Bjarni Dagur Bakkmann Thordarson BS, Nils Danielsson MD, Eric Contant MD, Hjalti Mar Bjornsson MD
Background
Endotracheal (ET) intubation is a common emergency procedure generally done with direct laryngoscopy (DL). Digital intubation (DI), which uses blind finger guidance to manipulate the ET tube, is rarely used but is useful if secretions block the view or a laryngoscope is not available. DI can also be done bougie-assisted. This study aimed to compare three different approaches to intubation in simulation.
Methods
Medical students without prior airway training were invited to participate in this simulation study on an airway manikin. Participants viewed brief instructional videos on three different methods—DL, DI, and bougie-assisted DI—and performed three attempts with each method in a randomized order. Data were collected for the rate of successful intubations, the timing to intubation, and dental trauma.
Results
Fifty-one medical students performed 459 attempts at intubation on a manikin. On the third attempt, the trachea was successfully intubated in 65% of the attempts using DL, 53% with DI, and 90% with bougie-assisted DI. At the last attempt, the time to intubation was 35 (±16) s for DL, 28 (±10) s with DI, and 44 (±30) s with bougie-guided DI. Dental trauma was less frequent with DI.
Conclusion
Ninety percent of medical students successfully intubated a manikin on the third attempt when using a bougie to guide DI. A bougie-guided DI could be more likely to result in successful ET intubation than DL for those without sufficient training.
{"title":"Comparison of direct laryngoscopy and digital intubation with and without bougie assistance in novice learners: A simulation-based study","authors":"Bjarni Dagur Bakkmann Thordarson BS, Nils Danielsson MD, Eric Contant MD, Hjalti Mar Bjornsson MD","doi":"10.1002/aet2.70053","DOIUrl":"https://doi.org/10.1002/aet2.70053","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Endotracheal (ET) intubation is a common emergency procedure generally done with direct laryngoscopy (DL). Digital intubation (DI), which uses blind finger guidance to manipulate the ET tube, is rarely used but is useful if secretions block the view or a laryngoscope is not available. DI can also be done bougie-assisted. This study aimed to compare three different approaches to intubation in simulation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Medical students without prior airway training were invited to participate in this simulation study on an airway manikin. Participants viewed brief instructional videos on three different methods—DL, DI, and bougie-assisted DI—and performed three attempts with each method in a randomized order. Data were collected for the rate of successful intubations, the timing to intubation, and dental trauma.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty-one medical students performed 459 attempts at intubation on a manikin. On the third attempt, the trachea was successfully intubated in 65% of the attempts using DL, 53% with DI, and 90% with bougie-assisted DI. At the last attempt, the time to intubation was 35 (±16) s for DL, 28 (±10) s with DI, and 44 (±30) s with bougie-guided DI. Dental trauma was less frequent with DI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Ninety percent of medical students successfully intubated a manikin on the third attempt when using a bougie to guide DI. A bougie-guided DI could be more likely to result in successful ET intubation than DL for those without sufficient training.</p>\u0000 </section>\u0000 </div>","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143949972","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}
Catriana R. Thorne, Colin Shaughnessy, Lindsay Adelson MD, David Cannata, Emily Orosco, Katie Rong MD, Regina Kostyun PhD, Meghan Kelly Herbst MD
Objective
Despite mandatory point-of-care ultrasound (PoCUS) training in residency, utilization varies across emergency departments (EDs). We sought to characterize PoCUS utilization patterns in the United States, specifically comparing academic to nonacademic settings.
Methods
A nationwide cross-sectional survey was conducted from March to November 2024, targeting general EDs open 24/7. Site directors completed a 15-question survey on PoCUS use, workflow, and billing. Academic EDs (those with emergency medicine residents or ultrasound fellows) were compared to nonacademic EDs. Regular PoCUS use for a physician was defined as using two or more applications at least once per week; regular PoCUS use for an application was defined as at least one scan per week. A strong workflow required image storage to Picture Archiving and Communication System/Middleware and physician review. Differences in PoCUS utilization, workflow, and billing were analyzed using chi-square, Mann–Whitney U, and unpaired t-tests. Correlations between study variables and ED academic status were assessed using Pearson's and Spearman's coefficients. Odds ratios (ORs) measured the strength of associations.
