Sara Marie Krzyzaniak

All Publications

• Development and Initial Validity Evidence for the EvaLeR Tool: Assessing Quality of Emergency Medicine Educational Resources. AEM education and training Preiksaitis, C., Barber, R., Caretta-Weyer, H., Krzyzaniak, S., Chan, T. M., Gisondi, M. A. 2025; 9 (3): e70063

  Abstract

  Background: Emergency medicine (EM) residents increasingly favor digital educational resources over traditional textbooks, with studies showing over 90% regularly using blogs, podcasts, and other online platforms. No standardized instruments exist to comparatively assess quality across both formats, leading to uncertainty in resource selection and potential inconsistencies in learning. We developed the Evaluation of Learning Resources (EvaLeR) tool and gathered initial validity evidence for its use in assessing both textbooks and digital EM educational resources.Methods: This two-phase mixed-methods study developed the EvaLeR tool and gathered validity evidence for its use. Phase 1 comprised a systematic literature review, quality indicator analysis, and expert consultation. In Phase 2, 34 EM faculty evaluated 20 resources (10 textbook chapters, 10 blog posts) using EvaLeR. We collected evidence for reliability, internal consistency, and relationships with other variables.Results: The EvaLeR tool showed excellent average-measure reliability (Intraclass correlation coefficient=0.97, 95% CI [0.94-0.99]). We found high internal consistency (Cronbach's alpha=0.86) and moderate correlation with educator gestalt ratings (r=0.53, p<0.001). The tool performed similarly across resource types, with no significant differences between textbook chapters (13.34/18, SD 3.41) and digital resources (13.21/18, SD 3.25; p=0.62).Conclusions: Initial validity evidence supports the use of EvaLeR for quality assessment of both textbooks and digital EM educational resources. This tool provides educators with an evidence-based approach to resource selection, moving beyond format-based assumptions to focus on content quality, and represents the first standardized instrument for comparative evaluation across educational resource formats.

  View details for DOI 10.1002/aet2.70063

  View details for PubMedID 40574933

• Gender Representation Among Invited Physician Speakers at National Emergency Medicine Conferences. Annals of emergency medicine Krzyzaniak, S. M., Rider, A., Moran, T. P., Davis, J. J., Gue, S., Bhat, R., Oh, L. 2025

  Abstract

  This study aimed to assess gender representation among speakers invited to give presentations at the 2022 and 2023 annual meetings of the American College of Emergency Physicians (ACEP), Society for Academic Emergency Medicine (SAEM), and the American Academy of Emergency Medicine (AAEM) and identify trends in the representation of women physician speakers.A retrospective analysis was conducted using speaker gender demographics from the 2022 and 2023 ACEP, SAEM, and AAEM conferences. Data were collected from publicly available conference programs, online resources, or the genderize.io tool. Gender representation was evaluated using generalized estimating equations.There were 2,133 physician speakers across all conferences during the 2-year period: 1,077 (50.5%) women, 1,045 (49.0%) men, and 11 (0.5%) nonbinary. There was no statistically significant difference in representation between men and women physician speakers (1.51%, 95% confidence interval -2.64 to 5.75). Gender representation remained stable between 2022 and 2023, with no significant conference-by-year interaction (P=.58).The representation of women physicians among invited speakers at national emergency medicine conferences in 2022 and 2023 was approximately equal to that of men, contrasting with historical trends. Continued efforts to monitor gender representation at conferences are essential for maintaining and advancing this progress. Encouraging speakers to share preferred pronouns is one way organizations can hold themselves accountable in this regard.

  View details for DOI 10.1016/j.annemergmed.2025.04.021

  View details for PubMedID 40448985

• Resident clinical dashboards to support precision education in emergency medicine. AEM education and training Moser, J. S., Genes, N., Hekman, D. J., Krzyzaniak, S. M., Layng, T. A., Miller, D., Rider, A. C., Sagalowsky, S. T., Smith, M. E., Schnapp, B. H. 2025; 9 (Suppl 1): S29-S39

