The more things change the more they stay the same: Factors influencing emergency medicine residency selection in the virtual era.

Background: Interviews for emergency medicine (EM) residency positions largely transitioned to a virtual-only format in 2020-2021. The impact of virtual interview factors on applicants' rank of programs is unknown. Objective: We sought to assess the impact of modifiable factors in virtual interviews on applicants' rank of EM residency programs. Methods: We conducted a cross-sectional mixed-methods survey of students applying to at least one of seven study authors' EM residency programs in the United States during the 2020-2021 application cycle. The survey was developed using an interactive Delphi process and piloted prior to implementation. The survey was administered from May to June 2021 with up to four email reminders. Quantitative analysis included descriptive statistics. Three authors performed a thematic qualitative analysis of free-text responses. Results: A total of 664 of 2281 (29.1%) students completed the survey, including 335 (50.5%) male, 316 (47.7%) female, and six (0.9%) nonbinary. A total of 143 (21.6%) respondents identified as underrepresented in medicine and 84 (12.7%) identified as LGBTQIA+. Respondents participated in a median of 14 interviews and ranked a median of 14 programs. Most respondents (335, 50.6%) preferred a choice of in-person or virtual, while 183 (27.6%) preferred all in-person, and 144 (21.8%) preferred all virtual. The program website and interview social were the most important factors influencing respondent ranking. Qualitative analysis revealed several positive aspects of virtual interviews including logistical ease and comfort. Negative aspects include technical issues, perceived interview hoarding, and barriers to applicant assessment and performance. Demonstrated effort by the program, effective information delivery, communication of resident culture, and a well-implemented interview day positively influenced respondents' rank of programs. Conclusions: This study identified characteristics of the virtual interview format that impact applicants' rank of programs. These results can inform future recruitment practices.

The Effect of a Flipped Classroom Learning Model Versus Traditional Lecture Model on Resident's Knowledge Acquisition for Atraumatic Back Pain in the Emergency Department.

Objective: The effectiveness of lecture-based (LB) formats for residency education has recently been challenged as the gold standard. Studies suggest a flipped classroom (FC) lecture improves resident satisfaction, but evidence that showing improved knowledge acquisition is lacking. To determine whether the flipped classroom model improves knowledge acquisition compared to traditional LB model. Methods: Emergency medicine resident physicians at 2 academic programs were included in December 2019; at Sinai-Grace Hospital, a traditional lecture was the teaching method and at Detroit Receiving Hospital, FC was utilized. Residents completed prelecture and postlecture content tests. The primary outcome was change in test results (pretest to post-test). A noninferiority design comparing the changes between intervention and control groups was utilized (1-sided t-test, noninferiority margin of -0.5; 1-sided alpha = 0.05). Results: Results were available for 31 residents (17 controls and 14 interventions) out of 83 enrolled. There were 14 postgraduate year 1 (PGY-1), 9 PGY-2, and 8 PGY-3 residents. The mean difference in score was +0.71 (SD 1.38) and +0.77 (SD 1.48) for the FC and LB groups, respectively. This resulted in a mean difference between groups of -0.05 (lower bound of the upper 95% confidence interval -0.93 and therefore crossing the noninferiority margin of -0.05; P = .20). Conclusions: This study of resident education at 2 training programs was unable to demonstrate noninferiority of an FC format compared to standard lecture. Surprisingly, there was little improvement in test results after both teaching formats. Larger studies are needed to power results.

Video-assisted self-reflection of resuscitations for resident education and improvement of leadership skills: A pilot study.

INTRODUCTION: One of the most challenging aspects of Emergency Medicine (EM) residency is mastering the leadership skills required during a resuscitation. Use of resuscitation video recording for debriefing is gaining popularity in graduate medical education. However, there are limited studies of how video technology can be used to improve leadership skills in the emergency department. We aim to evaluate the utility of video-assisted self-reflection, compared with self-reflection alone, in the setting of resuscitation leadership. METHODS: This was a prospective, randomized, controlled pilot study conducted in 2018 at an urban level 1 trauma center with a three-year EM residency program. The trial included postgraduate year (PGY) 2 and 3 residents (n = 10). Each resident acted as an individual team leader for a live real-time resuscitation in the emergency department. The authors classified a patient as a resuscitation if there was an immediate life- or limb-threatening disease process or an abnormal vital sign with an indication of hypoperfusion. Each resident was recorded as the team leader twice. Both control and intervention groups produced written self-reflection after their first recording. The intervention group viewed their resuscitation recording while completing the written reflection. After their reflection, all participants were recorded for a second resuscitation. Two faculty experts, blinded to the study, scored each video using the Concise Assessment of Leader Management (CALM) scale to measure the leadership skills of the resident team leader. RESULTS: Five PGY­3 and five PGY­2 residents participated. The weighted kappa between the two experts was 0.45 (CI 0.34-0.56, p < 0.0001). The median gain score in the control group was -1.5 (IQR) versus 0.5 in the intervention group (IQR). DISCUSSION: Video-assisted self-reflection showed positive gain score trends in leadership evaluation for residents during a resuscitation compared with the non-video assisted control group. This tool would be beneficial to implement in EM residency.

Factors influencing emergency medicine residency choice: Diversity, community, and recruitment red flags.

BACKGROUND: Emergency medicine (EM) applicants consider many factors when selecting residency programs. Prior studies have demonstrated that applicants consider geography as well as modifiable/nonmodifiable program factors. Less attention, however, has been paid to underrepresented groups. Additionally, the prevalence and characteristics of "red flags," or factors that may lead an applicant to lower a program's rank or not rank it at all, remain unknown in EM. Our objective was to describe the factors that influence current EM-bound medical students' residency selection focusing on underrepresented applicants and red flags encountered during the recruitment process. METHODS: We conducted a mixed-methods survey study of EM-bound graduates from U.S. medical schools in the 2020 application cycle. Quantitative analysis included descriptive statistics, measures of central tendency, 95% confidence intervals (CIs), nonparametric tests for ordinal data, and logistic regression. For the qualitative portion of the study, two independent reviewers performed a thematic analysis of the red flag free-text responses. Discrepancies were addressed via consensus with third-party oversight. RESULTS: Our survey response rate was 49%, and most applicants considered both geographic and program factors. Underrepresented applicants prioritized program diversity, program commitment to the underserved, neighborhood/community, and patient population. Of all respondents, 71% reported red flags. Women had a significantly higher odds of encountering red flags (odds ratio = 1.64, 95% CI = 1.25 to 2.18). Red flags included seven key themes: violations of regulatory standards, program characteristics, interview day experience, program culture, interpersonal interactions, lack of fit, and quality of life; subthemes included lack of diversity and racism. CONCLUSIONS: Modifiable/nonmodifiable program factors and geography continue to influence EM-bound applicants' residency choices. Underrepresented applicants place a higher value on diversity, community, and patients served. Residency programs should consider modifiable factors and self-assess for red flags to successfully recruit the next generation of EM physicians.