Virtual Shadowing: An Effective Approach to Gaining Exposure to the Field of Emergency Medicine.

Purpose: Shadowing is an important part of medical student education. The COVID-19 pandemic limited medical students' hospital access. At the same time, virtual access to learning experiences has expanded greatly. In response, we implemented a novel virtual shadowing system to provide students with convenient and safe exposure to the Emergency Department (ED). Patients and Methods: Six EM faculty hosted 2-hour virtual shadowing for up to 10 students per experience. Students registered via signupgenius.com. Virtual shadowing was conducted using a HIPAA-compliant ZOOM account on an ED issued mobile telehealth Monitor/iPad. The physician would bring the iPad into the room, obtain consent from patients, and ensure students were able to see the encounter. Between visits, students were encouraged to ask questions using the chat function and microphone. A short de-briefing followed each shift. Each participant received a survey about the experience. The survey consisted of 4 questions for demographics, 9 Likert style questions to assess efficacy, and 2 free response sections for comments and feedback. All survey responses were anonymous. Results: In total, 58 students participated in 18 virtual shadowing sessions with an average of 3-4 students per session. Survey responses were collected between October 20, 2020 and November 20, 2020. The overall response rate was 96.6% (56/58 surveys completed). Of respondents, 46 (82.1%) rated the experience as "effective" or "very effective" at providing exposure to Emergency Medicine. Fifty-three (94.6%) said they would participate in virtual shadowing in the ED again, and 48 (85.7%) would do virtual shadowing in another specialty were it available. Conclusion: We found virtual shadowing to be an easy to implement and effective way for students to shadow physicians in the ED. Even in post-pandemic times, virtual shadowing should be explored as an accessible and effective way to expose students to a broad array of specialties.

Impact of a financial incentive on the completion of educational metrics.

BACKGROUND: The Accreditation Council for Graduate Medical Education (ACGME) requires all emergency medicine (EM) training programs to evaluate resident performance and also requires core faculty to attend didactic conference. Assuring faculty participation in these activities can be challenging. Previously, our institution did not have a formal tracking program nor financial incentive for participation in these activities. In 2017, we initiated an educational dashboard which tracked and published all full-time university faculty conference attendance and participation in resident evaluations and other educational activities. OBJECTIVES: We sought to determine if the implementation of a financially-incentivized educational dashboard would lead to an increase in faculty conference attendance and the number of completed resident evaluations. METHODS: We conducted a pre- and post-intervention observational study at our EM residency training program between July 2017 and July 2019. Participants were 17 full-time EM attendings at one training site. We compared the number of completed online resident evaluations (MedHub) and number of conference days attended (call-in verification) before and after the introduction of our financial incentive in June 2018. The incentive required 100% completion of resident evaluations and at least 25% attendance at eligible didactic conference days. We calculated pre- and post-intervention averages, and comparisons were made using a chi-square test. RESULTS: Prior to implementation of the intervention, the 90-day resident evaluation completion rate was 71.8%. This increased to 100% after implementation (p < 0.001). Conference attendance prior to implementation was 43.8%, which remained unchanged at 41.3% after implementation of the financial incentive (p = 0.920). CONCLUSIONS: Attaching a financial incentive to a tracked educational dashboard increased faculty participation in resident evaluations but did not change conference attendance. This difference likely reflects the minimum thresholds required to obtain the financial incentive.

The Eyes Have It: A Low-Cost Model for Corneal Foreign Body Removal Training.

