The current landscape of emergency medicine resident scheduling

Background

The Accreditation Council for Graduate Medical Education (ACGME) and Residency Review Committee oversee resident physician work hours with additional specifics for U.S. emergency medicine (EM) residency programs. While there are maximum work hours, the regulatory bodies do not describe minimum work hours to achieve competency, leading to variable scheduling practices. This study aimed to understand the current landscape of U.S. EM residency scheduling given the expansion of programs, evolution of policies, and increased emphasis on wellness.

Methods

We conducted a cross-sectional study to assess current strategies of U.S. EM residency scheduling. The RedCap survey was sent to all ACGME-accredited EM residency programs across the United States via individualized emails between January 10, 2023, and March 15, 2023. Data were combined using Microsoft Excel.

Results

A total of 138 of 278 (50%) programs responded to the survey. A total of 73.2% of programs were using thirteen 28-day blocks with the remainder using twelve 1-month blocks or reported "other" block scheduling. The number of blocks in the ED increases with each postgraduate year (PGY). For PGY-1 through PGY-3, the most commonly used shift duration was 9 h. The mean total shifts per ED block and hours worked per ED block are as follows: 19 shifts and 185.1 h (PGY-1), 18.2 shifts and 173.9 h (PGY-2), 17.3 shifts and 163.6 h (PGY-3), and 14.8 shifts and 157.2 h (PGY-4). Programs provide a median for 4 weeks of vacation per year of residency.

Conclusions

Given the expansion of U.S. EM residency programs, we reevaluated the landscape of resident scheduling. We described scheduling patterns related to night shifts, vacations, requested time off, conference coverage, charting time, and circadian rhythms. Programs should utilize these data as a starting point for setting a clinical experience for their residents.

Educator's blueprint: A guide for clinician-educators to achieve promotion in emergency medicine

Promotion and tenure (P&T) can be a complex process, which many junior faculty in academic emergency medicine may struggle navigating. This paper presents perspectives and key considerations to guide faculty through the promotions process. We explore tips through three key phases: plotting the course for a successful academic career, collecting data to support academic advancement, and packaging materials into a compelling application portfolio. This resource can inform faculty and faculty developers when planning for P&T.

Education Value Units: A Currency for Recognizing Faculty Effort

n/a

Ethnic and Racial Differences in Ratings in the Medical Student Standardized Letters of Evaluation (SLOE)

BACKGROUND

The Standardized Letter of Evaluation (SLOE) stratifies the assessment of emergency medicine (EM) bound medical applicants. However, bias in SLOE, particularly regarding race and ethnicity, is an underexplored area.

OBJECTIVE

This study aims to assess whether underrepresented in medicine (UIM) and non-UIM applicants are rated differently in SLOE components.

METHODS

This was a cross-section study of EM-bound applicants across 3 geographically distinct US training programs during the 2019-2020 application cycle. Using descriptive and regression analyses, we examine the differences between UIM applicants and non-UIM applicants for each of the SLOE components: 7 qualifications of an EM physician (7QEM), global assessment (GA) rating, and projected rank list (RL) position.

RESULTS

Out of a combined total of 3759, 2002 (53.3%) unique EM-bound applicants were included. UIM applicants had lower ratings for each of the 7QEM questions, GA, and RL positions. Compared to non-UIM applicants, only some of the 7QEM components: "Work ethic and ability to assume responsibility," "Ability to work in a team, and "Ability to communicate a caring nature," were associated with their SLOE. "Commitment to EM" correlated more with GA for UIM than for non-UIM applicants.

CONCLUSIONS

This study shows a difference in SLOE rating, with UIM applicants receiving lower ratings than non-UIM applicants.

Distribution of core content coverage among three popular emergency medicine podcasts: A 10-year analysis

Objective

Podcasts are increasingly utilized as educational tools within emergency medicine (EM). As EM residency programs seek to incorporate asynchronous educational material, it is important to ensure we are covering the full breadth of EM core content. This study sought to describe the distribution of EM core content among three popular EM podcasts.

Methods

We performed a retrospective study of the distribution of podcast topics among three popular EM podcasts from July 2011 to June 2021. We evaluated the podcast episode content and alignment with the EM core content, as defined by the Model of the Clinical Practice of Emergency Medicine (MCPEM) and American Board of Emergency Medicine (ABEM) examination distribution. Data are presented descriptively.

