Core and cluster or head to toe?: a comparison of two types of curricula for teaching physical examination skills to preclinical medical students.

BACKGROUND: Despite the central importance of physical examination (PE) skills to patient evaluation, early trainees struggle with its correct application and interpretation. This struggle may reflect the instructional strategies of PE courses which have largely ignored the clinical reasoning necessary to accurately apply these skills. The "core + cluster" (C + C) is a recent approach to teaching PE to clerkship-level medical students that combines a basic 'core' exam with 'cluster' based on the student's hypothesis about their patient's clinical presentation. Our institution developed a novel C + C curriculum to teach PE to preclinical students. We aimed to assess the impact of this new curriculum on students' clinical skills and course evaluations in comparison to the traditional "head-to-toe" approach we'd used previously. METHODS: This was a retrospective study comparing two consecutive medical school cohorts exposed to the new (C + C) and prior (HTT) curricula respectively. We studied two complete cohorts of first-year medical students at our institution who matriculated in 2014 and 2015. The 2014 cohort received PE training via an HTT approach. The 2015 cohort received PE training via a C + C approach. Outcomes included performance scores on a statewide clinical performance exam (CPX) and student course evaluations. RESULTS: We found no statistically significant difference in mean CPX scores between the two cohorts. However, student course ratings were significantly higher in the C + C cohort and students rated the C + C format as highly useful in clinical encounters. CONCLUSIONS: The C + C curriculum appears to be as effective a method of teaching PE to preclinical students as the HTT approach and is better received by students. We believe that this approach more appropriately reflects the way PE is used in clinical encounters and may help students with diagnostic hypothesis generation.

Current Status and Future Perspectives on MRNA Drug Manufacturing.

The coronavirus disease of 2019 (COVID-19) pandemic launched an unprecedented global effort to rapidly develop vaccines to stem the spread of the novel severe acute respiratory syndrome coronavirus (SARS-CoV-2). Messenger ribonucleic acid (mRNA) vaccines were developed quickly by companies that were actively developing mRNA therapeutics and vaccines for other indications, leading to two mRNA vaccines being not only the first SARS-CoV-2 vaccines to be approved for emergency use but also the first mRNA drugs to gain emergency use authorization and to eventually gain full approval. This was possible partly because mRNA sequences can be altered to encode nearly any protein without significantly altering its chemical properties, allowing the drug substance to be a modular component of the drug product. Lipid nanoparticle (LNP) technology required to protect the ribonucleic acid (RNA) and mediate delivery into the cytoplasm of cells is likewise modular, as are technologies and infrastructure required to encapsulate the RNA into the LNP. This enabled the rapid adaptation of the technology to a new target. Upon the coattails of the clinical success of mRNA vaccines, this modularity will pave the way for future RNA medicines for cancer, gene therapy, and RNA engineered cell therapies. In this review, trends in the publication records and clinical trial registrations are tallied to show the sharp intensification in preclinical and clinical research for RNA medicines. Demand for the manufacturing of both the RNA drug substance (DS) and the LNP drug product (DP) has already been strained, causing shortages of the vaccine, and the rise in development and translation of other mRNA drugs in the coming years will exacerbate this strain. To estimate demand for DP manufacturing, the dosing requirements for the preclinical and clinical studies of the two approved mRNA vaccines were examined. To understand the current state of mRNA-LNP production, current methods and technologies are reviewed, as are current and announced global capacities for commercial manufacturing. Finally, a vision is rationalized for how emerging technologies such as self-amplifying mRNA, microfluidic production, and trends toward integrated and distributed manufacturing will shape the future of RNA manufacturing and unlock the potential for an RNA medicine revolution.

Research Pioneers in Emergency Medicine-Reflections on Their Paths to Success and Advice to Aspiring Researchers: A Qualitative Study.

