CORD Abstracts 2019 Issue by Western Journal of Emergency Medicine

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Open Access at WestJEM.com

ISSN 1936-900X

CORD Abstracts Special Issue Supplement to

Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Council of Residency Directors in Emergency Medicine Advances in Education Research and Innovations

PAGES S1-S53

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MARCH 8 - 11, 2020

Volume 20, August 2019 Supplement

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VOLUME 20, August 2019 Supplement

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Western Journal of Emergency Medicine

COUNCIL OF RESIDENCY DIRECTORS IN EMERGENCY MEDICINE

A Peer-Reviewed, International Professional Journal

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Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health Indexed in MEDLINE and PubMed Andrew W. Phillips, MD, Associate Editor University of North Carolina-Chapel Hill, North Carolina

Mark I. Langdorf, MD, MHPE, Editor-in-Chief University of California, Irvine School of MedicineIrvine, California

Chadd Kraus, DO, DrPH, MPH, Associate Editor Geisinger Health System- Danville, Pennsylvania

Michael Gottlieb, MD, Associate Editor Rush Medical Center-Chicago, Illinois

Edward Michelson, MD, Associate Editor Texas Tech University- El Paso, Texas

Michael Menchine, MD, MPH, Deputy Editor University of Southern California, Keck School of Medicine-Los Angeles, California

Gavin Budhram, MD, Associate Editor Tufts University- Medford, Massachusetts James R. Langabeer II, MBA, EMT, PhD, Associate Editor University of Texas Medical School-Austin, Texas

Resident Editors AAEM/RSA

Cortlyn Brown, MD Resident/Fellow Section Editor University of California, San Francisco Medical Center

ACOEP

Michael J. Tranovich, DO Resident Editor Ohio Valley Medical Center

Shahram Lotfipour, MD, MPH, Managing Associate Editor University of California, Irvine School of MedicineIrvine, California

Rick A. McPheeters, DO, Associate Editor Kern Medical- Bakersfield, California

Susan R. Wilcox, MD, Associate Editor Massachusetts General Hospital- Boston, Massachusetts

Education Danya Khoujah, MBBS University of Maryland School of Medicine

Stephen Liang, MD, MPHS Washington University School of Medicine

Muhammad Waseem, MD Lincoln Medical & Mental Health Center

Douglas Ander, MD Emory University

Injury Prevention Mark Faul, PhD, MA Centers for Disease Control and Prevention

Public Health

Jeffrey Druck, MD University of Colorado

Wirachin Hoonpongsimanont, MD, MSBATS UC Irvine Health School of Medicine

Jeremy Hess, MD, MPH University of Washington Medical Center

John Burkhardt, MD, MA University of Michigan Medical School

International Medicine

Jacob Manteuffel, MD Henry Ford Hospital

Michael Epter, DO Maricopa Medical Center

Behavioral Emergencies Erin Duhon, PhD University of Mississippi Medical Center

ED Administration David C. Lee, MD Northshore University Hospital

Leslie Zun, MD, MBA Chicago Medical School

Gary Johnson, MD Upstate Medical University

Marc L. Martel, MD Hennepin County Medical Center

Emergency Cardiac Care Michael Kurz, MD University of Alabama at Birmingham

Eric Snoey, MD Alameda County Medical Center David Thompson, MD University of California, San Francisco Kenneth S. Whitlow, DO Kaweah Delta Medical Center Michael Abraham, MD University of Maryland Critical Care Christopher â&#x20AC;&#x153;Kitâ&#x20AC;? Tainter, MD University of California, San Diego Gabriel Wardi, MD University of California, San Diego Joseph Shiber, MD University of Florida-College of Medicine Matt Prekker MD, MPH Hennepin County Medical Center Todd Slesinger, MD Aventura Hospital and Medical Center Disaster Medicine Christopher Kang, MD Madigan Army Medical Center Gentry Wilkerson, MD University of Maryland

Shadi Lahham, MD, MS, Deputy Editor University of California, Irvine School of MedicineIrvine, California

Niels K. Rathlev, MD, Associate Editor Tufts University School of Medicine-Boston, Massachusetts

Section Editors

Clinical Practice

Sanjay Arora, MD, Deputy Editor University of Southern California, Keck School of Medicine- Los Angeles, California

Chris Mills, MD, MPH Santa Clara Valley Medical Center

John Ashurst, DO Lehigh Valley Health Network

Rolando Valenzuela, MD University of Southern California

Tony Zitek, MD Kendall Regional Medical Center

Legal Medicine

Greg P. Moore, MD, JD Madigan Army Medical Center

Methodology and Biostatistics Christian McClung, MD MPhil University of Southern California

Robert L. Rogers, MD University of Kentuky

Shu B. Chan MD, MS Resurrection Medical Center

Trauma

Stormy M. Morales Monks, PhD, MPH Texas Tech Health Science University

Joshua B. Gaither, MD University of Arizona, Tuscon

Musculoskeletal

Shira A. Schlesinger, MD, MPH Harbor-UCLA Medical Center

Juan F. Acosta DO, MS Pacific Northwest University

Geriatrics Kathleen Walsh, DO, MS University of Wisconsin

Neurosciences Antonio Siniscalchi, MD Annunziata Hospital

Pierre Borczuk, MD Massachusetts General Hospital/Havard Medical School William Paolo, MD SUNY Upstate

Toxicology

Kori S. Zachrison, MD Harvard Medical Center

Infectious Disease Elissa Schechter-Perkins, MD, MPH Boston University School of Medicine Ioannis Koutroulis, MD, MBA, PhD Drexel University College of Medicine Kevin Lunney, MD, MHS, PhD University of Maryland School of Medicine

Brandon Wills, DO, MS Virginia Commonwealth University

Rick Lucarelli, MD Medical City Dallas Hospital

Jeffrey R. Suchard, MD University of California, Irvine

William D. Whetstone, MD University of California, San Francisco

Ultrasound

Pediatric Emergency Medicine

Robert Derlet, MD Founding Editor, California Journal of Emergency Medicine University of California, Davis

David Peak, MD Massachusetts General Hospital/Havard Medical School Patrick Joseph Maher, MD Icahn School of Medicine at Mount Sinai

Edward P. Sloan, MD, MPH University of Illinois at Chicago

Teresita M. Hogan, MD University of Chicago

Technology in Emergency Medicine Phillips Perera, MD Stanford University Medical Center

Elizabeth Burner, MD, MPH University of Southern California

Emergency Medical Services Derek Cooney, MD State University of New York Upstate Medical University, New York

Trevor Mills, MD, MPH Northern California VA Health Care Nikhil Goyal, MD Henry Ford Hospital

Craig L. Anderson, MPH, PhD University of California, Irvine

Semhar Z. Tewelde, MD University of Maryland School of Medicine

Cristina M. Zeretzke-Bien, MD University of Florida-College of Medicine

J. Matthew Fields, MD Thomas Jefferson University

Judith Klein, MD University of California, San Francisco

Laleh Gharahbaghian, MD Stanford University

Paul Walsh, MD, MSc University of California, Davis

Shane Summers, MD Brooke Army Medical Center

Official Journal of the California Chapter of the American College of Emergency Physicians, the America College of Osteopathic Emergency Physicians, and the California Chapter of the American Academy of Emergency Medicine

Available in MEDLINE, PubMed, PubMed Central, CINAHL, SCOPUS, Google Scholar, eScholarship, Melvyl, DOAJ, EBSCO, EMBASE, Medscape, HINARI, and MDLinx Emergency Med. Members of OASPA. Editorial and Publishing Office: WestJEM/Depatment of Emergency Medicine, UC Irvine Health, 333 City Blvd, West, Rt 128-01, Orange, CA 92868, USA Office: 1-714-456-6389; Email: Editor@westjem.org

Volume 20, Supplement: August 2019

Western Journal of Emergency Medicine

Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health Indexed in MEDLINE and PubMed

Editorial Board

Amin A. Kazzi, MD, MAAEM The American University of Beirut, Beirut, Lebanon Anwar Al-Awadhi, MD Mubarak Al-Kabeer Hospital, Jabriya, Kuwait Arif A. Cevik, MD United Arab Emirates University College of Medicine and Health Sciences, Al Ain, United Arab Emirates Abhinandan A.Desai, MD University of Bombay Grant Medical College, Bombay, India

Edward Panacek, MD, MPH University of South Alabama

Hjalti Björnsson, MD Icelandic Society of Emergency Medicine

Daniel J. Dire, MD University of Texas Health Sciences Center San Antonio David F.M. Brown, MD Massachusetts General Hospital/ Harvard Medical School

Elena Lopez-Gusman, JD California ACEP American College of Emergency Physicians Janice Wachtler, BAE, CBA American College of Osteopathic Emergency Physicians John B. Christensen, MD California Chapter Division of AAEM Lori Winston, MD California ACEP American College of Emergency Physicians Kaweah Delta Healthcare District Mark I. Langdorf, MD, MHPE UC Irvine Health School of Medicine

Samuel J. Stratton, MD, MPH Orange County, CA, EMS Agency Scott Rudkin, MD, MBA University of California, Irvine

Niels K. Rathlev, MD Tufts University School of Medicine Pablo Aguilera Fuenzalida, MD Pontificia Universidad Catolica de Chile, Región Metropolitana, Chile

Jacob (Kobi) Peleg, PhD, MPH Tel-Aviv University, Tel-Aviv, Israel

Peter A. Bell, DO, MBA Liberty University College of Osteopathic Medicine

Jonathan Olshaker, MD Boston University

Peter Sokolove, MD University of California, San Francisco

Katsuhiro Kanemaru, MD University of Miyazaki Hospital, Miyazaki, Japan

Robert M. Rodriguez, MD University of California, San Francisco

Advisory Board

Amal Khalil, MBA UC Irvine Health School of Medicine

Rosidah Ibrahim, MD Hospital Serdang, Selangor, Malaysia

Nadeem Qureshi, MD St. Louis University, USA Emirates Society of Emergency Medicine, United Arab Emirates

Francis Counselman, MD Eastern Virginia Medical School

Barry E. Brenner, MD, MPH Case Western Reserve University

Robert W. Derlet, MD University of California, Davis

Linda S. Murphy, MLIS University of California, Irvine School of Medicine Librarian

Francesco Dellacorte, MD Azienda Ospedaliera Universitaria “Maggiore della Carità,” Novara, Italy

Gayle Galleta, MD Sørlandet Sykehus HF, Akershus Universitetssykehus, Lorenskog, Norway

Robert Suter, DO, MHA UT Southwestern Medical Center

Leslie Zun, MD, MBA Chicago Medical School

Erik D. Barton, MD, MBA Icahn School of Medicine, Mount Sinai, New York

Bandr Mzahim, MD King Fahad Medical City, Riyadh, Saudi Arabia

Brent King, MD, MMM University of Texas, Houston

Khrongwong Musikatavorn, MD King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand

Edward Michelson, MD Texas Tech University

Scott Zeller, MD University of California, Riverside Steven Gabaeff, MD Clinical Forensic Medicine Steven H. Lim, MD Changi General Hospital, Simei, Singapore Terry Mulligan, DO, MPH, FIFEM ACEP Ambassador to the Netherlands Society of Emergency Physicians Vijay Gautam, MBBS University of London, London, England Wirachin Hoonpongsimanont, MD, MSBATS Siriraj Hospital, Mahidol University, Bangkok, Thailand

Editorial Staff

Nicholas T. Sawyer, MD, MBA California ACEP American College of Emergency Physicians University of California, Davis Peter A. Bell, DO, MBA American College of Osteopathic Emergency Physicians Liberty University, College of Osteopathic Medicine Robert Suter, DO, MHA American College of Osteopathic Emergency Physicians UT Southwestern Medical Center Shahram Lotfipour, MD, MPH UC Irvine Health School of Medicine Trevor Mills, MD, MPH California Chapter Division of AAEM

Leila Danishgar, BS Editorial Director

Dana Le, BS WestJEM Publishing Director

Maria Nguyen, BS WestJEM Associate Editorial Director

Christine Louis, BS WestJEM Associate Publishing Director

Joseph Bui, BS CPC-EM Associate Editorial Director

Cassandra Saucedo, BS CPC-EM Publishing Director

Tushank Chadha, BS Media and Communications Director

Argineh Shahbandari, BS CPC-EM Associate Publishing Director

Alissa Fiorentino, BA WestJEM Staff Liaison

June Casey, BA Copy Editor

Northern California VA Health Care

Available in MEDLINE, PubMed, PubMed Central, Europe PubMed Central, PubMed Central Canada, CINAHL, SCOPUS, Google Scholar, eScholarship, Melvyl, DOAJ, EBSCO, EMBASE, Medscape, HINARI, and MDLinx Emergency Med. Members of OASPA. Editorial and Publishing Office: WestJEM/Depatment of Emergency Medicine, UC Irvine Health, 333 City Blvd, West, Rt 128-01, Orange, CA 92866, USA Office: 1-714-456-6389; Email: Editor@westjem.org

Western Journal of Emergency Medicine

Volume 20, Supplement: August 2019

Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health Indexed in MEDLINE and PubMed This open access publication would not be possible without the generous and continual financial support of our society sponsors, department and chapter subscribers.

Professional Society Sponsors American College of Osteopathic Emergency Physicians California ACEP

California Chapter Division of American Academy of Emergency Medicine

Academic Department of Emergency Medicine Subscriber Albany Medical College Albany, NY

INTEGRIS Health Oklahoma City, OK

Robert Wood Johnson University Hospital New Brunswick, NJ

University of Florida, Jacksonville Jacksonville, FL

American University of Beirut Beirut, Lebanon

Kaweah Delta Health Care District Visalia, CA

Rush University Medical Center Chicago, IL

University of Illinois at Chicago Chicago, IL

Arrowhead Regional Medical Center Colton, CA

Kennedy University Hospitals Turnersville, NJ

Southern Illinois University Carbondale, IL

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Kern Medical Bakersfield, CA

St. Lukeâ&#x20AC;&#x2122;s University Health Network Bethlehem, PA

University of Illinois College of Medicine Peoria, IL

Baystate Medical Center Springfield, MA

Lakeland HealthCare St. Joseph, MI

Beaumont Hospital Royal Oak, MI

Lehigh Valley Hospital and Health Network Allentown, PA

Stanford/Kaiser Emergency Medicine Residency Program Stanford, CA

Beth Israel Deaconess Medical Center Boston, MA

Loma Linda University Medical Center Loma Linda, CA

Boston Medical Center Boston, MA

Louisiana State University Health Sciences Center New Orleans, LA

Brigham and Womenâ&#x20AC;&#x2122;s Hospital Boston, MA

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University of Maryland Baltimore, MD

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University of Michigan Ann Arbor, MI

Temple University Philadelphia, PA

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University of Nebraska Medical Center Omaha, NE

University of Alabama, Birmingham Birmingham, AL

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University of Southern California/Keck School of Medicine Los Angeles, CA University of Tennessee, Memphis Memphis, TN University of Texas, Houston Houston, TX University of Texas Health San Antonio, TX University of Warwick Library Coventry, United Kingdom University of Washington Seattle, WA

University of Chicago, Chicago, IL

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Volume 20, Supplement: August 2019

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Western Journal of Emergency Medicine

Council of Residency Directors in Emergency Medicine Advances in Education Research and Innovations

The Council of Residency Directors in Emergency Medicine Advances in Education Research and Innovations Forum presented a peer-reviewed selection of emergency medicine graduate and undergraduate educational research and innovations in both oral and poster formats at CORD Academic Assembly 2019. Emphasis was placed on novel research questions and designs. Innovation submissions included curricular designs, computer applications, faculty development, recruitment processes or similar topics. v x S1 S21 S47 S50

Table of Contents Author Index Research Abstracts Innovation Abstracts Educational Soundbites Oral Presentations Best of the Best Research Oral Presentations

The Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health would like to thank the Council of Emergency Medicine Residency Directors Board of Directors for helping to make this collaborative special issue possible. CORD abstracts are archived at http://westjem.com/cord-abstracts and http://escholarship.org/uc/uciem_westjem. Western Journal of Emergency Medicine

Volume 20, Supplement : August 2019

CORD Abstracts Special Issue - Table of Contents 10. Impact of an Emergency Department Resident Sign-out Checklist on Attending Assessments of Quality Connie Lorenzo, DO, Holly Stankewicz, DO, Brendan Healy, MSII, Jill Stoltzfus, Ph.D., Philip Salen, MD

Research Abstracts 1. Scholarly Tracks: Not Just for Academic Careers Christian DeFazio, MD, Heather Lindstrom, PhD, Jacob Canavan

11. Retrospective Review of Third-Year Medical Students’ Clinical Evaluations via Entrustable Professional Activities Kayla King, BS, Benjamin Mogni, BA, Adam Dugan, MSc, Dianna Black, BA, Theresa Mims, RN, James Motes, BS, Jonathan Bronner, MD

2. The Anticipated Negative Impact on Emergency Medicine Faculty of the New ACGME Common Program Requirements Shawn Quinn, DO, Bryan Kane, MD, Terrence Goyke, DO, Dawn Yenser, C-TAGME, Marna Greenberg, DO, MPH, Gavin Barr, JR, MD

12. Impact of Ambient Background Noise on Sign-Out in the Emergency Department Connie Lorenzo, DO, Holly Stankewicz, DO, Brendan Healy, MSII, Jill Stoltzfus, Ph.D., Philip Salen, MD

3. Do Personality Characteristics Vary by Gender in Emergency Medicine Residents? Jaime Jordan, MD, Martine Maculatis, PhD, Judith Linden, MD, Jeffrey Schneider, MD, H. Gene Hern, MD, MS, John Marshall, MD, Charlotte Wills, MD, Alan Friedman, MA, Lalena Yarris, MD, MCR

13. Setting a Minimum Passing Standard for the Uncertainty Communication Checklist Through Patient and Physician Engagement David Salzman, MD, MEd, Kristin Rising, MD, MS, Kenzie Cameron, PhD, MPH, Rhea Powell, MD, MPH, Dimitrios Papanagnou, MD, MPH, EdD(c), Amanda Doty, MS, Katherine Piserchia, BA, Lori Latimer, MSW, LCSW, William McGaghie, PhD, Danielle McCarthy, MD, MS

4. Speaker Training Pilot Program for Women in Healthcare Decreases Fear of Public Speaking Jeanette Wolfe, MD, Ashley Deutsch, MD, Kye Poronsky,, Deborah Hoadley, MD, MPH 5. When Less Is More: A Novel Strategy for Improving Resident Evaluations Casey MacVane, MD, MPH, Andrew Perron, MD

14. Sex and Gender Education in Emergency Medicine: A Residency-Based Curricular Audit Amanda Smith, MD, Robert Wians, Sullivan Hanback,, Adrienne Fowler, Andrew Edwards, MD, Lauren Walter, MD

6. Examining the Relationship Between the AAMC Standardized Video Interview and Step 2 CS Subscores Bobby Naemi, Ph.D., Amanda Clauser, Ed.D., MSEd, Malika Fair, MD, MPH

15. Current EM Resident Knowledge of Community Resources and the Impact of Structured Community Resource Visits Jeffrey Norvell, MD, MBA, Jonathan Dangers, MD, MPH, Kenneth Marshall, MD, MA, Niaman Nazir, MBBS, MPH, Courtney Marlin, LMSW

7. Graded Responsibility Among Emergency Medicine Residency Programs Jason Lai, MD, David Tillman, MD, Aaron S Kraut, MD, Benjamin H. Schnapp, MD, MEd, Jamie Hess, MD, Mary Westergaard, MD

16. Viewing Trends in Emergency Medicine Residency Program Websites Neeraj Chhabra, MD, Sean Dyer, MD

8. Learning Experience Design (LED) in Health Professions Education: A Critical Review Joann Pan, Jessica Sheu, Lauren Massimo, MD, MS, Andrew Phillips, MD, MEd

17. “I Have Nothing Else to Give”: A Qualitative Exploration of Emergency Medicine Residents’ Perceptions of Burnout And Compassion Fatigue Aarti Jain, MD, Ramin Tabatabai, MD, Anne Vo, PhD, Jeffrey Riddell, MD

9. A Novel and Well-Received Process for Tracking the ACGME 15 Key Index Procedures Hossein Mohagheghian, MD, Frederick Fiesseler, DO, Brian Walsh, MD, Amanda Esposito, MD, Nicole Riley,, Danielle Biggs, MD

Volume 20, Supplement : August 2019

Western Journal of Emergency Medicine

CORD Abstracts Special Issue - Table of Contents 18. Improving Residency Didactics Through Interdisciplinary Query Kara Sawyer, MD, Margaret Carlson, BS, Megan Fix, MD, Angela Presson, Ph.D., MS

26. Mapping Emergency Medicine: Geographic Distribution of Emergency Medicine Clerkship and Residency Positions Based on 2016-2017 eSLOE Statistics Timothy Montrief, MD, MPH, Jennifer S. Jackson, MD, FACEP

19. Trends in Individualized Interactive Instruction Utilization and Correlation to Intraining Examination Erich Heine, DO, Anne Shaughnessy, MD, David Bailey, MD, Michael Clemmons, MD, Josef Thundiyil, MD, Jay Ladde, MD

27. A Novel Method for Blinding Reviewers to Gender for the Purposes of Gender Bias Research Michael Pallaci, DO, Adam Aluisio, MD, Ashley See, DO, Michael Weinstock, MD, Jennifer BeckEsmay, MD, Allen Frye, MSN, Jeff Riddell, MD

20. Hiring for Attitude Stephanie Duckett, DO, Jonathan Nichol, DO, Ryan Roten, DO, Babak Khazaeni, MD

28. Standard Video Interview (SVI) Scores and Applicant Position on Residency Program List: A Correlation Study Kaitlin Bowers, DO, Geoff Comp, DO, Andrew Kalnow, DO, John Casey, DO, William Fraser, DO, Christopher Lloyd, DO, Andrew Little, DO

21. Correlating SLOE Rankings with EM Match Status: Is a Lower-Third SLOE a No-Go? Joseph Hansroth, MD, Kristin Davis, MD, Melinda Sharon, MPH, Stephen Davis, Ph.D., Erica Shaver, MD, Christopher Kiefer, MD, Scott Cottrell, Ed.D., Norman Ferrari, MD

29. Teaching and Evaluating Medical Students’ Oral Presentations Skills in Emergency Medicine Kathryn Fisher, MD, MS, Catherine Reynolds, MD, Hilary Fairbrother, MD, MPH

22. Decreasing Stroke Alerts in the Emergency Department: A Lesson in Resource Utilization Derek DeWitt, BA, Erin Muckey, MD, MBA, Elena DiMiceli, MD, Koto Ishida, MD, Nirmala RossanRaghunath, RN, MSN, Robert Femia, MD, MBA, Tina Wu, MD, MBA

30. Emergency Department Thoracotomy Education Needs Assessment Hashim Q. Zaidi, MD, Abra L. Fant, MD, MS, Sarah N. Sanders, MD, Danielle T. Miller, MD, Matthew J. Pirotte, MD, David H. Salzman, MD, MEd

23. Effect of a Pediatric Critical Care Bootcamp on the Knowledge and Confidence of Emergency Medicine Interns W. Gannon Sungar, DO, Genie Roosevelt, MD, MPH, Emily Hopkins, MSPH, Patricia Hagan, MD, Mauricio Palau, MD, Claudia Kunrath, MD, Kathryn Walsh, MD, Patrick Mahar, MD, Kelley Roswell, MD, Taylor McCormick, MD, MSc

31. A Needs Assessment for the Development of “Orphan” Topic Curricular Toolkits Holly Caretta-Weyer, MD, Aleksandr Tichter, MD, MS, Jessica Fujimoto, MD

24. Implementation of an Educational Dashboard with a Financial Incentive Improves Faculty Participation in Residency Evaluations Megan L Fix, MD, Andrew Pugh, MD, Troy Madsen, MD, Christine Carlson, BA, Gerard Doyle, MD, Robert Stephen, MD, Susan Stroud, MD

Innovation Abstracts 1. Peer-Guided Lightning Electrocardiogram Curriculum Benjamin Cooper, MD, Jennifer Grodus, DO

25. Increased Space for Comments on End-OfShift Card Associated with Longer Comments Jessie Nelson, MD, Cullen Hegarty, MD, Kelly Barringer, MD, Kristi Grall, MD, MHPE, Keith Henry, MD, Brad Hernandez, MD, Paula Miller, MPH, Michael Paddock, DO, MS, Benjamin Willenbring, MD, Casey Woster, MD

Western Journal of Emergency Medicine

2. A Novel Standardized Multimodal Model of Critical Care Assessment of Junior Residents Emberlynn Liu, MD, Kavita Joshi, MD, Jessica Hernandez, MD, Lynn Roppolo, MD, Larissa Velez, MD, Joseph Martinez, MD

Volume 20, Supplement : August 2019

CORD Abstracts Special Issue - Table of Contents 3. A Unique Video-Review Curriculum to Improve Resident Education and Quality Measures in Cardiac Arrest Evan Kuhl, MD, David Yamane, MD, Katherine Newell, MD, Carolyn Lanam, MD, Jennifer Rabjohns, MD, Natalie Sullivan, MD, Patrick McCarville, MD, Ty Nichols, MD

12. Notes vs Recall: Can Third-Year Medical Students Benefit from Obtaining and Presenting an HPI Without Using Notes? Lindsay MacConaghy, MD, Casey Moore, DO, Kara Welch, BA, Matthew Sarsfield, MD, Susan Wojcik, PhD 13. An Innovative Meat Model-Based Faculty Development Workshop to Increase Faculty Comfort with Performing Nerve blocks Judy Lin, MD, Simran Buttar, MD, Lawrence Haines, MD, Antonios Likourezos

4. Reversing the Script: Peer-Based Teaching of Foundational Concepts in Emergency Medicine Using a FOAMed Curriculum Samuel Goldman, MD, MPH, Michael Barthman, MD, Rory Merritt, MD

14. Small-Scale High-Fidelity Simulation for Mass Casualty Incident Readiness Jessie Nelson, MD, Andrea Weiers, MD

5. Assessing How a Shared Mental Model Influences Team Performance in Blunt Trauma Resuscitation Ryan Gardner, MD, Patrick Tyler, MD, Charles Parsons, MD, Carlo Rosen, MD

15. Doctors on the Hill: Initiation and Integration of Policy Advocacy in Emergency Medicine Residency Training Scott H Pasichow, MD, MPH, Bryn DeKosky, DO, MBA, Catherine Cummings, MD

6. Advancing Diversity in Emergency Medicine: The NYU EM Summer Fellowship for Underrepresented Minority Medical Students Audrey Bree Tse, MD, Max Berger, MD, Leigh Nesheiwat, MD

16. The Zipperator! A Novel Model to Simulate Penile Zipper Entrapment Sage Wexner, MD, Dale Till, Jessica Morrison, MD

7. The New Morbidity and Mortality Conference â&#x20AC;&#x201C; A Prospective Approach Benjamin Ostro, MD, Kushal Nandam, MD, David Way, MEd, Matthew Malone, MD, Geremiha Emerson, MD, Simiao Li-Sauerwine, MD, MS, Sorabh Khandelwal, MD, Andrew King, MD

17. Assessing the Quality of Resident Verbal Handoffs â&#x20AC;&#x201C; Do You Know What Your Residents Are Communicating? Linda Spillane, MD, Julie Pasternack, MD, Lee Marks, MD, Kathleen Stephanos, MD

8. Burnout Scoring Using the Electronic Medical Record Samantha Reeder, MD

18. Email for Staff Education: The Good, the Bad, the Ugly Jessie Nelson, MD, Sara Schroeder Hevesi, MD, Robert Welborn, MD, Andrea Weiers, MD, Ben Eide, MPH, Krista Carlson, MS

