Coming in Warm: Qualitative Study and Concept Map to Cultivate Patient‐Centered Empathy in Emergency Care

Background Increased empathy may improve patient perceptions and outcomes. No training tool has been derived to teach empathy to emergency care providers. Accordingly, we engaged patients to assist in creating a concept map to teach empathy to emergency care providers. Methods We recruited patients, patient caretakers and patient advocates with emergency department experience to participate in three separate focus groups (n = 18 participants). Facilitators guided discussion about behaviors that physicians should demonstrate in order to rapidly create trust, enhance patient perception that the physician understood the patient's point of view, needs, concerns, fears, and optimize patient/caregiver understanding of their experience. Verbatim transcripts from the three focus groups were read by the authors and by consensus, 5 major themes with 10 minor themes were identified. After creating a codebook with thematic definitions, one author reviewed all transcripts to a library of verbatim excerpts coded by theme. To test for inter‐rater reliability, two other authors similarly coded a random sample of 40% of the transcripts. Authors independently chose excerpts that represented consensus and strong emotional responses from participants. Results Approximately 90% of opinions and preferences fell within 15 themes, with five central themes: Provider transparency, Acknowledgement of patient's emotions, Provider disposition, Trust in physician, and Listening. Participants also highlighted the need for authenticity, context and individuality to enhance empathic communication. For empathy map content, patients offered example behaviors that promote perceptions of physician warmth, respect, physical touch, knowledge of medical history, explanation of tests, transparency, and treating patients as partners. The resulting concept map was named the “Empathy Circle”. Conclusions Focus group participants emphasized themes and tangible behaviors to improve empathy in emergency care. These were incorporated into the “Empathy Circle”, a novel concept map that can serve as the framework to teach empathy to emergency care providers

Curated Collections for Educators: Five Key Papers on Clinical Teaching

The ability to teach in the clinical setting is of paramount importance. Clinical teaching is at the heart of medical education, irrespective of the learner’s level of training. Learners desire and need effective, competent, and thoughtful clinical teaching from their instructors. However, many clinician-educators lack formal training on this important skill and thus may provide a variable experience to their learners. Although formal training of clinician-educators is standard and required in many other countries, the United States has yet to follow suit, leaving many faculty members to fend for themselves to learn these important skills. In September 2018, the Academic Life in Emergency Medicine (ALiEM) 2018-2019 Faculty Incubator program discussed the topic of clinical teaching techniques. We gathered the titles of papers that were cited, shared, and recommended within our online discussion forum and compiled the articles pertaining to the topic of clinical teaching techniques. To augment the list, the authors did a formal literature search using the search terms “teaching techniques", "clinical teaching", "medical education", "medical students", and "residents” on Google Scholar and PubMed. Finally, we posted a call for important papers on the topic of clinical teaching techniques on Twitter. Through this process, we identified 48 core articles on the topic of clinical teaching. We conducted a modified Delphi methodology to identify the key papers on the topic. In this paper, we present the five highest-rated articles based on the relevance to junior faculty and faculty developers. This article will review and summarize the articles we found to be the most impactful to improve one’s clinical teaching skills

Can We Actually Improve Resident Wellness? Pilot Data from a Longitudinal Wellness Curriculum for Emergency Medicine Residents

Objectives/Background: The wellness of resident physicians, particularly in emergency medicine with its high rate of burnout, has become of paramount importance to residency programs. This study aims to evaluate the effects of the implementation of an evidence-based wellness curriculum on self-reported resident wellness across three emergency medicine residency programs. Methods: This is a prospective, interventional study of the impact of a well-defined, longitudinal wellness curriculum administered to all categorical residents in three emergency medicine residency programs. Anonymous surveys incorporating the Perceived Stress Scale (PSS) and the Connor-Davidson Resilience Scale (CD-RISC) were administered before and after implementation of the wellness curriculum. The curriculum consisted of three modules (Introduction to Wellness, Dealing with Medical Errors, and Shame and Debriefing Traumatic Events in the Emergency Department) over 3 months. Participation was anonymous and voluntary, and all data collection and analysis were provided by a third-party not affiliated with residency program leadership. Results: 64 out of 114 (56.1%) residents completed the pre-intervention survey and 58 (50.9%) residents completed the post-intervention survey. The mean of the PSS pre-intervention was 15.5 (SD±4.85) and post-intervention was 15.4 (SD±5.42) points while the mean of the CD-RISC was 75.1 (SD±8.9) pre-intervention and was 74.9 (SD±9.88) post-intervention. Both the PSS and CD-RISC scores showed an improvement post-intervention although only the CD-RISC was statistically significant (p=0.015). There was no statistically significant difference on either scoring system with respect to gender, post-graduate year of training, or residency training site. Conclusions: Implementation of a wellness curriculum in our cohort of residents was shown to improve resilience amongst residents. Gender, post-graduate year of training, and residency training site did not affect these outcomes. This represents the first longitudinal residency wellness curriculum in emergency medicine that has a proven beneficial effect on residents