STUDY OBJECTIVE: Research in basic, translational, and clinical emergency medicine has made great strides since the formalization of emergency medicine as a specialty. Our objective is to identify and analyze strategies used by emergency medicine research pioneers to inform further advancement of research in emergency medicine, particularly for aspiring researchers and those in emerging areas, using emergency medicine medical education as one example. METHODS: This was a prospective, grounded-theory, qualitative study, using a constructivist/interpretivist paradigm. Leading basic science, translational, and clinical emergency medicine researchers who completed residency before 1995 were eligible for structured interviews. Thematic coding followed an iterative process until saturation was reached. A theoretic model was developed and analyzed. RESULTS: Research pioneers valued advanced methodological training and mentorship. Barriers to funding were lack of recognition of emergency medicine as a specialty, absence of a research history, and lack of training and funding resources. Deliberate interventions to improve emergency medicine research included educational sessions at national meetings, external (to emergency medicine) mentor pairings, targeted funding by emergency medicine organizations, and involvement with funding agencies. Pioneers facilitate research excellence by serving as mentors and allocating funds or protected time to develop researchers. To advance emerging subfields of research in emergency medicine, pioneers recommend advanced methodological training that is specific to the area, deliberate mentorship, and the formation of research consortia to conduct generalizable outcomes-based studies. CONCLUSION: Research pioneers in emergency medicine cite mentorship, advanced skills obtained through fellowship or graduate degrees, deliberate collaboration with experienced researchers, support from emergency medicine organizations, and forming networks as the cornerstones of success.

The rotation-coupled sliding of EcoRV.

It has been proposed that certain type II restriction enzymes (REs), such as EcoRV, track the helical pitch of DNA as they diffuse along DNA, a so-called rotation-coupled sliding. As of yet, there is no direct experimental observation of this phenomenon, but mounting indirect evidence gained from single-molecule imaging of RE-DNA complexes support the hypothesis. We address this issue by conjugating fluorescent labels of varying size (organic dyes, proteins and quantum dots) to EcoRV, and by fusing it to the engineered Rop protein scRM6. Single-molecule imaging of these modified EcoRVs sliding along DNA provides us with their linear diffusion constant (D(1)), revealing a significant size dependency. To account for the dependence of D(1) on the size of the EcoRV label, we have developed four theoretical models describing different types of motion along DNA and find that our experimental results are best described by rotation-coupled sliding of the protein. The similarity of EcoRV to other type II REs and DNA binding proteins suggests that this type of motion could be widely preserved in other biological contexts.

Heart rate, anxiety and performance of residents during a simulated critical clinical encounter: a pilot study.

BACKGROUND: High-fidelity patient simulation has been praised for its ability to recreate lifelike training conditions. The degree to which high fidelity simulation elicits acute emotional and physiologic stress among participants - and the influence of acute stress on clinical performance in the simulation setting - remain areas of active exploration. We examined the relationship between residents' self-reported anxiety and a proxy of physiologic stress (heart rate) as well as their clinical performance in a simulation exam using a validated assessment of non-technical skills, the Ottawa Crisis Resource Management Global Rating Scale (Ottawa GRS). METHODS: This was a prospective observational cohort study of emergency medicine residents at a single academic center. Participants managed a simulated clinical encounter. Anxiety was assessed using a pre- and post-simulation survey, and continuous cardiac monitoring was performed on each participant during the scenario. Performance in the simulation scenario was graded by faculty raters using a critical actions checklist and the Ottawa GRS instrument. RESULTS: Data collection occurred during the 2011 academic year. Of 40 eligible residents, 34 were included in the analysis. The median baseline heart rate for participants was 70 beats per minute (IQR: 62 - 78). During the simulation, the median maximum heart rate was 140 beats per minute (IQR: 137 - 151). The median minimum heart rate during simulation was 81 beats per minute (IQR: 72 - 92), and mean heart rate was 117 beats per minute (95% CI: 111 - 123). Pre- and post-simulation anxiety scores were equal (mean 3.3, IQR: 3 to 4). The minimum and maximum Overall Ottawa GRS scores were 2.33 and 6.67, respectively. The median Overall score was 5.63 (IQR: 5.0 to 6.0). Of the candidate predictors of Overall performance in a multivariate logistic regression model, only PGY status showed statistical significance (P = 0.02). CONCLUSIONS: Simulation is associated with physiologic stress, and heart rate elevation alone correlates poorly with both perceived stress and performance. Non-technical performance in the simulation setting may be more closely tied to one's level of clinical experience than to perceived or actual stress.

