Nicholas D. Hartman

Background: Scholarship is a requirement for Emergency Medicine (EM) residency training. However, there is limited understanding of the rigor and degree to which scholarly requirements are completed by EM residents. The objective of this study was to measure the proportion of residents that met the standards delineated by a newly‐proposed rubric for EM resident scholarship assessment. Methods: This was a cross‐sectional study of eight diverse EM residency programs. Each program collected data from their residents graduating in 2024 and assessed their scholarly project completion. The assessment utilized a previously‐published rubric that evaluates the rigor of a resident's scholarly project based on six criteria: clear goals, adequate preparation, appropriate methods, verifiable results, presentation/dissemination, and reflective critique. Data were de‐identified and combined to report the overall rates across programs. Results: A total of 114 residents participated in the study (96.6%), of which 59 residents (52%) fulfilled all of the rubric‐defined standards for resident scholarship. Of the six standards, setting clear goals (performed by 61%) and obtaining reflective critique (performed by 71%) proved most difficult to attain. Adequate preparation was done by 84%, methodology by 77%, results by 83%, and presentation by 99%. The median number of projects to fulfill all standards was one (IQR 0). Of the graduates in the eight programs, 45 (39%) presented an abstract at a conference and 31 (31%) published manuscripts during residency. Conclusion: We demonstrated that 48% of graduating residents in this pilot study did not complete the scholarship requirement as assessed by the rubric. This study highlights the need for clearly defined standards and highlights that the increased use of predefined standards for scholarship may enhance the educational value of this graduation requirement for EM residents.

Background: Situational awareness (SA) and positive safety climate are crucial to patient safety. Little is known about emergency medicine (EM) trainees' SA and perception of emergency department (ED) safety climate, and the interactions of those factors with safety‐related behaviors.Objectives: Our objective was to evaluate EM residents' perceptions of ED safety climate, self‐reported SA, and comfort with identifying, rectifying, and reporting safety hazards.Methods: In this cross‐sectional study at two EM residencies, residents completed the Situational Awareness Rating Technique (SART) after ED‐based or simulated resuscitations as well as a survey regarding safety climate and comfort with identifying, rectifying, and reporting ED hazards. Descriptive statistics were used for SART, safety climate, and comfort. A correlation coefficient was calculated between post graduate year (PGY) and SA, PGY and comfort, comfort and SA, and ED safety climate and comfort.Results: 51/91 residents completed the SART; the mean score was 13.4 (max 39). 64/91 completed the additional survey; 57.8% identified a positive safety climate. 46.0%, 41.3%, and 36.5% expressed comfort with identifying, rectifying, and reporting hazards, respectively. PGY correlated with comfort with identifying, rectifying, and reporting hazards and with the number of reported hazards; there was no correlation with PGY and SA. Residents' SA did not correlate with comfort with identifying, rectifying, or reporting hazards or with the number of reported hazards. Perception of a positive safety climate correlated with comfort with reporting hazards, but not with comfort with identifying or rectifying hazards or with the number of reported hazards.Conclusion: Perceiving a culture of safety may not translate to behaviors associated with addressing hazards, and SA itself does not necessarily mean that hazards will be addressed. Targeting departmental culture alone may be insufficient toward equipping residents to address patient safety; there is a need for longitudinal curricular interventions targeting patient safety and SA across all PGYs.

Introduction: Effective supervision of learners in the clinical environment is essential for learner professional development and patient safety. Despite this importance, many supervising attendings receive little to no training around supervising learners. As faculty join emergency departments (EDs) at primary and affiliate training sites, it is essential to provide them with a framework to utilize when approaching learner supervision.Methods: A workgroup of members from the Society for Academic Emergency Medicine (SAEM) Education Committee was formed to respond to a directive from the SAEM board to identify best practices for new clinician educators when supervising learners. Drawing on their experience and expertise in learner supervision, medical education, and faculty development, the members completed a literature search to identify best practices in supervision, with a special focus on the ED environment.Analysis: The workgroup identified three domains that must be considered to provide effective supervision to learners: learner characteristics, supervisor characteristics, and clinical environment.Recommendations: Implementing effective supervision in the clinical environment requires a multifaceted approach and consideration of factors for both the learner and the supervisor. Direct observation, supplemented by standardized assessment tools, is the preferred supervision method; however, the demands of our clinical environment may require supervisors to assess the learner's proficiency using other methods including informal knowledge assessments, inference from oral presentations, review of clinical documentation, feedback from patients themselves, procedural walkthroughs, and secondhand information from the health care or training team.