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

Development of a Case-based Reading Curriculum and Its Effect on Resident Reading

Textbook reading plays a foundational role in a resident’s knowledge base. Many residency programs place residents on identical reading schedules, regardless of the clinical work or rotation the resident is doing. We sought to develop a reading curriculum that takes into account the clinical work a resident is doing so their reading curriculum corresponds with their clinical work. Preliminary data suggests an increased amount of resident reading and an increased interest in reading as a result of this change to their reading curriculum

Development of a Case-based Reading Curriculum and Its Effect on Resident Reading

Textbook reading plays a foundational role in a resident’s knowledge base. Many residency programs place residents on identical reading schedules, regardless of the clinical work or rotation the resident is doing. We sought to develop a reading curriculum that takes into account the clinical work a resident is doing so their reading curriculum corresponds with their clinical work. Preliminary data suggests an increased amount of resident reading and an increased interest in reading as a result of this change to their reading curriculum

Development of a Case-based Reading Curriculum and Its Effect on Resident Reading

Textbook reading plays a foundational role in a resident’s knowledge base. Many residency programs place residents on identical reading schedules, regardless of the clinical work or rotation the resident is doing. We sought to develop a reading curriculum that takes into account the clinical work a resident is doing so their reading curriculum corresponds with their clinical work. Preliminary data suggests an increased amount of resident reading and an increased interest in reading as a result of this change to their reading curriculum

LIMEs and LEMONs: Critically Examining the Effect of a Blog Post on Junior Faculty Learners

IntroductionThe usage of asynchronous resources such as blogs and podcasts is pervasive in academic medicine, despite little understanding of their actual effect on learner knowledge acquisition. This study sought to examine the objective effect of a blog post on knowledge acquisition and application among junior faculty in emergency medicine (EM) via randomized controlled study.MethodsAll accredited EM residency programs in the United States and Canada were contacted to identify assistant and associate program directors and medical education fellows for recruitment into this study. Upon enrollment, participants were randomized as to whether they received access to a supplemental blog post prior to listening to a podcast episode. After listening to the podcast episode, all participants completed an assessment that included a test of knowledge application and knowledge acquisition; demographic information was also obtained.ResultsUltimately, 103 participants completed the study; the study closed for enrollment in July 2019. Data were nonnormally distributed and groups were compared using the Wilcoxon rank‐sum test. There were no significant differences between the demographics of the two groups nor was there a significant difference in knowledge between the two groups.ConclusionThe addition of a supplementary blog post did not increase junior faculty knowledge of a podcast episode.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/168262/1/aet210553.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/168262/2/aet210553_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/168262/3/aet210553-sup-0001-DataSupplementS1.pd

LIMEs and LEMONs: Critically Examining the Effect of a Blog Post on Junior Faculty Learners

IntroductionThe usage of asynchronous resources such as blogs and podcasts is pervasive in academic medicine, despite little understanding of their actual effect on learner knowledge acquisition. This study sought to examine the objective effect of a blog post on knowledge acquisition and application among junior faculty in emergency medicine (EM) via randomized controlled study.MethodsAll accredited EM residency programs in the United States and Canada were contacted to identify assistant and associate program directors and medical education fellows for recruitment into this study. Upon enrollment, participants were randomized as to whether they received access to a supplemental blog post prior to listening to a podcast episode. After listening to the podcast episode, all participants completed an assessment that included a test of knowledge application and knowledge acquisition; demographic information was also obtained.ResultsUltimately, 103 participants completed the study; the study closed for enrollment in July 2019. Data were nonnormally distributed and groups were compared using the Wilcoxon rank‐sum test. There were no significant differences between the demographics of the two groups nor was there a significant difference in knowledge between the two groups.ConclusionThe addition of a supplementary blog post did not increase junior faculty knowledge of a podcast episode.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/168262/1/aet210553.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/168262/2/aet210553_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/168262/3/aet210553-sup-0001-DataSupplementS1.pd