Al'ai Alvarez, MD

All Publications

• Interventions to reduce burnout in emergency medicine: a national inventory of the Canadian experience to support global implementation of wellness initiatives. Internal and emergency medicine Liu, K., Patey, C., Norman, P., Moellekaer, A. B., Lim, R., Alvarez, A., Heymann, E. P. 2024

  Abstract

  Burnout in healthcare workers is a global issue, with Emergency Medicine (EM) particularly impacted. Many countries have tried implementing wellness initiatives to reduce burnout and improve wellness. This paper summarizes interventions implemented in Canada to-date with the aim of supporting the design of wellness interventions in EDs globally. A systematic review and a grey literature search were completed in November 2023. Original studies in both English and French that included the implementation and evaluation of a wellness intervention in EDs in Canada were included. The study design, content of the intervention, target population, and outcomes were extracted and narratively analyzed. 13 studies were included. Each implemented a unique wellness intervention for EDs. All three studies (3/3, 100%) that included a structured wellness curriculum demonstrated significant improvement in burnout as measured by the Maslach Burnout Inventory, physical health (PCS-8), and Brief Resident Wellness Profile (BRWP). Other interventions included Ice Cream Rounds, therapy dogs, changing the duration of night shifts, and sessions on resilience and self-care. Our Canada-wide analysis of wellness interventions identified initiatives geared towards trainees, staff, or entire ED workface groups. Examples include educational programs, dedicated sessions for compassion literacy and resilience, critical events debriefing, and optimizing shift schedules. Structured wellness curriculums seem to be effective, and this area warrants further study. Moreover, we identify a need for global collaboration to build wellness programs and for more easily translatable standardized outcome measures for assessing the efficacy of wellness programs in EM.

  View details for DOI 10.1007/s11739-024-03811-4

  View details for PubMedID 39652281

  View details for PubMedCentralID 8792132

• ChatG-PD? Comparing large language model artificial intelligence and faculty rankings of the competitiveness of standardized letters of evaluation. AEM education and training Schnapp, B., Sehdev, M., Schrepel, C., Bord, S., Pelletier-Bui, A., Alvarez, A., Dubosh, N. M., Park, Y. S., Shappell, E. 2024; 8 (6): e11052

  Abstract

  While faculty have previously been shown to have high levels of agreement about the competitiveness of emergency medicine (EM) standardized letters of evaluation (SLOEs), reviewing SLOEs remains a highly time-intensive process for faculty. Artificial intelligence large language models (LLMs) have shown promise for effectively analyzing large volumes of data across a variety of contexts, but their ability to interpret SLOEs is unknown.The objective was to evaluate the ability of LLMs to rate EM SLOEs on competitiveness compared to faculty consensus and previously developed algorithms.Fifty mock SLOE letters were drafted and analyzed seven times by a data-focused LLM with instructions to rank them based on desirability for residency. The LLM was also asked to use its own criteria to decide which characteristics are most important for residency and revise its ranking of the SLOEs. LLM-generated rank lists were compared with faculty consensus rankings.There was a high degree of correlation (r = 0.96) between the rank list initially generated by LLM consensus and the rank list generated by trained faculty. The correlation between the revised list generated by the LLM and the faculty consensus was lower (r = 0.86).The LLM generated rankings showed strong correlation with expert faculty consensus rankings with minimal input of faculty time and effort.

  View details for DOI 10.1002/aet2.11052

  View details for PubMedID 39660298

  View details for PubMedCentralID PMC11628426

• Generalizability of consensus regarding standardized letters of evaluation competitiveness: A validity study in a national sample of emergency medicine faculty AEM EDUCATION AND TRAINING Bord, S., Sehdev, M., Pelletier-Bui, A., Alvarez, A., Schnapp, B., Dubosh, N., Schrepel, C., Park, Y., Shappell, E. 2024; 8 (6)

  View details for DOI 10.1002/aet2.11049

  View details for Web of Science ID 001372446600001

• Faculty consensus on competitiveness for the new competency-based emergency medicine standardized letter of evaluation AEM EDUCATION AND TRAINING Schnapp, B., Sehdev, M., Schrepel, C., Bord, S., Pelletier-Bui, A., Alvarez, A., Dubosh, N. M., Park, Y., Shappell, E. 2024; 8 (5): e11024

  Abstract

  Emergency medicine (EM) has introduced a new, competency-based standardized letter of evaluation (SLOE) template. While a previous version of the SLOE has been shown to promote a high degree of faculty consensus regarding competitiveness, this has not been shown for the new SLOE template.The objective was to evaluate faculty consensus on competitiveness for the new EM SLOE 2.0.Fifty mock SLOE 2.0 letters using the new template were drafted and sent to a group of experienced EM educators. The 50 letters were ranked by the experienced faculty as well as a point-based prediction model and a regression model and the results were compared.Faculty consensus on competitiveness remained strong when using the new SLOE 2.0 format. The points-based prediction model and regression model both demonstrated a high level of agreement with faculty consensus rankings for the SLOE 2.0.Introduction of the new, competency-based SLOE 2.0 format did not have a deleterious effect on faculty consensus rankings of competitiveness.

  View details for DOI 10.1002/aet2.11024

  View details for Web of Science ID 001312640400001

  View details for PubMedID 39280103

  View details for PubMedCentralID PMC11393300

• Measuring Burnout and Professional Fulfillment Among Emergency Medicine Residency Program Leaders in the United States: A Cross-Sectional Survey Study. Clinical and experimental emergency medicine Preiksaitis, C., Wright, K. N., Alvarez, A., Chan, T. M., Gottlieb, M., Little, A. G., Landry, A. 2024

  Abstract

  Objective: Emergency medicine (EM) physicians face high burnout rates, even in academic settings. Research on burnout among EM residency program leaders is limited, despite their role in shaping the training environment and influencing resident well-being. This study aims to measure burnout and professional fulfillment among EM residency program leaders and identify contributing factors.Methods: A cross-sectional survey using the adapted Stanford Professional Fulfillment Index (SPFI) was conducted in 2023 to assess burnout and professional fulfillment among EM residency program leaders at US programs. The survey, tailored to EM leaders, was distributed to all current EM Program Directors (PDs) and Assistant or Associate Program Directors (APDs) from accredited US programs. Descriptive statistics and odds ratios were used to compare burnout and professional fulfillment across various groups.Results: A total of 112 of 281 PDs (39.9% response rate) and 130 of 577 APDs (22.5% response rate) participated. Professional fulfillment was reported by 59.8% of PDs and 58.5% of APDs. Burnout was experienced by 42.0% of PDs and 26.9% of APDs. Higher professional fulfillment correlated with alignment with expectations, positive work environments, and perceived appreciation, while burnout was strongly associated with negative impacts on personal health and relationships. About 27.7% of PDs and 23.8% of APDs expressed intentions to leave their current positions within 18 months.Conclusion: A significant portion of US EM residency program leaders experience burnout and low professional fulfillment. Addressing well-being in this population has important implications for education and mentorship provided to future physicians in the field.

  View details for DOI 10.15441/ceem.24.255

  View details for PubMedID 39237138

• Underrepresented in Medicine Trainees' Sense of Belonging and Professional Identity Formation after Participation in the Leadership Education in Advancing Diversity Program. Academic pediatrics Yemane, L., Powell, C., Edwards, J., Shumba, T., Alvarez, A., Bandstra, B., Brooks, M., Brown-Johnson, C., Caceres, W., Dunn, T., Johnson, C., Perez, F. D., Reece-Nguyen, T., Thomas, R. P., Watkins, A. C., Blankenburg, R. 2024

  Abstract

  There are persistent structural barriers that threaten inclusion and retention of underrepresented in medicine (UIM) residents and fellows (trainees) as future faculty in academic medicine. We developed the Leadership Education in Advancing Diversity (LEAD) Program at a single, academic institution, to address these barriers through a 10-month longitudinal curriculum across GME for trainees to develop leadership and scholarship skills in DEI.Explore how participation in LEAD impacted UIM trainees' sense of belonging and professional identity formation in academic medicine; as well as perceptions about pursuing a career in academic medicine and future leadership roles.IRB-approved qualitative study in August 2020-August 2021 with individual, semi-structured interviews of UIM LEAD graduates from the first 4 cohorts (2017-2021). Data were analyzed by two authors using modified grounded theory.14 UIM trainees were interviewed; seven themes emerged. Critical aspects of the program: (1) Creation of a community of shared DEI values (2) Mentorship (3) Role of allies. Results of the program: (4) Deepened appreciation of personal and professional identity as UIM (5) Fostered belonging in academic medicine (6) Appreciation of different careers in academic medicine and how to integrate DEI interests (7) Inspired trainees to pursue leadership roles.LEAD can serve as a model for other institutions that seek to support UIM trainees' sense of belonging, professional identity formation, and perceptions about pursuing careers in academic medicine and future leadership roles.

