Dr Michael Gisondi

All Publications

• Physician, know thyself: Applying brand management principles to professional identity in academic medicine. Medical education Branzetti, J., Gisondi, M. A., Hopson, L. R., Regan, L., Botti, S. 2024

  Abstract

  CONTEXT: A career in medicine is a journey of countless opportunities, challenges and choices. Determining the "right" decision for any given career choice ultimately must come from within; thus, a clear understanding of a physician's core professional identity is critical. Existing conceptualizations of professional identity within medicine focus primarily on medical training; however, it is clear that professional identity evolves throughout one's career. We propose the use of brand management principles as a novel means of understanding and expressing a physician's evolving professional identity throughout their career.METHODS: We propose a conceptual framework for managing academic physician professional identity based upon brand management principles derived from marketing and consumer research literature. The four key framework elements include brand identity ("Who am I?"), brand delivery ("What actions do I choose to present myself to others"), brand experience ("How are my actions experienced by others?") and brand image ("How do others see me?"). Successful management of one's brand starts with understanding the core professional brand identity, then determining the best way to deliver this identity through specific actions experienced by target audiences (e.g., patients, collaborators, colleagues, employers, learners, promotion committees, etc.), and ends with the target audience having a clear and compelling brand image that reflects the underlying professional identity. Alignment of these components results in an array of benefits; misalignment can result in feelings of burnout or career stalling.CONCLUSIONS: We contend that physicians can and should see themselves as their own unique brand. Though often confused with naked self-promotion, developing a professional brand is an identity exploration and reflection experience that allows individuals to better control the course of their careers. A strong personal brand has numerous practical applications; three key examples presented herein include navigating promotion through the professoriate, managing one's reputation and achieving professional fulfilment.

  View details for DOI 10.1111/medu.15601

  View details for PubMedID 39707864

• Development and Initial Validity Evidence for a Pregnancy Disclosure and Options Counseling Checklist in Emergency Medicine. AEM education and training Preiksaitis, C., Beshar, I., Dobiesz, V., Frisch, S., Henkel, A., Rider, A., Saxena, M., Gisondi, M. A. 2024; 8 (6): e11043

  Abstract

  Background: Many patients first learn of a pregnancy in the emergency department (ED). However, limited ED physician knowledge in pregnancy disclosure and options counseling may contribute to challenges in patient care and potential missed opportunities for timely access to reproductive care. No standardized instruments exist to teach or assess this important communication skill for the ED physicians. This study aimed to develop and collect validity evidence for a checklist for effective pregnancy disclosure and options counseling by ED physicians in an environment with unrestricted access to comprehensive reproductive care.Methods: A prospective checklist creation and validity evidence collection study was conducted, involving literature review, expert input through a modified Delphi process, and pilot testing with ED faculty and residents at an urban academic medical center. We structured the validity evidence collection process using Messick's criteria for construct validity, addressing content, response process, internal structure, and relations to other variables. Data analysis focused on collecting validity evidence, including inter-rater reliability and participant performance assessment based on faculty or resident status.Results: The study resulted in a final 17-item checklist for pregnancy disclosure and options counseling in the ED. Pilot testing with 20 participants (eight faculty members and 12 residents) revealed high overall inter-rater reliability with almost perfect agreement (kappa=0.81) and acceptable internal consistency (Cronbach's alpha=0.88). Checklist scores showed no significant difference across standardized patients, indicating consistency. Faculty members outperformed residents, suggesting concurrent validity based on levels of clinical experience.Conclusions: Preliminary validity evidence supports the use of this novel checklist to assess physician competency in pregnancy disclosure and options counseling in the ED. Given the frequency of new pregnancy encounters in the ED and the dynamic changes to pregnant patients' reproductive rights, enhancing physician education in these areas is critical for optimizing patient care and autonomy.

  View details for DOI 10.1002/aet2.11043

  View details for PubMedID 39611097

• Error Management Training and Adaptive Expertise in Learning Computed Tomography Interpretation: A Randomized Clinical Trial. JAMA network open Aliaga, L., Bavolek, R. A., Cooper, B., Mariorenzi, A., Ahn, J., Kraut, A., Duong, D., Burger, C., Gisondi, M. A. 2024; 7 (9): e2431600

  Abstract

  Adaptive expertise helps physicians apply their skills to novel clinical cases and reduce preventable errors. Error management training (EMT) has been shown to improve adaptive expertise with procedural skills; however, its application to cognitive skills in medical education is unclear.To evaluate whether EMT improves adaptive expertise when learning the cognitive skill of head computed tomography (CT) interpretation.This 3-arm randomized clinical trial was conducted from July 8, 2022, to March 30, 2023, in 7 geographically diverse emergency medicine residency programs. Participants were postgraduate year 1 through 4 emergency medicine residents masked to the hypothesis.Participants were randomized 1:1:1 to a difficult EMT, easy EMT, or error avoidance training (EAT) control learning strategy for completing an online head CT curriculum. Both EMT cohorts received no didactic instruction before scrolling through head CT cases, whereas the EAT group did. The difficult EMT cohort answered difficult questions about the teaching cases, leading to errors, whereas the easy EMT cohort answered easy questions, leading to fewer errors. All 3 cohorts used the same cases.The primary outcome was a difference in adaptive expertise among the 3 cohorts, as measured using a head CT posttest. Secondary outcomes were (1) differences in routine expertise, (2) whether the quantity of errors during training mediated differences in adaptive expertise, and (3) the interaction between prior residency training and the learning strategies.Among 212 randomized participants (mean [SD] age, 28.8 [2.0] years; 107 men [50.5%]), 70 were allocated to the difficult EMT, 71 to the easy EMT, and 71 to the EAT control cohorts; 150 participants (70.8%) completed the posttest. The difficult EMT cohort outperformed both the easy EMT and EAT cohorts on adaptive expertise cases (60.6% [95% CI, 56.1%-65.1%] vs 45.2% [95% CI, 39.9%-50.6%], vs 40.9% [95% CI, 36.0%-45.7%], respectively; P < .001), with a large effect size (η2 = 0.19). There was no significant difference in routine expertise. The difficult EMT cohort made more errors during training than the easy EMT cohort. Mediation analysis showed that the number of errors during training explained 87.2% of the difficult EMT learning strategy's effect on improving adaptive expertise (P = .01). The difficult EMT learning strategy was more effective in improving adaptive expertise for residents earlier in training, with a large effect size (η2 = 0.25; P = .002).In this randomized clinical trial, the findings show that EMT is an effective method to develop physicians' adaptive expertise with cognitive skills.ClinicalTrials.gov Identifier: NCT05284838.

  View details for DOI 10.1001/jamanetworkopen.2024.31600

  View details for PubMedID 39250155

• Assessing Team Performance: A Mixed-Methods Analysis Using Interprofessional in situ Simulation. The western journal of emergency medicine Rider, A. C., Williams, S. R., Jones, V., Rebagliati, D., Schertzer, K., Gisondi, M. A., Sebok-Syer, S. S. 2024; 25 (4): 557-564

  Abstract

  Optimizing the performance of emergency department (ED) teams impacts patient care, but the utility of current, team-based performance assessment tools to comprehensively measure this impact is underexplored. In this study we aimed to 1) evaluate ED team performance using current team-based assessment tools during an interprofessional in situ simulation and 2) identify characteristics of effective ED teams.This mixed-methods study employed case study methodology based on a constructivist paradigm. Sixty-three eligible nurses, technicians, pharmacists, and postgraduate year 2-4 emergency medicine residents at a tertiary academic ED participated in a 10-minute in situ simulation of a critically ill patient. Participants self-rated performance using the Team Performance Observation Tool (TPOT) 2.0 and completed a brief demographic form. Two raters independently reviewed simulation videos and rated performance using the TPOT 2.0, Team Emergency Assessment Measure (TEAM), and Ottawa Crisis Resource Management Global Rating Scale (Ottawa GRS). Following simulations, we conducted semi-structured interviews and focus groups with in situ participants. Transcripts were analyzed using thematic analysis.Eighteen team-based simulations took place between January-April 2021. Raters' scores were on the upper end of the tools for the TPOT 2.0 (R1 4.90, SD 0.17; R2 4.53, SD 0.27, IRR [inter-rater reliability] 0.47), TEAM (R1 3.89, SD 0.19; R2 3.58, SD 0.39, IRR 0.73), and Ottawa GRS (R1 6.6, SD 0.56; R2 6.2, SD 0.54, IRR 0.68). We identified six themes from our interview data: team member entrustment; interdependent energy; leadership tone; optimal communication; strategic staffing; and simulation empowering team performance.Current team performance assessment tools insufficiently discriminate among high performing teams in the ED. Emergency department-specific assessments that capture features of entrustability, interdependent energy, and leadership tone may offer a more comprehensive way to assess an individual's contribution to a team's performance.

  View details for DOI 10.5811/westjem.18012

  View details for PubMedID 39028241

• 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

• 2023 Society for Academic Emergency Medicine Consensus Conference on Precision Emergency Medicine: Development of a policy-relevant, patient-centered research agenda. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine Strehlow, M., Gisondi, M. A., Caretta-Weyer, H., Ankel, F., Brackett, A., Brar, P., Chan, T. M., Garabedian, A., Gunn, B., Isaacs, E., von Isenburg, M., Jarman, A., Kuehl, D., Limkakeng, A. T., Lydston, M., McGregor, A., Pierce, A., Raven, M. C., Salhi, R. A., Stave, C., Tan, J., Taylor, R. A., Wong, H. N., Yiadom, M. Y., Zachrison, K. S., Vogel, J. 2024

  Abstract

  Precision medicine is data-driven health care tailored to individual patients based on their unique attributes, including biologic profiles, disease expressions, local environments, and socioeconomic conditions. Emergency medicine (EM) has been peripheral to the precision medicine discourse, lacking both a unified definition of precision medicine and a clear research agenda. We convened a national consensus conference to build a shared mental model and develop a research agenda for precision EM.We held a conference to (1) define precision EM, (2) develop an evidence-based research agenda, and (3) identify educational gaps for current and future EM clinicians. Nine preconference workgroups (biomedical ethics, data science, health professions education, health care delivery and access, informatics, omics, population health, sex and gender, and technology and digital tools), comprising 84 individuals, garnered expert opinion, reviewed relevant literature, engaged with patients, and developed key research questions. During the conference, each workgroup shared how they defined precision EM within their domain, presented relevant conceptual frameworks, and engaged a broad set of stakeholders to refine precision EM research questions using a multistage consensus-building process.A total of 217 individuals participated in this initiative, of whom 115 were conference-day attendees. Consensus-building activities yielded a definition of precision EM and key research questions that comprised a new 10-year precision EM research agenda. The consensus process revealed three themes: (1) preeminence of data, (2) interconnectedness of research questions across domains, and (3) promises and pitfalls of advances in health technology and data science/artificial intelligence. The Health Professions Education Workgroup identified educational gaps in precision EM and discussed a training roadmap for the specialty.A research agenda for precision EM, developed with extensive stakeholder input, recognizes the potential and challenges of precision EM. Comprehensive clinician training in this field is essential to advance EM in this domain.

  View details for DOI 10.1111/acem.14932

  View details for PubMedID 38779704

• Trainee advocacy for medical education on the care of people with intellectual and/or developmental disabilities: a sequential mixed methods analysis. BMC medical education Clarke, L., O'Neill, N., Patel, B., Steeman, S., Segal, G., Merrell, S. B., Gisondi, M. A. 2024; 24 (1): 491

  Abstract

  Medical trainees (medical students, residents, and fellows) are playing an active role in the development of new curricular initiatives; however, examinations of their advocacy efforts are rarely reported. The purpose of this study was to understand the experiences of trainees advocating for improved medical education on the care of people with intellectual and/or developmental disabilities.In 2022-23, the authors conducted an explanatory, sequential, mixed methods study using a constructivist paradigm to analyze the experiences of trainee advocates. They used descriptive statistics to analyze quantitative data collected through surveys. Participant interviews then yielded qualitative data that they examined using team-based deductive and inductive thematic analysis. The authors applied Kern's six-step approach to curriculum development as a framework for analyzing and reporting results.A total of 24 participants completed the surveys, of whom 12 volunteered to be interviewed. Most survey participants were medical students who reported successful advocacy efforts despite administrative challenges. Several themes were identified that mapped to Steps 2, 4, and 5 of the Kern framework: "Utilizing Trainee Feedback" related to Needs Assessment of Targeted Learners (Kern Step 2); "Inclusion" related to Educational Strategies (Kern Step 4); and "Obstacles", "Catalysts", and "Sustainability" related to Curriculum Implementation (Kern Step 5).Trainee advocates are influencing the development and implementation of medical education related to the care of people with intellectual and/or developmental disabilities. Their successes are influenced by engaged mentors, patient partners, and receptive institutions and their experiences provide a novel insight into the process of trainee-driven curriculum advocacy.

  View details for DOI 10.1186/s12909-024-05449-4

  View details for PubMedID 38702741

• Precision medicine within health professions education: Defining a research agenda for emergency medicine using a foresight and strategy technique (FaST) review. AEM education and training Chan, T. M., Thoma, B., Finnell, J. T., Gordon, B. D., Farrell, S., Pusic, M., Cabrera, D., Gisondi, M. A., Caretta-Weyer, H. A., Stave, C., Ankel, F. 2024; 8 (Suppl 1): S5-S16

  Abstract

  Background: Precision medicine, sometimes referred to as personalized medicine, is rapidly changing the possibilities for how people will engage health care in the near future. As technology to support precision medicine exponentially develops, there is an urgent need to proactively improve our understanding of precision medicine and pose important research questions (RQs) related to its inclusion in the education and training of future emergency physicians.Methods: A seven-step process was employed to develop a research agenda exploring the intersection of precision and emergency medicine education/training. A literature search of articles about precision medicine was conducted first, which informed the creation of future four scenarios in which trainees and practicing physicians regularly discuss and incorporate precision medicine tools into their discussions and work. Based on these futurist narratives, potential education RQs were generated by an expert panel. A total of 59 initial questions were subsequently categorized and refined to a priority list through a nominal group voting method. The top/priority questions were presented at the 2023 SAEM Consensus Conference on Precision Medicine, Austin, Texas, for further input.Results: Eight high-value education RQs were developed, reflecting a holistic view of the challenges and opportunities for precision medicine education in the knowledge, skills, and attitudes relevant to emergency medicine. These questions contend with topics such as most effective pedagogical methods; intended resulting outcomes and behaviors; the generational differences between practicing emergency physicians, educators, and future trainees; and the desires and expectations of patients.Conclusions: Emergency medicine and emergency physicians must be prepared to understand precision medicine and incorporate this information into their "toolbox" of thinking, problem solving, and communication with patients and colleagues. This research agenda on how best to educate future emergency physicians in the use of personalized data to provide optimal health care is the focus of this article.

  View details for DOI 10.1002/aet2.10983

  View details for PubMedID 38774830

• Better together: A multistakeholder approach to developing specialty-wide entrustable professional activities in emergency medicine. AEM education and training Caretta-Weyer, H. A., Sebok-Syer, S. S., Morris, A. M., Schnapp, B. H., Fant, A. L., Scott, K. R., Pirotte, M., Gisondi, M. A., Yarris, L. M. 2024; 8 (2): e10974

  Abstract

  Entrustable professional activities (EPAs) are a widely used framework for curriculum and assessment, yet the variability in emergency medicine (EM) training programs mandates the development of EPAs that meet the needs of the specialty as a whole. This requires eliciting and incorporating the perspectives of multiple stakeholders (i.e., faculty, residents, and patients) in the development of EPAs. Without a shared understanding of what a resident must be able to do upon graduation, we run the risk of advancing ill-prepared residents that may provide inconsistent care.In an effort to address these challenges, beginning in February 2020, the authors assembled an advisory board of 25 EM faculty to draft and reach consensus on a final list of EPAs that can be used across all training programs within the specialty of EM. Using modified Delphi methodology, the authors came to consensus on an initial list of 22 EPAs. The authors presented these EPAs to faculty supervisors, residents, and patients for refinement. The authors collated and analyzed feedback from focus groups of residents and patients using thematic analysis. The EPAs were subsequently refined based on this feedback.Stakeholders in EM residency training endorsed a final revised list of 22 EPAs. Stakeholder focus groups highlighted two main thematic considerations that helped shape the finalized list of EM EPAs: attention to the meaningful nuances of EPA language and contextualizing the EPAs and viewing them developmentally.To foreground all key stakeholders within the EPA process for EM, the authors chose within the development process to draft; come to consensus; and refine EPAs for EM in collaboration with relevant faculty, patient, and resident stakeholders. Each stakeholder group contributed meaningfully to the content and intended implementation of the EPAs. This process may serve as a model for others in developing stakeholder-responsive EPAs.

  View details for DOI 10.1002/aet2.10974

  View details for PubMedID 38532740

  View details for PubMedCentralID PMC10962124

• Training student teachers to improve LGBTQ plus health education MEDICAL EDUCATION Moutwakil, A., Wary, N. K., Laniakea, B., Gisondi, M. A. 2024

  View details for DOI 10.1111/medu.15330

  View details for Web of Science ID 001161028000001

  View details for PubMedID 38348609

• What the experts see: A qualitative analysis of the behaviors of master adaptive learners in emergency medicine AEM EDUCATION AND TRAINING Hopson, L. R., Branzetti, J., Gisondi, M. A., Regan, L. 2024; 8 (1)

  View details for DOI 10.1002/aet2.10943

  View details for Web of Science ID 001168955800001

• Belongingness among first-generation students at Stanford School of Medicine. MedEdPublish (2016) Delgado, A. C., Dowling, S., Sanchez-Guzman, M., Sebok-Syer, S. S., Gisondi, M. A. 2023; 13: 288

  Abstract

  Nationally, underrepresented minorities represent a significant proportion of the first-generation student population. These students also tend to report lower levels of belongingness compared to their peers, which may impact their wellness and be an important factor in their academic success. This study aimed to explore whether status as a first-generation student was associated with belongingness amongst medical students.In 2019, a previously validated 16-item survey was used to examine potential disparities in belongingness amongst groups of first-generation medical students. Differences between groups were assessed using a Mann-Whitney U-test for each individual item and three composite groupings of items regarding social belonging, academic belonging, and institutional support.First-generation to college and first-generation to graduate school students reported lower belongingness across most individual items as well as in all three composite groups.Given that peer relationships and institutional support play an important role in medical student belonging, these findings represent an opportunity to address the specific needs of individuals from underrepresented groups in medicine. Doing so can support the academic and professional success of first-generation students and help close the diversity gap in medicine.

  View details for DOI 10.12688/mep.19912.1

  View details for PubMedID 38694949

  View details for PubMedCentralID PMC11061589

• A Conference (Missingness in Action) to Address Missingness in Data and AI in Health Care: Qualitative Thematic Analysis. Journal of medical Internet research Rose, C., Barber, R., Preiksaitis, C., Kim, I., Mishra, N., Kayser, K., Brown, I., Gisondi, M. 2023; 25: e49314

  Abstract

  BACKGROUND: Missingness in health care data poses significant challenges in the development and implementation of artificial intelligence (AI) and machine learning solutions. Identifying and addressing these challenges is critical to ensuring the continued growth and accuracy of these models as well as their equitable and effective use in health care settings.OBJECTIVE: This study aims to explore the challenges, opportunities, and potential solutions related to missingness in health care data for AI applications through the conduct of a digital conference and thematic analysis of conference proceedings.METHODS: A digital conference was held in September 2022, attracting 861 registered participants, with 164 (19%) attending the live event. The conference featured presentations and panel discussions by experts in AI, machine learning, and health care. Transcripts of the event were analyzed using the stepwise framework of Braun and Clark to identify key themes related to missingness in health care data.RESULTS: Three principal themes-data quality and bias, human input in model development, and trust and privacy-emerged from the analysis. Topics included the accuracy of predictive models, lack of inclusion of underrepresented communities, partnership with physicians and other populations, challenges with sensitive health care data, and fostering trust with patients and the health care community.CONCLUSIONS: Addressing the challenges of data quality, human input, and trust is vital when devising and using machine learning algorithms in health care. Recommendations include expanding data collection efforts to reduce gaps and biases, involving medical professionals in the development and implementation of AI models, and developing clear ethical guidelines to safeguard patient privacy. Further research and ongoing discussions are needed to ensure these conclusions remain relevant as health care and AI continue to evolve.

  View details for DOI 10.2196/49314

  View details for PubMedID 37995113

• How are students learning to care for people with disabilities?: exploring the curriculum design of a sample of disability electives offered by US health professions schools. Disability and rehabilitation Clarke, L., Tabor, H. K., Gisondi, M. A. 2023: 1-11

  Abstract

  PURPOSE: There is an increased demand among health professions students for disability-focused training. We aimed to characterize the development and structure of a sample of disability electives offered at health professions schools in the United States.MATERIALS AND METHODS: A survey was developed to capture data on the curriculum design of disability electives offered at health professions schools across the United States. The primary outcome measures were elective development, elective structure, learner and instructor demographics, disability inclusion, and evaluation methodologies. A cross-sectional survey study was conducted, during which the survey was distributed to relevant professional societies focused on disability advocacy within healthcare.RESULTS: Data were collected on fifteen disability electives. Most electives were developed within the past four years, and many electives were initiated by students. The structure, duration, and evaluation methodology of electives were highly variable. Most electives took the form of a longer didactic-based course or a shorter clinical experience. All electives involved people with disabilities in some capacity.CONCLUSIONS: Disability electives fill an important gap in disability education at some health professions schools. Elective directors should have an increased focus on assessing student learning and ensuring that people with disabilities are involved in elective design and instruction.