Oh, the places you'll go! A qualitative study of resident career decisions in emergency medicine.

Objectives: Postresidency career choices are complex decisions that involve personal, professional, and financial preferences and may be influenced by training programs. It is unknown how residents navigate these decisions during emergency medicine (EM) residency. We explored EM residents' perspectives on career decision making and how residency programs can support career planning. Methods: We conducted semistructured interviews at seven accredited EM residency programs from diverse locations and training formats. We used purposive sampling to reflect the diversity of trainees with regard to gender, level of training, and career plans. Two researchers independently coded the transcripts. We used a constructivist-interpretivist paradigm to guide our thematic analysis. Results: We interviewed 11 residents and identified major themes in three categories. Residents described being exposed to career options through formalized curricula such as required rotations, career fairs, and subspeciality tracks, highlighting the importance of access to faculty with diverse areas of clinical and academic expertise. Many noted that exposure was often self-driven. We identified three major themes regarding career decisions: instrumental factors, people involved, and processes of decision making. Instrumental factors included personal interests, goals, and values as well as practice characteristics, financial considerations, timing, and opportunity costs. Mentors and family were highly involved in resident career decisions. Residents often utilized reflection and conversations with mentors and peers in their decision-making process. Participants recommended that programs provide exposure to diverse career options early in training, protect time for career education, and ensure adequate mentorship and a supportive community. Participants suggested specific curricular content and strategies to support career decisions. Conclusions: This study illuminates important factors involved in resident career decision making and how programs can support their trainees. Essential components include diverse experiences and building a reflective mentorship environment.

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.

Probing cellular events, one quantum dot at a time.

Monitoring the behavior of single molecules in living cells is a powerful approach to investigate the details of cellular processes. Owing to their optical, chemical and biofunctional properties, semiconductor quantum dot (QD) probes promise to be tools of choice in this endeavor. Here we review recent advances that allow ever more controlled experiments at the single-nanoparticle level in live cells. Several examples, related to membrane dynamics, cell signaling or intracellular transport, illustrate how single QD tracking can be readily used to decipher complex biological processes and address key concepts that underlie cellular organization and dynamics.

Asynchronous vs didactic education: it's too early to throw in the towel on tradition.

BACKGROUND: Asynchronous, computer based instruction is cost effective, allows self-directed pacing and review, and addresses preferences of millennial learners. Current research suggests there is no significant difference in learning compared to traditional classroom instruction. Data are limited for novice learners in emergency medicine. The objective of this study was to compare asynchronous, computer-based instruction with traditional didactics for senior medical students during a week-long intensive course in acute care. We hypothesized both modalities would be equivalent. METHODS: This was a prospective observational quasi-experimental study of 4th year medical students who were novice learners with minimal prior exposure to curricular elements. We assessed baseline knowledge with an objective pre-test. The curriculum was delivered in either traditional lecture format (shock, acute abdomen, dyspnea, field trauma) or via asynchronous, computer-based modules (chest pain, EKG interpretation, pain management, trauma). An interactive review covering all topics was followed by a post-test. Knowledge retention was measured after 10 weeks. Pre and post-test items were written by a panel of medical educators and validated with a reference group of learners. Mean scores were analyzed using dependent t-test and attitudes were assessed by a 5-point Likert scale. RESULTS: 44 of 48 students completed the protocol. Students initially acquired more knowledge from didactic education as demonstrated by mean gain scores (didactic: 28.39% ± 18.06; asynchronous 9.93% ± 23.22). Mean difference between didactic and asynchronous = 18.45% with 95% CI [10.40 to 26.50]; p = 0.0001. Retention testing demonstrated similar knowledge attrition: mean gain scores -14.94% (didactic); -17.61% (asynchronous), which was not significantly different: 2.68% ± 20.85, 95% CI [-3.66 to 9.02], p = 0.399. The attitudinal survey revealed that 60.4% of students believed the asynchronous modules were educational and 95.8% enjoyed the flexibility of the method. 39.6% of students preferred asynchronous education for required didactics; 37.5% were neutral; 23% preferred traditional lectures. CONCLUSIONS: Asynchronous, computer-based instruction was not equivalent to traditional didactics for novice learners of acute care topics. Interactive, standard didactic education was valuable. Retention rates were similar between instructional methods. Students had mixed attitudes toward asynchronous learning but enjoyed the flexibility. We urge caution in trading in traditional didactic lectures in favor of asynchronous education for novice learners in acute care.

