Tim Baker MBBS (Hons), BMedSc (Hons), MClinEd, FACEM, Hannah Beks PhD, MPH, BN, RN, Franco Schreve MbChB, MBA, FACEM, Mary Lawson BS (Hons), Vincent L. Versace PhD, BSc (Hons)
Objective
The objective was to scope the literature and describe the extent and type of evidence about entrustable professional activities (EPAs) in postgraduate emergency medicine (EM) education.
Methods
Joanna Briggs Institute's methodology was used to find and extract relevant data from documents found in Ovid MEDLINE, EMBASE, and CINAHL, supplemented by a gray literature search using Google Advanced for EPA frameworks. Eligible documents discussed EPAs for doctors in structured EM training programs. Data extracted included research methods, research approach, participants, scope, EPA element addressed, and dominant logic used by EPA creators.
Results
Data were extracted from 58 documents. Thirty-four of the documents (58.6%) were peer-reviewed journal articles, 18 (31.1%) were conference abstracts, and six (10.4%) were curriculum documents from EM organizations. Thirty documents were from Canada (51.7%). Twenty-five documents (43.1%) took an explorative approach. Twenty-one documents (36.2%) were translational in approach. Thirteen EPA frameworks, containing a total of 158 EPAs, were found.
Conclusions
EM is an expanding area of EPA development, but frameworks remain highly variable and unstandardized. Most studies are explorative or translational, leaving gaps in experimental research to justify EPA adoption and observational research to assess real-world outcomes.
{"title":"Entrustable professional activity use in emergency medicine: A scoping review","authors":"Tim Baker MBBS (Hons), BMedSc (Hons), MClinEd, FACEM, Hannah Beks PhD, MPH, BN, RN, Franco Schreve MbChB, MBA, FACEM, Mary Lawson BS (Hons), Vincent L. Versace PhD, BSc (Hons)","doi":"10.1002/aet2.70035","DOIUrl":"https://doi.org/10.1002/aet2.70035","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The objective was to scope the literature and describe the extent and type of evidence about entrustable professional activities (EPAs) in postgraduate emergency medicine (EM) education.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Joanna Briggs Institute's methodology was used to find and extract relevant data from documents found in Ovid MEDLINE, EMBASE, and CINAHL, supplemented by a gray literature search using Google Advanced for EPA frameworks. Eligible documents discussed EPAs for doctors in structured EM training programs. Data extracted included research methods, research approach, participants, scope, EPA element addressed, and dominant logic used by EPA creators.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Data were extracted from 58 documents. Thirty-four of the documents (58.6%) were peer-reviewed journal articles, 18 (31.1%) were conference abstracts, and six (10.4%) were curriculum documents from EM organizations. Thirty documents were from Canada (51.7%). Twenty-five documents (43.1%) took an explorative approach. Twenty-one documents (36.2%) were translational in approach. Thirteen EPA frameworks, containing a total of 158 EPAs, were found.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>EM is an expanding area of EPA development, but frameworks remain highly variable and unstandardized. Most studies are explorative or translational, leaving gaps in experimental research to justify EPA adoption and observational research to assess real-world outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 2","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aet2.70035","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143809791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"In reply to “Diagnostic reasoning and cognitive error in emergency medicine: Implications for teaching and learning”","authors":"Joshua Ginsburg MD","doi":"10.1002/aet2.70025","DOIUrl":"https://doi.org/10.1002/aet2.70025","url":null,"abstract":"","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 2","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143809792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Brooke L. Watanabe MD, Robert A. Weston MD, Christopher R. Wyatt MD, Lawrence H. Brown PhD
Objective
There is limited understanding of factors influencing recruitment of emergency medicine (EM) residents identifying as races and ethnicities underrepresented in medicine (URM): Black/African American, Hispanic, American Indian/Alaskan Native, or Native Hawaiian/Pacific Islander. This study explored whether diversity of EM residents at the program level is associated with community diversity at the county level.