  View details for DOI 10.1080/09638288.2023.2254694

  View details for PubMedID 37671804

• Teaching LGBTQ+ Health, a Web-Based Faculty Development Course: Program Evaluation Study Using the RE-AIM Framework. JMIR medical education Gisondi, M. A., Keyes, T., Zucker, S., Bumgardner, D. 2023; 9: e47777

  Abstract

  Many health professions faculty members lack training on fundamental lesbian, gay, bisexual, transgender, and queer (LGBTQ+) health topics. Faculty development is needed to address knowledge gaps, improve teaching, and prepare students to competently care for the growing LGBTQ+ population.We conducted a program evaluation of the massive open online course Teaching LGBTQ+ Health: A Faculty Development Course for Health Professions Educators from the Stanford School of Medicine. Our goal was to understand participant demographics, impact, and ongoing maintenance needs to inform decisions about updating the course.We evaluated the course for the period from March 27, 2021, to February 24, 2023, guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. We assessed impact using participation numbers, evidence of learning, and likelihood of practice change. Data included participant demographics, performance on a pre- and postcourse quiz, open-text entries throughout the course, continuing medical education (CME) credits awarded, and CME course evaluations. We analyzed demographics using descriptive statistics and pre- and postcourse quiz scores using a paired 2-tailed t test. We conducted a qualitative thematic analysis of open-text responses to prompts within the course and CME evaluation questions.Results were reported using the 5 framework domains. Regarding Reach, 1782 learners participated in the course, and 1516 (85.07%) accessed it through a main course website. Of the different types of participants, most were physicians (423/1516, 27.9%) and from outside the sponsoring institution and target audience (1452/1516, 95.78%). Regarding Effectiveness, the median change in test scores for the 38.1% (679/1782) of participants who completed both the pre- and postcourse tests was 3 out of 10 points, or a 30% improvement (P<.001). Themes identified from CME evaluations included LGBTQ+ health as a distinct domain, inclusivity in practices, and teaching LGBTQ+ health strategies. A minority of participants (237/1782, 13.3%) earned CME credits. Regarding Adoption, themes identified among responses to prompts in the course included LGBTQ+ health concepts and instructional strategies. Most participants strongly agreed with numerous positive statements about the course content, presentation, and likelihood of practice change. Regarding Implementation, the course cost US $57,000 to build and was intramurally funded through grants and subsidies. The course faculty spent an estimated 600 hours on the project, and educational technologists spent another 712 hours. Regarding Maintenance, much of the course is evergreen, and ongoing oversight and quality assurance require minimal faculty time. New content will likely include modules on transgender health and gender-affirming care.Teaching LGBTQ+ Health improved participants' knowledge of fundamental queer health topics. Overall participation has been modest to date. Most participants indicated an intention to change clinical or teaching practices. Maintenance costs are minimal. The web-based course will continue to be offered, and new content will likely be added.

  View details for DOI 10.2196/47777

  View details for PubMedID 37477962

• Characteristics of Emergency Medicine ResidencyPrograms With Unfilled Positions inthe2023 Match. Annals of emergency medicine Preiksaitis, C., Krzyzaniak, S., Bowers, K., Little, A., Gottlieb, M., Mannix, A., Gisondi, M. A., Chan, T. M., Lin, M. 2023

  Abstract

  STUDY OBJECTIVE: The unprecedented number of unfilled emergency medicine post-graduate year 1 (PGY-1) residency positions in the 2023 National Resident Matching Program shocked the emergency medicine community. This study investigates the association between emergency medicine program characteristics and the likelihood of unfilled positions in the 2023 Match.METHODS: This cross-sectional, observational study examined 2023 National Residency Matching Program data, focusing on program type, length, location, size, proximity to other programs, previous American Osteopathic Association (AOA) accreditation, first accreditation year, and emergency department ownership structure. We constructed a generalized linear mixed model with a logistic linking function to determine predictors of unfilled positions.RESULTS: A total of 554 of 3,010 (18.4%) PGY-1 positions at 131 of 276 (47%) emergency medicine programs went unfilled in the 2023 Match. In our model, predictors included having unfilled positions in the 2022 Match (odds ratio [OR] 48.14, 95% confidence interval [CI] 21.04 to 110.15), smaller program size (less than 8 residents, OR 18.39, 95% CI 3.90 to 86.66; 8 to 10 residents, OR 6.29, 95% CI 1.50 to 26.28; 11 to 13 residents, OR 5.88, 95% CI 1.55 to 22.32), located in the Mid Atlantic (OR 14.03, 95% CI 2.56 to 77.04) area, prior AOA accreditation (OR 10.13, 95% CI 2.82 to 36.36), located in the East North Central (OR 6.94, 95% CI 1.25 to 38.47) area, and corporate ownership structure (OR 3.21, 95% CI 1.06 to 9.72).CONCLUSION: Our study identified 6 characteristics associated with unfilled emergency medicine residency positions in the 2023 Match. These findings may be used to guide student advising and inform decisions by residency programs, hospitals, and national organizations to address the complexities of residency recruitment and implications for the emergency medicine workforce.

  View details for DOI 10.1016/j.annemergmed.2023.06.002

  View details for PubMedID 37436344

• Patient handoffs and multi-specialty trainee perspectives across an institution: informing recommendations for health systems and an expanded conceptual framework for handoffs. BMC medical education Williams, S. R., Sebok-Syer, S. S., Caretta-Weyer, H., Katznelson, L., Dohn, A. M., Park, Y. S., Gisondi, M. A., Tekian, A. 2023; 23 (1): 434

  Abstract

  Safe and effective physician-to-physician patient handoffs are integral to patient safety. Unfortunately, poor handoffs continue to be a major cause of medical errors. Developing a better understanding of challenges faced by health care providers is critical to address this continued patient safety threat. This study addresses the gap in the literature exploring broad, cross-specialty trainee perspectives around handoffs and provides a set of trainee-informed recommendations for both training programs and institutions.Using a constructivist paradigm, the authors conducted a concurrent/embedded mixed method study to investigate trainees' experiences with patient handoffs across Stanford University Hospital, a large academic medical center. The authors designed and administered a survey instrument including Likert-style and open-ended questions to solicit information about trainee experiences from multiple specialties. The authors performed a thematic analysis of open-ended responses.687/1138 (60.4%) of residents and fellows responded to the survey, representing 46 training programs and over 30 specialties. There was wide variability in handoff content and process, most notably code status not being consistently mentioned a third of the time for patients who were not full code. Supervision and feedback about handoffs were inconsistently provided. Trainees identified multiple health-systems level issues that complicated handoffs and suggested solutions to these threats. Our thematic analysis identified five important aspects of handoffs: (1) handoff elements, (2) health-systems-level factors, (3) impact of the handoff, (4) agency (duty), and (5) blame and shame.Health systems, interpersonal, and intrapersonal issues affect handoff communication. The authors propose an expanded theoretical framework for effective patient handoffs and provide a set of trainee-informed recommendations for training programs and sponsoring institutions. Cultural and health-systems issues must be prioritized and addressed, as an undercurrent of blame and shame permeates the clinical environment.

  View details for DOI 10.1186/s12909-023-04355-5

  View details for PubMedID 37312085

• The role of emergency physicians in the fight against health misinformation: Implications for resident training. AEM education and training Sheng, A. Y., Gottlieb, M., Bautista, J. R., Trueger, N. S., Westafer, L. M., Gisondi, M. A. 2023; 7 (Suppl 1): S48-S57

  Abstract

  Emergency physicians on the frontlines of the COVID-19 pandemic are first-hand witnesses to the direct impact of health misinformation and disinformation on individual patients, communities, and public health at large. Therefore, emergency physicians naturally have a crucial role to play to steward factual information and combat health misinformation. Unfortunately, most physicians lack the communications and social media training needed to address health misinformation with patients and online, highlighting an obvious gap in emergency medicine training. We convened an expert panel of academic emergency physicians who have taught and conducted research about health misinformation at the Society for Academic Emergency Medicine (SAEM) Annual Meeting in New Orleans, LA, on May 13, 2022. The panelists represented geographically diverse institutions including Baystate Medical Center/Tufts University, Boston Medical Center, Northwestern University, Rush Medical College, and Stanford University. In this article, we describe the scope and impact of health misinformation, introduce methods for addressing misinformation in the clinical environment and online, acknowledge the challenges of tackling misinformation from our physician colleagues, demonstrate strategies for debunking and prebunking, and highlight implications for education and training in emergency medicine. Finally, we discuss several actionable interventions that define the role of the emergency physician in the management of health misinformation.

  View details for DOI 10.1002/aet2.10877

  View details for PubMedID 37383831

  View details for PubMedCentralID PMC10294217

• Child-focused climate change and health content in medical schools and pediatric residencies. Pediatric research Goshua, A., Gomez, J., Erny, B., Gisondi, M., Patel, L., Sampath, V., Sheffield, P., Nadeau, K. C. 2023

  Abstract

  Anthropogenic climate change-driven primarily by the combustion of fossil fuels that form greenhouse gases-has numerous consequences that impact health, including extreme weather events of accelerating frequency and intensity (e.g., wildfires, thunderstorms, droughts, and heat waves), mental health sequelae of displacement from these events, and the increase in aeroallergens and other pollutants. Children are especially vulnerable to climate-related exposures given that they are still developing, encounter higher exposures compared to adults, and are at risk of losing many healthy future years of life. In order to better meet the needs of generations of children born into a world affected by climate change, medical trainees must develop their knowledge of the relationships between climate change and children's health-with a focus on applying that information in clinical practice. This review provides an overview of salient climate change and children's health topics that medical school and pediatric residency training curricula should cover. In addition, it highlights the strengths and limitations of existing medical school and residency climate change and pediatric health curricula. IMPACT: Provides insight into the current climate change and pediatric health curricular opportunities for medical trainees in North America at both the medical school and residency levels. Condenses climate change and pediatric health material relevant to trainees to help readers optimize curricula at their institutions.

  View details for DOI 10.1038/s41390-023-02600-7

  View details for PubMedID 37081111

  View details for PubMedCentralID 6265068

• Digital Impact Factor: A Quality Index for Educational Blogs and Podcasts in Emergency Medicine and Critical Care. Annals of emergency medicine Lin, M., Phipps, M., Chan, T. M., Thoma, B., Nash, C. J., Yilmaz, Y., Chen, D., He, S., Gisondi, M. A. 2023

  Abstract

  Given the popularity of educational blogs and podcasts in medicine, learners and educators need tools to identify trusted and impactful sites. The Social Media Index was a multi-sourced formula to rank the effect of emergency medicine and critical care blogs. In 2022, a key data point for the Social Media Index became unavailable. This bibliometric study aimed to develop a new measure, the Digital Impact Factor, as a replacement.The Digital Impact Factor incorporated modern measures of website authority and reach. This formula was applied to a cross-sectional study of active emergency medicine and critical care blogs and podcasts. For each website, we generated a Digital Impact Factor score based on Ahrefs Domain Rating and the follower count of the websites' pages from 8 social media platforms. A series of Spearman correlations provided evidence of association by comparing a rank-ordered list to rank lists derived from the Social Media Index over the last 5 years. The Bland-Altman analysis assessed for agreement.The authors identified 88 relevant websites with a median Ahrefs Domain Rating of 28 (range 0 to 71, maximum 100) and total social media followership count across 8 platforms of 1,828,557. The Domain Rating and individual social media followership scores were normalized based on the highest recorded values to yield the Digital Impact Factor (median 4.57; range 0.02 to 9.50, maximum 10). The correlation between the 2022 Digital Impact Factor and the 2021 Social Media Index was 0.94 (95% confidence interval 0.89 to 0.97; p<.001; n=41 rankings correlated), suggesting that they measure similar constructs. The Bland-Altman plot also demonstrated fair agreement between the 2 scores.The Digital Impact Factor is a measure of the relative effect of educational blogs and podcasts within emergency medicine and critical care.

  View details for DOI 10.1016/j.annemergmed.2023.02.011

  View details for PubMedID 36967275

• Training for Adaptive Expertise: Why, What, and How. Academic medicine : journal of the Association of American Medical Colleges Branzetti, J., Hopson, L. R., Gisondi, M. A., Regan, L. 2023

  View details for DOI 10.1097/ACM.0000000000005217

  View details for PubMedID 36972136

• The Role of Graduate Medical Education in the Fight Against Health Misinformation. Journal of graduate medical education Sheng, A. Y., Gottlieb, M., Bautista, J. R., Trueger, N. S., Westafer, L. M., Gisondi, M. A. 2023; 15 (1): 9-14

  View details for DOI 10.4300/JGME-D-22-00383.1

  View details for PubMedID 36817520

• Practical tips for navigating a program director transition. MedEdPublish (2016) Gisondi, M. A., Hopson, L., Regan, L., Branzetti, J. 2023; 13: 3

  Abstract

  Residency and fellowship program directors profoundly impact trainees, institutions, and patient safety. Yet, there is concern for rapid attrition in the role. The average program director tenure is only 4-7 years, and that timeline is likely a result of burnout or opportunities for career advancement. Program director transitions must be carefully executed to ensure minimal disruption to the program. Transitions benefit from clear communication with trainees and other stakeholders, well-planned successions or searches for a replacement, and clearly delineated expectations and responsibilities of the outgoing program director. In this Practical Tips, four former residency program directors offer a roadmap for a successful program director transition, with specific recommendations to guide critical decisions and steps in the process. Themes emphasized include readiness for a transition, communication strategies, alignment of program mission and search efforts, and anticipatory support to ensure the success of the new director.

  View details for DOI 10.12688/mep.19492.1

  View details for PubMedID 36895799

• Filling the Core EPA 10 assessment void: A framework for individual assessment of Core Entrustable professional activity 10 competencies in medical students. AEM education and training Miller, D. T., Gibb, W., Caretta-Weyer, H., Ng, K., Sebok-Syer, S. S., Gisondi, M. A. 2022; 6 (6): e10787

  Abstract

  Objectives: The goal of this study was to develop and evaluate a novel curriculum and assessment tool for Core Entrustable Professional Activity (EPA) 10 competencies and entrustment scoring in a cohort of medical students in their emergency medicine (EM) clerkship using a framework of individualized, ad hoc, formative assessment. Core EPA 10 is an observable workplace-based activity for graduating medical students to recognize a patient requiring urgent or emergent care and initiate evaluation and management.Methods: This is a prospective, pretest-posttest study of medical students during their EM clerkship. Using the Thomas and Kern framework, we created a curriculum of simulation cases about chest pain/cardiac arrest and respiratory distress, which included novel assessment checklists, and instructional videos about recognizing and managing emergencies. Students were individually pretested on EPA 10 competencies using the simulation cases. Two raters scored students using standardized checklists. Students then watched instructional videos, underwent a posttest with the simulation cases, and were scored again by the two raters using the checklists. Differences between pretest and posttest scores were analyzed using paired t-tests and Wilcoxon signed-rank tests.Results: Seventy-three out of 85 (86%) students completed the curriculum. Mean scores from pretest to final posttest in the chest pain/cardiac arrest and respiratory distress cases significantly improved from 14.8/19 (SD 1.91), to 17.1/19 (SD=1.00), t(68)=10.56, p<0.001, and 8.5/13 (SD 1.79), to 11.1/13(SD 0.89), t(67)=11.15, p<0.001, respectively. The kappa coefficients were 0.909 (n=2698, p<0.001) and 0.931 (n=1872, p<0.001). Median modified Chen entrustment scores improved from 1b (i.e., "Watch me do this") to 2b (i.e., "I'll watch you") for the chest pain/cardiac arrest case (p<0.001) and 1b/2a (i.e., "Watch me do this"/ "Let's do this together") to 3a (i.e. "You go ahead, and I'll double-check all of your findings") for the respiratory distress case (p<0.001).Conclusion: A new directed curriculum of standardized simulation cases and asynchronous instructional videos improved medical student performance in EPA 10 competencies and entrustment scores. This study provides a curricular framework to support formative individualized assessments for EPA 10.

  View details for DOI 10.1002/aet2.10787

  View details for PubMedID 36389650

• Is it worth it? A qualitative analysis of the impact of medical education fellowships on careers. AEM education and training Jordan, J., Gisondi, M. A., Buchanavage, J., Diller, D., Pedigo, R., Ahn, J., Riddell, J. 2022; 6 (6): e10819

  Abstract

  Objectives: Medical education fellowships provide training in teaching, assessment, educational program administration, and scholarship. The longitudinal impact of this training is unknown. The objective of this study was to explore the impact of medical education fellowships on the careers of graduates.Methods: The authors performed a qualitative study with a constructivist-interpretivist paradigm using semistructured interviews in 2021. The authors used a purposeful randomized stratified sampling strategy of graduates to ensure diversity of representation (gender, region, fellowship duration, and career stage). Two researchers independently analyzed interview transcriptions using a modified grounded theory approach.Results: The authors interviewed 10 graduates and identified three overarching concepts: motivations for pursuing fellowship, benefits of training, and drivers of career development. Graduates sought training because of their desire for growth and career preparation and at the advice of mentors. Fellowships provided knowledge and skills in a structured learning environment, supported by mentors and a collaborative community. Fellowship training shaped the careers of graduates by increasing their self-efficacy, enhancing their outcome expectations, refining their goals, and influencing their professional identity formation. They acquired expertise that prepared them for jobs, developed credibility, felt competitive in the job market, anticipated successful promotion, reached for greater goals, broadened their educational worldview, and evolved their professional identity as a result of fellowship training.Conclusions: Fellowship training in medical education provides knowledge and skills, a structured learning environment, and important relationships that shape the careers of graduates by impacting their self-efficacy, outcome expectations, goal creation, and professional identity formation.

  View details for DOI 10.1002/aet2.10819

  View details for PubMedID 36518233

• Educating for adaptive expertise: case examples along the medical education continuum. Advances in health sciences education : theory and practice Pusic, M. V., Hall, E., Billings, H., Branzetti, J., Hopson, L. R., Regan, L., Gisondi, M. A., Cutrer, W. B. 2022

  Abstract

  Adaptive expertise represents the combination of both efficient problem-solving for clinical encounters with known solutions, as well as the ability to learn and innovate when faced with a novel challenge. Fostering adaptive expertise requires careful approaches to instructional design to emphasize deeper, more effortful learning. These teaching strategies are time-intensive, effortful, and challenging to implement in health professions education curricula. The authors are educators whose missions encompass the medical education continuum, from undergraduate through to organizational learning. Each has grappled with how to promote adaptive expertise development in their context. They describe themes drawn from educational experiences at these various learner levels to illustrate strategies that may be used to cultivate adaptive expertise.At Vanderbilt University School of Medicine, a restructuring of the medical school curriculum provided multiple opportunities to use specific curricular strategies to foster adaptive expertise development. The advantage for students in terms of future learning had to be rationalized against assessments that are more short-term in nature. In a consortium of emergency medicine residency programs, a diversity of instructional approaches was deployed to foster adaptive expertise within complex clinical learning environments. Here the value of adaptive expertise approaches must be balanced with the efficiency imperative in clinical care. At Mayo Clinic, an existing continuous professional development program was used to orient the entire organization towards an adaptive expertise mindset, with each individual making a contribution to the shift.The different contexts illustrate both the flexibility of the adaptive expertise conceptualization and the need to customize the educational approach to the developmental stage of the learner. In particular, an important benefit of teaching to adaptive expertise is the opportunity to influence individual professional identity formation to ensure that clinicians of the future value deeper, more effortful learning strategies throughout their careers.

  View details for DOI 10.1007/s10459-022-10165-z

  View details for PubMedID 36414880

• Rejecting Reforms, Yet Calling for Change: A Qualitative Analysis of Proposed Reforms to the Residency Application Process. Academic medicine : journal of the Association of American Medical Colleges Dacre, M., Branzetti, J., Hopson, L. R., Regan, L., Gisondi, M. A. 2022

  Abstract

  PURPOSE: Annual increases in the number of residency applications burden students and challenge programs. Several reforms to the application process have been proposed; however, stakeholder input is often overlooked. The authors examined key stakeholders' opinions about several proposed reforms to the residency application process and identified important factors to guide future reforms.METHOD: Using semistructured interviews, the authors asked educational administrators and trainees to consider 5 commonly proposed reforms to the residency application process: match to obtain residency interviews, preference signaling, application limits, geographic preference disclosure, and abolishing the match. The authors conducted a modified content analysis of interview transcripts using qualitative and quantitative analytic techniques. frequency analysis regarding the acceptability of the 5 proposed reforms and thematic analysis of important factors to guide reform were performed. Fifteen-minute interviews were conducted between July and October 2019, with data analysis completed during a 6-month period in 2020 and 2021.RESULTS: Participants included 30 stakeholders from 9 medical specialties and 15 institutions. Most participants wanted to keep the Match process intact; however, they noted several important flaws in the system that disadvantage students and warrant change. Participants did not broadly support any of the 5 proposed reforms. Two themes were identified: principles to guide reform (fairness, transparency, equity, reducing costs to students, reducing total applications, reducing work for program directors, and avoiding unintended consequences) and unpopular reform proposals (concern that application limits threaten less: competitive students and signaling adds bias to the system).CONCLUSIONS: Key stakeholders in the residency application process believe the system has important flaws that demand reform. Despite this, the most commonly proposed reforms are unacceptable to these stakeholders because they threaten fairness to students and program workload. These findings call for a larger investigation of proposed reforms with a more nationally representative stakeholder cohort.

