Cortlyn Brown

Objective: Our objectives were to evaluate what proportion of simulation centers use high-fidelity simulation manikins to teach cultural humility, and to evaluate if manikin skin color and sex breakdown are representative of the USA population. Methods: Surveys were sent to simulation centers from our simple random sample. Key outcomes included skin color and gender of manikins and if cultural humility was taught via simulation. Point and interval estimates were calculated for the proportion of light-, medium-, and dark-colored manikins, the proportion of female and male manikins, and the proportion of centers using simulation to teach cultural humility. Confidence intervals were employed to test the null hypothesis that light/medium/dark skin color was 60/20/20 and female/male was 50/50 which is extrapolated from the US Census data. Results: Our response rate was 75% (41/55). All of the 41 responding simulation centers had manikins (1.0000, 95% CI: 0.9180, 1.0000). Twenty seven of the 41 simulation centers with manikins reported simulation scenarios with cultural humility (0.6585, 95% CI: 0.5127, 0.8044). Proportions of light-, medium-, and dark-colored manikins were 0.5150 (0.4669, 0.5625), 0.3086 (0.2651, 0.3547), and 0.1764 (0.1563, 0.1964), respectively. Proportions of male and female manikins were 0.6402 (0.6163, 0.6640) and 0.3598 (0.3360, 0.3837). The null hypotheses that skin color follows a 60/20/20 split and gender follows a 50/50 split were rejected. Conclusions: Most simulation centers surveyed teach cultural humility via simulation, however their manikins do not reflect the sex and skin tone of the USA population.

Background: Evaluating diversity, equity, and inclusion (DEI) in health education is crucial to ensure an inclusive and effective learning environment. In this pilot study, we aimed to create and validate the first tool, the Diversity, Equity, and Inclusion Index (DEII), to assess DEI within health education lectures. We hypothesized that the DEII would demonstrate strong face and content validity as well as acceptable to excellent interrater reliability. Methods: This pilot cross-sectional study was conducted from January 2022 to December 2023. We developed the Diversity, Equity, and Inclusion Index (DEII) and assessed its face and content validity. The study followed the COSMIN taxonomy guidelines. Interrater reliability was calculated using intraclass correlation coefficients from DEII scores of 50 YouTube lectures. Setting: The study was conducted at several academic medical centers in the United States of America, encompassing diverse health education settings. Participants: 10 expert-DEI reviewers as well as 10 non-expert DEI reviewers who represented the major sections of health professions including physicians, nurses, researchers, social workers, respiratory therapists, and physical therapists, as well as multiple institutions assessed face and contentvalidity. Expert reviewers were defined based on specific criteria, including board certification, leadership positions in DEI, authorship of peer-reviewed DEI publications, national presentations on DEI topics, and implementation of DEI initiatives. Non-expert faculty were selected based on their involvement in health education but without specific DEI expertise. Participants were recruited through a convenience sample approach. All approached participants agreed to take part in the study. To assess interrater reliability, three researchers scored 50 health education lectures on YouTube whose audiences ranged from respiratory therapists, nurses, physicians, physician associates and those training to be each. Results: Interrater reliability analysis demonstrated that 16 out of 17 items met the threshold for acceptable reliability (ICC ≥ 0.50). Specifically, 7 items exhibited excellent reliability (ICC ≥ 0.90), 5 demonstrated good reliability (0.70 ≤ ICC < 0.90), and 4 showed moderate reliability (0.50 ≤ ICC < 0.70). At the domain level, three of the four domains achieved acceptable reliability (ICC ≥ 0.70), with one domain reaching the threshold for excellent reliability (ICC ≥ 0.90). Discussion: In this pilot study, the DEII is a reliable and valid tool for assessing diversity, equity, and inclusion in health education lectures. Its implementation may enhance the inclusivity of health education, ultimately leading to better-preparedhealthcare professionals and improved patient outcomes. Further research is needed to refine the tool and explore its impact on educational practices and outcomes.