Fostering Adaptive Expertise Through Simulation.

Technology-enhanced simulation has been used to tackle myriad challenges within health professions education. Recently, work has typically adopted a mastery learning orientation that emphasizes trainees' sequential mastery of increasingly complex material. Doing so has privileged a focus on performance and task completion, as captured by trainees' observable behaviors and actions. Designing simulation in these ways has provided important advances to education, clinical care, and patient safety, yet also placed constraints around how simulation-based activities were enacted and learning outcomes were measured. In tracing the contemporary manifestations of simulation in health professions education, this article highlights several unintended consequences of this performance orientation and draws from principles of adaptive expertise to suggest new directions. Instructional approaches grounded in adaptive expertise in other contexts suggest that uncertainty, struggle, invention, and even failure help learners to develop deeper conceptual understanding and learn innovative approaches to novel problems. Adaptive expertise provides a new lens for simulation designers to think intentionally around how idiosyncrasy, individuality, and inventiveness could be enacted as central design principles, providing learners with opportunities to practice and receive feedback around the kinds of complex problems they are likely to encounter in practice. Fostering the growth of adaptive expertise through simulation will require a fundamental reimagining of the design of simulation scenarios, embracing the power of uncertainty and ill-defined problem spaces, and focusing on the structure and pedagogical stance of debriefing. Such an approach may reveal untapped potential within health care simulation.

Rethinking Radiology: An Active Learning Curriculum for Head Computed Tomography Interpretation.

INTRODUCTION: Head computed tomography (CT) interpretation is a vital skill for emergency physicians. Existing literature shows poor concordance between emergency physicians and radiologists in head CT interpretation. Prior studies have used passive learning methods to address this knowledge gap. We created an active learning curriculum for teaching head CT interpretation to emergency medicine (EM) residents and compared its effectiveness to a passive learning strategy. METHODS: We conducted a prospective, randomized controlled study of EM residents at a single institution. Three educational sessions were delivered over a three-month period via video conference. The active learning cohort (ALC) scrolled through head CT teaching cases we designed on Pascbin, a web-based radiology picture archiving and communication system. The passive learning cohort (PLC) watched instructional videos that scrolled through the same cases. Both cohorts were given equal time to review the cases and ask an instructor questions. Residents took pre-intervention and post-intervention tests on head CT interpretation. We analyzed scores using paired and unpaired t-tests. RESULTS: Forty-two residents took the pre-intervention test. Mean pre- and post-test scores for the ALC were 43.8% and 59.0% (P <0.001), and for the PLC were 41.7% and 45.3% (P = 0.29). The difference in ALC and PLC post-test scores was statistically significant (P = 0.009) with a large effect size (Cohen's d = 1.34). CONCLUSION: Our active learning head CT curriculum using Pacsbin showed superior learning outcomes when compared to a passive learning strategy and required no additional time or resources. This intervention offers a more effective and learner-centric method for implementing radiology curricula in EM residency programs.

Beyond the CLAIM: A comprehensive needs assessment strategy for creating an Advanced Medical Education Research Training Program (ARMED-MedEd).

BACKGROUND: The health professions education (HPE) landscape has shifted substantively with increasing professionalization of research and scholarship. Clinician educators seeking to become competitive in this domain often pursue fellowships and master's degrees in HPE, but there are few resources for the continuing professional development (CPD) of those who seek to continue developing their scholarly practice within HPE. Acknowledging the multiple players in this landscape, the authors sought to design a new "beyond beginners" HPE research program using a novel needs assessment planning process. METHODS: The authors developed and conducted a new three-phase, five-step process that sets forth a programmatic approach to conducting a needs assessment for a CPD course in HPE research. The five steps of the CLAIM method are: Competitive analysis, Literature review with thematic analysis, Ask stakeholders, Internal review by experts, and Mapping of a curriculum. These steps are organized into three phases (Discovery, Convergence, and Synthesis). RESULTS: Over a 12-month period, the authors completed a comprehensive needs assessment. The CLAIM process revealed that longitudinal digital connection, diverse and in depth exposure to HPE research methods, skills around scholarly publishing, and leadership and management of research would be beneficial to our design. CONCLUSIONS: The CLAIM method provided scaffolding to help the authors create a robust curriculum that adopts a scholarly approach for developing a HPE research course. This needs assessment methodology may be useful in other CPD contexts.