Results
Of 664 invited EDs (15.3% of all U.S. EDs), 423 completed surveys (63.8% response rate) from all 50 states and Washington, DC. Academic EDs (n = 220) were more likely to own four or more ultrasound machines (54.1%) compared to nonacademic EDs (54.2% owned ≤1, p < 0.001). More physicians performed ultrasound regularly at academic sites (58.7% ± 28.1%) versus nonacademic sites (46.7% ± 27.2%, p < 0.001), but there was no association between recent residency training and ultrasound utilization (r = −0.008, p = 0.875). Academic EDs had stronger workflow integration (OR 3.9, 95% confidence interval [CI] 2.6–5.9, p < 0.001) and were more likely to bill for PoCUS (OR 3.8, 95% CI 2.4–6.0, p < 0.001).
Conclusion
PoCUS utilization is lower in nonacademic EDs, with suboptimal workflows and fewer billing practices. Addressing these disparities may enhance PoCUS implementation and improve patient care.
{"title":"A nationwide survey of point-of-care ultrasound utilization in academic versus nonacademic general emergency departments","authors":"Catriana R. Thorne, Colin Shaughnessy, Lindsay Adelson MD, David Cannata, Emily Orosco, Katie Rong MD, Regina Kostyun PhD, Meghan Kelly Herbst MD","doi":"10.1002/aet2.70051","DOIUrl":"https://doi.org/10.1002/aet2.70051","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Despite mandatory point-of-care ultrasound (PoCUS) training in residency, utilization varies across emergency departments (EDs). We sought to characterize PoCUS utilization patterns in the United States, specifically comparing academic to nonacademic settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A nationwide cross-sectional survey was conducted from March to November 2024, targeting general EDs open 24/7. Site directors completed a 15-question survey on PoCUS use, workflow, and billing. Academic EDs (those with emergency medicine residents or ultrasound fellows) were compared to nonacademic EDs. Regular PoCUS use for a physician was defined as using two or more applications at least once per week; regular PoCUS use for an application was defined as at least one scan per week. A strong workflow required image storage to Picture Archiving and Communication System/Middleware and physician review. Differences in PoCUS utilization, workflow, and billing were analyzed using chi-square, Mann–Whitney <i>U</i>, and unpaired <i>t</i>-tests. Correlations between study variables and ED academic status were assessed using Pearson's and Spearman's coefficients. Odds ratios (ORs) measured the strength of associations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 664 invited EDs (15.3% of all U.S. EDs), 423 completed surveys (63.8% response rate) from all 50 states and Washington, DC. Academic EDs (<i>n</i> = 220) were more likely to own four or more ultrasound machines (54.1%) compared to nonacademic EDs (54.2% owned ≤1, <i>p</i> < 0.001). More physicians performed ultrasound regularly at academic sites (58.7% ± 28.1%) versus nonacademic sites (46.7% ± 27.2%, p < 0.001), but there was no association between recent residency training and ultrasound utilization (<i>r</i> = −0.008, <i>p</i> = 0.875). Academic EDs had stronger workflow integration (OR 3.9, 95% confidence interval [CI] 2.6–5.9, <i>p</i> < 0.001) and were more likely to bill for PoCUS (OR 3.8, 95% CI 2.4–6.0, <i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>PoCUS utilization is lower in nonacademic EDs, with suboptimal workflows and fewer billing practices. Addressing these disparities may enhance PoCUS implementation and improve patient care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143949971","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}
Jeffery Hill MD, MEd, Grace Hickam MD, MEHP, Jazmyn Shaw MD, Joel Moll MD, John W. Cyrus MLIS, Sally A. Santen MD, PhD, Michael Gottlieb MD
Background
Emergency department (ED) overcrowding and boarding has been shown to have negative effects on patient care. However, there has been less focus on the effects of overcrowding and boarding on resident education.
Methods
We conducted a scoping review to map the current literature on the educational effects of ED overcrowding, summarizing the current research findings and identifying gaps for future research. We sought to answer (1) How is overcrowding defined by individual studies? (2) What educational outcomes have been studied in overcrowding and how have they been measured? (3) What are the educational effects of physician-in-triage (PIT) care models? (4) What educational responses have been initiated in response to ED overcrowding? and (5) What are the effects of those educational responses? We searched Medline, Embase, ERIC, MedEdPortal, Web of Science, and Google Scholar. Two authors independently extracted data. All authors performed quantitative and qualitative synthesis, consistent with best practice recommendations for scoping reviews.
Results
The initial search strategy identified 2570 articles, with 14 articles meeting inclusion criteria. The literature found perceptions of a negative impact of overcrowding and boarding on resident education. However, these negative perceptions have not consistently translated to demonstrably negative educational outcomes. Educational outcomes assessed include measures of resident productivity, procedural experience, in-training examination scores, and perceived measures of teaching quality and educational value. Several studies assessed the impact of PIT models finding changes in the type and volume of patients seen by residents as a result.