9. Essentials of the Emergency Medicine Match Process: The Couples Match Addendum, on behalf of the CORD Advising Students Committee in EM Caitlin Schrepel, MD, Katie Harter, MD, Heather Streich, MD, Emily Hillman, MD, Adam Kellogg, MD, Jose Nable, MD, Alexis Pelletier-Bui, MD

19. Rosh Review in the Clerkship: Utilization of a TestEnhanced Learning Resource and Performance on the National Board of Medical Examiners Emergency Medicine Advanced Clinical Exam Chelsea Bonfiglio, MD, Jonathan Fisher, MD, MPH, Thomas Whitting, DO, Jeremi Smith, M.ED

10. Incorporating Rapid Cycle Deliberate Practice into Traditional Simulation-Based Medical Education Tim Montrief, MD, MPH, Kelly Medwid, MD, Mark Supino, MD

20. Just Checking In: A Peer Mentor Program for Emergency Medicine Residents Angelica McPartlin, MD, Erin Dehon, PhD, Jacklyn McParlane, DO, Diane Birnbaumer, MD

11. Just in Time: A Faculty Development Primer to Help Prepare Core Faculty for Clinical Teaching Shifts Jonathan Karademos, MD, Carlos Rodriguez, MD, Mansoor Siddiqui, MD, Robin Naples, MD, Dimitri Papanagnou, MD, MPH

21. Residency Families: The Development of a Peer Mentoring Program in an Emergency Medicine Residency Katie Tausch, MD, Andrew Grock, MD, Lori Weichenthal, MD, Kristin Kahale, MD, Danielle Turner-Lawrence, MD

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Western Journal of Emergency Medicine

CORD Abstracts Special Issue - Table of Contents 22. Implementation of a “Family Orientation” as Part of New Resident Orientation Molly Hartrich, MD, MPH

32. Rapid Cycle Deliberate Practice Simulation for Resuscitation Training of Medical Students Suzana Tsao, DO, Erica Tabakin, MD, Ashley Wivel, MD, Gregory Siegel, MD

23. A Novel Approach to Remediating Communication Skills in “At-Risk” Residents Using Professional Coaching Ryan Bodkin, MD, Linda Spillane, MD, Julie Pasternack, MD, Jason Rotoli, MD, Lee Marks, MD, Flavia Nobay, MD

33. A Novel Standardized Rubric for Medical Student Emergency Medicine Oral Presentations Catherine Reynolds, MD, Kathryn Fisher, MD, Hilary Fairbrother, MD 34. EM Residents as Mentors: Toward a Curriculum on Mentoring Kendra Parekh, MD, Charles Lei, MD, Emily Brumfield, MD

24. The “EM in 5” Curriculum: Learner and Presenter Perceptions Adriana Olson, MD, MAEd, Quincy Moore, MD, Nathan Olson, MD, MAEd, William Weber, MD, MPH, Amelia Derstine, MD, Matthew Heuton, MD, James Ahn, MD, MHPE

35. A Personal Crisis Management Plan for Residents Angela Chen, MD, Loice Swisher, MD, Mary Jane Brown, MD

25. Escape the Trauma Room Mikhail Podlog, DO, Snaha Sanghvi, DO, Abbas Husain, MD, Josh Greenstein, MD

36. Assessment of an Opt-Out Employee Assistance Program Assessment to Mitigate Burnout and Reduce Barriers to Seeking Mental Healthcare in Emergency Medicine Residents Arlene Chung, MD, MACM, Ramin Tabatabai, MD, Glenn Paetow, MD, MACM, Rochelle Zarzar, MD, Nathaniel Scott, MD, Elizabeth Fruchter, MD, Lois Isaksen, MD, Danielle Hart, MD

26. Case-Linked Simulation Exercises Improve Resident Engagement in Palliative Care Discussions Kathryn Kirsch, MD, Ryan Guzik, DO, Susan Boyle, MSN, APN, AGNP-C 27. Ultrasound-Guided Serratus Anterior Plane (SAP) Blocks: An Emergency Medicine Residency Module Using a Homemade Phantom Kathleen Cowling, MS, DO, MBA, FAAEM, FACEP, Rupinder Sekhon, MD, Therese Mead, DO, RDMS, FACEP

37. Does an Educational Interactive Airway Lab Change Residents’ Choice of Airway and Comfort Level? Innocent Akujuobi, MD, Josef Thundiyil, MD, MPH, Christopher Hunter, MD, PhD, Jay Ladde, MD 38. Foundations EKG I and EKG II: Open-Access, Flipped-Classroom Critical EKG Curricula William Burns, MD, Shanna Jones, MD, Holly Caretta-Weyer, MD, Paul Logan Weygandt, MD, MPH, Nicholas Hartman, MD, Kristen Grabow Moore, MD, MEd

28. ECGStampede.com: An Exercise in Electrocardiogram Interpretation and Triage Catherine Reynolds, MD, Tom Fadial, MD 29. February Teach-Off Competition: A $60 Teaching Intervention to Beat the Winter Blues Meghan McGrath, MD

39. 3D Printed Do-It-Yourself Ultrasound Femoral Nerve Block Task Trainer Scott Crawford, MD, Patrick Palacios, Medical Student, Erik Nordquist, MD, Stormy Monks, PHD

30. Building Interest in Emergency Medicine Through a Cadaver-Based Procedural Skills Workshop Kendra Parekh, MD, Emily Brumfield, MD, Charles Lei, MD

40. Transparency in the Culture of Assessment and Feedback: A Currently Opaque Environment and the Case for Resident Feedback Dashboards Raquel Harrison, MD, Katja Goldflam, MD, Alina Tsyrulnik, MD, Brian Wood, MD, David DellaGiustina, MD

31. Academic Promotion Workshop Series Enhances Emergency Physicians’ Knowledge of and Experience with the Promotion Process Casey MacVane, MD, MPH, Tania Strout, PhD, RN, MS, Michael Baumann, MD

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CORD Abstracts Special Issue - Table of Contents 41. Using a Novel Online Relational Database Tool to Track Attendance and Increase Didactic Evaluations in Graduate Medical Education W. Gannon Sungar, DO, Richard Byyny, MD, MSc, Maria Moreira, MD, Taylor McCormick, MD, MSC, Bonnie Kaplan, MD, MEd, Jennie Buchanan, MD, Barbara Blok, MD, Christy Angerhofer, Brook Baker, BSW, Charlotte Lawson, MD, MSc

Best of the Best Research Oral Presentations

42. Innovative Evaluation Tool: Fast, Robust and Mobile Engaging Faculty In Both Written Evaluations and Verbal Communication Raquel Harrison, MD, Katja Goldflam, MD, Alina Tsyrulnik, MD, Brian Wood, MD, David DellaGiustina, MD

1. Faculty Perception of Medical Student Documentation in Emergency Medicine Jason Lai, MD, David Tillman, MD 2. Comparison of the Standardized Video Interview and Interview Assessments of Professionalism and Interpersonal Communication Skills in Emergency Medicine Laura Hopson, MD, Michele Dorfsman, MD, Jeremy Branzetti, MD, Michael Gisondi, MD, Danielle Hart, MD, Jaime Jordan, MD, James Cranford, PhD, Sarah Williams, MD, Linda Regan, MD

43. Residents as Teachers: Applying the Foundations Model for Structured Near-Peer Education Kristne Grabow Moore, MD, MEd, Andrew Ketterer, MD, MA, Ryan Dick-Perez, DO, P. Logan Weygandt, MD, MPH, Holly Caretta-Weyer, MD, MA, Jeremy Berberian, MD

3. The Correlation of Emergency Medicine Residentsâ&#x20AC;&#x2122; Grit and Non-Cognitive Characteristics Nathan Olson, MD, MAEd, Kelly Williamson, MD, Nicholas Hartman, MD, MPH, Navneet Cheema, MD, Adriana Olson, MD, MAEd

Educational Soundbites Oral Presentations 1. Using Simulation to Engage and Educate During Monthly Emergency Medicine Residency Morbidity and Mortality Conferences Megan Stobart-Gallagher, DO, Henry Kramarski, DO, Jason Becker, MD, Deborah Pierce, DO

4. The Correlation of Emergency Medicine Residentsâ&#x20AC;&#x2122; Grit and Achievement Adriana Olson, MD, MAEd, Kelly Williamson, MD, Nicholas Hartman, MD, MPH, Navneet Cheema, MD, Nathan Olson, MD, MAEd

2. Escape Room: An Innovative Approach to Teaching Disaster Preparedness to Emergency Medicine Residents and Medical Students Andrea Patineau, MD, Nicholas Leonowicz, MD, Christine Mlynarek, MD

5. Impact of Interpolated Questions on Podcast Knowledge Acquisition and Retention: A DoubleBlind, Multicenter, Randomized Controlled Trial Michael Weinstock, MD, Mike Pallaci, DO, Adam Aluisio, MD, Ben Cooper, MD, Dana Gottlieb, MD, Andy Grock, MD, Allen Frye, NP, Jeff Love, MD, Rob Orman, MD, Jeff Riddell, MD

3. A Structured Curriculum for Interprofessional Training of Emergency Medicine Interns Ashley Rider, MD, Mariko Nomura, MD, Tiffany Anaebere, MD, Charlotte Wills, MD, David Duong, MD

Volume 20, Supplement : August 2019

4. A Simulation-Based Curriculum on Best Practices for Firearms Safety Andrew Ketterer, MD, MA, Jason Lewis, MD, Victor Novack, MD, PhD, Nicole Dubosh, MD, Edward Ullman, MD

Western Journal of Emergency Medicine

CORD Abstracts Special Issue - Author Index

Ahn, J, S33 Akujuobi, I, S42 Aluisio, A, S17, S53 Anaebere, T, S48 Angerhofer, C, S45 Bailey, D, S12 Baker, B, S45 Barr Jr, G, S1 Barringer, K, S16 Barthman, M, S23 Baumann, M, S37 Beck-Esmay, J, S17 Becker, J, S47 Berberian, J, S46 Berger, M, S24 Biggs, D, S6 Birnbaumer, D, S32 Black, D, S7 Blok, B, S45 Bodkin, R, S33 Bonfiglio, C, S31 Bowers, K, S18 Boyle, S, S35 Branzetti, J, S50 Bronner, J, S7 Brown M, S41 Brumfield, E, S40 Buchanan, J, S45 Burns, W, S42 Buttar, S, S28 Byyny, R, S45 Cameron, K, S8 Canavan, J, S1 Carlson, C, S15 Carlson, K, S31 Carlson, M, S12 Caretta-Weyer, H, S20, S42, S46 Casey, J, S18 Cheema, N, S51, S52 Chen, A, S41 Chhambra, N, S10 Chung, A, S41 Clauser, A, S4 Clemmons, M, S12 Comp, G, S18 Cooper, B, S21, S53 Cottrell, S, S13 Cowling, K, S35 Cranford, J, S50 Crawford, S, S43 Cummings, C, S29 Dangers, J, S10 Davis, K, S13 Davis, S, S13

DeFazio, C, S1 Dehon, E, S32 DeKosky, B, S29 Della-Giustina, D, S44, S46 Derstine, A, S33 DeWitt, D, S14 Dick-Perez, R, S46 DiMiceli, E, S14 Dorfsman, M, S50 Doty, A, S8 Doyle, G, S15 Dubosh, N, S49 Duckett, S, S13 Dugan, A, S7 Duetsch, A, S3 Duong, D, S48 Dyer, S, S10 Edwards, A, S9 Eide, B, S31 Emerson, G, S24 Esoposito, A, S6 Fadial, T, S36 Fair, M, S4 Fairbrother, H, S19, S38 Fant, A, S19 Femia, R, S14 Ferrari, N, S13 Fiesseler, F, S6 Fisher, J, S31 Fisher, K, S19, S38 Fix, M, S12, S15 Fowler, A, S9 Fraser, W, S18 Friedman, A, S2 Fruchter, E, S41 Frye, A, S17, S53 Fujimoto, J, S20 Gardner, R, S23 Gisondi, M, S50 Goldflam, K, S44, S46 Goldman, S, S23 Gottlieb, D, S53 Goyke, T, S1 Grabow Moore, K, S42, S46 Grall, K, S16 Greenberg, M, S1 Greenstein, J, S34 Grock, A, S32, S53 Grodus, J, S21 Guzik, R, S35 Hagan, P, S15 Haines, L, S28 Hanback, S, S9 Hansroth, J, S13

Western Journal of Emergency Medicine

Harrison, R, S44, S46 Hart, D, S41, S50 Harter, K, S26 Hartman, N, S42, S51, S52 Hartrich M, S33 Healy, B, S6, S7 Hegarty, C, S16 Henry, K, S16 Heine, E, S12 Hern, H, S2 Heuton, M, S33 Hernandez, B, S16 Hernandez, J, S22 Hess, J, S4 Hillman, E, S26 Hoadley, D, S3 Hopkins, E, S15 Hopson, L, S50 Hunter, C, S42 Husain, A, S34 Isaksen, L, S41 Ishida, K, S14 Jain, A, S11 Jackson, J, S16 Jones, S, S42 Jordan, J, S2, S50 Joshi, K, S22 Kahale, K, S32 Kalnow, A, S18 Kane, B, S1 Kaplan, B, S45 Karademos, J, S27 Kellogg, A, S26 Ketterer, A, S46, S49 Khandelwal, S, S24 Khazaeni, B, S13 Kiefer, C, S13 King, A, S24 King, K, S7 Kirsch, K, S35 Kramarski, H, S47 Kraut, A, S4 Kuhl, E, S22 Kunrath, C, S15 Ladde, J, S12, S42 Lai, J, S4, S50 Lanam, C, S22 Latimer, L, S8 Lawson, C, S45 Lei, C, S40 Leonowics, N, S48 Lewis, J, S49 Likourezos, A, S28 Lin, J, S28

Linden, J, S2 Lindstrom, H, S1 Little, A, S18 Liu, E, S22 Li-Sauerwine, S, S24 Lloyd, C, S18 Lorenzo, C, S6, S7 Love, J, S53 MacConaghy, L, S27 Maculatis, M, S2 MacVane, C, S3, S37 Madsen, T, S15 Mahar, P, S15 Malone, M, S24 Marks, L, S30, S33 Marlin, C, S10 Marshall, J, S2 Marshall, K, S10 Martinez, J, S22 Massimo, L, S5 Mead, T, S35 Medwid, K, S26 Merritt, R, S23 McCarthy, D, S8 McCarville, P, S22 McCormick, T, S15, S45 McGaghie, W, S8 McGrath, M, S37 McParlane, J, S32 McPartlin, A, S32 Miller, D, S19 Miller, P, S16 Mims, T, S7 Mlynarek, C, S48 Mogni, B, S7 Mohagheghian, H, S6 Monks, S, S43 Montrief, T, S16, S26 Moore, C, S27 Moore, Q, S33 Moreira, M, S45 Morrison, J, S29 Motes, J, S7 Muckey, E, S14 Nable, J, S26 Naemi, B, S4 Nandam, K, S24 Naples, R, S27 Nazir, N, S10 Nelson, J, S16, S29, S31 Nesheiwat, L, S24 Newell, K, S22 Nichol, J, S13 Nichols, T, S22

Volume 20, Supplement : August 2019

CORD Abstracts Special Issue - Author Index

Nobay, F, S33 Nomura, M, S48 Nordquist, E, S43 Norvell, J, S10 Novack, V, S49 Olson, A, S33, S51, S52 Olson, N, S33, S51, S52 Ostro, B, S24 Orman, R, S53 Paddock, M, S16 Paetow, G, S41 Palacios, P, S43 Palau, M, S15 Pallaci, M, S17, S53 Pan, J, S5 Papanagnou, D, S8, S27 Pareck, K, S40 Parson, C, S23 Pasichow, S, S29 Pasternack, J, S30, S33 Patineau, A, S48 Pelletier-Bui, A, S26 Perron, A, S3 Phillips, A, S5 Pierce, D, S47 Pirotte, M, S19 Piserchia, K, S8 Podlog, M, S34 Poronsky, K, S3 Powell, R, S8 Presson, A, S12 Pugh, A, S15 Rabjohns, J, S22 Reeder, S, S25 Regan, L, S50 Reynolds, C, S19, S36, S38 Riddell, J, S11, S17, S53 Rider, A, S48 Riley, N, S6 Rising, K, S8 Rodriguez, C, S27 Roosevelt, G, S15 Roppolo, L, S22 Rosen, C, S23 Rossan-Raghunath, N, S14 Roswell, K, S15 Roten, R, S13 Rotoli, J, S33 Salen, P, S6, S7 Salzman, D, S8, S19 Sander, S, S19 Sanghvi, S, S34 Sarsfield, M, S27 Sawyer, K, S12

Schnapp, B, S4 Schneider, J, S2 Schrepel, C, S26 Schroeder Hevesi, S, S31 Scott, N, S41 See, A, S17 Sekhon, R, S35 Sharon, M, S13 Shaver, E, S13 Shaughnessy, A, S12 Sheu, J, S5 Siddiqui, M, S27 Siegel, G, S38 Smith, A, S9 Smith, J, S31 Spillane, L, S30, S33 Stankewicz, H, S6, S7 Stephanos, K, S30 Stephen R, S15 Stobart-Gallagher, M, S47 Stoltzfus, J, S6, S7 Streich, H, S26 Stroud, S, S15 Strout, T, S37 Sullivan, N, S22 Sungar, W, S15, S45 Supino, M, S26 Swisher, L, S41 Tabakin, E, S38 Tabatabai, R, S11, S41 Tausch, K, S32 Thundiyil, J, S12, S42 Ticherter, A, S20 Till, D, S29 Tillman, D, S4, S50 Tsao, S, S38 Tse, A, S24 Tsyrulnik, A, S44, S46 Turner-Lawrence, D, S32 Tyler, P, S23 Ullman, E, S49 Velez, L, S22 Vo, A, S11 Quinn, S, S1 Way, D, S24 Walsh, B, S6 Walsh, K, S15 Walter, L, S9 Weber, W, S33 Weichenthal, L, S32 Weiers, A, S29, S31 Weinstock, M, S53 Welborn, R, S31 Welch, K, S27

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Westergaard, M, S4 Wexner, S, S29 Weygandt, P, S42, S46 Whitting, T, S31 Wians, R, S9 Willenbring, B, S16 Williams, S, S50 Williamson, K, S51, S52 Wills, C, S2, S48 Wivel, A, S38 Wood, B, S44, S46 Wolfe, J, S3 Wojcik, S, S27 Woster, C, S16 Wu, T, S14 Yamane, D, S22 Yarris, L, S2 Yenser, D, S1 Zaidi, H, S19 Zarzar, R, S41

Western Journal of Emergency Medicine

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Volume 20, Supplement: August 2019

Western Journal of Emergency Medicine

CORD Abstracts Issue 2019

Research Abstracts

Scholarly Tracks: Not Just for Academic Careers

DeFazio C, Lindstrom H, Canavan J / University at Buffalo, Buffalo, New York Background: Scholarly tracks are effective tools for developing residents’ academic skills and preparing them for a career in academia. Scholarly tracks’ impact is less well understood on those pursuing careers in community settings. Objectives: Explore scholarly tracks’ impact on residents’ employment and career paths. Methods: The University at Buffalo EM (UBEM) residency program director emailed 2012-2018 program graduates and invited them to participate in an anonymous 9 item Google survey. Results: Of the 83 graduates contacted, 57 responses (69%) were received. The most frequently completed scholarly tracks were ultrasound (43.9%) and EMS (24.6%). Respondents agreed scholarly tracks added value to their working skill set (96.5%), and 80.7% reported using the skills in their current job. Respondents were asked about (52.6%) and brought up scholarly track experience to gain a competitive advantage (66.7%) during job interviews. Nearly half (49.1%) reported potential employers implied scholarly tracks added value to their job candidacy. Half (52.6%) felt their scholarly track gave them an advantage securing their first job. A majority (62.5%) obtained a first job in a non-academic, community setting. Responses were compared for those in community vs. academic jobs. Almost all community respondents (97.1%) and academic respondents (95.2%) reported scholarly tracks added value to their working skill set, and they were using the skills (community: 77.1%; academic: 85.7%). Those respondents whose first job was in an academic setting were more likely to perceive that their scholarly track experience gave them an advantage in securing their job (71.4%) vs. those in a community setting (40.0%). Conclusions: Survey respondents who graduated from the UBEM Residency program reported scholarly track experiences added value to their working skill sets. Respondents were asked about and discussed their scholarly track experience during job interviews, and nearly half reported they perceived the tracks added value to their candidacy. While the perceived value of scholarly tracks appeared to be more evident in an academic setting, there is still perceived value for graduates heading into the community setting.

The Anticipated Negative Impact On Emergency Medicine Faculty Of The New ACGME Common Program Requirements

Quinn S, Kane B, Goyke T, Yenser D, Greenberg M, BarrJR, G / Lehigh Valley Health Network, University of South Florida Morsani College of Medicine, Bethlehem, Pennsylvania Background: EM residencies are regulated by Program Requirements from the EM RRC. These must comply with the Common Program Requirements (CPR) established by the ACGME. In 2018, the ACGME issued new CPR that altered the definitions for core faculty. Objectives: To determine, via EM faculty perceptions, the impact of the new CPR on their well-being and job satisfaction. The faculty were asked to anticipate the impact on the educational experience of residents. Methods: A 7-question electronic survey was iteratively developed. After CORD approval, it was distributed using the listserve. Responses were either dichotomous (Yes/NO) or on a 1 (No Impact) to 10 (Maximum Negative Impact) Likert scale and were analyzed descriptively. A single open-ended question was analyzed qualitatively. Results: There were 212 responses. Program Directors (79) and their Associates/Assistants (81) were the majority. Core

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Western Journal of Emergency Medicine

CORD Abstracts Issue 2019 faculty (46) and administrators such as Chairs (7), Vice Chairs (8) and Research Directors (7) also responded. 21 responded “other”, of which the majority were Clerkship Directors (9). Likert responses are reported in Table One. 214 (97.14%) stated that the loss of protected time would impact their ability to perform their jobs. Table 2 summarizes the 94 open-ended responses. Negative impact to stated core ACGME values such as the educational environment, scholarly output, resident evaluation/remediation, and the patient care environment were all noted. Conclusions: The self-reported anticipated impact by EM faculty concerning the ACGME changes to the CPR appear mostly negative. The overwhelming majority of respondents anticipate a very strong negative impact from these changes on their job satisfaction, their personal well-being, and the experiences of their residents in training. Particularly concerning are their reported potential for negative impact on their ability to perform their academic duties for their residents and their unwillingness to continue their current positions considering these changes. Table 1. Self-reported impact of Accreditation Council for Graduate Medical Education Common Program requirement changes.

Table 2. Qualitative analysis and selected responses.

CCC, clinical competency committee.

Western Journal of Emergency Medicine

Do Personality Characteristics Vary by Gender in Emergency Medicine Residents?

Jordan J, Maculatis M, Linden J, Schneider J, Hern H, Marshall J, Wills C, Friedman A, Yarris L / UCLA, Ronald Reagan UCLA Medical Center, Los Angeles, California; Kantar Health, New York, New York; Boston University School of Medicine, Boston, Massachusetts; Alameda Health System - Highland Hospital, Oakland, California; Maimonides Medical Center, Brooklyn, New York; J3Personica, Eatontown, New Jersey; Oregon Health and Science University, Portland, Oregon Background: Understanding and assessing trainee personality characteristics may be helpful to medical educators and program leadership in a variety of applications, including specialty advising, residency selection, faculty selection, mentoring, coaching, and remediation. Objectives: This study aimed to understand gender differences in personality characteristics of emergency medicine (EM) residents. Methods: In this cross-sectional study, a convenience sample of residents (N=140) at five EM residency programs in the United States (U.S.) completed three personality assessments: the Hogan Personality Inventory (HPI)– describing usual tendencies, the Hogan Development Survey (HDS)–describing tendencies under stress or fatigue, and the Motives Values and Preferences Inventory (MVPI)– describing motivators. Independent-samples t-tests were performed to examine differences between male and female EM residents across programs. To evaluate the magnitude of sex differences, standardized effect sizes (Cohen’s d) were estimated, using the thresholds reflecting small (d≤.20), medium (d=.50), and large (d≥.80) mean differences. Results: One hundred forty (100%), 124 (88.6%), and 121 (86.4%) residents completed the HPI, HDS, and MVPI respectively. T-test results comparing male and female EM residents on all personality measures are displayed in Table 1. For the HPI, male EM residents scored significantly higher than females in Inquisitiveness (M=67.6 vs. M=47.7, p=.001) and Sociability (M=67.2 vs. M=49.9, p=.004). In contrast, female residents scored significantly higher than males in Prudence (M=48.3 vs. M=32.5, p=.03). Effect size estimates, which ranged from d=.55 to d=.88, indicated that sex differences on these three measures were moderate to large in magnitude. No sex differences were found for the remaining four HPI scales or on any of the HDS and MVPI scales. Conclusions: Our findings suggest that, while male and female EM residents scored similarly on most personality traits, stress tendencies and motives, male residents may be more likely to engage in strategic thinking and to be socially proactive, whereas female residents may have a greater tendency to be organized and dependable. S2

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CORD Abstracts Issue 2019 Table 1. Sex Differences in Personality Scale Scores.

Speaker Training Pilot Program for Women in Health Care Decreases Fear of Public Speaking

Wolfe J, Deutsch A, Poronsky K, Hoadley D / Baystate Medical Center, Springfield, Massachusetts Background: Effective and engaging public speaking is a skill that facilitates academic advancement in healthcare by increasing name recognition as a source expert and creating networking and collaborating opportunities. Studies suggest that female speakers are under-represented in academic settings and face unique challenges in developing speaking skills. To address this problem, our institution’s resource group “Women Advancing and Achieving in Medicine” piloted a women’s speaker training program. Objectives: This study aims to assess feasibility, value to participants, and effectiveness in encouraging public speaking. Methods: Participants were nominated by department chairs to attend a 6-month program created in collaboration with Speaker Sisterhood, a network of speaking clubs for women. Sessions included didactics, speaking exercises and immediate group feedback, culminating in a final videotaped speech by each participant. Participants completed a before and after validated survey “Personal Report of Communication Apprehension” (PRCA_24). Qualitative reported value to participants was documented in their final videotaped session. Non-parametric Wilcoxon Ranks Signed tests were run in conjunction with descriptive statistics using SPSS software. Results: 28 participants registered for the program, 57.7 % being attending physicians and the remainder trainees or advanced practitioners. Over 70% of participants reported professional advancement as motivation to attend. 16 completed the pre and post-survey PRCA-24. Post-program scores (55.5, IQR 53.75-63.25) were statistically significantly lower than pre-program scores (65, IQR 58.75-66.5). Conclusions: This pilot women’s speaker training program resulted in decreased apprehension around public speaking among our participants. Participants reported the program gave them in increased comfort in teaching that may lead to career advancement.

5 HDS, Hogan Development Survey; HPI, Hogan Performance Inventory; MVPI, Motives, Values, Preferences Inventory. ns=34 to 37 males; ns=25 to 31 females. Scores on each measure could range from 0-100%. Degrees of freedom are shown in parentheses.

