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Physicians depend on access to accurate, up-to-date information and knowledge to make decisions and carry out their work. Today, access to online medical information has become easier than ever before. There is a stream of research interested in understanding how online health information intervenes and influences the patient-physician relationship. While many studies have focused on patients' online health information seeking, fewer studies have addressed how physicians seek and use online medical information. In this qualitative study, focus groups using clinical scenarios were conducted to examine why and when resident physicians turn to search engines like Google for medical information seeking at the point of care. The paper provides insights in physicians' perceptions and experiences of using digital tools for information seeking during patient consultations. Specifically, we identify and discuss information-seeking strategies of physicians during the patient consultation, contributing crucial knowledge for improving the quality of healthcare and patient outcomes., CC BY-NC 4.0

PurposeResidency programs must ensure resident competence for independent practice. The coronavirus disease-19 (COVID-19) pandemic disrupted health care delivery, impacting pediatric residencies. This study examines the impact on pediatric resident education.MethodsThe authors conducted a mixed methods national survey of pediatric residency program directors (PDs) from May 2020 to July 2020. Data analysis included descriptive statistics, chi-square, and Wilcoxon rank sum tests. Multivariable modeling identified factors associated with resident preparation for more senior roles. Thematic analysis was performed on open-ended questions about PD COVID-19 pandemic recommendations to peers, Accreditation Council for Graduate Medical Education and American Board of Pediatrics.ResultsResponse rate was 55% (110/199). PDs reported the COVID-19 pandemic negatively affected inpatient (n = 86, 78.2%), and outpatient education (n = 104, 94.5%), procedural competence (n = 64; 58.2%), and resident preparation for more senior roles (n = 50, 45.5%). In bivariate analyses, increasingly negative impacts on inpatient and outpatient education were associated with an increasingly negative impact on resident preparation for more senior roles (P = .03, P = .008), these relationships held true in multivariable analysis. Qualitative analysis identified 4 themes from PD recommendations: 1) Clear communication from governing bodies and other leaders; 2) Flexibility within programs and from governing bodies; 3) Clinical exposure is key for competency development; 4) Online platforms are important for education, communication, and support.ConclusionsThe COVID-19 pandemic negatively impacted inpatient and outpatient education. When these were more negatively impacted, resident preparation for more senior roles was worse, highlighting the importance of competency based medical education to tailor experiences ensuring each resident is compe

Through a literature review in combination with qualitative analysis of course evaluations, this study examines aspects that contribute to enhancing elearning for physicians in a residency education program. The literature review and the qualitative analysis outline three main factors (pedagogical, technological, and organizational), highlighting the importance of a holistic approach that includes learning and technology in context when integrating e-learning strategies in adult learning programs. The findings contribute insights and practical guidance for education organizers on how to conduct e-learning during and after the pandemic., CC BY-NC 4.0

Physicians depend on access to accurate, up-to-date information and knowledge to make decisions and carry out their work. Today, access to online medical information has become easier than ever before. There is a stream of research interested in understanding how online health information intervenes and influences the patient-physician relationship. While many studies have focused on patients' online health information seeking, fewer studies have addressed how physicians seek and use online medical information. In this qualitative study, focus groups using clinical scenarios were conducted to examine why and when resident physicians turn to search engines like Google for medical information seeking at the point of care. The paper provides insights in physicians' perceptions and experiences of using digital tools for information seeking during patient consultations. Specifically, we identify and discuss information-seeking strategies of physicians during the patient consultation, contributing crucial knowledge for improving the quality of healthcare and patient outcomes., CC BY-NC 4.0

Through a literature review in combination with qualitative analysis of course evaluations, this study examines aspects that contribute to enhancing elearning for physicians in a residency education program. The literature review and the qualitative analysis outline three main factors (pedagogical, technological, and organizational), highlighting the importance of a holistic approach that includes learning and technology in context when integrating e-learning strategies in adult learning programs. The findings contribute insights and practical guidance for education organizers on how to conduct e-learning during and after the pandemic., CC BY-NC 4.0

Through a literature review in combination with qualitative analysis of course evaluations, this study examines aspects that contribute to enhancing elearning for physicians in a residency education program. The literature review and the qualitative analysis outline three main factors (pedagogical, technological, and organizational), highlighting the importance of a holistic approach that includes learning and technology in context when integrating e-learning strategies in adult learning programs. The findings contribute insights and practical guidance for education organizers on how to conduct e-learning during and after the pandemic., CC BY-NC 4.0

Physicians depend on access to accurate, up-to-date information and knowledge to make decisions and carry out their work. Today, access to online medical information has become easier than ever before. There is a stream of research interested in understanding how online health information intervenes and influences the patient-physician relationship. While many studies have focused on patients' online health information seeking, fewer studies have addressed how physicians seek and use online medical information. In this qualitative study, focus groups using clinical scenarios were conducted to examine why and when resident physicians turn to search engines like Google for medical information seeking at the point of care. The paper provides insights in physicians' perceptions and experiences of using digital tools for information seeking during patient consultations. Specifically, we identify and discuss information-seeking strategies of physicians during the patient consultation, contributing crucial knowledge for improving the quality of healthcare and patient outcomes., CC BY-NC 4.0

Physicians depend on access to accurate, up-to-date information and knowledge to make decisions and carry out their work. Today, access to online medical information has become easier than ever before. There is a stream of research interested in understanding how online health information intervenes and influences the patient-physician relationship. While many studies have focused on patients' online health information seeking, fewer studies have addressed how physicians seek and use online medical information. In this qualitative study, focus groups using clinical scenarios were conducted to examine why and when resident physicians turn to search engines like Google for medical information seeking at the point of care. The paper provides insights in physicians' perceptions and experiences of using digital tools for information seeking during patient consultations. Specifically, we identify and discuss information-seeking strategies of physicians during the patient consultation, contributing crucial knowledge for improving the quality of healthcare and patient outcomes., CC BY-NC 4.0

