Program Director Opinion on the Ideal Length of Residency Training in Emergency Medicine

ObjectiveThis study sought to define expert opinion on the ideal length of training (LoT) for Accreditation Council of Graduate Medical Education (ACGME)‐accredited emergency medicine (EM) residency programs.MethodsA cross‐sectional Web‐based survey was sent to program directors (PDs) at all ACGME‐accredited EM residency programs during a study period of August to October 2014. The primary outcome of ideal LoT was determined in two ways: 1) subjects provided the ideal total LoT in months and 2) then separately selected the type and number of rotations for an ideal EM residency curriculum by month, the sum of which provided an alternative measurement of their ideal LoT. We did not include vacation time. Descriptive statistics and an analysis of variance are reported.ResultsResponse rate was 68.0% (108/159) with 72% of respondents (78/108) directing programs in the PGY 1–3 (36‐month) format and 28% directing PGY 1–4 (48‐month) programs. More than half of subjects (51.9%) have direct personal experience with both formats. When asked about ideal total LoT, PDs averaged 41.5 months (n = 107; SD = 5.5 months, range = 36–60 months). When asked to provide durations of individual clinical experiences for their ideal EM program, the sum total (n = 104) averaged 45.0 months. Results from a factorial analysis of variance revealed statistically significant effects of PDs’ past training experiences: participants who trained in a 36‐month program had statistically significantly lower LoT (mean = 39.2 months) than participants who trained in a 48‐month program (mean = 44.5 months). There was also a statistically significant effect of current program format on ideal LoT: participants who directed a 36‐month program had statistically significantly lower LoT (mean = 39.8 months) than participants who directed a 48‐month program (mean = 45.8 months).ConclusionsPD opinion on ideal LoT averages between 36 and 48 months, but is longer when the sum of desired clinical rotations is considered. While half of the respondents reported direct experience with both PGY 1–3 and PGY 1–4 training programs, opinions on ideal LoT through both methods corresponded strongly with the length of the program the PDs trained in and the format of the program they currently direct. PD opinions may be too biased by their own experiences to provide objective input on the ideal LoT for EM residency programs.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/133574/1/acem12968-sup-0001-DataSupplementS1.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/133574/2/acem12968.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/133574/3/acem12968_am.pd

Racial and Ethnic Diversity in Academic Emergency Medicine: How Far Have We Come? Next Steps for the Future

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.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147225/1/aet210204.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/147225/2/aet210204_am.pd

Comparison of the Standardized Video Interview and Interview Assessments of Professionalism and Interpersonal Communication Skills in Emergency Medicine

ObjectivesThe Association of American Medical Colleges Standardized Video Interview (SVI) was recently added as a component of emergency medicine (EM) residency applications to provide additional information about interpersonal communication skills (ICS) and knowledge of professionalism (PROF) behaviors. Our objective was to ascertain the correlation between the SVI and residency interviewer assessments of PROF and ICS. Secondary objectives included examination of 1) inter‐ and intrainstitutional assessments of ICS and PROF, 2) correlation of SVI scores with rank order list (ROL) positions, and 3) the potential influence of gender on interview day assessments.MethodsWe conducted an observational study using prospectively collected data from seven EM residency programs during 2017 and 2018 using a standardized instrument. Correlations between interview day PROF/ICS scores and the SVI were tested. A one‐way analysis of variance was used to analyze the association of SVI and ROL position. Gender differences were assessed with independent‐groups t‐tests.ResultsA total of 1,264 interview‐day encounters from 773 unique applicants resulted in 4,854 interviews conducted by 151 interviewers. Both PROF and ICS demonstrated a small positive correlation with the SVI score (r = 0.16 and r = 0.17, respectively). ROL position was associated with SVI score (p < 0.001), with mean SVI scores for top‐, middle‐, and bottom‐third applicants being 20.9, 20.5, and 19.8, respectively. No group differences with gender were identified on assessments of PROF or ICS.ConclusionsInterview assessments of PROF and ICS have a small, positive correlation with SVI scores. These residency selection tools may be measuring related, but not redundant, applicant characteristics. We did not identify gender differences in interview assessments.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/150548/1/aet210346_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/150548/2/aet210346.pd