  View details for DOI 10.1016/j.acap.2024.08.003

  View details for PubMedID 39117029

• Decoding competitiveness: Exploring how emergency medicine faculty interpret standardized letters of evaluation. AEM education and training Schrepel, C., Sehdev, M., Dubosh, N. M., Schnapp, B. H., Alvarez, A., Pelletier-Bui, A., Hegarty, C., Bord, S., Shappell, E. 2024; 8 (4): e11019

  Abstract

  Background: Given the importance of the standardized letter of evaluation (SLOE) for application to emergency medicine (EM) residency, it is important that SLOE developers and authors understand how reviewers determine SLOE competitiveness. To inform SLOE design and authorship, the authors set out to build a novel theory to explain how faculty holistically interpret SLOE competitiveness.Methods: The authors used constructivist grounded theory to explore how EM faculty determine SLOE competitiveness. They used purposive sampling to recruit EM faculty participants with at least 1year of experience in scoring SLOEs. One author conducted hour-long, semistructured interviews over Zoom between August 2023 and March 2024. Two authors iteratively coded the data to develop the initial codebook, organize codes into categories, and build connections to construct the resulting theory.Results: The authors interviewed 11 EM faculty from throughout the United States. Participants described a complex process to determine SLOE competitiveness. They began by contextualizing the SLOE to determine its trustworthiness and value before using various components of the SLOE to stratify and refine their understanding of competitiveness. Finally, when participants noted the inconsistency between different aspects of the SLOE, they used various methods to reconcile discordances and determine competitiveness.Conclusions: This study illuminates the framework used by EM faculty to determine applicant competitiveness based on the SLOE and highlights several factors that SLOE authors should consider to ensure the accurate and efficient transfer of information.

  View details for DOI 10.1002/aet2.11019

  View details for PubMedID 39185031

• Precision emergency medicine. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine Strehlow, M., Alvarez, A., Blomkalns, A. L., Caretta-Wyer, H., Gharahbaghian, L., Imler, D., Khan, A., Lee, M., Lobo, V., Newberry, J. A., Riberia, R., Sebok-Syer, S., Shen, S., Gisondi, M. A. 2024

  Abstract

  Precision health is a burgeoning scientific discipline that aims to incorporate individual variability in biological, behavioral, and social factors to develop personalized health solutions. To date, emergency medicine has not deeply engaged in the precision health movement. However, rapid advances in health technology, data science, and medical informatics offer new opportunities for emergency medicine to realize the promises of precision health.In this article, we conceptualize precision emergency medicine as an emerging paradigm and identify key drivers of its implementation into current and future clinical practice. We acknowledge important obstacles to the specialty-wide adoption of precision emergency medicine and offer solutions that conceive a successful path forward.Precision emergency medicine is defined as the use of information and technology to deliver acute care effectively, efficiently, and authentically to individual patients and their communities. Key drivers and opportunities include leveraging human data, capitalizing on technology and digital tools, providing deliberate access to care, advancing population health, and reimagining provider education and roles. Overcoming challenges in equity, privacy, and cost is essential for success. We close with a call to action to proactively incorporate precision health into the clinical practice of emergency medicine, the training of future emergency physicians, and the research agenda of the specialty.Precision emergency medicine leverages new technology and data-driven artificial intelligence to advance diagnostic testing, individualize patient care plans and therapeutics, and strategically refine the convergence of the health system and the community.

  View details for DOI 10.1111/acem.14962

  View details for PubMedID 38940478

• A national pilot study on simulation-based upstander training for emergency medicine clinicians. AEM education and training Mundo, W., Vaughn, J., Odetunde, A., Donovan, T., Alvarez, A., Smith, K., Brown, C., Brown, I., Datta, S., Vora, S., Ward-Gaines, J. 2024; 8 (3): e10990

  Abstract

  Objective: This study assesses the effectiveness of clinical simulation-based training in boosting self-perceived confidence for using upstander communication skills to confront racism, discrimination, and microaggressions (RDM).Methods: We conducted an observational cohort study with emergency medicine professionals at the 2023 Scientific Assembly of the American Academy of Emergency Medicine in New Orleans, Louisiana. The study featured a clinical simulation-based training on upstander communications skills session followed by small- and large-group debriefs. Participants completed pre- and post-training questionnaires assessing demographics and confidence in health equity competencies. This survey was used in a previous study with emergency medicine residents. Data were analyzed using an independent Student's t-test, with a significance threshold of 0.05.Results: Thirty-two individuals participated in the simulation-based training, and 24 completed surveys, with a 75% response rate. Most participants were non-Hispanic (24, 85.7%) and women (18, 64%), with racial demographics mostly White (8, 28.6%), Black or African American (8, 28.6%), and Asian (6, 21.4%). After the workshop, there was a notable increase in self-perceived ability and confidence in identifying RDM (from 7±3.2 to 8.6±1.6, p<0.003), using upstander communication tools (from 6.1±3.5 to 8.5±1, p<0.0001), and the likelihood of intervening in RDM situations (from 7.1±3.3 to 8.8±1.1, p<0.0002).Conclusions: The clinical simulation-based training significantly improved participants' confidence and self-perceived ability to address RDM in simulated clinical environments. This training method is a promising tool for teaching health equity topics in clinical medicine.

  View details for DOI 10.1002/aet2.10990

  View details for PubMedID 38800608

• Applying the master adaptive learner framework to just-in-time training of procedures. AEM education and training Alvarez, A., Manthey, D., Promes, S. B., Haas, M., Santen, S. A., Wagner, J., Schnapp, B. 2024; 8 (Suppl 1): S17-S23

  Abstract

  Background: Just-in-time training (JITT) occurs in the clinical context when learners need immediate guidance for procedures due to a lack of proficiency or the need for knowledge refreshment. The master adaptive learner (MAL) framework presents a comprehensive model of transforming learners into adaptive experts, proficient not only in their current tasks but also in the ongoing development of lifelong skills. With the evolving landscape of procedural competence in emergency medicine (EM), trainees must develop the capacity to acquire and master new techniques consistently. This concept paper will discuss using JITT to support the development of MALs in the emergency department.Methods: In May 2023, an expert panel from the Society for Academic Emergency Medicine (SAEM) Medical Educator's Boot Camp delivered a comprehensive half-day preconference session entitled "Be the Best Teacher" at the society's annual meeting. A subgroup within this panel focused on applying the MAL framework to JITT. This subgroup collaboratively developed a practical guide that underwent iterative review and refinement.Results: The MAL-JITT framework integrates the learner's past experiences with the educator's proficiency, allowing the educational experience to address the unique requirements of each case. We outline a structured five-step process for applying JITT, utilizing the lumbar puncture procedure as an example of integrating the MAL stages of planning, learning, assessing, and adjusting. This innovative approach facilitates prompt procedural competence and cultivates a positive learning environment that fosters acquiring adaptable learning skills with enduring benefits throughout the learner's career trajectory.Conclusions: JITT for procedures holds the potential to cultivate a dynamic learning environment conducive to nurturing the development of MALs in EM.