Physicians depend on access to accurate, up-to-date information and knowledge to make decisions and carry out their work. Today, access to online medical information has become easier than ever before. There is a stream of research interested in understanding how online health information intervenes and influences the patient-physician relationship. While many studies have focused on patients' online health information seeking, fewer studies have addressed how physicians seek and use online medical information. In this qualitative study, focus groups using clinical scenarios were conducted to examine why and when resident physicians turn to search engines like Google for medical information seeking at the point of care. The paper provides insights in physicians' perceptions and experiences of using digital tools for information seeking during patient consultations. Specifically, we identify and discuss information-seeking strategies of physicians during the patient consultation, contributing crucial knowledge for improving the quality of healthcare and patient outcomes., CC BY-NC 4.0

Through a literature review in combination with qualitative analysis of course evaluations, this study examines aspects that contribute to enhancing elearning for physicians in a residency education program. The literature review and the qualitative analysis outline three main factors (pedagogical, technological, and organizational), highlighting the importance of a holistic approach that includes learning and technology in context when integrating e-learning strategies in adult learning programs. The findings contribute insights and practical guidance for education organizers on how to conduct e-learning during and after the pandemic., CC BY-NC 4.0

Through a literature review in combination with qualitative analysis of course evaluations, this study examines aspects that contribute to enhancing elearning for physicians in a residency education program. The literature review and the qualitative analysis outline three main factors (pedagogical, technological, and organizational), highlighting the importance of a holistic approach that includes learning and technology in context when integrating e-learning strategies in adult learning programs. The findings contribute insights and practical guidance for education organizers on how to conduct e-learning during and after the pandemic., CC BY-NC 4.0

In Sweden, like in other countries worldwide, the COVID-19 pandemic forced many education programs to a sudden and urgent switch to online teaching and learning, often without sufficient study. This was the case not only for schools and higher education butalso for continuing education and training. In this study, we exploratively examine resident physicians' perceptions and experiences of using a digital learning environment as part of their specialist medical training. The paper focuses on synchronous learning through video conferencing (virtual lectures and seminars) and addresses the following research question: What are the perceived opportunities and challenges related to digitallearning from the perspective of the course participants? The methodological approach is qualitative, based on thematic analysis of course evaluations and semi-structured interviews. The results suggest that: i) pedagogical methods, reliable technology, and the effect of course management on learning outcomes are essential factors; ii) insightsinto participants' perceptions of learning via video conferencing emphasize that interactive communication and group discussions are significant for their learning, and iii) sociotechnical aspects were part of the elements that influenced participants'satisfaction with digital learning. Findings from this study contribute to better knowledge and understanding of how a digital learning environment in general, and learning through virtual lectures and seminars in particular, can be developed and incorporated into the programs to increase their usefulness.

Residents commonly feel that a lack of time is a significant barrier in keeping up-to-date with both medical knowledge and literature. In this study, we addressed that barrier by placing an iPad-based live fact feed in the resident workroom of our emergency department, therefore allowing for passive learning while on shift. We hypothesized that residents with access to the live feed would score higher on monthly post-curriculum block exams. We ended up finding that the residents actually prefer a more active approach to learning and that many more people in the emergency department other than the residents benefitted from the fact board.

Residents commonly feel that a lack of time is a significant barrier in keeping up-to-date with both medical knowledge and literature. In this study, we addressed that barrier by placing an iPad-based live fact feed in the resident workroom of our emergency department, therefore allowing for passive learning while on shift. We hypothesized that residents with access to the live feed would score higher on monthly post-curriculum block exams. We ended up finding that the residents actually prefer a more active approach to learning and that many more people in the emergency department other than the residents benefitted from the fact board.

Feedback is defined as a regulatory mechanism where the effect of an action is fed back to modify and improve future action. In medical education, newer conceptualizations of feedback place the learner at the center of the feedback loop and emphasize learner engagement in the entire process. But, learners reject feedback if they doubt its credibility or it conflicts with their self-assessment. Therefore, attention has turned to sociocultural factors that influence feedback-seeking, acceptance, and incorporation into performance. Understanding and application of specific aspects of psychosocial theories could help in designing initiatives that enhance the effect of feedback on learning and growth. In the end, the quality and impact of feedback should be measured by its influence on recipient behavior change, professional growth, and quality of patient care and not the skills of the feedback provider. Our objective is to compare and contrast older and newer definitions of feedback, explore existing feedback models, and highlight principles of relevant psychosocial theories applicable to feedback initiatives. Finally, we aim to apply principles from patient safety initiatives to emphasize a safe and just culture within which feedback conversations occur so that weaknesses are as readily acknowledged and addressed as strengths.

Residents commonly feel that a lack of time is a significant barrier in keeping up-to-date with both medical knowledge and literature. In this study, we addressed that barrier by placing an iPad-based live fact feed in the resident workroom of our emergency department, therefore allowing for passive learning while on shift. We hypothesized that residents with access to the live feed would score higher on monthly post-curriculum block exams. We ended up finding that the residents actually prefer a more active approach to learning and that many more people in the emergency department other than the residents benefitted from the fact board.

Feedback is defined as a regulatory mechanism where the effect of an action is fed back to modify and improve future action. In medical education, newer conceptualizations of feedback place the learner at the center of the feedback loop and emphasize learner engagement in the entire process. But, learners reject feedback if they doubt its credibility or it conflicts with their self-assessment. Therefore, attention has turned to sociocultural factors that influence feedback-seeking, acceptance, and incorporation into performance. Understanding and application of specific aspects of psychosocial theories could help in designing initiatives that enhance the effect of feedback on learning and growth. In the end, the quality and impact of feedback should be measured by its influence on recipient behavior change, professional growth, and quality of patient care and not the skills of the feedback provider. Our objective is to compare and contrast older and newer definitions of feedback, explore existing feedback models, and highlight principles of relevant psychosocial theories applicable to feedback initiatives. Finally, we aim to apply principles from patient safety initiatives to emphasize a safe and just culture within which feedback conversations occur so that weaknesses are as readily acknowledged and addressed as strengths.