Methods
The proportion of URM residents in each EM residency program was determined using Association of American Medical Colleges academic year 2023–2024 data. We excluded newer programs without a full complement of residents and those not reporting race/ethnicity data. We used U.S. Census data to categorize each program's surrounding county as having lower diversity (<30% URM population), moderate diversity (≥30% to <49% URM population), or higher diversity (≥49% URM population). We used Kruskal–Wallis test with Dunn's procedure to determine whether the proportion of URM residents in a program was associated with the level of diversity in the surrounding county.
Results
Among 247 included EM programs, 5% of residents were Black (range 0%–46% per program), 8% Hispanic (range 0%–43%), and 4% another URM race/ethnicity. The proportion of URM EM residents was significantly lower among programs in lower-diversity counties (median [IQR] 10% [6%–16%]) than among programs in moderate-diversity (median [IQR] 14% [8%–20%], p < 0.001) or higher-diversity (median [IQR] 15% [9%–22%], p < 0.001) counties. Similarly, programs in counties with higher Black populations had more Black EM residents, and programs in counties with higher Hispanic populations had more Hispanic EM residents.
Conclusions
EM residents at programs in lower-diversity counties are less likely to be URM than those in moderate- or higher-diversity counties. EM programs located in less diverse communities may require unique strategies to increase resident diversity.
{"title":"Recruiting diverse emergency medicine residents: The influence of community diversity","authors":"Brooke L. Watanabe MD, Robert A. Weston MD, Christopher R. Wyatt MD, Lawrence H. Brown PhD","doi":"10.1002/aet2.70001","DOIUrl":"https://doi.org/10.1002/aet2.70001","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>There is limited understanding of factors influencing recruitment of emergency medicine (EM) residents identifying as races and ethnicities underrepresented in medicine (URM): Black/African American, Hispanic, American Indian/Alaskan Native, or Native Hawaiian/Pacific Islander. This study explored whether diversity of EM residents at the program level is associated with community diversity at the county level.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The proportion of URM residents in each EM residency program was determined using Association of American Medical Colleges academic year 2023–2024 data. We excluded newer programs without a full complement of residents and those not reporting race/ethnicity data. We used U.S. Census data to categorize each program's surrounding county as having lower diversity (<30% URM population), moderate diversity (≥30% to <49% URM population), or higher diversity (≥49% URM population). We used Kruskal–Wallis test with Dunn's procedure to determine whether the proportion of URM residents in a program was associated with the level of diversity in the surrounding county.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 247 included EM programs, 5% of residents were Black (range 0%–46% per program), 8% Hispanic (range 0%–43%), and 4% another URM race/ethnicity. The proportion of URM EM residents was significantly lower among programs in lower-diversity counties (median [IQR] 10% [6%–16%]) than among programs in moderate-diversity (median [IQR] 14% [8%–20%], <i>p</i> < 0.001) or higher-diversity (median [IQR] 15% [9%–22%], <i>p</i> < 0.001) counties. Similarly, programs in counties with higher Black populations had more Black EM residents, and programs in counties with higher Hispanic populations had more Hispanic EM residents.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>EM residents at programs in lower-diversity counties are less likely to be URM than those in moderate- or higher-diversity counties. EM programs located in less diverse communities may require unique strategies to increase resident diversity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 2","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143793443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ivan Zvonar MD, Neelou Tabatabai DO, Esther H. Chen MD
{"title":"The write of passage: Overcoming barriers to academic writing during emergency medicine fellowship training","authors":"Ivan Zvonar MD, Neelou Tabatabai DO, Esther H. Chen MD","doi":"10.1002/aet2.70008","DOIUrl":"https://doi.org/10.1002/aet2.70008","url":null,"abstract":"","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 2","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143793501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sarah A. Uriarte BS, Elijah M. Persad-Paisley BA, Hannah Barber Doucet MD, MPH
Objectives
The emergency medicine (EM) patient population is racially and ethnically diverse, and the presence of racial and gender minority physicians may help overcome health disparities among these patients. The purpose of this study was to examine representation and its trends of racial, ethnic, and gender identities entering the EM workforce.