  View details for DOI 10.1097/ACM.0000000000005100

  View details for PubMedID 36512846

• A Fork in the Road for Emergency Medicine and Critical Care Blogs and Podcasts: Cross-sectional Study. JMIR medical education Lin, M., Phipps, M., Yilmaz, Y., Nash, C. J., Gisondi, M. A., Chan, T. M. 2022; 8 (4): e39946

  Abstract

  BACKGROUND: Free open-access meducation (FOAM) refers to open-access, web-based learning resources in medicine. It includes all formats of digital products, including blogs and podcasts. The number of FOAM blog and podcast sites in emergency medicine and critical care increased dramatically from 2002 to 2013, and physicians began to rely on the availability of these resources. The current landscape of these FOAM sites is unknown.OBJECTIVE: This study aims to (1) estimate the current number of active, open-access blogs and podcasts in emergency medicine and critical care and (2) describe observed and anticipated trends in the FOAM movement using the Theory of Disruptive Innovation by Christensen as a theoretical framework.METHODS: The authors used multiple resources and sampling strategies to identify active, open-access blogs and podcasts between April 25, 2022, and May 8, 2022, and classified these websites as blogs, podcasts, or blogs+podcasts. For each category, they reported the following outcome measures using descriptive statistics: age, funding, affiliations, and team composition. Based on these findings, the authors projected trends in the number of active sites using a positivist paradigm and the Theory of Disruptive Innovation as a theoretical framework.RESULTS: The authors identified 109 emergency medicine and critical care websites, which comprised 45.9% (n=50) blogs, 22.9% (n=25) podcasts, and 31.2% (n=34) blogs+podcasts. Ages ranged from 0 to 18 years; 27.5% (n=30) sold products, 18.3% (n=20) used advertisements, 44.0% (n=48) had institutional funding, and 27.5% (n=30) had no affiliation or external funding sources. Team sizes ranged from 1 (n=26, 23.9%) to ≥5 (n=60, 55%) individuals.CONCLUSIONS: There was a sharp decline in the number of emergency medicine and critical care blogs and podcasts in the last decade, dropping 40.4% since 2013. The initial growth of FOAM and its subsequent downturn align with principles in the Theory of Disruptive Innovation by Christensen. These findings have important implications for the field of medical education.

  View details for DOI 10.2196/39946

  View details for PubMedID 36306167

• A workforce study of emergency medicine medical education fellowship directors: Describing roles, responsibilities, support, and priorities AEM EDUCATION AND TRAINING Golden, A., Diller, D., Riddell, J., Jordan, J., Gisondi, M., Ahn, J. 2022; 6 (5)

  View details for DOI 10.1002/aet2.10799

  View details for Web of Science ID 000854762500001

• A workforce study of emergency medicine medical education fellowship directors: Describing roles, responsibilities, support, and priorities. AEM education and training Golden, A., Diller, D., Riddell, J., Jordan, J., Gisondi, M., Ahn, J. 2022; 6 (5): e10799

  Abstract

  Despite emergency medicine (EM) medical education fellowships increasing in number, the position of the medical education fellowship director (FD) remains incompletely defined. The goal of this study was to characterize the roles, responsibilities, support, and priorities for medical education FDs.We adapted and piloted an anonymous electronic survey consisting of 31 single-answer, multiple-answer, and free-response items. The survey was distributed to FDs via listserv and individual emails from a directory compiled from multiple online resources. We used descriptive statistics to analyze data from items with discrete answer choices. Using a constructivist paradigm, we performed a thematic analysis of free-response data.Thirty-four medical education FDs completed the survey, resulting in a response rate of 77%. Thirty-eight percent of respondents were female. Fifty-three percent earned master's degrees in education and 35% completed a medical education fellowship. Most respondents held other education leadership roles including program director (28%), associate/assistant program director (28%), and vice chair (25%). Sixty-three percent received support in their role, including clinical buy-down (90%), administrative assistants (55%), and salary (5%). There was no difference (χ2 [2, n = 32] = 1.77, p = 0.41) between availability of support and type of hospital (community, university, or public hospital). Medical education FDs dedicated a median of 12 h per month to fellowship responsibilities, include education (median 35% of time), program administration (25%), research mentorship (15%), and recruitment (10%). Medical education FDs describe priorities that can be categorized into three themes related to fellows, fellowship, and institution.This study provides insight into the current position and experience of medical education FDs. The results can clarify the role and responsibilities of FDs as the demand for medical education FDs increases.

  View details for DOI 10.1002/aet2.10799

  View details for PubMedID 36189449

  View details for PubMedCentralID PMC9482417

• The OSSE: Development and validation of an "Objective Structured Supervision Evaluation". AEM education and training Pokrajac, N., Roszczynialski, K. N., Rider, A., Poffenberger, C. M., Williams, S., Eakin, M. K., Sapp, R. W., Jenkins, E., Gisondi, M. A., Schertzer, K. 2022; 6 (4): e10784

  Abstract

  Trainee supervision and teaching are distinct skills that both require faculty physician competence to ensure patient safety. No standard approach exists to teach physician supervisory competence, resulting in variable trainee oversight and safety threats. The Objective Structured Teaching Evaluation (OSTE) does not adequately incorporate the specific skills required for effective supervision. To address this continuing medical education gap, the authors aimed to develop and identify validity evidence for an "Objective Structured Supervision Evaluation" (OSSE) for attending physicians, conceptually modeled on the historic OSTE.An expert panel used an iterative process to create an OSSE instrument, which was a checklist of key supervision items to be evaluated during a simulated endotracheal intubation scenario. Three trained "standardized residents" scored faculty participants' performance using the instrument. Validity testing modeled a contemporary approach using Kane's framework. Participants underwent simulation-based mastery learning (SBML) with deliberate practice until meeting a minimum passing standard (MPS).The final instrument contained 19 items, including three global rating measures. Testing domains included supervision climate, participant control of patient care, trainee evaluation, instructional skills, case-specific measures, and overall supervisor rating. Reliability of the assessment tool was excellent (ICC range 0.84-0.89). The assessment tool had good internal consistency (Cronbach's α = 0.813). Out of 24 faculty participants, 17 (70.8%) met the MPS on initial assessment. All met the MPS after SBML and average score increased by 19.5% (95% CI of the difference 10.3%-28.8%, p = 0.002).

  View details for DOI 10.1002/aet2.10784

  View details for PubMedID 35903423

  View details for PubMedCentralID PMC9305721

• The OSSE: Development and validation of an "Objective Structured Supervision Evaluation" AEM EDUCATION AND TRAINING Pokrajac, N., Roszczynialski, K. N., Rider, A., Poffenberger, C., Williams, S., Eakin, M., Sapp, R. W., Jenkins, E., Gisondi, M. A., Schertzer, K. 2022; 6 (4)

  View details for DOI 10.1002/aet2.10784

  View details for Web of Science ID 000828655600001

• The relationship between publication citations and twitter mentions in emergency medicine. The American journal of emergency medicine Faber, J. M., Carlson, M., Lai, D., Calvano, J. D., Monette, D. L., Gisondi, M., He, S. 2022

  View details for DOI 10.1016/j.ajem.2022.05.052

  View details for PubMedID 35680508

• The Purpose, Design, and Promise of Medical Education Research Labs. Academic medicine : journal of the Association of American Medical Colleges Gisondi, M. A., Michael, S., Li-Sauerwine, S., Brazil, V., Caretta-Weyer, H. A., Issenberg, B., Giordano, J., Lineberry, M., Olson, A. S., Burkhardt, J. C., Chan, T. M. 2022

  Abstract

  Medical education researchers are often subject to challenges that include lack of funding, collaborators, study subjects, and departmental support. The construct of a research lab provides a framework that can be employed to overcome these challenges and effectively support the work of medical education researchers; however, labs are relatively uncommon in the medical education field. Using case examples, the authors describe the organization and mission of medical education research labs contrasted with those of larger research team configurations, such as research centers, collaboratives, and networks. They discuss several key elements of education research labs: the importance of lab identity, the signaling effect of a lab designation, required infrastructure, and the training mission of a lab. The need for medical education researchers to be visionary and strategic when designing their labs is emphasized, start-up considerations and the likelihood of support for medical education labs is considered, and the degree to which department leaders should support such labs is questioned.

  View details for DOI 10.1097/ACM.0000000000004746

  View details for PubMedID 35612923

• The Best Laid Plans? A Qualitative Investigation of How Resident Physicians Plan Their Learning. Academic medicine : journal of the Association of American Medical Colleges Branzetti, J., Commissaris, C., Croteau, C., Ehmann, M. R., Gisondi, M. A., Hopson, L. R., Lai, K. Y., Regan, L. 2022

  Abstract

  PURPOSE: Adaptive expertise (AE) has been identified as a critical trait to cultivate in future physicians. The 4-phase master adaptive learner (MAL) conceptual model describes the learning skills and behaviors necessary to develop AE. Though prior work has elucidated skills and behaviors used by MALs in the initial planning phase of learning, most resident learners are not thought to be MALs. In this study, the authors investigated how these majority "typical" learners develop AE by exploring the strategies they used in the planning phase of learning.METHOD: Participants were resident physicians at graduate medical education (GME) training programs located at 4 academic medical centers in the United States. Participants participated in semistructured individual interviews in 2021, and interview transcripts were analyzed using constant comparative analysis of grounded theory.RESULTS: Fourteen subjects representing 8 specialties were interviewed, generating 152 pages of transcripts for analysis. Three themes were identified: "Typical" learners were challenged by the transition from structured undergraduate medical education (UME) learning to less-structured GME learning, lacked necessary skills to easily navigate this transition, and relied on trial and error to develop their learning skills.CONCLUSIONS: Participants used trial and error to find learning strategies to help them manage the systemic challenges encountered when transitioning from medical school to residency. The success (or failure) of these efforts was tied to learners' efficacy with the self-regulated learning concepts of agency, metacognitive goal setting, and motivation. A conceptual model is provided to describe the impact of these factors on residents' ability to be adaptive learners, and actionable recommendations are provided to help educators' efforts to foster adaptive learning skills and behaviors. These findings also provided valuable evidence of validity of the MAL model that has thus far been lacking.

  View details for DOI 10.1097/ACM.0000000000004751

  View details for PubMedID 35612927

• Simulation-Based Mastery Learning Improves the Performance of Donning and Doffing of Personal Protective Equipment by Medical Students. The western journal of emergency medicine Miller, D. T., Pokrajac, N., Ngo, J., Gallegos, M., Dixon, W., Roszczynialski, K. N., Ng, K., Taleghani, N., Gisondi, M. A. 2022; 23 (3): 318-323

  Abstract

  Medical students lack adequate training on how to correctly don and doff personal protective equipment (PPE). Simulation-based mastery learning (SBML) is an effective technique for procedural education. The aim of this study was to determine whether SBML improves proper PPE donning and doffing by medical students.This was a prospective, pre-test/post-test study of 155 medical students on demonstration of correct PPE use before and after a SBML intervention. Subjects completed standard hospital training by viewing a US Centers for Disease Control and Prevention training video on proper PPE use prior to the intervention. They then participated in a SBML training session that included baseline testing, deliberate practice with expert feedback, and post-testing until mastery was achieved. Students were assessed using a previously developed 21-item checklist on donning and doffing PPE with a minimum passing standard (MPS) of 21/21 items. We analyzed differences between pre-test and post-test scores using paired t-tests. Students at preclinical and clinical levels of training were compared with an independent t-test.Two participants (1.3%) met the MPS on pre-test. Of the remaining 153 subjects who participated in the intervention, 151 (98.7%) reached mastery. Comparison of mean scores from pre-test to final post-test significantly improved from an average raw score of 12.55/21 (standard deviation [SD] = 2.86), to 21/21(SD = 0), t(150) = 36.3, P <0.001. There was no difference between pre-test scores of pre-clinical and clinical students.Simulation-based mastery learning improves medical student performance in PPE donning and doffing in a simulated environment. This approach standardizes PPE training for students in advance of clinical experiences.

  View details for DOI 10.5811/westjem.2022.2.54748

  View details for PubMedID 35679489

• Adaptive expertise: The optimal outcome of emergency medicine training. AEM education and training Branzetti, J., Gisondi, M. A., Hopson, L. R., Regan, L. 2022; 6 (2): e10731

  View details for DOI 10.1002/aet2.10731

  View details for PubMedID 35368500

• A mixed-methods needs assessment to identify pharmacology education objectives for emergency medicine residents. Journal of the American College of Emergency Physicians open Rider, A. C., Dang, B. T., Caretta-Weyer, H. A., Schertzer, K. A., Gisondi, M. A. 2022; 3 (2): e12682

  Abstract

  Objectives: Medication errors represent a significant threat to patient safety. Pharmacotherapy is one of the 23 Accreditation Council of Graduate Medical Education milestones for emergency medicine, yet there is minimal understanding of what content should be prioritized during training. The study aim was to develop objectives for a patient-safety focused pharmacology curriculum for emergency medicine residents.Methods: We incorporated data from a de-identified safety event database and survey responses of 30 faculty and clinical pharmacists at a single-site suburban university hospital with 24-hour emergency medicine pharmacists and an annual volume of approximately 70,000. We reviewed the database to quantify types and severity of medication errors over a 5-year period for a total of 370 errors. Anonymous surveys included categorical items that we analyzed with descriptive statistics and short answer questions that underwent thematic analysis by 2 coders. We summarized all data sources to identify curriculum gaps.Results: Common medication errors reported in our database were wrong dose (43%) and computer order entry errors (14%). Knowledge gaps were medication cost (63%), pregnancy risk information (60%), antibiotic stewardship (53%), interactions (47%), and side effects (47%). Qualitative analysis revealed the need to optimize computer order entry, understand the scope of critical medications, use references, and consult pharmacists. Integration of data suggested specific medications should be covered in curricular efforts, including antibiotics, analgesics, sedatives, and insulin.Conclusion: We developed objectives of pharmacology topics to prioritize during emergency medicine training to enhance prescribing safety. This study is limited due to its small sample and single institution source of data. Future studies should investigate the impact of pharmacology curriculum on minimizing clinical errors.

  View details for DOI 10.1002/emp2.12682

  View details for PubMedID 35310405

• Creating a better learning environment: a qualitative study uncovering the experiences of Master Adaptive Learners in residency. BMC medical education Regan, L., Hopson, L. R., Gisondi, M. A., Branzetti, J. 2022; 22 (1): 141

  Abstract

  BACKGROUND: Adaptive expertise is an important physician skill, and the Master Adaptive Learner (MAL) conceptual model describes learner skills and behaviors integral to the acquisition of adaptive expertise. The learning environment is postulated to significantly impact how MALs learn, but it is unclear how these successful learners experience and interact with it. This study sought to understand the authentic experience of MALs within the learning environment and translate those experiences into practical recommendations to improve the learning environment for all trainees.METHODS: Following a constructivist paradigm, we conducted a thematic analysis of transcripts from focus groups composed of MALs to identify commonalities in experiences and practices of successful postgraduate trainees in the learning environment. Saturation was achieved after seven focus groups, consisting of thirty-eight participants representing fourteen specialties from four institutions. Researchers coded transcripts using constant comparison analysis, which served as the foundation for our thematic analysis.RESULTS: We identified eight themes and situated them within a 4-component model of the learning environment. Four themes were identified within the personal component: (1) patients drive learning; (2) learning has no endpoint; (3) management of emotions is crucial for learning; (4) successful learning requires a structured approach. Two themes were identified in the social component: (5) positive social relationships are leveraged to maximize learning; (6) teaching facilitates personal learning. Two themes were identified in the organizational component: (7) transitions challenge learners to adapt; (8) the learning environment dictates goal setting strategy. No major themes were identified in the physical/virtual component, although participants frequently used technology when learning.CONCLUSIONS: Master Adaptive Learners experience similar facilitators of, and barriers to, success in the learning environment. Overall, our data show that acquisition of many successful strategies and skills that support learning are relegated to the hidden curriculum of residency training. Educators could support a more effective learning environment for all trainees by: (1) highlighting patients as the focal point of learning, (2) building a professional 'learner' identity, (3) teaching learning skills, and (4) creating opportunities for collaborative learning.

  View details for DOI 10.1186/s12909-022-03200-5

  View details for PubMedID 35241060

• This Article Corrects: "Gender-based Barriers in the Advancement of Women Leaders in Emergency Medicine: A Multi-institutional Qualitative Study". The western journal of emergency medicine Graham, E. M., Ferrel, M. N., Wells, K. M., Egan, D. J., MacVane, C. Z., Gisondi, M. A., Burns, B. D., Madsen, T. E., Fix, M. L. 2022; 23 (2): 290

  View details for DOI 10.5811/westjem.2022.2.56587

  View details for PubMedID 35302468

• A Qualitative Thematic Analysis of 'INFODEMIC: A Stanford Conference on Social Media, Ethics, and COVID-19 Misinformation'. Journal of medical Internet research Gisondi, M. A., Chambers, D., La, T. M., Ryan, A., Shankar, A., Xue, A., Barber, R. A. 1800

  Abstract

  BACKGROUND: The COVID-19 pandemic continues to challenge the world's population, with approximately 266 million cases and 5 million deaths to date. COVID-19 misinformation and disinformation led to vaccine hesitancy among the public, particularly in vulnerable communities, which persists today. Social media companies are attempting to curb the ongoing spread of an overwhelming amount of COVID-19 misinformation on their platforms. In response to this problem, the authors hosted INFODEMIC: A Stanford Conference on Social Media and COVID-19 Misinformation (INFODEMIC) to develop best practices for social media companies to mitigate online misinformation and disinformation.OBJECTIVE: The primary aim of this study was to develop recommendations for social media companies to address The COVID-19 Infodemic. The authors report the methods used to execute the INFODEMIC conference, conference attendee engagement and analytics, and a qualitative thematic analysis of the conference presentations. The primary study outcomes were the identified themes and corresponding recommendations.METHODS: Using a constructivist paradigm, the authors conducted a thematic analysis of the 6-hour conference transcript to develop best practice recommendations. The INFODEMIC conference was the study intervention, the conference speakers were the study participants, and transcripts of their presentations were the data for this study. The authors followed the 6-step framework for thematic analysis described by Clark and Braun. They also used descriptive statistics to report measures of conference engagement including registrations, viewership, post-conference asynchronous participation, and conference evaluations.RESULTS: A total of 26 participants spoke at the virtual conference and represented a wide array of occupations, expertise, and countries of origin. From their remarks, the authors identified 18 response categories and four themes: trust, equity, social media practices, and interorganizational partnerships. From these, a total of 16 best practice recommendations were formulated for social media companies, healthcare organizations, and the general public. These recommendations focused on rebuilding trust in science and medicine among certain communities, redesigning social media platforms and algorithms to reduce the spread of misinformation, improving partnerships between key stakeholders, and educating the public to critically analyze online information. Of the 1,090 conference registrants, 587 (54%) attended the live conference and another 9,996 individuals viewed or listened to the conference recordings asynchronously. Conference evaluations averaged 8.9 (best = 10).CONCLUSIONS: Social media companies play a significant role in the The COVID-19 Infodemic and should adopt evidence-based measures to mitigate misinformation on their platforms.CLINICALTRIAL:

  View details for DOI 10.2196/35707

  View details for PubMedID 35030089

• A Deadly Infodemic: Social Media and the Power of COVID-19 Misinformation. Journal of medical Internet research Gisondi, M. A., Barber, R., Faust, J. S., Raja, A., Strehlow, M., Westafer, L., Gottlieb, M. 1800

  Abstract

  UNSTRUCTURED: COVID-19 is currently the third leading cause of death in the United States and unvaccinated people continue to die in high numbers. Vaccine hesitancy and vaccine refusal are fueled by COVID-19 misinformation and disinformation on social media platforms. This online 'COVID-19 Infodemic' has deadly consequences. In this editorial, the authors examine the roles that social media companies play in The COVID-19 Infodemic and their obligations to end it. They describe how 'fake news' about the virus developed on social media and acknowledge the initially muted response by the scientific community to counteract misinformation. The authors then challenge social media companies to better mitigate The COVID-19 Infodemic, describing legal and ethical imperatives to do so. They close with recommendations for better partnerships with community influencers and implementation scientists, and they provide next steps for all readers to consider. This guest editorial accompanies the JMIR special theme issue, "Social Media, Ethics, and COVID-19 Misinformation."

  View details for DOI 10.2196/35552

  View details for PubMedID 35007204

• Lessons from designing a medical school course on mortality. Medical Education Horak, P. W., Bair, H., Pompei, P., Gisondi, M. A. 2022

  View details for DOI 10.1111/medu.14767

• Assessment of Entrustable Professional Activities Using a Web-Based Simulation Platform During Transition to Emergency Medicine Residency: Mixed Methods Pilot Study. JMIR medical education Peng, C. R., Schertzer, K. A., Caretta-Weyer, H. A., Sebok-Syer, S. S., Lu, W., Tansomboon, C., Gisondi, M. A. 2021; 7 (4): e32356

  Abstract

  BACKGROUND: The 13 core entrustable professional activities (EPAs) are key competency-based learning outcomes in the transition from undergraduate to graduate medical education in the United States. Five of these EPAs (EPA2: prioritizing differentials, EPA3: recommending and interpreting tests, EPA4: entering orders and prescriptions, EPA5: documenting clinical encounters, and EPA10: recognizing urgent and emergent conditions) are uniquely suited for web-based assessment.OBJECTIVE: In this pilot study, we created cases on a web-based simulation platform for the diagnostic assessment of these EPAs and examined the feasibility and acceptability of the platform.METHODS: Four simulation cases underwent 3 rounds of consensus panels and pilot testing. Incoming emergency medicine interns (N=15) completed all cases. A maximum of 4 "look for" statements, which encompassed specific EPAs, were generated for each participant: (1) performing harmful or missing actions, (2) narrowing differential or wrong final diagnosis, (3) errors in documentation, and (4) lack of recognition and stabilization of urgent diagnoses. Finally, we interviewed a sample of interns (n=5) and residency leadership (n=5) and analyzed the responses using thematic analysis.RESULTS: All participants had at least one missing critical action, and 40% (6/15) of the participants performed at least one harmful action across all 4 cases. The final diagnosis was not included in the differential diagnosis in more than half of the assessments (8/15, 54%). Other errors included selecting incorrect documentation passages (6/15, 40%) and indiscriminately applying oxygen (9/15, 60%). The interview themes included psychological safety of the interface, ability to assess learning, and fidelity of cases. The most valuable feature cited was the ability to place orders in a realistic electronic medical record interface.CONCLUSIONS: This study demonstrates the feasibility and acceptability of a web-based platform for diagnostic assessment of specific EPAs. The approach rapidly identifies potential areas of concern for incoming interns using an asynchronous format, provides feedback in a manner appreciated by residency leadership, and informs individualized learning plans.

