Increasing Faculty Attendance at Emergency Medicine Resident Conferences: Does CME Credit Make a Difference?

Twelve tips for adapting grand rounds for contemporary demands

Grand rounds have evolved since inception in the early 1900s and subsequently, there has been a continual debate surrounding the best purpose for the time-honoured event. However, the purpose of grand rounds can be broadened to meet the needs of the medical community today, especially at a time where there is great distribution of medical practitioners and learners geographically and events such as COVID-19, which prevent the community from physically gathering. Using the evidence and lessons available from the literature we developed a grand rounds series with goals and objectives suited to our context. In this guide we provide twelve tips covering goal planning, logistics, presentation preparation and presentation delivery in order to illustrate how one could organize an informed grand rounds which is successful contextually.

Faculty support bundle for simulation education

BACKGROUND

Postgraduate training programmes rely on faculty to meet core educational needs, including simulation. Time is arguably the most valuable resource for academic physicians, which presents a challenge for recruiting faculty to provide extra-clinical teaching. To increase faculty engagement in simulation-based education (SBE), we first identified barriers to participation. Next, we sought to overcome barriers using a self-determination theory (SDT) framework to increase motivation using strategies that addressed faculty autonomy, competence and relatedness.

METHODS

Faculty from a single department of emergency medicine were surveyed about factors influencing participation in SBE. Responses were grouped into themes and used to develop the intervention-a faculty support bundle-to overcome common barriers and promote participation. Supports focused on course materials, organisational consistency and peer recognition. Faculty participation in SBE pre- and post-implementation of the support bundle was analysed via chi-squared analysis. Faculty who delivered SBE were resurveyed after the implementation phase to explore how the support bundle affected their experience.

RESULTS

Initial survey response was 41%. Reported barriers to participation in SBE included scheduling issues, preparation time, competing responsibilities, lack of confidence with simulation and lack of interest. Twenty-four faculty participated in SBE during the pre-implementation phase, compared to 39 post implementation (p = 0.03).

DISCUSSION

The faculty support bundle increases faculty participation in SBE. Strategies focused on internal motivators identified using an SDT framework. In contrast to traditional external motivators, these were no cost interventions. Those seeking to increase faculty participation in SBE should consider implementing similar strategies.

Conference Didactic Planning and Structure: An Evidence-based Guide to Best Practices from the Council of Emergency Medicine Residency Directors

Emergency medicine residency programs around the country develop didactic conferences to prepare residents for board exams and independent practice. To our knowledge, there is not currently an evidence-based set of guidelines for programs to follow to ensure maximal benefit of didactics for learners. This paper offers expert guidelines for didactic instruction from members of the Council of Emergency Medicine Residency Directors Best Practices Subcommittee, based on best available evidence. Programs can use these recommendations to further optimize their resident conference structure and content. Recommendations in this manuscript include best practices in formatting didactics, selection of facilitators and instructors, and duration of individual sessions. Authors also recommend following the Model of Clinical Practice of Emergency Medicine when developing content, while incorporating sessions dedicated to morbidity and mortality, research methodology, journal article review, administration, wellness, and professionalism.

Financial Incentive, in Place of Nonclinical Time, Increases Faculty Involvement and Improves Resident Didactic Evaluation Scores in an Anesthesiology Residency Training Program

BACKGROUND

Providing clinical faculty to lead high-quality resident didactic sessions remains a challenge for academic departments that host graduate medical education training programs. In an effort to both reduce costs and to continue to recruit faculty to give lectures, our department began to incentivize clinicians with a $500 stipend in place of a nonclinical day to present didactics. Our hypothesis is that with financial incentive, more attendings would present didactics and the quality would improve.

METHODS

Residents routinely evaluate all didactic sessions using a Likert scale of 1 to 5. Residents also answer yes or no to indicate whether the presenter should return. We compared academic year (AY) 2016, in which faculty were incentivized with nonclinical time, with AY 2017 and AY 2018, in which incentive came in the form of a $500 stipend. For each, the mean Likert score and percentage of positive responses for lecturer returning were calculated. A 1-way ANOVA and post hoc t tests were performed to determine significant changes.

RESULTS

Comparing AY 2016 (before the incentive switch) with AY 2017 and AY 2018, there was more faculty involvement in resident didactic after implementing the financial incentive. The quality of lectures also improved after the incentive switch, according to resident evaluations. There were higher overall Likert scores in AY 2018 and a higher percentage of positive responses to the question of whether presenters should return in AY 2017 and AY 2018, compared with AY 2016.

CONCLUSIONS

After implementation of a financial incentive in place of nonclinical time, more faculty became involved in lectures and overall lecture quality improved as measured by resident evaluations.

Development, implementation and first insights of a time- and location-independent longitudinal postgraduate curriculum in emergency medicine

Introduction, background and context: There have been few reports on the implementation of a structured curriculum for emergency medicine, as emergency medicine is not yet an established medical specialty for training in many European countries, including Switzerland and Germany. Because of the non-plannable workload in the emergency setting, common training approaches are often difficult to implement. Need-assessments of emergency medicine trainees commonly identify a need for interactive, time-independent ways of learning that integrate modern forms of knowledge transfer. Methods: In the present study, we assess the local needs of emergency medicine specialists and trainees for a curriculum in emergency medicine and elaborate possible solutions for the implementation of this curriculum, taking into account the special needs in a highly dynamic, unplannable environment, such as an interdisciplinary emergency department. Results: We describe the development of the emergency medicine curriculum on the basis of the six steps proposed by Kern for curriculum development in medical education, as well as the implementation, lessons learned and interval evaluation. Conclusions: The combination of multiple teaching formats, ranging from time- and location-independent solutions such as podcasted lectures to simulation-based training sessions, as well as small-group workshops and skill training sessions, might be a valuable approach to implementing a state-of-the-art curriculum in a busy emergency department.

