John L Kendall

All Publications

• Declining Performance on American Board of Emergency Medicine Written Examinations. AEM education and training Reisdorff, E. J., Keim, S. M., Gorgas, D. L., White, S. R., Kendall, J. L., Ruff, K. C., Ankel, F. K., Farrell, S. E., Calderon, Y., Gottlieb, M., Bhakta, Y., Barton, M. A., Joldersma, K. B. 2025; 9 (5): e70105

  Abstract

  Emergency medicine (EM) is at a critical juncture with pervasive boarding and overcrowding, a rapid rise in new residency programs, and continuing recovery from the COVID-19 pandemic. These factors could all potentially impact trainees' learning experiences. To explore how this has influenced trainee knowledge acquisition, we analyzed the trends in the American Board of Emergency Medicine (ABEM) In-training Examination (ITE) and the written Qualifying Examination (QE).This was a retrospective study of multiyear performance trends for the ITE (2018-2024) and QE (2019-2024). Only ITE results from residents in categorical ACGME-accredited EM programs were included. ITE performance was the aggregate mean scaled (equated) scores of all EM training levels. The measures for QE performance were the mean scaled scores (equated) and the pass rates. For each test, descriptive statistics were reported and an omnibus analysis of variance (ANOVA) comparing scores across years was computed. When an ANOVA result was statistically significant (α < 0.01), Tukey's tests were performed.For the ITE, there were 61,512 test results, of which 59,075 (96.0%) met inclusion criteria. The mean (SD) scaled ITE scores declined from 77.36 (8.85) in 2018 to 72.19 (9.44) in 2024. The ANOVA for the ITE scaled scores was statistically significant (p < 0.01). The QE had 17,040 test results, of which 15,651 (91.8%) met inclusion criteria. The mean (SD) scaled scores declined from 82.8 (4.6) in 2019 to 80.5 (4.5) in 2024, while the pass rate also declined from 92.3% in 2019 to 82.0% in 2024. The ANOVA for the QE scaled scores across years was significant (p < 0.01).Physician performance on the ABEM ITE has steadily declined since 2018; performance on the QE has declined since 2019. Future research is needed to understand and address the potential causes of these trends.

  View details for DOI 10.1002/aet2.70105

  View details for PubMedID 41141361

  View details for PubMedCentralID PMC12552112

• Design and implementation of an automated patient-care dashboard to provide individualized patient care data and quality metrics to emergency medicine residents AEM EDUCATION AND TRAINING Miller, D. T., Michael, S. S., Michael, S. H., Bookman, K., Brevik, C., Dewispelaere, W., Johns, C., Kaplan, B., Nguyen, D., Owens, D., Sungar, G., Kendall, J. 2025; 9 (2): e70031

  Abstract

  The emergency department (ED) is a high-stakes training environment for emergency medicine (EM) residents and residents' ability to reflect and self-evaluate patient care is of critical importance. Patient care dashboards have been shown to increase adherence to quality guidelines and improve patient outcomes. The objectives of this study were: (1) to create a comprehensive list of evidence-based, psychologically safe patient care and quality metrics to include in a patient care dashboard for EM residents; (2) to design an EM patient care residency dashboard in a secure, cloud-based environment integrated with the electronic health record (EHR); and (3) to pilot the usability and acceptability of the dashboard among EM residents.We created a list of potential EM resident patient care metrics using ACGME Emergency Medicine Defined Key Index Procedure Minimums, leading EM quality indicators, and current EM dashboard literature. We surveyed PGY-1 to -4 EM residents at a single residency program for their recommendations about inclusion, exclusion, and the psychological safety of each metric. We then developed a dashboard utilizing Power BI software integrated with Epic EHR. After development, we conducted a 2-month pilot evaluation for usability and acceptability among EM residents utilizing a mixed-methods approach.We identified 41 metrics within five domains (productivity metrics, patient safety and leading quality indicators, key procedures, complex/high-acuity cases, and uncertain diagnosis) to consider for inclusion in the dashboard. Residents (n = 32/68; 47% survey completion rate) recommended inclusion of 33 metrics; among these, three were identified as moderate-high psychological risk (ED length of stay, patients per hour, death within 24 h) whereas the rest were considered low psychological risk. Based on these survey results, we created an EM resident patient dashboard using Microsoft Power BI. Over a 2-month pilot period with 16 residents, user data showed a change between each resident's prior patient care review practices and review practices when using a dashboard; specifically, there were notable variations in frequency of use, time spent per review session, number of patients reviewed per session, and data categories reviewed. Eleven of 16 residents completed the technology usability and acceptability survey, with general acceptability and few concerns on usability.Our dashboard provides individualized patient care data to EM residents related to productivity, patient safety and quality, key procedures, complex/high-acuity cases, and uncertain diagnoses. A pilot group of EM residents found the dashboard acceptable and useable. Continued research is needed to explore ideal implementation and integration of patient care dashboards in residency training.