  View details for DOI 10.1002/aet2.10953

  View details for PubMedID 38774829

• Breaking point: the hidden crisis of emergency physician burnout. CJEM Lim, R., Alvarez, A., Cameron, B., Gray, S. 2024

  View details for DOI 10.1007/s43678-024-00659-7

  View details for PubMedID 38598075

• An Exploration of the Interplay Between Well-being and Quality and Safety. CJEM Hrymak, C., Lim, R., Trivedi, S., Alvarez, A., Purdy, E., Belisle, S., Thull-Freedman, J., Leeies, M., Lang, E., Chartier, L. B. 2024

  Abstract

  Quality improvement and patient safety (QIPS) and clinician well-being work are interconnected and impact each other. Well-being is of increased importance in the current state of workforce shortages and high levels of burnout. The Canadian Association of Emergency Physicians (CAEP) Academic Symposium sought to understand the interplay between QIPS and clinician well-being and to provide practical recommendations to clinicians and institutions on ensuring that clinician well-being is integrated into QIPS efforts.A team of emergency physicians with expertise in well-being and QIPS performed a literature review, drafted goals and recommendations, and presented at the CAEP Academic Symposium in 2023 for feedback. Goals and recommendations were then further refined.Three goals and recommendations were developed as follows: QIPS leaders and practitioners must (1) understand the potential intersection of well-being and QIPS, (2) consider a well-being lens for all QIPS work, and (3) incorporate QIPS methodology in efforts to improve clinician well-being.QIPS and clinician well-being are often closely linked. By incorporating these recommendations, QIPS strategies can enhance clinician well-being.

  View details for DOI 10.1007/s43678-024-00653-z

  View details for PubMedID 38421518

  View details for PubMedCentralID 9615985

• "I don't want to be the squeaky wheel": Addressing bias as a leader in emergency medicine. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine Suri, A., Yang, D., Sun, W. W., Fofana, M., Binstadt, E. S., Weygandt, P. L., Moll, J. L., Strout, T. D., Gipson, K., Norman, M. S., Tsuchida, R. E., Alvarez, A., Balhara, K. S. 2024

  Abstract

  BACKGROUND: Implicit bias poses a barrier to inclusivity in the health care workforce and is detrimental to patient care. While previous studies have investigated knowledge and training gaps related to implicit bias, emergency medicine (EM) leaders' self-awareness and perspectives on bias have not been studied. Using art to prompt reflections on implicit bias, this qualitative study explores (1) the attitudes of leaders in EM toward implicit bias and (2) individual or structural barriers to navigating and addressing bias in the workplace.METHODS: Investigators facilitated an hour-long workshop in May 2022 for those with leadership positions in the Society for Academic Emergency Medicine (SAEM), a leading national EM organization, including 62 attending physicians, eight residents/fellows, and four medical students. The workshop utilized arts-based methods to generate a psychologically supportive space to lead conversations around implicit bias in EM. The session included time for individual reflection, where participants used an electronic platform to respond anonymously to questions regarding susceptibility, fears, barriers, and experiences surrounding bias. Two independent coders compiled, coded, and reviewed the responses using an exploratory constructivist approach.RESULTS: A total of 125 responses were analyzed. Four major themes emerged: (1) acceptance that bias exists; (2) individual barriers, including fear of negative reactions, often due to power dynamics between respondents and other members of the ED; (3) institutional barriers, such as insufficient funding and unprotected time committed to addressing bias; and (4) ambiguity about defining and prioritizing bias.CONCLUSIONS: This qualitative analysis of reflections from an arts-based workshop highlights perceived fears and barriers that may impact EM physicians' motivation and comfort in addressing bias. These results may help guide interventions to address individual and structural barriers to mitigating bias in the workplace.

  View details for DOI 10.1111/acem.14869

  View details for PubMedID 38390743

• Measuring and Predicting Faculty Consensus Rankings of Standardized Letters of Evaluation. Journal of graduate medical education Sehdev, M., Schnapp, B., Dubosh, N. M., Alvarez, A., Pelletier-Bui, A., Bord, S., Schrepel, C., Park, Y. S., Shappell, E. 2024; 16 (1): 51-58

  Abstract

  Background Standardized letters of evaluation (SLOE) are becoming more widely incorporated into the residency application process to make the letter of recommendation, an already critical component in a residency application packet, more objective. However, it is not currently known if the reviewers of these letters share consensus regarding the strength of an applicant determined by their SLOE. Objective We measured the level of faculty agreement regarding applicant competitiveness as determined by SLOEs and the ability of 2 algorithms to predict faculty consensus rankings. Methods Using data from the 2021-2022 Match cycle from the Council of Residency Directors in Emergency Medicine SLOE Database as a blueprint, authors created 50 fictional SLOEs representative of the national data. Seven faculty then rated these SLOEs in order of applicant competitiveness, defined as suggested rank position. Consensus was evaluated using cutoffs established a priori, and 2 prediction models, a point-based system and a linear regression model, were tested to determine their ability to predict consensus rankings. Results There was strong faculty consensus regarding the interpretation of SLOEs. Within narrow windows of agreement, faculty demonstrated similar ranking patterns with 83% and 93% agreement for "close" and "loose" agreement, respectively. Predictive models yielded a strong correlation with the consensus ranking (point-based system r=0.97, linear regression r=0.97). Conclusions Faculty displayed strong consensus regarding the competitiveness of applicants via SLOEs, adding further support to the use of SLOEs for selection and advising. Two models predicted consensus competitiveness rankings with a high degree of accuracy.

  View details for DOI 10.4300/JGME-D-22-00901.1

  View details for PubMedID 38304605

• Re-THINK: Use of narratives to explore social justice in clinical practice and education. Journal of evaluation in clinical practice Alvarez, A., Monteiro, S., Chen, R., Cohen, K., Fofana, M., Powell, C., Tago, A., Martin, L. 2023

  View details for DOI 10.1111/jep.13946

  View details for PubMedID 38062679

• Brain versus bot: Distinguishing letters of recommendation authored by humans compared with artificial intelligence. AEM education and training Preiksaitis, C., Nash, C., Gottlieb, M., Chan, T. M., Alvarez, A., Landry, A. 2023; 7 (6)

  Abstract

  Letters of recommendation (LORs) are essential within academic medicine, affecting a number of important decisions regarding advancement, yet these letters take significant amounts of time and labor to prepare. The use of generative artificial intelligence (AI) tools, such as ChatGPT, are gaining popularity for a variety of academic writing tasks and offer an innovative solution to relieve the burden of letter writing. It is yet to be determined if ChatGPT could aid in crafting LORs, particularly in high-stakes contexts like faculty promotion. To determine the feasibility of this process and whether there is a significant difference between AI and human-authored letters, we conducted a study aimed at determining whether academic physicians can distinguish between the two.A quasi-experimental study was conducted using a single-blind design. Academic physicians with experience in reviewing LORs were presented with LORs for promotion to associate professor, written by either humans or AI. Participants reviewed LORs and identified the authorship. Statistical analysis was performed to determine accuracy in distinguishing between human and AI-authored LORs. Additionally, the perceived quality and persuasiveness of the LORs were compared based on suspected and actual authorship.A total of 32 participants completed letter review. The mean accuracy of distinguishing between human- versus AI-authored LORs was 59.4%. The reviewer's certainty and time spent deliberating did not significantly impact accuracy. LORs suspected to be human-authored were rated more favorably in terms of quality and persuasiveness. A difference in gender-biased language was observed in our letters: human-authored letters contained significantly more female-associated words, while the majority of AI-authored letters tended to use more male-associated words.Participants were unable to reliably differentiate between human- and AI-authored LORs for promotion. AI may be able to generate LORs and relieve the burden of letter writing for academicians. New strategies, policies, and guidelines are needed to balance the benefits of AI while preserving integrity and fairness in academic promotion decisions.

