Faculty Bibliography

Background/UNASSIGNED:The Accreditation Council for Graduate Medical Education Common Program Requirements effective 2017 state that programs and sponsoring institutions have the same responsibility to address well-being as they do other aspects of resident competence. Objectives/UNASSIGNED:The authors sought to determine if the implementation of a multifaceted wellness curriculum improved resident burnout as measured by the Maslach Burnout Inventory (MBI). Methods/UNASSIGNED:We performed a multicenter educational interventional trial at 10 emergency medicine (EM) residencies. In February 2017, we administered the MBI at all sites. A year-long wellness curriculum was then introduced at five intervention sites while five control sites agreed not to introduce new wellness initiatives during the study period. The MBI was readministered in August 2017 and February 2018. Results/UNASSIGNED:Of 523 potential respondents, 437 (83.5%) completed at least one MBI assessment. When burnout was assessed as a continuous variable, there was a statistically significant difference in the depersonalization component favoring the control sites at the baseline and final survey administrations. There was also a higher mean personal accomplishment score at the control sites at the second survey administration. However, when assessed as a dichotomous variable, there were no differences in global burnout between the groups at any survey administration and burnout scores did not change over time for either control or intervention sites. Conclusions/UNASSIGNED:In this national study of EM residents, MBI scores remained stable over time and the introduction of a multifaceted wellness curriculum was not associated with changes in global burnout scores.

Objectives/UNASSIGNED:Despite increasing prevalence in emergency medicine (EM), the vice chair of education (VCE) role remains ambiguous with regard to associated responsibilities and expectations. This study aimed to identify training experiences of current VCEs, clarify responsibilities, review career paths, and gather data to inform a unified job description. Methods/UNASSIGNED:A 40-item, anonymous survey was electronically sent to EM VCEs. VCEs were identified through EM chairs, residency program directors, and residency coordinators through solicitation e-mails distributed through respective listservs. Quantitative data are reported as percentages with 95% confidence intervals and continuous variables as medians with interquartiles (IQRs). Open- and axial-coding methods were used to organize qualitative data into thematic categories. Results/UNASSIGNED:Forty-seven of 59 VCEs completed the survey (79.6% response rate); 74.4% were male and 89.3% were white. Average time in the role was 3.56 years (median = 3.0 years, IQR = 4.0 years), with 74.5% serving as inaugural VCE. Many respondents held at least one additional administrative title. Most had no defined job description (68.9%) and reported no defined metrics of success (88.6%). Almost 78% received a reduction in clinical duties, with an average reduction of 27.7% protected time effort (median = 27.2%, IQR = 22.5%). Responsibilities thematically link to faculty affairs and promotion of the departmental educational mission and scholarship. Conclusion/UNASSIGNED:Given the variability in expectations observed, the authors suggest the adoption of a unified VCE job description with detailed responsibilities and performance metrics to ensure success in the role. Efforts to improve the diversity of VCEs are encouraged to better match the diversity of learners.

PURPOSE/OBJECTIVE:To compare the performance characteristics of the Electronic Standardized Letter of Evaluation (eSLOE), a widely used structured assessment of emergency medicine (EM) residency applicants, and the AAMC Standardized Video Interview (SVI), a new tool designed by the Association of American Medical Colleges to assess interpersonal and communication skills and professionalism knowledge. METHOD/METHODS:The authors matched EM residency applicants with valid SVI total scores and completed eSLOEs in the 2018 Match application cycle. They examined correlations and group differences for both tools, United States Medical Licensing Examination (USMLE) Step exam scores, and honor society memberships. RESULTS:The matched sample included 2,884 applicants. SVI score and eSLOE global assessment ratings demonstrated small positive correlations approaching r = 0.20. eSLOE ratings had higher correlations with measures of academic ability (USMLE scores, academic honor society membership) than did SVI scores. Group differences were minimal for the SVI, with scores slightly favoring women (d = -.21) and U.S.-MD applicants (d = .23-.42). Group differences in eSLOE ratings were small, favoring women over men (approaching d = -0.20) and white applicants over black applicants (approaching d = 0.40). CONCLUSIONS:Small positive correlations between SVI total score and eSLOE global assessment ratings, alongside varying correlations with academic ability indicators, suggest these are complementary tools. Findings suggest the eSLOE is subject to similar sources and degrees of bias as other common assessments; these group differences were not observed with the SVI. Further examination of both tools is necessary to understand their ability to predict clinical performance.

