Steven McGaughey, Jordan Wackett, Elizabeth Silbermann
{"title":"AI Is Not a Four-Letter Word: Moving From Resistance to Responsible Integration in Emergency Medicine Education","authors":"Steven McGaughey, Jordan Wackett, Elizabeth Silbermann","doi":"10.1002/aet2.70114","DOIUrl":"https://doi.org/10.1002/aet2.70114","url":null,"abstract":"","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 6","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145739549","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}
Kenji Numata, Masaya Higuchi, Yasuhiko Hirose, Anita Chary, Tadayuki Hashimoto, Daisuke Kato, Shan W. Liu, Tammie E. Quest, Joshua Hauser, Kirsten G. Engel, Kei Ouchi
Background
In Japan, the aging population has led to an increase in seriously ill patients requiring emergency care. Although palliative care training opportunities are limited in Japan, established programs exist in the United States (U.S.). To inform future adaptation of such programs for use in Japan, this study aims to identify barriers that emergency physicians (EPs) in Japan encounter when providing palliative care.
Methods
This qualitative study explored the end-of-life care decision-making processes of EPs in Japan. Semi-structured interviews were conducted with board-certified EPs using snowball sampling. Data were analyzed using a modified grounded theory approach, which was chosen for its ability to capture culturally nuanced decision-making, emphasizing reflection, theoretical clarity, and practical applicability. Iterative coding was conducted to inductively generate concepts and develop a conceptual framework describing EPs' decision-making processes. Data collection continued until theoretical saturation was achieved. Data were collected through online interviews conducted between January and August 2024.
Results
Thirteen board-certified EPs in Japan completed interviews. Most participants were male (76.9%) and most were 11–15 years after medical school graduation (n = 7). Analysis identified 16 concepts illustrating a three-phase decision-making process: (1) deciding to accept the transfer of end-of-life patients, (2) building trust with patients and families and conducting an assessment, and (3) determining the treatment plan. Common challenges included struggles with stalled interactions amid family distress and the dilemma of making decisions in the setting of clinical uncertainty, reflecting the emotional and ethical complexity of providing end-of-life care in time-pressured emergency settings.
Conclusions
This study highlights the challenges EPs in Japan face when making urgent decisions with limited time and information while building trust with patients and families. These findings clarify the current barriers to integrating palliative and end-of-life care in emergency settings and provide a foundation for developing culturally adapted educational programs.
{"title":"Adapting Palliative and End-of-Life Care Training for Emergency Physicians in Japan: A Modified Grounded Theory Study","authors":"Kenji Numata, Masaya Higuchi, Yasuhiko Hirose, Anita Chary, Tadayuki Hashimoto, Daisuke Kato, Shan W. Liu, Tammie E. Quest, Joshua Hauser, Kirsten G. Engel, Kei Ouchi","doi":"10.1002/aet2.70113","DOIUrl":"https://doi.org/10.1002/aet2.70113","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In Japan, the aging population has led to an increase in seriously ill patients requiring emergency care. Although palliative care training opportunities are limited in Japan, established programs exist in the United States (U.S.). To inform future adaptation of such programs for use in Japan, this study aims to identify barriers that emergency physicians (EPs) in Japan encounter when providing palliative care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This qualitative study explored the end-of-life care decision-making processes of EPs in Japan. Semi-structured interviews were conducted with board-certified EPs using snowball sampling. Data were analyzed using a modified grounded theory approach, which was chosen for its ability to capture culturally nuanced decision-making, emphasizing reflection, theoretical clarity, and practical applicability. Iterative coding was conducted to inductively generate concepts and develop a conceptual framework describing EPs' decision-making processes. Data collection continued until theoretical saturation was achieved. Data were collected through online interviews conducted between January and August 2024.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirteen board-certified EPs in Japan completed interviews. Most participants were male (76.9%) and most were 11–15 years after medical school graduation (<i>n</i> = 7). Analysis identified 16 concepts illustrating a three-phase decision-making process: (1) deciding to accept the transfer of end-of-life patients, (2) building trust with patients and families and conducting an assessment, and (3) determining the treatment plan. Common challenges included <i>struggles with stalled interactions amid family distress</i> and <i>the dilemma of making decisions in the setting of clinical uncertainty</i>, reflecting the emotional and ethical complexity of providing end-of-life care in time-pressured emergency settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study highlights the challenges EPs in Japan face when making urgent decisions with limited time and information while building trust with patients and families. These findings clarify the current barriers to integrating palliative and end-of-life care in emergency settings and provide a foundation for developing culturally adapted educational programs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 6","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145739580","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}
Carrie Maupin, Ambika Anand, Danielle Nesbit, Casey Morrone, Danielle Sultan