When Less is More: A Novel Strategy for Improving Resident Evaluations

MacVane C, Perron A / Maine Medical Center; Tufts University School of Medicine, Portland, Maine Background: Residency programs from all specialties, including Emergency Medicine (EM) frequently have difficulty obtaining a sufficient amount of meaningful feedback

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Western Journal of Emergency Medicine

CORD Abstracts Issue 2019 on residents. This burden increased with the adoption of the ACGME Milestones in 2013, when EM programs were tasked with obtaining data on 23 Milestones for each resident. With persistently low evaluation numbers we decided to implement a new strategy to improve feedback received. Objectives: We sought to determine whether asking faculty to complete less evaluations per month would paradoxically result in increased quality and quantity of resident evaluations we received. Methods: Historically in our program, we asked each faculty member to evaluate all the residents rotating through the Emergency Department each month (approximately 15 residents per month). Starting in July 2016, we asked each faculty member to provide meaningful feedback on only 3 residents per month. Completion of 36 evaluations at the end of the academic year was tallied and tied to faculty compensation. Results: In the academic year before the intervention we received 469 evaluations on 24 residents, for an average of 19.5 evaluations per resident. Post-intervention we received 1019 evaluations on 26 residents, for an average of 39.2 evaluations per resident. Pre-intervention no faculty completed the targeted number of evaluations. Postintervention, 59.4% of faculty completed the expected number of evaluations. Conclusions: Giving EM faculty physicians a clear, achievable metric for the number of evaluations they are expected to complete can result in a significantly increased number of evaluations. This effect is seen even with a low target such as demonstrated in our study. The strategy we used could easily be translated to other residency programs and specialties.

Examining the Relationship Between the AAMC Standardized Video Interview and Step 2 Cs Subscores

Naemi B, Clauser A, Fair M / Association of American Medical Colleges, Washington, DC; National Board of Medical Examiners, Philadelphia, Pennsylvania; George Washington University/AAMC, Washington, DC Background: The Association of American Medical Colleges (AAMC) Structured Video Interview (SVI) is an assessment tool designed to measure interpersonal and communication skills and professionalism, two competencies identified by the Accreditation Council for Graduate Medical Education (ACGME) as critical when considering information about residency applicants. Step 2 CS of the USMLE is designed to assess the applicantâ&#x20AC;&#x2122;s patient centered skills including communication. As both the SVI and CS attempt to measure related competencies, demonstrating that the SVI positively relates to the relevant subscore of the Step 2 CS will bolster the validity case for the SVI as a valuable tool for

Western Journal of Emergency Medicine

residency selection and contribute to the nomological network for residency selection tools in emergency medicine. Objectives: The goal of the study is to examine the relationship between scores on the SVI and subscores for the Step 2 CS Exam. We expect SVI will have the strongest relation to the CIS (Communication and Interpersonal Skills) subscore, and the weakest relation to the SEP (Standardized English proficiency) subscore. Methods: This is an observational retrospective study of existing data for 2201 residency applicants in 2017 who had both valid Step 2 CS subscores and SVI scores. We obtained data for the full population of 2017 residency applicants with both scores and examined Pearson correlations between each of the three subscores and SVI total score. Results: SVI total score and Step 2 CS subscores exhibited sufficient variance for prediction. SVI was correlated at r = .16 with Step 2 CIS score, r = .13 with Step 2 Integrated Clinical Encounter (ICE) score, and r = .10 with Step 2 SEP score. Conclusions: There is a small positive correlation between the SVI and each Step 2 subscore. As hypothesized, the strongest relation is between the Step 2 CIS score and SVI, and the weakest relation is between the Step 2 SEP score and SVI. Although these correlations are small, they are in line with reported correlations in the employment and educational literature for personality and non-cognitive competencies, which are generally more difficult to assess. Further research should examine the predictive validity of selection tools for emergency medicine with additional outcome variables.

Graded Responsibility Among Emergency Medicine Residency Programs

Lai J, Tillman D, Kraut AS, Schnapp BH, Hess J, Westergaard M / University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin Background: The ACGME requires all residency programs to provide increasing autonomy as residents progress through training, known as graded responsibility. However, there is little guidance on how to implement graded responsibility in practice and a paucity of literature on how it is currently implemented among emergency medicine residency programs. Objectives: We sought to elucidate which domains of practice are subject to graded responsibility among EM residency programs and what factors are used to determine a residentâ&#x20AC;&#x2122;s progression within each domain. We hypothesized that postgraduate year is the most commonly applied factor in determining graded responsibility. Methods: A 23-question web-based survey was created, assessed for response process validity, and distributed by

Volume 20, Supplement : August 2019

CORD Abstracts Issue 2019 email to 162 ACGME-accredited EM residency program directors from April through October 2018. Names and email addresses were obtained from the CORD mailing list and programs’ public websites. Responses were manually screened for duplicate entries from the same program, and only the most recent response was recorded. Results: We received 91 individual program responses (56% response rate) to the survey. Graded responsibility was utilized for intubating trauma patients by 54% of programs, managing critically ill trauma patients by 60% of programs, managing critically ill medical patients by 30% of programs, acting as physician-in-triage by 50% of applicable programs, supervising medical students by 68% of applicable programs, supervising junior residents by 50% of applicable programs, and moonlighting by 91% of programs. When graded responsibility was applied to a domain of practice, PGY level was ranked an “extremely important” or “very important” factor between 81% and 100% of the time, more frequently than any other factor. Conclusions: There is no clear prevailing pattern to whether EM residency programs are utilizing graded responsibility for most surveyed domains of practice. When graded responsibility is applied, PGY level is consistently the most important factor in determining progression. While competency-based educational models such as milestones and entrustable professional activities (EPAs) appear to be a major feature in the future direction of graduate medical education, EM residency programs still rely heavily on a time-based learning model.

Table 1. Utlization of graded responsibility among surveyed emergency medicine residency programs.

Learning Experience Design (LED) in Health Professions Education: A Critical Review

Pan J, Sheu J, Massimo L, Phillips A / Baylor College of Medicine, Houston, Texas; University of North Carolina Hospitals, Chapel Hill, North Carolina Background: Internet-based learning (IBL) technologies have become increasingly prevalent in medical education, particularly in Emergency Medicine and Critical Care. Studies have shown learner preference towards IBL, emphasizing the importance of optimizing these platforms. Learning experience design (LED) is an approach aimed to enhance the learning experience in order to improve performance. This strategy can be applied to IBL in order to optimize learning outcomes. Objectives: To critically evaluate current literature to identify optimal design features for text and media presentation in IBL technology. Methods: Articles for this review were located using the PubMed database, followed by hand tracing of the initial search results. Exclusion criteria included studies that used CRT monitors, Kindle PaperWhite, or non-adult learners, and descriptive articles without comparisons. Results: 42 articles were included with the following results (Table 1). Larger character sizes had greater legibility, shorter reading time, higher reader preference, lower mental workload, and greater accuracy. Veranda and Arial typefaces had greater legibility, higher reader preference, and lower mental workload than Times New Roman. Reading accuracy was unchanged with color and decreased with case enhancement. Boldface and font smoothing enhancements improved, while italics worsened legibility. Font smoothing also had higher reader preference and lower mental workload. Positive polarity increased legibility, reader preference, and outcomes. Greater glare increased learner fatigue, but did not have impact on performance. Greater luminance increased performance, although may be screen contrast dependent. Increased interletter spacing lead to slower reading times, but improved performance, while increased interword spacing lead to faster reading times with variable impact on outcome. Longer line lengths resulted in faster speed, yet poorer accuracy and reader preference. Accuracy was greatest with RSVP display, while reading time was fastest with scrolling display.

Table 2. Factors rated as “extremely important” or “very important” in determining progression of graded responsibility.

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CORD Abstracts Issue 2019 Conclusions: Recommendations for optimal reading performance for IBL technologies include 14 point font size, Veranda or Arial typeface, font smoothing, positive polarity, increased interletter spacing, and shorter line lengths. Table 1. Summary of design features and learning outcomes.

A Novel and Well-Received Process for Tracking the ACGME 15 Key Index Procedures

Mohagheghian H, Fiesseler F, Walsh B, Esposito A, Riley N, Biggs D / Morristown Medical Center, Morristown, New Jersey Background: The ACGME has created minimum procedural requirements for graduation. Tracking of these procedures is cumbersome and fraught with inconsistencies. A simplified means for residencies to track procedures is needed. Objectives: We sought to implement a simplified tracking system and determine how residents viewed this Procedural Achievement Count Evaluation (PACE) score to track procedural progress vs a traditional counting method. Methods: The setting was a three-year ACGME-approved residency with 25 residents and an annual census of 96,000. We performed a prospective analysis of a procedural tracking system using residents’ progression. Data were imported from New Innovations into a Google spreadsheet. The total number of procedures required for each procedure was divided by Western Journal of Emergency Medicine

36 (total months of residency) and then multiplied by the resident’s month of residency, creating an expected number of procedures that a resident should have completed at that specific time. We calculated this number for each of the resident’s 15 core procedures. We termed this the PACE score. Residents can be 1) below the PACE (too few procedures for level of training); 2) at PACE (at the expected number for level of training); or 3) above PACE (exceeding the expected number for level of training). The cumulative resident PACE score spreadsheet was distributed to all the residents. Subsequently, we analyzed the perception of residents on this scoring system. We used a chi-squared test on the proportions along with differences and calculated 95% confidence interval (CI). Results: All 25 residents completed the evaluation, of whom 72% (N=18) were male. One additional resident resided in the PGY3 year. Sixty-eight percent of residents said that the PACE score was more beneficial than a count of procedures, compared to 8% who said it was less beneficial (Difference 60%, 95% CI, 34-76; p<0.0001). Thirty-six percent said that seeing other residents’ PACE scores was motivating, compared to 8% who said it was not motivating (Difference 28%, 95% CI, 5-48; p<0.05). Ninety-six percent of residents said that they were neutral or not offended by having their PACE scores shared with the other residents compared to one resident (4%) who said he or she was “slightly offended” (Difference 92%; 95% CI, 70-97; p<0.0001). Conclusion: Calculating a PACE score is an easy way to track residents’ procedural progress, and it is motivating and well-received by residents.

Impact of an Emergency Department Resident Sign-Out Checklist on Attending Assessments of Quality

Lorenzo C, Stankewicz H, Healy B, Stoltzfus J, Salen P / St. Luke’s University Health Network, Bethlehem, Pennsylvania; St. Luke’s Temple School of Medicine, Bethlehem, Pennsylvania Background: Education and assessment of transition of care during emergency department (ED) shift change constitute essential elements of emergency medicine (EM) training. Objectives: To determine if using a sign-out (SO) checklist (CL) resulted in improvement in the quality of transfer-of-patient responsibilities and impacted the consistency of attendings’ assessments. Methods: Oncoming and departing attending physicians prospectively assessed EM residents’ unstructured morning SO for 38 consecutive days. They then assessed their CLguided, structured, morning SO over the subsequent 39 days. Assessments included SO duration, SO patient quantity, SO quality visual analog scores (VAS), patient management issues, and oncoming and departing attending interobserver agreement. Results: Oncoming and departing attendings made 548 S6

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CORD Abstracts Issue 2019 assessments for non-checklist (NCL) SO and 697 for the CL cohort. Increasing numbers of SO patients correlated with increased SO duration (Pearson r = 0.74, P < 0.0001). CL did not impact the mean number of SO patients per minute (CL mean ± standard deviation [SD] = 0.86 ± 0.31, NCL mean ± SD = 0.86 ± 0.23). VAS assessment of SO improved to 8 (range 2.5 to 10; P < 0.0001) for CL compared to 7.5 (0.5 - 0.95) for NCL. Important aspects of SO improved with implementation of CL (see Table): tasks, disposition, and necessity of attending clarification. Overall, comparison of oncoming and departing attending physician global assessment SO scores manifested low interobserver agreement (intraclass correlation coefficient = 0.39;, 95% confidence interval,CI -0.26 to 0.70). Oncoming and departing attendings perceived significantly improved SO global VAS assessments for the CL cohort (CL mean ± SD = 8.3 ± 0.55;, NCL mean ± SD = 7.0 ± 1.2; P < 0.0001 and CL mean ± SD = 7.6 ± 1.1;, NCL mean ± SD = 7.0 ± 1.1; P = 0.05, respectively). Conclusion: Although assessments demonstrated inconsistent interobserver agreement, CL utilization improved oncoming and departing attendings’ perceptions of residents’ SO quality compared to unstructured SO. Table. Impact of checklist on sign-out (SO) quality.

standards. National Board of Medical Examiners (NBME) subject exams in other core clerkships suggest students’ medical knowledge improves with increased clinical exposure. Consequently, no M3 EM-specific grading tool exists for this student cohort. At our institution, Entrustable Professional Activities (EPA) have been adopted for M3 clerkship evaluations, yet have not been longitudinally studied in relation to EM student performance. Objectives: In absence of an M3 NBME exam to assess EM learners’ development, this study reviewed M3 EPAs over one academic year. We hypothesized that EPA scores would improve temporally as students gained more clinical experience. Methods: This was an observational, retrospective review of 123 students rotating in three EM clerkship blocks from July 2017–June 2018 at the University of Kentucky. Standardized EPA scoring on a scale of 1-4 (graded 65%, 75%, 85% ,and 95% respectively) for differential diagnosis, diagnostic plan, and oral presentation were reviewed for every patient encounter-based faculty evaluation. Faculty and students were instructed on grading criteria prior to clerkship. Results: Of 2917 total EPA scores reviewed, 81 did not receive grades and were excluded from analysis. One EPA was excluded due to an absent faculty signature. We analyzed the remaining 2835 EPAs by rotation block. Statistically significant differences were found for all assessment categories and overall average scores. The mean differential diagnosis scores for rotations 1-3 were 3.11, 3.13 and 3.25, respectively. Conclusion: Our results suggest that overall student clinical EPA evaluations increased over time during the M3 year as well as within the individual categories of differential diagnosis, diagnostic plan, and oral presentation. Further study is needed to identify comparability at other institutions as well as the influence of M3 clerkship experiences prior to the EM rotation.

12 VAS, visual analog scores; SD, standard deviation; cm, centimeters.

Retrospective Review of Third-Year Medical Students’ Clinical Evaluations via Entrustable Professional Activities

King K, Mogni B, Dugan A, Black D, Mims T, Motes J, Bronner J /University of Kentucky, Lexington, Kentucky Background: Emergency medicine (EM) is not a required third-year (M3) clinical clerkship for medical schools per Liaison Committee on Medical Education accreditation

Impact of Ambient Background Noise on Sign-Out in the Emergency Department

Lorenzo C, Stankewicz H, Healy B, Stoltzfus J, Salen P / St. Luke’s University Health Network, Bethlehem, Pennsylvania; St. Luke’s Temple School of Medicine, Bethlehem, Pennsylvania Background: Elevated emergency department (ED) noise levels can impact physician communication during physician sign-out (SO). Objectives: To assess the impact that time of day, background music, background discussion, and SO have on ambient noise in an emergency department’s physician charting area. Methods: This prospective observational study monitored ambient noise levels in an emergency physician charting area

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CORD Abstracts Issue 2019 at various times during the day (7 am - 3 pm), evening (3 pm 11 pm), and night (11 pm - 7 am) shifts using a cellular phone sound-level monitor app (Decibal X application by Skypaw, Hanoi, Vietnam). A research assistant and two physicians collected a convenience sample of noise measurements in decibels (dB) of a physician charting area over a 36- day period. Monitoring of SO noise measurements occurred within one meter of SO physicians; non-SO noise measurements were made centrally in the charting area. SO data collected also included duration of SO and number of SO patients. Results: The 358 ambient noise measurements demonstrated that day (66.6 dB ± 3.9, n = 104) and evening (65.3 dB ± 4.7, n= 175) shifts generated more noise than night shifts (57.8 dB ± 8, n = 79; P = 0.05). Background music (BM) in the charting area resulted in higher mean ambient noise levels during physician SO: BM 65.6 dB ± 7.4, n = 14 vs no BM 55.4 dB ± 7.8, n = 65; P < 0.001. Background discussion (BD) in the physicians’ charting area resulted in higher mean ambient noise during physician SO: BD 67 dB ± 6.5, n = 23 vs 53.2 dB ± 5.8, n = 55; P < 0.001. Higher decibel volumes correlated with longer SO duration (rho = -0.41; p < 0.001) and higher numbers of SO patients (rho = -0.56; P < 0.001). SO impacted mean ambient noise: SO 60 dB ± 8.7, n = 97 v. non-SO 65.5 dB ± 4.4, n = 261; P < 0.0001. Conclusion: Time of day, BM, BD, and physician SO impact ambient noise levels in a physician charting area. Higher ambient noise levels correlate with longer physician SO and increased numbers of SO patients.

Setting a Minimum Passing Standard for the Uncertainty Communication Checklist Through Patient and Physician Engagement

competency when conducting an emergency department (ED) discharge conversation in the setting of diagnostic uncertainty. Methods: Emergency medicine residency program directors (PD) were solicited via email, with a goal of recruiting a diverse sample based on both geography and residency program length (three years or four years). English-speaking adult (> 17 years) patients recently discharged from the ED at Northwestern University or Thomas Jefferson University with a non-pathologic discharge diagnosis also were recruited. PDs participated as judges in one of four teleconference calls; patients participated in one of four in-person focus groups. Physicians and patients participated in setting a MPS using the Mastery Angoff method. The MPS for the physician and the patient panels were independently calculated. Results: Thirteen PDs and 25 patients completed MPS setting procedures. Participant characteristics are reported in Tables 1 and 2. The patient-generated MPS was 84.0% and the physician-generated MPS 88.2%. Conclusion: With similar instruction, both patients and PDs completed the standard-setting task. The scores set by both groups suggested similar expectations of proficiency for the residents to achieve “mastery.” Applying the calculated MPS to the checklist resulted in the patients accepting 18/21 items correct to pass as opposed to the physicians, who had higher expectations of 19/22 items correct. Inclusion of patient perspective is vital for assessing patient-centered care delivery, yet standardized approaches for including patient assessments are limited. Our work suggests a novel and feasible approach for including patients as assessors of resident competency in patient-centered tasks.

Table 1. Program director (PD) demographics.

Salzman D, Rising K, Cameron K, Powell R, Papanagnou D, Doty A, Piserchia K, Latimer L, McGaghie W, McCarthy D / Northwestern University, Feinberg School of Medicine, Chicago, Illinois; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; Northwestern University, Feinberg School of Medicine, Chicago, Illinois Background: Mastery learning (ML), a form of competency-based medical education, has been successfully implemented to improve clinical skills in a variety of domains. A critical step in ML curriculum creation is establishing a defensible minimum passing standard (MPS) score, which has historically been done by medically-trained experts. As ML expands from procedure-based skills to patient-centered domains, such as communication, there is opportunity to incorporate patients as judges in MPS procedures. Objectives: To compare physician- and patient-generated MPS scores for a checklist designed to assess physician

Western Journal of Emergency Medicine

*PDs listed more than one specialty and board certification.

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CORD Abstracts Issue 2019 Table 2. Patient demographics.

expert review were performed on reviewer discrepancies and provided by a designated “SGBM Task Force Committee,” which included an SGBM EM faculty expert. Results: The majority of faculty members, 22 (88%), submitted 77 lectures (92.7%) for SGBM audit. Roughly half (53%) of applicable lectures included SGBM material. Of the included SGBM data the majority (77%) referred to epidemiology, while fewer lectures mentioned or considered SGBM as it pertained to risk factors (26%), presentation (13%), treatment (8%), or prognosis (5%). Of the nearly half (47%) of applicable lectures that did not include SGBM data, 37% were identified as “missing” relevant SGBM material based upon expert and literature review. The majority (77%) of “missing” SGBM material was EM specific, while a lesser amount, (23%), pertained to medicine in general and was not EM specific. Conclusion: Despite SGBM’s importance as a first step toward personalized medicine, EM residency education is lacking in its inclusion. This creates significant opportunities for increased awareness and expansion of the EM graduate medical education core curriculum with the aim to improve SGBM-based residency education and, ultimately, patient care.

*At least one participant declined to answer.

Sex and Gender Education in Emergency Medicine: A Residency-Based Curricular Audit

Smith A, Wians R, Hanback S, Fowler A, Edwards A, Walter L / University of Alabama at Birmingham, Birmingham, Alabama Background: Sex- and gender-based medicine (SGBM) embraces the role that sex (biological designation) and gender (social construct) plays in every aspect of clinical medicine. SGBM, however, tends to be excluded from modern medical education and consequently not routinely integrated into practice. This educational gap is also thought to extend to emergency medicine (EM), a subspecialty uniquely situated at the juncture of a variety of medical disciplines and exceptionally positioned to implement SGBM medicine acutely. Objectives: To review core EM residency didactic curriculum material for inclusion of SGBM material and, when present, define the type of inclusion. Methods: A convenience sample of the previous 18-month curriculum from the University of Alabama at Birmingham (UAB) EM Residency Program (July 2016–December 2017) was audited by two independent reviewers for inclusion of SGBM material. “SGBM inclusive” material was then further categorized as pertaining to “patient presentation,” “epidemiology,” “risk factor,” “management/care,” and/or “outcome.” Academic faculty (25) were solicited for voluntary submission of their didactic material (PowerPoint presentations, slidesets, etc). Oversight and

Figure 1. Inclusion of sex- and gender-based medicine (SGBM) data in University of Alabama at Birmingham (UAB) lectures.

Figure 2. Stratification of University of Alabama at Birmingham (UAB) lectures not including sex-and gender-based medicine (SGBM) data. EM, emergency medicine.

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Table. Non-parametric Wilcoxon test.

Current Emergency Medicine Resident Knowledge of Community Resources and the Impact of Structured Community Resource Visits

Norvell J, Dangers J, Marshall K, Nazir N, Marlin C / University of Kansas Medical Center, Kansas City, Kansas Background: Ensuring safe discharge plans for patients is a critical and complex part of emergency medicine (EM). Emergency physicians are required to align the needs of underserved patients with an array of community resources. Despite their crucial role, the capabilities of these resources may be poorly understood by emergency physicians and residents. Objectives: To evaluate our EM residents’ current knowledge of community resources and evaluate their knowledge after structured community resource visits. Methods: We conducted a 12-item pre-visit survey using a five-point Likert scale (1 = strongly disagree, 3 = neutral, 5 = strongly agree) on the residents’ current knowledge of community resources in general, knowledge about specific community resources, and interest in learning more. Next, we conducted visits to several community health partners: a safety net clinic; a drug rehabilitation center; a mental health center; and the area’s largest homeless shelter. During transportation to each site, emergency department social workers spoke with residents regarding the role each center plays in safely discharging our patients. This information was supplemented with a tour and a question-and-answer session with staff at each location. A similar 13-item post-survey was administered at the end of the visits. Results: Twenty of 24 residents participated in the community resources visits: 20/20 completed the previsit survey, and 19/20 completed the post-visit survey. Residents significantly improved their understanding of community resources after the visit (p<0.0001) and significantly improved their understanding of how long it takes for patients to access community resources (p<0.0001). All residents either agreed or strongly agreed that they learned important information from the community resource visits that will help them take better care of patients. Eighteen of 19 agreed or strongly agreed that they enjoyed the opportunity to visit the safety net clinics. (One was neutral). Conclusion: Providing residents with structured visits to community resources provides them an enjoyable experience, greatly increases their knowledge and understanding of these very important resources, and allows them to deliver better patient care.

Western Journal of Emergency Medicine

Viewing Trends in Emergency Medicine Residency Program Websites

Chhabra N, Dyer S / Cook County Health and Hospital System, Chicago, Illinois Background: Emergency medicine residency programs use program-specific websites with multiple goals including highlighting curriculum, providing information for applicants, and supplying relevant contact information. Little is known, however, regarding how often these websites are accessed and for what purposes, particularly around residency interview season. Objectives: To describe trends in program website visits that can be used to create a schedule for website updates in order to relay up-to-date information to potential applicants. Methods: Statistics regarding website access information from one ACGME-accredited postgraduate year 1-4 large, urban EM residency program website was compiled retrospectively using SquareSpace analytics over the period July 1, 2016 – June 31, 2018. We specifically analyzed the annual top five most-visited dates, along with daily trends during the residency interview season (October – February). Additionally, we described the most frequently viewed sections, methods of visit (tablet, desktop, mobile device), and source of viewership. Results: Over the 24-month study period, there was an average of 56.2 visits/day including 267.4 pageviews/day: 67% of all visits were via desktop, 30% via mobile device, and 3% via tablet. Google search accounted for 49% of visits, direct url entry for 42%, and Bing search for 3%. The vast majority of visits (94%) originated from the United States with less than 1% from each of Canada, India, Korea, the United Kingdom, and Russia. The most popular content by pageview were “people”(72,542), “home page” (41,442), “clinical curriculum” (37,346), and “medical students” (15,314). The five most-visited dates are all related to various medical student submission processes. During interview season, peaks occurred on the dates immediately preceding an interview date.

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CORD Abstracts Issue 2019 Conclusion: Peak access to the residency website occurred during scheduled events involving medical student and residency applicants, such as ERAS application opening, Match Day, Visiting Student Application Service applications, and the day before interview sessions. While most visits were via desktop computer and search engines, a large percentage were via mobile device. Website managers should use these dates to establish scheduled updates to content and ensure access is enabled via mobile devices as well as desktops.

been briefly examined in other specialties; however, the specific stressors that characterize emergency medicine (EM) training may lead residents to perceive burnout differently. As such, exploring the ways in which EM residents conceptualize burnout can provide a richer understanding of their experience to guide future, targeted wellness interventions. Objectives: We aimed to describe EM resident experiences with burnout and compassion fatigue to better inform the development of specialty-specific wellness interventions. Methods: We performed a qualitative thematic analysis as part of a broader study involving a wellness intervention implemented at an academic EM residency program. We conducted three, one-hour semi-structured focus groups between May–June 2018. A subset of interview questions explored resident definitions and perspectives on burnout and compassion fatigue. Drawing from elements of a constructivist grounded-theory approach, three authors (AJ, RT, JR) analyzed the first transcript in an iterative manner. One author (AJ) then analyzed the remaining two transcripts. Results: After thematic analysis, we identified 10 themes. Conclusions: Residents viewed compassion as a finite resource limited by emotional exhaustion and concerns for self-preservation. Their experience with burnout included overwhelming pessimism, lack of self-care, and mood dysregulation as well as reflection on a loss of career fulfillment. They often recognized burnout when it manifested outside of their clinical duties, impacting their home and family life. Table 1. Thematic analysis of emergency medicine residents’ perceptions of burnout.