The Vice Chair of Education in Emergency Medicine: A Workforce Study to Establish the Role, Clarify Responsibilities, and Plan for Success

ObjectivesDespite 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.MethodsA 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.ResultsForty‐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.ConclusionGiven 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.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154254/1/aet210407_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154254/2/aet210407.pd

Transitioning Traditions in the Time of COVID

With COVID-19 causing a rift in schedules and long-standing educational activities while restricting in person sessions that typically foster a sense of community, residencies were left to devise new ways to come together and continue on with education. The deeply engrained tradition of a morning case-based report led by senior residents was adapted to a virtual report in the evenings. While the format for presenting cases was similar, participation increased while helping build a further reaching community. This not only allowed for a 40-year-old tradition to continue to carry on through a pandemic, it gave a space for residents, alumni, and attendings to come together and rebuild a sense of normalcy and community to help bear through life altering events

Transitioning Traditions in the Time of COVID

With COVID-19 causing a rift in schedules and long-standing educational activities while restricting in person sessions that typically foster a sense of community, residencies were left to devise new ways to come together and continue on with education. The deeply engrained tradition of a morning case-based report led by senior residents was adapted to a virtual report in the evenings. While the format for presenting cases was similar, participation increased while helping build a further reaching community. This not only allowed for a 40-year-old tradition to continue to carry on through a pandemic, it gave a space for residents, alumni, and attendings to come together and rebuild a sense of normalcy and community to help bear through life altering events

Adaptive expertise: The optimal outcome of emergency medicine training

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/172108/1/aet210731_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/172108/2/aet210731.pd

Emergency Medicine Faculty Are Poor at Predicting Burnout in Individual Trainees: An Exploratory Study.

Objective: Burnout is common among emergency medicine (EM) physicians, and it is prevalent even among EM trainees. Recently proposed Accreditation Council for Graduate Medical Education requirements encourage faculty to alert residency leadership when trainees display signs of burnout. It remains uncertain how trainees experiencing burnout can be reliably identified. We examined if EM faculty advisers at one institution can accurately predict burnout in their EM resident advisees. Methods: In this cross-sectional, exploratory study at a single institution, we measured EM trainee burnout using the Maslach Burnout Inventory through a confidential, electronic survey. We subsequently asked EM faculty to predict if their designated advisees were experiencing burnout through a separate confidential, electronic survey. Burnout results were dichotomized from each survey and compared using a 2 × 2 contingency table and Fisher\u27s exact test. Results: Thirty-six of 54 (66.7%) eligible EM trainees completed the burnout assessment. Eleven of 19 (57.9%) eligible faculty advisers completed trainee burnout predictions, resulting in 30 of 54 (55.6%) trainees who completed the burnout assessment and had a faculty burnout prediction. Trainees reported an overall burnout rate of 70.0% (95% confidence interval [CI] = 53.6% to 86.4%). Cumulative faculty predictions of trainee burnout resulted in an overall burnout rate of 16.7% (95% CI = -5.3% to 38.7%). The sensitivity and specificity of faculty predictions of trainee burnout were 19.1% (95% CI = 5.5% to 41.9%) and 88.9% (95% CI = 51.8% to 99.7%), respectively. Faculty prediction of trainee burnout had a positive predictive value of 80.0% (95% CI = 28.4% to 99.5%) and a negative predictive value of 32.0% (95% CI = 15.0% to 53.5). The difference between trainees\u27 reported rate of burnout and faculty predictions of trainee burnout was significant (p \u3c 0.001). Conclusion: Emergency medicine faculty prediction of trainee burnout was poor. Education on recognizing burnout and other methods of identifying trainee burnout may be necessary