Observed Structured Teaching Experiences (OSTEs) in a Students as Teachers Course.

Introduction: Teaching is an important competency in graduate medical education (GME). Many residency programs have implemented curricula to develop residents' teaching skills and observed structured teaching experiences (OSTEs) have been used to assess these skills. There is an increasing focus on building teaching skills earlier in the medical education continuum, however, there is limited literature on assessing medical students' teaching skills. The authors developed an OSTE for medical students enrolled in a students-as-teachers course to address this gap and provide formative feedback on teaching skills. Materials and Methods: OSTEs were conducted for fourth-year medical students (M4s) enrolled in a Students as Teachers Advanced Elective at a US medical school. An M4 observed a first-year medical student (M1) during a simulated encounter with a standardized patient. The M4 gave feedback and a chalk talk. A physician observer assessed the M4's teaching using the modified Stanford Faculty Development Program (SFDP) questionnaire. The M1s and M4s also completed the SFDP. The M4 completed pre- and post-OSTE self-efficacy surveys (score range 6-30) and a post-OSTE acceptability survey. Results: All (30/30) M4s completed the OSTE. The SFDP identified common teaching strengths and areas for growth. ANOVA tests demonstrated significant differences between the mean (SD) scores from physician assessors, M1s, and M4s [4.56 (0.63) vs. 4.87 (0.35) vs. 4.08 (0.74), p<0.001]. There was a statistically significant difference in mean (SD) self-efficacy scores pre- and post-OSTE [18.72 (3.39) vs. 23.83 (3.26), p<0.001]. All M4s (30/30) somewhat or strongly agreed with all three OSTE acceptability questions. Lessons Learned: The authors successfully conducted an OSTE in an M4 advanced elective. The OSTE was highly acceptable to participants, and M4s demonstrated improved teaching self-efficacy. Further research should explore the validity of the OSTE to measure medical students' teaching skills and the long-term impact of developing teaching skills in medical school. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-023-01952-3.

Who leaves the emergency department without being seen? A public hospital experience in Georgetown, Guyana.

BACKGROUND: Left without being seen (LWBS) proportions are commonly used as quality control indicators, but little data is available on LWBS proportions in the developing world. This study sought to determine the proportion and characteristics of patients who LWBS from the emergency department (ED) of the main public hospital in Georgetown, Guyana. METHODS: This is a retrospective cross-sectional analysis of an ED quality assurance database. Registration personnel collected demographic information on patients presenting to the ED over a 2-week period in July 2010. Both univariate and multivariate analysis were conducted to determine patient characteristics associated with LWBS. RESULTS: The LWBS proportion was 5.7%. In univariate analysis, patients 18 or older (OR 1.48, 95%CI 1.03-2.12), presenting during the 4PM-12AM shift (OR 2.15, 95%CI 1.53-3.01), with non-urgent triage classification (OR 1.88, 95%CI 1.76-4.66), with non-traumatic chief complaints (OR 1.70, 95%CI 1.14-2.55), or who were not transferred (OR 2.13, 95%CI 1.00-4.55) had significantly higher odds of LWBS. On multivariate analysis, only patients 18 or older (OR 1.54, 95%CI 1.02-2.33), presenting during the 4PM-12AM shift (OR 2.29, 95%CI 1.54-3.40), and with non-traumatic chief complaints (OR 2.39, 95%CI 1.43-4.02) were found to be significantly associated with LWBS. Sex, residence in the capital city, time to triage, transfer status, use of EMS, and triage classification were not statistically associated with LWBS. CONCLUSIONS: LWBS proportions are used as quality control indicators and this study determined the LWBS proportion at a public hospital in a developing country and some of the patient characteristics associated with LWBS. This can be helpful to develop strategies to decrease LWBS proportions and to assess progress over time.

Teaching Future Teachers: Development of a Students-as-Teachers Advanced Elective for Post-Clerkship Medical Students.