  View details for DOI 10.2196/32356

  View details for PubMedID 34787582

• Gender-based Barriers in the Advancement of Women Leaders in Emergency Medicine: A Multi-institutional Qualitative Study. The western journal of emergency medicine Graham, E. M., Ferrel, M. N., Wells, K. M., Egan, D. J., MacVane, C. Z., Gisondi, M. A., Burns, B. D., Madsen, T. E., Fix, M. L. 2021; 22 (6): 1355-1359

  Abstract

  INTRODUCTION: Leadership positions occupied by women within academic emergency medicine have remained stagnant despite increasing numbers of women with faculty appointments. We distributed a multi-institutional survey to women faculty and residents to evaluate categorical characteristics contributing to success and differences between the two groups.METHODS: An institutional review board-approved electronic survey was distributed to women faculty and residents at eight institutions and were completed anonymously. We created survey questions to assess multiple categories: determination; resiliency; career support and obstacles; career aspiration; and gender discrimination. Most questions used a Likert five-point scale. Responses for each question and category were averaged and deemed significant if the average was greater than or equal to 4 in the affirmative, or less than or equal to 2 in the negative. We calculated proportions for binary questions.RESULTS: The overall response rate was 55.23% (95/172). The faculty response rate was 54.1% (59/109) and residents' response rate was 57.1% (36/63). Significant levels of resiliency were reported, with a mean score of 4.02. Childbearing and rearing were not significant barriers overall but were more commonly reported as barriers for faculty over residents (P <0.001). Obstacles reported included a lack of confidence during work-related negotiations and insufficient research experience. Notably, 68.4% (65/95) of respondents experienced gender discrimination and 9.5% (9/95) reported at least one encounter of sexual assault by a colleague or supervisor during their career.CONCLUSION: Targeted interventions to promote female leadership in academic emergency medicine include coaching on negotiation skills, improved resources and mentorship to support research, and enforcement of safe work environments. Female emergency physician resiliency is high and not a barrier to career advancement.

  View details for DOI 10.5811/westjem.2021.7.52826

  View details for PubMedID 34787562

• LGBTQ+ health: a failure of medical education. CJEM Gisondi, M. A., Bigham, B. 2021; 23 (5): 577-578

  View details for DOI 10.1007/s43678-021-00185-w

  View details for PubMedID 34491560

• Geographic mobility in the emergency medicine residency match and the influence of gender. AEM education and training Regan, L., Gisondi, M. A., Branzetti, J., Mitchell, M., Romeo, M., Kayko, C., Hopson, L. R. 2021; 5 (4): e10706

  Abstract

  Objectives: Women are underrepresented in emergency medicine (EM) leadership. Some evidence suggests that geographic mobility improves career advancement. We compared movement between medical school and residency by gender. Our hypothesis was that women move a shorter distance than men.Methods: We collected National Residency Matching Program (NRMP) lists of ranked applicants from eight EM residency programs from the 2020 Main Residency Match. We added the gender expressed in interviews and left the Association of American Medical Colleges (AAMC) number as the unique identifier. Applicant data for matched osteopathic and allopathic seniors in the continental United States was included. We obtained street addresses for medical schools from an AAMC database and residency program addresses from the ACGME website. We performed geospatial analysis using ArcGIS Pro and compared results by gender. NRMP approved the data use and our institutional review board granted exempt status.Results: A total of 881 of 944 unique applicants met inclusion criteria and included 48.5% (830/1,713) of matched allopaths and 37% of all matched seniors; 48% (420) were female. There was no significant difference between genders for distance moved (p=0.31). Women moved a mean (±SD) 619 (±698) miles (median=341 miles, range=0-2,679 miles); and men, a mean (±SD) 641 (±717) miles (median=315 miles, range=0-2,671 miles). Further analysis of applicants traveling less than 50 miles (49 women, 51 men) and by census division showed no significant frequency differences.Conclusion: Women and men travel similar distances for EM residency with the majority staying within geographic proximity to their medical school. This suggests that professional mobility at this stage is not a constraint. Our study findings are limited because we do not know which personal and professional factors inform relocation decisions. Gender is not associated with a difference in distance moved by students for residency. This finding may have implications for resident selection and career development.

  View details for DOI 10.1002/aet2.10706

  View details for PubMedID 34859171

• Mastery learning improves simulated central venous catheter insertion by emergency medicine teaching faculty. AEM education and training Pokrajac, N., Schertzer, K., Roszczynialski, K. N., Rider, A., Williams, S. R., Poffenberger, C. M., Gisondi, M. A. 2021; 5 (4): e10703

  Abstract

  Routine competency assessments of procedure skills, such as central venous catheter (CVC) insertion, do not occur beyond residency training. Evidence suggests variable, suboptimal attending physician procedure skills. Our study aimed to assess CVC insertion skill by academic emergency physicians, determine whether a simulation-based mastery learning (SBML) intervention improves performance and investigate for variables that predict competence.This is a pretest-posttest study that evaluated simulated CVC insertion by emergency medicine (EM) faculty physicians. We assessed 44 volunteer participants at a large academic medical center over a 1-month period using a published 29-item checklist. Our primary outcome was the difference in assessment score before and after a SBML intervention. A secondary analysis evaluated predictors of pretest performance.A total of 44 subjects participated. Only four of 44 (9.1%) of subjects met a predefined minimum passing score on pretest. Mean assessment scores increased by 21.5% following the SBML intervention (95% confidence interval [CI] of the difference = 18.1% to 24.8%, p < 0.001). In a regression model, pretest scores increased by 10.8% (95% CI = 2.9 to 18.7%, p = 0.009) if subjects completed postgraduate training within 5 years. Frequency of CVC insertion did not predict performance, but 25 of 44 (56.8%) faculty members had no documented performance or supervision of a CVC insertion within 1 year of assessment.SBML is a promising method to assess and improve CVC insertion performance by EM faculty physicians. Recent completion of postgraduate training was a significant predictor of CVC insertion performance. Our results require validation in larger cohorts of EM physicians across other academic institutions.

  View details for DOI 10.1002/aet2.10703

  View details for PubMedID 34723048

  View details for PubMedCentralID PMC8541755

• Leveling the field: Development of reliable scoring rubrics for quantitative and qualitative medical education research abstracts. AEM education and training Jordan, J., Hopson, L. R., Molins, C., Bentley, S. K., Deiorio, N. M., Santen, S. A., Yarris, L. M., Coates, W. C., Gisondi, M. A. 2021; 5 (4): e10654

  Abstract

  Background: Research abstracts are submitted for presentation at scientific conferences; however, criteria for judging abstracts are variable. We sought to develop two rigorous abstract scoring rubrics for education research submissions reporting (1) quantitative data and (2) qualitative data and then to collect validity evidence to support score interpretation.Methods: We used a modified Delphi method to achieve expert consensus for scoring rubric items to optimize content validity. Eight education research experts participated in two separate modified Delphi processes, one to generate quantitative research items and one for qualitative. Modifications were made between rounds based on item scores and expert feedback. Homogeneity of ratings in the Delphi process was calculated using Cronbach's alpha, with increasing homogeneity considered an indication of consensus. Rubrics were piloted by scoring abstracts from 22 quantitative publications from AEM Education and Training "Critical Appraisal of Emergency Medicine Education Research" (11 highlighted for excellent methodology and 11 that were not) and 10 qualitative publications (five highlighted for excellent methodology and five that were not). Intraclass correlation coefficient (ICC) estimates of reliability were calculated.Results: Each rubric required three rounds of a modified Delphi process. The resulting quantitative rubric contained nine items: quality of objectives, appropriateness of methods, outcomes, data analysis, generalizability, importance to medical education, innovation, quality of writing, and strength of conclusions (Cronbach's alpha for the third round=0.922, ICC for total scores during piloting=0.893). The resulting qualitative rubric contained seven items: quality of study aims, general methods, data collection, sampling, data analysis, writing quality, and strength of conclusions (Cronbach's alpha for the third round=0.913, ICC for the total scores during piloting=0.788).Conclusion: We developed scoring rubrics to assess quality in quantitative and qualitative medical education research abstracts to aid in selection for presentation at scientific meetings. Our tools demonstrated high reliability.

  View details for DOI 10.1002/aet2.10654

  View details for PubMedID 34485805

• Outcome assessment of medical education fellowships in emergency medicine. AEM education and training Jordan, J., Ahn, J., Diller, D., Riddell, J., Pedigo, R., Tolles, J., Gisondi, M. A. 2021; 5 (4): e10650

  Abstract

  Objectives: Medical education fellowships in emergency medicine (EM) provide training in teaching, assessment, educational program administration, and scholarship. The longitudinal impact of this training is unknown. Our objective was to characterize the career outcomes of medical education fellowship graduates.Methods: We solicited curriculum vitae (CV) from graduates of U.S. EM education fellowships by email. We abstracted data from CVs with a standard instrument that included program characteristics, employment history, leadership positions, awards, and scholarly productivity. We calculated and reported descriptive statistics.Results: A total of 71 of 91 (78%) graduates participated. Thirty-three completed a 1-year fellowship and 38 completed a 2-year fellowship. Nineteen (27%) completed an advanced degree during fellowship. Median (range) graduation year was 2016 (1997-2020). The majority, 63 of 71 (89%), work in an academic setting. Graduates held leadership positions in continuing medical education, graduate medical education, and undergraduate medical education. Forty-eight (68%) served on national medical education committees. The mean±SD number of national medical education awards was 1.27±2.03. The mean±SD number of national medical education presentations was 7.63±10.83. Graduates authored a mean±SD of 3.63±5.81 book chapters and a mean±SD of 4.99±6.17 peer-reviewed medical education research publications. Ten (14%) served on journal editorial boards, 34 (48%) were journal reviewers, and 31 (44%) had received a medical education grant.Conclusion: EM medical education fellowship graduates are academically productive and hold education leadership positions.

  View details for DOI 10.1002/aet2.10650

  View details for PubMedID 34568714

• A randomized controlled trial of simulation-based mastery learning to teach the extended focused assessment with sonography in trauma. AEM education and training Smith, S., Lobo, V., Anderson, K. L., Gisondi, M. A., Sebok-Syer, S. S., Duanmu, Y. 2021; 5 (3): e10606

  Abstract

  Background: Mastery learning has gained popularity for training residents in procedural skills due to its demonstrated superiority over traditional methods. However, no studies have compared the efficacy of traditional versus mastery learning methods in residency point-of-care ultrasound education. We hypothesized that mastery learning would improve residents' skills in performing the extended focused assessment with sonography in trauma (eFAST).Methods: All first-year emergency medicine (EM) resident physicians at a single university hospital underwent a crossover randomized controlled trial to receive mastery-learning eFAST training either at the beginning of the academic year or 6months into intern year. Participants were taught using a checklist validated by a panel of experts using Mastery Angoff methods and were given feedback on missed tasks until each trainee completed the eFAST with a minimum passing standard (MPS). Our primary outcome was technical proficiency between the two groups for eFAST examinations performed in the emergency department during the academic year.Results: Sixteen interns were enrolled; eight were randomized to each group. The group that received mastery training at the beginning of the year had mean clinical eFAST proficiency scores above the MPS in the first two quarters of the academic year, while the control group did not. Once the control group underwent eFAST mastery training at the midpoint of the year, both groups had mean proficiency scores above the MPS for the remainder of the year.Conclusion: Simulation-based mastery learning is an effective method of teaching the eFAST examination. This training during intern orientation conferred early proficiency in clinical performance of eFAST among EM residents. This difference in proficiency was no longer present after the control group received mastery learning education halfway through the academic year.

  View details for DOI 10.1002/aet2.10606

  View details for PubMedID 34141999

• Ethical imperative of psychological safety in healthcare: in response to the Manifesto for healthcare simulation practice BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING Griswold, S., Uchida, T., Issenberg, S., Motola, I., McGaghie, W. C., Gisondi, M. A., Lorenz, A., Barsuk, J. H. 2021; 7 (5): 457-458

  View details for DOI 10.1136/bmjstel-2021-000889

  View details for Web of Science ID 000672226300034

• The Summer Match: A qualitative study exploring a two-stage residency match option. AEM education and training Dacre, M., Hopson, L. R., Branzetti, J., Regan, L., Sebok-Syer, S. S., Gisondi, M. A. 2021; 5 (3): e10616

  Abstract

  Background: The number of residency applications submitted by medical students rises annually, resulting in increased work and costs for residency programs and applicants, particularly in emergency medicine. We propose a solution to this problem: an optional, two-stage Match with a "summer match" stage, in which applicants can submit a limited number of applications early. This would be conducted similarly to the early decision process for college admissions. The study objectives were to explore stakeholder opinions on the feasibility of a summer match and to identify the ideal logistic parameters to operationalize this proposal.Methods: We used exploratory qualitative methodology following a constructivist paradigm to develop an understanding of the potential impact of a summer match. We interviewed 34 key stakeholders in the U.S. residency application process identified through purposive sampling including educational administrators (program directors, designated institutional officials, medical school deans) and trainees (students, residents). We coded and thematically analyzed interview data in two stages using an inductive approach.Results: We identified six themes from the participant interviews that broadly reflected issues of the residency application process, value, and equity. These themes included disrupting the status quo, logistic concerns, match strategy, differential benefits, unintended consequences, and return on investment. Most study participants supported the summer match concept, with medical students and residents most in favor. We developed a theoretical summer match protocol based on these findings.Conclusions: A summer match may reduce the burdens of increasing residency applications and associated costs. Pilot testing is necessary to confirm this hypothesis and determine the impact of the proposed summer match protocol. Unintended consequences must be considered carefully during implementation.

  View details for DOI 10.1002/aet2.10616

  View details for PubMedID 34222750

• Ethical imperative of psychological safety in healthcare: in response to the Manifesto for healthcare simulation practice. BMJ simulation & technology enhanced learning Griswold, S., Uchida, T., Issenberg, S. B., Motola, I., McGaghie, W. C., Gisondi, M. A., Lorenz, A., Barsuk, J. H. 2021; 7 (5): 457-458

  Abstract

  Psychological safety is valued in other high-risk industries as an essential element to ensure safety. Yet, in healthcare, psychological safety is not mandatorily measured, quantified, or reported as an independent measure of safety. All members of the healthcare team's voice and safety are important. Calls for personal, physical or patient safety should never be disregarded or met with retaliation.

  View details for DOI 10.1136/bmjstel-2021-000889

  View details for PubMedID 35515745

  View details for PubMedCentralID PMC8936733

• 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

• Sustainable Engaged Accountable Learners. AEM education and training Gisondi, M. A., Branzetti, J., Hopson, L. R., Regan, L. 2021; 5 (2): e10470

  Abstract

  The development of lifelong learners is among the most challenging goals for medical educators. The authors identify two important scholarly works that profoundly altered their understanding and approach to lifelong learning and curriculum design: L. Dee Fink's Taxonomy of Significant Learning and Cutrer et al.'s Master Adaptive Learner model. By applying these guides to their teaching and related research, three important characteristics of lifelong learning became evident: sustainability, engagement, and accountability. These are abbreviated "SEALs," for sustainable engaged accountable learners. This paper defines these qualities as they relate to emergency medicine training, significant learning, and the development of adaptive expertise. Connections to Fink's and Cutrer's works are offered for each learner characteristic. Educational and psychological theories that support the SEALs model are paired with practical suggestions for educators to promote these desired qualities in their trainees. Relevant features of adult learning are highlighted, including self-regulation, motivation, agency, and autonomy.

  View details for DOI 10.1002/aet2.10470

  View details for PubMedID 33842802

• The Prevalence of Disability Health Training and Residents With Disabilities in Emergency Medicine Residency Programs. AEM education and training Sapp, R. W., Sebok-Syer, S. S., Gisondi, M. A., Rotoli, J. M., Backster, A., McClure Poffenberger, C. 2021; 5 (2): e10511

  Abstract

  Objectives: Individuals with disabilities experience significant health care disparities due to a multitude of barriers to effective care, which include a lack of adequate physician training on this topic and negative attitudes of physicians. This results in disparities through inadequate physical examination and diagnostic testing, withholding or inferior treatment, and neglecting preventative care. While much has been published about disability education in undergraduate medical education, little is known about the current state of disability education in emergency medicine (EM) residency programs.Methods: In 2019, a total of 237 EM residency program directors (PDs) in the United States were surveyed about the actual and desired number of hours of disability health instruction, perceived barriers to disability health education, prevalence of residents and faculty with disabilities, and confidence in providing accommodations to residents with disabilities.Results: A total of 104 surveys were completed (104/237, 43.9% response rate); 43% of respondents included disability-specific content in their residency curricula for an average of 1.5 total hours annually, in contrast to average desired hours of 4.16 hours. Reported barriers to disability health education included lack of time and lack of faculty expertise. A minority of residency programs have faculty members (13.5%) or residents (26%) with disabilities. The prevalence of EM residents with disabilities was 4.02%. Programs with residents with disabilities reported more hours devoted to disability curricula (5 hours vs 1.54hours, p=0.017) and increased confidence in providing workplace accommodations for certain disabilities including mobility disability (p=0.002), chronic health conditions (p=0.022), and psychological disabilities (p=0.018).Conclusions: A minority of EM PDs in our study included disability health content in their residency curricula. The presence of faculty and residents with disabilities is associated with positive effects on training programs, including a greater number of hours devoted to disability health education and greater confidence in accommodating learners with disabilities. To reduce health care disparities for patients with disabilities, we recommend that a dedicated disability health curriculum be integrated into all aspects of the EM residency curriculum, including lectures, journal clubs, and simulations and include direct interaction with individuals with disabilities. We further recommend that disability be recognized as an aspect of diversity when hiring faculty and recruiting residents to EM programs, to address this training gap and to promote a diverse and inclusive learning environment.

  View details for DOI 10.1002/aet2.10511

  View details for PubMedID 33898914

• Words Matter: An Antibias Workshop for Health Care Professionals to Reduce Stigmatizing Language. MedEdPORTAL : the journal of teaching and learning resources Raney, J., Pal, R., Lee, T., Saenz, S. R., Bhushan, D., Leahy, P., Johnson, C., Kapphahn, C., Gisondi, M. A., Hoang, K. 2021; 17: 11115

  Abstract

  Introduction: Biased language influences health care providers' perceptions of patients, impacts their clinical care, and prevents vulnerable populations from seeking treatment. Training clinicians to systematically replace biased verbal and written language is an essential step to providing equitable care.Methods: We designed and implemented an interactive workshop to teach health care professionals a framework to identify and replace stigmatizing language in clinical practice. The workshop included a reflective exercise, role-play, brief didactic session, and case-based discussion. We developed the program for a broad target audience of providers and initially delivered it at three academic conferences. We used descriptive statistics to analyze Likert-style items on course evaluations and identified themes in open-text responses.Results: A total of 66 participants completed course evaluations; most believed the workshop met its objectives (4.8 out of 5.0) and strongly agreed that they would apply skills learned (4.8). Participants planned to incorporate reflection into their verbal and written language. Potential barriers to applying course content included perceived difficulty in changing entrenched practice habits, burnout, and fatigue. Suggestions for improvement included more time for group discussions and strategies to teach skills to colleagues.Discussion: Participants found the course material highly engaging and relevant to their clinical practice. Learners left the workshop feeling motivated to engage in more mindful word choice and to share key concepts with their colleagues.

  View details for DOI 10.15766/mep_2374-8265.11115

  View details for PubMedID 33768147

• Best Practices for Video-Based Branding During Virtual Residency Recruitment. Journal of graduate medical education Brown, C. A., Jewell, C., Haidar, D. A., Forcade, Z., Schnapp, B. H., Haas, M. R., Hopson, L. R., Gisondi, M. 2021; 13 (1): 6-10

  View details for DOI 10.4300/JGME-D-20-00750.1

  View details for PubMedID 33680291

• Mastery learning improves simulated central venous catheter insertion by emergency medicine teaching faculty Academic Emergency Medicine Education & Training Pokrajac, N., Schertzer, K., Rosczcnyialski, K. N., Rider, A., Williams, S. R., Poffenberger, C. M., Gisondi, M. A. 2021

  View details for DOI 10.1002/aet2.10703

• Teaching medical students about the impacts of climate change on human health The Journal of Climate Change and Health Gomez, J., Goshua, A., Pokrajac, N., Erny, B., Auerbach, P., Nadeau, K., Gisondi, M. A. 2021; 3

  View details for DOI 10.1016/j.joclim.2021.100020

• Peer Teaching by Stanford Medical Students in a Sexual and Gender Minority Health Education Program. Medical science educator Gomez, J., Gisondi, M. A. 2020; 30 (4): 1731-1733

  Abstract

  Medical school curricula devote few instructional hours to LGBTQ-inclusive content. Innovative approaches are required to prepare students to care for sexual and gender minority patients. We describe a student-led program at Stanford School of Medicine in which peer educators are trained to teach about sexual and gender minority health issues.