“I Have Nothing Else to Give”: A Qualitative Exploration of Emergency Medicine Residents’ Perceptions of Burnout and Compassion Fatigue

Jain A, Tabatabai R, Vo A, Riddell J / Keck School of Medicine at USC, Los Angeles, California Background: Resident physicians experience high degrees of burnout and compassion fatigue. Attempts to assess burnout using questionnaires are plagued by significant heterogeneity in defining burnout and may insufficiently capture the complexities of the resident experience of burnout. Qualitative studies examining how residents conceptualize burnout have

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Improving Residency Didactics Through Interdisciplinary Query

Sawyer K, Carlson M, Fix M, Presson A / University of Utah, Salt Lake City, Utah Background: For optimal care of emergency department patients, emergency medicine (EM) providers must stay current with a variety of specialties practice patterns. It is unclear how providers in other specialties perceive emergency care and how EM providers can be best equipped to stay current in the management of specialist patients. Objectives: To query consultants at our institution regarding the clinical areas of EM in which EM providers needed improvement with regard to the workup, treatment, consultation, follow-up and referral of their patients. Methods: We sent an electronic surgery to all residents and program directors (PD) at our institution. Participants were asked to rate EM providers on a six-point scale regarding how appropriately patient care was provided in specific clinical areas and on a four-point scale regarding how appropriately consultations, follow-ups, and referrals were performed. Results: A total of 130 participants completed our survey. We analyzed questions based on the following: level of training (postgraduate year (PGY) 1; 13%; PGYs 2, 3, 4. 53%; and PGY 5+ and faculty; 34%); specialty groups (hospital based (HB) 12%, medicine (M) 15%, medical specialties (MS) 33%, obstetrics 8%, pediatrics (P) 9%, and surgery (S) 39%). The means scores for clinical care of patients were highest from HB (4.3) and OB (4.2). S reported that clinical knowledge of EM providers needed more improvement compared to all other groups (mean=3, p=0.02). Similarly, the mean score for the workup of S patients was significantly lower compared to other groups (mean S = 2.5 vs P = 4.5, all others = 4, p = 0.02). Mean scores for management of referrals across specialities and years of training were rated as needing the most improvement (mean = 2) compared to followup and consults (mean = 3). Conclusions: A multidisciplinary survegery of all residents and PDâ&#x20AC;&#x2122;s revealed that consultants feel EM providers need the most improvement in management of patients sent for referrals. Surgical clinical knowledge also stood out as an area of needed improvement. This information can be used to target specific areas within our didactic curriculum to bolster knowledge and management gaps as well as strengthen alliances across specialties.

Background: Self-learning is an important adjunct to traditional didactic emergency medicine (EM) education and one widely adopted by residency programs nationwide. Best practices are established by the CORD Individualized Interactive Instruction (III) Task Force with regard to national and regional meetings, simulation, and Free Open Access Medical Education (FOAMed). Objectives: To evaluate whether type and total active selflearning/III utilization changed over a five-year period in five consecutive academic-year cohorts, and if this correlated with in-training examination (ITE) scores. Methods: We performed this retrospective cohort study at an academic Level I trauma center with an ACGME-accredited EM residency program. The residency program maintains a bi-weekly, 2.5 hour didactic day and encourages residents to participate in III. We collected data from a dataset of resident III submissions that were approved and logged by a program coordinator. The study population included EM residents who successfully graduated in the preceding five years and were divided into five cohorts by academic year from 2014-2018. We collected data from postgraduate years (PGY) 1-3 for each resident. No residents were excluded from selected classes. We performed analysis to evaluate trends in utilization and correlation with ITE during this time period. Results: We included a total of 71 PGY 1-3 residents in the study: 15 from the 2014 clas; 14 from each academic class 2015-2018. Consecutive means from 2014 to 2018 demonstrated an increase in total residency III hours. Mean FOAMed use increased greatly from 2014-2018. National and local conference III submissions increased in the two most recent academic cohorts. The Pearson correlation coefficient for total residency III hours, retrospective lecture III and FOAMed III compared to PGY-3 ITE scores was -0.16, -0.11, and -0.10, respectively. These correlations were strongest in the PGY-1 year. Conclusion: Mean total utilization of III in academic cohorts shows increasing use in five academic year cohorts. FOAMed III use has drastically increased in the most recent two academic year cohorts. Total III residency hours, retrospective lecture III, and FOAMed III were weakly negatively correlated with cumulative ITE percentile scores, particularly during PGY-1.

Trends in Individualized Interactive Instruction Utilization and Correlation to Intraining Examination

Heine E, Shaughnessy A, Bailey D, Clemmons M, Thundiyil J, Ladde J / Orlando Health, Orlando, Florida

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Hiring for Attitude

Duckett S, Nichol J, Roten R, Khazaeni B / Desert Regional Medical Center, Palm Springs, California Background: No interview tool has yet been identified to adequately predict a candidateâ&#x20AC;&#x2122;s propensity for success or fit within a residency program. Additionally, interpreting candidatesâ&#x20AC;&#x2122; responses is largely based on interviewer feelings or gestalt, which is fraught with many confounders and susceptible to significant bias. Objectives: We set out to identify a series of questions that could objectively predict future success of interview candidates at our program, regardless of changes in the interviewer line-up. We expected that thoughtful, targeted, objective questions could reliably predict performance as gauged by clinical competency committee (CCC) Milestone achievement. Methods: Our program is a relatively new emergency medicine residency at a community hospital. This observational study was designed using the steps outlined in Hiring for Attitude (HFA) by Mark Murphy et al. We initiated a multistep, team-consensus process to first identify our unique culture. Qualities were identified that best supported that culture. We then created questions to target these qualities and provided a correlating scoring system. The residency class of 2020 cohort was first interviewed using traditional interview questions and their rank order list created by gestalt. In their first weeks as interns, this same class was re-interviewed with the HFA questions. One year later, we compared the scores from the interview tool against the residentsâ&#x20AC;&#x2122; in-service exam scores, CCC Milestone scores, and original rank list standing, assessing for areas of correlation using a Pearson R score and plotted on a scatter plot. Results: For the class of 2020, we found a positive correlation between their HFA scores and their Milestone performance (R = 0.359). There was a very weakly negative correlation between their position on the rank list and their Milestone performance (R = -0.046). Interestingly, we also found a negative correlation between their HFA performance and their in-service performance (R = -0.18). Conclusion: We found a positive correlation between our HFA questions and Milestone performance. While our results

at this time are not statistically significant due to our low N = 8, if this trend were to continue for the next two years, an N = 24 would likely yield statistical significance.

Correlating SLOE Rankings with EM Match Status: Is a Lower-Third SLOE a No-Go?

Hansroth J, Davis K, Sharon M, Davis S, Shaver E, Kiefer C, Cottrell S, Ferrari N / West Virginia University, Morgantown, West Virginia Background: The Standardized Letter of Evaluation (SLOE) is consistently ranked as the most important application component by program directors. The SLOE

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CORD Abstracts Issue 2019 provides a uniform assessment of student performance, regardless of rotation site. Despite its perceived importance, no prior research has actually correlated objective SLOE performance data with final match status. Objectives: The purpose of this study was to determine whether lower-third performance on the SLOE global assessment (GA) was predictive of final match status, with the hypothesis that a lower-third ranking would be associated with an increased risk of not matching into emergency medicine (EM). Methods: We conducted a retrospective cohort study evaluating Liaison Committee on Medical Education (LCME) applicants to a single EM residency program in the mid-Atlantic region during the 2018 match cycle. GA SLOE rankings from all applications were extracted and compared to National Resident Matching Program (NRMP) data for each applicant on match outcome. We conducted comparative analyses between SLOE groupings and calculated odds ratios (OR). Results: A total of 919 SLOEs were reviewed from 364 applicants, representing 20% of all EM applicants for the 2018 match cycle. Of these, 93 applicants (26%) had one GA ranking in the lower third, which significantly decreased an applicantâ&#x20AC;&#x2122;s odds of matching in EM by 79% (OR 0.21, 95% confidence interval [CI], 0.11-0.39). Additionally, 11 applicants (3%) had two or more lower-third rankings, decreasing the odds of an EM match by 92% (OR 0.08, 95% CI, 0.02-0.30). Conclusion: This study was the first to evaluate the effect of SLOE GA ranking on matching into an EM residency. One or more lower-third rankings on the GA significantly reduced an applicantâ&#x20AC;&#x2122;s chances of matching into an EM program. Given the strong correlation between lower-third GA ranking and a non-match in EM, EM faculty advisors, while keeping the confidentiality of the SLOE in mind, may want to consider ongoing review of EM applicant files during the SLOE upload timeframe and strongly advise students with lower-third GA rankings to use a parallel plan. Potential limitations of this study include the use of data from a single program during a single application cycle, without the identification of specific performance factors that place students in the lower-third GA.

Decreasing Stroke Alerts in the Emergency Department: A Lesson in Resource Utilization

DeWitt D, Muckey E, DiMiceli E, Ishida K, RossanRaghunath N, Femia R, Wu T / New York University School of Medicine, New York, New York Background: Stroke code activations are a valuable tool in providing prompt care to stroke patients who may be eligible for treatments such as tPA and endovascular interventions. However, stroke codes involve the immediate attention of many members of the healthcare team and significant hospital resources. The National Institutes of Health Stroke Scale (NIHSS) is commonly used to evaluate stroke severity; however, even patients with an NIHSS score of zero can have ongoing neurologic symptoms and disability. Confusion over the goals of stroke codes and the appropriate situations for their use may contribute to unnecessary activations. Objectives: The purpose of this analysis was to evaluate the frequency of stroke code activations in situations where activating a stroke code provides little potential benefit in terms of therapeutic options over a non-emergent neurology consult. Methods: We reviewed the records for all emergency department (ED) stroke code activations over the first five months of 2018, looking specifically at cases with an NIHSS score of zero. Within this pool, we identified cases where the patient was documented as being asymptomatic during initial ED evaluation as their symptoms had resolved (transient ischemic attack), as well as those who had been symptomatic for over 24 hours and were outside the therapeutic window. These patients were not eligible for emergent therapeutic intervention. Thus, these were cases in which a stroke code activation was avoidable. Results: Of the 120 stroke codes with an NIHSS of zero, 39 (32.5%) involved patients whose symptoms had completely resolved prior to arrival. Another three cases involved patients who had been symptomatic for over 24 hours and were outside the therapeutic window. Thus, of the stroke code activations with an NIHSS of zero in this time period, 42 (35%) were avoidable as these patients would not have been considered candidates for emergent treatment. Conclusion: Clarification and reinforcement of appropriate criteria for stroke code activation have the potential to reduce overutilization of resources in situations unlikely to affect acute therapeutic management. Addressing this would allow for a reduction in the burden on healthcare professionals and ED resources.

Figure 1. Percentage of students successfully matching into EM residency, categorized by the number of lower third GA rankings in the SLOE. (Note: Six applicants did not have any SLOE data as part of their application and are not represented above.

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CORD Abstracts Issue 2019

Effect of a Pediatric Critical Care Bootcamp on the Knowledge and Confidence of Emergency Medicine Interns

Sungar W, Roosevelt G, Hopkins E, Hagan P, Palau M, Kunrath C, Walsh K, Mahar P, Roswell K, McCormick T / Denver Health Medical Center, Denver, Colorado; Childrenâ&#x20AC;&#x2122;s Hospital Colorado, Aurora, Colorado Background: Emergency medicine (EM) residents may not receive adequate pediatric training, particularly in the care of critically ill children. EM residency programs must develop novel and efficient educational tools to provide residents competence and confidence in the care of critically ill pediatric patients. Objectives: We hypothesized that following completion of a single-day, intensive pediatric critical care bootcamp, EM interns would demonstrate improved knowledge and increased confidence in caring for critically ill children. Methods: This was a prospective pre-test/post-test cohort study. We sent a survey to senior EM residents and recent graduates to identify areas of educational need; the most-requested topics were respiratory equipment, newborn resuscitation, cardiac arrest, sepsis, diabetic ketoacidosis, status asthmaticus and status epilepticus. A multidisciplinary group designed a simulationbased curriculum. The bootcamp was five hours long: a 30-minute lecture on neonatal resuscitation; three neonatal resuscitation simulation stations; five high-fidelity simulations covering the identified topics above; and an airway station. A test of 23 fill-in-the-blank questions and 17 questions on confidence of caring for critically ill children (scale 1-10), including both content covered and not covered in the bootcamp, was given prior to the bootcamp (pre-test), one week after (post-test), and 12 weeks after (follow-up test). Results: Sixteen of 17 interns were included in the study, and all 16 completed the three tests. Post-test median scores showed significant improvement from pre-test medians (27.8 [interquartile range (IQR) 23.6-32.0] vs 75.0 [IQR 68.1-80.6], p<0.01) and follow-up median scores remained significantly different from pre-test scores (58.3 [IQR 51.4-63.9], p<0.01). There was a significant increase in the comfort levels associated with caring for critically ill pediatric patients, both for topics covered in the bootcamp, as well as for topics that were not covered (Figure 2). Conclusion: We saw significant improvements in both the knowledge and confidence of EM interns in the care of critically ill pediatric patients following a single-day intensive curriculum. These gains persisted through the follow-up test, suggesting retention. Interestingly, confidence levels increased even for topics not covered in the curriculum.

Implementation of an Educational Dashboard with a Financial Incentive Improves Faculty Participation in Residency Evaluations

Fix M, Pugh A, Madsen T, Carlson C, Doyle G, Stephen R, Stroud S / University of Utah, Salt Lake City, Utah Background: The ACGME requires all emergency mediciine (EM) training programs to evaluate resident performance and also requires core faculty to attend didactic conference. Assuring faculty participation in these activities can be challenging. Previously, our institution had neither a formal tracking program nor a financial incentive for faculty participation in these activities. In 2018 we initiated an Educational Dashboard, which tracked and published all fulltime university faculty conference attendance and participation

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CORD Abstracts Issue 2019 in resident evaluations and other educational activities. Objectives: We sought to determine if the implementation of a financially incentivized Educational Dashboard would lead to an increase in faculty conference attendance and the number of completed resident evaluations. Methods: We conducted a pre- and post-intervention observational study at our EM residency training program between July 2017–August 2018. Participants were 17 fulltime EM attendings at one training site. We compared the number of completed online resident evaluations by faculty (MedHub) and number of conference days attended (callin verification) before and after the introduction of our Educational Dashboard, which included a financial incentive for faculty. The incentive required 100% completion of resident evaluations and at least 25% attendance at eligible didactic conference days. We calculated pre- and postintervention averages and made comparisons using a chisquare test. Results: Prior to implementation of the Educational Dashboard with a financial incentive, the 90-day resident evaluation completion rate by faculty was 72%. This increased to 100% after implementation. Conclusions: Attaching a financial incentive to a tracked Educational Dashboard increased faculty participation in resident evaluations but did not change conference attendance. This difference likely reflects the minimum thresholds required to obtain the financial incentive.

Increased Space for Comments on Endof-Shift Card Associated with Longer Comments

on each card for all residents for three months before and after use of the new cards was implemented. Reviewers also rated how specific and actionable the comments were on a three-point scale (0 = not at all, 1 = somewhat, 2 = yes). To assess inter-rater reliability, we had 49 cards reviewed by two authors. Word count variables were summarized descriptively and compared using Wilcoxon rank-sum tests. We assessed inter-rater agreement using Cohen’s kappa. Results: Nine EM faculty reviewed 1204 cards for 32 residents. On the new-format cards, faculty wrote a significantly higher number of words, both overall and for each “List tasks or behaviors done well” and “List specific suggestions for improvement,”,when compared to word count on the previous cards. The rating of whether feedback was actionable was also significantly different when comparing the new cards with the previous cards, with a trend toward more actionable feedback on the new cards. There was no significant difference in rating regarding specificity between the two card types. For the subset of cards evaluated for inter-rater reliability, for specificity of feedback, kappa = 0.5837, and for rating on whether feedback was actionable, kappa = 0.9275. Conclusion: By simply allowing more space on endof-shift cards for comments, our faculty wrote 50% longer comments for our residents, including significantly more positive feedback and suggestions for improvement. Table 1. Comparison of word count and whether feedback is actionable and specific, by type of card.

Nelson J, Hegarty C, Barringer K, Grall K, Henry K, Hernandez B, Miller P, Paddock M, Willenbring B, Woster C / Regions Hospital; HealthPartners Institute, St. Paul, Minnesota Background: Emergency medicine (EM) faculty members are expected to provide end-of-shift feedback to EM residents to enhance and focus their learning. However, quantity and quality of feedback is difficult to measure. We use paper cards to prompt an end-of-shift conversation, record faculty assessment of a Milestone and allow written comments for later review by the resident, clinical competency committee, and program leadership. We altered our end-ofshift feedback cards to allow for more space for comments hoping faculty would write more. Objectives: Our primary objective was to assess length of written comments for three months before and after altering the structure of our feedback cards. A secondary objective was to assess how specific and actionable the comments were. Methods: This was a prospective, observational study in which the authors counted the number of words written Western Journal of Emergency Medicine

Mapping Emergency Medicine: Geographic Distribution of Emergency Medicine Clerkship and Residency Positions Based on 2016-2017 eSLOE Statistics

Montrief T, Jackson J / University of Miami Miller School of Medicine / Jackson Memorial Hospital, Miami, Florida

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Background: Visiting rotations are an essential part of the Volume 20, Supplement : August 2019

CORD Abstracts Issue 2019 emergency medicine (EM) residency application. Most programs require at least one Standardized Letter of Evaluation (eSLOE) from an away institution, which necessitates visiting rotations. (An eSLOE is filed electronically on the eSLOE website created by the Council of Residency Directors in Emergency Medicine.) However, there is little information regarding the geographic distribution of EM clerkship positions compared to ACGMEapproved postgraduate year (PGY)-1 positions. Objectives: Our goal was to examine the geographic distribution of EM clerkship spots to ACGME-approved PGY-1 residency positions. Through a geographic distribution, state and regional imbalances in academic EM training can be identified. Our hypothesis was that states with a large number of EM graduate medical education (GME) spots would also have a high capacity of EM undergraduate medical education (UME) clerkship spots. Methods: We performed an observational, retrospective analysis of all EM eSLOEs written during the 2016-2017 residency application cycle, categorizing authorship by institution and state. All ACGME-approved EM residency programs in the United States, registered in the 2017 National Resident Matching Program were also categorized by state. UME to GME ratios were calculated for each State and the geographic distribution was determined. We also identified the top 25 institutions with the largest EM UME volume. Results: In 2016-2017, 6715 eSLOEs were submitted on 3138 unique EM applicants, written at 222 different institutions. Ratios of UME to GME positions varied from 1.6 in Connecticut to 21 in Vermont, with a nationwide average of 3.3. The top 25 institutions authored 1660 eSLOEs, accounting for 25% of the total eSLOEs. Conclusion: There were large differences in the geographic distribution of UME and GME EM positions in 2016-2017. These data identify states and institutions with large EM clerkship capacities, which can enhance EM student advising for visiting rotations and geographic residency goals. EM subspecialty elective rotations and institutions with non-group eSLOE authorship are potential confounding limitations to this research.

A Novel Method for Blinding Reviewers to Gender for the Purposes of Gender Bias Research

Pallaci M, Aluisio A, See A, Weinstock M, Beck-Esmay J, Frye A, Riddell J / Adena Health System Emergency Medicine Residency, Chillicothe, Ohio; Warren Alpert School of Medicine, Brown University, Providence, Rhode Island; Mount Sinai St. Luke’s-Mount Sinai West, New York, New York; Keck School of Medicine of the University of Southern California, Los Angeles, California Background: Research has shown a gender gap on ACGME Milestone evaluations, with the largest differences in procedural competency. There are currently no established methods by which researchers can blind reviewers to gender to evaluate for bias. Objectives: This study evaluated whether a novel method could effectively blind evaluators to the gender of trainees performing simulated procedures. Since correct gender identification would be 50% based on chance, it was hypothesized that blinding would be effective if the reviewers did not correctly identify proceduralists’ genders in ≥ 50% of assessments. Methods: After removing all jewelry from their hands, proceduralists were gowned, double-gloved, and filmed by a professional videographer while performing simulated procedures. Only their double-gloved hands, gowned forearms and lower torsos were visible in the videos. Five residents (two male and three female) performed three procedures each (lumbar puncture, chest tube, and central line placement), yielding 15 videos. Short video clips (30-45 seconds) were scored by seven graduate medical educators on a Likert scale (1 = definitely male, 3 = likely male, 5 = can’t tell, 7 = likely female, 9 = definitely female). A response concordant with proceduralist gender with a confidence level of likely or higher (1-3 for males, 7-9 for females) was considered correct

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CORD Abstracts Issue 2019 gender identification. Gender was considered to have not been correctly identified if the reviewer was unsure (score 4-6) or if the score was discordant with proceduralist gender. Reviewer scores were described, and we used one sample equality of proportions to assess significances against the null of >50% correct gender identification. Results: Of 105 total responses, 56 (53.3%) expressed confidence in the gender of the proceduralist (1-3 or 7-9). Across all reviewers and procedures, 30.8% (95% confidence interval, 22.7-39.9%) correctly identified the proceduralist’s gender. This proportion was statistically non-significant as compared to the null of >50% correct gender identification (p = 1.00). The same non-significant differences were maintained when the data were stratified by each procedure assessed. Conclusions: Our method effectively blinded reviewers to the gender of the proceduralist and represents an innovative approach to perform needed research pertaining to gender bias in education.

competencies or subsequent resident performance/success. While the SVI is currently being used without added cost to the applicant, it is projected that this will not be the case in the future. Thus, this additional student and training program expense should provide residency programs with enough objective data to make it worth the cost; these data do not yet exist. Objectives: This study evaluated if a correlation existed between an applicant’s SVI score and his or her position within a program’s rank list during the 2018 National Resident Matching Program (NRMP) cycle. We hypothesized that the SVI score would not correlate with an applicant’s place on an emergency medicine (EM) rank list. Methods: We performed a prospective, survey-based study to evaluate correlation between an applicant’s SVI score, and rank location by EM programs during the 2018 NRMP match. Inclusion criterion was defined as any ACGME-accredited EM program that participated in the NRMP match. Collected data included program demographics and de-identified applicant information, including rank and SVI score. Results: Five programs participated in the survey study. Four programs were three years in length and one was four years. Three programs reported an academic setting, whereas the other two were community programs. On average, participating programs interviewed 175 applicants out of an average of 1003 applications received during the 2018 match cycle. We found no correlation between SVI score and position on a program’s rank list (coefficient = -0.121, p-value = 0.076). Conclusion: The results of this study revealed no correlation between a student’s SVI score and his or her position on a program’s rank list. Based on this small study, we question the utility of the SVI score in aiding programs during the recruitment process. Larger studies will be needed in the future to validate these results.

Standard Video Interview Scores and Applicant Position on Residency Program List: A Correlation Study

Bowers K, Comp G, Kalnow A, Casey J, Fraser W, Lloyd C, Little A / Doctors Hospital Ohio Health, Columbus, Ohio Background: The Standard Video Interview (SVI) is an interview tool developed by the Association of American Medical Colleges to assess professionalism and interpersonal/ communication skills in medical students applying for residency. The individual SVIs for each applicant are graded on 1-5 scale with the sum of all interviews used to create the applicants overall SVI score ranging from 6-30. The higher the score, the more the applicant demonstrated proficiency in managing difficult situations presented to them. There are conflicting opinions on the value and usefulness of the SVI, as scoring does not yet have a known correlation with ACGME Western Journal of Emergency Medicine

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CORD Abstracts Issue 2019

Teaching and Evaluating Medical Students’ Oral Presentations Skills in Emergency Medicine

Fisher K, Reynolds C, Fairbrother H / McGovern Emergency Medicine, University of Texas Houston, Houston, Texas Background: Medical students receive generalized training in oral presentations yet lack preparation for emergency medicine (EM)-specific presentations, which differ in length, focus, and structure. Prior research suggests that students need further instruction in EM-focused oral presentations. Objectives: In our pilot study, we assessed the need for training of EM-bound medical students in EM-specific oral presentations and trialed a multimodal curriculum. In this study we implemented a novel grading rubric to evaluate efficacy of the didactic curriculum. Methods: Fourth-year, EM-bound students from 26 different medical schools rotating in July–October 2018 were voluntarily enrolled. Students (n = 49) completed preand post-intervention surveys. Attending physicians graded their oral presentations on their first shift (pre-intervention) and last shift (post-intervention) using a novel grading rubric (Figure 1). During the four-week rotation, students completed a self-paced, multimodal curriculum designed using expert sources (Figure 2). We analyzed data using paired t-test for statistical significance. Results: In our study population, 61% of students had previous education in oral presentations, but less than 25% received EM-specific training. On pre-intervention surveys, students had an average of 6.4/10 when asked how prepared they felt presenting EM-specific oral presentations and 8.1/10 on post-intervention surveys (p<0.001). Our novel grading rubric assessed nine components of oral presentations with average scores increasing from 3.4/5.0 to 4.0/5.0 after implementation of the curriculum (p<0.05). Conclusion: Our study suggests that medical students feel ill-prepared for presenting EM-focused oral presentations and have limited EM-specific prior training. Implementation of a multimodal, didactic curriculum created statistically significant increases in the students’ feelings of preparedness. Use of a novel grading rubric demonstrated objective increases in students’ performance on oral presentations.

Emergency Department Thoracotomy Education Needs Assessment

Zaidi H, Fant A, Sanders S, Miller D, Pirotte M, Salzman D / Feinberg School of Medicine, Northwestern University, Chicago, Illinois Background: Emergency department thoracotomy (EDT) is a rare and potentially life-saving procedure that emergency medicine (EM) residents must be able to perform correctly. Due to the infrequent occurrence of EDTs, studies evaluating whether EM residents are competent to perform this procedure are rare. Objectives: To assess EM residents’ baseline abilities to perform an EDT on a novel, simulated model. Methods: This was a prospective, single-site study of EM residents in a four-year, urban, academic residency program. Residents were asked to individually complete an emergent

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CORD Abstracts Issue 2019 thoracotomy on a simulator. They were given a standardized prompt and their performance was evaluated in real time via a dichotomous, previously validated checklist. A score of 90.4% of checklist items correct was derived using the Mastery Angoff approach and was set as the minimum passing standard. All EM residents not involved with the development of the checklist were invited to participate. We compared the percentage of checklist items completed by postgraduate year (PGY) and selfreported prior experience with emergent thoracotomy, using one-way analysis of variance. Results: Of eligible residents, 52/56 (92.8%) completed the needs assessment testing. Overall average performance on the checklist was 47% of actions performed correctly. We found a significant difference in performance by level of training (p<0.01). Trainees who had previously witnessed or performed an EDT performed significantly better than those who had not (p<0.01). No resident met the previously established minimum passing standard. Conclusion: Baseline performance of residents performing an EDT is poor with no residents meeting the minimum passing standard. Senior residents (PGY-3 and PGY-4) performed better compared to junior residents (PGY-1 and PGY-2). Residents with prior exposure or experience to EDT performed better compared to residents without exposure or experience. However, routine training in residency is insufficient to ensure successful performance of this procedure. Further education regarding ED thoracotomy is necessary in residency training.