  View details for DOI 10.1002/aet2.10924

  View details for PubMedID 38046089

  View details for PubMedCentralID PMC10688127

• #StopTheStigmaEM: Building a Social Media Based Movement to Support Emergency Medicine Mental Health. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine Deutsch, A. J., Alvarez, A., Balint, S., Pappal, R. D., Roseen, S., Sun, W. W., Warren, J., Stanton, K., Agarwal, A. K. 2023

  View details for DOI 10.1111/acem.14829

  View details for PubMedID 37897107

• Influence of COVID-19 on stress at work during the first wave of the pandemic among emergency health care workers. Disaster medicine and public health preparedness Dupuy, M., Dutheil, F., Alvarez, A., Godet, T., Adeyemi, O. J., Clinchamps, M., Schmidt, J., Lambert, C., Bouillon-Minois, J. B. 2023: 1-21

  Abstract

  For more than 2 years, COVID-19 has forced worldwide healthcare systems to adapt their daily practice. These adaptations add to the already stressful demands of providing timely medical care in an overcrowded healthcare system. Specifically, the COVID-19 pandemic added stress to an already overwhelmed emergency and critical care health care workers (HCWs) on the frontlines during the first wave of the pandemic.This study assessed comparative subjective and objective stress among frontline HCWs using a visual analog scale and biometric data, specifically heart rate variability (HRV).Setting and Participants: This is a prospective, observational study using surveys and heart rate monitoring among HCWs who work in three frontline healthcare units (emergency department, mobile intensive care unit, and intensive care unit) in the University Hospital of Clermont-Ferrand, France. Two sessions were performed: one during the first wave of the pandemic (April 10 to May 10, 2020) and one after the first wave of the pandemic (June 10 to July 15, 2020).Main outcomes and measures: The primary outcome is the difference in stress levels between the two time points. Secondary objectives were the impact of overcrowding, sociodemographics, and other variables on stress levels. We also assessed the correlation between subjective and objective stress levels.Among 199 HCWs, 98 participated in biometric monitoring, 84 had biometric and survey data, and 12 with only biometric data. Subjective stress was higher during the second time point compared to the first (4.39±2.11 vs. 3.16±2.34 p=0,23). There were higher objective stress levels with a decrease in HRV between the first and the second time points. Furthermore, we found higher patient volumes as a source of stress during the second time point. We did not find any significant correlation between subjective and objective stress levels.HCWs had higher stress levels between the two waves of the pandemic. Overcrowding in the emergency department is associated with higher stress levels. We did not find any correlation between subjective and objective stress among intensive care and emergency HCWs during the first wave of the pandemic.

  View details for DOI 10.1017/dmp.2023.134

  View details for PubMedID 37533367

• A Virtual National Diversity Mentoring Initiative to Promote Inclusion in Emergency Medicine. The western journal of emergency medicine Carrillo, T., Rodriguez, L. M., Landry, A., Alvarez, A., Ceniza, A., Gay, R., Green, A., Faiz, J. 2023; 24 (4): 662-667

  Abstract

  Trainees underrepresented in medicine (URiM) face additional challenges seeking community in predominantly white academic spaces, as they juggle the effects of institutional, interpersonal, and internalized racism while undergoing medical training. To offer support and a space to share these unique experiences, mentorship for URiM trainees is essential. However, URiM trainees have limited access to mentorship from URiM faculty. To address this gap, we developed a national virtual mentoring program that paired URiM trainees interested in emergency medicine (EM) with experienced mentors.We describe the implementation of a virtual Diversity Mentoring Initiative (DMI) geared toward supporting URiM trainees interested in EM. The program development involved 1) partnering of national EM organizations to obtain funding; (2) identifying a comprehensive platform to facilitate participant communication, artificial intelligence-enabled matching, and ongoing data collection; 3) focusing on targeted recruitment of URiM trainees; and (4) fostering regular leadership meeting cadence to customize the platform and optimize the mentorship experience.We found that by using a virtual platform, the DMI enhanced the efficiency of mentor-mentee pairing, tailored matches based on participants' interests and the bandwidth of mentors, and successfully established cross-institutional connections to support the mentorship needs of URiM trainees.

  View details for DOI 10.5811/westjem.59666

  View details for PubMedID 37527394

• Trends of Academic Faculty Identifying as Hispanic at US Medical Schools, 1990-2021. Journal of graduate medical education Saxena, M. R., Ling, A. Y., Carrillo, E., Alvarez, A., Yiadom, M. Y., Bennett, C. L., Gallegos, M. 2023; 15 (2): 175-179

  Abstract

  Background: According to recent census data, Hispanic and Latino populations comprise the largest minority group in the United States. Despite ongoing efforts for improved diversity, equity, and inclusion, Hispanics remain underrepresented in medicine (UIM). In addition to well-established benefits to patient care and health systems, physician diversity and increased representation in academic faculty positively impact the recruitment of trainees from UIM backgrounds. Disproportionate representation (as compared to increases of certain underrepresented groups in the US population) has direct implications for recruitment of UIM trainees to residency programs.Objective: To examine the number of full-time US medical school faculty physicians who self-identify as Hispanic in light of the increasing Hispanic population in the United States.Methods: We analyzed data from the Association of American Medical Colleges from 1990 to 2021, looking at those academic faculty who were classified as Hispanic, Latino, of Spanish Origin, or of Multiple Race-Hispanic. We used descriptive statistics and visualizations to illustrate the level of representation of Hispanic faculty by sex, rank, and clinical specialty over time.Results: Overall, the proportion of faculty studied who identified as Hispanic increased from 3.1% (1990) to 6.01% (2021). Moreover, while the proportion of female Hispanic academic faculty increased, there remains a lag between females versus males.Conclusions: Our analysis shows that the number of full-time US medical school faculty who self-identify as Hispanic has not increased, though the population of Hispanics in the United States has increased.

  View details for DOI 10.4300/JGME-D-22-00384.1

  View details for PubMedID 37139207

• Ethnic and Racial Differences in Ratings in the Medical Student Standardized Letters of Evaluation (SLOE). Journal of graduate medical education Alvarez, A., Mannix, A., Davenport, D., Gore, K., Krzyzaniak, S. M., Parsons, M., Miller, D. T., Eraso, D., Monteiro, S., Chan, T. M., Gottlieb, M. 2022; 14 (5): 549-553

  Abstract

  Background: The Standardized Letter of Evaluation (SLOE) stratifies the assessment of emergency medicine (EM) bound medical applicants. However, bias in SLOE, particularly regarding race and ethnicity, is an underexplored area.Objective: This study aims to assess whether underrepresented in medicine (UIM) and non-UIM applicants are rated differently in SLOE components.Methods: This was a cross-section study of EM-bound applicants across 3 geographically distinct US training programs during the 2019-2020 application cycle. Using descriptive and regression analyses, we examine the differences between UIM applicants and non-UIM applicants for each of the SLOE components: 7 qualifications of an EM physician (7QEM), global assessment (GA) rating, and projected rank list (RL) position.Results: Out of a combined total of 3759, 2002 (53.3%) unique EM-bound applicants were included. UIM applicants had lower ratings for each of the 7QEM questions, GA, and RL positions. Compared to non-UIM applicants, only some of the 7QEM components: "Work ethic and ability to assume responsibility," "Ability to work in a team, and "Ability to communicate a caring nature," were associated with their SLOE. "Commitment to EM" correlated more with GA for UIM than for non-UIM applicants.Conclusions: This study shows a difference in SLOE rating, with UIM applicants receiving lower ratings than non-UIM applicants.

  View details for DOI 10.4300/JGME-D-21-01174.1

  View details for PubMedID 36274773

• Physician Pipeline and Pathway Programs: An Evidence-based Guide to Best Practices for Diversity, Equity, and Inclusion from the Council of Residency Directors in Emergency Medicine. The western journal of emergency medicine Parsons, M., Caldwell, M. T., Alvarez, A., Davenport, D., Gallegos, M., Landry, A., Gottlieb, M., Natesan, S. 2022; 23 (4): 514-524

  Abstract

  Improving the diversity and representation in the medical workforce requires intentional and deliberate efforts to improve the pipeline and pathway for underrepresented in medicine (UIM) applicants. Diversity enhances educational experiences and improves patient care and outcomes. Through a critical review of the literature, in this article we offer evidence-based guidelines for physician pipeline and pathway programs (PP). Recommendations are provided regarding considerations on the types of programs and surrounding implementation to ensure a sound infrastructure and framework. We believe this guide will be valuable for all leaders and faculty members seeking to grow the UIM applicant pool in our efforts to advance diversity, equity, and inclusion within medicine.