  View details for DOI 10.1007/s40670-020-01056-2

  View details for PubMedID 34457837

  View details for PubMedCentralID PMC8368763

• Addressing Climate Change and Its Effects on Human Health: A Call to Action for Medical Schools. Academic medicine : journal of the Association of American Medical Colleges Goshua, A., Gomez, J., Erny, B., Burke, M., Luby, S., Sokolow, S., LaBeaud, A. D., Auerbach, P., Gisondi, M. A., Nadeau, K. 2020

  Abstract

  Human health is increasingly threatened by rapid and widespread changes in the environment and climate, including rising temperatures, air and water pollution, disease vector migration, floods, and droughts. In the United States, many medical schools, the American Medical Association, and the National Academy of Sciences have published calls for physicians and physicians-in-training to develop a basic knowledge of the science of climate change and an awareness of the associated health risks. The authors--all medical students and educators--argue for the expeditious redesign of medical school curricula to teach students to recognize, diagnose, and treat the many health conditions exacerbated by climate change as well as understanding public health issues. In this Invited Commentary, the authors briefly review the health impacts of climate change, examine current climate change course offerings and proposals, and describe the rationale for promptly and comprehensively including climate science education in medical school curricula. Efforts in training physicians now will benefit those physicians' communities, whose health will be impacted by a period of remarkable climate change. The bottom line is that the health effects of climate reality cannot be ignored, and people everywhere must adapt as quickly as possible.

  View details for DOI 10.1097/ACM.0000000000003861

  View details for PubMedID 33239537

• Sex-Based Barriers to the Advancement of Women in Academic Emergency Medicine: A Multi-Institutional Survey Study Graham, E. M., Ferrel, M., Wells, K., Egan, D. J., MacVane, C. Z., Gisondi, M. A., Burns, B. D., Madsen, T. E., Fix, M. L. MOSBY-ELSEVIER. 2020: S131

  View details for Web of Science ID 000582805600335

• Use of an Online Simulation Platform for Diagnostic Assessment of Entrustable Professional Activities during Transition to Residency Peng, C. R., Caretta-Weyer, H., Sebok-Syer, S., Schertzer, K., Gisondi, M. A. MOSBY-ELSEVIER. 2020: S84

  View details for Web of Science ID 000582805600213

• Factors Contributing to the Advancement of Women in Academic Emergency Medicine: A Multi-Institution Survey Study of Resident Physicians Ferrel, M. N., Graham, E. M., Wells, K., Egan, D. J., MacVane, C. Z., Gisondi, M. A., Burns, B. D., Madsen, T. E., Fix, M. L. MOSBY-ELSEVIER. 2020: S47

  View details for Web of Science ID 000582805600117

• Consensus Guidelines for Digital Scholarship in Academic Promotion. The western journal of emergency medicine Husain, A., Repanshek, Z., Singh, M., Ankel, F., Beck-Esmay, J., Cabrera, D., Chan, T. M., Cooney, R., Gisondi, M., Gottlieb, M., Khadpe, J., Repanshek, J., Mason, J., Papanagnou, D., Riddell, J., Trueger, N. S., Zaver, F., Brumfield, E. 2020; 21 (4): 883–91

  Abstract

  INTRODUCTION: As scholarship moves into the digital sphere, applicant and promotion and tenure (P&T) committee members lack formal guidance on evaluating the impact of digital scholarly work. The P&T process requires the appraisal of individual scholarly impact in comparison to scholars across institutions and disciplines. As dissemination methods evolve in the digital era, we must adapt traditional P&T processes to include emerging forms of digital scholarship.METHODS: We conducted a blended, expert consensus procedure using a nominal group process to create a consensus document at the Council of Emergency Medicine Residency Directors Academic Assembly on April 1, 2019.RESULTS: We discussed consensus guidelines for evaluation and promotion of digital scholarship with the intent to develop specific, evidence-supported recommendations to P&T committees and applicants. These recommendations included the following: demonstrate scholarship criteria; provide external evidence of impact; and include digital peer-review roles. As traditional scholarship continues to evolve within the digital realm, academic medicine should adapt how that scholarship is evaluated. P&T committees in academic medicine are at the epicenter for supporting this changing paradigm in scholarship.CONCLUSION: P&T committees can critically appraise the quality and impact of digital scholarship using specific, validated tools. Applicants for appointment and promotion should highlight and prepare their digital scholarship to specifically address quality, impact, breadth, and relevance. It is our goal to provide specific, timely guidance for both stakeholders to recognize the value of digital scholarship in advancing our field.

  View details for DOI 10.5811/westjem.2020.4.46441

  View details for PubMedID 32726260

• Improving Emergency Department Airway Preparedness in the Era of COVID-19: An Interprofessional, In Situ Simulation. Journal of education & teaching in emergency medicine Warner, K. J., Rider, A. C., Marvel, J., Gisondi, M. A., Schertzer, K., Roszczynialski, K. N. 2020; 5 (3): S28-S49

  Abstract

  The target audience for this airway simulation includes all emergency department (ED) staff who are potential members of a COVID-19 intubation team, including emergency medicine attendings, emergency medicine residents, nurses, respiratory therapists, pharmacists, and ED technicians.As of May 7, 2020 there were 1,219,066 diagnosed cases of COVID-19 in the U.S. and 73,297 deaths.1 A special report from the Centers for Disease Control and prevention on infections in healthcare personnel reported 9,282 cases between February 12th and April 9th.2 Sars-CoV-2 is a novel virus that requires a careful, coordinated approach to airway management given the high risk of aerosolization.3 It is essential to train ED staff (1) to appropriately care for patients with suspected COVID-19 disease and (2) to provide an organized, safe working environment for providers during high-risk, aerosolizing procedures such as intubation. In addition to providing a set of airway management guidelines, we aimed to educate the staff through participation in a simulation activity. Due to the multiple team members involved and the array of equipment needed, an in-person in situ strategy was implemented. The goals of the simulation were to optimize patient care and minimize viral exposure to those involved during intubation.At the conclusion of the simulation session, learners will be able to: 1) Understand the need to notify team members of a planned COVID intubation including: physician, respiratory therapist, pharmacist, nurse(s), and ED technician. 2) Distinguish between in-room and out-of-room personnel during high-risk aerosolizing procedures. 3) Distinguish between in-room and out-of-room equipment during high-risk aerosolizing procedures to minimize contamination. 4) Appropriately select oxygenation therapies and avoid high-risk aerosolizing procedures. 5) Manage high risk scenarios such as hypotension or failed intubation and be prepared to give push-dose vasoactive medications or place a rescue device such as an I-gel ®.This is a high-fidelity, interprofessional, in-situ simulation used to train a team of providers that would normally participate in the management of a patient with suspected COVID-19 requiring endotracheal intubation. Participants might include emergency medicine attendings, emergency medicine residents, nurses, respiratory therapists, pharmacists, and ED technicians. The patient is best represented by a high-fidelity mannequin such as Trauma HAL® (Miami, FL USA) https://www.gaumard.com/products/trauma/trauma-halr), with a monitor displaying vital signs and voice-response capabilities. The simulation includes an interprofessional debriefing session, during which an airway checklist, communication strategies, and best practices are reviewed.Airway management guidelines were developed by an interdisciplinary team at our institution. We used these guidelines from Stanford Health Care and best practices from a literature review to create a checklist of recommended steps. Two assessors used the checklist to track team actions. Any missed items were discussed in the team debrief and participants were encouraged to ask questions. At the end of the session, to check for understanding, participants were provided with a brief anonymous online survey accessed by a QR code. These assessments allowed the simulation team to iteratively edit the case before future simulations.From 3/23/20-4/23/20, we held 12 in-situ simulations with 62 participants, including emergency medicine physicians, nurses, technicians, respiratory therapists, and pharmacists. Two individuals observed each simulation and compared team performance to the checklist of recommended steps. The actions that were not completed during the simulation served as teaching points during the simulation debrief. The debrief discussions helped to identify misconceptions regarding oxygenation strategies, difficulties in staff communication due to physical barriers, and various other quality or safety concerns. Participant reactions following the simulation and debriefs were overwhelmingly positive.This simulation was an effective, easy-to-implement method of interprofessional team training for a risk-inherent procedure in the ED. We learned that the deliberate simulation of each step of the COVID19-specific intubation procedure with all team members provided opportunities to identify safety challenges in communication, equipment, and approach. Each debrief stimulated an excellent discussion among team members, and allowed for interprofessional feedback, clarification of questions, and recommendations for areas of improvement. Our main take-away from the pilot of this novel simulation case is that new, high-risk procedures require a coordinated team effort to minimize risks to patients and staff, and that team training is feasible and effective using frequent in situ simulations.Medical simulation, in-situ simulation, interprofessional, COVID-19, novel coronavirus, SARS-CoV-2, intubation, medical education, health professions education, team training, airway management.

  View details for DOI 10.21980/J8V06M

  View details for PubMedID 37465216

  View details for PubMedCentralID PMC10332557

• Medical Student Pride Alliance: The first national LGBTQ+ medical student affinity organisation. Medical education Goetz, T. G., Zucker, S., Keyes, T., Gisondi, M. 2020; 54 (5): 471-472

  View details for DOI 10.1111/medu.14112

  View details for PubMedID 32242963

• Transforming didactic conferences with live technology-facilitated crowdsourcing MEDICAL EDUCATION Regan, L., Hopson, L. R., Branzetti, J., Gisondi, M. A. 2020; 54 (5): 484-485

  View details for DOI 10.1111/medu.14123

  View details for Web of Science ID 000528706500054

  View details for PubMedID 32180245

• Development of a 3D printed simulator for closed reduction of distal radius fractures. Perspectives on medical education Dixon, W. n., Miller, N. n., Toal, G. G., Sebok-Syer, S. S., Gisondi, M. A. 2020

  Abstract

  The use of simulators in medical education is critical for developing procedural competence prior to treating patients. Current training of emergency physicians to perform distal radius fracture reduction is inconsistent and inadequate.We developed a 3D printed distal radius fracture simulation training model that is easy to assemble and relatively inexpensive. We present step-by-step instructions to reproduce the model.The model was found to have high fidelity for training by both instructors and participants in a simulation-based mastery learning course.We successfully designed a low cost, easy to reproduce, high fidelity model for use in a simulation-based mastery learning course to teach distal radius fracture reduction.

  View details for DOI 10.1007/s40037-020-00609-w

  View details for PubMedID 32989709

• Improving Emergency Department Airway Preparedness in the Era of COVID-19: An Interprofessional, In Situ Simulation. Journal of Education and Teaching in Emergency Medicine Warner, K. J. 2020; 5 (3)

  View details for DOI 10.21980/J8V06M

• Physicians in Myanmar Provide Palliative Care Despite Limited Training and Low Confidence in Their Abilities. Palliative medicine reports Earl-Royal, E., Feltes, M., Gisondi, M. A., Matheson, L., Htoo, M. O., Walker, R. 2020; 1 (1): 314-320

  Abstract

  Background: Patients in low-income and middle-income countries (LMICs) have limited access to palliative care providers. In Myanmar, little is known about physician knowledge of or perceptions about palliative care. An assessment of physician practice and capacity to provide palliative care is needed. Objective: Our objective was to identify physician practice patterns, knowledge gaps, and confidence in providing palliative and end-of-life care in Myanmar. Design: This was a cross-sectional survey study. Setting/Subjects: Participants were physicians practicing in Myanmar who attended the Myanmar Emergency Medicine Updates Symposium on November 10 to 11, 2018 in Yangon, Myanmar (n=89). Measurements: The survey used modified Likert scales to explore four aspects of palliative care practice and training: frequency of patient encounters, confidence in skills, previous training, and perceived importance of formal training. Results: Study participants were young (median age 27 years old); 89% cared for terminally ill patients monthly, yet 94% reported less than two weeks of training in common palliative care domains. Lack of training significantly correlated with lack of confidence in providing care. Priorities for improving palliative care services in Myanmar include better provider training and medication access. Conclusions: Despite limited training and low confidence in providing palliative care, physicians in Myanmar are treating patients with palliative needs on a monthly basis. Future palliative care education and advocacy in Myanmar and other LMICs could focus on physician training to improve end-of-life care, increase physician confidence, and reduce barriers to medication access.

  View details for DOI 10.1089/pmr.2020.0090

  View details for PubMedID 34223491

• Peer Teaching by Stanford Medical Students in a Sexual and Gender Minority Health Education Program Medical Science Educator Gomez, J., Gisondi, M. A. 2020: 3

  View details for DOI 10.1007/s40670-020-01056-2

• Patient Age, Race and Emergency Department Treatment Area Associated with "Topbox" Press Ganey Scores. The western journal of emergency medicine Lee, M. O., Altamirano, J. n., Garcia, L. C., Gisondi, M. A., Wang, N. E., Lippert, S. n., Maldonado, Y. n., Gharahbaghian, L. n., Ribeira, R. n., Fassiotto, M. n. 2020; 21 (6): 117–24

  Abstract

  Hospitals commonly use Press Ganey (PG) patient satisfaction surveys for benchmarking physician performance. PG scores range from 1 to 5, with 5 being the highest, which is known as the "topbox" score. Our objective was to identify patient and physician factors associated with topbox PG scores in the emergency department (ED).We looked at PG surveys from January 2015-December 2017 at an academic, urban hospital with 78,000 ED visits each year. Outcomes were topbox scores for the questions: "Likelihood of your recommending our ED to others"; and "Courtesy of the doctor." We analyzed topbox scores using generalized estimating equation models clustered by physician and adjusted for patient and physician factors. Patient factors included age, gender, race, ethnicity, and ED area where patient was seen. The ED has four areas based on patient acuity: emergent; urgent; vertical (urgent but able to sit in a recliner rather than a gurney); and fast track (non-urgent). Physician factors included age, gender, race, ethnicity, and number of years at current institution.We analyzed a total of 3,038 surveys. For "Likelihood of your recommending our ED to others," topbox scores were more likely with increasing patient age (odds ratio [OR] 1.07; 95% confidence interval [CI], 1.03-1.12); less likely among female compared to male patients (OR 0.81; 95% CI, 0.70-0.93); less likely among Asian compared to White patients (OR 0.71; 95% CI, 0.60-0.83); and less likely in the urgent (OR 0.71; 95% CI, 0.54-0.93) and vertical areas (OR 0.71; 95% CI 0.53-0.95) compared to fast track. For "Courtesy of the doctor," topbox scores were more likely with increasing patient age (OR 1.1; CI, 1.06-1.14); less likely among Asian (OR 0.70; 95% CI, 0.58-0.84), Black (OR 0.66; 95% CI, 0.45-0.96), and Hispanic patients (OR 0.68; 95% CI, 0.55-0.83) compared to White patients; and less likely in urgent area (OR 0.69; 95% CI, 0.50-0.95) compared to fast track.Increasing patient age was associated with increased likelihood of topbox scores, while Asian patients, and urgent and vertical areas had decreased likelihood of topbox scores. We encourage hospitals that use PG topbox scores as financial incentives to understand the contribution of non-service factors to these scores.

  View details for DOI 10.5811/westjem.2020.8.47277

  View details for PubMedID 33207156

• Simulation-Based Mastery Learning to Teach Distal Radius Fracture Reduction. Simulation in healthcare : journal of the Society for Simulation in Healthcare Toal, G. G., Gisondi, M. A., Miller, N. M., Sebok-Syer, S. S., Avedian, R. S., Dixon, W. W. 2020; Publish Ahead of Print

  Abstract

  Distal radius fractures are common orthopedic injuries managed in emergency departments. Simulation-based mastery learning is widely recognized to improve provider competence for bedside procedures but has not been studied to teach fracture management. This study evaluated the effectiveness of a simulation-based mastery learning curriculum to teach distal radius fracture reduction to novice orthopedic surgery and emergency medicine residents.We created a novel mastery learning checklist using the Mastery Angoff method of standard setting, paired with a new simulation model designed for this project, to teach orthopedic surgery and emergency medicine interns (N = 22) at the study site. Orthopedic surgery and emergency medicine faculty members participated in checklist development, curriculum design, and implementation. Training included just-in-time asynchronous education with a readiness assessment test, in-classroom expert demonstration, and deliberate practice with feedback. Residents completed a pretest/posttest skills examination and a presurvey/postsurvey assessing procedural confidence.Standard setting resulted in a 41-item checklist with minimum passing score of 37/41 items. All participants met or surpassed the minimum passing score on postexamination. Postsurvey confidence levels were significantly higher than presurvey in all aspects of the distal radius fracture procedure (P < 0.05).This study demonstrated that a simulation-based mastery learning curriculum improved skills and confidence performing distal radius fracture reductions for orthopedic surgery and emergency medicine interns. Future planned studies include curriculum testing across additional institutions, examination of clinical impact, and application of mastery learning for other orthopedic procedures.

  View details for DOI 10.1097/SIH.0000000000000534

  View details for PubMedID 33337726

• To Do, This: On Physician Training During COVID-19. AEM education and training Gisondi, M. A. 2020; 4 (4): 463

  View details for DOI 10.1002/aet2.10492

  View details for PubMedID 33150295

  View details for PubMedCentralID PMC7592821

• The Vice Chair of Education in Emergency Medicine: A Workforce Study to Establish the Role, Clarify Responsibilities, and Plan for Success. AEM education and training Papanagnou, D. n., Messman, A. M., Branzetti, J. n., Diemer, G. n., Hobgood, C. n., Hopson, L. R., Regan, L. n., Zhang, X. C., Gisondi, M. A. 2020; 4 (Suppl 1): S5–S12

  Abstract

  Despite increasing prevalence in emergency medicine (EM), the vice chair of education (VCE) role remains ambiguous with regard to associated responsibilities and expectations. This study aimed to identify training experiences of current VCEs, clarify responsibilities, review career paths, and gather data to inform a unified job description.A 40-item, anonymous survey was electronically sent to EM VCEs. VCEs were identified through EM chairs, residency program directors, and residency coordinators through solicitation e-mails distributed through respective listservs. Quantitative data are reported as percentages with 95% confidence intervals and continuous variables as medians with interquartiles (IQRs). Open- and axial-coding methods were used to organize qualitative data into thematic categories.Forty-seven of 59 VCEs completed the survey (79.6% response rate); 74.4% were male and 89.3% were white. Average time in the role was 3.56 years (median = 3.0 years, IQR = 4.0 years), with 74.5% serving as inaugural VCE. Many respondents held at least one additional administrative title. Most had no defined job description (68.9%) and reported no defined metrics of success (88.6%). Almost 78% received a reduction in clinical duties, with an average reduction of 27.7% protected time effort (median = 27.2%, IQR = 22.5%). Responsibilities thematically link to faculty affairs and promotion of the departmental educational mission and scholarship.Given the variability in expectations observed, the authors suggest the adoption of a unified VCE job description with detailed responsibilities and performance metrics to ensure success in the role. Efforts to improve the diversity of VCEs are encouraged to better match the diversity of learners.

  View details for DOI 10.1002/aet2.10407

  View details for PubMedID 32072103

  View details for PubMedCentralID PMC7011427

• 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

• Aiming Beyond Competent: The Application of the Taxonomy of Significant Learning to Medical Education TEACHING AND LEARNING IN MEDICINE Branzetti, J., Gisondi, M. A., Hopson, L. R., Regan, L. 2019; 31 (4): 466–78

  View details for DOI 10.1080/10401334.2018.1561368

  View details for Web of Science ID 000477726400010

• Learning to learn: A qualitative study to uncover strategies used by Master Adaptive Learners in the planning of learning. Medical teacher Regan, L., Hopson, L. R., Gisondi, M. A., Branzetti, J. 2019: 1–11

  Abstract

  Background: The ability to adapt expertise to both routine and uncommon situations, termed adaptive expertise, has been suggested as a necessary skill for physicians. The Master Adaptive Learner (MAL) framework proposes four phases necessary to develop adaptive expertise. The first phase, "planning" for learning, includes three stages: identification of gaps, prioritization of gaps, and identification of learning resources. This study explored key strategies used by MALs in "planning" for learning. Methods: Focus groups were used to identify strategies that successful postgraduate trainees use to plan learning. Researchers analyzed transcripts using constant comparison analysis and grounded theory to guide the generation of themes. Results: 38 participants, representing 14 specialties, participated in 7 focus groups. Six key strategies used in the "planning" phase of learning were found. During gap identification, they used performance-driven gap identification and community-driven gap identification. To prioritize gaps, they used the schema of triage and adequacy. To identify resources they used intentional adaptation and weighted curation. Barriers such as lack of time and inexperience were noted. Conclusions: MALs use six strategies to plan learning, using patients, health-care team roles, and clinical questions to guide them. Understanding these strategies can help educators design learning opportunities and overcome barriers.

