of reflection in emergency medicine education.

Reflection is a cognitive process in which new information and experiences are integrated into existing knowledge structures and mental models, resulting in meaningful learning. Reflection often occurs after an experience is over, promoting professional development and lifelong learning. However, a reflective emergency physician (EP) is also able to apply reflection in real time: self-monitoring, coping with the unexpected, and quickly thinking on his or her feet to solve complicated, unique, and challenging clinical problems. Reflection is a skill that can be taught and developed in medical education. Evidence demonstrating the value of teaching reflection is emerging that substantiates longstanding educational theories. While a few educators have started to explore the use of reflection for emergency medicine (EM) learners, the potential for broader application exists. This review summarizes the literature regarding reflection in medical education and provides a basic primer for teaching reflection.

Comparison of Broselow tape measurements versus physician estimations of pediatric weights.

OBJECTIVE: We sought to determine the agreement of physician estimates compared with Broselow tape measurements in accurately determining children's weights. Our secondary objective was to evaluate whether physician adjustment of the Broselow tape weight measurement is a better estimate of pediatric weight compared with either method alone. METHODS: This cross-sectional study was conducted in the emergency department (ED) of a tertiary children's hospital. Children between the ages of 0 and 14 years consecutively registered in the pediatric ED were eligible for enrollment. Height, weight, body mass index, and Broselow tape measurement were obtained for all subjects. Blinded ED physicians provided estimates for weight and body habitus for enrolled subjects. Physicians next were given the Broselow weight measurement and then submitted a second, amended estimate (hybrid). Percentage differences were used to analyze the discrepancy between estimates and actual weight. Specifically examined were the proportion of estimates that fell within 10% of the patients' actual body weights. RESULTS: A total of 372 subjects met the inclusion criteria. Mean age was 45.7 months, mean body mass index was 17.4, mean weight was 16.8 kg, and 39 participants (18.1%) met the definition for obese. Broselow estimates were within 10% of actual weight 63% of the time, physician estimates were within 10% of the actual weight 43% of the time and hybrid estimates 55% of the time. Based on average mean percent error, compared with actual weight, Broselow differed by 10.8% (95% confidence interval [CI], 9.7-12), hybrid estimate by 11.3% (95% CI, 10.3-12.2), and physician estimate by 16.2% (95% CI, 14.7-17.7). The Broselow tape was significantly worse than physician estimate for obese patients: 26.4% (95% CI, 19.7-33.1) versus 16.0% (95% CI, 12.3-19.8). CONCLUSION: The Broselow tape generally has greater agreement with actual weight than physician visual estimation, except for obese children. Physician adjustment of the Broselow measurement also proved to be comparable to the Broselow tape.

Trimming the fat: identification of risk factors associated with obesity in a pediatric emergency department.

OBJECTIVE: The purpose of this study was to assess which knowledge deficits and dietary habits in an urban pediatric emergency department (ED) population are risk factors for obesity. METHODS: This cross-sectional study in an urban pediatric ED used a modified version of the Diet and Health Knowledge Survey, an in-person interview questionnaire, to collect data on demographics, dietary knowledge, and practices. All patients aged 2 to 17 years were enrolled in the study over a 4-month period. Subjects were excluded if they were in extremis, pregnant, incarcerated, institutionalized, considered an emancipated minor, or consumed only a modified consistency diet. RESULTS: One hundred seventy-nine subjects were enrolled in this study. Based on body mass index, the prevalence of obesity in our study population was 24%. Parents with obese children answered a mean of 62.9% (95% confidence interval, 60.4%-65.5%) of knowledge questions correctly, whereas all others scored 60.3% (95% confidence interval, 58.3%-62.3%) correctly. Based on the univariate analysis, 10 predictors met inclusion criteria into logistic regression analysis: screen time (P = 0.03), race (P = 0.08), sex (P = 0.04), parental education (P = 0.08), parental estimation that child is overweight (P < 0.0001), parental estimation that child is underweight (P = 0.003), trimming fat from meat (P = 0.06), soft-drink consumption (P = 0.03), exercise (P = 0.07), and chip consumption (P = 0.04). In a multivariate analysis, only male sex, regularly trimming fat from meat, and parental assessment of obesity were independently associated with obesity. CONCLUSIONS: Knowledge deficiencies regarding healthy nutrition among parents in an urban pediatric ED population were not significantly associated with having obese children; however, specific habits were. Emergency physicians may provide a valuable role in identification and brief behavioral intervention in high-risk populations during the current epidemic of childhood obesity.