Methods
Reports on race, ethnicity, and gender for medical school graduates, EM applicants, and residents were obtained for the years 2005–2021. Racial and ethnic groups included Asian, Black, Hispanic, and White; gender identities included men and women. The proportion of each identity in each cohort was divided by a denominator of their corresponding U.S. medical school graduate proportion, producing representation quotients among applicants and matriculants (RQapp, RQmat) that refer to the group's medical school graduate representation. Mann–Whitney U-tests were used on RQ averages to assess for differences in representation among applicants compared to matriculants. Linear regressions of yearly RQs were used to assess representation trends.
Results
Men who self-identified as Black (RQapp 1.50), Hispanic (RQapp 1.84), or White (RQapp 1.15) had the highest EM applicant representation trend relative to other groups while making up 3.5%, 5.4%, and 36.3% of all applicants, respectively. Asian women were the least represented group among applicants (RQapp 0.52), dropping from 10.7% of medical school graduates to 5.7% of EM residency applicants. Among EM matriculants, Hispanic men (RQmat 1.56) and White men (RQmat 1.43) were the only overrepresented groups. Linear regression indicated that nearly all groups had significant increases in applicant representation over time, except for Asian women and Black men. White men and White women were the only two groups to experience increases in matriculant representation compared to their applicant counterparts.
Conclusions
Asian men, Asian women, and Black women remain underrepresented in EM residencies. Additional recruitment efforts to ensure their equitable representation are necessary in future application cycles.
{"title":"Examining racial, ethnic, and gender representation of applicants and matriculants to emergency medicine residency programs from 2005 to 2021","authors":"Sarah A. Uriarte BS, Elijah M. Persad-Paisley BA, Hannah Barber Doucet MD, MPH","doi":"10.1002/aet2.70028","DOIUrl":"https://doi.org/10.1002/aet2.70028","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The emergency medicine (EM) patient population is racially and ethnically diverse, and the presence of racial and gender minority physicians may help overcome health disparities among these patients. The purpose of this study was to examine representation and its trends of racial, ethnic, and gender identities entering the EM workforce.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Reports on race, ethnicity, and gender for medical school graduates, EM applicants, and residents were obtained for the years 2005–2021. Racial and ethnic groups included Asian, Black, Hispanic, and White; gender identities included men and women. The proportion of each identity in each cohort was divided by a denominator of their corresponding U.S. medical school graduate proportion, producing representation quotients among applicants and matriculants (RQ<sub>app</sub>, RQ<sub>mat</sub>) that refer to the group's medical school graduate representation. Mann–Whitney <i>U</i>-tests were used on RQ averages to assess for differences in representation among applicants compared to matriculants. Linear regressions of yearly RQs were used to assess representation trends.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Men who self-identified as Black (RQ<sub>app</sub> 1.50), Hispanic (RQ<sub>app</sub> 1.84), or White (RQ<sub>app</sub> 1.15) had the highest EM applicant representation trend relative to other groups while making up 3.5%, 5.4%, and 36.3% of all applicants, respectively. Asian women were the least represented group among applicants (RQ<sub>app</sub> 0.52), dropping from 10.7% of medical school graduates to 5.7% of EM residency applicants. Among EM matriculants, Hispanic men (RQ<sub>mat</sub> 1.56) and White men (RQ<sub>mat</sub> 1.43) were the only overrepresented groups. Linear regression indicated that nearly all groups had significant increases in applicant representation over time, except for Asian women and Black men. White men and White women were the only two groups to experience increases in matriculant representation compared to their applicant counterparts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Asian men, Asian women, and Black women remain underrepresented in EM residencies. Additional recruitment efforts to ensure their equitable representation are necessary in future application cycles.</p>\u0000 </section>\u0000 </div>","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 2","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143793502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Elizabeth D. Rosenman MD, James A. Grand PhD, Rosemarie Fernandez MD
Background
Team leadership is a critical skill in trauma resuscitation teams, linked to better teamwork and improved patient care. There are numerous published team leadership assessments, though data regarding the performance of these measures in patient care settings (vs. simulation-based settings) remain limited. There remains a need for a valid, reliable, and efficient measure of resuscitation team leadership in the clinical setting to support medical education and research efforts.