Results

We identified 2759 podcast episodes, consisting of 7413 total topics and 2498.7 hours of content. The most frequently covered topics were "signs, symptoms, and presentations" (20.1% of total hours vs. 7.9% of MCPEM and 10.0% of ABEM exam) and "procedures and skills integral to the practice of emergency medicine" (14.8% of total hours vs. 8.1% of MCPEM and 8.0% of ABEM exam). The least frequently covered topics was were "immune system disorders"(0.5% of total hours vs. 2.0% of MCPEM and 2.0% of ABEM exam),"environmental disorders"(0.8% of total hours vs. 2.4% of MCPEM and 2.0% of ABEM exam), "obstetrics and gynecology" (1.0% of total hours vs. 5.4% of MCPEM and 3.0% of ABEM exam), and "cutaneous disorders" (0.9% of total hours vs. 4.3% of MCPEM and 3.0% of ABEM exam).

Conclusions

Our findings suggest an imbalance of MCPEM core content in three popular EM podcasts.

Gender Distribution of Emergency Medicine Podcast Speakers

STUDY OBJECTIVE

Over the past 2 decades, podcasting has become an easy and inexpensive way to disseminate information. Given the increasing importance of podcasts in medicine and medical education, it is important to understand the current status of diverse voices on podcasts. The primary objective of this study was to describe the distribution of women and men as hosts and guest speakers among 3 popular emergency medicine podcasts across a 10-year period. The secondary objective was to evaluate the association between host gender and speaker gender.

METHODS

We performed a retrospective cohort study of the gender distribution of hosts and guest speakers among 3 popular emergency medicine podcasts from July 2011 to June 2021. Data were extracted and their gender determined using pronouns listed in their faculty profiles or using Genderize. The data were presented descriptively using subanalyses by year and the type of speaker. We calculated the odds ratio (OR) with 95% confidence interval (CI) for the likelihood of a single host predicting a speaker's gender.

RESULTS

We identified 2,834 podcasts (n=5,962 speakers), with 964 (16.2%) women and 4,996 (83.8%) men speakers. Among hosts, 10.2% were women and 89.8% were men, whereas among guest speakers, 23.4% were women and 76.5% were men. The distribution of women speakers increased from 9.1% in 2011 to 23.1% in 2021. Having a woman host had an OR of 2.40 (95% CI 1.72 to 3.34) for having a woman guest speaker, whereas having a man host had an OR of 0.42 (95% CI 0.30 to 0.58) for having a woman guest speaker.

CONCLUSION

Among the 3 popular emergency medicine podcasts, there are few women speakers, hosts, and guest speakers; however, the proportion has risen over the past 10 years.

Gender differences in emergency medicine standardized letters of evaluation

OBJECTIVES

The Standardized Letter of Evaluation (SLOE) is a vital portion of any medical student's emergency medicine (EM) residency application. Prior literature suggests gender bias in EM SLOE comparative ranking, but there is limited understanding of the impact of gender on other SLOE components. The study objective was to evaluate the presence of gender differences in the 7 Qualifications for EM (7QEM), Global Assessment (GA), and anticipated Rank List (RL) position. A secondary objective was to evaluate the gender differences in 7QEM scores and their link to GA and anticipated RL position.

METHODS

We performed a cross-sectional study using SLOEs from a subset of United States applicants to three EM residency programs during the 2019-2020 application cycle. We collected self-reported demographics, 7QEM scores, GA, and anticipated RL position. We utilized linear regression analyses and repeated measures ANOVA to evaluate if the relationship between the 7QEM scores, GA score, and anticipated RL position was different for men and women.

RESULTS

2103 unique applicants were included (38.6% women, 61.4% men), with 4952 SLOEs meeting inclusion criteria. The average QEM (2.51 vs. 2.39; p < 0.001), GA (2.68 vs. 2.48; p < 0.001), and RL (2.68 vs. 2.47; p < 0.001) scores were statistically higher for women than men. When exploring the relationship between the 7QEM and GA, Ability to communicate a caring nature to patients was not found to be a statistically significant predictor for men, but it was for women. When exploring the relationship between 7QEM and RL, Commitment to EM was not a significant predictor for men, but it was for women.

CONCLUSIONS

Women scored higher than men on the 7QEM, GA, and anticipated RL position on SLOEs. The 7QEM scores factored differently for men and women.

Leveraging Google Scholar to Facilitate Resident Research Reporting

Introduction The Accreditation Council for Graduate Medical Education (ACGME) requires annual reporting of resident scholarly activities. However, this can be time-consuming for both residents and residency leadership and may not contain the most accurate or up-to-date information. This study sought to determine whether Google Scholar could adequately identify resident publications when compared with their ACGME self-report. Methods This was a cross-sectional study comparing resident Google Scholar publications with their ACGME self-reported data from 2018 to 2020. Manuscripts were only included if they were published prior to June 30, 2020, and while the participant was a resident at Rush University Medical Center. We did not count articles published prior to beginning residency. We independently collected data from the residents' self-report and Google Scholar profiles and compared the results. We assessed the overall concordance between data. When a discordant publication was identified, it was reviewed in full and discussed with the resident to ensure that it was correctly attributed to the resident. Data were presented primarily as descriptive statistics including percentages. Results Of 24 (96%) residents, 23 created Google Scholar profiles. There were 22 total publications. Google Scholar was concordant with self-report in 18 (78.3%) instances and discordant in five (21.7%) cases. In all five residents (n = 9 publications), the discordant publication was correctly identified by Google Scholar despite not being reported by the resident in their ACGME self-report. Conclusion We found that resident Google Scholar accounts resulted in the identification of publications that had not been previously reported on their ACGME self-report without missing any relevant publications.