  View details for DOI 10.5811/westjem.2022.2.54875

  View details for PubMedID 35980420

• Factors driving burnout and professional fulfillment among emergency medicine residents: A national wellness survey by the Society for Academic Emergency Medicine. AEM education and training Sakamoto, J. T., Lee, J., Lu, D. W., Sundaram, V., Bird, S. B., Blomkalns, A. L., Alvarez, A. 2022; 6 (Suppl 1): S5-S12

  Abstract

  This study aimed to identify rates of and contributors to burnout and professional fulfillment among emergency medicine (EM) resident physicians.This was a cross-sectional, national survey of resident members of the Society for Academic Emergency Medicine (SAEM). Primary outcomes were burnout and professional fulfillment measured using a previously validated instrument with additional domains pertaining to the academic environment. The survey included question domains examining organizational factors (e.g., academic work environment, satisfaction with training, electronic health records, values alignment, and control over schedule) and individual factors (e.g., self-compassion, meaningfulness of clinical work, impact of work on health and personal relationships, perceived appreciation, thoughts of attrition, and expectations of the field of EM). Logistic regression was performed to determine the relationships between the primary outcomes and each domain.The survey was sent electronically to 2641 SAEM resident members. A total of 275 residents completed the survey with a response rate of 10.4%. A total of 151 (55%) respondents were male, and 210 (76%) were White. A total of 132 (48%) residents reported burnout, and 75 (28%) reported professional fulfillment. All organizational and individual factors were significantly associated with both primary outcomes. EM residents reported that meaningfulness of clinical work had the most significant positive association with professional fulfillment (adjusted odds ratio [OR] 2.2 [95% confidence interval {CI} 1.8-2.7]) and negative association with burnout (adjusted OR 0.46 [95% CI 0.37-0.56]). Thoughts of attrition from academics and accurate expectations of EM were also associated with both primary outcomes, with adjusted ORs (95% CIs) of 0.40 (0.21-0.72) and 5.6 (1.9-23.8) for professional fulfillment and 4.1 (2.5-7.1) and 0.19 (0.08-0.40) for burnout, respectively.This study found a high prevalence of burnout and a low prevalence of professional fulfillment among EM residents. Multiple factors were significantly associated with each occupational phenomenon, with meaningfulness of clinical work demonstrating the strongest relationships with burnout and professional fulfillment.

  View details for DOI 10.1002/aet2.10746

  View details for PubMedID 35783080

  View details for PubMedCentralID PMC9222870

• Sex and race visual representation in emergency medicine textbooks and the hidden curriculum AEM EDUCATION AND TRAINING Kalantari, A., Alvarez, A., Battaglioli, N., Chung, A., Cooney, R., Boehmer, S. J., Nwabueze, A., Gottlieb, M. 2022; 6 (3): e10743

  Abstract

  In addition to formal training, informal training often occurs through a hidden curriculum. As the hidden curriculum shapes the knowledge and values held by learners, we must consider its role in implicit bias. One example is through the selection of images used in formal instruction. This study aimed to examine the representation of sex and race among images in two textbooks in emergency medicine (EM).We performed a cross-sectional study of the sex and race representation of figures in Rosen's Emergency Medicine: Concepts and Clinical Practice 9th Edition and Tintinalli's Emergency Medicine: A Comprehensive Study Guide 9th Edition. Two reviewers screened all images for inclusion, with disagreements resolved by a third reviewer. Images were excluded if they did not include visualized skin. Two reviewers independently reviewed each image and assessed the sex, race, and roles in the image. A third reviewer resolved any disagreements.A total of 959 images (Rosen's n = 377; Tintinalli's n = 582) met inclusion criteria. Race was estimated in 877 cases (91.3%). Of those, White individuals comprised 77.6% (95% confidence interval [CI] 75.0%-80.2%). Sex was estimated in 362 cases (37.7%). Of those images, males comprised 70.2% (95% CI 65.4%-74.9%), and females comprised 29.8% (95% CI 25.1%-34.6%).There is a male sex and White race predominance in visual representation among two EM textbooks. We propose a call to action for the mindful selection of images in formal education to represent diversity, equity, and inclusion and close the gap between the formal and hidden curriculum.

  View details for DOI 10.1002/aet2.10743

  View details for Web of Science ID 000810680600001

  View details for PubMedID 35747318

  View details for PubMedCentralID PMC9197153

• Holistic Review, Mitigating Bias, and Other Strategies in Residency Recruitment for Diversity, Equity, and Inclusion: An Evidence-based Guide to Best Practices from the Council of Residency Directors in Emergency Medicine. The western journal of emergency medicine Gallegos, M., Landry, A., Alvarez, A., Davenport, D., Caldwell, M. T., Parsons, M., Gottlieb, M., Natesan, S. 2022; 23 (3): 345-352

  Abstract

  Advancement of diversity, equity, and inclusion (DEI) in emergency medicine can only occur with intentional recruitment of residency applicants underrepresented in medicine (UIM). Shared experiences from undergraduate and graduate medical education highlight considerations and practices that can contribute to improved diversity in the resident pool, such as holistic review and mitigating bias in the recruitment process. This review, written by members of the Council of Residency Directors in Emergency Medicine (CORD) Best Practices Subcommittee, offers best practice recommendations for the recruitment of UIM applicants. Recommendations address pre-interview readiness, interview approach, and post-interview strategies that residency leadership may use to implement holistic review and mitigate bias for recruitment of a diverse class.

  View details for DOI 10.5811/westjem.2022.3.54419

  View details for PubMedID 35679505

• Gender differences in emergency medicine standardized letters of evaluation. AEM education and training Mannix, A., Monteiro, S., Miller, D., Parsons, M., Alvarez, A., Krzyzaniak, S. M., Gore, K., Eraso, D., Davenport, D., Chan, T. M., Gottlieb, M. 2022; 6 (2): e10740

  Abstract

  Objectives: The Standardized Letter of Evaluation (SLOE) is a vital portion of any medical student's emergency medicine (EM) residency application. Prior literature suggests gender bias in EM SLOE comparative ranking, but there is limited understanding of the impact of gender on other SLOE components. The study objective was to evaluate the presence of gender differences in the 7 Qualifications for EM (7QEM), Global Assessment (GA), and anticipated Rank List (RL) position. A secondary objective was to evaluate the gender differences in 7QEM scores and their link to GA and anticipated RL position.Methods: We performed a cross-sectional study using SLOEs from a subset of United States applicants to three EM residency programs during the 2019-2020 application cycle. We collected self-reported demographics, 7QEM scores, GA, and anticipated RL position. We utilized linear regression analyses and repeated measures ANOVA to evaluate if the relationship between the 7QEM scores, GA score, and anticipated RL position was different for men and women.Results: 2103 unique applicants were included (38.6% women, 61.4% men), with 4952 SLOEs meeting inclusion criteria. The average QEM (2.51 vs. 2.39; p<0.001), GA (2.68 vs. 2.48; p<0.001), and RL (2.68 vs. 2.47; p<0.001) scores were statistically higher for women than men. When exploring the relationship between the 7QEM and GA, Ability to communicate a caring nature to patients was not found to be a statistically significant predictor for men, but it was for women. When exploring the relationship between 7QEM and RL, Commitment to EM was not a significant predictor for men, but it was for women.Conclusions: Women scored higher than men on the 7QEM, GA, and anticipated RL position on SLOEs. The 7QEM scores factored differently for men and women.

  View details for DOI 10.1002/aet2.10740

  View details for PubMedID 35493289

• Drivers of Professional Fulfillment and Burnout Among Emergency Medicine Faculty: A National Wellness Survey by the Society for Academic Emergency Medicine. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine Lu, D. W., Lee, J., Alvarez, A., Sakamoto, J. T., Bird, S. B., Sundaram, V., Lall, M. D., Nordenholz, K. E., Manfredi, R. A., Blomkalns, A. L. 2022

  Abstract

  BACKGROUND: Professional fulfillment and the mitigation of burnout can enhance clinician well-being and the resiliency of the healthcare organization. This study examined the extent to which specific individual and workplace factors are associated with professional fulfillment and burnout among a national sample of academic emergency physicians.METHODS: This was a cross-sectional survey of faculty members of the Society for Academic Emergency Medicine. Primary outcomes were professional fulfillment and burnout. The survey also examined individual and workplace factors, as well as faculty's thoughts of attrition from academic and clinical medicine. Logistic regression was performed to determine the relationships between each outcome and each factor, respectively.RESULTS: 771 out of 3130 faculty completed the survey (response rate 24.6%). 38.7% reported professional fulfillment and 39.1% reported burnout. Meaningfulness of work (OR 2.2, 95% CI 1.9-2.5), perceived appreciation (OR 1.9, 95% CI 1.7-2.1), and the academic work environment (OR 1.7, 95% CI 1.5-1.9) had the highest odds of being associated with professional fulfillment. In contrast, low score responses for meaningfulness of work (OR 0.6, 95% CI 0.5-0.6), self-compassion (0.6, 95% CI 0.5-0.6), and control over schedule (OR 0.6, 95% CI 0.6-0.7) were most associated with burnout. Faculty with professional fulfillment were less likely to report plans for attrition from academics (OR 0.1, 95% CI 0.1-0.2) and from clinical medicine (OR 0.2, 95% CI 0.1-0.4). Faculty with burnout were more likely to report plans for attrition from academics (OR 7, 95% CI 4.8-10.4) and clinical medicine (OR 5.7, 95% CI 3.9-8.6).CONCLUSIONS: Individual and workplace factors that contributed to professional fulfillment and burnout were identified, with meaningfulness of clinical work demonstrating the strongest association with both occupational phenomena. Knowledge of which factors are most impactful in promoting professional fulfillment and mitigating burnout may be useful in guiding efforts to enhance clinician well-being.

