This study was designed to assess the impact of a break-taking initiative for resident physicians to encourage nutrition and patient note writing during their shift in the emergency department (ED). The primary objective was to determine if the intervention improved hunger, fatigue, incomplete documentation in the medical record, and post-shift exit time.
We introduced an intervention titled the R.E.S.T. initiative, which consisted of encouraging residents to take a 15-min break during their shift to eat and write notes, providing food in the resident break room, and encouraging disposition-focused rounds with the attending physician approximately 1 h prior to the end of shift. An ecologic momentary assessment (EMA) tool was used to assess residents' hunger, fatigue, note burden, and participation in the intervention at three timepoints throughout their ED shift. Pre-intervention baseline data were collected as well. Mixed-effects models were used to assess changes pre- and post-intervention. A post-intervention survey collected feedback and opinions on the intervention from both faculty and residents.
A total of 44 residents participated in the intervention. On-shift break frequency improved from 19% to 56% during the intervention (p < 0.001). Post-shift hunger and fatigue scores improved significantly during the intervention (OR 4.10, p < 0.001 and OR 2.53, p = 0.001, respectively), without a significant change in the number of new patients seen nor patients signed out to the oncoming team. All faculty and residents reported that there were no adverse effects on patients as a result of the intervention. Residents felt the breaks improved their efficiency and the quality of care they provided.
An intervention to encourage breaks for eating and charting, along with disposition-focused rounds near the end of shift, improved hunger and fatigue in emergency medicine residents without negatively impacting patient safety or perceived resident efficiency.
India has one of the largest pediatric populations globally, with one in five children affected by a neurological condition. However, access to specialized pediatric neurology care is limited due to a shortage of trained pediatric neurologists. Most pediatric neurology cases are managed by emergency medicine (EM) physicians, adult neurologists, or pediatricians. Strengthening EM physicians' ability to recognize and manage these conditions is critical. Simulation-based medical education (SBME) offers an effective avenue to enhance knowledge, procedural skills, and self-efficacy.
The Ronald Reagan Institute of Emergency Medicine at George Washington University has partner programs across India to deliver postgraduate EM training programs. In October 2024, a 2-week, in-person pediatric neurology SBME training was conducted across eight partner sites. Faculty included three visiting specialists in pediatric EM and EM, one pediatric neurology resident, and local EM faculty. Training included a didactic session on pediatric neurological emergencies, a procedural workshop, and simulation cases in pediatric neurology emergencies. The structured procedural workshops used pre-existing checklists to achieve mastery learning in pediatric skills: Intravenous access, intraosseous access, bag-valve-mask ventilation, intubation, and lumbar puncture. Trainees completed three pediatric neurology simulation clinical cases, including procedural skills. Pre- and posttests, including a 3-month follow-up knowledge test and survey, were used to evaluate the effectiveness of the educational intervention.
A total of 106 EM trainees from eight sites across India participated in the study with matched pre- and postintervention data. Statistically significant improvements were observed across all domains: Medical knowledge, self-efficacy in procedural skills, and managing pediatric neurologic emergencies.
The findings of this study suggest that SBME can enhance EM trainees' self-efficacy, knowledge, and procedural skills in managing pediatric neurological emergencies. The training model is scalable, adaptable, and effective in resource-variable environments.
Feedback in graduate medical education is often felt to be inadequate, particularly in the Emergency Department where limited time and continuity hinder meaningful reflections. We introduced an emotion-linked debriefing model at three emergency medicine residencies, using structured prompts to explore both positive and negative emotions experienced during shifts. This approach encouraged richer feedback conversations, deeper trainee engagement, and generation of specific, actionable learning goals. Emotion-linked debriefing offers a practical strategy to enhance real-time feedback and warrants further evaluation of its educational impact.
Choosing a post-residency career path in emergency medicine (EM) represents a complex set of decisions involving personal preferences and training program characteristics. It is unclear to what degree the training program environment shapes these choices or if residents select training programs that align with their pre-existing career plans. We sought to evaluate resident career plans over time and assess differences between 3- and 4-year training formats in EM.
We conducted a prospective, observational, cohort study of EM residents at six ACGME-accredited residencies in the United States from 2020 to 2024. Participants reported demographics and career plans at the onset of their training and at graduation. We used analysis of covariance to determine differences in career choice and change over time between 3-year and 4-year programs. We used univariable regression to assess associations between personal and program factors on change in career choice during residency.
Eighty-one residents completed both the initial and graduation surveys. We did not detect any statistical difference between three- and four-year programs for either initial (p = 0.32) or graduation (p = 0.80) career plans. Thirty participants were undecided about their career plans at the beginning of training. There was no difference between types of changes in career choices between three- and four-year programs when including (p = 0.40) or excluding (p = 0.60) those changes of participants who were initially undecided. We did not detect any significant associations between individual (age, gender) or program (program identity, program format) factors on the change of career plans during residency.
We did not find a significant difference between program format and career plans. A minority of residents changed career plans during residency, and neither program length nor demographic factors were significantly associated with those changes. A proportion of residents begins training undecided about their career path, highlighting a potential role for early, structured career guidance.