Western Journal of Emergency Medicine

A Needs Assessment for the Development of “Orphan” Topic Curricular Toolkits

Caretta-Weyer H, Tichter A, Fujimoto J / Stanford Universiry, Stanford, California; New York Presbyterian, New York, New York; Temple University, Philadelphia, Pennsylvania Background: The Council of Residency Directors in Emergency Medicine (CORD) Education Committee was tasked with the development of curricular tool kits for dissemination to all emergency medicine (EM) programs. To understand existing educational gaps, the Curricular Toolkit Subcommittee sought to perform a targeted needs assessment. Objectives: Our goals were to identify “orphan” curricular topics that are not effectively taught but are regarded as important for inclusion in the residency curriculum, and to determine which instructional methods are considered best for conveying the educational content for each “orphan” topic. Methods: We conducted a national survey of EM residents and program faculty. Questions were developed iteratively by members of the Curricular Toolkit Subcommittee, with example topics chosen from the American Board of Emergency Medicine Model of Clinical Practice, as well as from the expert opinion of the subcommittee members. The survey was piloted among the membership of the CORD Education Committee, with feedback from the pilot incorporated into the final version, which was distributed to the CORD listserv in September 2018. Results: There were a total of 105 respondents, of whom 58 (55%) were faculty, and 47 (45%) were residents. Fifty-one (49%) identified their primary training site as “university,” 20 (19%) as “community,” 16 (15%) as “county,” and 18 (17%) as“hybrid.” Seventy-eight (74%) described the setting of their primary hospital as urban, and 74 (70%) were from three-year programs. Resident respondents most strongly agreed that evidence-based medicine (67%), team management (47%), and resident as teacher (43%) should be included in the EM curriculum, of which resident as teacher was rated as most ineffectively taught (13%). Faculty responded that a dedicated curricular toolkit provided by CORD would be of highest value for billing and coding (46%), quality improvement (44%), and medicolegal (43%) topics. Both faculty and residents favored in-person lectures for medicolegal and billing & coding vs small groups for quality improvement as the best instructional method. Conclusions: We found discordance between residents and faculty as to which “orphan topics” are more important to include in the residency curriculum, but more of a consensus with regard to best instructional method for each topic. S20

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Innovations Abstracts

Peer-Guided Lightning Electrocardiogram Curriculum

Cooper B, Grodus J / McGovern Medical School at UTHealth, Houston, Texas Background: Electrocardiogram (ECG) competence is widely recognized as an important and necessary component of emergency medicine (EM) training, but there is no standard educational curriculum. Residents are neither confident nor accurate in their ability to interpret ECGs. Educational Objectives: We aimed to evaluate the effectiveness of a novel educational curriculum to improve EM interns’ ECG interpretation competence and confidence. Curricular Design: EM interns (n = 18) were randomly assigned two specific ECG topics to review and discuss during a month-long educational orientation (total of 36 topics). Subjects were instructed to prepare a “lightning talk”(< 10 minutes) for each of their assigned topics, highlighting the salient features of at least five ECGs, and to distribute them beforehand. In this manner, traditional classroom lectures were replaced with peer discussions. A baseline examination was administered prior to the orientation month, followed by another immediately after completion of the curriculum. A third examination was administered six months later. The three examinations were administered in a proctored classroom using the webbased RoshReview application, each with 20 questions of equivalent difficulty. We used a paired t-test to compare the scores of participants who completed all three examinations. Surveys using a visual analog scale (VAS, 0-100) assessed interns’ confidence in ECG interpretation before and after completion of the curriculum. We analyzed survey results using the Mann-Whitney U test. Impact/Effectiveness: Fifteen interns completed all three examinations (83.3%). The mean baseline, postorientation, and six-month scores were 72.5%, 88.8%, and 81.1%, respectively. Both the post-orientation and sixmonth scores were significant higher than baseline (16.3%, 95% confidence interval [CI], 6.82 to 25.84; p = 0.002; 8.6%, 95% CI, 2.11 to 15.08; p = 0.013). Six-month scores were significantly lower than the post-orientation scores (-7.7%, 95% CI, -14.9% to -0.6%, p = 0.036). Fourteen interns completed both surveys (78%). ECG interpretation confidence was significantly greater after completion of the curriculum (median VAS 80 vs 45, p = 0.01).This study provides preliminary evidence for the effectiveness of a non-traditional, peer-guided, “lightning talk” educational curriculum for improving the ECG interpretation skills and confidence in EM interns. Volume 20, Supplement : August 2019 S21

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A Novel Standardized Multimodal Model of Critical Care Assessment of Junior Residents

Liu E, Joshi K, Hernandez J, Roppolo L, Velez L, Martinez J / University of Texas Southwestern, Dallas, Texas Background: With our residency program’s primary teaching facility moving to a new building the resident staffing model changed, resulting in a perceived decrease in critical care experiences for interns. Because in their second year, postgraduate year (PGY)-2 residents take on the role of resident in charge, there was a need to provide additional training and to ascertain that the new PGY-2s had sufficient critical care understanding and ability prior to being assigned this graduated responsibility. Educational Objectives: 1) Standardize and enhance critical care teaching among junior residents; 2) evaluate readiness to function as the resident in charge; 3) maximize translation effectiveness while allowing for flexibility in the curriculum to address individual learning needs; and 4) ensure patient safety Curricular Design: Unlike traditional teaching, the the “Critical Care Checklist” (CCC) used a blended learning approach to evaluate procedural competency, mastery of pharmacology, EKG interpretation, understanding of protocols, clinical performance, as well as team and resource management. The CCC included a procedural skills course; a vignette-based oral exam; a written exam; a preparatory simulation that included rhythm recognition and code scenarios; a scavenger hunt; and an assessment simulation followed by a faculty-led debriefing. PGY2s with difficulties were given remedial training and reassessed. Impact/Effectiveness: This multimodal assessment of junior residents provided insight that each element of the checklist individually could not. The CCC highlighted the learning needs of each resident and helped to provide individualized instruction to residents to fill performance gaps. Effectiveness of the CCC was measured by rate of successful completion of the CCC, postassessment resident surveys, and feedback from faculty. Results showed simulation and active learning were highly valued compared to written testing and traditional teaching (Figure 1). Faculty feedback of residents’ performance after implementation of the curriculum has also been positive.

Western Journal of Emergency Medicine

A Unique Video-Review Curriculum to Improve Resident Education and Quality Measures in Cardiac Arrest

Kuhl E, Yamane D, Newell K, Lanam C, Rabjohns J, Sullivan N, McCarville P, Nichols T / The George Washington University, Washington, District of Columbia Background: Currently residents are trained to manage cardiac arrests through simulation or observation. While simulated training with video is heavily studied, few data exist on the utilization of video review of actual cases. Our program provides education through video review and individual feedback. We are one of the first to show improvement in a core resuscitation measure. Educational Objectives: Our program aims to improve cardiopulmonary resuscitation (CPR) knowledge and competency through individual feedback and monthly didactics. For each case, feedback is given by email to build individual strengths and identify educational opportunities. This is done with a set template with objective data and subjective remarks. A case is selected based on educational content and presented monthly. Data are collected annually to assess whether video review improves knowledge of core resuscitation measures. Curricular Design: Video review of trauma is common and felt to improve the care of patients. We expanded this practice to CPR cases. Videos from 24 hour/day surveillance in resuscitation rooms are reviewed by two independent observers, and feedback is sent to the resident, nursing, and attendings involved. Videos are reviewed for Cardiac Arrest Registry to Enhance Survival (CARES) elements, a national standard for cardiac arrest research. Monthly one-hour lectures review a case selected for a specific educational topic and build in a stepwise fashion. When possible, topics correspond to the 2013 Model of the Clinical Practice of Emergency Medicine.This program has many stakeholders, including information technnology, the hospital, and department administrators. Once installed, the program requires significant faculty and resident involvement to capture and review cases. Once staff was encouraged to use the resuscitation bays with videotaping capability and initial training problems were resolved, our program collected 7080% of all resuscitations. Impact/Effectiveness: While early data are encouraging, we do not have enough data to show a statistically significant improvement in outcomes. Anecdotally, residents, faculty, and staff have identified video review as an important adjunct to their education. We will work with focus groups of staff and residents to better identify areas of strength and improvement of this program.

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Reversing the Script: Peer-Based Teaching of Foundational Concepts in Emergency Medicine Using a FOAMed Curriculum

Goldman S, Barthman M, Merritt R / Brown University, Providence, Rhode Island Background: Every emergency medicine (EM) residency creates experiences allowing learners to master their most foundational skill: the approach to an undifferentiated patient. While extraordinary clinical experiences can literally roll through the door, crafting meaningful didactic experiences is fraught with the challenges of delivering content appropriate for learner ability, using faculty resources efficiently, and remaining appropriately responsive to learner preferences. At our institution, formal feedback from learners underscored these issues while also revealing a desire among senior residents for more teaching opportunities and, among junior residents, a desire for dedicated introductory content. Educational Objectives: The objectives of our curricular innovation were multifaceted: 1) provide introductory content; 2) develop teaching opportunities for senior residents; 3) involve junior residents in the didactic process to cultivate self-directed learning, leadership, and confidence; and 4) create an additional setting that would allow junior residents to feel comfortable expressing knowledge gaps. Specifically, our innovation places the learner in the teaching role, supplanting a faculty-led program with a peer-based teaching model. Peer-based teaching allows for increased learner engagement, leadership development, and fosters an open learning environment. Curricular Design: We implemented a modified version of the Foundations of Emergency Medicine (Foundations) curriculum. Foundations is an open-access, peer-reviewed program modeled on the American Board of Emergency Medicine Model of the Clinical Practice of Emergency Medicine (EM) and has been adopted by over 20 EM residencies. Foundations employs a case-based, flippedclassroom approach and was originally designed with three faculty members guiding residents through three cases per week. Once per month during the residency’s weekly didactic session, we offer two-hour Foundations breakout sessions. First-year residents, a departmental fellow, and two senior residents meet in a separate learning space. Three preselected first-year residents, who have been provided teaching cases in advance, alternate guiding their peers through each Foundations case in an oral-boards format. Each intern is expected to review his or her case and act as a topic “expert” by supplementing their knowledge with Foundationssuggested reading. Senior residents and the fellow help guide learning as needed and provide real-life clinical perspectives. Impact/Effectiveness: This intervention meets our

institutional goals for medical education and honors formal feedback obtained from our residents. The peer instructional model engages residents in a didactic experience that requires demonstration of knowledge while cultivating teaching skills, leadership, and confidence. The Foundations curriculum is of high quality, tailored to the learner’s level of training, and fosters familiarity with the oral-boards format. The employment of a breakout session during departmental conference allows concurrent scheduling of advanced topics to be taught by faculty for senior residents. Furthermore, breakout sessions provide a setting in which first-year residents feel secure asking questions and demonstrating knowledge gaps that can be addressed by facilitators. Qualitative and quantitative feedback regarding each Foundations session was collected from learners. Overwhelmingly, learners found the sessions extremely relevant to their education and a refreshing approach. Unexpectedly, several interns reported that the sessions provided a safe space for mental health check-ins, suggesting that the small group setting of peers may have additional benefits. Areas for suggested improvement included providing a reference sheet of salient teaching points and providing paper copies of electrocardiograms. Future goals include expanding the program from monthly to weekly sessions and potentially offering an advanced peer-to-peer Foundations curriculum to senior residents.

Assessing How a Shared Mental Model Influences Team Performance in Blunt Trauma Resuscitation

Gardner R, Tyler P, Parsons C, Rosen C / Beth Israel Deaconess Medical Center, Boston, Massachusetts Background: Successful trauma resuscitation is complex and requires cooperation of several different team members. Having a shared mental model that includes emphasis on nontechnical skills has been shown to reduce medical errors and improve performance in resuscitations. This is important in trauma centers where frequent turnover of residents managing resuscitations limits teamwork. Additionally, while individual technical skills are often adequately trained, non-technical skills are underemphasized. The purpose of this innovation was to assess how specific interventions to create a shared mental model and improve non-technical skills would influence trauma resuscitation performance. Educational Objectives: Our goals were to 1) create a shared mental model for the approach to the blunt trauma patient; 2) translate this model into three educational tools – a) an instructional video simulating ideal resuscitation, b) a trauma care checklist, and c) a positioning map for each role; 3) deliver this model to all residents; and 4) assess

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CORD Abstracts Issue 2019 teamwork over time using the Trauma Non-Technical Skills (T-NOTECHs) tool, a validated tool in the assessment of teamwork skills of trauma teams. Curricular Design: Based on a trauma roles educational slide show, institutional leaders in trauma education developed a script demonstrating the ideal blunt trauma resuscitation, which was translated into a simulated resuscitation video. The video emphasized non-technical skills believed to improve trauma team performance including leadership, situational awareness, and effective communication. A positioning map and a trauma checklist were created to ensure clear roles and Advanced Trauma Life Support task performance. The three tools were delivered to current residents via lectures and casebased discussions. Following implementation, trauma team performance was tracked by trained coders reviewing video of trauma resuscitations using the T-NOTECHs tool. Impact/Effectiveness: Given the variety in trauma, agreement on an “ideal” resuscitation was challenging to create. Following implementation, initial surveys of both residents and attendings indicated perceived improvement in trauma team performance as compared to pre-implementation. Currently, trained coders are measuring team performance over time using T-NOTECHs tool. Results at six and 12 months are pending.

2018), with full funding (housing, travel, and food) provided to the four who were accepted. Components aimed to explore the full breadth of EM and included faculty and resident mentorship, shadowing, social medicine initiatives, procedure workshops, didactics, simulation sessions, conferences, journal clubs, high school teaching, grand rounds, a wilderness medicine outing, meetings with the Office of Diversity Affairs, and a final scholarly project. A post-fellowship anonymous survey and focus group were conducted to assess their interest in pursuing an EM career. We aim to follow the fellows longitudinally to track career choice. Impact/Effectiveness: We merged much of the curriculum with our inaugural NYU EM Summer Fellowship. Of the three NYU fellows, two were URM. Immediately post-fellowship, we conducted a focus group with all seven students and distributed an anonymous survey to assess our effectiveness in meeting our goals and the fellows’ interest in pursuing EM. The fellows’ average self-reported knowledge of EM and likelihood of pursuing a career in EM increased after the fellowship. From the focus group, students appreciated hearing from “someone [who] had [their] experience and made it to where they were.” Due to the success of our 2018 fellowship, we have received funding for 2019.

Advancing Diversity In Emergency Medicine: The NYU EM Summer Fellowship for Underrepresented Minority Medical Students

Tse AB, Berger M, Nesheiwat L / Ronald O. Perelman Department of Emergency Medicine at NYU Langone Health, NYC Health + Hospitals, Bellevue, New York, New York Background: Although under-represented minorities (URM) comprise 30% of the U.S. population, only 15% of medical students and 9% of emergency physicians self-identify as URM. We seek to provide early emergency medicine (EM) exposure for URM medical students in order to promote diversity and inclusion within EM. A physician workforce that more closely reflects our general population will facilitate learning and enhance cultural competency. Most medical schools do not offer exposure to EM until the clinical years, often as an optional rotation. As a result, many students are never formally exposed to EM, and thus lack the knowledge to make an informed career decision. A handful of EM programs in the country offer stipends for URM senior medical students who have already decided to specialize in EM. These programs, however, are not targeted at the early, undifferentiated, URM medical student. Educational Objectives: Our fellowship was developed to engage pre-clinical URM medical students in EM and encourage them to pursue EM as a career. Curricular Design: A total of 145 URM students from across the country applied to our five-week fellowship (July

Western Journal of Emergency Medicine

The New Morbidity and Mortality Conference – A Prospective Approach

Ostro B, Nandam K, Way D, Malone M, Emerson G, Li-Sauerwine S, Khandelwal S, King A / The Ohio State University, Columbus, Ohio Background: In an effort to make morbidity and mortality (M&M) conference more engaging with an emphasis on cognitive biases, we launched a novel, prospective approach. Traditionally, the M&M format has been a case presentation with a retrospective analysis in a lecture-based format. Our previous conferences used a root-cause analysis to assess where errors occurred. Learners felt that the traditional format not only failed to promote engagement and faculty participation, but also lacked adequate attention to cognitive biases. Our new format, which incorporates small group learning, provides learners with a more S24

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CORD Abstracts Issue 2019 engaging environment to learn about cognitive errors and debiasing strategies. Educational Objectives: Our goal was to implement and execute a novel prospective approach to M&M conference that increases attendee engagement with an emphasis on cognitive biases and de-biasing strategies. Curricular Design: Cases are selected from referrals by resident and attending physicians or cases involving an adverse outcome. The case is presented by an education faculty member. The conference begins with a brief case presentation that includes only pertinent, critical data in one to two slides. The next slide defines the adverse outcome. We intentionally omit the details of the emergency department course in order to foster discussion regarding possible patient-related, systems-related, and cognitive factors that may have contributed to the outcome. Attendees are then divided into small groups comprised of both residents and attendings. Each group has a spokesperson and facilitator. Open-ended questions are posed to the group. Each group develops a fault-tree analysis of the potential errors; this is followed by a discussion of de-biasing strategies that could have been implemented to prevent cognitive errors that may have occurred. Small groups then reconvene and the actual fishbone analysis is discussed. Impact/Effectiveness: A survey was disseminated to postgraduate year 2-3 residents. We received 21 out of 36 possible responses (58.3%). Survey items asked residents to rate features of the prospective conference format as compared to the traditional format using a Likert scale: 1 = strongly disagree; 2 = disagree; 3 = neutral; 4 = agree; 5 = strongly agree. The residents nearly unanimously agreed that the new format is more effective at teaching cognitive errors and de-biasing strategies, while promoting attendee engagement.

Burnout Scoring Using Electronic Medical Record

concern. Large bodies of evidence have shown that burnout detracts from educational opportunity and decreases the quality of patient care. Burnout can also limit the amount of time a physician is able to practice his or her trade. Much of physician wellness involves prevention, identification, and treatment of burnout. There are many prevention models and treatment regimens but very few objective ways to identify those at risk for burnout. Educational Objectives: We sought to 1) identify those at risk for burnout, using the electronic medical record (EMR); 2) improve physician wellness by increasing interventions based on burnout identification; 3) eliminate the stigma surrounding burnout by increasing conversation about risk; 4) encourage communication about traumatic events; and 5) improve debriefing. Curricular Design: We are creating risk values for different types of patient encounters to be identified by the EPIC EMR. While some patient encounters are at average risk, others including patient death, drug-seeking patients, and pediatric traumas may increase risk of burnout. Patient interactions are labelled in the EMR with scores based upon perceived risk to burnout based on resident surveys. We have assigned these patient encounters with specific risk values based upon the potential for causing physician distress or frustration. These risk values are to be entered into the EPIC EMR, flagging certain types of patient encounters and giving them a shift- associated burnout score. Through EPIC each resident will be given a burnout score based upon these identifiably higher-risk patient encounters. While clinical stressors are not the only or even primary cause of physician burnout, they do lead to decreased morale and increased burnout risk. We are collecting the data on these EPIC-monitored scores and comparing them to pre- and post- evaluation Mini Z burnout surveys. We can then narrow the patient encounters that potentially have higher risk for burnout based upon the changes in Mini Z survey results in light of the scores EPIC has generated. The benefit to this program is that it will allow the residency leadership to identify residents who may need more than average resources including debriefing, counseling, or further narrative communication. This will give leadership a chance to reach out to those residents who may be in need and identify their needs. Impact/Effectiveness: This project allows for rapid identification of physicians at higher risk for burnout and the opportunity for quick intervention. This project can be applied to residency programs as well as physician groups.

Reeder S / Maricopa Emergency Medicine, Phoenix, Arizona Background: In emergency medicine and among physicians in general, burnout is a high risk and a growing

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Essentials of the Emergency Medicine Match Process: The Couples Match Addendum, on Behalf of the CORD Advising Students Committee in Emergency Medicine

Western Journal of Emergency Medicine

CORD Abstracts Issue 2019 Schrepel C, Harter K, Streich H, Hillman E, Kellogg A, Nable J, Pelletier-Bui A / University of Washington, Seattle, Washington; University of Southern California, Los Angeles, California; University of Virginia, Charlottesville, Virginia; University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; University of Massachusetts - Baystate Health, Springfield, Massachusetts; Georgetown University School of Medicine, Washington, District of Columbia; Cooper Medical School of Rowan University, Camden, New Jersey Background: The couples match, which gives any two people the choice to match into residency by linking their rank lists, is a stressful process. There is little in the literature to guide students on an optimal application strategy. The Council of Emergency Medicine Residency Directors (CORD) Advising Students Committee in Emergency Medicine (ASC-EM) is a working group comprised of leaders in EM education. The committee created a consensus-based resource and surveyed educators regarding couples match applicants to provide prospective couples application guidance. Educational Objectives: Our goals were to identify challenges specific for couples entering the match process, and to generate targeted advising recommendations specific for the EM couples match applicants. Curricular Design: The CORD ASC-EM identified best practice guidelines for the EM couples match based on recommendations collected from EM residents, faculty, existing online advising resources and a survey of CORD members. A total of 104 educators responded to the survey. The majority (98%) stated that they advise EM- bound students and are part of program leadership. This working group compiled the key best practice recommendations supported by survey data. An experienced advisor is an important part of every application process as each partner entering the couples match process will have unique circumstances that may warrant adjustments to these recommendations. Impact/Effectiveness: There are limited data to guide individuals engaging in the couples match. The CORD ASC-EM, comprised of leaders in EM advising, has developed consensus-based recommendations that have been supported by survey data and endorsed by CORD, CDEM (EM clerkship directors), and the Emergency Medicine Residency Association. These recommendations have been distributed to advisors and students via the CORD website, listservs, and The Vocal CORD blog. These recommendations were first posted on The Vocal CORD blog in March 2017 and have been viewed >800 times.

Western Journal of Emergency Medicine

Incorporating Rapid Cycle Deliberate Practice into Traditional Simulation-Based Medical Education

Montrief T, Medwid K, Supino M / Jackson Memorial Health System, Miami, Florida Background: Traditional simulation-based education (SBME) has been widely accepted and includes a structured post-simulation debriefing; however, little is known concerning learnersâ&#x20AC;&#x2122; experience with alternative simulation modalities, including rapid cycle deliberate practice (RCDP). RCDP is a team-based simulation method consisting of progressively more challenging rounds with frequent starts and stops, emphasizing repetitive practice over reflective debriefing with real-time, direct coaching via microdebriefing. In contrast, SBME focuses on learning after the scenario is complete, using advocacy-inquiry debriefing and allowing less skill repetition. Educational Objectives: Our primary objective was to identify the potential benefits of RCDP and its effect on learnersâ&#x20AC;&#x2122; experience in a simulated patient care environment, as well as to evaluate learner feedback regarding RDCP vs SBME. Curricular Design: A two-hour RCDP session provided simulation education to two teams of four emergency medicine residents. Each case highlighted skills associated with Pediatric Advanced Life Support using high-fidelity mannequins. Skills reviewed in the evaluation of the critically ill infant included obtaining a focused history, performing cardiopulmonary resuscitation, airway management including intubation, obtaining intraosseous access, and dysrhythmia management. Critical actions were identified within the scenario that led to hard stops if done incorrectly. Debriefing was then done via quick bursts of feedback to correct these critical actions within these pauses. The

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CORD Abstracts Issue 2019 teams would then swap and the scenario was started over again. This form of debriefing within the scenario via a start-and-stop method allowed for more repetitive practice with the goal of mastery learning. After the scenario the instructor summarized key educational objectives and solidified main teaching points, and participants provided feedback on RCDP vs SBME via anonymous questionnaires. Impact/Effectiveness: We propose a novel way to incorporate RCDP into a residency curriculum as a supplement to SBME. Feedback has been very positive with almost all respondents believing RCDP is an effective adjunct to SBME. Furthermore, a majority of respondents to a residency-wide survey felt that RCDP provides timely feedback and creates skills through increased repetition.

culture of teaching and learning. As a solution, several institutions have developed faculty teaching shifts dedicated to improving on-shift resident and student education. Training and comfort level among faculty, however, is remarkably heterogeneous. The authors propose the development and adoption of a just-in-time (JIT) learning module to assist faculty to prepare for teaching shifts. Educational Objectives: Our goals were to develop a JIT training module on best teaching practices for faculty to review immediately before their teaching shifts in the ED,and to improve faculty comfort level with clinical teaching shifts by offering them a toolkit of best practices. Curricular Design: After a needs analysis was conducted with core faculty through focus groups, the authors created a learning module using Articulate (RISE) e-learning software. The module was distributed to all teaching faculty, with the recommendation that it be completed before a teaching shift. The module also included resources for a more substantial understanding of educational principles such as workstation/ bedside teaching; feedback; morning report (ie, logistics, facilitation tips); downtime teaching; direct observation tips; and a compendium of acceptable open-access educational resources. Several quizzes were embedded in the module to evaluate faculty progress and track their completion. A survey was distributed to faculty to solicit feedback and reassess their comfort level with the newly-integrated teaching shift. Impact/Effectiveness: The JIT module exposed faculty to several teaching techniques and resources, provided them with a framework for delivering effective feedback, and improved their comfort level with the teaching shift. Our innovation can easily be replicated for any level of training across most specialties to assist faculty in teaching and evaluating students in the clinical environment.

Notes vs Recall: Can Third-Year Medical Students Benefit from Obtaining and Presenting an HPI Without Using Notes?

MacConaghy L, Moore C, Welch K, Sarsfield M, Wojcik S / SUNY Upstate Medical University, Syracuse, New York

Just in Time: A Faculty Development Primer to Help Prepare Core Faculty for Clinical Teaching Shifts

Karademos J, Rodriguez C, Siddiqui M, Naples R, Papanagnou D /Thomas Jefferson University, Philadelphia, Pennsylvania Background: The clinical environment in the academic emergency department (ED) is challenged by the struggle of maintaining efficient patient throughput while supporting a

Background: Medical students often struggle while transitioning from the use of handwritten notes to obtain and present a patient history to the expectation of using recall during residency and ultimately independent practice. Educational Objectives: We sought to educate medical students to improve patient interactions regarding flow, efficiency, and communication while still providing a complete and fluid patient presentation without using notes. Curricular Design: Third-year emergency medicine clerkship students from Juneâ&#x20AC;&#x201C;November 2018 at SUNY Upstate Medical University were challenged to evaluate and

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CORD Abstracts Issue 2019 present patients using notes during their first five shifts and using recall only for their last five shifts. Students indicated on end-of-shift cards whether notes were used. They were evaluated by preceptors on presentation flow and inclusion of all pertinent information on a scale of 1-4 (developing, meets, exceeds, or exemplary). Students were also asked to take a pre and post survey (five-point Likert scale strongly disagree to strongly agree) of their perception of the impact of using recall for patient history and presentation. Impact/Effectiveness: Of 39 clerkship students, 36 participated. A total of 214 preceptor evaluations were completed (106 notes and 108 recall). Evaluation of studentsâ&#x20AC;&#x2122; flow was significantly higher using recall (p = 0.01, mean 2.71 vs 2.34). There was no difference in inclusion of all pertinent information (p = 0.12, mean 2.62 vs 2.42). Studentsâ&#x20AC;&#x2122; perception of using recall was more favorable on the post survey overall (28.7 vs 22.5) and on both history (14.9 vs 11.9) and presentation (13.9 vs 10.7) subcategories.

59% of participants agreed that they felt comfortable with the SACB and 0% strongly disagreed. Prior to the workshop, 48% of participants strongly disagreed with feeling comfortable performing the FICB. After the workshop, 50% agreed that they felt comfortable, and 0% strongly disagreed. This suggests that our meat model simulation for compartment blocks increases physician comfort with performing these blocks. The number of SACB and FICBs performed before and after the workshop did not substantially change. This may indicate improvements are needed, but may also be confounded by the survey having been taken within six months of the workshop, and by the possibility that the meat model did not address other barriers to performing this procedure in the emergency department.