  View details for DOI 10.1111/acem.14487

  View details for PubMedID 35304931

• Faculty Recruitment, Retention, and Representation in Leadership: An Evidence-Based Guide to Best Practices for Diversity, Equity, and Inclusion from the Council of Residency Directors in Emergency Medicine. The western journal of emergency medicine Davenport, D., Alvarez, A., Natesan, S., Caldwell, M. T., Gallegos, M., Landry, A., Parsons, M., Gottlieb, M. 1800; 23 (1): 62-71

  Abstract

  Improving the recruitment, retention, and leadership advancement of faculty who are under-represented in medicine is a priority at many academic institutions to ensure excellence in patient care, research, and health equity. Here we provide a critical review of the literature and offer evidence-based guidelines for faculty recruitment, retention, and representation in leadership. Recommendations for recruitment include targeted recruitment to expand the candidate pool with diverse candidates, holistic review of applications, and incentivizing stakeholders for success with diversity efforts. Retention efforts should establish a culture of inclusivity, promote faculty development, and evaluate for biases in the promotion and tenure process. We believe this guide will be valuable for all leaders and faculty members seeking to advance diversity, equity, and inclusion in their institutions.

  View details for DOI 10.5811/westjem.2021.8.53754

  View details for PubMedID 35060865

• A Point-of-Care Ultrasound Rotation for Medical Education Fellows in Emergency Medicine. POCUS journal O'Connell, A., Alvarez, A., Tomaselli, P., Au, A., Papanagnou, D., Lewiss, R. E. 2022; 7 (1): 120-123

  View details for DOI 10.24908/pocus.v7i1.14745

  View details for PubMedID 36896272

• Standardizing terminology in academic medical journals: understanding sex and gender. European journal of emergency medicine : official journal of the European Society for Emergency Medicine Dessie, A., Alvarez, A., Lewiss, R. E. 2021; 28 (5): 331-332

  View details for DOI 10.1097/MEJ.0000000000000869

  View details for PubMedID 34433787

• Institutions' role in postpandemic support. Science (New York, N.Y.) de Morree, A., Alvarez, A. 2021; 373 (6561): 1318

  Abstract

  [Figure: see text].

  View details for DOI 10.1126/science.abm2585

  View details for PubMedID 34529491

• Institutions' role in postpandemic support SCIENCE de Morree, A., Alvarez, A. 2021; 373 (6561): 1318

  View details for Web of Science ID 000697488600034

• Bias in recruitment: A focus on virtual interviews and holistic review to advance diversity AEM EDUCATION AND TRAINING Otugo, O., Alvarez, A., Brown, I., Landry, A. 2021; 5: S135-S139

  View details for DOI 10.1002/aet2.10661

  View details for Web of Science ID 000701048000023

  View details for PubMedID 34616988

  View details for PubMedCentralID PMC8480505

• Professional development during a pandemic: a live virtual conference for emergency medicine chief residents. CJEM Zaver, F., Battaglioli, N., Rose, C. C., Montrief, T., Alvarez, A., Lin, M. 2021

  Abstract

  Limited professional development training exists for chief residents. The available training uses in-person lectures and workshops at annual national conferences. The COVID-19 pandemic prevented most in-person gatherings in 2020, including pivotal onboarding and training events for new chief residents. However, for the last five years, Academic Life in Emergency Medicine's Chief Resident Incubator conducted year-long remote training programs, creating virtual communities of practice for chief residents in emergency medicine (EM). As prior leaders and alumni from the Incubator, we sought to respond to the limitations presented by the pandemic and create an onboarding event to provide foundational knowledge for incoming chief residents. We developed a half-day virtual conference, whereupon 219 EM chief residents enrolled. An effective professional development experience is feasible and scalable using online videoconferencing technologies, especially if constructed with content expertise, psychological safety, and production design in mind.

  View details for DOI 10.1007/s43678-021-00146-3

  View details for PubMedID 34264507

• The standardized letter of evaluation in emergency medicine: Are the qualifications useful? AEM education and training Miller, D. T., Krzyzaniak, S., Mannix, A., Alvarez, A., Chan, T., Davenport, D., Eraso, D., Foote, C. J., Gore, K., Parsons, M., Gottlieb, M. 2021; 5 (3): e10607

  Abstract

  Objectives: The standardized letter of evaluation (SLOE) in emergency medicine (EM) is a widely used metric for determining interview invitations and ranking of candidates. Previous research has questioned the validity of certain sections of the SLOE. However, there remains a paucity of literature on the qualifications for EM section, which evaluates seven attributes of applicants. The aim of this study was to determine the correlation between the qualifications questions and grades, global assessment, and anticipated rank list position for EM applicants.Methods: A multi-institutional cross-sectional study was performed using SLOEs from applicants to three geographically distinct U.S. EM residency programs during the 2019-2020 application cycle. We abstracted EM rotation grade, qualifications scores, global assessment, and anticipated rank list position from the SLOEs. A Spearman correlation was calculated between each of the qualifications scores and the applicant's grades, global assessment, and anticipated rank list position in a pairwise fashion.Results: In total, 2,106 unique applicants (4,939 SLOEs) were included. Of the seven qualifications for EM questions, three were moderately to strongly correlated with global assessment and anticipated rank list position: "ability to develop and justify an appropriate differential and a cohesive treatment plan" (rho=0.65 and rho=0.63, respectively; p<0.001), "how much guidance do you predict this applicant will need during residency?" (rho=0.68 and rho=0.68, respectively; p<0.001), and "what is your prediction of success for the applicant?" (rho=0.69 and rho=0.69, respectively; p<0.001). There was no strong correlation between the seven qualifications and grades.Conclusions: There was a moderate to strong correlation between three of seven qualifications for EM questions (ability to develop and justify a differential and develop a cohesive plan, anticipated need for the amount of guidance, and prediction of success) with both global assessment and anticipated rank list position, suggesting that these qualifications may provide the most useful data to residency selection while some of the other factors may not be needed.

  View details for DOI 10.1002/aet2.10607

  View details for PubMedID 34222747

• ALiEM Connect: Large-Scale, Interactive Virtual Residency Programming in Response to COVID-19. Academic medicine : journal of the Association of American Medical Colleges Rose, C. C., Haas, M. R., Yilmaz, Y., Alvarez, A., Mott, S. E., Landry, A. I., Gisondi, M. A., Ankel, F., Lin, M., Chan, T. M. 2021

  Abstract

  PROBLEM: The COVID-19 pandemic restricted in-person gatherings, including residency conferences. The pressure to quickly reorganize educational conferences and convert content to a remote format overwhelmed many programs. This article describes the pilot event of a large-scale, interactive virtual educational conference model designed and implemented by Academic Life in Emergency Medicine (ALiEM), called ALiEM Connect.APPROACH: The pilot ALiEM Connect event was conceptualized and implemented within a 2-week period in March 2020. The pilot was livestreamed via a combination of Zoom and YouTube and was archived by YouTube. Slack was used as a backchannel to allow interaction with other participants and engagement with the speakers (via moderators who posed questions from the backchannel to the speakers live during the videoconference).OUTCOMES: The RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework was used for program evaluation, showing that 64 U.S. Accreditation Council for Graduate Medical Education-accredited emergency medicine residency programs participated in the pilot event, with 1,178 unique users during the event (reach). For effectiveness, 93% (139/149) of trainees reported the pilot as enjoyable and 85% (126/149) reported it was equivalent to or better than their usual academic proceedings. Adoption for ALiEM Connect was fairly good with 64/237 (27%) of invited residency programs registering and participating in the pilot event. Implementation was demonstrated by nearly half of the livestream viewers (47%, 553/1,178) interacting in the backchannel discussion, sending a total of 4,128 messages in the first 4 hours.NEXT STEPS: The final component of the RE-AIM framework, maintenance, will take more time to evaluate. Further study is required to measure the educational impact of events like the ALiEM Connect pilot. The ALiEM Connect model could potentially be used to replace educational conferences that have been cancelled or to implement and/or augment a large-scale, shared curriculum among residency programs in the future.