  View details for DOI 10.1080/0142159X.2019.1630729

  View details for PubMedID 31287741

• Comparison of the Standardized Video Interview and Interview Assessments of Professionalism and Interpersonal Communication Skills in Emergency Medicine. AEM education and training Hopson, L. R., Dorfsman, M. L., Branzetti, J., Gisondi, M. A., Hart, D., Jordan, J., Cranford, J. A., Williams, S. R., Regan, L. 2019; 3 (3): 259–68

  Abstract

  Objectives: The Association of American Medical Colleges Standardized Video Interview (SVI) was recently added as a component of emergency medicine (EM) residency applications to provide additional information about interpersonal communication skills (ICS) and knowledge of professionalism (PROF) behaviors. Our objective was to ascertain the correlation between the SVI and residency interviewer assessments of PROF and ICS. Secondary objectives included examination of 1) inter- and intrainstitutional assessments of ICS and PROF, 2) correlation of SVI scores with rank order list (ROL) positions, and 3) the potential influence of gender on interview day assessments.Methods: We conducted an observational study using prospectively collected data from seven EM residency programs during 2017 and 2018 using a standardized instrument. Correlations between interview day PROF/ICS scores and the SVI were tested. A one-way analysis of variance was used to analyze the association of SVI and ROL position. Gender differences were assessed with independent-groups t-tests.Results: A total of 1,264 interview-day encounters from 773 unique applicants resulted in 4,854 interviews conducted by 151 interviewers. Both PROF and ICS demonstrated a small positive correlation with the SVI score (r=0.16 and r=0.17, respectively). ROL position was associated with SVI score (p<0.001), with mean SVI scores for top-, middle-, and bottom-third applicants being 20.9, 20.5, and 19.8, respectively. No group differences with gender were identified on assessments of PROF or ICS.Conclusions: Interview assessments of PROF and ICS have a small, positive correlation with SVI scores. These residency selection tools may be measuring related, but not redundant, applicant characteristics. We did not identify gender differences in interview assessments.

  View details for DOI 10.1002/aet2.10346

  View details for PubMedID 31360819

• The Birth of a Return to work Policy for New Resident Parents in Emergency Medicine ACADEMIC EMERGENCY MEDICINE Gordon, A., Sebok-Syer, S. S., Dohn, A. M., Smith-Coggins, R., Wang, N., Williams, S. R., Gisondi, M. A. 2019; 26 (3): 317–26

  View details for DOI 10.1111/acem.13684

  View details for Web of Science ID 000461220000006

• Aiming Beyond Competent: The Application of the Taxonomy of Significant Learning to Medical Education. Teaching and learning in medicine Branzetti, J., Gisondi, M. A., Hopson, L. R., Regan, L. 2019: 1–13

  Abstract

  ISSUE: Competency-Based Medical Education (CBME) focuses on demonstrable outcomes, as well as upholding medical education's accountability to society. Despite calls for a robust, multifaceted approach to competency-based assessment (CBA), lingering critiques exist. These critiques include reductionism, reinforcement of an external locus of control within learners, an loss of focus on learner development. Both CBME and CBA may be strengthened if viewed through the lens of a complementary curriculum design framework that broadens the focus on the learner.EVIDENCE: Researchers and physician organizations have articulated the need for medical practitioners trained to provide optimal care in the rapidly changing care environment. In the drive to ensure accountability to patients and society, CBME may overlook the duty of educators to foster the necessary intrinsic development of learners as holistic professionals. The focus of CBA on outcomes may reward memorization and rote performance but may fail to ensure the underlying comprehension or critical thinking necessary to adapt to the variability of real-life patient care. Learners focus on tasks chosen for assessment; thus, areas less easily assessed may be overlooked or deemed unimportant. Reinforcement for learner motivation becomes externalized in CBA, as opposed to being driven by the desire for self-improvement and self-actualization. A recently proposed framework that views learner development as a process-based improvement cycle, the "Master Adaptive Learner," may help remedy this issue. L. Dee Fink's Taxonomy of Significant Learning aims to create meaningful learning experiences in higher education. This taxonomy consists of six interwoven domains: (a) Learning How to Learn, (b) Foundational Knowledge, (c) Application, (d) Integration, (e) Human Dimension, and (f) Caring. Each domain encompasses a unique perspective on the learning process, and when collectively applied to curriculum design, significant learning occurs. This taxonomy has not been widely applied to medical education but may offer an important counterbalance to the outcomes-based focus of CBME.IMPLICATIONS: The outcomes-based focus of CBME is well suited for skill-based tasks, such as procedures, that are observable and measurable. However, other essential physician skills-such as critical thinking, reflection, empathy, and self-directed learning-are not easily assessed, and thus may receive little focus in an outcomes-based model. A holistic approach, such as the Taxonomy of Significant Learning, can counter the deficits of CBME and provide a balanced approach to education program design and assessment.

  View details for PubMedID 30686049

• The Birth of a Return to Work Policy for New Resident Parents in Emergency Medicine. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine Gordon, A. J., Sebok-Syer, S., Dohn, A. M., Smith-Coggins, R., Wang, N. E., Williams, S. R., Gisondi, M. A. 2019

  Abstract

  OBJECTIVE: With the rising number of female physicians, there will be more children than ever born in residency and the current system is inadequate to handle this increase in new resident parents. Residency is stressful and rigorous in isolation, let alone when pregnant or with a new child. Policies that ease these stressful transitions are generally either insufficient or do not exist. Therefore, we created a comprehensive Return to Work Policy for resident parents and piloted its implementation. Our policy aims to: 1) establish a clear, shared understanding of the regulatory and training requirements as they pertain to parental leave, 2) facilitate a smooth transition for new parents returning back to work, and 3) summarize the local and institutional resources available for both males and females during residency training.METHOD: In Fall 2017, a task force was convened to draft a Return to Work Policy for New Resident Parents. The task force included 9 key stakeholders (i.e., residents, faculty, and administration) at our institution and was made up of 3 Graduate Medical Education (GME) Program Directors, a Vice Chair of Education, a Designated Institutional Official (DIO), a Chief Resident, and 3 members of our academic department's Faculty Affairs Committee. The task force was selected because of individual expertise in gender equity issues, mentorship of resident parents, GME, and departmental administration.RESULTS: After development, the policy was piloted from November 2017 to June 2018. Our pilot implementation period included 7 new resident parents. All of these residents received schedules that met the return to work scheduling terms of our Return to Work Policy including no overnight shifts, no sick call, no more than 3 shifts in a row. Of equal importance, throughout our pilot, the emergency department schedules at all of our clinical sites remained fully staffed and our sick call pool was unaffected.CONCLUSION: Our Return to Work Policy for New Resident Parents provides a comprehensive guide to training requirements and family leave policies, an overview of available resources, and a scheduling framework that makes for a smooth transition back to clinical duties. This article is protected by copyright. All rights reserved.

  View details for PubMedID 30636353

• Design Your Clinical Workplace to Facilitate Competency-Based Education. The western journal of emergency medicine Caretta-Weyer, H. A., Gisondi, M. A. 2019; 20 (4): 651–53

  View details for DOI 10.5811/westjem.2019.4.43216

  View details for PubMedID 31316706

  View details for PubMedCentralID PMC6625682

• The AAMC Standardized Video Interview and the Electronic Standardized Letter of Evaluation in Emergency Medicine: A Comparison of Performance Characteristics. Academic medicine : journal of the Association of American Medical Colleges Hopson, L. R., Regan, L. n., Bond, M. C., Branzetti, J. n., Samuels, E. A., Naemi, B. n., Dunleavy, D. n., Gisondi, M. A. 2019

  Abstract

  To compare the performance characteristics of the Electronic Standardized Letter of Evaluation (eSLOE), a widely used structured assessment of emergency medicine (EM) residency applicants, and the AAMC Standardized Video Interview (SVI), a new tool designed by the Association of American Medical Colleges to assess interpersonal and communication skills and professionalism knowledge.The authors matched EM residency applicants with valid SVI total scores and completed eSLOEs in the 2018 Match application cycle. They examined correlations and group differences for both tools, United States Medical Licensing Examination (USMLE) Step exam scores, and honor society memberships.The matched sample included 2,884 applicants. SVI score and eSLOE global assessment ratings demonstrated small positive correlations approaching r = 0.20. eSLOE ratings had higher correlations with measures of academic ability (USMLE scores, academic honor society membership) than did SVI scores. Group differences were minimal for the SVI, with scores slightly favoring women (d = -.21) and U.S.-MD applicants (d = .23-.42). Group differences in eSLOE ratings were small, favoring women over men (approaching d = -0.20) and white applicants over black applicants (approaching d = 0.40).Small positive correlations between SVI total score and eSLOE global assessment ratings, alongside varying correlations with academic ability indicators, suggest these are complementary tools. Findings suggest the eSLOE is subject to similar sources and degrees of bias as other common assessments; these group differences were not observed with the SVI. Further examination of both tools is necessary to understand their ability to predict clinical performance.

  View details for DOI 10.1097/ACM.0000000000002889

  View details for PubMedID 31335814

• A Multicenter Collaboration for Simulation-Based Assessment of ACGME Milestones in Emergency Medicine SIMULATION IN HEALTHCARE-JOURNAL OF THE SOCIETY FOR SIMULATION IN HEALTHCARE Salzman, D. H., Watts, H., Williamson, K., Sergel, M., Dobiesz, V., DeGarmo, N., Vora, S., Sharp, L. J., Wang, E. E., Gisondi, M. A. 2018; 13 (5): 348–55

  View details for DOI 10.1097/SIH.0000000000000291

  View details for Web of Science ID 000447177200007

• In Reply to Walls and Gingles. Academic medicine : journal of the Association of American Medical Colleges Gisondi, M. A., Regan, L., Branzetti, J., Hopson, L. R. 2018; 93 (9): 1266

  View details for PubMedID 30153164

• Online Mastermind Groups: A Non-hierarchical Mentorship Model for Professional Development. Cureus Paetow, G., Zaver, F., Gottlieb, M., Chan, T. M., Lin, M., Gisondi, M. A. 2018; 10 (7): e3013

  Abstract

  Mentorship is an important driver of professional development and scholarship in academic medicine. Several mentorship models have been described in the medical education literature, with the majority featuring a hierarchical relationship between senior and junior members of an institution. 'Mastermind Groups', popularized in the business world, offer an alternative model of group mentorship that benefits from the combined intelligence and accumulated experience of the participants involved. We describe an online application of the Mastermind model, used as an opportunity for faculty development by a globally distributed team of health professions educators. The majority of our participants rated their experiences over two online Mastermind group mentoring sessions as 'very valuable', resulting in recommendations of specific developmental resources, professional referrals, and identifiable immediate 'next steps' for their careers. Our experience suggests that online Mastermind groups are an effective, feasible, zero-cost model for group mentorship and professional development in medicine.

  View details for PubMedID 30397564

• Online Mastermind Groups: A Non-hierarchical Mentorship Model for Professional Development CUREUS Paetow, G., Zaver, F., Gottlieb, M., Chan, T. M., Lin, M., Gisondi, M. A. 2018; 10 (7)

  View details for DOI 10.7759/cureus.3013

  View details for Web of Science ID 000450942900111

• Branding and Recruitment: A Primer for Residency Program Leadership. Journal of graduate medical education Shappell, E., Shakeri, N., Fant, A., Branzetti, J., Gisondi, M., Babcock, C., Ahn, J. 2018; 10 (3): 249-252

  View details for DOI 10.4300/JGME-D-17-00602.1

  View details for PubMedID 29946377

• More Learners, Finite Resources, and the Changing Landscape of Procedural Training at the Bedside. Academic medicine : journal of the Association of American Medical Colleges Gisondi, M. A., Regan, L., Branzetti, J., Hopson, L. R. 2018; 93 (5): 699–704

  Abstract

  There is growing competition for nonoperative, procedural training in teaching hospitals, due to an increased number of individuals seeking to learn procedures from a finite number of appropriate teaching cases. Procedural training is required by students, postgraduate learners, and practicing providers who must maintain their skills. These learner groups are growing in size as the number of medical schools increases and advance practice providers expand their skills to include complex procedures. These various learner needs occur against a background of advancing therapeutic techniques that improve patient care but also act to reduce the overall numbers of procedures available to learners. This article is a brief review of these and other challenges that are arising for program directors, medical school leaders, and hospital administrators who must act to ensure that all of their providers acquire and maintain competency in a wide array of procedural skills. The authors conclude their review with several recommendations to better address procedural training in this new era of learner competition. These include a call for innovative clinical rotations deliberately designed to improve procedural training, access to training opportunities at new clinical sites acquired in health system expansions, targeted faculty development for those who teach procedures, reporting of competition for bedside procedures by trainees, more frequent review of resident procedure and case logs, and the creation of an institutional oversight committee for procedural training.

  View details for PubMedID 29166352

• More Learners, Finite Resources, and the Changing Landscape of Procedural Training at the Bedside ACADEMIC MEDICINE Gisondi, M. A., Regan, L., Branzetti, J., Hopson, L. R. 2018; 93 (5): 699–704

  View details for DOI 10.1097/ACM.0000000000002062

  View details for Web of Science ID 000437677300027

• A Multicenter Collaboration for Simulation-Based Assessment of ACGME Milestones in Emergency Medicine. Simulation in healthcare : journal of the Society for Simulation in Healthcare Salzman, D. H., Watts, H., Williamson, K., Sergel, M., Dobiesz, V., DeGarmo, N., Vora, S., Sharp, L. J., Wang, E. E., Gisondi, M. A. 2018

  Abstract

  STATEMENT: In 2014, the six allopathic emergency medicine (EM) residency programs in Chicago established an annual, citywide, simulation-based assessment of all postgraduate year 2 EM residents. The cases and corresponding assessment tools were designed by the simulation directors from each of the participating sites. All assessment tools include critical actions that map directly to numerous EM milestones in 11 different subcompetencies. The 2-hour assessments provide opportunities for residents to lead resuscitations of critically ill patients and demonstrate procedural skills, using mannequins and task trainers respectively. More than 80 residents participate annually and their assessment experiences are essentially identical across testing sites. The assessments are completed electronically and comparative performance data are immediately available to program directors.

  View details for PubMedID 29620703

• Curriculum Design and Implementation of the Emergency Medicine Chief Resident Incubator. Cureus Gisondi, M. A., Chou, A., Joshi, N., Sheehy, M. K., Zaver, F., Chan, T. M., Riddell, J., Sifford, D. P., Lin, M. 2018; 10 (2): e2223

  Abstract

  Background Chief residents receive minimal formal training in preparation for their administrative responsibilities. There is a lack of professional development programs specifically designed for chief residents. Objective In 2015, Academic Life in Emergency Medicine designed and implemented an annual, year-long, training program and virtual community of practice for chief residents in emergency medicine (EM). This study describes the curriculum design process and reports measures of learner engagement during the first two cycles of the curriculum. Methods Kern's Six-Step Approach for curriculum development informed key decisions in the design and implementation of the Chief Resident Incubator. The resultant curriculum was created using constructivist social learning theory, with specific objectives that emphasized the needs for a virtual community of practice, longitudinal content delivery, mentorship for participants, and the facilitation of multicenter digital scholarship. The 12-month curriculum included 11 key administrative or professional development domains, delivered using a combination of digital communications platforms. Primary outcomes measures included markers of learner engagement with the online curriculum, recognized as modified Kirkpatrick Level One outcomes for digital learning. Results An average of 206 chief residents annually enrolled in the first two years of the curriculum, with an overall participation by 33% (75/227) of the allopathic EM residency programs in the United States (U.S.). There was a high level of learner engagement, with an average 13,414 messages posted per year. There were also 42 small group teaching sessions held online, which included 39 faculty and 149 chief residents. The monthly e-newsletter had a 50.7% open rate. Digital scholarship totaled 23 online publications in two years, with 67 chief resident co-authors and 21 faculty co-authors. Conclusions The Chief Resident Incubator is a virtual community of practice that provides longitudinal training and mentorship for EM chief residents. This incubator conceptual framework may be used to design similar professional development curricula across various health professions using an online digital platform.

  View details for PubMedID 29696101

• Curriculum Design and Implementation of the Emergency Medicine Chief Resident Incubator CUREUS Gisondi, M. A., Chou, A., Joshi, N., Sheehy, M. K., Zaver, F., Chan, T. M., Riddell, J., Sifford, D. P., Lin, M. 2018; 10 (2)

  View details for DOI 10.7759/cureus.2223

  View details for Web of Science ID 000450936000089

• A Ten-year Program Evaluation of an Emergency Medicine Scholarly Track in Education Using a Qualitative Approach. AEM education and training Schnapp, B. H., Fant, A. L., Gisondi, M. A. 2017; 1 (3): 215–20

  Abstract

  Background: Residency scholarly tracks have allowed training programs to better prepare residents for a future in academia. Despite their success, however, few evaluations of these scholarly tracks have been completed to ensure they are meeting the goals of their stakeholders.Objective: The objective was to evaluate the education scholarly track at Northwestern University Emergency Medicine by querying key stakeholders on the current state of the track and its ideal state.Methods: Current emergency medicine residents, faculty, and track alumni were identified as essential stakeholders. Their perspectives on the track were elicited with a focus group and online survey, respectively, and responses were analyzed using grounded theory.Results: Four distinct themes emerged from the analysis as critical to the track: "education skills and learning theory," "education research methodology," "leadership," and "collaboration."Conclusion: These themes will be used to inform further development of the track. A similar self-reflection process may benefit other programs with scholarly tracks.

  View details for PubMedID 30051037

• Measuring the Correlation Between Emergency Medicine Resident and Attending Physician Patient Satisfaction Scores Using Press Ganey \ AEM EDUCATION AND TRAINING Lang, S. C., Weygandt, P. L., Darling, T., Gravenor, S., Evans, J. J., Schmidt, M. J., Gisondi, M. A. 2017; 1 (3): 179-184

  View details for DOI 10.1002/aet2.10039

  View details for Web of Science ID 000770011500002

• A Ten-year Program Evaluation of an Emergency Medicine Scholarly Track in Education Using a Qualitative Approach AEM EDUCATION AND TRAINING Schnapp, B. H., Fant, A. L., Gisondi, M. A. 2017; 1 (3): 215-220

  View details for DOI 10.1002/aet2.10040

  View details for Web of Science ID 000770011500007

• Measuring the Correlation Between Emergency Medicine Resident and Attending Physician Patient Satisfaction Scores Using Press Ganey. AEM education and training Lang, S. C., Weygandt, P. L., Darling, T., Gravenor, S., Evans, J. J., Schmidt, M. J., Gisondi, M. A. 2017; 1 (3): 179–84

  Abstract

  Objective: The purpose of this study was to assess the relationship between emergency medicine (EM) resident and attending physician patient satisfaction scores.Methods: We added four resident questions to the standard Press Ganey survey used at a large, urban, university hospital with a PGY-1 to -4 EM residency. The resident questions were identical to the traditional attending questions. Press Ganey distributed the modified survey to a random sample of 30% of discharged patients. We assessed the correlation between resident and attending top-box Press Ganey scores using Pearson's coefficients. Two-tailed two-sample comparisons of proportions were used to compare top-box responses between residents and attendings.Results: From September 1, 2012, to August 31, 2015, a total of 66,216 patients received surveys, and 7,968 responded, resulting in a 12.03% response rate, similar to Press Ganey survey response rate at comparable peer institutions. Patients were able to discriminate between residents and attendings; however, 751 surveys did not contain responses for residents, resulting in a total number of 6,957. All 64 of the EM residents had a minimum of 5 or more surveys returned. There was a high degree of correlation between resident and attending top-box scores with correlation coefficients ranging from 0.75 to 0.80. However, the proportion of top-box scores was consistently higher for residents (p<0.05).Conclusions: There is a high degree of correlation between resident and attending top-box scores on Press Ganey surveys, with residents scoring slightly higher than attendings. The addition of resident questions to the standard Press Ganey survey does not appear to decrease overall attending scores.

  View details for PubMedID 30051032

• A User's Guide to the ALiEM Emergency Medicine Match Advice Web Series WESTERN JOURNAL OF EMERGENCY MEDICINE Gisondi, M. A., Fant, A., Shakeri, N., Schnapp, B. H., Lin, M. 2017; 18 (4): 698–704

  Abstract

  ALiEM EM Match Advice is a web series hosted on the Academic Life in Emergency Medicine website. The intended audience includes senior medical students seeking a residency in emergency medicine (EM) and the faculty members who advise them. Each episode features a panel of three EM program directors who discuss a critical step in the residency application process. This article serves as a user's guide to the series, including a timeline for viewing each episode, brief summaries of the panel discussions, and reflection questions for discussion between students and their faculty advisors.

  View details for PubMedID 28611891

• A Novel Collaboration to Reduce the Travel-Related Cost of Residency Interviewing WESTERN JOURNAL OF EMERGENCY MEDICINE Shappell, E., Fant, A., Schnapp, B., Craig, J. P., Ahn, J., Babcock, C., Gisondi, M. A. 2017; 18 (3): 539–43

  Abstract

  Interviewing for residency is a complicated and often expensive endeavor. Literature has estimated interview costs of $4,000 to $15,000 per applicant, mostly attributable to travel and lodging. The authors sought to reduce these costs and improve the applicant interview experience by coordinating interview dates between two residency programs in Chicago, Illinois.Two emergency medicine residency programs scheduled contiguous interview dates for the 2015-2016 interview season. We used a survey to assess applicant experiences interviewing in Chicago and attitudes regarding coordinated scheduling. Data on utilization of coordinated dates were obtained from interview scheduling software. The target group for this intervention consisted of applicants from medical schools outside Illinois who completed interviews at both programs.Of the 158 applicants invited to both programs, 84 (53%) responded to the survey. Scheduling data were available for all applicants. The total estimated cost savings for target applicants coordinating interview dates was $13,950. The majority of target applicants reported that this intervention increased the ease of scheduling (84%), made them less likely to cancel the interview (82%), and saved them money (71%).Coordinated scheduling of interview dates was associated with significant estimated cost savings and was reviewed favorably by applicants across all measures of experience. Expanding use of this practice geographically and across specialties may further reduce the cost of interviewing for applicants.