<p>The recent development of entrustable professional activities (EPAs) for emergency medicine (EM) medical education (MedEd) fellowships by Villa et al. [<span>1</span>] represents a significant milestone in the movement toward competency-based education in academic medicine training. These 16 EPAs, developed through a modified Delphi consensus process, provide a much-needed framework for establishing uniform expectations for MedEd fellowships across institutions and offer a common language for assessing fellows' readiness for independent educational practice. Previous literature has focused on implementing EPAs within undergraduate medical education and residency training structures, with limited focus on fellowships [<span>2-4</span>]. Additionally, many EPAs have been focused on improving clinical training rather than solely focusing on educational standards. However, implementation in the real-world setting of diverse fellowships with unique structures, resources, and cultures raises an important question: how can a national framework be meaningfully adopted across locally distinct programs?</p><p>To explore this question, we conducted a cross-institutional mapping exercise among three EM MedEd fellowship programs—Virginia Commonwealth University (VCU), Thomas Jefferson University, and UMass Chan Medical School. These fellowships vary in structure, scope, and available resources, but share a commitment to developing future clinician-educators. Our goal was to examine how each program's current activities align with these EPAs, identify areas of overlap or divergence, and assess the feasibility of adopting this new outcomes-based framework.</p><p>We reviewed the 16 EPAs outlined in the original article and mapped current fellowship competencies to each one. The mapping process was conducted in three deliberate stages to promote both local accuracy and cross-institutional consistency. First, each fellowship independently identified all formal and informal learning activities within its curriculum, drawing from program handbooks, rotation objectives, and course syllabi. These activities were then mapped to the 16 published EM MedEd EPAs by at least two program leaders at each site. Next, each site conducted an internal reconciliation step, classifying activities as “fully aligned,” “partially aligned,” or “not aligned” with specific EPAs. Finally, representatives from all three institutions shared results, reviewing each EPA and discussing discrepancies until full consensus was achieved. This collaborative adjudication ensured shared interpretation and reproducibility across programs. Our findings, summarized in the accompanying table, demonstrate a high degree of natural alignment with the proposed EPAs, underscoring the relevance and utility of the framework. For instance, all three programs address key EPAs such as “Creating an academic CV,” “Serving as a mentor to learners,” and “Applying evidence-based teaching methods to didactic instruct
{"title":"Applying Entrustable Professional Activities Across Emergency Medicine Medical Education Fellowships: A Cross-Institutional Commentary","authors":"Carrie Maupin, Ambika Anand, Danielle Nesbit, Casey Morrone, Danielle Sultan","doi":"10.1002/aet2.70110","DOIUrl":"https://doi.org/10.1002/aet2.70110","url":null,"abstract":"<p>The recent development of entrustable professional activities (EPAs) for emergency medicine (EM) medical education (MedEd) fellowships by Villa et al. [<span>1</span>] represents a significant milestone in the movement toward competency-based education in academic medicine training. These 16 EPAs, developed through a modified Delphi consensus process, provide a much-needed framework for establishing uniform expectations for MedEd fellowships across institutions and offer a common language for assessing fellows' readiness for independent educational practice. Previous literature has focused on implementing EPAs within undergraduate medical education and residency training structures, with limited focus on fellowships [<span>2-4</span>]. Additionally, many EPAs have been focused on improving clinical training rather than solely focusing on educational standards. However, implementation in the real-world setting of diverse fellowships with unique structures, resources, and cultures raises an important question: how can a national framework be meaningfully adopted across locally distinct programs?</p><p>To explore this question, we conducted a cross-institutional mapping exercise among three EM MedEd fellowship programs—Virginia Commonwealth University (VCU), Thomas Jefferson University, and UMass Chan Medical School. These fellowships vary in structure, scope, and available resources, but share a commitment to developing future clinician-educators. Our goal was to examine how each program's current activities align with these EPAs, identify areas of overlap or divergence, and assess the feasibility of adopting this new outcomes-based framework.</p><p>We reviewed the 16 EPAs outlined in the original article and mapped current fellowship competencies to each one. The mapping process was conducted in three deliberate stages to promote both local accuracy and cross-institutional consistency. First, each fellowship independently identified all formal and informal learning activities within its curriculum, drawing from program handbooks, rotation objectives, and course syllabi. These activities were then mapped to the 16 published EM MedEd EPAs by at least two program leaders at each site. Next, each site conducted an internal reconciliation step, classifying activities as “fully aligned,” “partially aligned,” or “not aligned” with specific EPAs. Finally, representatives from all three institutions shared results, reviewing each EPA and discussing discrepancies until full consensus was achieved. This collaborative adjudication ensured shared interpretation and reproducibility across programs. Our findings, summarized in the accompanying table, demonstrate a high degree of natural alignment with the proposed EPAs, underscoring the relevance and utility of the framework. For instance, all three programs address key EPAs such as “Creating an academic CV,” “Serving as a mentor to learners,” and “Applying evidence-based teaching methods to didactic instruct","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 6","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aet2.70110","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145739550","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}