Conclusions
This scoping review summarizes the existing literature assessing the educational impact of ED overcrowding and boarding as well as PIT models. The review provides context and insights for future research into these effects.
急诊科（ED）过度拥挤和登机已被证明对病人护理有负面影响。然而，对过度拥挤和寄宿对居民教育的影响的关注较少。方法对ED过度拥挤对教育影响的现有文献进行了范围综述，总结了目前的研究成果，并确定了未来研究的差距。我们试图回答(1)个体研究如何定义过度拥挤？(2)在过度拥挤的情况下，研究了哪些教育成果？如何衡量这些成果？(3)医师分诊（PIT）护理模式的教育效果如何？(4)针对急诊科人满为患的情况，当局采取了哪些教育措施？(5)这些教育反应的影响是什么？我们搜索了Medline， Embase， ERIC, MedEdPortal， Web of Science和b谷歌Scholar。两位作者独立提取数据。所有作者都进行了定量和定性综合，与范围审查的最佳实践建议一致。结果初始检索策略共筛选到2570篇文献，其中14篇符合纳入标准。文献发现过度拥挤和寄宿对居民教育的负面影响。然而，这些负面看法并没有始终转化为明显的负面教育成果。评估的教育成果包括住院医师生产力、程序经验、培训考试分数以及教学质量和教育价值的感知指标。几项研究评估了PIT模型的影响，结果发现住院医生看到的患者类型和数量发生了变化。本综述总结了现有的评估ED过度拥挤和寄宿以及PIT模型对教育影响的文献。这篇综述为未来对这些影响的研究提供了背景和见解。
{"title":"The effects of overcrowding, boarding, and physician-in-triage on resident education: A scoping review","authors":"Jeffery Hill MD, MEd, Grace Hickam MD, MEHP, Jazmyn Shaw MD, Joel Moll MD, John W. Cyrus MLIS, Sally A. Santen MD, PhD, Michael Gottlieb MD","doi":"10.1002/aet2.70040","DOIUrl":"https://doi.org/10.1002/aet2.70040","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Emergency department (ED) overcrowding and boarding has been shown to have negative effects on patient care. However, there has been less focus on the effects of overcrowding and boarding on resident education.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a scoping review to map the current literature on the educational effects of ED overcrowding, summarizing the current research findings and identifying gaps for future research. We sought to answer (1) How is overcrowding defined by individual studies? (2) What educational outcomes have been studied in overcrowding and how have they been measured? (3) What are the educational effects of physician-in-triage (PIT) care models? (4) What educational responses have been initiated in response to ED overcrowding? and (5) What are the effects of those educational responses? We searched Medline, Embase, ERIC, MedEdPortal, Web of Science, and Google Scholar. Two authors independently extracted data. All authors performed quantitative and qualitative synthesis, consistent with best practice recommendations for scoping reviews.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The initial search strategy identified 2570 articles, with 14 articles meeting inclusion criteria. The literature found perceptions of a negative impact of overcrowding and boarding on resident education. However, these negative perceptions have not consistently translated to demonstrably negative educational outcomes. Educational outcomes assessed include measures of resident productivity, procedural experience, in-training examination scores, and perceived measures of teaching quality and educational value. Several studies assessed the impact of PIT models finding changes in the type and volume of patients seen by residents as a result.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This scoping review summarizes the existing literature assessing the educational impact of ED overcrowding and boarding as well as PIT models. The review provides context and insights for future research into these effects.</p>\u0000 </section>\u0000 </div>","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aet2.70040","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143944684","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}
Arthur Broadstock MD, Annahieta Kalantari DO, MEd, Almaz S. Dessie MD, Al’ai Alvarez MD, Resa E. Lewiss MD, Josie Acuna MD, Anthony Weekes MD, MSc, Kaylah Maloney MD, Uwe Stolz PhD, MPH, Lori Stolz MD, Aalap Shah MD
Background
Recently, nontraditional educational resources like podcasts, blogs, and online media have gained prominence in medical education and are abundant within the field of point-of-care ultrasound (POCUS). However, the extent to which POCUS educators utilize online resources compared to traditional resources, like textbooks, journal articles, and in-person workshops, is unknown. We aim to define which types of educational resources are used and preferred by POCUS educators to teach trainees.
Methods
An expert working group developed a survey aimed to characterize the types of materials used by POCUS educators and their perceived importance on a 6-point forced ranking scale. We administered the survey to POCUS educators at the 2023 Society for Clinical Ultrasound Fellowships conference. Responses were analyzed using random-effects regression analyses.