Observations on presumptive lumpy skin disease in native cattle and Asian water buffaloes around the tiger reserves of the central Indian highlands

CASE HISTORY

Between August and October 2020, following the monsoon, signs of lumpy skin disease (LSD) were recorded and described in 154 oxen, 34 cows, 13 calves (Bos indicus) and two Asian water buffalo (Bubalus bubalis) cows belonging to smallholder farmers in 32 villages located around the Kanha and Bandhavgarh tiger reserves in the state of Madhya Pradesh, central India. Affected animals were subjected to a full clinical examination and detailed findings were recorded in a clinical register. A semi-structured questionnaire was attached to the existing clinical register format to gather information on the clinical disease history and animal husbandry practices relevant to the spread of LSD virus.

CLINICAL FINDINGS

The affected animals were between 4 months and 14 years of age (mean 6.4 (SD 2.5) years). Persistent high temperature, depression, anorexia, and characteristic round nodules (lumps) on the skin were reported. The nodules were 2-5 cm in diameter and spread over the face, ears, neck, back, perineum, scrotum, legs, tail, udder, and nasal and oral mucosa. Secondary complications of myiasis (n = 39), mastitis (n = 16) and ulcerative lesions on legs were noticed. Death was reported for one animal (0.5%). The affected animals' recovery times were variable (mean 18.4 (SD 2.7) days). There was a significant positive correlation between delay in initiating treatment and the duration of sickness. Reduction in milk yield of 30-55% was reported in Bos indicus cows.

DIAGNOSIS

Clinical findings and treatment responses consistent with lumpy skin disease and its sequelae.

CLINICAL RELEVANCE

The presumptive LSD outbreak caused serious economic loss to the animal keepers. LSD is a new disease for India and in the absence of active immunisation, efficient vector control, animal movement control and stall-feeding practice, it will inevitably become endemic in the country. The severe impacts resulting from the introduction of a new disease to a previously unaffected country highlight the need for iterative improvements in global transboundary disease surveillance. The value of clinical examination and recording of findings is demonstrated in the context of smallholder farming systems with limited access to laboratory diagnosis, which are common around the world. The description of an LSD outbreak in naïve populations of cattle and buffalo illustrates the need for increased awareness of the associated clinical signs and maintenance of high levels of biosecurity in hitherto disease-free countries.

The standardized letter of evaluation in emergency medicine: Are the qualifications useful?

OBJECTIVES

The standardized letter of evaluation (SLOE) in emergency medicine (EM) is a widely used metric for determining interview invitations and ranking of candidates. Previous research has questioned the validity of certain sections of the SLOE. However, there remains a paucity of literature on the qualifications for EM section, which evaluates seven attributes of applicants. The aim of this study was to determine the correlation between the qualifications questions and grades, global assessment, and anticipated rank list position for EM applicants.

METHODS

A multi-institutional cross-sectional study was performed using SLOEs from applicants to three geographically distinct U.S. EM residency programs during the 2019-2020 application cycle. We abstracted EM rotation grade, qualifications scores, global assessment, and anticipated rank list position from the SLOEs. A Spearman correlation was calculated between each of the qualifications scores and the applicant's grades, global assessment, and anticipated rank list position in a pairwise fashion.

RESULTS

In total, 2,106 unique applicants (4,939 SLOEs) were included. Of the seven qualifications for EM questions, three were moderately to strongly correlated with global assessment and anticipated rank list position: "ability to develop and justify an appropriate differential and a cohesive treatment plan" (ρ = 0.65 and ρ = 0.63, respectively; p < 0.001), "how much guidance do you predict this applicant will need during residency?" (ρ = 0.68 and ρ = 0.68, respectively; p < 0.001), and "what is your prediction of success for the applicant?" (ρ = 0.69 and ρ = 0.69, respectively; p < 0.001). There was no strong correlation between the seven qualifications and grades.

CONCLUSIONS

There was a moderate to strong correlation between three of seven qualifications for EM questions (ability to develop and justify a differential and develop a cohesive plan, anticipated need for the amount of guidance, and prediction of success) with both global assessment and anticipated rank list position, suggesting that these qualifications may provide the most useful data to residency selection while some of the other factors may not be needed.