Aims: Electronic prescribing systems may improve medication safety, but only when used appropriately. The effects of task analysis-based training on clinical, learning and behavioural outcomes were evaluated in the outpatient setting, compared with the usual educational approach. Methods: This was a multicentre, cluster randomized trial [EDUCATional intervention for IT-mediated MEDication management (MEDUCATE trial)], with physicians as the unit of analysis. It took place in the outpatient clinics of two academic hospitals. Participants comprised specialists and residents (specialty trainees, in the UK) and their patients. Training took the form of a small-group session and an e-learning. The primary outcome was the proportion of medication discrepancies per physician, measured as discrepancies between medications registered by physicians in the electronic prescribing system and those reported by patients. Clinical consequences were estimated by the proportion of patients per physician with at least one missed drug–drug interaction with the potential for causing adverse drug events. A questionnaire assessed physicians' knowledge and skills. Results: Among 124 participating physicians, primary outcome data for 115 (93%) were available. A total of 1094 patients were included. A mean of 48% of registered medications per physician were discrepant with the medications that their patients reported in both groups (P = 0.14). Due to registration omissions, a mean of 4% of patients per physician had one or more missed drug–drug interactions with the potential to cause a clinically relevant adverse drug event in the intervention group, and 7% in controls (P = 0.11). The percentages of correct answers on the knowledge and skills test were higher in the intervention group (57%) compared with controls (51%; P = 0.01). Conclusion: The training equipped outpatient physicians with the knowledge and skills for appropriate use of electronic prescribing systems, but had no effect on m

Introduction: Prior work links empathy and positive physician-patient relationships to improved healthcare outcomes. The objective of this study was to analyze a patient experience simulation for emergency medicine (EM) interns as a way to teach empathy and conscientious patient care.Methods: We conducted a qualitative descriptive study on an in situ, patient experience simulation held during EM residency orientation. Half the interns were patients brought into the emergency department (ED) by ambulance and half were family members. Interns then took part in focus groups that discussed the experience. Data collected during these focus groups were coded by two investigators using a grounded theory approach and constant comparative methodology. Results: We identified 10 major themes and 28 subthemes in the resulting qualitative data. Themes were in three broad categories: the experience as a patient or family member in the ED; application to current clinical practice; and evaluation of the exercise itself. Interns experienced firsthand the physical discomfort, emotional stress and confusion patients and families endure during the ED care process. They reflected on lessons learned, including the importance of good communication skills, frequent updates on care and timing, and being responsive to the needs and concerns of patients and families. All interns felt this was a valuable orientation experience.Conclusion: Conducting a patient experience simulation may be a practical and effective way to develop empathy in EM resident physicians. Additional research evaluating the effect of participation in the simulation over a longer time period and assessing the effects on residents’ actual clinical care is warranted.

Introduction: Prior work links empathy and positive physician-patient relationships to improved healthcare outcomes. The objective of this study was to analyze a patient experience simulation for emergency medicine (EM) interns as a way to teach empathy and conscientious patient care.Methods: We conducted a qualitative descriptive study on an in situ, patient experience simulation held during EM residency orientation. Half the interns were patients brought into the emergency department (ED) by ambulance and half were family members. Interns then took part in focus groups that discussed the experience. Data collected during these focus groups were coded by two investigators using a grounded theory approach and constant comparative methodology. Results: We identified 10 major themes and 28 subthemes in the resulting qualitative data. Themes were in three broad categories: the experience as a patient or family member in the ED; application to current clinical practice; and evaluation of the exercise itself. Interns experienced firsthand the physical discomfort, emotional stress and confusion patients and families endure during the ED care process. They reflected on lessons learned, including the importance of good communication skills, frequent updates on care and timing, and being responsive to the needs and concerns of patients and families. All interns felt this was a valuable orientation experience.Conclusion: Conducting a patient experience simulation may be a practical and effective way to develop empathy in EM resident physicians. Additional research evaluating the effect of participation in the simulation over a longer time period and assessing the effects on residents’ actual clinical care is warranted.

INTRODUCTION Since the creation of HCAHPS Patient Satisfaction (PS) scores, Patient Experience (PE) has become a metric that can profoundly affect the fiscal balance of hospital systems, reputation of entire departments and welfare of individual physicians. While government and hospital mandates demonstrate the prominence of PE as a quality measure, no such mandate exists for its education. The objective of this study was to determine the education and evaluation landscape for PE in categorical Emergency Medicine (EM) residencies. METHODS This was a prospective survey analysis of the Council of Emergency Medicine Residency Directors (CORD) membership. Program directors (PDs), assistant PDs and core faculty who are part of the CORD listserv were sent an email link to a brief, anonymous electronic survey. Respondents were asked their position in the residency, the name of their department, and questions regarding the presence and types of PS evaluative data and PE education they provide. RESULTS 146 responses were obtained from 139 individual residencies, representing 72% of all categorical EM residencies. This survey found that only 27% of responding residencies provide PS data to their residents. Of those programs, 61% offer simulation scores, 39% provide third party attending data on cases with resident participation, 37% provide third party acquired data specifically about residents and 37% provide internally acquired quantitative data.Only 35% of residencies reported having any organized PE curricula. Of the programs that provide an organized PE curriculum, most offer multiple modalities. 96% provide didactic lectures, 49% small group sessions, 47% simulation sessions and 27% specifically use standardized patient encounters in their simulation sessions. CONCLUSION The majority of categorical EM residencies do not provide either PS data or any organized PE curriculum. Those that do utilize a heterogeneous set of data collection modalities and educationa

Introduction: Workplace-based assessment is integral to programmatic assessment in a competency-based curriculum. In 2013, one such assessment, a mini-Clinical Evaluation Exercise (mini-CEX) with a novel "entrustability scale", became compulsory for over 1,200 Australia and New Zealand College of Anaesthetists (ANZCA) trainees. We explored trainees' and supervisors' understanding of the mini-CEX, their experience with the assessment, and their perceptions of its influence on learning and supervision. Method(s): We conducted semi-structured telephone interviews with anesthesia supervisors and trainees and performed an inductive thematic analysis of the verbatim transcripts. Result(s): Eighteen supervisors and 17 trainees participated (n = 35). Interrelated themes concerned the perceived purpose of the mini-CEX, its value in trainee learning and supervision, and the process of performing the assessment. While few participants saw the mini-CEX primarily as an administrative burden, most focused on its potential for facilitating trainee improvement and reported positive impacts on the quantity and quality of feedback, trainee learning, and supervision. Finding time to schedule assessments and deliver timely feedback proved to be difficult in busy clinical workplaces. Views on case selection were divided and driven by contrasting goals - i.e., receiving useful feedback on challenging cases or receiving a high score by choosing lenient assessors or easy cases. Whether individual mini-CEXs were summative or formative was subject to intense debate, while the intended summative use of multiple mini-CEXs in programmatic assessment was poorly understood. Conclusion(s): Greater clarity of purpose and consistency of time commitment are necessary to embed the mini-CEX in the culture of the workplace, to realize the full potential for trainee learning, and to reach decisions on trainee progression.Copyright © 2016, Canadian Anesthesiologists' Society.