Results
Sixty-two participants completed the questionnaire. In-person workshops (mean importance 5.1, 95% confidence interval [CI] 4.8–5.4) and online media (mean importance 4.8, 95% CI 4.4–5.1) were ranked as the most important resources for POCUS education overall, though not statistically different from each other (p > 0.001). Journal articles (mean importance 3.4, 95% CI 2.2–4.6), eBooks (mean importance 2.9, 95% CI 1.4–4.4), and podcasts (mean importance 2.8, 95% CI 1.5–4.1) were found to be of moderate importance and were not statistically different from each other. Respondents reported that textbooks were of least importance (mean importance 2.1, 95% CI 0.7–3.5).
Conclusions
POCUS educators view nontraditional educational materials with great importance, though in-person workshops remain the mainstay of POCUS education. POCUS educators utilize nontraditional educational materials and consider them more important than textbooks within POCUS curricula.
最近，非传统的教育资源，如播客、博客和在线媒体在医学教育中获得了突出的地位，并且在护理点超声（POCUS）领域中非常丰富。然而，与传统资源（如教科书、期刊文章和面对面研讨会）相比，POCUS教育者利用在线资源的程度尚不清楚。我们的目标是确定POCUS教育者使用和首选的教育资源类型来教授学员。方法一个专家工作组开展了一项调查，旨在描述POCUS教育者使用的材料类型及其在6分强制排名量表上的重要性。我们在2023年临床超声学会会议上对POCUS的教育工作者进行了调查。采用随机效应回归分析对反应进行分析。结果共62人完成问卷调查。面对面研讨会（平均重要性5.1,95%可信区间[CI] 4.8 - 5.4）和在线媒体（平均重要性4.8,95% CI 4.4-5.1）被列为POCUS教育总体上最重要的资源，尽管彼此之间没有统计学差异（p > 0.001）。期刊文章（平均重要性3.4,95% CI 2.2-4.6）、电子书（平均重要性2.9,95% CI 1.4-4.4）和播客（平均重要性2.8,95% CI 1.5-4.1）被认为具有中等重要性，彼此之间没有统计学差异。受访者报告说教科书是最不重要的（平均重要性2.1,95% CI 0.7-3.5）。结论POCUS教育工作者非常重视非传统的教育材料，尽管面对面的研讨会仍然是POCUS教育的主要形式。POCUS教育者利用非传统的教育材料，并认为它们比POCUS课程中的教科书更重要。
{"title":"Evaluating the role of traditional and nontraditional educational resources in point-of-care ultrasound training: A cross-sectional survey of educator preferences and practices","authors":"Arthur Broadstock MD, Annahieta Kalantari DO, MEd, Almaz S. Dessie MD, Al’ai Alvarez MD, Resa E. Lewiss MD, Josie Acuna MD, Anthony Weekes MD, MSc, Kaylah Maloney MD, Uwe Stolz PhD, MPH, Lori Stolz MD, Aalap Shah MD","doi":"10.1002/aet2.70039","DOIUrl":"https://doi.org/10.1002/aet2.70039","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Recently, nontraditional educational resources like podcasts, blogs, and online media have gained prominence in medical education and are abundant within the field of point-of-care ultrasound (POCUS). However, the extent to which POCUS educators utilize online resources compared to traditional resources, like textbooks, journal articles, and in-person workshops, is unknown. We aim to define which types of educational resources are used and preferred by POCUS educators to teach trainees.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An expert working group developed a survey aimed to characterize the types of materials used by POCUS educators and their perceived importance on a 6-point forced ranking scale. We administered the survey to POCUS educators at the 2023 Society for Clinical Ultrasound Fellowships conference. Responses were analyzed using random-effects regression analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixty-two participants completed the questionnaire. In-person workshops (mean importance 5.1, 95% confidence interval [CI] 4.8–5.4) and online media (mean importance 4.8, 95% CI 4.4–5.1) were ranked as the most important resources for POCUS education overall, though not statistically different from each other (<i>p</i> > 0.001). Journal articles (mean importance 3.4, 95% CI 2.2–4.6), eBooks (mean importance 2.9, 95% CI 1.4–4.4), and podcasts (mean importance 2.8, 95% CI 1.5–4.1) were found to be of moderate importance and were not statistically different from each other. Respondents reported that textbooks were of least importance (mean importance 2.1, 95% CI 0.7–3.5).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>POCUS educators view nontraditional educational materials with great importance, though in-person workshops remain the mainstay of POCUS education. POCUS educators utilize nontraditional educational materials and consider them more important than textbooks within POCUS curricula.</p>\u0000 </section>\u0000 </div>","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aet2.70039","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143925865","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}
Christopher D. Thom MD RDMS, Kathryn Mutter MD, James Martindale PhD, Vanessa Khoury MD, Margaret Sande MD
Background
Transvenous cardiac pacing (TVP) is a life-saving intervention that is infrequently performed in emergency medicine (EM). While competency can be achieved through dedicated procedural training, the longevity of skill retention in TVP placement has not been well demonstrated. Our study sought to assess retention of procedural skills among EM resident physicians following an immersive TVP training simulation.
