Faculty Bibliography

BACKGROUND/UNASSIGNED:A lack of educational continuity creates disorienting friction at the onset of residency. Few programs have harnessed the benefits of coaching, which can facilitate self-directed learning, competency development, and professional identity formation, to help ease this transition. OBJECTIVE/UNASSIGNED:To describe the process of training faculty Bridge Coaches for the Transition to Residency Advantage (TRA) program for interns. METHODS/UNASSIGNED:Nineteen graduate faculty educators participated in a coaching training course with formative skills assessment as part of a faculty development program starting in January 2020. Surveys (n = 15; 79%) and a focus group (n = 7; 37%) were conducted to explore the perceived impact of the training course on coaching skills, perceptions of coaching, and further program needs during the pilot year of the TRA program. RESULTS/UNASSIGNED:Faculty had strong skills around establishing trust, authentic listening, and supporting goal-setting. They required more practice around guiding self-discovery and following a coachee-led agenda. Faculty found the training course to be helpful for developing coaching skills. Faculty embraced their new roles as coaches and appreciated having a community of practice with other coaches. Suggestions for improvement included more opportunities to practice and receive feedback on skills and additional structures to further support TRA program encounters with coaches. CONCLUSIONS/UNASSIGNED:The faculty development program was feasible and had good acceptance among participants. Faculty were well-suited to serve as coaches and valued the coaching mindset. Adequate skills reinforcement and program structure were identified as needs to facilitate a coaching program in graduate medical education.

PURPOSE/OBJECTIVE:Annual increases in the number of residency applications burden students and challenge programs. Several reforms to the application process have been proposed; however, stakeholder input is often overlooked. The authors examined key stakeholders' opinions about several proposed reforms to the residency application process and identified important factors to guide future reforms. METHOD/METHODS:Using semistructured interviews, the authors asked educational administrators and trainees to consider 5 commonly proposed reforms to the residency application process: match to obtain residency interviews, preference signaling, application limits, geographic preference disclosure, and abolishing the match. The authors conducted a modified content analysis of interview transcripts using qualitative and quantitative analytic techniques. frequency analysis regarding the acceptability of the 5 proposed reforms and thematic analysis of important factors to guide reform were performed. Fifteen-minute interviews were conducted between July and October 2019, with data analysis completed during a 6-month period in 2020 and 2021. RESULTS:Participants included 30 stakeholders from 9 medical specialties and 15 institutions. Most participants wanted to keep the Match process intact; however, they noted several important flaws in the system that disadvantage students and warrant change. Participants did not broadly support any of the 5 proposed reforms. Two themes were identified: principles to guide reform (fairness, transparency, equity, reducing costs to students, reducing total applications, reducing work for program directors, and avoiding unintended consequences) and unpopular reform proposals (concern that application limits threaten less: competitive students and signaling adds bias to the system). CONCLUSIONS:Key stakeholders in the residency application process believe the system has important flaws that demand reform. Despite this, the most commonly proposed reforms are unacceptable to these stakeholders because they threaten fairness to students and program workload. These findings call for a larger investigation of proposed reforms with a more nationally representative stakeholder cohort.

PURPOSE/OBJECTIVE:Adaptive expertise (AE) has been identified as a critical trait to cultivate in future physicians. The 4-phase master adaptive learner (MAL) conceptual model describes the learning skills and behaviors necessary to develop AE. Though prior work has elucidated skills and behaviors used by MALs in the initial planning phase of learning, most resident learners are not thought to be MALs. In this study, the authors investigated how these majority "typical" learners develop AE by exploring the strategies they used in the planning phase of learning. METHOD/METHODS:Participants were resident physicians at graduate medical education (GME) training programs located at 4 academic medical centers in the United States. Participants participated in semistructured individual interviews in 2021, and interview transcripts were analyzed using constant comparative analysis of grounded theory. RESULTS:Fourteen subjects representing 8 specialties were interviewed, generating 152 pages of transcripts for analysis. Three themes were identified: "Typical" learners were challenged by the transition from structured undergraduate medical education (UME) learning to less-structured GME learning, lacked necessary skills to easily navigate this transition, and relied on trial and error to develop their learning skills. CONCLUSIONS:Participants used trial and error to find learning strategies to help them manage the systemic challenges encountered when transitioning from medical school to residency. The success (or failure) of these efforts was tied to learners' efficacy with the self-regulated learning concepts of agency, metacognitive goal setting, and motivation. A conceptual model is provided to describe the impact of these factors on residents' ability to be adaptive learners, and actionable recommendations are provided to help educators' efforts to foster adaptive learning skills and behaviors. These findings also provided valuable evidence of validity of the MAL model that has thus far been lacking.

