Addressing diversity in the physician workforce through social determinants of medical education.

Social determinants of medical education are the most impactful aspects of recruiting, retaining, and producing the next generation of a diverse physician workforce. We can use the same framework well known to describe social determinants of health to identify social determinants that impact medical education learners and their ability to enter the workforce and succeed to completion. Efforts aimed at recruitment and retention should not exist in isolation and must be matched with those that continuously assess and evaluate the learning environment.

Clinician Distress and Inappropriate Antibiotic Prescribing for Acute Respiratory Tract Infections: A Retrospective Cohort Study.

Background: The National Academy of Medicine's 2019 consensus study on clinician burnout identified a need for research evaluating the impact of clinician distress on health care quality. This study examined the association between clinician distress and the inappropriate use of antibiotic prescriptions for acute respiratory tract infections (RTIs) in adult outpatients.

Methods: A retrospective cohort study was conducted using electronic health record visit data linked to annual wellness surveys administered to all clinicians at Boston Medical Center from May 4 to June 20, 2017, and June 5 to July 6, 2018.

Integrating Primary Care Appointments Into Resident Orientation.

Background: Trainee well-being is a major concern for institutions and programs, yet many residents report suboptimal access to or contact with primary care for themselves.

Objective: To address the health care needs of residents, we developed a mechanism whereby all incoming residents were offered an appointment with a primary care clinician (PCP) during institutional intern orientation.

Methods: In April 2019, all incoming residents (17 specialties) were invited to participate.

Describing the emotional exhaustion, depersonalization, and low personal accomplishment symptoms associated with Maslach Burnout Inventory subscale scores in US physicians: an item response theory analysis.

Purpose: Current US health policy discussions regarding physician burnout have largely been informed by studies employing the Maslach Burnout Inventory (MBI); yet, there is little in the literature focused on interpreting MBI scores. We described the burnout symptoms and precision associated with MBI scores in US physicians.

Methods: Using item response theory (IRT) analyses of secondary, cross-sectional survey data, we created response profiles describing the probability of burnout symptoms associated with US physicians' MBI emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA) subscale scores.

Program Administrator Burnout in Graduate Medical Education: a Longitudinal Study.

Background: Little is known about the level of burnout among program administrators (PAs) in medical education and its impact on the trainee environment.

Objective: To investigate variations in burnout levels over a 1-year period among a national cohort of PAs and examine any associations between perceived support and isolation.

Design: A 1-year longitudinal study conducted to assess burnout levels among PAs across the USA.

High-Risk Chief Complaints I: Chest Pain-The Big Three (an Update).

Nontraumatic chest pain is a frequent concern of emergency department patients, with causes that range from benign to immediately life threatening. Identifying those patients who require immediate/urgent intervention remains challenging and is a high-risk area for emergency medicine physicians where incorrect or delayed diagnosis may lead to significant morbidity and mortality. This article focuses on the 3 most prevalent diagnoses associated with adverse outcomes in patients presenting with nontraumatic chest pain, acute coronary syndrome, thoracic aortic dissection, and pulmonary embolism.

Usability of Learning Moment: Features of an E-learning Tool That Maximize Adoption by Students.

Introduction: E-learning is widely used in medical education. To maximize the potential of E-learning tools, every effort should be made to encourage adoption by optimizing usability. We created Learning Moment (LM), a web-based application that integrates principles of asynchronous learning and learning portfolios into a platform on which students can document and share learning experiences that occur during clinical work.

Variability in Institutional Board Review for a Multisite Assessment of Resident Professionalism.

Residents serve as both trainees and employees and can be considered potentially vulnerable research participants. This can lead to variation in the institutional review board (IRB) review. We studied sites participating in the Assessment of Professional Behaviors Study sponsored by the National Board of Medical Examiners (2009-2011).

A Novel Web-Based Experiential Learning Platform for Medical Students (Learning Moment): Qualitative Study.

Background: Experiential learning plays a critical role in learner development. Kolb's 4-part experiential learning model consists of concrete experience, reflective observation, abstract conceptualization, and active experimentation in a recurring cycle. Most clinical environments provide opportunities for experiences and active experimentation but rarely offer structured means for reflection and abstract conceptualization that are crucial for learners to learn through experience.

The Intersection of Gender and Resuscitation Leadership Experience in Emergency Medicine Residents: A Qualitative Study.

Objectives: The objective was to examine emergency medicine (EM) residents' perceptions of gender as it intersects with resuscitation team dynamics and the experience of acquiring resuscitation leadership skills.

Methods: This was an exploratory, qualitative study using grounded theory and a purposive sample of postgraduate year (PGY) 2-4 EM residents who function as resuscitation team leaders in two urban EM programs. One-on-one interviews were conducted by a single experienced researcher.

Identifying the Emergency Medicine Personality: A Multisite Exploratory Pilot Study.