To explore the prevalence of depression among emergency medicine (EM) interns before and during the COVID-19 pandemic. The Intern Health Study is a national longitudinal cohort study examining mental health among interns across various specialties. In this secondary analysis, we focused specifically on EM interns from 2008 to 2022. Participants completed a baseline survey before their intern year and quarterly surveys throughout their intern year. Depression severity was assessed using the Patient Health Questionnaire (PHQ9), with scores of 10 or higher indicating moderate-to-severe depression. In total, 1956 EM interns from 160 programs completed all PHQ9 surveys. PHQ9 scores at baseline (start of the intern year) were significantly lower prior to the COVID-19 pandemic compared to during it (p < 0.001). PHQ9 scores at month 9 were significantly higher during the COVID-19 pandemic (p < 0.05) compared to pre-COVID-19 pandemic interns at month 9. One-way ANOVA comparing pre-COVID-19 and during COVID-19 differences in PHQ9 from baseline to the end of intern year revealed a significant difference, with during COVID-19 differences being significantly less than pre-COVID-19. There was no significant difference in the proportion of interns with PHQ9 scores greater than 10 during the COVID-19 pandemic. The COVID-19 pandemic had a significant effect on the mental health of EM interns, with higher baseline depression scores observed during the pandemic. However, the smaller change in depression severity over the intern year during the pandemic suggests a complex interplay of factors that warrants further investigation. Our study is the first to examine depression among EM interns during the COVID-19 pandemic using a large, multi-year sample, providing a unique and comprehensive analysis of how the pandemic impacted mental health in this high-risk group. Unlike previous studies with smaller sample sizes, our research offers robust, generalizable insights into the trends and severity of depression in EM interns, highlighting the critical need for ongoing mental health support in medical training.

Background: Diversity within the physician workforce is associated with improved clinical outcomes and patient satisfaction. Despite this, the US physician workforce, particularly in emergency medicine (EM), remains relatively homogeneous. Of all Black medical school students in the US, 14% attend the four Historically Black Colleges and Universities (HBCU) that have a medical school. Unfortunately, none of these schools are affiliated with an academic EM program. Because of this, there is less professional mentorship focused on obtaining a career in EM and potentially less formal curricula for senior medical students doing their home sub-internship in EM. Objectives: Our objective was to fill the gap left by the absence of an academic EM department at Howard University College of Medicine (HUCOM) by creating a collaborative educational experience for fourth-year medical students during their home EM sub-internship. The curricular objectives were to teach core principles of EM, build relationships with students, and prepare them for pursuing EM residency training. Curricular Design: Four EM academic departments collaborated to create and implement a virtual curriculum using the six-step approach to curricular development. Impact/Effectiveness: After completion of the course, five students (100%) reported strongly agreeing with the following statements. These sessions 1) helped me learn the approach to core EM topics more than I would have been able to do on my own; 2) helped me learn key skills for excelling in an EM rotation more than I would have been able to do on my own; and 3) allowed me to connect with faculty and resident mentors to learn more about the field of EM. Of these five students, 80% and 20% reported strongly agreeing and agreeing, respectively, that these sessions helped them learn about the process of applying to and selecting an EM residency program.

Objective: Despite depression being common in residents, there are no published studies on the prevalence and risk factors for depression in emergency medicine (EM) interns. Our objectives were to explore the prevalence of depression among EM interns and to identify risk factors for depression including sleep, work hours, rotation type, race, ethnicity, sex, and age.Methods: The Intern Health Study is a national longitudinal cohort study on intern mental health in all specialties. Secondary analysis was performed for EM interns only in this study. Data were collected from 2007 to 2021 and study participants completed a pre–intern year baseline survey and quarterly surveys throughout intern year, which included demographics and information on depressive symptoms, work hours, sleep, and rotation specifics. Depression severity was objectified using the Patient Health Questionnaire (PHQ9) with scores of 10 and higher meeting criteria for moderate to severe depression.Results: A total of 1123 EM interns completed all surveys. The prevalence of moderate to severe depression among EM interns before starting internship was 4.8%. At Months 3, 6, 9, and 12 of intern year, the prevalence of moderate to severe depression was 17.8%, 20.5%, 20.8%, and 18.8%, respectively. PHQ9 scores were significantly higher at Month 3 of intern year compared to pre–intern year, but there were no differences at subsequent time points during intern year (p < 0.001). Females were more likely to have PHQ9 scores of 10 or above at all time points (p < 0.001). Clinical rotation type had a significant effect on PHQ9 scores, with intensive care unit rotations having a significantly higher PHQ9 score than other rotations (p < 0.001). Pearson's correlation revealed significant weak positive correlations between work hours and PHQ9 at each time point (r = 0.195, 0.200, 0.202, 0.243) and significant weak negative correlations between sleep hours and time off with PHQ9 (−0.162, −0.223, −0.180, −0.178; all p < 0.001).Conclusions: Many EM interns experience moderate to severe depression. Female EM interns are more likely to be depressed than male interns. Numerous factors influence depression scores for interns, many of which are modifiable.