An Innovative Meat Model-Based Faculty Development Workshop to Increase Faculty Comfort with Performing Nerve Blocks

Lin J, Buttar S, Haines L, Likourezos A / Maimonides Medical Center, Brooklyn, New York Background: Performing nerve blocks is an increasingly important skill in the practice of emergency medicine. They are an effective means of controlling pain and decreasing opiate use. A major barrier to widespread adoption is the lack of comfort with these procedures. Meat models have been described as a way to simulate these procedures, but these models have not described the ability to practice hydrodissection along a fascial plane. This is important when performing fascial compartment nerve blocks. We describe a low-cost meat model that allows for hydrodissection and its effectiveness in improving comfort with performing two nerve blocks. Educational Objectives: Our goal was to increase comfort with performing serratus anterior compartment (SACB) and fascia iliaca compartment blocks (FICB). Curricular Design: Forty board-certified emergency physicians participated in a workshop that consisted of a lecture on the SACB and FICB, followed by a one-hour hands-on session with a live human model and a meat model. Both procedures are large-volume, fascial plane blocks where the anesthetic is placed in a specific fascial compartment. No prior meat models described have provided learners the ability to practice hydrodissection along a fascial plane. We describe a novel meat model that uses commercially available meat glue to simulate a fascial plane, allowing the learner to practice hydrodissection. Impact/Effectiveness: Twenty-two participants responded to our survey. Prior to the workshop, 77% strongly disagreed with feeling comfortable performing the SACB. After the workshop,

Western Journal of Emergency Medicine

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CORD Abstracts Issue 2019

Small-Scale, High-Fidelity Simulation for Mass Casualty Incident Readiness

Nelson J, Weiers A / Regions Hospital/HealthPartners Institute, Saint Paul, Minnesota Background: For most emergency medicine (EM) processes and skills, we use repetition and analysis of past approaches to build competency and efficiency. With mass casualty incidents (MCI), occurrence is unpredictable and recurrence in a single location is rare. This leaves emergency departments (ED) with the need for high-level function during a MCI without past experience to shape that response. We developed a realistic, small-scale MCI simulation to bridge this gap. Educational Objectives: We sought to simulate the injuries and pace of incoming patients that could be expected in a mass shooting as a way to 1) strengthen provider competency in managing a rapid influx of high-acuity patients; 2) promote the sharing of ideas for novel approaches to MCI care at the patient level; and 3) hone the MCI logistical strategy for our Level I trauma center. Curricular Design: After a brief introduction to treatment priorities in mass penetrating trauma, small groups of residents participated in six 10-minute simulation sessions, each with a care team consisting of two nurses and two ED technicians, plus a new second-year resident team lead for each round. Remaining residents observed in the room. Each session had three highfidelity mannequin patients presenting in rapid succession (every three minutes) with penetrating trauma. Each patient was critically ill with multiple gunshot wounds, requiring rapid interventions and decisions about need for operative care or futility. Focused debriefing followed, allowing rapid turnaround for repeated simulations. The entire simulation took three hours, during our regularly scheduled EM small-group didactic time. Impact/Effectiveness: Feedback from the simulation was very positive, with multiple requests to repeat it. Nursing staff involved made changes to documentation plans and equipmentdistribution strategies. Residents offered novel ideas such as giving an intramuscular dose of ketamine to facilitate intubation and finger thoracotomy, as opposed to giving etomidate and succinylcholine, which necessitate a rigid timeline in a situation where the provider is frequently being pulled away from one task to another critical patient. We narrowed the list of supplies needed to bare necessities, developed a list of medications for stockpiling, and created a reference poster of altered MCI priorities to be rapidly placed in prominent places.

Doctors on the Hill: Initiation and Integration of Policy Advocacy in Emergency Medicine Residency Training

Pasichow S, DeKosky B, Cummings C / Brown University, Providence, Rhode Island; Kent Hospital, Warwick, Rhode Island

Background: Medicine and policy are intertwined, given that regulations at a state and federal level influence a physicianâ&#x20AC;&#x2122;s daily practice. Effective communication with legislators is an important part of physician engagement and essential to balanced policy creation. Currently, eight states have state-level advocacy events, but there are few curricula on state advocacy. Educational Objectives: The goals of this program were that, upon completion, residents, fellows, and junior faculty would understand 1) how to create a relationship with legislators; 2) how laws are created, debated, and approved in the state of Rhode Island; 3) how to craft testimony on legislative issues; and 4) how to testify on a law or issue within the Rhode Island legislature. Curricular Design: Senior emergency medicine faculty with experience in state and federal advocacy designed the curriculum in three parts. Part one was a lecture on 1) basics of state and federal government legislature organization; 2) relationship building with legislators; 3) advocacy modalities to influence policy (within and outside of the state legislature); and 4) past successes and challenges in state advocacy. Part two was training on advocacy for a specific issue to prepare residents to advocate for this issue within the state legislature. Part three was a trip to the statehouse that included a tour, meeting with legislators, and observing a public hearing on pending legislation. State medical society resources common to all states were used in the implementation of this curriculum. Impact/Effectiveness: Eight residents were involved in the initial training with all participants indicating desire for future participation. The ACGME Common Program Requirement for system-based practice and communication are addressed in this curriculum. Year two will include improved alignment with residency curriculum, improved topic organization for increased impact upon policy during bill creation, and expansion of the curriculum to residents throughout specialties.

The Zipperator! A Novel Model to Simulate Penile Zipper Entrapment

Wexner S, Till D, Morrison J / UC Davis Medical Center, Sacramento, California; Loyola University Medical Center, Chicago, Illinois Background: Zipper entrapment injuries may be uncommon, representing an incidence of less than 0.5% of pediatric emergency department (ED) visits; nevertheless. they are one of the leading causes of accidental genital injury presenting to the ED in the U.S. While publications on entrapment are relatively sparse, various methods have been proposed for releasing the entrapped tissue including mineral oil lubrication, mechanical zipper release techniques, and in extreme cases surgery. Given the low frequency of the

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CORD Abstracts Issue 2019 chief complaint and the wide variety of techniques available, a model for both practice and experimentation is warranted. Educational Objectives: The goal of the model was to increase familiarity with the concept of zipper entrapment, while the objectives were to attempt one or more of the various release techniques and to demonstrate successful release while avoiding excessive hand motions. Curricular Design: As part of a voluntary emergency medicine curriculum, we constructed a model for penile zipper entrapment using the Hasbro game Operation and materials easily obtainable and assembled in any ED. Forty-eight learners participated in the exercise. Participation was voluntary, was not graded or shared with the residency director, and all feedback was formative in nature. Prior to the exercise, only 10% had treated the zipper entrapment complaint. After the exercise, almost half of the learners (47%) indicated they felt completely or very comfortable regarding future cases of zipper entrapment. Impact/Effectiveness: Zipper entrapment is a low frequency, high-anxiety chief complaint to which the majority of emergency medicine residents have not been exposed, even by the end of training. Through the use of a well-known board game and supplies commonly found in the ED, we created a model that could be easily replicated to enable practice of the techniques necessary for zipper entrapment release. The resident physicians who had treated an actual zipper entrapment patient prior to participating in the exercise thought the model was somewhat similar. We therefore submit this inexpensive, simple model as a potential method to practice the hand motions and techniques to release a zipper entrapment. Learners in the ED found it enjoyable and felt it increased their confidence for treating this chief complaint.

Western Journal of Emergency Medicine

Assessing the Quality of Resident Verbal Hand-offs â&#x20AC;&#x201C; Do You Know What Your Residents Are Communicating?

Spillane L, Pasternack J, Marks L, Stephanos K / University of Rochester, Rochester, New York Background: Accurate patient hand-offs (HO) are an important safety initiative. This is especially true in emergency medicine (EM), where HOs routinely occur between shifts, between services, and even to a degree when talking to a consultant. An institutionwide structured tool was introduced to improve verbal and written communication between services when providing a patient HO. Programs were asked to evaluate resident competence in performing a HO prior to allowing them to do so independently. Educational Objectives: Our goal was to assess resident competence in providing a pertinent and accurate HO. Curricular Design: Residents received information about the new HO tool, elements of a good HO, and the new institutional policy. Several weeks later, EM residents participating in their annual assessment worked in teams to manage a simulated pediatric trauma patient with multiple non-operative injuries. Subsequently, residents individually provided a verbal phone HO to the pediatric intensive care unit. The quality of the HO was evaluated using the framework of the HO tool that includes patient identifiers, active issues, to-dos, potential problems, check-back for understanding, and time for questions. A global evaluation of the resident HO accuracy and efficiency was assessed. Faculty predetermined what information would be critical to share based on the simulated patient encounter.

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CORD Abstracts Issue 2019 Impact/Effectiveness: The quality of presentations varied significantly. The majority of residents included most of the components of the HO tool, but all omitted critical information regarding care of the patient. Interns were less likely to identify anticipated problems and issues requiring follow-up. With one exception, everyone encouraged questions. One team that missed key injuries gave the most organized and efficient HO, showing that the HO quality and medical management quality are distinct issues. Further education on using the tool would be necessary to ensure a culture shift in how residents give and receive presentations. Evaluation may require closer observation of HO in the clinical setting, as well as in didactic sessions. Also, reexamination of the tool is important when evaluating the resident’s use of it. During our simulation, we noted that the tool itself might not be ideal for the HO of critically ill patients. The HO skill and the tool both require repetitive practice with feedback.

correct) to mid-test (53.8% correct) to post-test (52.5% correct). Recipients of short e-mails had greater improvement in scores than recipients of longer e-mails. A survey was sent to all staff. Respondents generally felt more prepared than in the prior year. There was a preference in length of e-mail, with 66% of staff preferring shorter e-mails. Many staff reported even shorter e-mails would be more efficient. While the test scores failed to impress, we learned many lessons about using e-mail to educate: 1) Marketing software is inaccurate and makes useful e-mail look like spam; 2) e-mail not from a known person is less trusted; 3) bullet points are helpful; 4) shorter is better; and 5) conversational style, humor and pictures are very useful. Overall, staff confidence in our ED MCI plans improved through spaced learning via weekly e-mails to staff members, despite relatively similar test scores.

Email for Staff Education: The Good, the Bad, the Ugly

Rosh Review in the Clerkship: Utilization of a Test-Enhanced Learning Resource and Performance on the National Board of Medical Examiners Emergency Medicine Advanced Clinical Exam

Nelson J, Schroeder Hevesi S, Welborn R, Weiers A, Eide B, Carlson K /Regions Hospital/HealthPartners Institute, St. Paul, Minnesota

Bonfiglio C, Fisher J, Whitting T, Smith J / Maricopa Medical Center, Phoenix, AZ

Background: Mass casualty incidents (MCI) are part of our reality. The response plans that emergency departments (ED) prepare frequently change and are infrequently practiced, yet must be enacted quickly. Education must happen despite heavy cognitive load, limited budget, and even more limited attention span. E-mail is not optimal, but it’s what we have. Educational Objectives: We developed a disciplinespecific, spaced learning, e-mail curriculum to teach staff our department’s MCI plans. As part of a prospective observational crossover trial, each staff member received a weekly short or long e-mail from a dedicated project-specific e-mail account. Each e-mail covered a small portion of the MCI plans. We hypothesized shorter e-mails would be preferred, leading to improved retention. Curricular Design: Brief overviews of portions of the MCI plan were tailored to various disciplines (physicians, nurses, coordinators and ED technicians). Short (<250 words) and long e-mails (>500 words) covering the same topic were sent using marketing software (MailChimp, Atlanta, GA) to track the rates at which e-mails were opened. Each staff member received one e-mail per week for a total of eight months. Pre-, mid-, and post-implementation quizzes occurred to quantify retention of material. A post-study survey collected impressions from recipients. Impact/Effectiveness: Weekly e-mails were sent to 442 employees. Open rates were uninterpretable. Overall, scores minimally changed across all groups from pre-test (50.6%

Background: Students who perform well on emergency medicine (EM) clerkships and end-of-clerkship exams are more likely to successfully match into an EM residency. The EM advanced clinical examination (ACE) was released by the National Board of Medical Examiners (NBME) in 2013, and has been used across the nation to rate clerkship performance and future potential of both EM-bound and non-EM-bound medical students since that time. The most commonly used resource for the U.S. Medical Licensing Exam step and ACE exams do not include a subset of EM questions. Rosh Review is an online question bank originally designed for residents and board preparation that uses test-enhanced learning with high-fidelity images and customized testing modalities to prepare medical students to take the EM ACE examination. We predict that use of this resource will positively impact student outcomes on the ACE examination. Educational Objectives: To determine the usage and effect of implementing an online question bank on performance on the NBME ACE exam. Curricular Design: Rosh Review was made available to all students in a required fourth-year, four-week EM clerkship from May–November 2018. Students were given access to over 600 EM Rosh Review questions. They received credit toward their grade based on the number of questions completed. Student performance was tracked on the software’s dashboard. Impact/Effectiveness: Forty-one students completed a total of 17,381 questions. The median number of questions completed was 375 with an interquartile range of 265-612.

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CORD Abstracts Issue 2019 Thirty-six percent of students completed the entire question bank. The mean NBME ACE exam was 81.5 (standard deviation 6.2) vs the national fourth-year mean of 77.8.

questions will be administered to assess resident satisfaction with JCI. Post data will be collected this spring.

Just Checking In: A Peer Mentor Program for Emergency Medicine Residents

McPartlin A, Dehon E, McParlane J, Birnbaumer D / Harbor UCLA Medical Center, Torrance, California; University of Mississippi Medical Center, Jackson, Mississippi; Beaumont Hospital, Farmington Hills, Michigan; Harbor UCLA Medical Center, Torrance, California Background: Approximately half of resident physicians report symptoms of burnout and depression. Burnout and depression not only have deleterious effects on resident wellbeing, but also carry consequences directly affecting patient care. Despite efforts by residency programs across the country to implement programs to improve resident well-being, there is little existing evidence that any of these initiatives are significantly effective. Existing efforts may be limited by residents’ hesitancy to seek support. Educational Objectives: Just Checking In (JCI) is a peer-to-peer mentoring program characterized by regular contact with all residents, not just those who are showing clear signs of distress. The program is intended to foster a sense of community, provide support, and act as a screening tool for any burgeoning issues. Curricular Design: Peer mentors are recruited through a combination of peer selection and volunteering. All residents are assigned one peer mentor from the resident class immediately senior to their own. A fellow and nonadministrative faculty member are chosen as mentors for the fourth-year residents. Each mentor works with approximately 5-8 resident mentees. Every month, the mentors send text message “check-ins” to their designated resident mentees to inquire about their well-being with additional resources for mental health provided on an as-needed basis. All mentors receive training on good mentoring habits, available mental health resources, and the limits of confidentiality. Specific pathways for resident depression, suicidality, substance abuse, domestic violence, sexual assault, and bullying are discussed. This training is adapted from Stanford’s Peer Support Program and is delivered with the oversight of a psychiatry faculty member. Bimonthly mentor meetings are held during the program to provide support and address any issues that have arisen with program implementation. Impact/Effectiveness: All 64 residents in our program are included in this intervention. The efficacy of JCI is being assessed (pre/post) using validated inventories for burnout and depression. Use is assessed by tracking total number of text messages between mentors/ mentees as well as by the number of referrals provided. Anonymous surveys using open-ended

Western Journal of Emergency Medicine

Residency Families: The Development of a Peer Mentoring Program in an Emergency Medicine Residency

Tausch K, Grock A, Weichenthal L, Kahale K, TurnerLawrence D / Beaumont Health, Royal Oak, Michigan; UCLA, Los Angeles, California; UCSF Fresno, Fresno, California Background: Promoting wellness and resilience is important to combat the high rate of burnout in emergency medicine (EM). Mentoring can potentially ease the demands and stressors of residency. Senior residents may be the ideal mentors for junior residents as they most recently progressed through their junior residency years. Although effective peer mentoring may decrease resident burnout, little has been published on creating effective mentoring relationships. Educational Objectives: At the end of the education intervention, EM residents will have improved wellness/ resiliency as measured by the Professional Quality of Life Scale (ProQOL) and Major Depression Inventory (MDI), and they will have Improved understanding of the value of mentorship families as evaluated by a short survey. Curricular Design: Beaumont Health’s EM residency program has a resident-faculty mentoring program; however, no formal peer mentoring program exists. Faculty may not be able to effectively advise residents on the day-to-day realities of being a resident, how to thrive on specific rotations, or the nuances of managing current residents’ scheduling. Thus, it is valuable to have a peer mentor who can offer this guidance. This type of mentoring can simplify the transition from medical school while providing valuable insight into post-residency plans and goals. The peer mentoring program will involve voluntarily placing each resident into a resident family. Each family will consist of a postgraduate year (PGY) 1, 2, and 3 resident. Residents were surveyed to assess their preferences in a peer mentor. Factors used to assign resident families included gender, home address, future interests, hobbies, and availability. The ProQOL and MDI will be used to assess resident well-being following the one-year intervention. Additionally, a structured questionnaire will further evaluate the effectiveness of the peer mentoring program. Impact/Effectiveness: Almost 80% of the PGY-1 and 2 residents and 60% of the PGY-3 residents completed the survey and were matched to a family. Three PGY-3 residents were each assigned to two families due to a larger number of interested junior residents. Moving forward, we will plan to have families that consist of one member from

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CORD Abstracts Issue 2019 each training class. We will use data collected from our survey to provide a model that other programs may follow to create and implement a peer mentoring program.

A Novel Approach to Remediating Communication Skills in “At-Risk” Residents Using Professional Coaching

Implementation of a “Family Orientation” as Part of New Resident Orientation

Bodkin R, Spillane L, Pasternack J, Rotoli J, Marks L, Nobay F / University of Rochester, Rochester, New York

Hartrich M / Los Angeles County + University of Southern California Emergency Medicine Residency, Los Angeles, California

Background: Interpersonal and communication skills (IPC) are critical ACGME core competencies that are difficult to objectively assess and remediate. A resident struggling to effectively communicate with patients and colleagues affects his or her ability to establish rapport, obtain an accurate history, and work in teams. These deficits result in poor evaluations and patient complaints, creating a need to deploy comprehensive remediation plans, which are difficult to create and implement. Educational Objectives: We identified residents with poor IPCs early in their training in order to implement a novel remediation plan that provides competency-focused feedback and individualized strategies to improve performance. Curricular Design: When a resident falls below a minimum threshold in IPCs, our program contracts with a patient- and family-centered communication coach to shadow the resident in the clinical setting, and evaluate strengths and weaknesses in communication. A comprehensive micro-skills checklist is used over multiple patient encounters to evaluate behaviors related to 1) ability to develop initial rapport; 2) gathering of pertinent information; 3) building relationships; 4) explaining / planning; and 5) closing the session. After the shadowing, the coach and resident debrief with specific suggestions for improvement. Feedback is given to the program for incorporation into the resident’s individualized learning plan. The resident’s partnership with the coach is critical to the success of this innovation. Impact/Effectiveness: Without specific feedback, it can be challenging to correct subjective impressions of “poor communication.” Our approach allows for early detection, objective data collection, and a specific plan for remediation and evaluation. While all programs may not have access to a professional coach, a trained observer using the micro-skills checklist can help remediate deficiencies. Over the past four years, we have used this intervention with multiple residents, and mitigated the need for formal remediation or probation.

Background: Despite recent research, there is a paucity of data describing the effects of personal relationships (familial, romantic, platonic) on resident wellness. We explored the literature for existing curricula addressing the personal relationships of emergency medicine (EM) residents but found no family-focused orientations. Residency orientation is an important onboarding opportunity and an ideal time to implement a wellness initiative to include individuals on whom residents rely for support. Educational Objectives: We developed a family orientation for new interns and their support networks with three objectives: to discuss the effect of residency on personal relationships in a confidential and non-judgmental setting; to connect family members to add support for non-residents; and to establish a community of residents and their support networks for social events during the year. Curricular Design: Participants included 15 interns and nine family members within one EM residency. Family members were identified by interns as sources of support and invited by the organizers. Family orientation was scheduled during the general orientation for the interns in June 2018. The session was three hours in length followed by a social activity off-site. Family orientation was led by three residents, their partners, and one faculty member, who have interest in the wellness of personal relationships during residency. Orientation opened with a survey for residents and their families. Each group received a similar survey that explored topics such as expectations of time with family, ability to balance work and home, and comfort discussing work. This was followed by a facilitated, large-group discussion about logistics of resident life, burnout, families’ roles in residency, self-care, and homelife expectations. Attendees were then split into two small groups: residents were led by senior residents, and families were led by the partners. A post-orientation social event followed, which was the first in a series of monthly events open to all residents and their support networks. Impact/Effectiveness: We plan to implement a midyear survey to follow up the questions asked before the orientation to assess the utility and impact of this orientation and subsequent regular social events on both resident wellness and family inclusivity in resident life. The results of this survey will be available at the CORD Academic Assembly.

The “EM in 5” Curriculum: Learner and Presenter Perceptions

Olson A, Moore Q, Olson N, Weber W, Derstine A, Heuton M, Ahn J / University of Chicago, Pritzker School of Medicine, Chicago, Illinois Background: There has been a push by medical educators and learners away from lectures and toward the use of active learning strategies and non-traditional teaching sessions. Emergency medicine (EM) residents rate non-

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CORD Abstracts Issue 2019 traditional teaching sessions higher than lectures. Also, adult learners often prefer highly relevant learning as opposed to longer lectures. In response to these needs, the “EM in 5” curriculum was implemented; we collected learner feedback and perceptions to assess feasibility and acceptability. Educational Objectives: The objective of the “EM in 5” curriculum is to provide a high-yield brief teaching point during didactic sessions for EM residents in five minutes. Curricular Design: “EM in 5” was developed and implemented at the University of Chicago EM residency; Postgraduate year (PGY) 1-3 residents attended the sessions. The “EM in 5” format was developed to challenge PGY-2 residents to teach a five-minute, high-yield learning point during scheduled didactics. Additionally, the format allows for more focused attention by learners and a change of pace during our weekly didactic conferences. Non-traditional lecture formats are encouraged including live demonstration, discussions and videos. Guidelines include a strict five-minute limit, ≤3 slides with words, ≤10 words per slide, and presenters are encouraged to include graphics or visual representations. Regardless of the format, they need to deliver “3 to remember” concise take-away points as a summary. Additionally, residents create an indexcard size handout that visually organizes the material to be distributed following the presentation. Impact/Effectiveness: A survey was administered assessing resident perceptions as learners and presenters. Response rate was 40% with 27 residents (29.6% PGY-1, 40.7% PGY-2, 29.6% PGY-3) participating. The majority of residents rated “EM in 5” highly; additionally, most rated the “EM in 5” format more highly than both 20-minute and onehour lectures. Of the 17 respondents who presented an “EM in 5,” the majority rated the “EM in 5” format highly and enjoyed it more than preparing a one-hour lecture.We view this innovation as an impactful addition to our conference. In the future, we aim to study the impact on knowledge retention. Based on these preliminary findings, we encourage other programs to adopt similar concise presentations within their didactic platform.

locked room. The concept of an Escape Room educational activity offers the potential to expand an educator’s repertoire of active learning methods. Educational Objectives: Our aim was to adapt this game design to teach core EM content and procedural aptitude and create an engaging and team-building activity. Content taught included toxicology antidotes, electrocardiograminterpretations, and airway and ventilator management. Procedural skills included arterial line transducer setup, airway foreign body (FB) retrieval, and cast removal. Curricular Design: EM residents were debriefed outside the trauma room. Upon entering the room, learners were faced with a series of puzzles. The first three puzzles that could be solved all yielded a separate number to eventually open a locked box. These puzzles included a toxicology antidote matching puzzle, a maze with airway and ventilator management questions, and a series of EKGs with questions. Once the locked box was opened, the learners were able to retrieve additional clues that would allow them to solve the remaining puzzles. These included airway FB retrieval, setting up an arterial line transducer, using a cast cutter, and solving a jigsaw puzzle for a visual diagnosis prompt. These last four puzzles helped decipher a phone number, which led to completion of the activity. Learners were debriefed and later given a lecture summarizing the topics covered. Impact/Effectiveness: The Escape Room construct was successfully adopted as an engaging technique to teach EM core content and procedure skills. To gauge effectiveness, residents completed an anonymous survey after the educational activity: 82% rated this activity at a 5 on a 1-to-5 Likert scale on educational value; 94% stated the topics covered were very relevant to EM; and 100% stated they would want to do this activity again. Written comments were all overwhelmingly positive. This unique alternative educational activity can be easily implemented at any EM residency program.

Escape the Trauma Room

Podlog M, Sanghvi S, Husain A, Greenstein J / Northwell Health Staten Island University Hospital, Staten Island, New York Background: Traditional conference didactics often do not effectively meet the learning needs of today’s emergency medicine (EM) residents. Educators have been moving away from hour-long lectures and are now employing various interactive approaches to engage learners. Escape Room is a popular adventure game used for entertainment and team building in which participants must work together to solve a series of puzzles to escape a Western Journal of Emergency Medicine

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Case-Linked Simulation Exercises Improve Resident Engagement in Palliative Care Discussions

Kirsch K, Guzik R, Boyle S /Morristown Medical Center, Morristown, New Jersey Background: The ability to conduct difficult palliative care conversations is a critical skill in emergency medicine (EM) to ensure that patients’ wishes are respected while avoiding painful and futile medical interventions. However, EM residents often feel reluctant to partake in palliative care training since it can feel forced or irrelevant. Educational Objectives: This innovation was designed to provide residents with training on difficult palliative care conversations with the goal of improving participation and application of the acquired skills to their practice. Curricular Design: Groups of two to three residents completed a simulation case in which the patient suffered an acute ischemic stroke, requiring administration of tPA after a discussion of risks and benefits with both the patient and her son. The residents then transitioned to a second simulation station, where they were informed that their patient had a large intracerebral hemorrhage secondary to the tPA. The residents were met by the patient’s two sons (standardized patients) and were asked to conduct a palliative care discussion including sharing the bad news, discussing clinical prognosis, addressing code status, and clarifying goals of care. At conclusion, the case was debriefed and additional information about available palliative care resources was discussed. Residents were asked to complete questionnaires before the simulation case and again approximately six weeks later. This case format was chosen with the intent of facilitating a palliative care conversation relevant to the residents’ training with the opportunity for constructive feedback, in addition to providing residents a chance to process the implications of negative outcomes in a safe environment. The primary challenges involved securing funding for standardized patients and coordinating resident scheduling. Impact/Effectiveness: Following this exercise, the average level of reported comfort with initiating palliative care conversations increased from 6.6 to 7.5 on a 1-to-10 scale. The number of residents who had ordered a palliative consult from the emergency department increased from 69% to 82%; and 82% of respondents agreed that they felt this format made practicing difficult conversations feel “relevant and engaging.” Moving forward, we plan to expand this simulation format to address other critical communication and professionalism topics.

Background: Good analgesia is difficult to obtain in patients with multiple rib fractures, especially the elderly. Targeting the site of injury with a serratus anterior plane (SAP) block can provide remarkable pain relief, potentially decreasing the use of opioids. This block is not widely available to emergency department patients as this procedure is not included in most emergency medicine (EM) residency curricula. Given the importance of practicing nerve blocks on realistic models prior to performing the procedure on patients in a clinical setting, we designed a learning module including a homemade phantom to aid physicians in developing skill with SAP blocks. Educational Objectives: Learners will be able to 1) describe the indications, contraindications and setup for performing the block; 2) identify procedural landmarks on a human model using ultrasound (US); and (3) demonstrate a SAP block using a task trainer. Curricular Design: This module is designed to provide experience and assess competency in performing a SAP nerve block using an inexpensive homemade phantom. The learner will first describe the indications, contraindications and landmarks for the procedure to faculty and acquire ultrasound images using a live model. At a second station, the learner’s performance will be recorded on a check-off sheet after demonstrating the procedure. The phantom task trainer is created with pork ribs and chicken breasts to simulate tissue planes. First, the ribs are stabilized on a sturdy surface. Second, two chicken breasts are placed in two plastic bags simulating fascial tissue planes. The chicken breasts are then placed over the ribs to simulate the latissimus dorsi and serratus anterior overlying ribs. Artifact was minimized by ensuring full contact of the chicken with the plastic. This simple model created fairly realistic US images at a low cost of $20. Impact/Effectiveness: This module was implemented at a community EM residency in December 2018. Initial experience revealed the practical use of the phantom as a realistic model for teaching SAP blocks. This module could be reproduced by other residency programs. Further study will formally review the residents’ competency with the procedure after completing the module with the ultimate goal for the residents to use this skill to improve patient care.