  View details for PubMedID 28435508

• TRIAD VIII: Nationwide Multicenter Evaluation to Determine Whether Patient Video Testimonials Can Safely Help Ensure Appropriate Critical Versus End-of-Life Care. Journal of patient safety Mirarchi, F. L., Cooney, T. E., Venkat, A., Wang, D., Pope, T. M., Fant, A. L., Terman, S. A., Klauer, K. M., Williams-Murphy, M., Gisondi, M. A., Clemency, B., Doshi, A. A., Siegel, M., Kraemer, M. S., Aberger, K., Harman, S., Ahuja, N., Carlson, J. N., Milliron, M. L., Hart, K. K., Gilbertson, C. D., Wilson, J. W., Mueller, L., Brown, L., Gordon, B. D. 2017

  Abstract

  End-of-life interventions should be predicated on consensus understanding of patient wishes. Written documents are not always understood; adding a video testimonial/message (VM) might improve clarity. Goals of this study were to (1) determine baseline rates of consensus in assigning code status and resuscitation decisions in critically ill scenarios and (2) determine whether adding a VM increases consensus.We randomly assigned 2 web-based survey links to 1366 faculty and resident physicians at institutions with graduate medical education programs in emergency medicine, family practice, and internal medicine. Each survey asked for code status interpretation of stand-alone Physician Orders for Life-Sustaining Treatment (POLST) and living will (LW) documents in 9 scenarios. Respondents assigned code status and resuscitation decisions to each scenario. For 1 of 2 surveys, a VM was included to help clarify patient wishes.Response rate was 54%, and most were male emergency physicians who lacked formal advanced planning document interpretation training. Consensus was not achievable for stand-alone POLST or LW documents (68%-78% noted "DNR"). Two of 9 scenarios attained consensus for code status (97%-98% responses) and treatment decisions (96%-99%). Adding a VM significantly changed code status responses by 9% to 62% (P ≤ 0.026) in 7 of 9 scenarios with 4 achieving consensus. Resuscitation responses changed by 7% to 57% (P ≤ 0.005) with 4 of 9 achieving consensus with VMs.For most scenarios, consensus was not attained for code status and resuscitation decisions with stand-alone LW and POLST documents. Adding VMs produced significant impacts toward achieving interpretive consensus.

  View details for DOI 10.1097/PTS.0000000000000357

  View details for PubMedID 28198722

• Supplemental Milestones for Emergency Medicine Residency Programs: A Validation Study. The western journal of emergency medicine Ketterer, A. R., Salzman, D. H., Branzetti, J. B., Gisondi, M. A. 2017; 18 (1): 69–75

  Abstract

  INTRODUCTION: Emergency medicine (EM) residency programs may be 36 or 48 months in length. The Residency Review Committee for EM requires that 48-month programs provide educational justification for the additional 12 months. We developed additional milestones that EM training programs might use to assess outcomes in domains that meet this accreditation requirement. This study aims to assess for content validity of these supplemental milestones using a similar methodology to that of the original EM Milestones validation study.METHODS: A panel of EM program directors (PD) and content experts at two institutions identified domains of additional training not covered by the existing EM Milestones. This led to the development of six novel subcompetencies: "Operations and Administration," "Critical Care," "Leadership and Management," "Research," "Teaching and Learning," and "Career Development." Subject-matter experts at other 48-month EM residency programs refined the milestones for these subcompetencies. PDs of all 48-month EM programs were then asked to order the proposed milestones using the Dreyfus model of skill acquisition for each subcompetency. Data analysis mirrored that used in the original EM Milestones validation study, leading to the final version of our supplemental milestones.RESULTS: Twenty of 33 subjects (58.8%) completed the study. No subcompetency or individual milestone met deletion criteria. Of the 97 proposed milestones, 67 (69.1%) required no further editing and remained at the same level as proposed by the study authors. Thirty milestones underwent level changes: 15 (15.5%) were moved one level up and 13 (13.4%) were moved one level down. One milestone (1.0%) in "Leadership and Management" was moved two levels up, and one milestone in "Operations and Administration" was moved two levels down. One milestone in "Research" was ranked by the survey respondents at one level higher than that proposed by the authors; however, this milestone was kept at its original level assignment.CONCLUSION: Six additional subcompetencies were generated and assessed for content validity using the same methodology as was used to validate the current EM Milestones. These optional milestones may serve as an additional set of assessment tools that will allow EM residency programs to report these additional educational outcomes using a familiar milestone rubric.

  View details for PubMedID 28116011

• Workplace Violence and Harassment Against Emergency Medicine Residents WESTERN JOURNAL OF EMERGENCY MEDICINE Schnapp, B. H., Slovis, B. H., Shah, A. D., Fant, A. L., Gisondi, M. A., Shah, K. H., Lech, C. A. 2016; 17 (5): 567–73

  Abstract

  Several studies have shown that workplace violence in the emergency department (ED) is common. Residents may be among the most vulnerable staff, as they have the least experience with these volatile encounters. The goal for this study was to quantify and describe acts of violence against emergency medicine (EM) residents by patients and visitors and to identify perceived barriers to safety.This cross-sectional survey study queried EM residents at multiple New York City hospitals. The primary outcome was the incidence of violence experienced by residents while working in the ED. The secondary outcomes were the subtypes of violence experienced by residents, as well as the perceived barriers to safety while at work.A majority of residents (66%, 78/119) reported experiencing at least one act of physical violence during an ED shift. Nearly all residents (97%, 115/119) experienced verbal harassment, 78% (93/119) had experienced verbal threats, and 52% (62/119) reported sexual harassment. Almost a quarter of residents felt safe "Occasionally," "Seldom" or "Never" while at work. Patient-based factors most commonly cited as contributory to violence included substance use and psychiatric disease.Self-reported violence against EM residents appears to be a significant problem. Incidence of violence and patient risk factors are similar to what has been found previously for other ED staff. Understanding the prevalence of workplace violence as well as the related systems, environmental, and patient-based factors is essential for future prevention efforts.

  View details for PubMedID 27625721

• Program Director Opinion on the Ideal Length of Residency Training in Emergency Medicine ACADEMIC EMERGENCY MEDICINE Hopson, L., Regan, L., Gisondi, M. A., Cranford, J. A., Branzetti, J. 2016; 23 (7): 823–27

  Abstract

  This study sought to define expert opinion on the ideal length of training (LoT) for Accreditation Council of Graduate Medical Education (ACGME)-accredited emergency medicine (EM) residency programs.A cross-sectional Web-based survey was sent to program directors (PDs) at all ACGME-accredited EM residency programs during a study period of August to October 2014. The primary outcome of ideal LoT was determined in two ways: 1) subjects provided the ideal total LoT in months and 2) then separately selected the type and number of rotations for an ideal EM residency curriculum by month, the sum of which provided an alternative measurement of their ideal LoT. We did not include vacation time. Descriptive statistics and an analysis of variance are reported.Response rate was 68.0% (108/159) with 72% of respondents (78/108) directing programs in the PGY 1-3 (36-month) format and 28% directing PGY 1-4 (48-month) programs. More than half of subjects (51.9%) have direct personal experience with both formats. When asked about ideal total LoT, PDs averaged 41.5 months (n = 107; SD = 5.5 months, range = 36-60 months). When asked to provide durations of individual clinical experiences for their ideal EM program, the sum total (n = 104) averaged 45.0 months. Results from a factorial analysis of variance revealed statistically significant effects of PDs' past training experiences: participants who trained in a 36-month program had statistically significantly lower LoT (mean = 39.2 months) than participants who trained in a 48-month program (mean = 44.5 months). There was also a statistically significant effect of current program format on ideal LoT: participants who directed a 36-month program had statistically significantly lower LoT (mean = 39.8 months) than participants who directed a 48-month program (mean = 45.8 months).PD opinion on ideal LoT averages between 36 and 48 months, but is longer when the sum of desired clinical rotations is considered. While half of the respondents reported direct experience with both PGY 1-3 and PGY 1-4 training programs, opinions on ideal LoT through both methods corresponded strongly with the length of the program the PDs trained in and the format of the program they currently direct. PD opinions may be too biased by their own experiences to provide objective input on the ideal LoT for EM residency programs.

  View details for PubMedID 26999762

• Impact of Burnout on Self-Reported Patient Care Among Emergency Physicians WESTERN JOURNAL OF EMERGENCY MEDICINE Lu, D. W., Dresden, S., McCloskey, C., Branzetti, J., Gisondi, M. A. 2015; 16 (7): 996–1001

  Abstract

  Burnout is a syndrome of depersonalization, emotional exhaustion and sense of low personal accomplishment. Emergency physicians (EPs) experience the highest levels of burnout among all physicians. Burnout is associated with greater rates of self-reported suboptimal care among surgeons and internists. The association between burnout and suboptimal care among EPs is unknown. The objective of the study was to evaluate burnout rates among attending and resident EPs and examine their relationship with self-reported patient care practices.In this cross-sectional study burnout was measured at two university-based emergency medicine residency programs with the Maslach Burnout Inventory. We also measured depression, quality of life (QOL) and career satisfaction using validated questionnaires. Six items assessed suboptimal care and the frequency with which they were performed.We included 77 out of 155 (49.7%) responses. The EP burnout rate was 57.1%, with no difference between attending and resident physicians. Residents were more likely to screen positive for depression (47.8% vs 18.5%, p=0.012) and report lower QOL scores (6.7 vs 7.4 out of 10, p=0.036) than attendings. Attendings and residents reported similar rates of career satisfaction (85.2% vs 87.0%, p=0.744). Burnout was associated with a positive screen for depression (38.6% vs 12.1%, p=0.011) and lower career satisfaction (77.3% vs 97.0%, p=0.02). EPs with high burnout were significantly more likely to report performing all six acts of suboptimal care.A majority of EPs demonstrated high burnout. EP burnout was significantly associated with higher frequencies of self-reported suboptimal care. Future efforts to determine if provider burnout is associated with negative changes in actual patient care are necessary.

  View details for PubMedID 26759643

• R & P: The Medical Education Scarlet Letters ACADEMIC EMERGENCY MEDICINE Kuehl, D. R., Gisondi, M. A. 2015; 22 (1): 91–93

  View details for DOI 10.1111/acem.12567

  View details for Web of Science ID 000347447900012

  View details for PubMedID 25565490

• FACULTY PREDICTION OF IN-TRAINING EXAMINATION SCORES OF EMERGENCY MEDICINE RESIDENTS JOURNAL OF EMERGENCY MEDICINE Aldeen, A. Z., Salzman, D. H., Gisondi, M. A., Courtney, D. 2014; 46 (3): 390–94

  Abstract

  The Emergency Medicine In-Training Examination (EMITE) is one of the only valid tools for medical knowledge assessment in current use by emergency medicine (EM) residencies. However, EMITE results return late in the academic year, providing little time to institute potential remediation.The goal of this study was to determine the ability of EM faculty to accurately predict resident EMITE scores prior to results return.We asked EM faculty at the study site to predict the 2012 EMITE scores of the 50 EM residents 2 weeks prior to results being available. The primary outcome was prediction accuracy, defined as the proportion of predictions within 6% of the actual score. The secondary outcome was prediction precision, defined as the mean deviation of predictions from the actual scores. We assessed several faculty background variables, including years of experience, educational leadership status, and clinical hours worked, for correlation with the two outcomes.Thirty-two of the 38 faculty (84.2%, 95% confidence interval [CI] 69.6-92.6) participated in the study, rendering a total of 1600 predictions for 50 residents. Mean resident EMITE score was 81.1% (95% CI 79.5-82.8%). Mean prediction accuracy for all faculty participants was 69% (95% CI 65.9-72.1%). Mean prediction precision was 5.2% (95% CI 4.9-5.5%). Education leadership status was the only background variable correlated with the primary and secondary outcomes (Spearman's ρ = 0.51 and -0.53, respectively).Faculty possess only moderate accuracy at predicting resident EMITE scores. We recommend a multicenter study to evaluate the generalizability of the present results.

  View details for PubMedID 24161228

• Altered Mental Status in a Young, Healthy Female AMERICAN JOURNAL OF THERAPEUTICS Wheaton, N. B., Didwania, A. K., Gisondi, M. A., Pang, P. S. 2013; 20 (5): 558–63

  Abstract

  A young previously healthy patient presented with fever and altered mental status. Her evaluation would eventually reveal a profound hyponatremia in the setting of a viral meningoencephalitis. This case report reviews the evaluation of hyponatremia and treatment options for syndrome of inappropriate antidiuretic hormone hypersecretion, her ultimate diagnosis.

  View details for PubMedID 21822118

• Fibrinolysis and Thrombectomy for Massive Pulmonary Embolus AMERICAN JOURNAL OF THERAPEUTICS Rosiere, L. C., Gisondi, M. A., Courtney, D., Pang, P. S. 2013; 20 (5): 576–80

  Abstract

  Treatment options for massive and submassive pulmonary embolus may include hemodynamic support, fibrinolysis, anticoagulation, and thrombectomy. Selection of the appropriate therapy requires scrutiny of the patient's hemodynamic status, preexisting conditions, risk of complications, and availability of services at the treatment center. This article illustrates a case of successful fibrinolysis and thrombectomy in a woman with massive pulmonary embolus. A discussion of the indications, benefits, and disadvantages of several pharmacologic, radiologic, and surgical interventions considered in pulmonary embolus will follow.

  View details for PubMedID 21317623

• Evaluating Educational Interventions in Emergency Medicine ACADEMIC EMERGENCY MEDICINE Deiorio, N. M., Fitch, M. T., Jung, J., Promes, S. B., Thibodeau, L. G., Woolley, W. L., Gisondi, M. A., Gruppen, L. D. 2012; 19 (12): 1442–53

  Abstract

  This article presents the proceedings of the 2012 Academic Emergency Medicine consensus conference breakout group charged with identifying areas necessary for future research regarding effectiveness of educational interventions for teaching emergency medicine (EM) knowledge, skills, and attitudes outside of the clinical setting. The objective was to summarize both medical and nonmedical education literature and report the consensus formation methods and results. The authors present final statements to guide future research aimed at evaluating the best methods for understanding and developing successful EM curricula using all types of educational interventions.

  View details for PubMedID 23279250

• Palliative Care Symptom Assessment for Patients with Cancer in the Emergency Department: Validation of the Screen for Palliative and End-of-Life Care Needs in the Emergency Department Instrument JOURNAL OF PALLIATIVE MEDICINE Richards, C. T., Gisondi, M. A., Chang, C., Courtney, D., Engel, K. G., Emanuel, L., Quest, T. 2011; 14 (6): 757–64

  Abstract

  We sought to develop and validate a novel palliative medicine needs assessment tool for patients with cancer in the emergency department.An expert panel trained in palliative medicine and emergency medicine reviewed and adapted a general palliative medicine symptom assessment tool, the Needs at the End-of-Life Screening Tool. From this adaptation a new 13-question instrument was derived, collectively referred to as the Screen for Palliative and End-of-life care needs in the Emergency Department (SPEED). A database of 86 validated symptom assessment tools available from the palliative medicine literature, totaling 3011 questions, were then reviewed to identify validated test items most similar to the 13 items of SPEED; a total of 107 related questions from the database were identified. Minor adaptations of questions were made for standardization to a uniform 10-point Likert scale. The 107 items, along with the 13 SPEED items were randomly ordered to create a single survey of 120 items. The 120-item survey was administered by trained staff to all patients with cancer who met inclusion criteria (age over 21 years, English-speaking, capacity to provide informed consent) who presented to a large urban academic emergency department between 8:00 am and 11:00 pm over a 10-week period. Data were analyzed to determine the degree of correlation between SPEED items and the related 107 selected items from previously validated tools.A total of 53 subjects were enrolled, of which 49 (92%) completed the survey in its entirety. Fifty-three percent of subjects were male, age range was 24-88 years, and the most common cancer diagnoses were breast, colon, and lung. Cronbach coefficient α for the SPEED items ranged from 0.716 to 0.991, indicating their high scale reliability. Correlations between the SPEED scales and related assessment tools previously validated in other settings were high and statistically significant.The SPEED instrument demonstrates reliability and validity for screening for palliative care needs of patients with cancer presenting to the emergency department.

  View details for PubMedID 21548790

• Characteristics of Pediatric Trauma Transfers to a Level I Trauma Center: Implications for Developing a Regionalized Pediatric Trauma System in California ACADEMIC EMERGENCY MEDICINE Acosta, C. D., Delgado, M. K., Gisondi, M. A., Raghunathan, A., D'Souza, P. A., Gilbert, G., Spain, D. A., Christensen, P., Wang, N. E. 2010; 17 (12): 1364-1373

  Abstract

  since California lacks a statewide trauma system, there are no uniform interfacility pediatric trauma transfer guidelines across local emergency medical services (EMS) agencies in California. This may result in delays in obtaining optimal care for injured children.this study sought to understand patterns of pediatric trauma patient transfers to the study trauma center as a first step in assessing the quality and efficiency of pediatric transfer within the current trauma system model. Outcome measures included clinical and demographic characteristics, distances traveled, and centers bypassed. The hypothesis was that transferred patients would be more severely injured than directly admitted patients, primary catchment transfers would be few, and out-of-catchment transfers would come from hospitals in close geographic proximity to the study center.this was a retrospective observational analysis of trauma patients ≤ 18 years of age in the institutional trauma database (2000-2007). All patients with a trauma International Classification of Diseases, 9th revision (ICD-9) code and trauma mechanism who were identified as a trauma patient by EMS or emergency physicians were recorded in the trauma database, including those patients who were discharged home. Trauma patients brought directly to the emergency department (ED) and patients transferred from other facilities to the center were compared. A geographic information system (GIS) was used to calculate the straight-line distances from the referring hospitals to the study center and to all closer centers potentially capable of accepting interfacility pediatric trauma transfers.of 2,798 total subjects, 16.2% were transferred from other facilities within California; 69.8% of transfers were from the catchment area, with 23.0% transferred from facilities ≤ 10 miles from the center. This transfer pattern was positively associated with private insurance (risk ratio [RR] = 2.05; p < 0.001) and negatively associated with age 15-18 years (RR = 0.23; p = 0.01) and Injury Severity Score (ISS) > 18 (RR = 0.26; p < 0.01). The out-of-catchment transfers accounted for 30.2% of the patients, and 75.9% of these noncatchment transfers were in closer proximity to another facility potentially capable of accepting pediatric interfacility transfers. The overall median straight-line distance from noncatchment referring hospitals to the study center was 61.2 miles (IQR = 19.0-136.4), compared to 33.6 miles (IQR = 13.9-61.5) to the closest center. Transfer patients were more severely injured than directly admitted patients (p < 0.001). Out-of-catchment transfers were older than catchment patients (p < 0.001); ISS > 18 (RR = 2.06; p < 0.001) and age 15-18 (RR = 1.28; p < 0.001) were predictive of out-of-catchment patients bypassing other pediatric-capable centers. Finally, 23.7% of pediatric trauma transfer requests to the study institution were denied due to lack of bed capacity.from the perspective an adult Level I trauma center with a certified pediatric intensive care unit (PICU), delays in definitive pediatric trauma care appear to be present secondary to initial transport to nontrauma community hospitals within close proximity of a trauma hospital, long transfer distances to accepting facilities, and lack of capacity at the study center. Given the absence of uniform trauma triage and transfer guidelines across state EMS systems, there appears to be a role for quality monitoring and improvement of the current interfacility pediatric trauma transfer system, including defined triage, transfer, and data collection protocols.

  View details for DOI 10.1111/j.1553-2712.2010.00926.x

  View details for PubMedID 21122022

• Examining Emergency Department Communication Through a Staff-Based Participatory Research Method: Identifying Barriers and Solutions to Meaningful Change ANNALS OF EMERGENCY MEDICINE Cameron, K. A., Engel, K. G., McCarthy, D. M., Buckley, B. A., Kollar, L., Donlan, S. M., Pang, P. S., Makoul, G., Tanabe, P., Gisondi, M. A., Adams, J. G. 2010; 56 (6): 614–22

  Abstract

  We test an initiative with the staff-based participatory research (SBPR) method to elicit communication barriers and engage staff in identifying strategies to improve communication within our emergency department (ED).ED staff at an urban hospital with 85,000 ED visits per year participated in a 3.5-hour multidisciplinary workshop. The workshop was offered 6 times and involved: (1) large group discussion to review the importance of communication within the ED and discuss findings from a recent survey of patient perceptions of ED-team communication; (2) small group discussions eliciting staff perceptions of communication barriers and best practices/strategies to address these challenges; and (3) large group discussions sharing and refining emergent themes and suggested strategies. Three coders analyzed summaries from group discussions by using latent content and constant comparative analysis to identify focal themes.A total of 127 staff members, including attending physicians, residents, nurses, ED assistants, and secretaries, participated in the workshop (overall participation rate 59.6%; range 46.7% to 73.3% by staff type). Coders identified a framework of 4 themes describing barriers and proposed interventions: (1) greeting and initial interaction, (2) setting realistic expectations, (3) team communication and respect, and (4) information provision and delivery. The majority of participants (81.4%) reported that their participation would cause them to make changes in their clinical practice.Involving staff in discussing barriers and facilitators to communication within the ED can result in a meaningful process of empowerment, as well as the identification of feasible strategies and solutions at both the individual and system levels.