Introduction: Burnout is well known as a prevalent hazard in emergency medicine (EM) careers, but the literature is less clear about what specific work-related factors actually contribute to wellness and burnout among academic EM faculty. Objectives: 1) To explore themes and specific concerns that contribute to faculty wellness in an academic emergency department, in a qualitative fashion. 2) To determine whether these themes and concerns changed appreciably in the time of the COVID-19 pandemic. Methods: EM faculty members at an academic institution were invited to participate in the study, including an on-line survey and a structured interview. Survey results were analyzed using descriptive statistics, interviews were coded and analyzed in qualitative fashion with frequency of themes as the primary outcome. Results: 33 of 40 EM faculty members at one institution participated in interviews with the study team. Twenty-four returned Maslach Burnout Inventory (MBI) and Areas of Worklife surveys, with 5 of the 24 registering as burned out by standard definitions. In qualitative analysis of the interviews, the most common negative themes were psychological stress, balancing work and family life, negative perceptions of non-departmental administration and certain aspects of clinical work. The most common positive themes included positive views of departmental leadership, teamwork among colleagues, trainees and others, and self-worth derived from doing the work of EM. Themes before and during the COVID-19 pandemic were similar, with an increase in positive comments related to patient care during the COVID-era (p = 0.02). Conclusion: Among one group of EM faculty, positive drivers of wellness were primarily relational in nature, including working in teams to care for patients and carry out the various missions of academic EM. Negative drivers were consistent with previous work in burnout among medical professionals, to include stress, tensions between work and family obligations, and conflicts in the care and work environments.

Background: Interviews for emergency medicine (EM) residency positions largely transitioned to a virtual‐only format in 2020–2021. The impact of virtual interview factors on applicants’ rank of programs is unknown.Objective: We sought to assess the impact of modifiable factors in virtual interviews on applicants’ rank of EM residency programs.Methods: We conducted a cross‐sectional mixed‐methods survey of students applying to at least one of seven study authors’ EM residency programs in the United States during the 2020–2021 application cycle. The survey was developed using an interactive Delphi process and piloted prior to implementation. The survey was administered from May to June 2021 with up to four email reminders. Quantitative analysis included descriptive statistics. Three authors performed a thematic qualitative analysis of free‐text responses.Results: A total of 664 of 2281 (29.1%) students completed the survey, including 335 (50.5%) male, 316 (47.7%) female, and six (0.9%) nonbinary. A total of 143 (21.6%) respondents identified as underrepresented in medicine and 84 (12.7%) identified as LGBTQIA+. Respondents participated in a median of 14 interviews and ranked a median of 14 programs. Most respondents (335, 50.6%) preferred a choice of in‐person or virtual, while 183 (27.6%) preferred all in‐person, and 144 (21.8%) preferred all virtual. The program website and interview social were the most important factors influencing respondent ranking. Qualitative analysis revealed several positive aspects of virtual interviews including logistical ease and comfort. Negative aspects include technical issues, perceived interview hoarding, and barriers to applicant assessment and performance. Demonstrated effort by the program, effective information delivery, communication of resident culture, and a well‐implemented interview day positively influenced respondents’ rank of programs.Conclusions: This study identified characteristics of the virtual interview format that impact applicants’ rank of programs. These results can inform future recruitment practices.