Simanjit K. Mand, Corlin M. Jewell, Dana E. Loke, Meinkeng S. Acha-Morfaw, Collin T. Michels, Benjamin H. Schnapp
Background
Coaching holds great potential for learners in graduate medical education (GME) as the specialty transitions towards competency-based medical education (CBME). Coaching has already demonstrated holding great benefits in a variety of learner performance and well-being metrics. However, there is limited data on learner perceptions of longitudinal GME coaching initiatives.
Objective
To provide insight into learner perceptions of a longitudinal coaching program by conducting focus groups consisting of residents from a single emergency medicine residency.
Methods
Four semi-structured focus groups were conducted with residents from each post-graduate year. Audio recordings of focus group discussions were transcribed and a thematic analysis utilizing a constructivist approach was conducted.
Results
We identified five overarching themes: (1) resident understanding of the coach's role, (2) logistical elements that can affect the effectiveness of the coaching relationship, (3) relational factors that contribute to a successful coaching relationship, (4) resident perceptions of discussion topics and goal creation, and (5) future group opportunities for fostering more personal relationships and professional development.
Conclusion
Overall, residents noted several strengths in the longitudinal coaching approach, particularly around feedback reflection and utility, accountability, and goal-setting. There remain areas for improvement when introducing coaching program goals and the faculty coach role, in addition to future considerations around group coaching opportunities.
{"title":"Resident Perspectives on the Coaching Approach: A Qualitative Analysis of a Longitudinal Coaching Program in an Emergency Medicine Residency","authors":"Simanjit K. Mand, Corlin M. Jewell, Dana E. Loke, Meinkeng S. Acha-Morfaw, Collin T. Michels, Benjamin H. Schnapp","doi":"10.1002/aet2.70111","DOIUrl":"10.1002/aet2.70111","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Coaching holds great potential for learners in graduate medical education (GME) as the specialty transitions towards competency-based medical education (CBME). Coaching has already demonstrated holding great benefits in a variety of learner performance and well-being metrics. However, there is limited data on learner perceptions of longitudinal GME coaching initiatives.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To provide insight into learner perceptions of a longitudinal coaching program by conducting focus groups consisting of residents from a single emergency medicine residency.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Four semi-structured focus groups were conducted with residents from each post-graduate year. Audio recordings of focus group discussions were transcribed and a thematic analysis utilizing a constructivist approach was conducted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified five overarching themes: (1) resident understanding of the coach's role, (2) logistical elements that can affect the effectiveness of the coaching relationship, (3) relational factors that contribute to a successful coaching relationship, (4) resident perceptions of discussion topics and goal creation, and (5) future group opportunities for fostering more personal relationships and professional development.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Overall, residents noted several strengths in the longitudinal coaching approach, particularly around feedback reflection and utility, accountability, and goal-setting. There remain areas for improvement when introducing coaching program goals and the faculty coach role, in addition to future considerations around group coaching opportunities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 6","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12672208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145678977","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":"The Pandemic and the Calm","authors":"Zhaohui Su","doi":"10.1002/aet2.70104","DOIUrl":"10.1002/aet2.70104","url":null,"abstract":"","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 6","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145678986","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}
Cameron Pawlik, Andrew Zahn, Joel Moll, Sally A. Santen
