Bio


Dr. Al'ai Alvarez FACEP FAAEM is an emergency physician and clinical associate professor of Emergency Medicine (EM) at Stanford University. Dr. Alvarez is the Director of Well-Being and co-chair of the Human Potential Team at Stanford Emergency Medicine. He also serves as the Director of the first Physician 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. His long-term interest is to optimize the interconnectedness between Medical Education, Process Improvement (Quality and Clinical Operations), Recruitment (Diversity), and Well-being (Inclusion) through human-centered design.

Dr. Alvarez is a faculty fellow at the Stanford Byers Center for Biodesign (2021-2022), exploring the role of mindfulness in high-stress environments. He is also the co-director and organizer for the High-Performance Resuscitation Teams Summit (https://bit.ly/HPRT2022) in May 2022 in Chicago, IL, in collaboration with Mayo Clinic and the Mission Critical Teams Institute. The goal of HPRT is to develop a collaborative inquiry among teams from various disciplines, including healthcare, aerospace, sports, military, special operations forces, fire rescue, and other high-performing/elite teams.

Dr. Alvarez has served as the associate residency program director (APD) at the Stanford Emergency Medicine Residency Program. Among his roles, he 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 currently also serves as the 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 well-being 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-founded and co-chairs the largest national diversity mentoring program in EM 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, compassion, and belongingness and their role in physician well-being and diversity, equity, and inclusion in medicine.

Dr. Alvarez is the recipient of the 2019 ACEP DIHE 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 also received the 2020 CORD Academy for Scholarship in Education in EM Academy Member Award on Teaching and Evaluation.

Clinical Focus


  • Emergency Medicine
  • High-Performance Teams
  • Design Thinking
  • Physician Well-Being
  • Diversity and Inclusion
  • Self Compassion
  • Patient Safety and Quality Improvement
  • Professionalism
  • Patient Experience and Clinical Operations
  • Recruitment

Academic Appointments


Administrative Appointments


  • 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 (ABEM) (2012 - Present)
  • Fellow, American Academy of Emergency Medicine (AAEM) (2016 - Present)
  • Fellow, American College of Emergency Physicians (ACEP) (2016 - Present)
  • Faculty Fellow, Stanford Byers Center for Biodesign (2021 - 2022)
  • Chair, Society of Academic Emergency Medicine (SAEM), Wellness Committee (2022 - Present)
  • Vice-Chair, American Academy of Emergency Medicine (AAEM) (2021 - Present)

Professional Education


  • 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

    Topic

    Mass Casualty training of staff

    Partnering Organization(s)

    Columbia University

    Populations Served

    austere environment

    Location

    International

    Ongoing Project

    No

    Opportunities for Student Involvement

    No

  • Post 2010 Earthquake Relief, Port-au-prince, Haiti

    Topic

    Disaster Emergency Medicine in austere environments

    Partnering Organization(s)

    MediShare, University of Miami

    Populations Served

    earthquake survivors

    Location

    International

    Ongoing Project

    No

    Opportunities for Student Involvement

    No

All Publications


  • 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

  • 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: S5-S12

    View details for DOI 10.1002/aet2.10746

    View details for Web of Science ID 000814784200001

  • 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

  • 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

  • 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
  • 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

  • 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

  • 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

  • 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

  • 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/