  View details for DOI 10.1002/aet2.70031

  View details for Web of Science ID 001448186600001

  View details for PubMedID 40123719

  View details for PubMedCentralID PMC11924277

• Physical and biophysical markers of assessment in medical training: A scoping review of the literature. Medical teacher Miller, D. T., Michael, S., Bell, C., Brevik, C. H., Kaplan, B., Svoboda, E., Kendall, J. 2024: 1-9

  Abstract

  PURPOSE: Assessment in medical education has changed over time to measure the evolving skills required of current medical practice. Physical and biophysical markers of assessment attempt to use technology to gain insight into medical trainees' knowledge, skills, and attitudes. The authors conducted a scoping review to map the literature on the use of physical and biophysical markers of assessment in medical training.MATERIALS AND METHODS: The authors searched seven databases on 1 August 2022, for publications that utilized physical or biophysical markers in the assessment of medical trainees (medical students, residents, fellows, and synonymous terms used in other countries). Physical or biophysical markers included: heart rate and heart rate variability, visual tracking and attention, pupillometry, hand motion analysis, skin conductivity, salivary cortisol, functional magnetic resonance imaging (fMRI), and functional near-infrared spectroscopy (fNIRS). The authors mapped the relevant literature using Bloom's taxonomy of knowledge, skills, and attitudes and extracted additional data including study design, study environment, and novice vs. expert differentiation from February to June 2023.RESULTS: Of 6,069 unique articles, 443 met inclusion criteria. The majority of studies assessed trainees using heart rate variability (n=160, 36%) followed by visual attention (n=143, 32%), hand motion analysis (n=67, 15%), salivary cortisol (n=67, 15%), fMRI (n=29, 7%), skin conductivity (n=26, 6%), fNIRs (n=19, 4%), and pupillometry (n=16, 4%). The majority of studies (n=167, 38%) analyzed non-technical skills, followed by studies that analyzed technical skills (n=155, 35%), knowledge (n=114, 26%), and attitudinal skills (n=61, 14%). 169 studies (38%) attempted to use physical or biophysical markers to differentiate between novice and expert.CONCLUSION: This review provides a comprehensive description of the current use of physical and biophysical markers in medical education training, including the current technology and skills assessed. Additionally, while physical and biophysical markers have the potential to augment current assessment in medical education, there remains significant gaps in research surrounding reliability, validity, cost, practicality, and educational impact of implementing these markers of assessment.

  View details for DOI 10.1080/0142159X.2024.2345269

  View details for PubMedID 38688520

• Nontechnically speaking: A review of tools and methods in the teaching and assessment of nontechnical skills in emergency medicine training AEM EDUCATION AND TRAINING Brevik, C., Miller, D., Kendall, J., Michael, S. 2023; 7 (6): e10911

  View details for DOI 10.1002/aet2.10911

  View details for Web of Science ID 001103955900001

  View details for PubMedID 37974662

  View details for PubMedCentralID PMC10641174

• Critical care ultrasound: A national survey across specialties JOURNAL OF CLINICAL ULTRASOUND Stowell, J. R., Kessler, R., Lewiss, R. E., Barjaktarevic, I., Bhattarai, B., Ayutyanont, N., Kendall, J. L. 2018; 46 (3): 167-177