  Abstract

  With the move toward competency-based medical education (CBME), data from the electronic health record (EHR) for informed self-improvement may be valuable as a part of programmatic assessment. Personalized dashboards are one way to view these clinical data. The purpose of this concept paper is to summarize the current state of clinical dashboards as they can be utilized by emergency medicine (EM) residency programs.The author group consisted of EM physicians from multiple institutions with medical education and informatics backgrounds and was identified by querying faculty presenting on resident clinical dashboards at the 2024 Society for Academic Emergency Medicine conference. Additional authors were identified by members of the initial group. Best practice literature was referenced; if none was available, group consensus was used.Clinical exposures as well as efficiency, quality, documentation, and diversity metrics may be included in a resident dashboard. Resident dashboard metrics should focus on resident-sensitive measures rather than those primarily affected by attendings or systems-based factors.Implementation of these dashboards requires the technical expertise to turn EHR data into actionable data, a process called EHR phenotyping. The dashboard can be housed directly in the EHR or on a separate platform. Dashboard developers should consider how their implementation plan will affect how often dashboard data will be refreshed and how to best display the data for ease of understanding.Dashboards can provide objective data to residents, residency leadership and clinical competency committees as they identify areas of strength, growth areas, and set specific and actionable goals. The success of resident dashboards is reliant on resident buy-in and creating a culture of psychological safety through thoughtful implementation, coaching, and regular feedback. .Personalized clinical dashboards can play a crucial role in programmatic assessment within CBME, helping EM residents focus their efforts as they advance and refine their skills during training.

  View details for DOI 10.1002/aet2.70020

  View details for PubMedID 40308868

  View details for PubMedCentralID PMC12038736

• A practical primer on clinical supervision of learners in the emergency department. AEM education and training Krzyzaniak, S. M., Tondt, J., Strokes, N., Hartman, N., Davis, J., Schnapp, B. H. 2025; 9 (Suppl 1): S7-S11

  Abstract

  Effective supervision of learners in the clinical environment is essential for learner professional development and patient safety. Despite this importance, many supervising attendings receive little to no training around supervising learners. As faculty join emergency departments (EDs) at primary and affiliate training sites, it is essential to provide them with a framework to utilize when approaching learner supervision.A workgroup of members from the Society for Academic Emergency Medicine (SAEM) Education Committee was formed to respond to a directive from the SAEM board to identify best practices for new clinician educators when supervising learners. Drawing on their experience and expertise in learner supervision, medical education, and faculty development, the members completed a literature search to identify best practices in supervision, with a special focus on the ED environment.The workgroup identified three domains that must be considered to provide effective supervision to learners: learner characteristics, supervisor characteristics, and clinical environment.Implementing effective supervision in the clinical environment requires a multifaceted approach and consideration of factors for both the learner and the supervisor. Direct observation, supplemented by standardized assessment tools, is the preferred supervision method; however, the demands of our clinical environment may require supervisors to assess the learner's proficiency using other methods including informal knowledge assessments, inference from oral presentations, review of clinical documentation, feedback from patients themselves, procedural walkthroughs, and secondhand information from the health care or training team.

  View details for DOI 10.1002/aet2.70015

  View details for PubMedID 40308865

  View details for PubMedCentralID PMC12038728

• The standardized letter of evaluation (SLOE) in emergency medicine: The internal validity of the SLOE 2.0. AEM education and training Mannix, A., Hegarty, C. B., Bord, S., Beardsley, T., Monteiro, S., Alvarez, A., Davis, T., Gore, K., Parsons, M., Pandey, A., Krzyzaniak, S. M., Gottlieb, M. 2025; 9 (1): e70000

  Abstract

  The standardized letter of evaluation (SLOE) is a crucial component of emergency medicine (EM) residency applications. Initially developed in 1995 and revised to electronic SLOE (eSLOE) 2.0, this tool aims to provide a standardized evaluation of medical students.This study aimed to conduct internal validation by analyzing the distribution and correlation of scores in eSLOE 2.0 and identify any ranking skew.A multi-institutional cross-sectional study conducted using eSLOE 2.0 data from applicants to five geographically diverse U.S. EM residency programs during the 2022-2023 application cycle. Data from 2891 eSLOE 2.0 s across 1633 applicants were analyzed using descriptive statistics, chi-square, and Spearman's rho.Scores for all questions were moderately left-skewed. The mean scores for all part B questions were above 4.0. Strong correlations were found between part A and B scores with anticipated guidance (AG) and rank list (RL) positions. The AG had a higher correlation with RL positions than grades. The mean RL score indicated that the average student fell between the middle and top thirds.The study demonstrates left skew in eSLOE 2.0 scoring, including a higher prevalence of scores in the fully and mostly entrustable ranges for part A and the consistently high scores in part B.