Audience: This corneal foreign body simulator is designed to instruct junior emergency medicine (EM) residents and medical students with an interest in emergency medicine. Introduction: Eye complaints are common in the emergency department (ED), accounting for approximately 2 million ED visits each year.1 Corneal foreign bodies (CFB) account for approximately 7.5% of these presentations, and many EM providers are uncomfortable with removal procedures.1-3 Simulation has been demonstrated to improve provider comfort with this skill.4,5 Previous models for CFB removal have been created using wax over glass spheres, molded materials with silicone and ballistics gel, bovine eyes, cardboard glove boxes with ink stains simulating foreign bodies and rust rings, and agar plates with pepper-corns. 4-9 Often, these models are expensive or time-consuming to create or lack spatial realism.We propose that a simple, inexpensive model will be effective in increasing emergency provider comfort with CFB removal under slit lamp magnification in addition to increasing provider comfort using a slit lamp. Educational Objectives: By the end of the session, the learner should be able to adequately focus a slit lamp in order to identify and magnify a corneal foreign body and demonstrate safe technique for removal of a corneal foreign body under slit lamp guidance. Educational Methods: We created a low-fidelity CFB simulator for approximately $15 utilizing a Styrofoam ball, toothpicks, grapes, novelty glasses, and magnesium shavings. Toothpicks secured grapes into simulated orbits, scooped out of a Styrofoam ball. We fastened the Styrofoam ball to the slit lamp using medical tape. We added novelty glasses to simulate working around facial features. A senior resident instructor then used forceps to insert small magnesium shavings into the grapes to simulate foreign bodies. Participants received an introduction on techniques for successful CFB removal using the bevel of a needle under slit lamp guidance.10,11 They practiced using the models under supervision of an instructor. Research Methods: We conducted a prospective trial using a convenience sample of 19 learners at a university-based EM residency program, including EM interns, one emergency advanced-practice clinician, and fourth-year medical students participating in an EM sub-internship. We analyzed results using a Fisher's exact test. Results: Before training, few participants (36.8%) had observed a corneal foreign body removal, and only 15.8% had performed the procedure. More than half (52.6%) of participants said they were somewhat or very comfortable using a slit lamp before the training and 89.5% were somewhat or very comfortable after training (p=0.029). None of the participants were somewhat or very comfortable removing CFBs before the training and 84.2% were somewhat or very comfortable post-training (p<0.001). Discussion: Results suggest that simulation with this low-cost model effectively improves provider comfort in CFB removal in addition to improving comfort using a slit lamp. Topics: Eye exam, eye injury, ocular injury, corneal injury, corneal foreign body, slit lamp, corneal foreign body removal.

A survey of the current utilization of asynchronous education among emergency medicine residents in the United States.

PROBLEM: Medical education is transitioning from traditional learning methods. Resident interest in easily accessible education materials is forcing educators to reevaluate teaching methodology. APPROACH: To determine emergency medicine residents' current methods of and preferences for obtaining medical knowledge, the authors created a survey and sent it to residents, at all levels of training throughout the United States, whose e-mail addresses were available via their residency's official Web site (June-December 2012). The eight-question voluntary survey asked respondents about demographics, their use of extracurricular time, and the materials they perceived as most beneficial. The authors used descriptive statistics to analyze results. OUTCOMES: Of the 401 residents who received the e-mailed survey, 226 (56.3%) completed it. Of these, 97.7% reported spending at least one hour per week engaging in extracurricular education, and 34.5% reported spending two to four hours per week (P < .001). Time listening to podcasts was the most popular (reported by 35.0% of residents), followed by reading textbooks (33.6%) and searching Google (21.4%; P < .001). Residents endorsed podcasts as the most beneficial (endorsed by 70.3%) compared with textbooks (endorsed by 54.3%), journals (36.5%), and Google (33.8%; P < .001). Most respondents reported evaluating the quality of evidence or reviewing references "rarely" or less than half the time. A majority (80.0%) selected the topics they accessed based on recent clinical encounters. NEXT STEPS: The results suggest that residents are using more open access interactive multimedia tools. Medical educators must engage with current learners to guide appropriate use of these.

Emergency Medicine resident anesthesia training in a private vs. academic setting.

BACKGROUND: Airway management is an essential part of any Emergency Medicine (EM) training program. Academic centers typically provide training to many learners at various training levels in a number of medical specialties during anesthesiology rotations. This potentially creates competition for intubation procedures that may negatively impact individual experiences. OBJECTIVES: We hypothesized that residents would report higher numbers of intubations and improved educational value in a private practice, rather than an academic, anesthesiology rotation. METHODS: EM residents' anesthesiology training was evaluated pre and post a change in training setting from an academic institution to a private practice institution. Outcome measures included the number of self-reported intubations, resident ratings of the rotation, and the number of positive comments. Residents' evaluation was measured with: a 14-item evaluation; subjective comments, which two blinded reviewers rated as positive, negative, or neutral; and transcripts from structured interviews to identify themes related to training settings. RESULTS: The number of intubations increased significantly in the private practice setting (4.6 intubations/day vs. 1.5 intubations/day, p < 0.001). Resident evaluations improved significantly with the private practice experience (mean scores of 3.83 vs. 2.23, p-values <0.05). Residents' impressions were also significantly higher for the private practice setting with respect to increased educational value, greater use of adjunct airway devices, and directed teaching. CONCLUSIONS: Number of intubations performed and residents' rating of the educational value were more favorable for a private practice anesthesiology rotation. Alternative settings may provide benefit for training in areas that have competition among trainees.