"Not just a checkbox": A qualitative study of the resident scholarly experience.

Objectives: Scholarship is a requirement of residency training; however, the scholarly productivity of trainees is highly variable. The purpose of this study was to explore the perspectives of residents who have been highly productive in scholarship. Methods: We performed a qualitative study using a constructivist-interpretivist paradigm and conducted semistructured interviews at seven Accreditation Council for Graduate Medical Education-accredited emergency medicine residency programs in the United States. We included sites of diverse locations and training formats (PGY-1 to -4 vs. PGY-1 to -3). Program leadership identified residents with high levels of scholarly productivity at their institutions. We used purposive sampling to seek out residents with diversity in gender and PGY level. Two researchers independently performed a thematic analysis of interview transcripts. Discrepancies were resolved through in-depth discussion and negotiated consensus. Results: We invited 14 residents and all consented to be interviewed. Residents felt scholarship enhanced their knowledge and skills, grew collaborative networks, and provided personal fulfillment and external rewards. Scholarship positively impacted their careers by focusing their professional interests and informing career decisions. Participants identified individual and institutional facilitators of success including personal prior knowledge and skills, project management skills, mindset, protected time, mentorship, and leadership support. Challenges to conducting scholarship included lack of time, expertise, and resources. Participants acknowledged that participating in scholarly activities was hard work and recommended that residents seek out quality mentorship, work on projects that they are passionate, start early, and be persistent in their efforts. Participants' advice to faculty supporting resident scholarship included recommendations to allow resident autonomy of projects, provide scholarly opportunities, and be responsive to trainee needs. Conclusions: Participants in this study highlighted benefits of participating in scholarly activity as well as challenges and strategies for success. These results can inform residencies seeking to enhance the scholarly experience of trainees.

A simple and general route for monofunctionalization of fluorescent and magnetic nanoparticles using peptides.

Nanoparticles are now utilized in many diverse biological and medical applications. Despite this, it remains challenging to tailor their surface for specific molecular targeting while maintaining high biocompatibility. To address this problem, we evaluate a phytochelatin-related peptide surface coating to produce functional and biocompatible nanoparticles (NPs) based on fluorescent InP/ZnS and CdSe/ZnS or superparamagnetic FePt and Fe(3)O(4). Using a combination of transmission electron microscopy, size-exclusion chromatography and gel electrophoresis (GE), we demonstrate the excellent colloidal properties of the peptide-coated NPs (pNPs) and the compact nature of the coating (∼4 nm thickness). We develop a simple protocol for the monofunctionalization of the pNPs with targeting biomolecules, by combining covalent conjugation with GE purification. We then employ functionalized InP/ZnS pNPs in a live-cell, single-molecule imaging application to specifically target and detect individual proteins in the cell membrane. These findings showcase the versatility of the peptides for preparing compact NPs of various compositions and sizes, which are easily functionalized, and suitable for a broad range of biomedical applications.

Covalent monofunctionalization of peptide-coated quantum dots for single-molecule assays.

Fluorescent probes for biological imaging of single molecules (SM) have many stringent design requirements. In the case of quantum dot (QD) probes, it remains a challenge to control their functional properties with high precision. Here, we describe the simple preparation of QDs with reduced size and monovalency. Our approach combines a peptide surface coating, stable covalent conjugation of targeting units and purification by gel electrophoresis. We precisely characterize these probes by ensemble and SM techniques and apply them to tracking individual proteins in living cells.

A practical guide for conducting qualitative research in medical education: Part 3-Using software for qualitative analysis.