  View details for PubMedID 20382446

• Adaptation of EPEC-EM (TM) Curriculum in a Residency with Asynchronous Learning WESTERN JOURNAL OF EMERGENCY MEDICINE Gisondi, M. A., Lu, D. W., Yen, M., Norris, R., Courtney, D., Tanabe, P., Engel, K. G., Emanuel, L. L., Quest, T. E. 2010; 11 (5): 491–99

  Abstract

  The Education in Palliative and End-of-life Care for Emergency Medicine Project (EPEC™-EM) is a comprehensive curriculum in palliative and end-of-life care for emergency providers. We assessed the adaptation of this course to an EM residency program using synchronous and asynchronous learning.Curriculum adaptation followed Kern's standardized six-step curriculum design process. Post-graduate year (PGY) 1-4 residents were taught all EPEC™-EM cognitive domains, divided as seven synchronous and seven asynchronous modules. All synchronous modules featured large group didactic lectures and review of EPEC™-EM course materials. Asynchronous modules use only EPEC™-EM electronic course media for resident self-study. Targeted evaluation for EPEC™-EM knowledge objectives was conducted by a prospective case-control crossover study, with synchronous learning serving as the quasi-control, using validated exam tools. We compared de-identified test scores for effectiveness of learning method, using aggregate group performance means for each learning strategy.Of 45 eligible residents 55% participated in a pre-test for local needs analysis, and 78% completed a post-test to measure teaching method effect. Post-test scores improved across all EPEC™-EM domains, with a mean improvement for synchronous modules of +28% (SD=9) and a mean improvement for asynchronous modules of +30% (SD=18). The aggregate mean difference between learning methods was 1.9% (95% CI -15.3, +19.0). Mean test scores of the residents who completed the post-test were: synchronous modules 77% (SD=12); asynchronous modules 83% (SD=13); all modules 80% (SD=12).EPEC™-EM adapted materials can improve resident knowledge of palliative medicine domains, as assessed through validated testing of course objectives. Synchronous and asynchronous learning methods appear to result in similar knowledge transfer, feasibly allowing some course content to be effectively delivered outside of large group lectures.

  View details for PubMedID 21293772

• Scholarly Tracks in Emergency Medicine ACADEMIC EMERGENCY MEDICINE Regan, L., Stahmer, S., Nyce, A., Nelson, B. P., Moscati, R., Gisondi, M. A., Hopson, L. R. 2010; 17 (10): S87–S94

  Abstract

  Over the past decade, some residency programs in emergency medicine (EM) have implemented scholarly tracks into their curricula. The goal of the scholarly track is to identify a niche in which each trainee focuses his or her scholarly work during residency. The object of this paper is to discuss the current use, structure, and success of resident scholarly tracks. A working group of residency program leaders who had implemented scholarly tracks into their residency programs collated their approaches, implementation, and early outcomes through a survey disseminated through the Council of Emergency Medicine Residency Directors (CORD) list-serve. At the 2009 CORD Academic Assembly, a session was held and attended by approximately 80 CORD members where the results were disseminated and discussed. The group examined the literature, discussed the successes and challenges faced during implementation and maintenance of the tracks, and developed a list of recommendations for successful incorporation of the scholarly track structure into a residency program. Our information comes from the experience at eight training programs (five 3-year and three 4-year programs), ranging from 8 to 14 residents per year. Two programs have been working with academic tracks for 8 years. Recommendations included creating clear goals and objectives for each track, matching track topics with faculty expertise, protecting time for both faculty and residents, and providing adequate mentorship for the residents. In summary, scholarly tracks encourage the trainee to develop an academic or clinical niche within EM during residency training. The benefits include increased overall resident satisfaction, increased success at obtaining faculty and fellowship positions after residency, and increased production of scholarly work. We believe that this model will also encourage increased numbers of trainees to choose careers in academic medicine.

  View details for DOI 10.1111/j.1553-2712.2010.00890.x

  View details for Web of Science ID 000282877900016

  View details for PubMedID 21199090

• Curriculum Design of a Case-based Knowledge Translation Shift for Emergency Medicine Residents Friedman, S., Sayers, B., Lazio, M., Friedman, S., Gisondi, M. A. WILEY. 2010: S42–S48

  Abstract

  Principles of evidence-based medicine (EBM) may be inconsistently applied to clinical decision-making due to lack of practice-based training, experience, and time.The authors sought to design, implement, and test the feasibility of an experiential learning model for senior emergency medicine (EM) residents to apply EBM principles during real-time clinical practice.Targeted program evaluation of this learning model was conducted through a prospective observational cohort study involving EM residents at a large, urban, 4-year EM residency program. The curriculum development of a case-based knowledge translation shift followed Kern's six-step design process. Subjects asynchronously completed a 1-hour EBM tutorial and were then assigned to clinical shifts in which they contributed to the care of emergency department (ED) patients by completing formal literature searches related to active management questions. Pre- and post-intervention self-assessments of practice norms and attitudes were used to evaluate the effect of this experiential learning model for individual residents. Self-assessments of the likelihood that the experience would result in future practice change were reported on a five-point Likert scale (1 = greatly impeded, 2 = somewhat impeded, 3 = no change, 4 = somewhat improved, 5 = greatly improved). Subjects presented available evidence to the primary ED team, formally disseminated their findings as a brief "EBM rounds" at sign-out and completed an "EBM consult note" and case log to document shift performance. Changes in patient management and/or disposition were recorded. EBM search questions and resultant findings were entered in a local database.Of the 45 eligible senior EM resident shifts, 91% resulted in complete sets of performance data and self-assessments. A total of 80 patient encounters were documented during 45 scheduled shifts over a 3-month study period. Literature review took a mean (±SD) of 36.2 (±26.4) minutes per case. During the 3-hour interval before or after shift sign-out, residents completed a mean (±SD) of 2.11 (±1.4) literature searches and recorded a mean (±SD) of 3.0 (±1.5) articles for each case. Alterations in ED management for 13 of 80 patient encounters (16.3%) were documented to be the direct result of on-shift literature searches.Case-based knowledge translation shifts for senior EM residents can provide opportunities to practice EBM skills in the ED. This experiential learning model may result in future practice change by resident learners, as well as affect the management of active patients in the ED.

  View details for PubMedID 21199083

• Impact of the Education in Palliative and End-of-Life Care Project on Emergency Medicine Education and Practice Quest, T., Emanuel, L., Gisondi, M., Engel, K., Osgood, K. ELSEVIER SCIENCE INC. 2010: 334–35

  View details for DOI 10.1016/j.jpainsymman.2009.11.247

  View details for Web of Science ID 000279280400044

• CAN EDUCATION AND STAFF-BASED PARTICIPATORY RESEARCH CHANGE NURSING PRACTICE IN AN ERA OF ED OVERCROWDING? A FOCUS GROUP STUDY JOURNAL OF EMERGENCY NURSING Tanabe, P., Gisondi, M. A., Barnard, C., Lucenti, M. J., Cameron, K. A. 2009; 35 (4): 290–98

  Abstract

  In our facility an operational process intervention was implemented to decrease overcrowding. The intervention consisted of implementing criteria (developed from a series of 8 interactive workshops led by the investigators with all charge and staff nurses) describing when we should "close the waiting room." The purpose of this study was to explore the charge nurses' perceptions of the intervention and their experiences with implementation several months after the operational change began.All charge nurses were invited to attend 1 of 2 focus groups that elicited participants' knowledge of the closing criteria as well as their use and perceptions of the criteria. Participants were asked to identify how often they had been able to close the waiting room or keep it closed and to note whether they used the developed criteria. Barriers and facilitators to closing the waiting room were also discussed.Charge nurses had internalized the criteria and reported that most of the time the waiting room was often closed between the hours of 3 and 9 am. Evening charge nurses, in particular, reported feeling a positive impact from waiting room closure during these hours earlier in the day. Facilitators included charge nurses receiving positive feedback from patients and perceiving an improvement in patient safety as fewer patients were waiting. Specific barriers included negative staff attitudes and hospital overcrowding.Feedback from focus group analysis with charge nurses responsible for closing the ED waiting room suggests that the operational change has been positive because of the staff-based participatory research methodology used to create the intervention.

  View details for DOI 10.1016/j.jen.2008.07.013

  View details for Web of Science ID 000268704400008

  View details for PubMedID 19591722

• A Case for Education in Palliative and End-of-life Care in Emergency Medicine ACADEMIC EMERGENCY MEDICINE Gisondi, M. A. 2009; 16 (2): 181–83

  View details for PubMedID 19133843

• Patient perspectives on communication with the medical team: Pilot study using the communication assessment tool-team (CAT-T) PATIENT EDUCATION AND COUNSELING Mercer, L. M., Tanabe, P., Pang, P. S., Gisondi, M. A., Courtney, D. M., Engel, K. G., Donlan, S. M., Adams, J. G., Makoul, G. 2008; 73 (2): 220-223

  Abstract

  Effective communication is an essential aspect of high-quality patient care and a core competency for physicians. To date, assessment of communication skills in team-based settings has not been well established. We sought to tailor a psychometrically validated instrument, the Communication Assessment Tool, for use in Team settings (CAT-T), and test the feasibility of collecting patient perspectives of communication with medical teams in the emergency department (ED).A prospective, cross-sectional study in an academic, tertiary, urban, Level 1 trauma center using the CAT-T, a 15-item instrument. Items were answered via a 5-point scale, with 5 = excellent. All adult ED patients (> or = 18 y/o) were eligible if the following exclusion criteria did not apply: primary psychiatric issues, critically ill, physiologically unstable, non-English speaking, or under arrest.81 patients were enrolled (mean age: 44, S.D. = 17; 44% male). Highest ratings were for treating the patient with respect (69% excellent), paying attention to the patient (69% excellent), and showing care and concern (69% excellent). Lowest ratings were for greeting the patient appropriately (54%), encouraging the patient to ask questions (54%), showing interest in the patient's ideas about his or her health (53% excellent), and involving the patient in decisions as much as he or she wanted (53% excellent).Although this pilot study has several methodological limitations, it demonstrates a signal that patient assessment of communication with the medical team is feasible and offers important feedback. Results indicate the need to improve communication in the ED.In the ED, focusing on the medical team rather then individual caregivers may more accurately reflect patients' experience.

  View details for DOI 10.1016/j.pec.2008.07.003

  View details for PubMedID 18703306

• The Effect of Wait Times and Emergency Department Length of Stay on Patient Perception of Medical Team Communication Donlan, S. M., Venkatesh, A., Pang, P. S., Mercer, L. M., Tanabe, P., Courtney, D., Engel, K., Duval-Arnould, J., Gisondi, M. A., Makoul, G., Adams, J. G. MOSBY-ELSEVIER. 2008: S111-S112

  View details for DOI 10.1016/j.annemergmed.2008.06.243

  View details for Web of Science ID 000259651900225

• Should you close your waiting room? Addressing ED overcrowding through education and staff-based participatory research JOURNAL OF EMERGENCY NURSING Tanabe, P., Gisondi, M. A., Medendorp, S., Engeldinger, L., Graham, L. J., Lucenti, M. J. 2008; 34 (4): 285–89

  Abstract

  The purpose of this project was to develop operational criteria to "close the ED waiting room".A prospective, staff-based participatory research model was used. Nurses at an urban ED with 70,000 visits attended a four-hour workshop concerning ED overcrowding. The workshops consisted of two parts, (1) educational sessions that reviewed key concepts of ED overcrowding, followed by (2) discussions of a proposal to "close the waiting room" as a means to decrease overcrowding. During the discussions, nurses were asked to develop guidelines to safely and consistently "close the waiting room." The investigators defined the waiting room as "closed" when (1) ambulatory patients could be taken directly to a room or hallway space for bedside triage, registration, and initiation of care, or (2) patients were triaged in the waiting room and then taken directly to a care space for registration at the bedside. The primary outcome measure of the project was the development of guidelines to open (use) or close (not use) the ED waiting room.Seventy three of 100 nurses participated in the workshops. ED waiting room closure criteria were developed as 4 "Questions to Guide the Use of the Waiting Room." These dichotomous (yes/no) questions reflected issues of available staff, available care space (traditional ED bed spaces and designated hall spaces), patient acuity, and additional surge capacity.Staff-based participatory research was an effective method to design an operational change. Nurses developed four explicit criteria describing when the waiting room should be closed.

  View details for PubMedID 18640406

• Images in emergency medicine. Ellis III and I tooth fractures. Annals of emergency medicine Louie, A. D., Gisondi, M. A. 2007; 49 (6): e1–2

  View details for PubMedID 17512863

• Characteristics of pediatric patients at risk of poor emergency department aftercare ACADEMIC EMERGENCY MEDICINE Wang, N. E., Kiernan, M., Golzari, M., Gisondi, M. A. 2006; 13 (8): 840-847

  Abstract

  To identify and characterize subgroups of a pediatric population at risk of poor emergency department (ED) aftercare compliance.This was a prospective, cohort study conducted at a university hospital ED with a 2003 pediatric census of 11,040 patients. A convenience sample of 461 children was enrolled. The study follow-up rate was 97%. The primary outcomes were guardian compliance with instructions for physician follow-up appointment and with obtaining prescribed medications. Predictors of compliance outcomes were analyzed by using recursive partitioning to describe population subgroups at risk of poor compliance.Only 60.4% of patient guardians followed up with instructions to see a physician. Children with private insurance were more likely to follow up than were children without private insurance (76.8% vs. 46.5%, p < 0.001). Of children with private insurance, those with high-acuity diagnoses were more likely to follow up than were patients with low-acuity diagnoses (80.0% vs. 38.5%, p < 0.001). Of children who were considered underinsured (defined as publicly insured or uninsured), those with English-speaking guardians were more likely to follow up than were those with non-English-speaking guardians (58.0% vs. 40.0%, p < 0.05). Only 63.3% of patient guardians obtained prescribed medications. Privately insured children were more likely to obtain medications than were underinsured children (71.0% vs. 58.0%, p < 0.05). Descriptive profiles of the subgroups revealed that those with lower socioeconomic status were at greatest risk of poor aftercare compliance.Compliance with ED aftercare instructions remains a challenge. Health insurance disparities are associated with poor ED aftercare compliance in our pediatric population. Interventions aimed at improving compliance could be targeted to specific subgroups on the basis of their descriptive profiles.

  View details for DOI 10.1197/j.aem.2006.04.021

  View details for PubMedID 16880500

• Bedside teaching in the emergency department ACADEMIC EMERGENCY MEDICINE Aldeen, A. Z., Gisondi, M. A. 2006; 13 (8): 860–66

  Abstract

  Bedside teaching is a valuable instructional method that facilitates the development of history and physical examination skills, the modeling of professional behaviors, and the direct observation of learners. The emergency department (ED) is an ideal environment for the practice of bedside teaching, because its high patient volume, increased acuity of illness, and variety of pathology provide plentiful patient-centered teaching opportunities. Unfortunately, the pressures of ED overcrowding at many institutions now limit the available time for formal bedside teaching per patient. This article will discuss the historical decline of bedside teaching on the wards, address obstacles to its use in the ED, and reestablish its specific benefits as a unique educational tool. The authors propose several practical strategies to increase bedside teaching by academic emergency physicians (EPs). These techniques emphasize careful preparation and a focused teaching approach to overcome the inherent challenges of a typically busy ED shift.

  View details for PubMedID 16766739

• Assessment of resident professionalism using high-fidelity simulation of ethical dilemmas Annual Educational Conference of the Accreditation-Council-for-Graduate-Medical-Education Gisondi, M. A., Smith-Coggins, R., Harter, P. M., Soltysik, R. C., Yarnold, P. R. WILEY-BLACKWELL PUBLISHING, INC. 2004: 931–37

  Abstract

  To examine the responses of emergency medicine residents (EMRs) to ethical dilemmas in high-fidelity patient simulations as a means of assessing resident professionalism.This cross-sectional observational study included all EMRs at a three-year training program. Subjects were excluded if they were unable or unwilling to participate. Each resident subject participated in a simulated critical patient encounter during an Emergency Medicine Crisis Resource Management course. An ethical dilemma was introduced before the end of each simulated encounter. Resident responses to that dilemma were compared with a professional performance checklist evaluation. Multi-response permutation procedure analysis was used to compare performance measures between resident classes, with the a priori hypothesis that mean performance should increase as experience increases.Of the 30 potential subjects, 90% (27) participated. The remaining three residents were unavailable due to scheduling conflicts. It was observed that senior residents (second and third year) performed more checklist items than did first-year residents (p < 0.028 for each senior class). Omnibus comparison of mean critical actions completed across all three years was not statistically significant (p < 0.13). Residents performed a critical action with 100% uniformity across training years in only one ethical scenario ("Practicing Procedures on the Recently Dead"). Residents performed the fewest critical actions and overall checklist items for the "Patient Confidentiality" case.Senior residents had better overall performance than incoming interns, suggesting that professional behaviors are learned through some facet of residency training. Although limited by small sample size, the application of this performance-assessment tool showed the ability to discriminate between experienced and inexperienced EMRs with respect to a variety of aspects of professional competency. These findings suggest a need for improved resident education in areas of professionalism and ethics.

  View details for DOI 10.1197/j.aem.2004.04.005

  View details for PubMedID 15347542

• Emergency department orientation utilizing web-based streaming video ACADEMIC EMERGENCY MEDICINE Mahadevan, S. V., Gisondi, M. A., Sovndal, S. S., Gilbert, G. H. 2004; 11 (8): 848-852

  Abstract

  To assure a smooth transition to their new work environment, rotating students and housestaff require detailed orientations to the physical layout and operations of the emergency department. Although such orientations are useful for new staff members, they represent a significant time commitment for the faculty members charged with this task. To address this issue, the authors developed a series of short instructional videos that provide a comprehensive and consistent method of emergency department orientation. The videos are viewed through Web-based streaming technology that allows learners to complete the orientation process from any computer with Internet access before their first shift. This report describes the stepwise process used to produce these videos and discusses the potential benefits of converting to an Internet-based orientation system.

  View details for DOI 10.1197/j.aem.2003.10.032

  View details for PubMedID 15289191

• Socioeconomic disparities are negatively associated with pediatric emergency department aftercare compliance ACADEMIC EMERGENCY MEDICINE Wang, N. E., Gisondi, M. A., Golzari, M., van der Vlugt, T. M., Tuuli, M. 2003; 10 (11): 1278-1284

  Abstract

  This study sought to identify demographic, socioeconomic, and clinical predictors of aftercare noncompliance by pediatric emergency department (ED) patients.The authors conducted a prospective, observational study of pediatric patients presenting to a university teaching hospital ED from July 1, 2002, through August 31, 2002. Demographic and clinical information was obtained from guardians during the ED visit. Guardians were contacted after discharge to determine compliance with ED aftercare instructions. Subjects were excluded if they were admitted or if guardians were unavailable or unwilling to consent. Data were analyzed using multivariable logistic regression to identify predictors of noncompliance from a list of predetermined variables.Of the 409 patients enrolled in the study, 111 were prescribed medications and 364 were given specific follow-up instructions. Subtypes of the variable "insurance status" were significantly associated with medication noncompliance in multivariable regression analysis. "Insurance status" and "low-acuity discharge diagnoses" were significantly associated with follow-up noncompliance.Disparity in health insurance has been shown to be a predictor of poor aftercare compliance for pediatric ED patients within the patient population.

  View details for DOI 10.1197/S1069-6563(03)00499-8

  View details for PubMedID 14597505

• Adverse cardiac events in emergency department patients with chest pain six months after a negative inpatient evaluation for acute coronary syndrome Annual Meeting of the Society-for-Academic-Emergency-Medicine Manini, A. F., Gisondi, M. A., van der Vlugt, T. M., Schreiber, D. H. WILEY-BLACKWELL PUBLISHING, INC. 2002: 896–902

  Abstract

  To evaluate the impact of the diagnostic test setting-inpatient versus outpatient-on adverse cardiac events (ACEs) after six months in emergency department (ED) patients with chest pain who were admitted to the hospital and subsequently had a negative evaluation for acute coronary syndrome (ACS).The authors retrospectively studied a consecutive sample of ED patients with chest pain over a nine-month period. All patients were admitted to the hospital and underwent negative evaluations for ACS, defined as the absence of diagnostic changes on serial electrocardiograms or cardiac markers (creatine kinase-MB and troponin T), and a negative diagnostic cardiac study. Subjects were classified according to cardiac diagnostic study setting-either inpatient or outpatient. Diagnostic testing included exercise treadmill, angiography, stress echocardiography, or stress thallium scans. Acute cardiac events at six months were defined as cardiac death, myocardial infarction, unstable angina, cardiac arrest, or emergent revascularization.The six-month rate of ACEs among 157 subjects was 14%, with 2% cardiac mortality. The outpatient group had higher ACE risk when compared with the inpatient group using multivariate logistic regression, both for the entire cohort (OR 3.5, p < 0.03) and for a subgroup excluding patients with prior coronary artery disease (OR 6.7, p < 0.05). The outpatient group included 19 of 52 (37%) noncompliant subjects who did not receive a diagnostic study.Long-term cardiac morbidity of patients after a negative ACS evaluation may be higher than previously thought. Risk of ACE is significantly higher in subjects scheduled for outpatient diagnostic tests. Inpatient diagnostic testing is justified for subjects at risk for poor compliance.

  View details for Web of Science ID 000177977300004

  View details for PubMedID 12208678

• Post exposure prophylaxis for HIV following possible sexual transmission: An ethical evaluation CAMBRIDGE QUARTERLY OF HEALTHCARE ETHICS Gisondi, M. A. 2000; 9 (3): 411-417

  View details for DOI 10.1017/S0963180100003157

  View details for Web of Science ID 000087317400013

  View details for PubMedID 10858892