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

Supplemental Milestones for Emergency Medicine Residency Programs: A Validation Study

Introduction: Emergency Medicine (EM) residency programs may be 36 or 48 months in length. The Residency Review Committee for EM requires that 48-month programs provide educational justification for the incremental 12 months. We developed additional milestones that EM training programs might use to outcomes in domains that meet this accreditation requirement. This study aims to validate these supplemental milestones using a similar methodology to that of the original EM Milestones validation study.Methods: A panel of EM program directors and content experts at two institutions identified domains of additional training not covered by the existing EM Milestones. This led to the development of 6 novel subcompetencies: Operations and Administration, Critical Care, Leadership and Management, Research, Teaching and Learning, and Career Development. Subject-matter experts at other 48-month EM residency programs refined the milestones for these subcompetencies. Program directors of all 48-month EM programs were then asked to order the proposed milestones using the Dreyfus model of skill acquisition for each subcompetency. Data analysis mirrored that used in the original EM Milestones validation study, leading to the final version of our supplemental milestones.Results: Twenty of 33 subjects (58.8%) completed the study. No subcompetency or individual milestone met deletion criteria. Of the 97 proposed milestones, 67 (69.1%) required no further editing and remained at the same level as proposed by the study authors. Thirty milestones underwent level changes: 15 (15.5%) were moved one level up and 13 (13.4%) were moved one level down. One milestone (1.0%) in ‘Leadership and Management’ was moved two levels up, and one milestone in ‘Operations and Administration’ was moved two levels down. One milestone in ‘Research’ was ranked by the survey respondents at one level higher than that proposed by the authors, however this milestone was kept at its original level assignment.Conclusion: Six additional subcompetencies were generated and validated using the same methodology as was used to validate the current EM Milestones. These optional milestones may serve as an additional set of assessment tools that will allow EM residency programs to report these additional educational outcomes using a familiar milestone rubric

Supplemental Milestones for Emergency Medicine Residency Programs: A Validation Study

Introduction: Emergency Medicine (EM) residency programs may be 36 or 48 months in length. The Residency Review Committee for EM requires that 48-month programs provide educational justification for the incremental 12 months. We developed additional milestones that EM training programs might use to outcomes in domains that meet this accreditation requirement. This study aims to validate these supplemental milestones using a similar methodology to that of the original EM Milestones validation study.Methods: A panel of EM program directors and content experts at two institutions identified domains of additional training not covered by the existing EM Milestones. This led to the development of 6 novel subcompetencies: Operations and Administration, Critical Care, Leadership and Management, Research, Teaching and Learning, and Career Development. Subject-matter experts at other 48-month EM residency programs refined the milestones for these subcompetencies. Program directors of all 48-month EM programs were then asked to order the proposed milestones using the Dreyfus model of skill acquisition for each subcompetency. Data analysis mirrored that used in the original EM Milestones validation study, leading to the final version of our supplemental milestones.Results: Twenty of 33 subjects (58.8%) completed the study. No subcompetency or individual milestone met deletion criteria. Of the 97 proposed milestones, 67 (69.1%) required no further editing and remained at the same level as proposed by the study authors. Thirty milestones underwent level changes: 15 (15.5%) were moved one level up and 13 (13.4%) were moved one level down. One milestone (1.0%) in ‘Leadership and Management’ was moved two levels up, and one milestone in ‘Operations and Administration’ was moved two levels down. One milestone in ‘Research’ was ranked by the survey respondents at one level higher than that proposed by the authors, however this milestone was kept at its original level assignment.Conclusion: Six additional subcompetencies were generated and validated using the same methodology as was used to validate the current EM Milestones. These optional milestones may serve as an additional set of assessment tools that will allow EM residency programs to report these additional educational outcomes using a familiar milestone rubric