Programmatic assessment is being adopted as a preferred method of assessment in postgraduate medical education in Australia. Programmatic assessment of professionalism is likely to receive increasing attention. This paper reviews the literature regarding the assessment of professionalism in psychiatry. A search using the terms 'professionalism AND psychiatry' was conducted in the ERIC database. Only original articles relevant to professionalism education and assessment in psychiatry were selected, rather than theoretical or review papers that applied research from other fields of medicine to psychiatry. Articles regarding the need for professionalism education in psychiatry were included as they provided a rationale for curriculum development in this field as a precursor to assessment. Key findings from the literature were summarised in light of the author's own experience as an educator and assessor of both medical students and trainees in psychiatry, and incorporated into a guide to implementing programmatic assessment of professionalism in psychiatry. Within psychiatry, the specific evidence base for use of particular tools in assessing professionalism is limited. However, used in conjunction with psychiatrists' views about what is important in professionalism education, as well as knowledge from other medical disciplines regarding professionalism assessment tools, this evidence can inform implementation of programmatic assessment of professionalism in undergraduate, postgraduate and continuing professional development settings. Given the emergent nature of such assessment initiatives, they should be subjected to rigorous evaluation.Copyright © 2017, Springer International Publishing AG.

Introduction: Workplace-based assessment is integral to programmatic assessment in a competency-based curriculum. In 2013, one such assessment, a mini-Clinical Evaluation Exercise (mini-CEX) with a novel "entrustability scale", became compulsory for over 1,200 Australia and New Zealand College of Anaesthetists (ANZCA) trainees. We explored trainees' and supervisors' understanding of the mini-CEX, their experience with the assessment, and their perceptions of its influence on learning and supervision. Method(s): We conducted semi-structured telephone interviews with anesthesia supervisors and trainees and performed an inductive thematic analysis of the verbatim transcripts. Result(s): Eighteen supervisors and 17 trainees participated (n = 35). Interrelated themes concerned the perceived purpose of the mini-CEX, its value in trainee learning and supervision, and the process of performing the assessment. While few participants saw the mini-CEX primarily as an administrative burden, most focused on its potential for facilitating trainee improvement and reported positive impacts on the quantity and quality of feedback, trainee learning, and supervision. Finding time to schedule assessments and deliver timely feedback proved to be difficult in busy clinical workplaces. Views on case selection were divided and driven by contrasting goals - i.e., receiving useful feedback on challenging cases or receiving a high score by choosing lenient assessors or easy cases. Whether individual mini-CEXs were summative or formative was subject to intense debate, while the intended summative use of multiple mini-CEXs in programmatic assessment was poorly understood. Conclusion(s): Greater clarity of purpose and consistency of time commitment are necessary to embed the mini-CEX in the culture of the workplace, to realize the full potential for trainee learning, and to reach decisions on trainee progression.Copyright © 2016, Canadian Anesthesiologists' Society.

Programmatic assessment is being adopted as a preferred method of assessment in postgraduate medical education in Australia. Programmatic assessment of professionalism is likely to receive increasing attention. This paper reviews the literature regarding the assessment of professionalism in psychiatry. A search using the terms 'professionalism AND psychiatry' was conducted in the ERIC database. Only original articles relevant to professionalism education and assessment in psychiatry were selected, rather than theoretical or review papers that applied research from other fields of medicine to psychiatry. Articles regarding the need for professionalism education in psychiatry were included as they provided a rationale for curriculum development in this field as a precursor to assessment. Key findings from the literature were summarised in light of the author's own experience as an educator and assessor of both medical students and trainees in psychiatry, and incorporated into a guide to implementing programmatic assessment of professionalism in psychiatry. Within psychiatry, the specific evidence base for use of particular tools in assessing professionalism is limited. However, used in conjunction with psychiatrists' views about what is important in professionalism education, as well as knowledge from other medical disciplines regarding professionalism assessment tools, this evidence can inform implementation of programmatic assessment of professionalism in undergraduate, postgraduate and continuing professional development settings. Given the emergent nature of such assessment initiatives, they should be subjected to rigorous evaluation.Copyright © 2017, Springer International Publishing AG.

INTRODUCTION Since the creation of HCAHPS Patient Satisfaction (PS) scores, Patient Experience (PE) has become a metric that can profoundly affect the fiscal balance of hospital systems, reputation of entire departments and welfare of individual physicians. While government and hospital mandates demonstrate the prominence of PE as a quality measure, no such mandate exists for its education. The objective of this study was to determine the education and evaluation landscape for PE in categorical Emergency Medicine (EM) residencies. METHODS This was a prospective survey analysis of the Council of Emergency Medicine Residency Directors (CORD) membership. Program directors (PDs), assistant PDs and core faculty who are part of the CORD listserv were sent an email link to a brief, anonymous electronic survey. Respondents were asked their position in the residency, the name of their department, and questions regarding the presence and types of PS evaluative data and PE education they provide. RESULTS 146 responses were obtained from 139 individual residencies, representing 72% of all categorical EM residencies. This survey found that only 27% of responding residencies provide PS data to their residents. Of those programs, 61% offer simulation scores, 39% provide third party attending data on cases with resident participation, 37% provide third party acquired data specifically about residents and 37% provide internally acquired quantitative data.Only 35% of residencies reported having any organized PE curricula. Of the programs that provide an organized PE curriculum, most offer multiple modalities. 96% provide didactic lectures, 49% small group sessions, 47% simulation sessions and 27% specifically use standardized patient encounters in their simulation sessions. CONCLUSION The majority of categorical EM residencies do not provide either PS data or any organized PE curriculum. Those that do utilize a heterogeneous set of data collection modalities and educationa