Methods
We constructed a 12-item behaviorally anchored rating scale (BARS) to measure trauma team leadership. Multiple raters then used the BARS to measure team leadership in 360 recorded trauma resuscitations across 60 participants. In addition to examining inter-rater reliability, we examined the construct validity of the BARS assessment through both correlational and latent modeling techniques to compare the ratings collected with the BARS to those collected using a previously studied checklist-based assessment using a multitrait–multimethod (MTMM) approach. Lastly, we examined the criterion validity of the BARS measure by examining its relationship with previously obtained patient care scores.
Results
BARS items demonstrated high inter-rater reliability when scores were computed using observations averaged over multiple raters (mean item intraclass correlations ICC1k 0.90, item range 0.85–0.98). The correlation between the aggregate ratings from the team leadership BARS and checklist measure demonstrated a strong positive correlation (r = 0.75), and the MTMM analyses indicated consistent evidence for both convergent (mean monotrait–heteromethod r = 0.50) and discriminant (mean heterotrait–heteromethod r = 0.27) validity. Hierarchical Bayesian regression analyses revealed that aggregate BARS scores were predictive of patient care scores (β = 7.06, 95% HDI 3.76–10.43).
Conclusions
The team leadership BARS and a previously studied checklist-based team leadership measure produced convergent assessments of team leadership behavior in the present data. Furthermore, higher overall ratings on the BARS correlated with better patient care delivery at the team level.
{"title":"Validity evidence of a resuscitation team leadership assessment measure for use in actual trauma resuscitations","authors":"Elizabeth D. Rosenman MD, James A. Grand PhD, Rosemarie Fernandez MD","doi":"10.1002/aet2.11061","DOIUrl":"https://doi.org/10.1002/aet2.11061","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Team leadership is a critical skill in trauma resuscitation teams, linked to better teamwork and improved patient care. There are numerous published team leadership assessments, though data regarding the performance of these measures in patient care settings (vs. simulation-based settings) remain limited. There remains a need for a valid, reliable, and efficient measure of resuscitation team leadership in the clinical setting to support medical education and research efforts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We constructed a 12-item behaviorally anchored rating scale (BARS) to measure trauma team leadership. Multiple raters then used the BARS to measure team leadership in 360 recorded trauma resuscitations across 60 participants. In addition to examining inter-rater reliability, we examined the construct validity of the BARS assessment through both correlational and latent modeling techniques to compare the ratings collected with the BARS to those collected using a previously studied checklist-based assessment using a multitrait–multimethod (MTMM) approach. Lastly, we examined the criterion validity of the BARS measure by examining its relationship with previously obtained patient care scores.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>BARS items demonstrated high inter-rater reliability when scores were computed using observations averaged over multiple raters (mean item intraclass correlations ICC1k 0.90, item range 0.85–0.98). The correlation between the aggregate ratings from the team leadership BARS and checklist measure demonstrated a strong positive correlation (<i>r</i> = 0.75), and the MTMM analyses indicated consistent evidence for both convergent (mean monotrait–heteromethod <i>r</i> = 0.50) and discriminant (mean heterotrait–heteromethod <i>r</i> = 0.27) validity. Hierarchical Bayesian regression analyses revealed that aggregate BARS scores were predictive of patient care scores (β = 7.06, 95% HDI 3.76–10.43).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The team leadership BARS and a previously studied checklist-based team leadership measure produced convergent assessments of team leadership behavior in the present data. Furthermore, higher overall ratings on the BARS correlated with better patient care delivery at the team level.</p>\u0000 </section>\u0000 </div>","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 2","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aet2.11061","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143793503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Matthew E Kelleher MD, MEd, Sally A Santen MD, PhD, Christiana Draper MD, PhD, Jaime Jordan MD, MA, Michael Gottlieb MD, Benjamin Kinnear MD, MEd