BACKGROUND:Adaptive expertise is an important physician skill, and the Master Adaptive Learner (MAL) conceptual model describes learner skills and behaviors integral to the acquisition of adaptive expertise. The learning environment is postulated to significantly impact how MALs learn, but it is unclear how these successful learners experience and interact with it. This study sought to understand the authentic experience of MALs within the learning environment and translate those experiences into practical recommendations to improve the learning environment for all trainees. METHODS:Following a constructivist paradigm, we conducted a thematic analysis of transcripts from focus groups composed of MALs to identify commonalities in experiences and practices of successful postgraduate trainees in the learning environment. Saturation was achieved after seven focus groups, consisting of thirty-eight participants representing fourteen specialties from four institutions. Researchers coded transcripts using constant comparison analysis, which served as the foundation for our thematic analysis. RESULTS:We identified eight themes and situated them within a 4-component model of the learning environment. Four themes were identified within the personal component: (1) patients drive learning; (2) learning has no endpoint; (3) management of emotions is crucial for learning; (4) successful learning requires a structured approach. Two themes were identified in the social component: (5) positive social relationships are leveraged to maximize learning; (6) teaching facilitates personal learning. Two themes were identified in the organizational component: (7) transitions challenge learners to adapt; (8) the learning environment dictates goal setting strategy. No major themes were identified in the physical/virtual component, although participants frequently used technology when learning. CONCLUSIONS:Master Adaptive Learners experience similar facilitators of, and barriers to, success in the learning environment. Overall, our data show that acquisition of many successful strategies and skills that support learning are relegated to the hidden curriculum of residency training. Educators could support a more effective learning environment for all trainees by: (1) highlighting patients as the focal point of learning, (2) building a professional 'learner' identity, (3) teaching learning skills, and (4) creating opportunities for collaborative learning.

Objectives/UNASSIGNED:Women are underrepresented in emergency medicine (EM) leadership. Some evidence suggests that geographic mobility improves career advancement. We compared movement between medical school and residency by gender. Our hypothesis was that women move a shorter distance than men. Methods/UNASSIGNED:We collected National Residency Matching Program (NRMP) lists of ranked applicants from eight EM residency programs from the 2020 Main Residency Match. We added the gender expressed in interviews and left the Association of American Medical Colleges (AAMC) number as the unique identifier. Applicant data for matched osteopathic and allopathic seniors in the continental United States was included. We obtained street addresses for medical schools from an AAMC database and residency program addresses from the ACGME website. We performed geospatial analysis using ArcGIS Pro and compared results by gender. NRMP approved the data use and our institutional review board granted exempt status. Results/UNASSIGNED: = 0.31). Women moved a mean (±SD) 619 (±698) miles (median = 341 miles, range = 0-2,679 miles); and men, a mean (±SD) 641 (±717) miles (median = 315 miles, range = 0-2,671 miles). Further analysis of applicants traveling less than 50 miles (49 women, 51 men) and by census division showed no significant frequency differences. Conclusion/UNASSIGNED:Women and men travel similar distances for EM residency with the majority staying within geographic proximity to their medical school. This suggests that professional mobility at this stage is not a constraint. Our study findings are limited because we do not know which personal and professional factors inform relocation decisions. Gender is not associated with a difference in distance moved by students for residency. This finding may have implications for resident selection and career development.