Introduction: Millennial learners are changing the face of residency education because they place emphasis on technology with new styles and means of learning. While research on the most effective way to teach the millennial learner is lacking, programs should consider incorporating educational theories and multimedia design principles to update the curriculum for these new learners. The purpose of the study is to discuss strategies for updating an emergency medicine (EM) residency program’s curriculum to accommodate the modern learner.Discussion: These 10 tips provide detailed examples and approaches to incorporate technology and learning theories into an EM curriculum to potentially enhance learning and engagement by residents.Conclusion: While it is unclear whether technologies actually promote or enhance learning, millennials use these technologies. Identifying best practice, grounded by theory and active learning principles, may help learners receive quality, high-yield education. Future studies will need to evaluate the efficacy of these techniques to fully delineate best practices.

Introduction: Residents and faculty in emergency medicine (EM) residency programs might be unaware of the professional and legal risks associated with the use of social media (SM). The objective of this study was to identify and characterize the types and reported incidence of unprofessional SM behavior by EM residents, faculty, and nurses and the concomitant personal and institutional risks.Methods: This multi-site study used an 18-question survey tool that was distributed electronically to the leaders of multiple EM residency programs, members of the Council of Emergency Medicine Residency Directors (CORD), and the residents of 14 EM programs during the study period May to June 2013.Results: We received 1,314 responses: 772 from residents and 542 from faculty. Both groups reported encountering high-risk-to-professionalism events (HRTPE) related to SM use by residents and non-resident providers (NRPs), i.e., faculty members and nurses. Residents reported posting of one of the following by a resident peer or nursing colleague: identifiable patient information (26%); or a radiograph, clinical picture or other image (52%). Residents reported posting of images of intoxicated colleagues (84%), inappropriate photographs (66%), and inappropriate posts (73%). Program directors (PDs) reported posting one of the following by NRPs and residents respectively: identifiable patient information (46% and 45%); a radiograph, clinical picture or other image (63% and 58%). PDs reported that NRPs and residents posted images of intoxicated colleagues (64% and 57%), inappropriate photographs (63% and 57%), or inappropriate posts (76% and 67%). The directors also reported that they were aware of or issued reprimands or terminations at least once a year (30% NRPs and 22% residents). Residents were more likely to post photos of their resident peers or nursing colleagues in an intoxicated state than were NRPs (p=0.0004). NRPs were more likely to post inappropriate content (p=0.04) and ident

Introduction: Residents and faculty in emergency medicine (EM) residency programs might be unaware of the professional and legal risks associated with the use of social media (SM). The objective of this study was to identify and characterize the types and reported incidence of unprofessional SM behavior by EM residents, faculty, and nurses and the concomitant personal and institutional risks.Methods: This multi-site study used an 18-question survey tool that was distributed electronically to the leaders of multiple EM residency programs, members of the Council of Emergency Medicine Residency Directors (CORD), and the residents of 14 EM programs during the study period May to June 2013.Results: We received 1,314 responses: 772 from residents and 542 from faculty. Both groups reported encountering high-risk-to-professionalism events (HRTPE) related to SM use by residents and non-resident providers (NRPs), i.e., faculty members and nurses. Residents reported posting of one of the following by a resident peer or nursing colleague: identifiable patient information (26%); or a radiograph, clinical picture or other image (52%). Residents reported posting of images of intoxicated colleagues (84%), inappropriate photographs (66%), and inappropriate posts (73%). Program directors (PDs) reported posting one of the following by NRPs and residents respectively: identifiable patient information (46% and 45%); a radiograph, clinical picture or other image (63% and 58%). PDs reported that NRPs and residents posted images of intoxicated colleagues (64% and 57%), inappropriate photographs (63% and 57%), or inappropriate posts (76% and 67%). The directors also reported that they were aware of or issued reprimands or terminations at least once a year (30% NRPs and 22% residents). Residents were more likely to post photos of their resident peers or nursing colleagues in an intoxicated state than were NRPs (p=0.0004). NRPs were more likely to post inappropriate content (p=0.04) and ident

Introduction: Millennial learners are changing the face of residency education because they place emphasis on technology with new styles and means of learning. While research on the most effective way to teach the millennial learner is lacking, programs should consider incorporating educational theories and multimedia design principles to update the curriculum for these new learners. The purpose of the study is to discuss strategies for updating an emergency medicine (EM) residency program’s curriculum to accommodate the modern learner.Discussion: These 10 tips provide detailed examples and approaches to incorporate technology and learning theories into an EM curriculum to potentially enhance learning and engagement by residents.Conclusion: While it is unclear whether technologies actually promote or enhance learning, millennials use these technologies. Identifying best practice, grounded by theory and active learning principles, may help learners receive quality, high-yield education. Future studies will need to evaluate the efficacy of these techniques to fully delineate best practices.

Introduction: Clinicians and residency programs are increasing their use of social media (SM) websites for educational and promotional uses, yet little is known about the use of these sites by residents and faculty. The objective of the study is to assess patterns of SM use for personal and professional purposes among emergency medicine (EM) residents and faculty.Methods: In this multi-site study, an 18-question survey was sent by e-mail to the residents and faculty in 14 EM programs and to the Council of Emergency Medicine Residency Directors (CORD) listserv via the online tool SurveyMonkey™. We compiled descriptive statistics, including assessment with the chi-square test or Fisher’s exact test. StatsDirect software (v 2.8.0, StatsDirect, Cheshire, UK) was used for all analyses.Results: We received 1,314 responses: 63% of respondents were male, 40% were <30 years of age, 39% were between the ages 31 and 40, and 21% were older than 40. The study group consisted of 772 residents and 542 faculty members (15% were program directors, 21% were assistant or associate PDs, 45% were core faculty, and 19% held other faculty positions. Forty-four percent of respondents completed residency more than 10 years ago. Residents used SM markedly more than faculty for social interactions with family and friends (83% vs 65% [p<0.0001]), entertainment (61% vs 47% [p<0.0001]), and videos (42% vs 23% [p=0.0006]). Residents used Facebook™ and YouTube™ more often than faculty (86% vs 67% [p<0.001]; 53% vs 46% [p=0.01]), whereas residents used Twitter™ (19% vs 26% [p=0.005]) and LinkedIn™ (15% vs 32% [p<0.0001]) less than faculty. Overall, residents used SM sites more than faculty, notably in daily use (30% vs 24% [p<0.001]). For professional use, residents were most interested in its use for open positions/hiring (30% vs 18% [p<0.0001]) and videos (33% vs 26% [p=0.005]) and less interested than faculty with award postings (22% vs 33% [p<0.0001]) or publications (30