Although teaching is an essential part of Graduate Medical Education and the practice of medicine, it is not often formally taught in Undergraduate Medical Education. Vanderbilt University School of Medicine (VUSM) has addressed this gap by creating a year-long Students-as-Teachers elective for post-clerkship medical students. The elective utilizes diverse activities to emphasize core tenets of medical education theory while simultaneously providing authentic teaching opportunities. The success of the elective is primarily attributable to its structure and design, the collaborative and supportive medical education environment, and student initiative and engagement. This manuscript describes the implementation and outcomes of the Students-as-Teachers elective.

Emergency medicine clerkship director experience adapting emergency remote learning during the onset of COVID-19 pandemic.

Objectives: The recent outbreak of the COVID-19 altered the traditional paradigm of clinical medical education. While individual clerkships have shared their curricular adaptations via social and academic networking media, there is currently no organizational standard in establishing a nonclinical, emergency medicine (EM) virtual rotation (VR). The primary objective of this study was to describe EM clerkship directors' (CDs) perspectives on their experience adapting an EM VR curriculum during the onset of the COVID-19 pandemic. Methods: A 21-item survey with quantitative and qualitative questions was disseminated between June and August 2020 to EM CDs via the Clerkship Director of Emergency Medicine Listserv to describe their experience and perspectives in adapting a VR during spring 2020. Results: We analyzed 59 of 77 EM clerkship survey responses. Among respondents, 52% adapted a VR while 47.5% did not. Of those who adapted a VR, 71% of CDs had 2 weeks or less to develop the new curriculum, with 84% reporting usual or increased clinical load during that time. Clerkships significantly diversified their asynchronous educational content and utilized several instructional models to substitute the loss of clinical experience. Reflecting on the experience, 71% of CDs did not feel comfortable writing a standardized letter of evaluation for students based on the VR, with the majority citing inability to evaluate students' competencies in a clinical context. Conclusion: A crisis such as COVID-19 necessitates change in all facets of medical education. While EM educators demonstrated the ability to create emergency remote learning with limited time, this was not equivalent to the formal development of preplanned VR experiences. Future faculty development and curriculum innovation are required to fully transition an in-person immersive experience to a noninferior virtual experience.

Core Entrustable Professional Activities (EPAs) and the Transition from Medical School to Residency: the Postgraduate Year One Resident Perspective.

INTRODUCTION: The Association of American Medical Colleges (AAMC) proposed thirteen core Entrustable Professional Activities (EPAs) that all graduates should be able to perform under indirect supervision upon entering residency. As an underlying premise is that graduates ready to do so will be better prepared to transition to the responsibilities of residency, we explored the relationship between postgraduate year (PGY)-1 residents' self-assessed preparedness to perform core EPAs under indirect supervision at the start of residency with their ease of transition to residency. METHODS: Using response data to a questionnaire administered in September 2019 to PGY-1 residents who graduated from AAMC core EPA pilot schools, we examined between-group differences and independent associations for each of PGY-1 position type, specialty, and "EPA-preparedness" score (proportion of EPAs the resident reported as prepared to perform under indirect supervision at the start of residency) and ease of transition to residency (from 1 = much harder to 5 = much easier than expected). RESULTS: Of 274 questionnaire respondents (19% of 1438 graduates), 241 (88% of 274) had entered PGY-1 training and completed all questionnaire items of interest. EPA-preparedness score (mean 0.71 [standard deviation 0.26]) correlated with ease of transition (3.1 [0.9]; correlation = .291, p < .001). In linear regression controlling for specialty (among other variables), EPA-preparedness score (ß-coefficient 1.08; 95% confidence interval .64-1.52; p < .001) predicted ease of transition to residency. CONCLUSION: Graduates who felt prepared to perform many of the core EPAs under indirect supervision at the start of PGY-1 training reported an easier-than-expected transition to residency. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40670-021-01370-3.

A Critical Disconnect: Residency Selection Factors Lack Correlation With Intern Performance.