<p>Board certification seeks to provide a rigorous and evolving mechanism to ensure physicians maintain high levels of clinical expertise throughout their careers. The American Board of Emergency Medicine (ABEM) board of directors has determined that ABEM certification will change. “ABEM is transitioning to a new Certifying Exam in 2026 to enhance the assessment of emergency physicians' competencies and relevance to practice. This move addresses feedback from stakeholders, including practicing physicians and healthcare leaders, indicating a desire for an exam that assesses a broader range of skills and provides a more meaningful assessment experience” [<span>1</span>].</p><p>With the impending change in EM board certification in summative assessment, it is helpful to understand how similar specialties to EM are determining initial certification. Understanding the variety of certification assessments and outcomes helps to evaluate the patterns in current EM pass rates in the greater community of medicine. This will help to evaluate the significance of recent changes in outcomes and to add credibility to our own certification process. This Educational Download provides information on current initial certification of the 10 most common specialties (Tables 1 and 2).</p><p>Certification ensures objective, arms-length validation of competencies, distinguishing it from passive, self-directed education. While initial certification verifies knowledge and skills at a single point in time, the structure of certification has transformed into a dynamic, longitudinal process that incorporates cognitive assessments, professional conduct verification, and quality improvement activities. This evolution is motivated by the accelerated pace of medical innovation and evidence that physician knowledge and skills decline over time without structured reinforcement [<span>2</span>]. Patients express a preference for certified physicians and expect ongoing verification of clinical currency. In this way, board certification can function as a public trust mechanism that reinforces professional standards and accountability [<span>3</span>]. Over time, the process for initial board certification across specialties, other than just EM, has constantly evolved. Examples of these changes include the move of standardized patient exams in Psychiatry to within residency, the addition of a communication observed standardized examination for Urology, and the continued effort at standardization of oral exams for procedural specialties [<span>4, 5</span>].</p><p>Data was compiled from the American Council for Graduate Medical Education (ACGME) [<span>6</span>] and respective medical specialty board certification websites as publicly published unless otherwise noted (see references for exact URL) [<span>7-26</span>].</p><p>C.P.: Study concept and design, acquisition of the data, analysis and interpretation of the data, drafting of the manuscript, critical revision of the manuscript. A.Z
{"title":"Across the Landscape: Initial Board Specialty Certification—Educational Download","authors":"Cameron Pawlik, Andrew Zahn, Joel Moll, Sally A. Santen","doi":"10.1002/aet2.70106","DOIUrl":"10.1002/aet2.70106","url":null,"abstract":"<p>Board certification seeks to provide a rigorous and evolving mechanism to ensure physicians maintain high levels of clinical expertise throughout their careers. The American Board of Emergency Medicine (ABEM) board of directors has determined that ABEM certification will change. “ABEM is transitioning to a new Certifying Exam in 2026 to enhance the assessment of emergency physicians' competencies and relevance to practice. This move addresses feedback from stakeholders, including practicing physicians and healthcare leaders, indicating a desire for an exam that assesses a broader range of skills and provides a more meaningful assessment experience” [<span>1</span>].</p><p>With the impending change in EM board certification in summative assessment, it is helpful to understand how similar specialties to EM are determining initial certification. Understanding the variety of certification assessments and outcomes helps to evaluate the patterns in current EM pass rates in the greater community of medicine. This will help to evaluate the significance of recent changes in outcomes and to add credibility to our own certification process. This Educational Download provides information on current initial certification of the 10 most common specialties (Tables 1 and 2).</p><p>Certification ensures objective, arms-length validation of competencies, distinguishing it from passive, self-directed education. While initial certification verifies knowledge and skills at a single point in time, the structure of certification has transformed into a dynamic, longitudinal process that incorporates cognitive assessments, professional conduct verification, and quality improvement activities. This evolution is motivated by the accelerated pace of medical innovation and evidence that physician knowledge and skills decline over time without structured reinforcement [<span>2</span>]. Patients express a preference for certified physicians and expect ongoing verification of clinical currency. In this way, board certification can function as a public trust mechanism that reinforces professional standards and accountability [<span>3</span>]. Over time, the process for initial board certification across specialties, other than just EM, has constantly evolved. Examples of these changes include the move of standardized patient exams in Psychiatry to within residency, the addition of a communication observed standardized examination for Urology, and the continued effort at standardization of oral exams for procedural specialties [<span>4, 5</span>].</p><p>Data was compiled from the American Council for Graduate Medical Education (ACGME) [<span>6</span>] and respective medical specialty board certification websites as publicly published unless otherwise noted (see references for exact URL) [<span>7-26</span>].</p><p>C.P.: Study concept and design, acquisition of the data, analysis and interpretation of the data, drafting of the manuscript, critical revision of the manuscript. A.Z","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 6","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12672183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145678989","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}
Michael J. Zdradzinski, Steven Lindsey, Rohit Anand, Sumeet Dixit, Tori Ehrhardt, Michelle D. Lall, Timothy P. Moran, Deanna M. Kaplan, James O'Shea
Objectives
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.