Graduate medical education is increasingly focused on patient safety and quality improvement; training programs must adapt their curriculum to address these changes. We propose a novel curriculum for emergency medicine (EM) residency training programs specifically addressing patient safety, systems-based management, and practice-based performance improvement, called “EM Debates.” Following implementation of this educational curriculum, we performed a cross-sectional study to evaluate the curriculum through resident self-assessment. Additionally, a cross-sectional study to determine the ED clinical competency committee’s (CCC) ability to assess residents on specific competencies was performed. Residents were overall very positive towards the implementation of the debates. Of those participating in a debate, 71% felt that it improved their individual performance within a specific topic, and 100% of those that led a debate felt that they could propose an evidence-based approach to a specific topic. The CCC found that it was easier to assess milestones in patient safety, systems-based management, and practice-based performance improvement (sub-competencies 16, 17, and 19) compared to prior to the implementation of the debates. The debates have been a helpful venue to teach EM residents about patient safety concepts, identifying medical errors, and process improvement.

Introduction: Residency coordinators may be overwhelmed when scheduling residency interviews.Applicants often have to coordinate interviews with multiple programs at once, and relying on verbalor email confirmation may delay the process. Our objective was to determine applicant mean time toschedule and satisfaction using online scheduling.Methods: This pilot study is a retrospective analysis performed on a sample of applicants offeredinterviews at an urban county emergency medicine residency. Applicants were asked their estimatedtime to schedule with the online system compared to their average time using other methods. Inaddition, they were asked on a five-point anchored scale to rate their satisfaction.Results: Of 171 applicants, 121 completed the survey (70.8%). Applicants were scheduling anaverage of 13.3 interviews. Applicants reported scheduling interviews using the online systemin mean of 46.2 minutes (median 10, range 1-1800) from the interview offer as compared with amean of 320.2 minutes (median 60, range 3-2880) for other programs not using this system. Thisdifference was statistically significant. In addition, applicants were more likely to rate their satisfactionusing the online system as “satisfied” (83.5% vs 16.5%). Applicants were also more likely to statethat they preferred scheduling their interviews using the online system rather than the way otherprograms scheduled interviews (74.2% vs 4.1%) and that the online system aided them coordinatingtravel arrangements (52.1% vs 4.1%).Conclusion: An online interview scheduling system is associated with higher satisfaction amongapplicants both in coordinating travel arrangements and in overall satisfaction. [West J Emerg Med.2015;16(2):352-354.]

Introduction: Clinicians and residency programs are increasing their use of social media (SM) websites for educational and promotional uses, yet little is known about the use of these sites by residents and faculty. The objective of the study is to assess patterns of SM use for personal and professional purposes among emergency medicine (EM) residents and faculty.Methods: In this multi-site study, an 18-question survey was sent by e-mail to the residents and faculty in 14 EM programs and to the Council of Emergency Medicine Residency Directors (CORD) listserv via the online tool SurveyMonkey™. We compiled descriptive statistics, including assessment with the chi-square test or Fisher’s exact test. StatsDirect software (v 2.8.0, StatsDirect, Cheshire, UK) was used for all analyses.Results: We received 1,314 responses: 63% of respondents were male, 40% were <30 years of age, 39% were between the ages 31 and 40, and 21% were older than 40. The study group consisted of 772 residents and 542 faculty members (15% were program directors, 21% were assistant or associate PDs, 45% were core faculty, and 19% held other faculty positions. Forty-four percent of respondents completed residency more than 10 years ago. Residents used SM markedly more than faculty for social interactions with family and friends (83% vs 65% [p<0.0001]), entertainment (61% vs 47% [p<0.0001]), and videos (42% vs 23% [p=0.0006]). Residents used Facebook™ and YouTube™ more often than faculty (86% vs 67% [p<0.001]; 53% vs 46% [p=0.01]), whereas residents used Twitter™ (19% vs 26% [p=0.005]) and LinkedIn™ (15% vs 32% [p<0.0001]) less than faculty. Overall, residents used SM sites more than faculty, notably in daily use (30% vs 24% [p<0.001]). For professional use, residents were most interested in its use for open positions/hiring (30% vs 18% [p<0.0001]) and videos (33% vs 26% [p=0.005]) and less interested than faculty with award postings (22% vs 33% [p<0.0001]) or publications (30

Graduate medical education is increasingly focused on patient safety and quality improvement; training programs must adapt their curriculum to address these changes. We propose a novel curriculum for emergency medicine (EM) residency training programs specifically addressing patient safety, systems-based management, and practice-based performance improvement, called “EM Debates.” Following implementation of this educational curriculum, we performed a cross-sectional study to evaluate the curriculum through resident self-assessment. Additionally, a cross-sectional study to determine the ED clinical competency committee’s (CCC) ability to assess residents on specific competencies was performed. Residents were overall very positive towards the implementation of the debates. Of those participating in a debate, 71% felt that it improved their individual performance within a specific topic, and 100% of those that led a debate felt that they could propose an evidence-based approach to a specific topic. The CCC found that it was easier to assess milestones in patient safety, systems-based management, and practice-based performance improvement (sub-competencies 16, 17, and 19) compared to prior to the implementation of the debates. The debates have been a helpful venue to teach EM residents about patient safety concepts, identifying medical errors, and process improvement.