BACKGROUND: Emergency medicine (EM) residency programs want to employ a selection process that will rank best possible applicants for admission into the specialty. OBJECTIVE: We tested if application data are associated with resident performance using EM milestone assessments. We hypothesized that a weak correlation would exist between some selection factors and milestone outcomes. METHODS: Utilizing data from 5 collaborating residency programs, a secondary analysis was performed on residents trained from 2013 to 2018. Factors in the model were gender, underrepresented in medicine status, United States Medical Licensing Examination Step 1 and 2 Clinical Knowledge (CK), Alpha Omega Alpha (AOA), grades (EM, medicine, surgery, pediatrics), advanced degree, Standardized Letter of Evaluation global assessment, rank list position, and controls for year assessed and program. The primary outcomes were milestone level achieved in the core competencies. Multivariate linear regression models were fitted for each of the 23 competencies with comparisons made between each model's results. RESULTS: For the most part, academic performance in medical school (Step 1, 2 CK, grades, AOA) was not associated with residency clinical performance on milestones. Isolated correlations were found between specific milestones (eg, higher surgical grade increased wound care score), but most had no correlation with residency performance. CONCLUSIONS: Our study did not find consistent, meaningful correlations between the most common selection factors and milestones at any point in training. This may indicate our current selection process cannot consistently identify the medical students who are most likely to be high performers as residents.

COVID-19: A Driver for Disruptive Innovation of the Emergency Medicine Residency Application Process.

The coronavirus disease (COVID-19) pandemic has had a significant impact on undergraduate medical education with limitation of patient care activities and disruption to medical licensing examinations. In an effort to promote both safety and equity, the emergency medicine (EM) community has recommended no away rotations for EM applicants and entirely virtual interviews during this year's residency application cycle. These changes affect the components of the EM residency application most highly regarded by program directors - Standardized Letters of Evaluation from EM rotations, board scores, and interactions during the interview. The Council of Residency Directors in Emergency Medicine Application Process Improvement Committee suggests solutions not only for the upcoming year but also to address longstanding difficulties within the process, encouraging residency programs to leverage these challenges as an opportunity for disruptive innovation.

Thematic Analysis of Emergency Medicine Applicants' Personal Statements.

BACKGROUND: The personal statement is an important part of the residency application. Although guidance exists, the composition of personal statements is not standardized; each statement reflects an applicant's unique personality. In emergency medicine (EM), the personal statement could thus provide insight into why applicants are choosing EM and what they hope to accomplish in the field that could guide advisors and applicants. OBJECTIVE: To perform a thematic analysis of personal statements from applicants accepted into an academic EM residency program to gain insight into what successful applicants include in their personal statements, why applicants are pursuing careers in emergency medicine, and anticipated career goals. METHODS: Thematic analysis was performed on ten randomly selected personal statements from matched allopathic, U.S. applicants at a single, large, urban 3-year EM residency program between 2008 and 2015. Themes and sub-themes were identified and analyzed for frequency. RESULTS: Ten personal statements were analyzed. Thirty-one (31) unique themes were identified and grouped into five main themes: personal characteristics related to a career in EM (38.3%, 116/303), why I love EM (36%, 109/303), my story (13.5%, 41/303), my career in EM (8.9%, 27/303), and ideal characteristics of a residency program (3.3%, 10/303). The most common personal characteristics described were altruism and the ability to work well under pressure. Applicants love EM due to the diversity of patients and disease presentations and the ability to perform procedures. CONCLUSIONS: Thematic analysis of EM applicants' personal statements highlights the uniqueness of EM as a specialty and what draws applicants to EM.

Implementation of a Departmental Female Emergency Medicine Physician Group.

Gender disparities exist in academic emergency medicine (EM). We developed and implemented a female EM physician group - Women in Academic Emergency Medicine (WAM) - to support female EM residents, fellows, and faculty. The goal of WAM is to provide a support system through mentorship, education, and outreach. A targeted needs assessment was completed to identify goals and objectives specific to our department. In the first full year of implementation, WAM hosted eight events, including three topical dinners and one formal panel. Of 42 female faculty and residents, 40 (95%) attended at least one WAM event, and all (20/20) of the female faculty strongly supported WAM. WAM advocated for increased female physician representation on the department's Physician Executive Leadership Group and preservation of dedicated lactation space in the emergency department. Using a needs assessment, the process of developing WAM can be replicated in any department to create a female physician group.

Motivational Advising Workshop: Utilizing Motivational Interviewing Theory to Facilitate and Engage Intrinsic Motivation to Change Learners' Behavior.