Characteristics of the first two years of applicants to a new emergency medicine residency program.

BACKGROUND: To the best of our knowledge, no study has compared the effect of using the Electronic Residency Application Service (ERAS) on applicant pool characteristics for a new emergency medicine (EM) residency program. OBJECTIVE: We sought to compare applicants in an EM residency program's first year, in which the ERAS is not typically used, to applicants in year 2 (using ERAS). METHODS: We reviewed the applications to the new University of Utah EM residency program for the entering classes of 2005 (year 1) and 2006 (year 2). RESULTS: In total, 130 and 458 prospective residents applied during year 1 and year 2, respectively. Applicants using and not using ERAS were similar in average Step 1 score (211.8 vs. 212.4, respectively; p = 0.791), previously failed Step 1 or Step 2 attempt (12.1% vs. 11.0%, respectively; p = 0.729), previous failure to match in a residency program (8.6% vs. 4.6%, respectively; p = 0.083), previous residency training (18.8% vs. 14.9%, respectively; p = 0.288), and the percent who had completed an EM clerkship (95.3% vs. 93.0%, respectively; p = 0.342). Applicants not using ERAS were more likely to have been remediated in medical school (13.2% vs. 4.2%; p < 0.001) and to have a Standardized Letter of Recommendation (SLOR) (87% vs. 78%; p = 0.024). Applicants using ERAS were more likely to have a SLOR match estimate of "very competitive" (38.2% vs. 54.1%; p = 0.004). Applicants were similar in having attended a "top tier" medical school (44.5% vs. 41.3%, p = 0.508). CONCLUSION: Despite significantly fewer applicants, those applying without the use of ERAS to a new EM residency program were generally comparable to the applicant pool that did permit the use of ERAS. The larger number of applicants the second year likely reflects the use of ERAS.

Evaluating applicants to a new emergency medicine residency program: subjective assessment of applicant characteristics.

BACKGROUND: Because of the Accreditation Council for Graduate Medical Education (ACGME) and the Residency Review Committee (RRC) approval timelines, new residency programs cannot use Electronic Residency Application Service (ERAS) during their first year of applicants. AIM: We sought to identify differences between program directors' subjective ratings of applicants from an emergency medicine (EM) residency program's first year (in which ERAS was not used) to their ratings of applicants the following year in which ERAS was used. METHOD: The University of Utah Emergency Medicine Residency Program received approval from the ACGME in 2004. Applicants for the entering class of 2005 (year 1) did not use ERAS, submitting a separate application, while those applying for the following year (year 2) used ERAS. Residency program directors rated applicants using subjective components of their applications, assigning scores on scales from 0-10 or 0-5 (10 or 5 = highest score) for select components of the application. We retrospectively reviewed and compared these ratings between the 2 years of applicants. RESULTS: A total of 130 and 458 prospective residents applied during year 1 and year 2, respectively. Applicants were similar in average scores for research (1.65 vs. 1.81, scale 0-5, p = 0.329) and volunteer work (5.31 vs. 5.56, scale 0-10, p = 0.357). Year 1 applicants received higher scores for their personal statement (3.21 vs. 2.22, scale 0-5, p < 0.001), letters of recommendation (7.0 vs. 5.94, scale 0-10, p < 0.001), dean's letter (3.5 vs. 2.7, scale 1-5, p < 0.001), and in their potential contribution to class characteristics (4.64 vs. 3.34, scale 0-10, p < 0.001). CONCLUSION: While the number of applicants increased, the use of ERAS in a new residency program did not improve the overall subjective ratings of residency applicants. Year 1 applicants received higher scores for the written components of their applications and in their potential contributions to class characteristics.