  View details for DOI 10.1097/ACM.0000000000004122

  View details for PubMedID 33883400

• Curated collection for clinician educators: Six key papers on residency recruitment. AEM education and training Schnapp, B. H., Alvarez, A., Bianchi, R., Caretta-Weyer, H., Jewell, C., Kalantari, A., Lee, E., Miller, D., Quinn, A. 2021; 5 (2): e10597

  Abstract

  Introduction: All emergency medicine (EM) residency programs must recruit new medical school graduates each year. The process is often overwhelming, with each program receiving far more applicants than available positions. We searched for evidence-based best practices to guide residency programs in screening, interviewing, and ranking applicants to ensure a high-performing and diverse residency class.Methods: A literature search was conducted on the topic of residency recruitment, utilizing a call on social media as well as multiple databases. After identifying relevant articles, we performed a modified Delphi process in three rounds, utilizing junior educators as well as more senior faculty.Results: We identified 51 relevant articles on the topic of residency recruitment. The Delphi process yielded six articles that were deemed most highly relevant over the three rounds. Transparency with selection criteria, holistic application review, standardized letters of evaluation, and blinding applicant files for interviewers were among noted best practices.Conclusions: Well-supported evidence-based practices exist for residency recruitment, and programs may benefit from understanding which common recruitment practices offer the most value. The articles discussed here provide a foundation for faculty looking to improve their program's recruiting practices.

  View details for DOI 10.1002/aet2.10597

  View details for PubMedID 33969251

• Thinking Outside the Inbox: Use of Slack in Clinical Groups as a Collaborative Team Communication Platform. AEM education and training Montrief, T., Haas, M. R., Alvarez, A., Gottlieb, M., Siegal, D., Chan, T. 2021; 5 (1): 121–29

  View details for DOI 10.1002/aet2.10497

  View details for PubMedID 33521500

• Outcomes From a Novel Graduate Medical Education Leadership Program in Advancing Diversity, Equity, and Inclusion Journal of Graduate Medical Education Powell, C., Yemane, L., Brooks, M., Johnson, C., Alvarez, A., Bandstra, B., Caceres, W., Dierickx, Q., Thomas, R., Blankenburg, R. 2021; 13 (6): 774–784

  View details for DOI 10.4300/JGME-D-21-00235.1

• Owning the Trauma Bay: Teaching Trauma Resuscitation to Emergency Medicine Residents and Nurses through In-situ Simulation. Journal of education & teaching in emergency medicine Bellino, A., Gordon, A. J., Alvarez, A., Schertzer, K. 2020; 5 (4): S108-S148

  Abstract

  The following two cases were designed to address learning objectives specific to interns, junior residents, and senior residents in emergency medicine, as well as trauma-certified emergency nurses.Traumatic and unintentional injuries account for 5.8 million deaths across the globe each year, with a high proportion of those deaths occurring within the initial hour from the time of injury. This "golden hour" begins in the pre-hospital setting yet is predominantly spent in the emergency department (ED).1 Being able to effectively manage the multidisciplinary team required to care for trauma patients is crucial to providing timely and appropriate care. In-situ simulation, where the learning case is moved out of the simulation lab and into the typical workplace, has emerged as a powerful training tool for improving care-systems and team dynamics.2,3 Multiple specialties have shown in-situ simulation to be an effective strategy to teach both educational content as well as critical procedural and communication skills.4,5 In-situ simulation training has also been applied with similar success to trauma management, allowing for the simultaneous education of different learners with different roles in trauma resuscitations.6,7 We present two in-situ simulation cases with specific educational objectives and feedback mechanisms that allow for easy implementation of a cost-effective approach to training multidisciplinary emergency medicine providers in trauma management.Educational Objectives: The core objectives of these simulations center on effective teamwork and communication during trauma resuscitation of a critically ill patient. Both cases are designed to include maneuvers that require coordinating team members' actions during a stressful situation such as rolling a vomiting patient with a head injury and applying a binder to an unstable pelvic fracture. While the cases are largely focused on improving communication, salient learning points on emergent management of intracranial hemorrhage and unstable pelvic fractures are highlighted during the encounter. In addition, this simulation module allowed for the practice of graduated level of responsibilities amongst residents in the trauma bay.Two in-situ simulation cases were run with the same group of learners using standardized patient actors as patients and functional medical equipment in actual rooms in the emergency department to recreate a realistic experience. These groups were composed of emergency medicine residents with at least one intern, one junior resident, and one senior resident in each group as well as a bedside nurse, documenting nurse, and simulation instructor. Each case was followed by a group debriefing session using multiple sources of feedback. Standardized patients, bedside nursing, and simulation instructors were all incorporated into the feedback and debriefing process.Pre- and post-simulation surveys were given to participants to assess their confidence in participating and leading trauma resuscitations.A total of 29 emergency medicine residents completed both our pre- and post-survey. We found that less than half of those surveyed felt comfortable leading trauma resuscitations. After the simulation scenarios, an overwhelming majority agreed that they felt more prepared to run trauma resuscitations as a result of the simulation experience. In their free response comments participants also remarked upon the ability of in-situ simulation to better foster realistic learning opportunities with regards to communication and resuscitation management.Based on our survey results, we found that a large portion of our participants did not feel comfortable leading trauma resuscitations. The post-survey and the free-text responses collected during the case scenarios show that our in-situ simulation proved to be an effective way to teach various types of learners new trauma roles and optimize high-stress communication during resuscitations. The use of in-situ simulation provides an effective and easily adapted framework even for those outside of academic centers and simulation labs while also offering an opportunity for multidisciplinary growth. Regular incorporation of similar learning opportunities into resident, nursing, and staff education can lead to better communication and teamwork during in-vivo patient encounters.Trauma resuscitation, in-situ simulation, code leader education, communication training.

  View details for DOI 10.21980/J8WK9X

  View details for PubMedID 37465328

  View details for PubMedCentralID PMC10332519

• The Impact of Due Process and Disruptions on Emergency Medicine Education in the United States. The western journal of emergency medicine Alvarez, A., Messman, A., Platt, M., Healy, M., Josephson, E. B., London, S., Char, D. 2020: 1–5

  Abstract

  INTRODUCTION: Academic Emergency Medicine (EM) departments are not immune to natural disasters, economic or political forces that disrupt a training program's operations and educational mission. Due process concerns are closely intertwined with the challenges that program disruption brings. Due process is a protection whereby an individual will not lose rights without access to a fair procedural process. Effects of natural disasters similarly create disruptions in the physical structure of training programs that at times have led to the displacement of faculty and trainees. Variation exists in the implementation of transitions amongst training sites across the country, and its impact on residency programs, faculty, residents and medical students.METHODS: We reviewed the available literature regarding due process in emergency medicine. We also reviewed recent examples of training programs that underwent disruptions. We used this data to create a set of best practices regarding the handling of disruptions and due process in academic EM.RESULTS: Despite recommendations from organized medicine, there is currently no standard to protect due process rights for faculty in emergency medicine training programs. Especially at times of disruption, the due process rights of the faculty become relevant, as the multiple parties involved in a transition work together to protect the best interests of the faculty, program, residents and students. Amongst training sites across the country, there exist variations in the scope and impact of due process on residency programs, faculty, residents and medical students.CONCLUSION: We report on the current climate of due process for training programs, individual faculty, residents and medical students that may be affected by disruptions in management. We outline recommendations that hospitals, training programs, institutions and academic societies can implement to enhance due process and ensure the educational mission of a residency program is given due consideration during times of transition.