Introduction: Residency coordinators may be overwhelmed when scheduling residency interviews.Applicants often have to coordinate interviews with multiple programs at once, and relying on verbalor email confirmation may delay the process. Our objective was to determine applicant mean time toschedule and satisfaction using online scheduling.Methods: This pilot study is a retrospective analysis performed on a sample of applicants offeredinterviews at an urban county emergency medicine residency. Applicants were asked their estimatedtime to schedule with the online system compared to their average time using other methods. Inaddition, they were asked on a five-point anchored scale to rate their satisfaction.Results: Of 171 applicants, 121 completed the survey (70.8%). Applicants were scheduling anaverage of 13.3 interviews. Applicants reported scheduling interviews using the online systemin mean of 46.2 minutes (median 10, range 1-1800) from the interview offer as compared with amean of 320.2 minutes (median 60, range 3-2880) for other programs not using this system. Thisdifference was statistically significant. In addition, applicants were more likely to rate their satisfactionusing the online system as “satisfied” (83.5% vs 16.5%). Applicants were also more likely to statethat they preferred scheduling their interviews using the online system rather than the way otherprograms scheduled interviews (74.2% vs 4.1%) and that the online system aided them coordinatingtravel arrangements (52.1% vs 4.1%).Conclusion: An online interview scheduling system is associated with higher satisfaction amongapplicants both in coordinating travel arrangements and in overall satisfaction. [West J Emerg Med.2015;16(2):352-354.]

Improving the quality and efficiency of surgical techniques, reducing technical errors in the operating suite, and ultimately improving patient safety and outcomes through education are common goals in all surgical specialties. Current surgical simulation programs represent an effort to enhance and optimize the training experience, to overcome the training limitations of a mandated 80-hour work week, and have the overall goal of providing a well-balanced resident education in a society with a decreasing level of tolerance for medical errors.

Introduction: The ACGME requires that residents perform scholarly activities prior to graduation, but this is difficult to complete and challenging to support. We describe a residency research program, taking advantage of environmental change aligning resident and faculty goals, to become a contributor to departmental cultural change and research development.Methods: A research program, Scholar Quest (SQ), was developed as a part of an Information Mastery program. The goal of SQ is for residents to gain understanding of scholarly activity through a mentor-directed experience in original research. This curriculum is facilitated by providing residents protected time for didactics, seed grants and statistical/staff support. We evaluated total scholarly activity and resident/faculty involvement before and after implementation (PRE-SQ; 2003-2005 and POST-SQ; 2007-2009).Results: Scholarly activity was greater POST-SQ versus PRE-SQ (123 versus 27) (p<0.05) with an incidence rate ratio (IRR)=2.35. Resident and faculty involvement in scholarly activity also increased PRE-SQ to POST-SQ (22 to 98 residents; 10 to 39 faculty, p<0.05) with an IRR=2.87 and 2.69, respectively.Conclusion: Implementation of a program using department environmental change promoting a resident longitudinal research curriculum yielded increased resident and faculty scholarly involvement, as well as an increase in total scholarly activity. [West J Emerg Med. 2014;15(3):299–305.]

Introduction: The ACGME requires that residents perform scholarly activities prior to graduation, but this is difficult to complete and challenging to support. We describe a residency research program, taking advantage of environmental change aligning resident and faculty goals, to become a contributor to departmental cultural change and research development.Methods: A research program, Scholar Quest (SQ), was developed as a part of an Information Mastery program. The goal of SQ is for residents to gain understanding of scholarly activity through a mentor-directed experience in original research. This curriculum is facilitated by providing residents protected time for didactics, seed grants and statistical/staff support. We evaluated total scholarly activity and resident/faculty involvement before and after implementation (PRE-SQ; 2003-2005 and POST-SQ; 2007-2009).Results: Scholarly activity was greater POST-SQ versus PRE-SQ (123 versus 27) (p<0.05) with an incidence rate ratio (IRR)=2.35. Resident and faculty involvement in scholarly activity also increased PRE-SQ to POST-SQ (22 to 98 residents; 10 to 39 faculty, p<0.05) with an IRR=2.87 and 2.69, respectively.Conclusion: Implementation of a program using department environmental change promoting a resident longitudinal research curriculum yielded increased resident and faculty scholarly involvement, as well as an increase in total scholarly activity. [West J Emerg Med. 2014;15(3):299–305.]

Resident physicians are particularly susceptible to burnout due to the stresses of residency training. They also experience the added pressures of multitasking because of the increased use of computers and mobile devices while delivering patient care. Our Family Medicine residency program addresses these problems by teaching residents about the mindful practice of medicine. We utilize A. A. Milne’s classic children’s books, Winnie-the-Pooh and The House at Pooh Corner, along with Benjamin Hoff’s The Tao of Pooh to explain Dr. Ron Epstein’s four habits of mindfulness: attentive observation, critical curiosity, beginner’s mind, and presence. We also use video clips from two Disney movies, The Many Adventures of Winnie-the-Pooh and A Day for Eeyore as well as Kenny Loggins’ song, House at Pooh Corner. With Winnie-the-Pooh’s help, residents learn how to become more mindful physicians by incorporating Epstein’s four habits of mindfulness into their daily practice.

Resident physicians are particularly susceptible to burnout due to the stresses of residency training. They also experience the added pressures of multitasking because of the increased use of computers and mobile devices while delivering patient care. Our Family Medicine residency program addresses these problems by teaching residents about the mindful practice of medicine. We utilize A. A. Milne’s classic children’s books, Winnie-the-Pooh and The House at Pooh Corner, along with Benjamin Hoff’s The Tao of Pooh to explain Dr. Ron Epstein’s four habits of mindfulness: attentive observation, critical curiosity, beginner’s mind, and presence. We also use video clips from two Disney movies, The Many Adventures of Winnie-the-Pooh and A Day for Eeyore as well as Kenny Loggins’ song, House at Pooh Corner. With Winnie-the-Pooh’s help, residents learn how to become more mindful physicians by incorporating Epstein’s four habits of mindfulness into their daily practice.