Background: The ability to adapt expertise to both routine and uncommon situations, termed adaptive expertise, has been suggested as a necessary skill for physicians. The Master Adaptive Learner (MAL) framework proposes four phases necessary to develop adaptive expertise. The first phase, "planning" for learning, includes three stages: identification of gaps, prioritization of gaps, and identification of learning resources. This study explored key strategies used by MALs in "planning" for learning. Methods: Focus groups were used to identify strategies that successful postgraduate trainees use to plan learning. Researchers analyzed transcripts using constant comparison analysis and grounded theory to guide the generation of themes. Results: 38 participants, representing 14 specialties, participated in 7 focus groups. Six key strategies used in the "planning" phase of learning were found. During gap identification, they used performance-driven gap identification and community-driven gap identification. To prioritize gaps, they used the schema of triage and adequacy. To identify resources they used intentional adaptation and weighted curation. Barriers such as lack of time and inexperience were noted. Conclusions: MALs use six strategies to plan learning, using patients, health-care team roles, and clinical questions to guide them. Understanding these strategies can help educators design learning opportunities and overcome barriers.

ISSUE/OBJECTIVE:Competency-Based Medical Education (CBME) focuses on demonstrable outcomes, as well as upholding medical education's accountability to society. Despite calls for a robust, multifaceted approach to competency-based assessment (CBA), lingering critiques exist. These critiques include reductionism, reinforcement of an external locus of control within learners, an loss of focus on learner development. Both CBME and CBA may be strengthened if viewed through the lens of a complementary curriculum design framework that broadens the focus on the learner. EVIDENCE/METHODS:Researchers and physician organizations have articulated the need for medical practitioners trained to provide optimal care in the rapidly changing care environment. In the drive to ensure accountability to patients and society, CBME may overlook the duty of educators to foster the necessary intrinsic development of learners as holistic professionals. The focus of CBA on outcomes may reward memorization and rote performance but may fail to ensure the underlying comprehension or critical thinking necessary to adapt to the variability of real-life patient care. Learners focus on tasks chosen for assessment; thus, areas less easily assessed may be overlooked or deemed unimportant. Reinforcement for learner motivation becomes externalized in CBA, as opposed to being driven by the desire for self-improvement and self-actualization. A recently proposed framework that views learner development as a process-based improvement cycle, the "Master Adaptive Learner," may help remedy this issue. L. Dee Fink's Taxonomy of Significant Learning aims to create meaningful learning experiences in higher education. This taxonomy consists of six interwoven domains: (a) Learning How to Learn, (b) Foundational Knowledge, (c) Application, (d) Integration, (e) Human Dimension, and (f) Caring. Each domain encompasses a unique perspective on the learning process, and when collectively applied to curriculum design, significant learning occurs. This taxonomy has not been widely applied to medical education but may offer an important counterbalance to the outcomes-based focus of CBME. IMPLICATIONS/CONCLUSIONS:The outcomes-based focus of CBME is well suited for skill-based tasks, such as procedures, that are observable and measurable. However, other essential physician skills-such as critical thinking, reflection, empathy, and self-directed learning-are not easily assessed, and thus may receive little focus in an outcomes-based model. A holistic approach, such as the Taxonomy of Significant Learning, can counter the deficits of CBME and provide a balanced approach to education program design and assessment.