Methods
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.
Results
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.
Conclusions
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.
目的：本研究旨在评估住院医师在急诊科（ED）轮班期间鼓励营养和患者笔记书写的休息倡议的影响。主要目的是确定干预是否改善了饥饿感、疲劳、医疗记录不完整和下班后出院时间。方法：我们引入了一项名为R.E.S.T.倡议的干预措施，其中包括鼓励住院医生在轮班期间休息15分钟吃东西和写笔记，在住院医生休息室提供食物，并鼓励在轮班结束前约1小时与主治医生进行集中检查。生态瞬时评估（EMA）工具用于评估居民在ED轮班期间三个时间点的饥饿、疲劳、笔记负担和干预参与情况。还收集了干预前的基线数据。混合效应模型用于评估干预前后的变化。干预后的调查收集了教师和住院医生对干预的反馈和意见。结果：共有44名居民参与了干预。在干预期间，轮班中断频率从19%提高到56% (p p p分别= 0.001)，新就诊的患者数量和即将就诊的患者数量没有显著变化。所有的教师和住院医生都报告说，由于干预，没有对患者产生不良影响。居民们觉得这些休息提高了他们的效率和提供的护理质量。结论：鼓励休息进食和作图的干预措施，以及在轮班结束时进行以倾向为重点的轮岗，改善了急诊医学住院医生的饥饿和疲劳，而不会对患者安全或住院医生的效率产生负面影响。
{"title":"The R.E.S.T. Initiative: A Pilot Program to Enhance Resident Performance by Taking Breaks On-Shift","authors":"Michael J. Zdradzinski, Steven Lindsey, Rohit Anand, Sumeet Dixit, Tori Ehrhardt, Michelle D. Lall, Timothy P. Moran, Deanna M. Kaplan, James O'Shea","doi":"10.1002/aet2.70112","DOIUrl":"10.1002/aet2.70112","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 44 residents participated in the intervention. On-shift break frequency improved from 19% to 56% during the intervention (<i>p</i> < 0.001). Post-shift hunger and fatigue scores improved significantly during the intervention (OR 4.10, <i>p</i> < 0.001 and OR 2.53, <i>p</i> = 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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 6","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145679001","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}
Rea Mittal, Serkan Toy, Susan Owens, Manu Madhok, Katherine Douglass, Tania Ahluwalia
Background
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.
Methods
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.
Results
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.
Conclusions
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.
{"title":"Enhancing Knowledge and Skills in Pediatric Neurologic Emergencies: A Simulation-Based Medical Education Program for Emergency Medicine Trainees India","authors":"Rea Mittal, Serkan Toy, Susan Owens, Manu Madhok, Katherine Douglass, Tania Ahluwalia","doi":"10.1002/aet2.70097","DOIUrl":"10.1002/aet2.70097","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 6","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145514705","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, Neelou Tabatabai, Michael Gottlieb, Jaime Jordan, Susan B. Promes, Esther H. Chen
{"title":"Top 10 Medical Education Articles of 2024","authors":"Ivan Zvonar, Neelou Tabatabai, Michael Gottlieb, Jaime Jordan, Susan B. Promes, Esther H. Chen","doi":"10.1002/aet2.70108","DOIUrl":"10.1002/aet2.70108","url":null,"abstract":"","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 6","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145514733","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}
Alessandra Karam, Morgan O'Neill, Katie Lorenz, Linda Regan, Jeremy Branzetti, Michael Gisondi, Laura R. Hopson
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.
{"title":"Harnessing Emotions to Enhance Feedback in the Emergency Department","authors":"Alessandra Karam, Morgan O'Neill, Katie Lorenz, Linda Regan, Jeremy Branzetti, Michael Gisondi, Laura R. Hopson","doi":"10.1002/aet2.70102","DOIUrl":"10.1002/aet2.70102","url":null,"abstract":"<p>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.</p>","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 6","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12610942/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145514690","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号