BACKGROUND: In the era of surgical resident work hour restrictions, the traditional apprenticeship model may provide fewer hours for neurosurgical residents to hone technical skills. Spinal dura mater closure or repair is 1 skill that is infrequently encountered, and persistent cerebrospinal fluid leaks are a potential morbidity. OBJECTIVE: To establish an educational curriculum to train residents in spinal dura mater closure with a novel durotomy repair model. METHODS: The Congress of Neurological Surgeons has developed a simulation-based model for durotomy closure with the ongoing efforts of their simulation educational committee. The core curriculum consists of didactic training materials and a technical simulation model of dural repair for the lumbar spine. RESULTS: Didactic pretest scores ranged from 4/11 (36%) to 10/11 (91%). Posttest scores ranged from 8/11 (73%) to 11/11 (100%). Overall, didactic improvements were demonstrated by all participants, with a mean improvement between pre- and posttest scores of 1.17 (18.5%; P = .02). The technical component consisted of 11 durotomy closures by 6 participants, where 4 participants performed multiple durotomies. Mean time to closure of the durotomy ranged from 490 to 546 seconds in the first and second closures, respectively (P = .66), whereby the median leak rate improved from 14 to 7 (P = .34). There were also demonstrative technical improvements by all. CONCLUSION: Simulated spinal dura mater repair appears to be a potentially valuable tool in the education of neurosurgery residents. The combination of a didactic and technical assessment appears to be synergistic in terms of educational development.

Introduction: Teaching ability and efficiency of clinical operations are important aspects of physician performance. In order to promote excellence in education and clinical efficiency, it would be important to determine physician qualities that contribute to both. We sought to evaluate the relationship between teaching performance and patient throughput times.Methods: The setting is an urban, academic emergency department with an annual census of 65,000patient visits. Previous analysis of an 18-question emergency medicine faculty survey at this institution identified 5 prevailing domains of faculty instructional performance. The 5 statistically significant domains identified were: Competency and Professionalism, Commitment to Knowledge and Instruction, Inclusion and Interaction, Patient Focus, and Openness and Enthusiasm. We fit a multivariate, random effects model using each of the 5 instructional domains for emergency medicine faculty as independent predictors and throughput time (in minutes) as the continuous outcome. Faculty that were absent for any portion of the research period were excluded as were patient encounters without direct resident involvement.Results: Two of the 5 instructional domains were found to significantly correlate with a change inpatient treatment times within both datasets. The greater a physician’s Commitment to Knowledge and Instruction, the longer their throughput time, with each interval increase on the domain scale associated with a 7.38-minute increase in throughput time (90% confidence interval [CI]: 1.89 to 12.88 minutes). Conversely, increased Openness and Enthusiasm was associated with a 4.45-minute decrease in throughput (90% CI: 8.83 to 0.07 minutes).Conclusion: Some aspects of teaching aptitude are associated with increased throughput times (Openness and Enthusiasm), while others are associated with decreased throughput times (Commitment to Knowledge and Instruction). Our findings suggest that a tradeoff may exist between ope

Consultation-liaison (C-L) psychiatry as a service entity has developed slowly and to a variable extent in Australia despite the presence of factors conducive to its development. These include a compulsory national health insurance system and a favorable disposition to the biopsychosocial model and to psychoanalytic ideas. C-L psychiatry, however, does enjoy a high profile in many undergraduate medical and postgraduate psychiatry teaching programs. Research on C-L psychiatry is emerging, complementing a strong history of research in psychosomatic medicine. An Australian and New Zealand C-L psychiatry interest group is being formed. Collaboration with the MICRO- CARES Consortium and the European Consultation-Liaison Workgroup is proving to be a great stimulus.

Background: Techniques are needed to assess anesthesiologists' performance when responding to critical events. Patient simulators allow presentation of similar crisis situations to different clinicians. This study evaluated ratings of performance, and the interrater variability of the ratings, made by multiple independent observers viewing videotapes of simulated crises. Method(s): Raters scored the videotapes of 14 different teams that were managing two scenarios: malignant hyperthermia (MH) and cardiac arrest. Technical performance and crisis management behaviors were rated. Technical ratings could range from 0.0 to 1.0 based on scenario-specific checklists of appropriate actions. Ratings of 12 crisis management behaviors were made using a five-point ordinal scale. Several statistical assessments of interrater variability were applied. Result(s): Technical ratings were high for most teams in both scenarios (0.78 +/- 0.08 for MH, 0.83 +/- 0.06 for cardiac arrest). Ratings of crisis management behavior varied, with some teams rated as minimally acceptable or poor (28% for MH, 14% for cardiac arrest). The agreement between raters was fair to excellent, depending on the item rated and the statistical test used. Conclusion(s): Both technical and behavioral performance can be assessed from videotapes of simulations. The behavioral rating system can be improved; one particular difficulty was aggregating a single rating for a behavior that fluctuated over time. These performance assessment tools might be nseful for educational research or for tracking a resident's progress. The rating system needs more refinement before it can be used to assess clinical competence for residency graduation or board certification.

This review aims to summarize the current literature on the effects of direct, clinical observation of residents in emergency departments (EDs) on learners, patients, and departmental functioning. A systematic literature search was conducted in Medline and ERIC, covering the years 1980-2009. Keywords were used to identify postgraduate medical staff working in the ED; direct observation of these trainees by supervising staff; and reports of outcomes relating to Kirkpatrick's levels of reaction, learning, behavior, and institutional change. From an initial 11,433 abstracts and titles, 193 full-text articles were retrieved for further study. Application of inclusion and exclusion criteria yielded seven that were relevant to the topic. These studies comprised a range of methods-descriptive, qualitative evaluation, cohort studies, and a cross-sectional survey. Learner reaction was very enthusiastic. Positive changes in behavior due to feedback provided during direct observation were suggested by two studies. A single study evaluated trainee's perceptions on patient outcomes and noted that thorough assessments and improved management decisions may be at the expense of slower throughput of patients and diversion of senior staff from direct patient care. Three studies noted the resource-intensive nature of direct observation. Direct observation of clinical practice may be useful in ED education; however, further research is required to evaluate its effects. © 2010 by the Society for Academic Emergency Medicine.