Methods
EM residents at a single academic tertiary care center participated in an immersive TVP training session using a high-fidelity simulator. The paradigm of deliberate practice was used to establish competency in the procedure, which was defined by success on a previously published checklist. Immediately following the training, each resident was tested on the checklist and a Global Rating Scale (GRS; 0–100). Three faculty raters assessed resident performance on these instruments. Inter-rater reliability (IRR) was assessed using the intraclass correlation coefficient. Competency in TVP placement skill retention was then reassessed at 3 months. The paired-samples t-test was used to evaluate the difference in performance between the time intervals.
Results
Thirty-one EM resident physicians participated in the study, with 25 completing the 3-month follow-up assessment. Immediately following the workshop, the mean (±SD) score on the 0–30 checklist was 29.7 (±0.51), while the mean score on the GRS was 98.3 (±1.9). At 3-month follow-up, the mean (±SD) score on the checklist decreased to 21.6 (±5; p < 0.001), and GRS was 75.4 (±19.7; p < 0.001). IRR between raters was 0.81 for the GRS and 0.75 for the checklist score, indicating excellent agreement.
Conclusions
Decay of skills in transvenous pacemaker placement was apparent at 3 months following initial baseline competency demonstration after an immersive training session. These findings may help inform TVP procedural teaching frequency for EM resident trainees.
{"title":"Procedural skill retention in transvenous pacer placement among emergency medicine physician trainees","authors":"Christopher D. Thom MD RDMS, Kathryn Mutter MD, James Martindale PhD, Vanessa Khoury MD, Margaret Sande MD","doi":"10.1002/aet2.70042","DOIUrl":"https://doi.org/10.1002/aet2.70042","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Transvenous cardiac pacing (TVP) is a life-saving intervention that is infrequently performed in emergency medicine (EM). While competency can be achieved through dedicated procedural training, the longevity of skill retention in TVP placement has not been well demonstrated. Our study sought to assess retention of procedural skills among EM resident physicians following an immersive TVP training simulation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>EM residents at a single academic tertiary care center participated in an immersive TVP training session using a high-fidelity simulator. The paradigm of deliberate practice was used to establish competency in the procedure, which was defined by success on a previously published checklist. Immediately following the training, each resident was tested on the checklist and a Global Rating Scale (GRS; 0–100). Three faculty raters assessed resident performance on these instruments. Inter-rater reliability (IRR) was assessed using the intraclass correlation coefficient. Competency in TVP placement skill retention was then reassessed at 3 months. The paired-samples <i>t</i>-test was used to evaluate the difference in performance between the time intervals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty-one EM resident physicians participated in the study, with 25 completing the 3-month follow-up assessment. Immediately following the workshop, the mean (±SD) score on the 0–30 checklist was 29.7 (±0.51), while the mean score on the GRS was 98.3 (±1.9). At 3-month follow-up, the mean (±SD) score on the checklist decreased to 21.6 (±5; <i>p</i> < 0.001), and GRS was 75.4 (±19.7; <i>p</i> < 0.001). IRR between raters was 0.81 for the GRS and 0.75 for the checklist score, indicating excellent agreement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Decay of skills in transvenous pacemaker placement was apparent at 3 months following initial baseline competency demonstration after an immersive training session. These findings may help inform TVP procedural teaching frequency for EM resident trainees.</p>\u0000 </section>\u0000 </div>","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143925772","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}
Rosemarie Diaz MD, MPH, Adam McFarland MD, Ryan Tsuchida MD, Tanesha Beckford MD, Sandra Coker MD, Jeremy Collado MD, Arthur Pope MD, PhD, Jeffrey I. Schneider MD, Alden Landry MD, MPH, Teresa Y. Smith MD, MSEd, Jessica Faiz MD, MS
A diverse workforce in emergency medicine (EM) aims to improve patient care by addressing racism in health care, increasing representation in medicine, and improving the quality of training for all residents. Many EM residency programs have launched recruitment efforts to attract residents from diverse backgrounds. However, recruitment efforts only represent the first step in building a culturally responsible workforce. Trainees who are underrepresented in medicine must be welcomed into an inclusive training environment that has been thoughtfully constructed before they arrive. This type of supportive environment can be achieved by shifting away from majority-serving ideals and building an informed infrastructure that functions to help all trainees succeed. We expand upon challenges and areas of opportunity at the individual, departmental, and institutional levels and describe common pitfalls when trying to create inclusive spaces for residents including lack of vision alignment, inadequate financial investment, and performative allyship. We also propose strategies that focus specifically on actionable changes that residency program, departmental, and institutional leadership can implement to mitigate these challenges.
