Dr. Al'ai Alvarez FACEP FAAEM is a clinical assistant professor of Emergency Medicine (EM) and the Director of Well-Being at Stanford Emergency Medicine. He also serves as the Co-Lead of the Human Potential Team, and serves as the Director of Emergency Medicine Wellness Fellowship. His work focuses on humanizing physician roles as individuals and teams through the harnessing of our individual human potential in the context of high-performance teams. This includes optimizing the interdependence between Process Improvement (Quality and Clinical Operations), Recruitment (Diversity), and Well-being (Inclusion).
Prior to this role, Dr. Alvarez served as an associate residency program director (APD) at the Stanford Emergency Medicine Residency Program. He was the APD for Residency Process Improvement (Quality and Clinical Operations), Recruitment (Diversity), and Well-being (Inclusion). He also served as the second-year class APD, and the Medicine Without Walls (MWOW) Line Director for the Stanford Emergency Medicine ACCEL Program (https://emed.stanford.edu/residency/ACCEL.html).
Dr. Alvarez serves as the co-chair of WellMD's Physician Wellness Forum and is one of the peer supporters for WellMD's Physician Resource Network (PRN) Support.
Nationally, Dr. Alvarez serves on committees on physician wellbeing and diversity, equity, and inclusion in medical education. He is the co-chair of the Council of EM Residency Directors (CORD) Wellness Leadership Mini-Fellowship, a mentor at the Academic Life in Emergency Medicine (ALiEM) Faculty Incubator, and co-chairs the largest national diversity mentoring program through the joint American College of Emergency Physician (ACEP)'s Diversity, Inclusion and Health Equity (DIHE) and the Emergency Medicine Residents Association (EMRA)'s Diversity Mentorship Initiative.
Dr. Alvarez has given numerous grand rounds as well as national and international conference lectures and workshops on relevant topics in gratitude and compassion, physician wellbeing, burnout, the imposter syndrome, as well as increasing leadership capacity and mentorship to enhance diversity and inclusion in medicine.
In addition to being active nationally on these endeavors, he applies all of these efforts into studying high-performance resuscitation teams (HPRT) with a focus on effective communication, psychological safety, belonging, and burnout, and has been an invited participant and leader at the annual Mission Critical Teams summits. Dr. Alvarez is the co-director of the joint Mayo Clinic-Stanford-Mission Critical Teams Institute High-Performance Resuscitation Teams Summit in Chicago this Fall of 2021.
Dr. Alvarez is the recipient of the 2019 American College of Emergency Physician (ACEP) Diversity, Inclusion and Health Equity Distance and Impact Award. He is also the recipient of the 2020 Society for Academic Emergency Medicine (SAEM) Academy for Diversity and Inclusion in Emergency Medicine (ADIEM) Outstanding Academician Award. Dr. Alvarez has already received the 2020 CORD Academy for Scholarship in Education in Emergency Medicine Academy Member Award on Teaching and Evaluation.
- Emergency Medicine
- Physician Wellbeing
- Diversity and Inclusion
- Self Compassion
- Patient Safety and Quality Improvement
- Patient Experience and Clinical Operations
Clinical Assistant Professor, Emergency Medicine
Director of Well-Being, Stanford Emergency Medicine (2021 - Present)
Co-Lead, Human Potential Team, Stanford Emergency Medicine (2021 - Present)
Fellowship Director, Stanford Emergency Medicine Wellness Fellowship (2021 - Present)
Co-Chair, Stanford WellMD Physician Wellness Forum (2019 - Present)
Faculty Diversity Liaison, Stanford Office of Faculty Development and Diversity (2020 - Present)
Associate Residency Program Director, Stanford Emergency Medicine (2021 - 2021)
Assistant Residency Program Director, Stanford Emergency Medicine (2016 - 2021)
Interim Assistant Clerkship Director, Stanford Emergency Medicine (2017 - 2019)
Honors & Awards
Distance and Impact Award, Diversity, Inclusion & Health Equity Section. American College of Emergency Physicians (ACEP) (2019)
National Organizational/Institutional Award, Building Next Generation of Academic Physicians (BNGAP) (2020)
Outstanding Academician Award, Society for Academic EM (SAEM) -- Academy for Diversity & Inclusion in EM (ADIEM) (2020)
Scholarship in Education in Emergency Medicine Academy Member Award on Teaching and Evaluation, Council of Residency Director (CORD) (2020)
Boards, Advisory Committees, Professional Organizations
Diplomate, American Board of Emergency Medicine (2012 - Present)
Fellow, American College of Emergency Physicians (2016 - Present)
Fellow, American Academy of Emergency Medicine (2016 - Present)
Residency: Albert Einstein College of Medicine (2011) NY
Internship: Albert Einstein College of Medicine (2008) NY
Board Certification: American Board of Emergency Medicine, Emergency Medicine (2012)
Residency, Jacobi/Montefiore Residency Program at the Albert Einstein College of Medicine, Bronx, NY, Emergency Medicine (2011)
Medical Education: University at Buffalo School of Medicine (2007) NY
BS, SUNY at Buffalo (University at Buffalo, Biological Sciences (2002)
BS, SUNY at Buffalo (University at Buffalo), Biophysics (2002)
BA, SUNY at Buffalo (University at Buffalo), English (2002)
Community and International Work
Systems Improvement at District Hospitals and Regional Training of Emergency Care (sidHARTe) Program, Kintampo, Ghana
Mass Casualty training of staff
Opportunities for Student Involvement
Post 2010 Earthquake Relief, Port-au-prince, Haiti
Disaster Emergency Medicine in austere environments
MediShare, University of Miami
Opportunities for Student Involvement
- Standardizing terminology in academic medical journals: understanding sex and gender. European journal of emergency medicine : official journal of the European Society for Emergency Medicine 2021; 28 (5): 331-332
- Institutions' role in postpandemic support. Science (New York, N.Y.) 2021; 373 (6561): 1318
- Bias in recruitment: A focus on virtual interviews and holistic review to advance diversity AEM EDUCATION AND TRAINING 2021; 5: S135-S139
Professional development during a pandemic: a live virtual conference for emergency medicine chief residents.
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
2021; 5 (3): e10607
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
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
2021; 5 (2): e10597
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 2021; 5 (1): 121–29
The Impact of Due Process and Disruptions on Emergency Medicine Education in the United States.
The western journal of emergency medicine
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
View details for DOI 10.1002/aet2.10436
Physically Distant, Educationally Connected: Interactive Conferencing in the Era of COVID-19.
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
2020; 1 (6): 1194–98
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
2020; 21 (5): 1089–94
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
2019; 3 (3): 202–7
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. International Clinical Educators (ICE) blog. 2019
IDEA Series: A Low-fidelity Simulation Workshop for Teaching Cricothyroidotomy.
Academic Life in Emergency Medicine.
An Interactive Session to Help Faculty Manage Difficult Learner Behaviors in the Didactic Setting.
MedEdPORTAL : the journal of teaching and learning resources
2018; 14: 10774
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 PubMedID 30800974
- Rough day? Be grateful. A talk on positive psychology in Emergency Medicine Stanford BeWell. 2018