<p>The American Board of Emergency Medicine (ABEM) recently announced plans to publicly report program-level board certification examination pass rates.<span><sup>1</sup></span> This initiative will present program-level board pass rates for public viewing. Multiple arguments can be made for such a change. Medical education is increasingly seen as a service for which trainees have paid large sums of money and sacrifice a significant amount of time and effort. Transparency and accountability to learners that show services are high quality is important. Additionally, public reporting of program board pass rates provides a mechanism for accountability to society at large and aligns with ABEM's mission “To ensure the highest standards in the specialty of Emergency Medicine.”<span><sup>2</sup></span> Graduate medical education (GME) is largely funded through tax dollars, and an argument can be made that the public should be able to see the degree to which different training programs are helping their graduates pass certifying examinations.<span><sup>3</sup></span> Finally, this change would align ABEM with multiple other major American Board of Medical Specialties (ABMS) member boards who publicly report program pass rates, such as the American Board of Internal Medicine, American Board of Pediatrics, and American Board of Family Medicine.<span><sup>4</sup></span> These rationales have merit, but unintended consequences lurk around the corner. In this perspective, we describe the potential negative impact of publicly reporting program-level certifying examination pass rates. Specifically, we explore how public reporting could disincentivize holistic review of applicants during residency recruitment. We propose actionable strategies that various stakeholders may consider for balancing transparency with the broader mission of holistic review and inclusive recruitment practices in GME.</p><p>Humans are influenced by incentive structures. As rational actors, we tend to (either implicitly or explicitly) alter our thinking and behavior when different incentive structures are presented to us. When such structures lead to unwanted consequences, they are labeled “perverse incentives.” A colloquial term for the impact of a perverse incentive is sometimes called the <i>Cobra Effect</i>.<span><sup>5</sup></span> The Cobra Effect draws from an anecdote in which a governmental effort to reduce the number of cobras in Delhi, India, backfired. The initiative offered a bounty for dead cobras, so people began breeding cobras to turn in more dead snakes. The bounty was intended to incentivize the killing of cobras, hence decreasing the overall population. However, people quickly realized they could game the system for financial gain, leading to an overall increase in the cobra population. The incentive structure led to unwanted consequences that could potentially have been predicted by considering how people would respond.</p><p>We believe that publicly reporting progra
{"title":"Board scores in the spotlight: Public reporting and the unintended consequences","authors":"Matthew E Kelleher MD, MEd, Sally A Santen MD, PhD, Christiana Draper MD, PhD, Jaime Jordan MD, MA, Michael Gottlieb MD, Benjamin Kinnear MD, MEd","doi":"10.1002/aet2.70006","DOIUrl":"https://doi.org/10.1002/aet2.70006","url":null,"abstract":"<p>The American Board of Emergency Medicine (ABEM) recently announced plans to publicly report program-level board certification examination pass rates.<span><sup>1</sup></span> This initiative will present program-level board pass rates for public viewing. Multiple arguments can be made for such a change. Medical education is increasingly seen as a service for which trainees have paid large sums of money and sacrifice a significant amount of time and effort. Transparency and accountability to learners that show services are high quality is important. Additionally, public reporting of program board pass rates provides a mechanism for accountability to society at large and aligns with ABEM's mission “To ensure the highest standards in the specialty of Emergency Medicine.”<span><sup>2</sup></span> Graduate medical education (GME) is largely funded through tax dollars, and an argument can be made that the public should be able to see the degree to which different training programs are helping their graduates pass certifying examinations.<span><sup>3</sup></span> Finally, this change would align ABEM with multiple other major American Board of Medical Specialties (ABMS) member boards who publicly report program pass rates, such as the American Board of Internal Medicine, American Board of Pediatrics, and American Board of Family Medicine.<span><sup>4</sup></span> These rationales have merit, but unintended consequences lurk around the corner. In this perspective, we describe the potential negative impact of publicly reporting program-level certifying examination pass rates. Specifically, we explore how public reporting could disincentivize holistic review of applicants during residency recruitment. We propose actionable strategies that various stakeholders may consider for balancing transparency with the broader mission of holistic review and inclusive recruitment practices in GME.</p><p>Humans are influenced by incentive structures. As rational actors, we tend to (either implicitly or explicitly) alter our thinking and behavior when different incentive structures are presented to us. When such structures lead to unwanted consequences, they are labeled “perverse incentives.” A colloquial term for the impact of a perverse incentive is sometimes called the <i>Cobra Effect</i>.