Emergency medicine (EM) is at a critical juncture with pervasive boarding and overcrowding, a rapid rise in new residency programs, and continuing recovery from the COVID-19 pandemic. These factors could all potentially impact trainees' learning experiences. To explore how this has influenced trainee knowledge acquisition, we analyzed the trends in the American Board of Emergency Medicine (ABEM) In-training Examination (ITE) and the written Qualifying Examination (QE).
This was a retrospective study of multiyear performance trends for the ITE (2018–2024) and QE (2019–2024). Only ITE results from residents in categorical ACGME-accredited EM programs were included. ITE performance was the aggregate mean scaled (equated) scores of all EM training levels. The measures for QE performance were the mean scaled scores (equated) and the pass rates. For each test, descriptive statistics were reported and an omnibus analysis of variance (ANOVA) comparing scores across years was computed. When an ANOVA result was statistically significant (α < 0.01), Tukey's tests were performed.
For the ITE, there were 61,512 test results, of which 59,075 (96.0%) met inclusion criteria. The mean (SD) scaled ITE scores declined from 77.36 (8.85) in 2018 to 72.19 (9.44) in 2024. The ANOVA for the ITE scaled scores was statistically significant (p < 0.01). The QE had 17,040 test results, of which 15,651 (91.8%) met inclusion criteria. The mean (SD) scaled scores declined from 82.8 (4.6) in 2019 to 80.5 (4.5) in 2024, while the pass rate also declined from 92.3% in 2019 to 82.0% in 2024. The ANOVA for the QE scaled scores across years was significant (p < 0.01).
Physician performance on the ABEM ITE has steadily declined since 2018; performance on the QE has declined since 2019. Future research is needed to understand and address the potential causes of these trends.
Emergency medicine (EM) has experienced considerable expansion in recent years, prompting concern among potential EM applicants. This study reports the growth rate for training positions in EM and other specialties during three consecutive 5-year periods from 2011 to 2025, with the goal of providing context for medical students and their advisors as they assess EM's growth relative to other fields.
This study analyzed National Residency Matching Program (NRMP) Main Residency Match data. The growth rate for first-year postgraduate (PGY-1) training positions was calculated for EM and eight other specialties from 2011 to 2015, 2016 to 2020, and 2021 to 2025, which correspond to the 5-year periods before, during, and after the transition to a single graduate medical education accreditation system. The percentage of total NRMP positions offered by each specialty was also calculated.
The number of EM PGY-1 positions grew by 13.3% from 2011 to 2015, 40.6% from 2016 to 2020, and 8.0% from 2021 to 2025. Among the specialties included in this analysis, EM had the sixth highest growth rate from 2011 to 2015, the second highest growth rate from 2016 to 2020, and the seventh highest growth rate from 2021 to 2025. The proportion of EM positions, as a percentage of all NRMP PGY-1 positions, decreased from 2011 to 2015, increased from 2016 to 2020, and then decreased from 2021 to 2025.
The growth rate for EM training positions offered through the NRMP increased during the transition to a single accreditation system, then slowed during the 5 years following the transition. From 2021 to 2025, the growth rate for EM positions was exceeded by anesthesiology, family medicine, general surgery, internal medicine, interventional radiology, and physical medicine and rehabilitation. These results demonstrate that the recent expansion in EM training opportunities is not unique.
Simulation-based education is well established in graduate medical education and augments medical knowledge acquisition. While a highly effective tool, some potentially negative impacts such as cognitive overload and anxiety have been described. The use of escape rooms to “gamify” simulation has been shown to be an enjoyable way to engage learners. However, it is unknown if the format causes a similar level of anxiety compared to scenario-based simulation. This study compares a traditional scenario-based simulation to an escape room format to demonstrate the effect on self-reported learner anxiety.
A peer-reviewed pediatric emergency medicine simulation case was modified into an escape room simulation. Emergency medicine (EM) residents were consented and randomized into the scenario-based control group or escape room intervention group. The primary outcome was comparing self-reported anxiety levels of the residents pre- and post-simulation. The secondary outcome was the acquisition of medical knowledge, as measured by improvement on pre- and post-simulation medical knowledge quizzes. Descriptive data and differences of means by two-tailed t-test are reported.
Fifty-two EM residents participated, with 40 available for analysis. Post-simulation self-reported anxiety levels of participants in the scenario-based simulation group were slightly increased (50.71–52.38), whereas the levels for those in the escape room format were significantly decreased (52.05–31.10), p = 0.002. Both groups showed similar improvement on the post-simulation medical knowledge quiz (73%–80%, p = 0.016 and 71%–79%, p = 0.004, scenario-based and escape room, respectively), with no difference between the groups (p = 0.665).
When comparing scenario-based simulation to an escape room format, medical knowledge acquisition was achieved equally, while anxiety levels were markedly lower in escape room participants. Escape room simulation shows promise in decreasing anxiety among the participants while teaching equal medical knowledge compared to traditional scenario-based simulation.
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