Ultrasound-Guided Serratus Anterior Plane Blocks: An Emergency Medicine Residency Module Using a Homemade Phantom

Cowling K, Sekhon R, Mead T / Central Michigan University Emergency Medicine Residency, Saginaw, Michigan Volume 20, Supplement : August 2019 S35

Western Journal of Emergency Medicine

CORD Abstracts Issue 2019 identification and feedback directly to the website creators, supporting continued improvement of the ECG database (Image 2). More than 320 ECGs from LBJ Hospital were used—interpreted by the site creators in consultation with other emergency physicians and cardiologists. Impact/Effectiveness: This innovation improves trainees’ ECG interpretation and triage through repetition and simulated real-world scenarios. In its first week after release, ECGstampede.com had over 5,000 visitors and an endorsement from Life in the Fast Lane. Our immediate next step will be to create a mobile application to increase accessibility. Planned additional modes include a “study mode,” which provides question-by-question feedback, and an “unlimited mode” without restriction on allotted resources. Ultimately, we aim to release an institutional version with robust analytics to support incorporation into EM residency curricula, and allow for research of trainees’ performance.

ECGstampede.com: An Exercise in Electrocardiogram Interpretation and Triage

Reynolds C, Fadial T / McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, Texas Background: Interpretation of electrocardiograms (ECG) is critical to emergency medicine (EM). Most emergency departments (ED) have protocols for ECG acquisition in triage for common complaints, making ECG “sign offs” a frequent interruption for emergency physicians. ECGstampede.com is the only educational resource designed to teach ECG interpretation in the context of patient triage. Educational Objectives: Our goals were to 1) simulate a busy ED using triage ECGs; 2) give performance feedback on users’ answers, providing correct triage labels and interpretations upon completion; and 3) improve users’ skill and confidence in triaging multiple ECGs and identifying critical ECGs. Curricular Design: The introduction page explains the setting (busy hospital with limited open beds), and the exercise (triage each patient into a location based on his or her ECG and given data). To start, users are given 10 ECGs, one at a time, with age, chief complaint, and vital signs when relevant. The user assigns a triage priority to each ECG: one Code STEMI, two to be roomed immediately, two for next available bed, and five to stay in the waiting room. As “beds” are used, triage priorities are eliminated to simulate an ED that is filling up. Users cannot return to prior ECGs after assignment, consistent with an actual ED. Upon completion, interpretations and correct labels of all 10 ECGs are revealed. A missed STEMI is considered an error, and over- or under-triage elicits a warning (Image 2). The feedback button sends the ECG Western Journal of Emergency Medicine

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February Teach-Off Competition: A $60 Teaching Intervention to Beat the Winter Blues

McGrath M / Boston Medical Center, Boston, Massachusetts Background: Bedside teaching is an important aspect of resident education. Demands on faculty time with rising patient volume, emergency department crowding, and charting can threaten teaching. Academic centers have seasonal flow; in summer we focus on interns assuming new roles and in spring on residents preparing for the next stages of training. For many of us, the winter brings role fatigue and loss of focus on teaching. This is also when the residents take the annual ACGME survey, which measures resident perception of faculty teaching. We piloted a February Teach-Off Competition in 2018 to address this need and boost our teaching. Educational Objectives: We aimed to 1) increase participation in on-shift teaching; 2) recognize teaching excellence; and 3) improve ACGME resident survey responses of faculty interest in teaching. Curricular Design: In January 2018, we promoted the competition in conference, e-mails and posters. The goal was to encourage resident and faculty participation in morning teaching rounds and change-of-shift teaching. All teaching counted: ultrasound, electrocardiogram, radiology, critical care, advances in literature, etc. We tracked rounds and reminded those responsible via e-mail. At the end of February, residents voted anonymously on-line for the best resident and faculty teacher. All nominees were recognized at conference and their names given to the residency program director and chair. The winners received a framed certificate, a coffee mug and gift card to a local café. The total program cost $60. Impact/Effectiveness: We expanded morning teaching rounds to six days per week and residents reported an increase in change-of-shift teaching. Fifteen residents and faculty were formally recognized for teaching. Our efforts did not lead to measurable improvements on the ACGME survey questions “faculty are interested in residency education” and “create environment of inquiry.” Mean scores were 4.0 and 3.7 in 2018, respectively ,and 4.1 and 4.0 in 2017. This blunt survey may not be the correct tool to measure impact of this project. This program is applicable to any residency suffering from seasonal slumps in teaching enthusiasm. It is low cost and easy to implement. Many residents and faculty who were not nominated this year asked how they could “make the winner list” next year. The award ceremony was met with cheers and was a fun celebration. It recognizes those who are dedicated to teaching and encourages others to compete for the same.

Building Interest in Emergency Medicine Through a Cadaver-Based Procedural Skills Workshop

Parekh K, Brumfield E, Lei C /Vanderbilt University Medical Center, Nashville, TN Background: Emergency medicine (EM) is often not a required course for medical students; thus, they may have limited exposure to EM in the pre-clinical curriculum. To promote early exposure to EM and to provide extracurricular opportunities for procedural skills practice, the EM Interest Group at Vanderbilt University School of Medicine developed and hosted two cadaver-based, procedural skills workshops. Educational Objectives: The objectives of the workshop were to increase interest in EM and to increase confidence in performing procedures. Curricular Design: Each workshop consisted of 1) a didactic session, and 2) a cadaver-based procedural session. Senior students planning careers in EM led the didactic session, reviewing the indications, contraindications, methods, and complications of each procedure. The cadaver-based session was conducted by EM faculty and residents who facilitated deliberate procedural practice. Included procedures were airway management, intraosseous and central venous catheter placement, tube thoracostomy, pericardiocentesis, and laceration repair. At the end of the cadaver-based session, participants completed anonymous paper evaluations consisting of a fivepoint Likert scale and two open-ended questions. Participant confidence in performing procedures was assessed using a five-point Likert scale. We compared pre- and post-workshop confidence using a Wilcoxon signed-rank test. Impact/Effectiveness: Of the 28 students who participated, all (28/28) completed an evaluation; 67.9% of participants (19/28) were first- or second-year students. The evaluation indicated that 75% (21/28) of participants reported increased interest in EM, and 25% (7/28) reported that their interest in EM did not change. Confidence in performing procedures significantly increased for all procedures. The most significant increase in confidence was for endotracheal intubation (preworkshop median = 2; post-workshop median = 3.

Academic Promotion Workshop Series Enhances Emergency Physicians’ Knowledge of and Experience with the Promotion Process

MacVane C, Strout T, Baumann M / Maine Medical Center, Portland, Maine Background: Academic promotion is important for emergency physicians, but the lack of formal guidance in navigating complex systems can present a challenge. Our Institutional transition in university partners left our faculty with little understanding of the new promotions process and required dossier. Educational Objectives: We sought to develop a structured, mentored academic promotion workshop series.

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CORD Abstracts Issue 2019 Round 1

Round 2

assess responsiveness assess responsiveness

Round 3

Round 4

Round 5

Round 6

Round 7

assess responsiveness

assess airway patency assess airway patency

assess airway patency

assess breathing

starts BVM ventilation

checks pulse

starts CPR (30:2)

attaches to monitor

attaches to defibrillator attaches to defibrillator assess rhythm

attaches to defibrillator

assess rhythm

states dx is VF

states need for defibrillation

continues CPR while charging

declares all clear prior to defibrillation declares all clear prior to defibrillation declares all clear prior to defibrillation declares all clear prior to defibrillation declares all clear prior to defibrillation declares all clear prior to defibrillation defibrillates at 200J biphasic

defibrillates at 200J biphasic

resumes CPR

CPR 5 cycles (30:2) or 2 minutes

IV/IO access

checks pulse

assess rhythm

states dx is VF

states need for defibrillation

continues CPR while charging

defibrillates at 200J biphasic

resumes CPR

CPR 5 cycles (30:2) or 2 minutes

give epinephrine 1mg (q3-5 min)

considers intubation

checks pulse

assess rhythm

states dx is VF

states need for defibrillation

continues CPR while charging

defibrillates at 200J biphasic

resumes CPR

CPR 5 cycles (30:2) or 2 minutes

compression x 2 minutes

give amiodarone 300mg IV

give epinephrine 1mg

check pulse

assess rhythm

states dx is VF

states need for defibrillation

continues CPR while charging

declares all clear prior to defibrillation declares all clear prior to defibrillation declares all clear prior to defibrillation defibrillates at 200J biphasic

defibrillates at 200J biphasic

resumes CPR

CPR 5 cycles (30:2) or 2 minutes

compression x 2 minutes

give amiodarone 150 mg IV

give epinephrine 1mg

check pulse

assess rhythm

states dx is VF

states need for defibrillation

continues CPR while charging

declares all clear prior to defibrillation declares all clear prior to defibrillation defibrillates at 200J biphasic

defibrillates at 200J biphasic

resumes CPR

resumes CPR CPR 5 cycles (30:2) or 2 minutes give epinephrine 1mg check pulse interpret rhythm (ROSC) obtains full set vital signs asks for EKG

Figure. Rapid Cycle Deliberate Practice (RCDP) ventricular tachycardia/ventricular fibrillation (VT/VF) simulation case for emergency medicine clerkship students (Abstract 32).

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CORD Abstracts Issue 2019 Goals included enhancing understanding of the promotions process; improving knowledge of the required educational dossier elements; heightening awareness of the characteristics of a strong dossier; and expanding the number of emergency medicine (EM) dossiers ready for submission. Curricular Design: We developed a novel format using adult learning theory principles, and team-based and flipped-classroom strategies. Workshop preparation began with brief readings, review of portfolio templates, and document gathering (eg, curriculum vitae [CV], learner evaluations). Monthly two-hour peer-led workshop topics included an introduction to the promotion process; CV preparation; developing an educational portfolio and teaching philosophy; documenting teaching roles in course and faculty development, medical education, and curricular affairs; learner and peer-teaching evaluations; letters; documenting scholarship; and portfolio appraisal. Each session included review of the month’s topics and materials, example sharing, discussion and structured time for dossier-preparation work. Impact/Effectiveness: Ten EM academic-track faculty were eligible to participate. Following session one, two faculty determined that they did not meet promotion criteria and four noted that their body of scholarly work needed further development; all identified specific areas needing enrichment. The remaining four faculty participated in the full program. At completion, two participants had full, submissionready dossiers. One had a near-complete (since submitted) dossier, and one participant chose to delay submission. All gained understanding of the process, dossier components, characteristics of a strong portfolio, and were able to discern their readiness for advancement. All reported that the program was useful and enjoyable. In sum, peer-mentored academic promotion workshops are an effective way to enhance the dossier-preparation process.

Rapid Cycle Deliberate Practice Simulation for Resuscitation Training of Medical Students

Tsao S, Tabakin E, Wivel A, Siegel G /University of Pennsylvania, Philadelphia, Pennsylvania Background: Medical simulation provides an opportunity for students to safely practice critical cases. However, standard simulation with post-event debriefing can overwhelm and frustrate medical students who may lack the skills to successfully complete the case. The novel simulation method of Rapid Cycle Deliberate Practice (RCDP) created by Hunt et al. may eliminate this issue and improve learning and retention. RCDP uses the concept of deliberate practice to allow learners to repeat skills after receiving targeted within-event feedback by instructors. Recent research suggests that RCDP is an ideal method of teaching the algorithms and technical skills of

Western Journal of Emergency Medicine

resuscitation. This research is still in its infancy. Absent are data testing RCDP in medical students. Using the methods below, we aimed to fill this gap by creating a RCDP model for emergency medicine (EM) clerkship students. Educational Objectives: The objective of using RCDP is to improve proficiency and retention of critical actions and skills while increasing student satisfaction compared to standard simulation. Curricular Design: We created an RCDP ventricular tachycardia/ventricular fibrillation (VT/VF) simulation case for medical students. We divided the stages of the Advanced Cardiac Life Support (ACLS) VT/VF algorithm into discrete rounds, with each consisting of required critical actions. Faculty would “pause and resume” or “stop and restart” the case to give quick directed feedback. Pause and resume is used when a task has been performed incorrectly. The case continues with students in their same roles. Faculty stop and restart the case when a task is missed, performed out of sequence, or the round has been completed. The round is restarted from the begining with students in new roles, thus giving everyone a chance to lead. This cycle repeats until case completion. Impact/Effectiveness: We used this RCDP protocol in place of standard simulation in our EM clerkship. Informal student feedback has been overwhelmingly positive. As teachers, we were able to correct errors and teach ACLS skills in real time. Students incorporated feedback, and their performance improved over the course of the session. By the end, students were able to complete the entire case with minimal correction. Future direction of our work will focus on assessing the long-term retention of skills learned in RCDP simulation.

A Novel Standardized Rubric for Medical Student Emergency Medicine Oral Presentations

Reynolds C, Fisher K, Fairbrother H / McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, Texas Background: Emergency medicine (EM)-specific oral presentations differ from general oral presentations in length, focus, and structure. Although we teach medical students to present differently in the emergency department, there is no established rubric for grading EM-focused presentations. We present a novel rubric for use in EM, derived from a published, validated rubric used in other medical specialties. Educational Objectives: Our goals were to provide a novel grading rubric for EM-specific medical student presentations, designed to specifically assess for length, focus, and structure; and improve standardization of oral presentation grading and feedback. Curricular Design: In 2014, Lewin et al. introduced the Patient Presentation Rating tool – a validated rubric for

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CORD Abstracts Issue 2019 grading medical student presentations created by a group of medical educators across many core specialties. The tool is comprised of 18 items divided into six sections, with an overall rating at the end. According to the original study, the tool had high inter-rater reliability, and a randomized controlled trial performed during a third-year pediatric clerkship showed that the intervention was significantly better than unstructured presentation feedback. We used this validated tool as a framework to create a rubric for EMfocused oral presentations using established EM guidelines. The critical elements of an EM oral presentation, as established by Davenport et al. in “The 3-Minute Emergency Medical Student Presentation: A Variation on a Theme,” were built into our novel rubric. Following the tenets of the published EM literature, our rubric has an emphasis on pertinent information, a focused exam, concise summary without unnecessary information, and an assessment and plan that provides a differential diagnosis and addresses the most important issues. Impact/Effectiveness: This rubric was used in our study of medical student presentations, “Teaching and Evaluating Medical Students’ Oral Presentation Skills in Emergency Medicine,” which documented an improvement in oral presentations after fourth-year medical students used a formalized self-didactic curriculum. We anticipate that this rubric will be incorporated into EM clerkships, improving educators’ ability to grade and provide feedback on medical student oral presentations. In the long term, this rubric will allow for standardized evaluations of students from different backgrounds and medical schools.

Western Journal of Emergency Medicine

Emergency Medicine Residents as Mentors: Toward a Curriculum on Mentoring

Parekh K, Lei C, Brumfield E / Vanderbilt University Medical Center, Nashville, Tennessee Background: Mentorship is critical in all stages of career development. Emergency medicine (EM) is increasing in popularity as a specialty choice, which increases the need for emergency physicians who can mentor medical students pursuing careers in EM. Students have traditionally sought mentorship from EM faculty. However, students are not directly exposed to EM during the clerkship phase of the curriculum, limiting their interaction with EM faculty and making early mentor identification difficult. Simultaneously, while residents are expected to be educators, mentoring is often not explicitly taught or practiced. Thus, we created a resident-student mentoring program for students exploring careers in EM. Educational Objectives: Our aim was to develop a residentstudent mentoring program to provide senior medical students advice and support as they consider a career in EM and apply to residency, while providing EM residents a formal opportunity to develop mentoring skills. Curricular Design: Interested senior medical students were assigned a volunteer senior resident mentor. Residents and students were introduced via e-mail. Contact information and mentoring program goals and expectations were provided. Residents were given core articles on mentoring. Residents and students attended two group events to discuss mentoring and pursuit of an EM career. Each dyad also arranged individual meetings. Impact/Effectiveness: Of 26 residents, 25 (96%) volunteered; 15 residents and 15 students participated in the program. After the 2016 Match, participants completed surveys regarding their experiences: 6/15 (40%) residents and 10/15 (67%) students completed the survey. All (6/6) of the residents agreed or strongly agreed that “I enjoy being a mentor” and all (6/6) would recommend the program to a colleague. Of the nine students surveyed, eight (89%) reported they would recommend the program to other students. The mentoring program was feasible; students did not overwhelm residents with requests and students found residents welcoming and easy to contact. Both groups enjoyed the program. Further development of the program includes a formal curriculum on mentoring, relation of program participation and resident job satisfaction, and expanding to junior medical students.

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CORD Abstracts Issue 2019

A Personal Crisis Management Plan for Residents

Chen A, Swisher L, Brown M / Mount Sinai Hospital, New York, New York; Drexel University, Philadelphia, Pennsylvania; University of Tennessee Health Science Center, Nashville, Tennessee Background: Studies have shown that approximately 30% of residents are depressed and 10% have had suicidal ideation, yet few tools have been developed for residents to address this professional risk. Educational Objectives: We aimed to develop a tool that can be used for identification and resources for mental health issues, and to design a session in which a personal crisis management plan can be introduced to residents early in the training curriculum. Curricular Design: Using a template similar to safety plans used by psychiatrists in suicidal patients, we created a personal crisis management plan given to interns during orientation. Interns were asked to identify warning signs that might indicate they were headed toward crisis and to create an individualized list of coping strategies and resources to use once they identified an impending crisis. They were also invited to give examples of triggers and coping mechanisms. The goal of introducing residents to this tool early in training was to make them aware of the potential for emotional crisis during the high-risk period of training, as well as to decrease the perceived social stigma of discussing mental health in medicine. We assessed the usefulness of the tool by surveying interns three months into their intern year to measure their perception of the likelihood of developing suicide ideation in their training, how useful they felt the personal crisis management plan would be if they found themselves in crisis, and whether or not they had used the tool. Feedback from interns indicated that an electronic version of the plan would be a useful modification as it would be more accessible than the paper version originally used. Impact/Effectiveness: A survey of the intern class with a response rate of 88% (21 out of 25) showed the following: 40.9% of interns felt they were “likely or “very likely” to become depressed or suicidal in residency; 40.9% and 27.3% agreed and strongly agreed that the personal crisis management tool would help them identify a crisis; 59.1% and 18.2% agreed and strongly agreed that the personal crisis management tool would help manage a crisis; and 31.8% of respondents indicated that they had used their personal plan in the preceding three months. Initial results indicate that interns recognize the high risk to mental health that residency training confers, and a majority feel that a personal crisis management tool would be useful in identifying and managing a personal crisis.

Assessment of an Opt-Out Employee Assistance Program Assessment to Mitigate Burnout and Reduce Barriers to Seeking Mental Health Care In Emergency Medicine Residents

Chung A, Tabatabai R, Paetow G, Zarzar R, Scott N, Fruchter E, Isaksen L, Hart D / Maimonides Medical Center, Brooklyn, New York; University of Southern California Keck School of Medicine, Los Angeles, California; Hennepin County Medical Center, Minneapolis, Minnesota Background: Burnout has been found to affect nearly 70% of emergency physicians and up to 76% of emergency medicine (EM) residents. Of the 28% of residents who screen positive for depression or depressive symptoms, only 2040% actually seek treatment. Some barriers include time, confidentiality, and stigma. A study of internal medicine residents who attended an opt-out, universal well-being assessment at the employee assistance program (EAP) reported increased likelihood of using EAP in the future. Educational Objectives: Our primary objective was to determine if attending an appointment as part of an opt-out EAP assessment program would increase postgraduate year (PGY)-1 EM residents’ reported likelihood of future EAP use. Curricular Design: Participants included 47 EM PGY-1s from three geographically diverse EM residencies. They were scheduled for a one-hour EAP appointment during protected non-clinical hours, with the ability to opt-out if desired. Prior to the appointment, participants completed the Maslach Burnout Inventory (MBI-HSS) and COPE Inventory. Each EAP session included review of EAP resources, proactive tools to mitigate burnout, and discussion of individual MBI and COPE results. Surveys and semi-structured interviews were conducted following the intervention. PGY-2, 3, and 4 residents completed a similar survey as a comparison group

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CORD Abstracts Issue 2019 Impact/Effectiveness: EAP appointments are nearly complete at one site; zero residents opted-out. Of those surveyed, 100% felt the program should be continued in future years. Ratings for “how likely would you be to attend EAP in the future if needed” were 5.17 +/- 1.68 before and 7.14 +/0.99 after the appointment, with a PGY-2+ rating of 4.38 +/1.93 (1 = not likely, 9 = very likely). These preliminary results suggest that this intervention may be effective in increasing the likelihood of future EAP use for residents who attend an appointment compared to those who do not. We plan to have additional data from the other participating sites by the 2019 CORD Academic Assembly.

learners reported a significant improvement in comfort for each airway modality after the course. This level and change in comfort level varied with level of training. An interactive airway course improves learners’ confidence and skill with difficult airways, but may not significantly impact their choice of device used. This effect is strongest for junior-level trainees.

Table 1. Mean comfort level with each airway device on VAS (10 point) for participants before and after course.

Does an Educational Interactive Airway Lab Change Residents Choice of Airway Device and Comfort Level?

Akujuobi I, Thundiyil J, Hunter C, Ladde J / Orlando Health, Orlando, Florida Background: Securing a difficult airway is a critical skill in emergency medicine (EM). Practicing these skills, improving confidence, and knowing backup techniques during residency training are critical. Educational Objectives: We aimed to assess the impact of an interactive airway lab on resident’s comfort with and choice of different airway devices. Curricular Design: EM faculty developed a two-part, three-hour interactive course for medical students, EM residents, and pediatric emergency fellows (PEMF) to improve airway management skills. The first part was a 30-minute faculty led discussion on approaching the difficult airway with difficult airway algorithms. The second part included eight hands-on stations employing direct laryngoscopy (DL), video laryngoscopy, laryngeal mask airway (LMA), bougie use, fiberoptic laryngoscopy, retrograde wire-guided intubation, pediatric airway, and cricothyrotomy. Learners circulated in 15-minute intervals to each skills station in small groups learning with various simulation mannequins using the latest equipment under direction of faculty preceptors and equipment vendors. Additional material was provided via social media and online teaching modules. Participants were surveyed before and immediately after the session to assess their primary and back-up airway preferences and comfort with each type of airway device covered in the session. Impact/Effectiveness: A total of 46 participants took part in this course including 11 MS4, 11 PGY-1, 11 PGY-2, 8 PGY3, and 5 PEMF. Prior to the course, learners stated their initial airway preference as follows: 20 DL, 20 Glidescope, and one LMA. After the course, 18 chose DL, 23 Glidescope, and one LMA. For rescue airway choice before the course, learners stated 5 DL, 14 Glidescope, and 11 LMA; after the course the choices were 6 DL, 12 Glidescope, and 8 LMA. Overall,

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Table 2. Mean comfort level on VAS (10 point) stratified by experience level for different airway devices before and after airway course.

Foundations EKG I and EKG II: Open-Access Flipped-Classroom Critical EKG Curricula

Burns W, Jones S, Caretta-Weyer H, Weygandt PL, Hartman N, Grabow Moore K / University of Wisconsin, Madison, Wisconsin; Oakland University, Auburn Hills, Michigan; Stanford University, Stanford, California; Johns Hopkins University, Baltimore, Maryland; Wake Forest University, Raleigh, North Carolina; Emory University, Atlanta, Georgia

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CORD Abstracts Issue 2019 Background: In 2003 Ginde et al. found that 35% of emergency medicine (EM) residencies lack formal electrocardiogram (EKG) curricula and 48% of EM residency directors supported the creation of a national EKG curriculum. No formal national curriculum currently exists, and it is unknown whether residents gain sufficient skill from clinical exposure alone. In 2016 Hartman et al. found only 28% of PGY-1s and 54% of PGY-3/4s passed a validated test of critical EKG interpretation. Educational Objectives: We sought to evaluate leader and learner perception of learner EKG interpretation skills at the start of EM residency and to assess the value of our flipped-classroom, critical EKG curriculum. Our curriculum provides 1) exposure to critical EKG pattern; 2) a framework for EKG interpretation when gestalt is not sufficient; and 3) implementation guidelines and openaccess to any interested residency. Additionally, in response to prior feedback,we sought to create separate curricula, EKG I and II, benchmarked to PGY-1 and PGY-2 level learners respectively. Curricular Design: The Foundations of Emergency Medicine (FoEM) EKG I and EKG II curricula were launched in 2017. Topics included 15 published critical EKG diagnoses and 33 selected by consensus. Cases include a brief history, EKG(s), a standard interpretation stem, and Free Open Access Medical Education links. Full EKG interpretations and answers to discussion questions were provided to facilitators. Impact/Effectiveness: EKG I enrollment for the 2017-2018 academic year included 39 residencies and 671 learners, an increase from six residencies and 76 learners in 2016-2017. EKG II enrollment included 24 residencies and 446 learners. In March 2018, program leaders and learners were surveyed, with 74 of 77 sites responding (96%). Leaders were highly satisfied and indicated that content was at an appropriate level for learners. Learners were also highly satisfied and indicated that the curricula improved their ability to interpret EKGs in clinical settings. Only 28% of learners agreed or strongly agreed that “at the beginning of residency, I was prepared to interpret EKGs.” Also, only 14% of leaders agreed or strongly agreed that “at the beginning of residency, compared to their classmates, interns are equally prepared to interpret EKGs.” These preliminary data suggest that an unmet need for standardization and improvement of EKG training exists.

Table 1. Foundations EKG I and EKG II course overview (www. foundationsem.com)

3D Printed, Do-It-Yourself UltrasoundGuided Femoral Nerve Block Task Trainer

Crawford S, Palacios P, Nordquist E, Monks S / Texas Tech University Health Science Center El Paso, El Paso, Texas Background: Emergency physicians are required to be well versed in a wide repertoire of procedures ranging from lifesaving resuscitative techniques to pain control and management. Pain management has conventionally been approached via pharmacological means; however, a relatively newer approach involves the use of peripheral nerve blocks. Specifically, for

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CORD Abstracts Issue 2019 patients with lower extremity and hip fractures, a femoral nerve block can be used. An economical device capable of demonstrating anatomic landmarks on ultrasound (US) is needed to make practice more accessible and ultimately lead to improved training and patient care. Educational Objectives: This innovation was designed to meet the following educational objectives: 1) Identify anatomical features for femoral nerve block using US; 2) develop tactile and spacial skills for real-time US-guided femoral nerve block; and 3) design a training device that is inexpensive, provides realistic imaging representation, and can be replicated across multiple training programs. Curricular Design: The femoral nerve block task trainer is composed of a 3D printed case with specific openings on its sides coinciding with anatomically correct femoral artery, nerve and vein dimensions. The interior of the case is filled with a superabsorbent polymer that will absorb water and give it a consistency comparable to subcutaneous tissue. A rubber â&#x20AC;&#x153;skinâ&#x20AC;? placed over the trainer contains components and maintains an US interface. Thirty-six EM residents provided feedback on the task trainer after participating in a deliberate practice exercise. Impact/Effectiveness: Using this low-cost, effective trainer allows for easier access to repeated practice as well as providing a safe method without the need for practicing on a human patient. Of the residents surveyed, 97% stated that this model was realistic, and 96% believed that the training activity using this model will help provide improved patient care.