  Abstract

  Management of the critically ill patient requires rapid assessment and differentiation. Point-of-care ultrasound (POCUS) improves diagnostic accuracy and guides resuscitation. This study sought to describe the use of critical care related POCUS amongst different specialties.This study was conducted as an online 18-question survey. Survey questions queried respondent demographics, preferences for POCUS use, and barriers to implementation.2735 recipients received and viewed the survey with 416 (15.2%) responses. The majority of respondents were pulmonary and critical care medicine (62.5%) and emergency medicine (19.9%) providers. Respondents obtained training through educational courses (26.5%), fellowship (23.9%), residency (21.6%), or self-guided learning (17.2%). POCUS use was common for diagnostic and procedural guidance. Emergency medicine providers were more likely to utilize POCUS to evaluate undifferentiated hypotension (98.5%, P < .001), volume status and fluid responsiveness (88.2%, P = .005), and cardiopulmonary arrest (94.1%, P < .001) compared to other specialties. Limited training, competency, or credentialing were the most common barriers, in up to 39.4% of respondents.Study respondents utilize POCUS in a variety of clinical applications. However, a disparity in utilization still exists among clinicians who care for critically ill patients. Overcoming barriers, such as a lack of formalized training, competency, or credentialing, may lead to increased utilization.

  View details for DOI 10.1002/jcu.22559

  View details for Web of Science ID 000426731500001

  View details for PubMedID 29131347

• Use of Ultrasound Guidance for Central Venous Catheter Placement: Survey From the American Board of Emergency Medicine Longitudinal Study of Emergency PhysiciansUso de la Ecografia para Guiar la Insercion de un Cateter Venoso Central: Encuesta a los Urgenciologos del Estudio Longitudinal de Medicina de Urgencias y Emergencias de la American Board ACADEMIC EMERGENCY MEDICINE Buchanan, M. S., Backlund, B., Liao, M. M., Sun, J., Cydulka, R. K., Smith-Coggins, R., Kendall, J. 2014; 21 (4): 416-421

  Abstract

  The objective was to survey practicing emergency physicians (EPs) across the United States regarding the frequency of using ultrasound (US) guidance in central venous catheter (CVC) placement and, secondarily, to determine factors associated with the use or barriers to the use of US guidance.This was a cross-sectional survey mailed to presumed practicing EPs as part of the American Board of Emergency Medicine (ABEM)'s longitudinal study of EPs. The selection process used stratified, random sampling of cohorts thought to represent four different stages within the development of the specialty of emergency medicine (EM). Multivariable logistic regression was used to identify independent factors associated with both high comfort using US guidance and high-percentage usage of US guidance.The survey was mailed to 1,165 subjects, and the response rate was 79%. The median number of years of practice was 20 (interquartile range [IQR]=7 to 28 years). As their primary practice setting, 64% work in private or community hospitals, 60% received training in US-guided vascular access, and 44% never use US guidance in placing CVCs. Barriers differed in those who never use US and those who sometimes or always used US guidance. In those who never use US, top barriers were insufficient training (67%) and lack of equipment (25%). In those who use US, top barriers were the perceptions that US was too time-consuming (27%) and that the preferred site was not amenable to US (24%). Independent factors associated with high comfort and high-percentage use of US guidance were training in US-guided vascular access (adjusted odds ratio=5.1 [high comfort]; 95% confidence interval [CI]=2.6 to 10.1; adjusted odds ratio 11.1=(high percentage); 95% CI=5.0 to 24.8) and being a recent residency graduate.Among EPs, the translation of evidence to clinical practice regarding the benefits of US guidance for CVC placement is poor and still faces many barriers. Training and education are potentially the best ways to overcome such barriers.

  View details for DOI 10.1111/acem.12350

  View details for Web of Science ID 000334288100008