{"title":"Beyond diversity recruitment: Next steps to ensure that underrepresented emergency medicine residents thrive","authors":"Rosemarie Diaz MD, MPH, Adam McFarland MD, Ryan Tsuchida MD, Tanesha Beckford MD, Sandra Coker MD, Jeremy Collado MD, Arthur Pope MD, PhD, Jeffrey I. Schneider MD, Alden Landry MD, MPH, Teresa Y. Smith MD, MSEd, Jessica Faiz MD, MS","doi":"10.1002/aet2.70037","DOIUrl":"https://doi.org/10.1002/aet2.70037","url":null,"abstract":"<p>A diverse workforce in emergency medicine (EM) aims to improve patient care by addressing racism in health care, increasing representation in medicine, and improving the quality of training for all residents. Many EM residency programs have launched recruitment efforts to attract residents from diverse backgrounds. However, recruitment efforts only represent the first step in building a culturally responsible workforce. Trainees who are underrepresented in medicine must be welcomed into an inclusive training environment that has been thoughtfully constructed before they arrive. This type of supportive environment can be achieved by shifting away from majority-serving ideals and building an informed infrastructure that functions to help all trainees succeed. We expand upon challenges and areas of opportunity at the individual, departmental, and institutional levels and describe common pitfalls when trying to create inclusive spaces for residents including lack of vision alignment, inadequate financial investment, and performative allyship. We also propose strategies that focus specifically on actionable changes that residency program, departmental, and institutional leadership can implement to mitigate these challenges.</p>","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aet2.70037","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143925771","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}
Udoka Oji MD, Samuel Bunting MD, Nitin Vidyasagar BS, Emily Jameyfield MD, MHPE, Paul Kukulski MD, MHPE
Objectives
The residency match can be a stressful and costly period for applicants. A notable portion of applicants choose to apply to multiple specialties during the residency match process, known as “parallel applying.” This study investigated the trends in parallel applications among emergency medicine (EM) residency applicants from 2009 to 2023.
Methods
This is a retrospective analysis on data obtained from the Association of American Medical Colleges (AAMC) Electronic Residency Application System (ERAS). The data set comprised applicants who applied either exclusively to EM or to EM in combination with other specialties. Variables analyzed included the number of applications submitted and the frequency of parallel applications across different applicant groups including international medical graduates (IMGs), U.S. international medical graduates (USIMGs), and graduates from U.S. allopathic and osteopathic institutions.
Results
The study included 64,095 applicant records corresponding to 57,572 unique individuals. The percentage of applicants to EM residency parallel applying decreased between 2009 (62.0%) and 2020 (43.0%) but subsequently increased through 2023 (62.6%). The total number of applications submitted by both single-specialty and parallel applicants increased over the same period. The mean number of applications to EM programs by parallel applicants rose significantly, reflecting a broader trend of increasing application volumes across all applicant groups while the proportion of applications that were to EM programs decreased, especially following 2021.
Conclusions
The trend of parallel applying among EM residency applicants slowly decreased from 2009 to 2021 and then increased through 2023, with the trend largely driven by an increase in the proportion of IMG applicants who were parallel applying. Understanding the motivations and impacts of parallel applications is crucial for developing strategies to support applicants and improve the matching process. Further research is needed to explore the factors influencing these trends and to inform policy and advising practices in medical education.