Education in Doctor of Medicine programs has moved towards an emphasis on clinical competency, with entrustable professional activities providing a framework of learning objectives and outcomes to be assessed within the clinical environment. While the identification and structured definition of objectives and outcomes have evolved, many methods employed to assess clerkship students’ clinical skills remain relatively unchanged. There is a paucity of medical education research applying advanced statistical design and analytic techniques to investigate the validity of clinical skills assessment. One robust statistical method, multitrait-multimethod matrix analysis, can be applied to investigate construct validity across multiple assessment instruments and settings. Four traits were operationalized to represent the construct of critical clinical skills (professionalism, data gathering, data synthesis, and data delivery). The traits were assessed using three methods (direct observations by faculty coaches, clinical workplace-based evaluations, and objective structured clinical examination type clinical practice examinations). The four traits and three methods were intercorrelated for the multitrait-multimethod matrix analysis. The results indicated reliability values in the adequate to good range across the three methods with the majority of the validity coefficients demonstrating statistical significance. The clearest evidence for convergent and divergent validity was with the professionalism trait. The correlations on the same method/different traits analyses indicated substantial method effect; particularly on clinical workplace-based assessments. The multitrait-multimethod matrix approach, currently underutilized in medical education, could be employed to explore validity evidence of complex constructs such as clinical skills. These results can inform faculty development programs to improve the reliability and validity of assessments within the clinical environment.

Background: The completion of a scholarly project is a common program requirement by the Accreditation Council for Graduate Medical Education (ACGME) for all residency training programs. However, the implementation can vary significantly between programs. Lack of generalizable standards for scholarly projects required of all trainees within ACGME‐accredited residencies has led to a large range of quality and effort put forth to complete these projects. Our goal is to introduce a framework and propose a corresponding rubric for application to resident scholarship to quantify and qualify the components of scholarship to better measure resident scholarly output across the graduate medical education (GME) continuum.Methods: Eight experienced educators and members of the Society for Academic Emergency Medicine Education Committee were selected to explore the current scholarly project guidelines and propose a definition that can be universally applied to diverse training programs. Following a review of the current literature, the authors engaged in iterative, divergent, and convergent discussions via meetings and asynchronous dialogue to develop a framework and associated rubric.Results: The group proposes that emergency medicine (EM) resident scholarship should (1) involve a structured process, (2) generate outcomes, (3) be disseminated, and (4) be peer reviewed. These components of resident scholarly activity are achieved whether this is a single project encompassing all four domains, or multiple smaller projects that sum to the whole. To assist residency programs in assessing a given individual resident's achievement of the standards set forth, a rubric is proposed.Conclusion: Based on current literature and consensus, we propose a framework and rubric for tracking of resident scholarly project achievement in an effort to elevate and advance EM scholarship. Future work should explore the optimal application of this framework and define minimal scholarship goals for EM resident scholarship.

Introduction Several factors are known to affect the way clinical performance evaluations (CPEs) of medical students are completed by supervising physicians. We sought to explore the effect of faculty perceived “level of interaction” (LOI) on these evaluations. Methods Our third-year CPE requires evaluators to identify perceived LOI with each student as low, moderate, or high. We examined CPEs completed during the academic year 2018–2019 for differences in (1) clinical and professionalism ratings, (2) quality of narrative comments, (3) quantity of narrative comments, and (4) percentage of evaluation questions left unrated. Results A total of 3682 CPEs were included in the analysis. ANOVA revealed statistically significant differences between LOI and clinical ratings (p ≤ .001), with mean ratings from faculty with a high LOI significantly higher than from faculty with a moderate or low LOI (p ≤ .001). Chi-squared analysis demonstrated differences based on faculty LOI and whether questions were left unrated (p ≤ .001), quantity of narrative comments (p ≤ .001), and specificity of narrative comments (p ≤ .001). Conclusions Faculty who perceive higher LOI were more likely to assign that student higher ratings, complete more of the clinical evaluation and were more likely to provide narrative feedback with more specific, higher-quality comments.