The process of performing qualitative analysis can be a daunting task. Technology can be employed to ease the burden of the work; however, the researcher may not fully appreciate how and when computer software can assist in conducting qualitative analysis. In this, the third installment of our "how-to" series on qualitative research methods, we describe basic concepts and approaches to using both simple word processing programs and specific qualitative research software programs to assist in coding and analysis. We hope that the concepts put forth in this paper will help qualitative researchers become more familiar with available technological approaches and that they will, in turn, enhance the efficiency of the research process as well as the depth, clarity and richness of research findings.

A practical guide for conducting qualitative research in medical education: Part 2-Coding and thematic analysis.

An organized and rigorous approach to analyzing qualitative data can yield important insights into the intricacies of human behavior and can answer "how" and "why" questions. One process of coding interview responses from study subjects using grounded theory with a constructivist approach is outlined and applied to an example study. The emergent themes can provide insight to medical educators to create interventions that optimize the learning environment. For researchers, they may generate hypotheses to study by quantitative analysis.

A nationwide survey of emergency medicine resident workflow efficiency: Are training programs teaching residents to be efficient?

BACKGROUND: Workflow efficiency (WFE) is essential to the practice of emergency medicine (EM), but a standardized approach to measuring and teaching it during residency is lacking. In this study we sought to describe how EM residency programs in the United States currently measure and teach WFE and to assess the relative importance of WFE teaching to EM residency program leaders. METHODS: We conducted a cross-sectional survey of all accredited EM residency training programs in the United States in Fall 2019. We invited all allopathic EM residency programs to participate in the study by directly emailing program directors and assistant/associate program directors. We conducted the study and performed descriptive statistics using SurveyMonkey software. RESULTS: We received a total of 133 responses out of 190 total programs (70%) with proportionate representation from 3- and 4-year programs and all regions of the United States. When asked to what extent teaching efficiency should be a priority compared to other educational goals, 65% of program leaders responded with "significant" or "moderate" priority. Most EM programs collect WFE data on their residents, either by tracking patients per hour (78%) or by written evaluations (59%). Common methods for providing WFE data to residents were: "individual data provided along with deidentified rank" (35%), "data provided only during private feedback meetings" (26%), and "no data or rank provided to residents" (16%). Regarding targeted WFE teaching to residents, 88% reported utilizing general on-shift teaching, 48% reported teaching WFE during formal didactics, and 45% during dedicated private feedback sessions. CONCLUSION: This national study of allopathic U.S. EM programs suggests that most EM program leaders do value WFE teaching. However, we found no consistent approach among programs for tracking or distributing resident WFE data, and many programs lack a formalized way to teach efficiency to their residents.

Academic springboard: The chief resident position correlates with career path in emergency medicine.

BACKGROUND: The chief resident role often includes additional administrative and educational experiences beyond those of nonchief senior residents. It is unclear to what extent these experiences influence the postresidency career path of those selected as chief residents. The objective of this study was to evaluate the association of chief resident status on immediate postresidency career characteristics relative to nonchief residents in emergency medicine (EM). METHODS: We retrospectively analyzed graduate data from 2016 to 2020 at six accredited EM residency programs. Participating sites were geographically diverse and included 3- and 4-year training formats. Each site abstracted data using a standardized form including program, year of graduation, chief resident status, publications during residency, and immediate postresidency position (academic vs. nonacademic). We calculated descriptive statistics and performed logistic regression to explore differences between the chief resident cohort and other graduates. RESULTS: We gathered information on 365 total graduates (45.8% from 3-year programs and 54.2% from 4-year programs) including 93 (25.5%) chief residents. A total of 129 (35%) graduates assumed an academic position immediately following residency. Fifty-six (60%) of 93 chief residents assumed an academic position immediately following residency, compared to 74 (27%) of 272 other graduates. After program, year of graduation, and number of publications completed during residency were controlled for, chief resident status was a significant predictor of immediate postresidency academic career (odds ratio for a chief resident assuming an academic job = 5.36, 95% confidence interval = 3.10 to 9.27). CONCLUSION: The chief resident role within EM is significantly associated with pursuit of an academic position immediately following residency compared to nonchiefs.