Transparency in the Culture of Assessment and Feedback: A Currently Opaque Environment and the Case for Resident Feedback Dashboards

Harrison R, Goldflam K, Tsyrulnik A, Wood B, Della-Giustina D / Yale School of Medicine, New Haven, Connecticut Background: Proper feedback practice should encourage the development of self-reflection, encourage dialogue between teacher and learner, and provide a framework to move toward desired performance. It should be ongoing, frequent and dynamic (Swanwick, Tim. Understanding Medical Education). Unfortunately, satisfaction with feedback among emergency medicine residents is lower than it should be. Resident dashboards have been described as platforms that inform the clinical competency committees (CCC) in internal medicine. Resident dashboards allow residents to access their feedback data on a real-time basis. Educational Objectives: The resident dashboard was designed to create a more transparent environment regarding performance. A dashboard enables residents to regularly reflect upon their feedback in an easy-tounderstand visual format that identifies their strengths and weaknesses within the framework of the ACGME Milestones. This immediate, timely feedback allows residents to refine their clinical practice on an ongoing basis. Over time, the accumulation of data will make it feasible to create individually tailored education plans. Curricular Design: After performing an internal needs assessment, we realized there was a need to change how evaluations of resident clinical performance were collected and communicated. Responses highlighted a need for increased quantity, specificity and transparency. We created a new evaluation tool that focused on obtaining Milestone-relevant clinical data coupled with focused qualitative questions. Rather than using a ranked scale to assess individual competencies within the Milestones

Figure for Abstract #40.

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CORD Abstracts Issue 2019 framework, we now collect Milestone data using a “check all that apply” evaluation system. The data collected from both attendings and nurses are mapped in real time into a visually easy-to-understand dashboard that allows residents and residency leadership to identify deficiencies and access specific qualitative feedback. While development of a dashboard is time intensive, it is easy to maintain. The cost of this project is supported by an internal grant, and the technology is currently being provided free of charge by Qualtrics as a pilot. Impact/Effectiveness: Using a feedback dashboard that is easily accessible to both residents and residency leadership provides the opportunity to significantly improve transparency regarding performance. The promise of being able to individually tailor resident education using similar technology is encouraging. Thus far, residency leadership and residents have been pleased with the ability to access the robust data quickly.

Example of Evaluation question:

Example of how the question is mapped to Resident Dashboard:

Using a Novel, Online Relational Database Tool to Track Attendance and Increase Didactic Evaluations in Graduate Medical Education

Sungar WG, Byyny R, Moreira M, McCormick T, Kaplan B, Buchanan J, Blok B, Angerhofer C, Baker B, Lawson C / Denver Health Medical Center, University of Colorado School of Medicine, Denver, Colorado; University of South Carolina School of Medicine Greenville, Greenville, South Carolina Background: The ACGME requirement that emergency medicine (EM) residents attend a specific percent of planned didactic experiences, makes accurate recording of attendance critical in residency program administration. Additionally, adequate evaluation of conference material is essential for program evaluation and faculty development and promotion. Educational Objectives: Our goal was to implement a system to automatically track resident conference attendance and to increase the number and quality of evaluations completed for sessions presented at the weekly didactic conference within our EM residency program. Curricular Design: Through a re-design of our conference curriculum we adopted a new curriculum management system (Emergency Medicine Curriculum Assessment Tool [EMCAT] created by MedEd Guru), operated through Airtable, a free cloud-based relational database system. This tool allows for curriculum mapping and scheduling, and further functionality was developed to collect online evaluations and track attendance. Due to the ease of the system, a new mandatory evaluation process was instituted within our program, whereby attendees – both faculty and residents – only receive attendance credit if they complete an evaluation for each session that they attend. Following each didactic session, attendees are reminded to access the online evaluation form via their smartphone to complete an evaluation. To evaluate effectiveness, we compared the number of evaluations completed in our old format, in which evaluations were completed through an e-mailed form, to the new process. Impact/Effectiveness: Using this system, attendance is recorded automatically and in real time, decreasing the amount of administrative efforts that were previously required, and allowing faculty and residents to access their attendance records at any time. Additionally, we have seen a drastic increase in the median number of evaluations that we receive for each conference session (3 [interquartile range (IQR) 2-4] vs 31 [IQR 25-40], difference 27 [95% confidence interval,

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CORD Abstracts Issue 2019 22.2-31.8]). This increase in the number of evaluations has also resulted in a more than threefold increase in the total character count of qualitative feedback per session (266.2 vs 851.5). This improvement in the quantity and quality of feedback incentivizes faculty participation and allows for more robust program evaluation.

Innovative Evaluation Tool: Fast, Robust and Mobile Engaging Faculty in Both Written Evaluations and Verbal Communication

Harrison R, Goldflam K, Tsyrulnik A, Wood B, Della-Giustina D /Yale School of Medicine, New Haven, Connecticut Background: Across all specialties, residency leadership is required to provide evaluation and feedback to residents. We identified a need for improved compliance with resident evaluation of clinical performance within the emergency department. Educational Objectives: A novel evaluation tool was developed to engage more faculty in the completion of evaluations and encourage more timely and useful feedback to residents. The evaluation tool assesses Milestones, procedural competencies, and general feedback in a quick, easy, and mobile fashion. Curricular Design: Gathering data from two focus groups and two internal surveys, we developed an evaluation tool using Qualtrics that faculty could access via a mobile device. A simple version of the tool was initially piloted, and modifications have since been made to make it more robust. Currently, the evaluation tool is a webbased survey form easily accessed on a mobile device or Western Journal of Emergency Medicine

computer. It takes 3-4 minutes to complete. The evaluator is given two randomized questions from a pool of 17 that represent the non-procedural Milestones. The language of the questions is designed to extract the clinical aspects of the Milestones. The evaluator is not forced to place the resident on a scale, but rather check all competencies that apply. The evaluator is then given a list of procedures. If the evaluator has observed a procedure performed by a resident, he or she can evaluate the residentâ&#x20AC;&#x2122;s performance based on Milestone competencies. Lastly, there are two qualitative questions that can be dictated if using a mobile device: strengths of shift, and items to work on/medical topic to focus on. A prompt is then provided to assess whether verbal feedback was given to the resident. Impact/Effectiveness: This survey-based evaluation form is an easy and quick method for faculty to complete resident evaluations. Compliance with evaluations has increased from approximately 18 faculty with the traditional system to over 45 with the new tool. Additionally, residents were surveyed after receiving the new evaluations and found the information to be more specific and more useful. Attendings have increasingly self-identified an increase in the amount of verbal feedback that is being communicated. During the pilot phase, 39.4% (n = 494) of individual evaluations noted that the attending did not provide any feedback. In the current model after a year of implementation, 31.7% (n = 1083) of individual evaluations noted that attendings did not provide feedback. The amount of constructive feedback has increased from 32.9% (n = 494) to 43.12% (n = 1083). In summary, the new survey-based tool has proven to engage more faculty in evaluation while providing more timely and specific information to the residents. Because the tool is based on a survey system, a similar tool would be easy to implement within other emergency medicine residencies.

Residents as Teachers: Applying the Foundations Model for Structured NearPeer Education

Grabow Moore K, Ketterer A, Dick-Perez R, Weygandt P. L, Caretta-Weyer H, Berberian J / Emory University, Atlanta, Georgia; Beth Israel Deaconess Medical Center, Boston, Massachusetts; Marquette General Hospital, Marquette, Michigan; Johns Hopkins University, Baltimore, Maryland; Stanford University, Stanford, California; Christiana Care Health System, Christiana, Delaware Background: Meeting the needs of learners of different levels is one of the major challenges of resident education. Most programs cover core content by teaching to the middle, leaving beginners confused and advanced residents disengaged. Foundations of Emergency Medicine

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CORD Abstracts Issue 2019 (FoEM) was designed to address this problem, providing resources to incorporate class-directed instruction. Postgraduate year (PGY)-1 residents review fundamental knowledge with Foundations I (F1), PGY-2/3 residents are challenged by advanced topics in Foundations II (F2), and PGY-3.4 residents solidify knowledge in the role of resident teachers. No studies to date have evaluated the benefits to learners and instructors of this near-peer teaching model. Educational Objectives: We sought to describe use of the resident instructor model at FoEM member sites, determine preferences among learners for resident vs faculty instructors, and quantify benefits to senior residents in the teaching role. Curricular Design: Didactics within the F1 and F2 courses entail small group, oral boards-style clinical cases. Case content, focused teaching points and best practice guidelines â&#x20AC;&#x201C; developed using a modified Delphi approach â&#x20AC;&#x201C; are given to instructors in advance. FoEM implementation guidelines encourage member sites to incorporate senior residents as instructors to 1) challenge knowledge; 2) provide structured resident-as-teacher opportunitie;, and 3) allow faculty to give feedback to resident instructors. Impact/Effectiveness: A survey of FoEM program leaders and learners was developed by our leadership team and piloted among site leaders. Formal survey administration in March 2018 rendered a 96% response rate (74 of 77 sites); 54% of site leaders reported use of resident instructors, more prominently for F1 compared to F2 cases. Senior residents (Chief, PGY-3/4) acted as instructors more frequently than advanced junior residents (PGY-2). The majority of learners in F1 and F2 preferred a mix of faculty and resident instructors (63%). Nearly all resident instructors reported educational benefit from teaching. Our results support the use of resident instructors within the Foundations model with demonstrated benefits to learners and resident instructors alike.

Table 1. Foundations of emergency medicine leader survey results.

Table 2. Foundations of emergency medicine learner survey results.

Educational Soundbites Oral Presentations

Using Simulation to Engage and Educate During Monthly Emergency Medicine Residency Morbidity and Mortality Conferences

Stobart-Gallagher M, Kramarski H, Becker J, Pierce D / Jefferson Health System, Philadelphia, Pennsylvania; Einstein Healthcare Network, Philadelphia, Pennsylvania Background: Participation in morbidity and morbidity (M&M) conferences are an educational requirement under the Accreditation Council for Graduate Medical Education (ACGME). There have been numerous articles published on varying ways to execute this requirement across multiple specialties, but to our knowledge there has not been a published utilization of simulation (SIM). Educational Objectives: Our goal in providing a visual and simulated representation of a recent challenging case was to promote engagement and participation in residency conference, as well as assist in promoting educational objectives defined by the predetermined M&M case. Curricular Design: The departmental quality improvement (QI) team chose a recent, challenging medical case with associated morbidity and mortality as usual. Once the case was de-identified, it was rewritten into a simulation case by a senior resident using a predetermined SIM case template identifying both educational objectives specific to the case and specific systems issues. On the day of conference,

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CORD Abstracts Issue 2019 the SimMan, iSIM, and procedural equipment were brought to the conference room. An attending, two residents, and nursing staff (who voluntarily attended weekly conference) were chosen at random to run the case in real time using the simulation equipment. They were then walked through a debriefing tool to discuss the set case-based educational and quality improvement objectives before the M&M was discussed in the more traditional step-by-step format, identifying areas for potential systematic improvement. Impact/Effectiveness: Using a live demonstration of an actual M&M case can improve engagement and participation in resident conference while satisfying learners desire for novel teaching methods and the ACGME requirement. Observers in attendance noted a significant increase in verbal participation during the conference, and evaluations of attendees (via Google Forms) reflected the majority of learners requesting that it replace the typical M&M review. They also noted it to be more educational discourse than “fingerpointing.” We believe that showing the case in multiple forms can reinforce the desired educational objectives and truly engage residents to participate in departmental QI processes.

Escape Room: An Innovative Approach to Teaching Disaster Preparedness to Emergency Medicine Residents and Medical Students

Patineau A, Leonowics N, Mlynarek C / Ascension St John Hospital, Detroit, Michigan; Lutheran Health Network, Fort Wayne, Indiana Background: Today’s adult learners find lecture-based curricula ineffective and inefficient. Simulation, small groups, and problem-based learning are now commonly used. Disaster preparedness is often taught using active education strategies such as these. Game-based instruction, however, has not been specifically studied. Educational Objectives: To determine if this educational strategy is beneficial, we created an Escape Room competition to develop problem-solving and resource utilization skills, which are vital in mass casualty incidents (MCI). Curricular Design: The workshop consisted of four “Escape Rooms.” The participants were divided into teams and presented with a scenario and a series of tasks to complete upon entering each room. In the first room, the participants were required to create a thoracostomy tube suction device out of limited hospital supplies. In the second room, the teams had to address stabilization and transport of an individual impaled through the thorax on a long pole. The third room required rapid, accurate triaging of multiple patients using Simple Triage and Rapid Treatment (START) criteria. Finally, the participants had to manage a patient with polytrauma in an austere, non-medical environment. After the competition, Western Journal of Emergency Medicine

there was a large- group debrief in which participants shared solutions to the problems. This competition provided learners with a unique challenge: to think creatively and work as a team to find solutions to atypical medical problems. Impact/Effectiveness: The participants were surveyed before and after the competition. The survey showed that medical students and residents do not feel confident handling an MCI. Given that most residents and medical students expect to encounter such an event during their future careers, this is a missed educational opportunity. Most participants agreed that this competition was engaging and useful. Selfperceived ability to troubleshoot and comfort with resource limitation both improved after the workshop (p = 0.005 and p = 0.001, respectively). All study participants agreed that the Escape Room competition was beneficial to their medical education. Game-based educational interventions show promise as an innovative approach for teaching disaster preparedness and may be an effective method for teaching other elements of emergency medicine curriculum.

A Structured Curriculum for Interprofessional Training of Emergency Medicine Interns

Rider A, Nomura M, Anaebere T, Wills C, Duong D / Highland Hospital, Oakland, California Background: Interprofessional Education (IPE) is now represented in the emergency medicine (EM) Milestones given the interprofessional, team-based nature of emergency department (ED) work. IPE can positively impact patient satisfaction and improve health outcomes. We present a structured curriculum for EM interns to improve interprofessional understanding. Educational Objectives: The Highland Allied Health Rotation Program (H-AHRP) was developed to help interns 1) understand the roles of fellow health professionals; 2) perform procedures common to those professions; and 3) develop skills of interprofessional communication and approach to patient care. Curricular Design: H-AHRP sessions were scheduled during orientation month of 2018, along with 10 ED shifts. Interns were paired with preceptors in ED nursing (RN), ED respiratory therapy (RT), ED pharmacy (PH), laboratory (LAB), and social work (SW) in either a fourhour shift (RN, RT, PH), or lecture-based overview (LAB, SW). Pre- and post-program surveys were conducted at the beginning and end of the month, using Likert scale responses (-2 strongly disagree to +2 strongly agree) to assess understanding of scope of practice and logistics of each professional. Interns also completed a post-shift survey to document procedures performed. Impact/Effectiveness: Of the surveys distributed, 12/12(100%) pre- and 11/12(92%) post-program surveys S48

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CORD Abstracts Issue 2019 were completed. All seven general interprofessional questions demonstrated better appreciation of IPE after the intervention (+1.0 to +1.7). Interns reported improved understanding of scope of all providers, most notably for RT (-0.6 to +1.6). Greater gains were seen in appreciation of logistics, particularly for PH (-1.2 to +1.1), RT (-1.0 to +1.0), and LAB (-1.0 to +1.0). Overall, participants agreed on the program’s helpfulness in their future (+1.7) and would recommend it to other residencies ( +1.8). By integrating IPE into intern year and increasing familiarity with the scope and logistics of colleagues, we hope to promote ED collaboration for effective team-based patient care in residency.

Emergency providers (EP) have been shown to have low levels of familiarity with firearms. Given the risks for encountering firearms while at work in the ED, EPs may benefit from dedicated training on safely handling firearms. Educational Objectives: After participation in this curriculum learners will be able to 1) describe safety measures if a firearm is found on a patient in the ED; and 2) demonstrate the ability to safely remove a firearm from the clinical work space until it can be secured by security personnel. Curricular Design: Participants included medical students rotating on their emergency medicine (EM) subinternship and EM bootcamp elective. An eight-item competency checklist was created by a group of attending EPs and hospital security personnel in accordance with gun safety standards, using a modified Delphi approach. Each student was asked to evaluate a patient with dyspnea during a regular simulation session. A model handgun was placed in the patient’s belongings, and upon discovering it the students were asked by the nurse to remove the firearm. The students’ baseline performance was evaluated using the checklist. Students then participated in a small group, hands-on didactic on how to safely handle firearms found in patients’ belongings. Students completed surveys regarding their baseline knowledge of, exposure to, and comfort with handling firearms. Two weeks later, the students were again presented with a model firearm in a different high-fidelity simulation case and asked by the nurse to remove the firearm. Students were evaluated using the checklist, and directed individual feedback was given. Impact/Effectiveness: Fourteen students completed the curriculum. The median number of correctly performed steps pre-intervention was 5 (interquartile range [IQR] 4-6), and post-intervention was 7 (IQR 7-8, p = 0.002). Learners showed statistically significant improvement in two steps: pointing the firearm in a safe direction at all times (3/14 to 14/14, p = 0.001); and holding the firearm by the grip only (6/14 to 14/14, p = 0.008). This innovation is the first to formally teach learners on the safe handling of firearms found in the ED. This low-cost pilot project is easily transferrable to other training centers for teaching principles of safe firearms handling. Table. Action checklist for the safe removal of firearms found in patients’ belongings.

A Simulation-Based Curriculum on Best Practices for Firearms Safety

Ketterer A, Lewis J, Novack V, Dubosh N, Ullman E / Beth Israel Deaconess Medical Center, Boston, Massachusetts Background: Gun violence in the United States is a significant public health concern, and emergency departments (ED) have been found to be at risk for the entry of firearms. Volume 20, Supplement : August 2019 S49

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Best of the Best Research Oral Presentations

Faculty Perception of Medical Student Documentation in Emergency Medicine

Lai J, Tillman D / University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin Background: In March 2018, the Centers for Medicare and Medicaid Services (CMS) announced that medical student documentation of patient care services would be accepted for billing purposes. Starting in August 2018, all fourthyear medical students enrolled in the four-week emergency medicine (EM) rotation at our academic emergency department (ED) undergo two hours of documentation training as part of orientation and then assume sole responsibility for documentation of all patients under their care. Faculty revise and co-sign these notes according to institutional policy. Given the recency of the change in CMS policy, it is unknown how implementing medical student documentation affects the learner and educator experiences. Objectives: We sought to characterize EM faculty perception of medical student responsibility for documentation in an academic ED. We hypothesized that faculty may find the need to heavily revise student notes to not be worth the assistance given in writing them, and that this may result in less face-to-face education between students and faculty. Methods: To assess educator experience, a web-based survey was created and distributed by e-mail to all EM faculty within our department starting October 2018. Response choices were modeled after validated Likert-type scale response anchors. All responses were recorded anonymously. Results: We received 29 faculty responses (81% response rate) to the survey. Their responses were as follows: 79% of faculty members perceived medical student notes to be “always” or “usually” useful for clinical documentation; 86% felt that student notes “always,” “usually,” or “frequently” contained enough information for billing and coding; 93% “strongly agreed” or “agreed” that it is worth revising and co-signing student notes compared to faculty writing notes themselves; and 69% of faculty noticed themselves having more face-to-face interaction with students on shift when students wrote notes compared to when they didn’t. Nearly all faculty (97%) found medical students to be a more useful part of the team when students write notes. Conclusion: Although limited to a single academic ED, our results suggest that implementing medical student documentation responsibility can result in high EM faculty satisfaction, increased face-to-face interaction between faculty and students, and a more prominent role for medical students on the physician team.

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Comparison of the Standardized Video Interview and Interview Assessments of Professionalism and Interpersonal Communication Skills in Emergency Medicine

Hopson L, Dorfsman M, Branzetti J, Gisondi M, Hart D, Jordan J, Cranford J, Williams S, Regan L / University of Michigan, Ann Arbor, Michigan; University of Pittsburgh, Pittsburgh, Pennsylvania; New York University, New York City, New York; Stanford University, Palo Alto, California; Hennepin County, Minneapolis, Minnesota; UCLA Ronald Reagan, Los Angeles, California; University of Michigan, Ann Arbor, Michigan; Stanford University, Palo Alto, California; Johns Hopkins University, Baltimore, Maryland

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CORD Abstracts Issue 2019 Background: The AAMC Standardized Video Interview (SVI) was recently added as a component of emergency medicine (EM) residency applications to provide additional information about knowledge of professionalism (PROF) and interpersonal communication skills (ICS). Objectives: Our objective was to ascertain the correlation between the SVI and residency interviewer assessments of PROF and ICS. Secondary objectives included examination of (a) inter- and intra-institutional assessments of ICS and PROF; (b) correlation of SVI scores with rank order list (ROL) positions; and (c) the influence of gender on interview day assessments. Methods: We conducted an observational study using prospectively-collected data from seven EM residency programs during 2017-2018 using a standardized instrument. Correlations between interview day PROF / ICS scores and the SVI were tested. We used a one-way analysis of variance to analyze the association of SVI and ROL position. Gender differences were assessed with independent-groups t-tests. Results: A total of 1,264 interview-day encounters from 773 unique applicants resulted in 4,854 interviews conducted by 151 interviewers. Both PROF and ICS demonstrated a small positive correlation with the SVI score (rs = .16 and .17, respectively). ROL position was associated with SVI score ( p < .001), with mean SVI scores for top-, middle-, and bottom-third applicants being 20.9, 20.5, and 19.8, respectively. No gender bias was identified on assessments of PROF or ICS. Conclusion: Interview assessments of PROF and ICS have a small, positive correlation with SVI scores. These residency selection tools may be measuring related, but not redundant, applicant characteristics.

Table. Correlations between SVI, ICS, and PROF Scores (N=1264 applicants).

Table 2. Descriptive statistics for applicants, interviewers, and interviews.

The Correlation of Emergency Medicine Residents’ Grit and Non-Cognitive Characteristics

Olson N, Williamson K, Hartman N, Cheema N, Olson A / University of Chicago, Pritzker School of Medicine, Chicago, Illinois; Advocate Christ Medical Center, Oak Lawn, Illinois; Wake Forest School of Medicine, Wake Forest, North Carolina Background: Identification and assessment of trainees at risk for burnout, depression, and career dissatisfaction can challenge educators. Grit, defined as “perseverance and passion for long-term goals,” is a means to quantify an aspect of personality that has been shown to predict future outcomes such as higher grade point average, fewer career changes, and increased retention in vigorous military programs. Grit-S is a validated eight-question scale scored from 1-5 (5 is the highest score); the average of the responses represents a person’s grit. Higher grit scores have been associated with positive non-cognitive outcomes including lower burnout rates in physicians in a number of contexts. Objectives: Our objective was to determine the correlation between emergency medicine (EM) resident Grit-S scores and the non-cognitive characteristics of burnout, a positive depression screen, and career satisfaction. Methods: This was a prospective, multicenter trial

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CORD Abstracts Issue 2019 involving 10 EM residencies over a one-year period. Study subjects were postgraduate year 1-4 EM residents at each site. A survey containing the Grit-S, the Maslach Burnout Inventory, a depression screen, and a career satisfaction scale was administered to participating residents. Correlation coefficients were computed to assess the relationship between residents’ grit and non-cognitive characteristics. Results: A total of 434 residents participated in the study; 49 residents were excluded who did not complete a Grit-S. The mean Grit-S score was 3.62. There was a negative correlation between grit and burnout (r = -0.22, n = 355, p < 0.001) and grit and a positive depression screen (r = -0.16, n = 382, p = 0.001). There was a positive correlation between grit and career satisfaction (r = 0.15, n = 381, p = 0.003). Conclusion: Our findings suggest that those EM residents with higher Grit-S score are less likely to experience burnout or to screen positive for depression and are more likely to have career satisfaction. These findings may be useful in early identification of residents who may be at risk for burnout, depression, and dissatisfaction with their career choice. Table. Correlation of grit and non-cognitive characteristics.

and passion for long-term goals,” is a means to quantify an aspect of personality. Grit-S is a validated eight-question scale scored 1-5 (5 is the highest score); the average of the responses represents a person’s grit. Grit has been shown to predict educational attainment in spelling bees, high school graduation rates, undergraduate grade point average, and success in gross anatomy. Objectives: Our objective was to determine the correlation between EM resident Grit-S scores and achievement as measured by Medical College Admission Test (MCAT) percentiles, ITE scores, and need for remediation. Methods: This was a prospective, multicenter trial involving 10 EM residencies over a one-year period. Study subjects were postgraduate year (PGY)1-4 EM residents. The Grit-S was administered as part of a larger survey. MCAT percentile, remediation rates, ITE scores and the ITE score’s prediction of percent chance of passing EM boards were collected. We computed correlation coefficients to assess the relationship between residents’ grit and achievement. Results: A total of 434 residents participated in the study; 49 residents were excluded who did not complete a Grit-S. The mean Grit-S score was 3.62. Grit was positively correlated with the likelihood of passing EM boards as measured on the ITE (r = 0.134, n = 382, p = 0.025). There was no correlation between grit and the need for remediation (r = -0.04, n = 378, p = 0.46) or between grit and MCAT percentiles (r = -0.08, n = 262, p = 0.22). Conclusion: The positive correlation between grit and prediction of passing EM Boards demonstrates grit’s potential for the early prediction of success and achievement in EM residents.

The Correlation of Emergency Medicine Residents’ Grit And Achievement

Western Journal of Emergency Medicine

Figure. Correlation of grit score and percent change of passing emergency medicine boards.

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CORD Abstracts Issue 2019

Impact of Interpolated Questions on Podcast Knowledge Acquisition and Retention: A Double-Blind, Multicenter, Randomized Controlled Trial

Weinstock M, Pallaci M, Aluisio A, Cooper B, Gottlieb D, Grock A, Frye A, Love J, Orman R, Riddell J / Adena Medical Center Emergency Medicine Residency, Chillicothe, Ohio; Warren Alpert School of Medicine, Brown University, Providence, Rhode Island; The University of Texas Health Science Center at Houston, Houston, Texas; Zucker School of Medicine at Hofstra/ Northwell, New Hyde Park, New York; David Geffen School of Medicine, UCLA, Los Angeles, California: Georgetown University Medical Center, Washington, DC; Providence Portland Medical Center, Portland, Oregon; Keck School of Medicine of the University of Southern California, Los Angeles, California Background: Podcasting is a frequently used media in contemporary medical education, but there is minimal evidence evaluating techniques that enhance knowledge acquisition and retention. Adding embedded questions has been shown to improve learning in online lectures; this has not been studied with podcasting. Objectives: This study evaluated whether placing interpolated questions into a podcast improved short- and long-term knowledge in postgraduate emergency medicine (EM) trainees. Methods: This double-blinded, controlled trial randomized postgraduate trainees from six EM programs

in the United States to one of two versions of a podcast, produced de novo on the history of hypertension. The versions were identical except that one included five interpolated questions to highlight educational points. The post-podcast assessment consisted of 15 multiple-choice questions, with five questions directly related to the interpolated questions and 10 questions unrelated to them. Assessment occurred twice; once within 48 hours of listening and the second twothree weeks later. The primary outcome was the difference in inter-group mean assessment scores at each time point. We calculated a sample size of 67 participants per arm a priori to identify a significant inter-arm difference. Results: A total of 137 EM trainees were randomized and completed both assessments (69 in the non-interpolated arm and 68 in the interpolated arm). There were no significant differences in demographic characteristics. Though no significant difference was detected at the first assessment, the second assessment demonstrated significantly higher relative mean scores in the interpolated arm by 10.9% (95% confidence interval [CI], 0.5-21.3%; p = 0.041). For the questions related to the educational points that the interpolated questions addressed, the interpolated arm had significantly greater relative mean knowledge scores at both time points at 16.0% (95% CI, 3.029.1%; p = 0.016) and 21.5% (95% CI, 6.0-37.0%; p = 0.007), respectively. There was not a significant intergroup difference for the non-interpolated questions. Conclusion: Improvement in knowledge acquisition and retention was demonstrated for those whose podcast contained interpolated questions. This difference was driven by the improvement in retention for the material highlighted by the interpolated questions.

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