Introduction: It is important for physicians to learn how to provide culturally sensitive care. Cultural humility is defined as a lifelong process with a goal of fixing power imbalances and creating institutional accountability through learning about another’s culture as well as performing self-exploration about one’s own beliefs, identities, and biases. One way to teach cultural humility in medicine is simulation. However, there are no peer-reviewed published studies that examine whether the skin tone or gender of the high-fidelity simulation manikins (HFSM) used by emergency medicine (EM) residency programs reflects the US population nor whether high-fidelity simulation is used to teach cultural humility. We aimed to address that gap in the literature. Our primary objective was to evaluate what proportion of EM residency programs use HFS to teach cultural humility. Our secondary objective was to evaluate whether the skin tone and gender breakdown of the EM residency program HFSM is representative of the US population.Methods: We conducted a simple random sample of 80 EM residency programs to characterize HFSM and cultural humility training. Selected programs were emailed a questionnaire. Key outcomes included HFSM skin tone and gender and whether cultural humility was taught via HFSM. We calculated point and interval estimates for the proportion of dark-, medium-, and light-toned skin and the proportion of female and male manikins. Confidence intervals were employed to test the null hypothesis that dark/medium/light skin tone was 20/20/60 and that the female/male ratio was 50/50. Both ratios were extrapolated from the US Census data.Results: Our response rate was 74% (59/80). Fifty-five of 59 EM residency programs that had manikins (0.93, 95% confidence interval [CI] 0.88–0.99) reported data on a total of 348 manikins. Thirty-nine of the 55 programs with manikins reported using HFS to teach cultural humility (0.71, 95% CI 0.60–0.82). Proportions of light-, medium-, and dark-toned manikins were 0.52 (0.43–0.62), 0.38 (0.29–0.47), and 0.10 (0.07–0.14), respectively. Proportions of male and female HFSM were 0.69 (0.64–0.76) and 0.31 (0.24–0.36), respectively. The null hypotheses that skin tone follows a 60/20/20 split and gender follows a 50/50 split were rejected, as not all confidence intervals contained these hypothesized values.Conclusion: While most EM residency programs surveyed use high-fidelity simulation to teach cultural humility, the manikins do not reflect either the skin tone or gender of the US population. [West J Emerg Med. 2023;24(4)1–7.]

Objectives: Microaggressions and implicit bias occur frequently in medicine. No previous study, however, has examined the implicit bias and microaggressions that emergency medicine (EM) providers experience. Our primary objective was to understand how often EM providers experience implicit bias and microaggressions. Our secondary objective was to evaluate the types of microaggressions they experience and whether their own identifying characteristics are risk factors.Methods: A questionnaire was administered to EM providers across the United States. Outcome measures of experiencing or witnessing a microaggression, overt discrimination, or implicit bias were described using frequencies, proportions, and logistic regressions. Where a univariate association between outcome measures and demographic characteristics was found, multivariate regression to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) was performed. Proportional odds logistic regression models were used to evaluate the specific type of microaggressions experienced and if there was an association with demographic variables.Results: A total of 277 medical providers (48% trainees—medical students, residents, and fellows—and 52% attending physicians) completed the survey. A total of 181 (65%) respondents reported experiencing a microaggression. Female (OR = 5.9 [95% CI = 3.1 to 11.2]) and non‐White respondents (OR = 2.4 [95% CI = 1.2 to 4.5]) were more likely to report experiencing any microaggression. Misidentification, the most common form of microaggression, was more common with trainees compared to attending physicians (proportional OR [POR] = 2.6 [95% CI = 1.7 to 4.0]) and non‐White, compared to White, respondents (POR = 2.2 [95% CI = 1.3 to 3.6]). Misidentification as nonclinician staff was associated with gender (POR = 53 [95% CI = 24 to 116]) and 52% of female respondents reported being mistaken for nonclinician staff almost daily. Seventy‐six percent of respondents reported being called a vulgar term by a patient and 21% by a staff member.Conclusions: EM providers, particularly women and non‐Whites, who responded to our survey experienced and witnessed bias and microaggressions, most commonly misidentification, in the ED.

The patient injected methamphetamine into his neck 2 days prior to onset of pain. He reported dysphagia, odynophagia and subjective fevers. Physical examination of the neck was notable for induration and warmth overlying the right neck (figure 1). The oropharyngeal examination was unremarkable.