{"title":"Trends in parallel application to emergency medicine residency between 2009 and 2023","authors":"Udoka Oji MD, Samuel Bunting MD, Nitin Vidyasagar BS, Emily Jameyfield MD, MHPE, Paul Kukulski MD, MHPE","doi":"10.1002/aet2.70043","DOIUrl":"https://doi.org/10.1002/aet2.70043","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The residency match can be a stressful and costly period for applicants. A notable portion of applicants choose to apply to multiple specialties during the residency match process, known as “parallel applying.” This study investigated the trends in parallel applications among emergency medicine (EM) residency applicants from 2009 to 2023.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a retrospective analysis on data obtained from the Association of American Medical Colleges (AAMC) Electronic Residency Application System (ERAS). The data set comprised applicants who applied either exclusively to EM or to EM in combination with other specialties. Variables analyzed included the number of applications submitted and the frequency of parallel applications across different applicant groups including international medical graduates (IMGs), U.S. international medical graduates (USIMGs), and graduates from U.S. allopathic and osteopathic institutions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study included 64,095 applicant records corresponding to 57,572 unique individuals. The percentage of applicants to EM residency parallel applying decreased between 2009 (62.0%) and 2020 (43.0%) but subsequently increased through 2023 (62.6%). The total number of applications submitted by both single-specialty and parallel applicants increased over the same period. The mean number of applications to EM programs by parallel applicants rose significantly, reflecting a broader trend of increasing application volumes across all applicant groups while the proportion of applications that were to EM programs decreased, especially following 2021.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The trend of parallel applying among EM residency applicants slowly decreased from 2009 to 2021 and then increased through 2023, with the trend largely driven by an increase in the proportion of IMG applicants who were parallel applying. Understanding the motivations and impacts of parallel applications is crucial for developing strategies to support applicants and improve the matching process. Further research is needed to explore the factors influencing these trends and to inform policy and advising practices in medical education.</p>\u0000 </section>\u0000 </div>","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aet2.70043","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143925869","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}
Katherine A. Craemer MPH, Lauren Sayah MPH, Emilie Glass-Riveros MA, Cara J. Bergo PhD, Autumn Mels DNP, Roma Allen DNP, Diedra Stewart MSN, Stacie E. Geller PhD
Background
In Illinois, an average of 88 pregnant and postpartum individuals died annually from 2018 to 2020. Of these, 66% had at least one emergency department (ED) visit. To improve maternal health outcomes, the Illinois Maternal Mortality Review Committees recommended ED education on obstetric care, mental health conditions, and substance use disorders (SUD).
Methods
From January 1, 2023, to June 30, 2024, the Maternal Health Emergency Department Toolkit (Toolkit) training was piloted in six diverse Illinois hospitals. The Toolkit's effectiveness was evaluated using electronic medical record (EMR) data to assess changes in practice within the ED.
Results
A total of 281 (63%) ED providers and staff completed the training. From pre- to post-pilot, EMR documentation of pregnancy or postpartum status in female patients of reproductive age increased from 56.4% to 83.4%, and screening pregnant and postpartum patients for mental health or SUD rose from 52.2% to 69.6%.
Conclusions
The Toolkit is an evidence-based training of educational modules that led to positive changes in ED provider and staff's practice when caring for pregnant and postpartum patients. By fostering education, engagement, and collaboration, the Toolkit has the potential to play a key role in helping reduce maternal mortality and morbidity in Illinois. The Toolkit is now available statewide for all Illinois EDs.
{"title":"Emergency departments are part of the maternal health solution: Findings from piloting an educational toolkit in Illinois","authors":"Katherine A. Craemer MPH, Lauren Sayah MPH, Emilie Glass-Riveros MA, Cara J. Bergo PhD, Autumn Mels DNP, Roma Allen DNP, Diedra Stewart MSN, Stacie E. Geller PhD","doi":"10.1002/aet2.70046","DOIUrl":"https://doi.org/10.1002/aet2.70046","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In Illinois, an average of 88 pregnant and postpartum individuals died annually from 2018 to 2020. Of these, 66% had at least one emergency department (ED) visit. To improve maternal health outcomes, the Illinois Maternal Mortality Review Committees recommended ED education on obstetric care, mental health conditions, and substance use disorders (SUD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>From January 1, 2023, to June 30, 2024, the Maternal Health Emergency Department Toolkit (Toolkit) training was piloted in six diverse Illinois hospitals. The Toolkit's effectiveness was evaluated using electronic medical record (EMR) data to assess changes in practice within the ED.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 281 (63%) ED providers and staff completed the training. From pre- to post-pilot, EMR documentation of pregnancy or postpartum status in female patients of reproductive age increased from 56.4% to 83.4%, and screening pregnant and postpartum patients for mental health or SUD rose from 52.2% to 69.6%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The Toolkit is an evidence-based training of educational modules that led to positive changes in ED provider and staff's practice when caring for pregnant and postpartum patients. By fostering education, engagement, and collaboration, the Toolkit has the potential to play a key role in helping reduce maternal mortality and morbidity in Illinois. The Toolkit is now available statewide for all Illinois EDs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aet2.70046","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143925864","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}
Adaira I. Landry MD, MEd, Wendy Coates MD, Michael Gottlieb MD
In 2024, over 50,000 applicants submitted their rank order list (ROL) to the National Resident Matching Program (NRMP, The Match), which uses these rankings to match candidates with residency programs. Recent years have shown that many applicants find emergency medicine (EM) a desired speciality. In 2024 and 2025, 95% and 98% of EM residency spots were filled, respectively. To match, applicants must understand every aspect of the application process, including rank order strategies. The ROL is an essential step in the residency application process where applicants rank programs based on personal and professional priorities. Applicants weigh both tangible factors—such as program size, location, and salary—and intangible factors—such as work–life balance, faculty support, and the overall “feel” of a program. Virtual interviews have limited opportunities to assess both tangible and intangible factors hindering the more comprehensive evaluation EM applicants previously had with in-person interviews. We offer strategic advice to medical students and their mentors, on an approach to creating a ROL, evaluating the intangible and tangible aspects of each program, additional considerations for less common scenarios, and effective communication with program directors.