  View details for DOI 10.5811/westjem.2019.10.42800

  View details for PubMedID 31999245

• Emergency Medicine Gender in Resident Leadership Study (EM GIRLS): The Gender Distribution Among Chief Residents AEM Education and Training Mannix, A., Parsons, M., Krzyzaniak, S., Black, L. P., Alvarez, A., Mody, S., Gottlieb, M. 2020: 1-4

  View details for DOI 10.1002/aet2.10436

• Physically Distant, Educationally Connected: Interactive Conferencing in the Era of COVID-19. Medical education Rose, C. n., Mott, S. n., Alvarez, A. n., Lin, M. n. 2020

  Abstract

  During the coronavirus outbreak, physical distancing restrictions led to the cancellation of live, large-group events worldwide. This included weekly educational conferences required of Emergency Medicine (EM) residency programs in the United States. Specifically, the Residency Review Committee in EM under the Accreditation Council for Graduate Medical Education has mandated that there be at least four hours per week of synchronous conference didactics.

  View details for DOI 10.1111/medu.14192

  View details for PubMedID 32324933

• Patient feedback in the emergency department: A feasibility study of the Resident Communication Assessment Program (ReCAP). Journal of the American College of Emergency Physicians open Mozayan, C. n., Manella, H. n., Chimelski, E. n., Kline, M. n., Alvarez, A. n., Gisondi, M. A., Sebok-Syer, S. S. 2020; 1 (6): 1194–98

  Abstract

  Resident physicians must develop competence in interpersonal and communication skills, but workplace-based assessment of these skills remains challenging. We explored the feasibility of the Resident Communication Assessment Program (ReCAP) for eliciting patient feedback about resident physician communication in the emergency department (ED).This study is a prospective, observational study conducted in the ED of a university-based hospital from December 2018 through April 2019. ReCAP is a program that interviews patients prior to discharge from the ED using the Communication Assessment Tool (CAT). CAT consists of 14 Likert style questions and 3 open-ended questions for patient feedback about residents' communication. Open-text, narrative responses from patients were coded using a modified version of the Completed Clinical Evaluation Report Rating tool.We collected data from 42 subjects who completed the CAT, and provided 32 open-text, narrative responses about 20 resident physicians. Patient responses were overwhelmingly positive with 551/588 (94%) CAT responses scoring "Very Good," the highest category. Open-text, narrative comments analyzed using CCERR were unbalanced, favoring residents' strengths rather than areas for improvement. Patient comments offered more examples of strengths than weaknesses, and few subjects provided recommendations to improve resident performance.ReCAP represents a feasible method for eliciting patient feedback about resident communication skills in the ED. The CAT can be used to structure brief patient interviews by trained staff but generally elicits only positive feedback. Further studies are needed to identify more discriminatory assessment tools.

  View details for DOI 10.1002/emp2.12272

  View details for PubMedID 33392522

  View details for PubMedCentralID PMC7771786

• Mastery Learning Ensures Correct Personal Protective Equipment Use in Simulated Clinical Encounters of COVID-19. The western journal of emergency medicine Pokrajac, N. n., Schertzer, K. n., Poffenberger, C. M., Alvarez, A. n., Marin-Nevarez, P. n., Winstead-Derlega, C. n., Gisondi, M. A. 2020; 21 (5): 1089–94

  Abstract

  The correct use of personal protective equipment (PPE) limits transmission of serious communicable diseases to healthcare workers, which is critically important in the era of coronavirus disease 2019 (COVID-19). However, prior studies illustrated that healthcare workers frequently err during application and removal of PPE. The goal of this study was to determine whether a simulation-based, mastery learning intervention with deliberate practice improves correct use of PPE by physicians during a simulated clinical encounter with a COVID-19 patient.This was a pretest-posttest study performed in the emergency department at a large, academic tertiary care hospital between March 31-April 8, 2020. A total of 117 subjects participated, including 56 faculty members and 61 resident physicians. Prior to the intervention, all participants received institution-mandated education on PPE use via an online video and supplemental materials. Participants completed a pretest skills assessment using a 21-item checklist of steps to correctly don and doff PPE. Participants were expected to meet a minimum passing score (MPS) of 100%, determined by an expert panel using the Mastery Angoff and Patient Safety standard-setting techniques. Participants that met the MPS on pretest were exempt from the educational intervention. Testing occurred before and after an in-person demonstration of proper donning and doffing techniques and 20 minutes of deliberate practice. The primary outcome was a change in assessment scores of correct PPE use following our educational intervention. Secondary outcomes included differences in performance scores between faculty members and resident physicians, and differences in performance during donning vs doffing sequences.All participants had a mean pretest score of 73.1% (95% confidence interval [CI], 70.9-75.3%). Faculty member and resident pretest scores were similar (75.1% vs 71.3%, p = 0.082). Mean pretest doffing scores were lower than donning scores across all participants (65.8% vs 82.8%, p<0.001). Participant scores increased 26.9% (95% CI of the difference 24.7-29.1%, p<0.001) following our educational intervention resulting in all participants meeting the MPS of 100%.A mastery learning intervention with deliberate practice ensured the correct use of PPE by physician subjects in a simulated clinical encounter of a COVID-19 patient. Further study of translational outcomes is needed.

  View details for DOI 10.5811/westjem.2020.6.48132

  View details for PubMedID 32970559

• Detection of Type B Aortic Dissection in the Emergency Department with Point-of-Care Ultrasound. Clinical practice and cases in emergency medicine Earl-Royal, E., Nguyen, P. D., Alvarez, A., Gharahbaghian, L. 2019; 3 (3): 202–7

  Abstract

  Aortic dissection (AD) is a rare, time-sensitive, and potentially fatal condition that can present with subtle signs requiring timely diagnosis and intervention. Although definitive diagnosis is most accurately made through computed tomography angiography, this can be a time-consuming study and the patient may be unstable, thus preventing the study's completion. Chest radiography (CXR) signs of AD are classically taught yet have poor diagnostic reliability. Point-of-care ultrasound (POCUS) is increasingly used by emergency physicians for the rapid diagnosis of emergent conditions, with multiple case reports illustrating the sonographic signs of AD. We present a case of Stanford type B AD diagnosed by POCUS in the emergency department in a patient with vague symptoms, normal CXR, and without aorta dilation. A subsequent review of CXR versus sonographic signs of AD is described.

  View details for DOI 10.5811/cpcem.2019.5.42928

  View details for PubMedID 31404375

• ROUGH DAY? BE GRATEFUL. Alvarez, A., de Vries, p. P. International Clinical Educators (ICE) blog. 2019
• IDEA Series: A Low-fidelity Simulation Workshop for Teaching Cricothyroidotomy. Garcia, S., Alvarez, A. Academic Life in Emergency Medicine. 2019

  Abstract

  https://www.aliem.com/2019/02/idea-series-low-fidelity-simulation-workshop-cricothyroidotomy

  ALiEM
• An Interactive Session to Help Faculty Manage Difficult Learner Behaviors in the Didactic Setting. MedEdPORTAL : the journal of teaching and learning resources Schnapp, B. H., Alvarez, A., Ham, J., Paetow, G., Santen, S. A., Hart, D. 2018; 14: 10774

  Abstract

  The transition to more active learning during residency didactics has made the skill of managing difficult learner behaviors essential: Just one learner exhibiting difficult behavior can derail the educational experience for the room. Many educators feel uncomfortable handling these learners in real time and after the session.We created an interactive session for a mixed group of educators at a medical education boot camp. After learning about a framework for addressing difficult learner behaviors, participants were paired and presented with the case of a withdrawn learner. For each pair, the cause of the behavior was different. With one of the pair role-playing the learner, they were asked to identify the problem and solutions together. Multiple etiologies for the identical behavior reinforced the need to address underlying causes to create an effective plan for behavior change. Strategies to address difficult behaviors in real time were also discussed in large-group format.Participants gave the session a mean score of 4.5 out of 5, indicating a high likelihood of changing their teaching practice. Free-response comments remarked on the role-play's educational value and the enjoyability of the session overall.This session was effective in giving participants a framework for dealing with difficult learner behaviors, as well as hands-on practice with these skills. While this was a short (30-minute), single session, its success with participants with a wide variety of experience levels suggests it would be highly adaptable to other settings and may benefit from future expansion into the clinical setting.

  View details for DOI 10.15766/mep_2374-8265.10774

  View details for PubMedID 30800974

  View details for PubMedCentralID PMC6346279

• Rough day? Be grateful. A talk on positive psychology in Emergency Medicine Alvarez, A., deVries, P. S. Stanford BeWell. 2018

  Abstract

  https://bewell.stanford.edu/rough-day-be-grateful/