ACGME Clinical and Educational Work Hour Standards: Perspectives and Recommendations from Emergency Medicine Educators

Introduction

The American College of Emergency Physicians (ACEP) and the Council of Emergency Medicine Residency Directors (CORD) were invited to contribute to the 2016 Accreditation Council for Graduate Medical Education’s (ACGME) Second Resident Duty Hours in the Learning and Working Environment Congress. We describe the joint process used by ACEP and CORD to capture the opinions of emergency medicine (EM) educators on the ACGME clinical and educational work hour standards, formulate recommendations, and inform subsequent congressional testimony.

Methods

In 2016 our joint working group of experts in EM medical education conducted a consensus-based, mixed-methods process using survey data from medical education stakeholders in EM and expert iterative discussions to create organizational position statements and recommendations for revisions of work hour standards. A 19-item survey was administered to a convenience sample of 199 EM residency training programs using a national EM educational listserv.

Results

A total of 157 educational leaders responded to the survey; 92 of 157 could be linked to specific programs, yielding a targeted response rate of 46.2% (92/199) of programs. Respondents commented on the impact of clinical and educational work-hour standards on patient safety, programmatic and personnel costs, resident caseload, and educational experience. Using survey results, comments, and iterative discussions, organizational recommendations were crafted and submitted to the ACGME.

Conclusion

EM educators believe that ACGME clinical and educational work hour standards negatively impact the learning environment and are not optimal for promoting patient safety or the development of resident professional citizenship.

Increasing faculty participation in resident education and providing cost-effective self-assessment module credit to faculty through resident-generated didactics

PURPOSE/OBJECTIVE(S)

Board certified radiation oncologists and medical physicists are required to earn self-assessment module (SAM) continuing medical education (CME) credit, which may require travel costs or usage fees. Data indicate that faculty participation in resident teaching activities is beneficial to resident education. Our hypothesis was that providing the opportunity to earn SAM credit in resident didactics would increase faculty participation in and improve resident education.

METHODS AND MATERIALS

SAM applications, comprising CME certified category 1 resident didactic lectures and faculty-generated questions with respective answers, rationales, and references, were submitted to the American Board of Radiology for formal review. Surveys were distributed to assess main academic campus physician, affiliate campus physician, physicist, and radiation oncology resident impressions regarding the quality of the lectures. Survey responses were designed in Likert-scale format. Sign-test was performed with P < .05 considered statistically different from neutral.

RESULTS

First submission SAM approval was obtained for 9 of 9 lectures to date. A total of 52 SAM credits have been awarded to 4 physicists and 7 attending physicians. Main academic campus physician and affiliate campus physician attendance increased from 20% and 0%, respectively, over the 12 months preceding CME/SAM lectures, to 55.6% and 20%, respectively. Survey results indicated that the change to SAM lectures increased the quality of resident lectures (P = .001), attending physician participation in resident education (P < .0001), physicist involvement in medical resident education (P = .0006), and faculty motivation to attend resident didactics (P = .004). Residents reported an increased amount of time required to prepare lectures (P = .008).

CONCLUSIONS

We are the first department, to our knowledge, to offer SAM credit to clinical faculty for participation in resident-generated didactics. Offering SAM credit at resident lectures is a cost-effective alternative to purchasing SAM resources, increases faculty attendance, and may improve the quality of radiation oncology resident education.

The Effect of Paging Reminders on Fellowship Conference Attendance: A Multi-Program Randomized Crossover Study

BACKGROUND

Educational conferences have long served as a foundation of medical education. Sending reminder text pages prior to the start of conferences is a method that may be employed to enhance conference attendance.

OBJECTIVE

The goal of our study was to determine if routine text paging before regularly scheduled conferences improves attendance among fellows in 3 internal medicine programs.

METHODS

A prospective, randomized, crossover study included 3 fellowship programs: pulmonary and critical care, cardiovascular disease, and hematology-oncology. The study was performed between October 2014 and March 2015. All fellows were included and randomized to 1 of 2 groups (with subsequent crossover to opposite group): Pages or No Pages. Paging reminders, which included conference title, location, and time, were sent 30 minutes prior to every conference for those in the intervention arm. Attendance was collected through a standard attendance log using self-registration.

RESULTS

A total of 46 fellows and 156 conferences were included for analysis, with 75 during the first 3 months and 81 during the second 3 months. There were no differences in individual overall attendance between randomized groups for the entire study period (42.9% versus 46.5%, P = .46). Paging reminders had no effect on overall individual attendance (43.7% versus 45.6%, P = .50). In addition, no significant differences were identified for individuals within each fellowship and training year.

CONCLUSIONS

Paging reminders prior to a regularly scheduled conference had no effect on overall attendance in this study. Fellows reported that clinical obligations were a major barrier to conference attendance.