Objectives: This study aimed to understand the personality characteristics of emergency medicine (EM) residents and assess consistency and variations among residency programs.

Methods: In this cross-sectional study, a convenience sample of residents ( = 140) at five EM residency programs in the United States completed three personality assessments: the Hogan Personality Inventory (HPI)-describing usual tendencies; the Hogan Development Survey (HDS)-describing tendencies under stress or fatigue; and the Motives, Values, and Preferences Inventory (MVPI)-describing motivators. Differences between EM residents and a normative population of U.

We Matter Too! Addressing the Wellness of Program Coordinators in Graduate Medical Education.

Introduction: Burnout and stress in medical settings have been associated with despondent staff and decreased productivity. Although Program Coordinators (PCs) play an integral role in residency training programs, there exist few, if any, interventions aimed at addressing their burnout.

Methods: A longitudinal study design was used to evaluate data from residency/fellowship training PCs who participated in a wellness retreat held at a single institution in August 2016.

Fantastic Learning Moments and Where to Find Them.

Introduction: Experiential learning is crucial for the development of all learners. Literature exploring how and where experiential learning happens in the modern clinical learning environment is sparse. We created a novel, web-based educational tool called "Learning Moment" (LM) to foster experiential learning among our learners.

The Interactive Candidate Assessment Tool: A New Way to Interview Residents.

The purpose of the residency interview is to determine the extent to which a well-qualified applicant is a good fit with a residency program. However, questions asked during residency interviews tend to be standard and repetitive, and they may not elicit information that best differentiates one applicant from another. The iCAT (interactive Candidate Assessment Tool) is a novel interview instrument that allows both interviewers and interviewees to learn about each other in a meaningful way.

Residency Applicant Preferences of Online Systems for Scheduling Interviews.

Background: Residency applicants often have difficulty coordinating interviews with multiple programs. An online scheduling system might improve this process.

Objective: The authors sought to determine applicant mean time to schedule interviews and satisfaction using online scheduling compared with manual scheduling.

Does the National Resident Match Program Rank List Predict Success in Emergency Medicine Residency Programs?

Background: Emergency medicine (EM) residency programs use nonstandardized criteria to create applicant rank lists. One implicit assumption is that predictive associations exist between an applicant's rank and their future performance as a resident. To date, these associations have not been sufficiently demonstrated.

Academic Emergency Medicine Physicians' Knowledge of Mechanical Ventilation.

Introduction: Although emergency physicians frequently intubate patients, management of mechanical ventilation has not been emphasized in emergency medicine (EM) education or clinical practice. The objective of this study was to quantify EM attendings' education, experience, and knowledge regarding mechanical ventilation in the emergency department.

Methods: We developed a survey of academic EM attendings' educational experiences with ventilators and a knowledge assessment tool with nine clinical questions.

Interactive Learning Module Improves Resident Knowledge of Risks of Ionizing Radiation Exposure From Medical Imaging.

Physician awareness of the risks of ionizing radiation exposure related to medical imaging is poor. Effective educational interventions informing physicians of such risk, especially in emergency medicine (EM), are lacking. The SIEVERT (Suboptimal Ionizing Radiation Exposure Education - A Void in Emergency Medicine Residency Training) learning module was designed to improve provider knowledge of the risks of radiation exposure from medical imaging and comfort in communicating these risks to patients.

Emergency medicine residents' knowledge of mechanical ventilation.

Background: Although Emergency physicians frequently intubate patients, management of mechanical ventilation has not been emphasized in emergency medicine (EM) residency curricula.

Objectives: The objective of this study was to quantify EM residents' education, experience, and knowledge regarding mechanical ventilation.

Methods: We developed a survey of residents' educational experiences with ventilators and an assessment tool with nine clinical questions.

A senior scholars forum can enhance the scholarship process.

Background: The purpose of our study was to evaluate the educational value of an annual Senior Scholars Forum (SSF) of graduating Emergency Medicine resident participants and attendees.

Description: This study was conducted at an urban academic medical center with a PGY1-4 year residency program. After completion of the 2nd annual SSF, a web-based survey instrument was sent to all resident and faculty attendees.

An agenda for increasing grant funding of emergency medicine education research.

Funding is a perennial challenge for medical education researchers. Through a consensus process, the authors developed a multifaceted agenda for increasing funding of education research in emergency medicine (EM). Priority agenda items include developing resources to increase the competitiveness of medical education research faculty in grant applications, identifying means by which departments may bolster their faculty's grant writing success, taking long-term steps to increase the number of grants available to education researchers in the field, and encouraging a shift in cultural attitudes toward education research.

Vertigo, vertebrobasilar disease, and posterior circulation ischemic stroke.

Dizzy patients present a significant diagnostic challenge to the emergency clinician. The discrimination between peripheral and central causes is important and will inform subsequent diagnostic evaluation and treatment. Isolated vertigo can be the only initial symptom of a posterior circulation stroke.