Background/UNASSIGNED:The number of residency applications submitted by medical students rises annually, resulting in increased work and costs for residency programs and applicants, particularly in emergency medicine. We propose a solution to this problem: an optional, two-stage Match with a "summer match" stage, in which applicants can submit a limited number of applications early. This would be conducted similarly to the early decision process for college admissions. The study objectives were to explore stakeholder opinions on the feasibility of a summer match and to identify the ideal logistic parameters to operationalize this proposal. Methods/UNASSIGNED:We used exploratory qualitative methodology following a constructivist paradigm to develop an understanding of the potential impact of a summer match. We interviewed 34 key stakeholders in the U.S. residency application process identified through purposive sampling including educational administrators (program directors, designated institutional officials, medical school deans) and trainees (students, residents). We coded and thematically analyzed interview data in two stages using an inductive approach. Results/UNASSIGNED:We identified six themes from the participant interviews that broadly reflected issues of the residency application process, value, and equity. These themes included disrupting the status quo, logistic concerns, match strategy, differential benefits, unintended consequences, and return on investment. Most study participants supported the summer match concept, with medical students and residents most in favor. We developed a theoretical summer match protocol based on these findings. Conclusions/UNASSIGNED:A summer match may reduce the burdens of increasing residency applications and associated costs. Pilot testing is necessary to confirm this hypothesis and determine the impact of the proposed summer match protocol. Unintended consequences must be considered carefully during implementation.

The development of lifelong learners is among the most challenging goals for medical educators. The authors identify two important scholarly works that profoundly altered their understanding and approach to lifelong learning and curriculum design: L. Dee Fink's Taxonomy of Significant Learning and Cutrer et al.'s Master Adaptive Learner model. By applying these guides to their teaching and related research, three important characteristics of lifelong learning became evident: sustainability, engagement, and accountability. These are abbreviated "SEALs," for sustainable engaged accountable learners. This paper defines these qualities as they relate to emergency medicine training, significant learning, and the development of adaptive expertise. Connections to Fink's and Cutrer's works are offered for each learner characteristic. Educational and psychological theories that support the SEALs model are paired with practical suggestions for educators to promote these desired qualities in their trainees. Relevant features of adult learning are highlighted, including self-regulation, motivation, agency, and autonomy.

Background and Objectives: The US residency application process intensified over the last decade, with a 73% increase in the number of applications submitted per US senior medical student. In emergency medicine there has been a 90% increase in the number of applications received per program. The purpose of this research is to explore the possibility of adding an earlier, optional "Summer Match", similar to the early decision programs used by many colleges, to mitigate this increase Methods: This IRB-approved qualitative study followed a constructivist paradigm. We conducted 30 minute semi-structured interviews of key stakeholders in the residency application process, exploring perspectives on the current process and the feasibility and value of a Summer Match. Recruitment was purposeful sampling via email. Participation was voluntary and based on participant availability. Each transcript was coded by two study authors with disputes mediated by a third. The resulting codes were analyzed using thematic analysis Results: We completed 34 interviews with stakeholders from 18 institutions: 6 assistant deans, 4 designated institutional officials, 12 program directors, 4 residents and 8 medical students. Preliminary analysis revealed several key themes related to the current residency application process and a potential Summer Match including 1) agreement among all stakeholder groups that reform is needed, 2) interest in a trial of a Summer Match, with strongest support from program directors and applicants, 3) fear about unintended consequences of a Summer Match, particularly potential disadvantage to weaker applicants
Conclusion(s): There is general agreement among all stakeholders that the ongoing escalation of the residency application process is harmful to both applicants and programs. A majority of participants believe that a well-implemented Summer Match could be part of the solution, but there is some fear of unintended consequences. These findings support the need to reassess the current residency application process