2024年，超过50,000名申请人向国家居民匹配计划（NRMP, the Match）提交了他们的排名名单（ROL），该计划使用这些排名来匹配候选人与居住计划。近年来，许多申请者发现急诊医学（EM）是一个理想的专业。2024年和2025年，分别有95%和98%的新兴市场住院医师名额被填补。为了匹配，申请人必须了解申请过程的各个方面，包括排名策略。ROL是居留申请过程中必不可少的一步，申请人根据个人和专业优先级对项目进行排名。申请人既要考虑有形因素——比如项目规模、地点和薪水，也要考虑无形因素——比如工作与生活的平衡、教员的支持和项目的整体“感觉”。虚拟面试评估有形和无形因素的机会有限，这些因素阻碍了EM申请人以前通过面对面面试进行更全面的评估。我们为医学生和他们的导师提供战略建议，包括创建ROL的方法、评估每个项目的无形和有形方面、对不常见情况的额外考虑以及与项目主管的有效沟通。
{"title":"A primer on creating a rank order list for medical students applying to residency","authors":"Adaira I. Landry MD, MEd, Wendy Coates MD, Michael Gottlieb MD","doi":"10.1002/aet2.70052","DOIUrl":"https://doi.org/10.1002/aet2.70052","url":null,"abstract":"<p>In 2024, over 50,000 applicants submitted their rank order list (ROL) to the National Resident Matching Program (NRMP, The Match), which uses these rankings to match candidates with residency programs. Recent years have shown that many applicants find emergency medicine (EM) a desired speciality. In 2024 and 2025, 95% and 98% of EM residency spots were filled, respectively. To match, applicants must understand every aspect of the application process, including rank order strategies. The ROL is an essential step in the residency application process where applicants rank programs based on personal and professional priorities. Applicants weigh both tangible factors—such as program size, location, and salary—and intangible factors—such as work–life balance, faculty support, and the overall “feel” of a program. Virtual interviews have limited opportunities to assess both tangible and intangible factors hindering the more comprehensive evaluation EM applicants previously had with in-person interviews. We offer strategic advice to medical students and their mentors, on an approach to creating a ROL, evaluating the intangible and tangible aspects of each program, additional considerations for less common scenarios, and effective communication with program directors.</p>","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143925866","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}
Donna Okoli MD, Nicole Schnabel MD, Mary R. C. Haas MD, MHPE, Sally Santen MD, PhD, Margaret Wolff MD, MHPE
Engaging learners in the virtual or hybrid learning environment requires a combination of interactive content, effective communication, and mastery of function in the virtual space. Teaching in the virtual and hybrid environment presents many challenges but it remains a part of emergency medicine resident didactics, making it imperative that theory underpins our approach to virtual and hybrid learning. Connecting didactic techniques to theory can ensure that innovation promotes the intended learning outcome. This paper will demonstrate how to connect education theory to common didactic techniques implemented in the virtual and hybrid environment.
{"title":"From the lecture hall to the cloud: Theoretical foundations for engaging virtual and hybrid didactics in emergency medicine","authors":"Donna Okoli MD, Nicole Schnabel MD, Mary R. C. Haas MD, MHPE, Sally Santen MD, PhD, Margaret Wolff MD, MHPE","doi":"10.1002/aet2.70038","DOIUrl":"https://doi.org/10.1002/aet2.70038","url":null,"abstract":"<p>Engaging learners in the virtual or hybrid learning environment requires a combination of interactive content, effective communication, and mastery of function in the virtual space. Teaching in the virtual and hybrid environment presents many challenges but it remains a part of emergency medicine resident didactics, making it imperative that theory underpins our approach to virtual and hybrid learning. Connecting didactic techniques to theory can ensure that innovation promotes the intended learning outcome. This paper will demonstrate how to connect education theory to common didactic techniques implemented in the virtual and hybrid environment.</p>","PeriodicalId":37032,"journal":{"name":"AEM Education and Training","volume":"9 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aet2.70038","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143925867","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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