Background/UNASSIGNED:Assessment of trainees' competency is challenging; the predictive power of traditional evaluations is debatable especially in regard to noncognitive traits. New assessments need to be sought to better understand affective areas like personality. Grit, defined as "perseverance and passion for long-term goals," can assess aspects of personality. Grit predicts educational attainment and burnout rates in other populations and is accurate with an informant report version. Self-assessments, while useful, have inherent limitations. Faculty's ability to accurately assess trainees' grit could prove helpful in identifying learner needs and avenues for further development. Objective/UNASSIGNED:This study sought to determine the correlation between EM resident self-assessed and faculty-assessed Grit Scale (Grit-S) scores of that same resident. Methods/UNASSIGNED:Subjects were PGY-1 to -4 EM residents and resident-selected faculty as part of a larger multicenter trial involving 10 EM residencies during 2017. The Grit-S Scale was administered to participating EM residents; an informant version was completed by their self-selected faculty. Correlation coefficients were computed to assess the relationship between residents' self-assessed and the residents' faculty-assessed Grit-S score. Results/UNASSIGNED:A total of 281 of 303 residents completed the Grit-S, for a 93% response rate; 200 of 281 residents had at least one faculty-assessed Grit-S score. No correlation was found between residents' self-assessed and faculty-assessed Grit-S scores. There was a correlation between the two faculty-assessed Grit-S scores for the same resident. Conclusion/UNASSIGNED:There was no correlation between resident and faculty-assessed Grit-S scores; additionally, faculty-assessed Grit-S scores of residents were higher. This corroborates the challenges faculty face at accurately assessing aspects of residents they supervise. While faculty and resident Grit-S scores did not show significant concordance, grit may still be a useful predictive personality trait that could help shape future training.

Although the U.S. population continues to become more diverse, black, Hispanic, and Native American doctors remain underrepresented in emergency medicine (EM). The benefits of a diverse medical workforce have been well described, but the percentage of EM residents from underrepresented groups is small and has not significantly increased over the past 20 years. A group of experts in the field of diversity and inclusion convened a work group during the Council of Emergency Medicine Residency Program Directors (CORD) and Society for Academic Emergency Medicine (SAEM) national meetings. The objective of the discussion was to develop strategies to help EM residency programs examine and improve racial and ethnic diversity in their institutions. Specific recommendations included strategies to recruit racially and ethnically diverse residency candidates and strategies to mentor, develop, retain, and promote minority faculty.

There is growing competition for non-operative, procedural training in teaching hospitals, due to an increased number of individuals seeking to learn procedures from a finite number of appropriate teaching cases. Procedural training is required by students, post-graduate learners, and practicing providers who must maintain their skills. These learner groups are growing in size as the number of medical schools increase and advance practice providers expand their skills to include complex procedures. These various learner needs occur against a background of advancing therapeutic techniques that improve patient care, but also act to reduce the overall numbers of procedures available to learners. This article is a brief review of these and other challenges that are arising for program directors, medical school leaders, and hospital administrators who must act to ensure that all of their providers acquire and maintain competency in a wide array of procedural skills. The authors conclude their review with several recommendations to better address procedural training in this new era of learner competition. These include a call for innovative clinical rotations deliberately designed to improve procedural training, access to training opportunities at new clinical sites acquired in health system expansions, targeted faculty development for those who teach procedures, reporting of competition for bedside procedures by trainees, more frequent review of resident procedure and case logs, and the creation of an institutional oversight committee for procedural training.

BACKGROUND:While the Accreditation Council for Graduate Medical Education (ACGME) mandates that emergency medicine residencies provide an educational curriculum that includes administrative seminars and morbidity and mortality conference, there is significant variation as to how administrative topics are implemented into training programs. We seek to determine the prevalence of dedicated administrative rotations and details about the components of the curriculum. METHODS:In this descriptive study, a 12-question survey was distributed via the CORD listserv; each member program was asked questions concerning the presence of an administrative rotation and details about its components. These responses were then analyzed with simple descriptive statistics. RESULTS:=44). CONCLUSION/CONCLUSIONS:This paper provides an overview of the most commonly covered resident administrative experiences that can be a guide as we work to develop an ideal administrative curriculum for EM residents.