Introduction: Motivational interviewing (MI) is a counseling method that utilizes a patient's own motivation to effect personal change. MI has been applied routinely and successfully to managing medical conditions (e.g., substance abuse). Employing MI techniques to engage medical learners (termed motivational advising [MA]) may help them overcome professional and/or personal challenges limiting their career development. Methods: Medical educators from four academic medical centers developed a module focused on teaching fellow educators MI theory and techniques for MA using didactic and interactive components. Participants participated in facilitated role-plays to practice MA delivery techniques and observed videos of a traditional advisor-advisee interaction as well as an MA-focused engagement. A postworkshop survey was used to evaluate the workshop. Results: In a survey of 48 educators attending the workshop at two medical conferences, over 80% of respondents demonstrated an interest in learning more about MA. Additionally, over 60% indicated that they would seek opportunities to practice and/or implement MA with their advisees. Knowledge of the technical components of MA also increased significantly in pre- and posttest analysis. Discussion: This module introducing the concept of MA was well received by medical educators and was viewed as a valuable tool in advising medical learners. The provided components enable replication of this workshop in other settings with or without an expert in MI techniques. Although the workshop has been conducted with physicians involved in medical education, it would be applicable to other health professionals who advise trainees such as nursing, dentistry, pharmacy, or veterinary medicine.

Personal experiences and attitudes towards intimate partner violence in healthcare providers in Guyana.

BACKGROUND: Intimate partner violence (IPV) is prevalent throughout the world and is a devastating public health problem. Healthcare workers (HCWs) are tasked with treating victims of IPV but may be victims themselves. Guyana is a lower-middle income country in South America. This study sought to determine the knowledge and attitudes of Guyanese HCWs and their perceived barriers to providing care in addition to determining the prevalence of IPV victimization and perpetration among HCWs. METHODS: HCWs at the only tertiary care hospital in the Guyana completed an anonymous survey that comprised 30 questions relating to IPV. RESULTS: The survey was completed by 87.5% of eligible HCWs. Of the respondents, 81.8% were female, 49.9% had ever experienced abuse and 21% admitted to perpetrating violence. Multivariate analysis found that the age groups 31-40 years (OR 2.3, 95% CI 1.1-4.6) and 41-50 years (OR 2.3, 95% CI 1.2-4.7) had higher odds of accepting justification for physical violence, and so did nursing staff (OR 4.3, 95% CI 1.4-13.1). Overall, 29.9% of HCWs accepted justification for physical violence in at least one of the named scenarios. CONCLUSION: This study demonstrates a high prevalence of IPV among HCWs and identifies prevailing attitudes regarding IPV. This knowledge is essential in developing effective, appropriate training programs and identifies a need to address IPV among the healthcare workforce.

Prevalence of intimate partner violence in patients presenting with traumatic injuries to a Guyanese emergency department.

BACKGROUND: Intimate partner violence (IPV) occurs throughout the world, and has both short- term and long- term negative health effects. Little is know about the prevalence of IPV in patients presenting to Emergency Departments (EDs) in the developing world. This information is needed to help delineate the scope of the problem and shape effective interventions to combat IPV. The purpose of this study was to determine the prevalence of intimate partner violence in adult patients with acute traumatic injuries presenting to an ED in Georgetown, Guyana. METHODS: Retrospective descriptive analysis of a prospectively collected ED quality assurance database. Patients 18 years or older who presented with a traumatic injury and answered the question "Was the injury inflicted by a domestic partner?" were included in the analysis. RESULTS: Overall, 38 of 475 (8%) patients admitted to having injuries inflicted by a domestic partner. Thirty- one (81.6%) patients disclosing IPV were female and 7 (18.4%) were male. The self- reported prevalence of IPV in females presenting with traumatic injuries was 16% compared to 2% for males (RR 6.4; 95% CI 2.9-14.3). IPV was the cause of 31 of the 67 (46.3%) women presenting with assaults. CONCLUSIONS: IPV is thought to be a serious problem in Guyana, and this study confirms a high prevalence (16%) of IPV in women presenting with traumatic injuries to the Georgetown Public Hospital Corporation ED. This is likely a significant underestimate of the true prevalence.