<span><sup>5</sup></span> The Cobra Effect draws from an anecdote in which a governmental effort to reduce the number of cobras in Delhi, India, backfired. The initiative offered a bounty for dead cobras, so people began breeding cobras to turn in more dead snakes. The bounty was intended to incentivize the killing of cobras, hence decreasing the overall population. However, people quickly realized they could game the system for financial gain, leading to an overall increase in the cobra population. The incentive structure led to unwanted consequences that could potentially have been predicted by considering how people would respond.</p><p>We believe that publicly reporting progra","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 2","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aet2.70006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Don't despair, not today","authors":"Zhaohui Su PhD","doi":"10.1002/aet2.70026","DOIUrl":"https://doi.org/10.1002/aet2.70026","url":null,"abstract":"","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 2","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Beyond mindscapes","authors":"Victor N. Oboli MD","doi":"10.1002/aet2.70033","DOIUrl":"https://doi.org/10.1002/aet2.70033","url":null,"abstract":"","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 2","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Catherine Yu MD, MEd, Rebecca Bavolek MD, Luigi Varilla, Jaime Jordan MD, MAEd, Steven Lai MD
Background
The Accreditation Council for Graduate Medical Education requires residency programs to train their residents to be teachers. Teaching resident (TR) rotations in emergency medicine (EM) residency programs provide both an opportunity to train residents in teaching skills and a dedicated teaching service for junior learners in the clinical setting. The impact that this experience has on the residents themselves is unknown. We sought to explore the impact of our residency program's TR rotation on our recent graduates.
Methods
We conducted a qualitative study using semistructured interviews. We recruited our residency program's recent graduates and interviewed participants over a videoconferencing platform. We used a constructivist paradigm to guide our thematic analysis.
Results
We interviewed 11 graduates and identified major themes regarding how the TR rotation impacted their comfort and preparedness to teach and supervise learners postgraduation: discovery of their teaching identity, communication skills, development of teaching and supervisory skills, and professional development.
Conclusions
EM residents found TR rotations helpful in developing skills that prepared them to educate learners and supervise patient care postgraduation. The findings of this study may inform the use and development of TR rotations in EM and other specialties.
{"title":"Impact and Influence of a Teaching Resident Rotation on Emergency Medicine Resident Physicians","authors":"Catherine Yu MD, MEd, Rebecca Bavolek MD, Luigi Varilla, Jaime Jordan MD, MAEd, Steven Lai MD","doi":"10.1002/aet2.70034","DOIUrl":"https://doi.org/10.1002/aet2.70034","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The Accreditation Council for Graduate Medical Education requires residency programs to train their residents to be teachers. Teaching resident (TR) rotations in emergency medicine (EM) residency programs provide both an opportunity to train residents in teaching skills and a dedicated teaching service for junior learners in the clinical setting. The impact that this experience has on the residents themselves is unknown. We sought to explore the impact of our residency program's TR rotation on our recent graduates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a qualitative study using semistructured interviews. We recruited our residency program's recent graduates and interviewed participants over a videoconferencing platform. We used a constructivist paradigm to guide our thematic analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We interviewed 11 graduates and identified major themes regarding how the TR rotation impacted their comfort and preparedness to teach and supervise learners postgraduation: discovery of their teaching identity, communication skills, development of teaching and supervisory skills, and professional development.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>EM residents found TR rotations helpful in developing skills that prepared them to educate learners and supervise patient care postgraduation. The findings of this study may inform the use and development of TR rotations in EM and other specialties.</p>\u0000 </section>\u0000 </div>","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 2","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aet2.70034","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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