  View details for DOI 10.1002/aet2.70000

  View details for PubMedID 39959258

  View details for PubMedCentralID PMC11828695

• A guide to creating an educator's portfolio for the 21st century. AEM education and training Krzyzaniak, S. M., Coates, W. C., Gottlieb, M. 2024; 8 (1): e10931

  Abstract

  An educator's portfolio is (EP) a collection of materials for demonstrating and assessing a clinician educator's performance and perspective. Although not all academic institutions require faculty to maintain an EP, it can serve as a valuable tool for both personal reflection and professional advancement. With newer advancements in technology and social media, there are also opportunities to enhance the EP for the digital era. This educator's blueprint highlights eight strategies for creating an EP for the 21st century clinician educator: use your educator's philosophy to introduce and anchor your EP, apply broad definitions of scholarship, include pertinent metrics for all scholarly products, describe mentorship activities, incorporate self-assessment and the assessments from others, report comprehensive accounting of presentations, highlight leadership activities, and utilize technology to facilitate dissemination and sharing of your EP.

  View details for DOI 10.1002/aet2.10931

  View details for PubMedID 38343630

  View details for PubMedCentralID PMC10858327

• Differences in Emergency Medicine Resident Procedural Reporting by Gender in the United States. Journal of graduate medical education Gottlieb, M., Mannix, A., Shappell, E., Jordan, J., Fix, M., Cooney, R., King, A., Krzyzaniak, S. 2024; 16 (1): 70-74

  Abstract

  Background Studies across specialties have demonstrated gender disparities in feedback, learner assessments, and operative cases. However, data are limited on differences in numbers of procedures among residents. Objective To quantify the association between gender and the number of procedures reported among emergency medicine (EM) residents. Methods We conducted a retrospective review of procedural differences by self-identified gender among graduating EM residents at 8 separate programs over a 10-year period (2013 to 2022). Sites were selected to ensure diversity of program length, program type, and geography. Residents from combined training programs, those who did not complete their full training at that institution, and those who did not have data available were excluded. We calculated the mean, SD, median, and IQR for each procedure by gender. We compared reported procedures by gender using linear regression, controlling for institution, and performed a sensitivity analysis excluding outlier residents with procedure totals >3 SD from the mean. Results We collected data from 914 residents, with 880 (96.3%) meeting inclusion criteria. There were 358 (40.7%) women and 522 (59.3%) men. The most common procedures were point-of-care ultrasound, adult medical resuscitation, adult trauma resuscitation, and intubations. After adjusting for institutions, the number of dislocation reductions, chest tube insertions, and sedations were higher for men. The sensitivity analysis findings were stable except for central lines, which were also more common in men. Conclusions In a national sample of EM programs, there were increased numbers of dislocation reductions, chest tube insertions, and sedations reported by men compared with women.

  View details for DOI 10.4300/JGME-D-23-00238.1

  View details for PubMedID 38304598

  View details for PubMedCentralID PMC10829910

• Exploring How House Staff Unions Impact the Program Director-Resident Educational Alliance. Academic medicine : journal of the Association of American Medical Colleges Krzyzaniak, S. M., Sebok-Syer, S. S., Akhtar, S., Gallahue, F. 2024

  Abstract

  In 1999, the National Labor Relations Board determined that residents function as employees, thereby allowing them to freely unionize. From 2020 to 2023, house staff (i.e., resident physicians and fellows) unions have significantly increased, and 8 physician training centers, representing nearly 4,000 house staff, have unionized since March 2021. While unions provide residents with an important tool in effecting change in their workplace, their introduction into the educational milieu has the potential to alter the program director (PD)-resident relationship. In this article, the authors use the educational alliance framework to detail 3 factors required to support a quality educational relationship between a resident and their PD. They also elaborate on how the introduction of unions may impact the PD-resident relationship and explore the potential unintended consequences of unionization as it pertains to this relationship. The authors then use 2 social psychology theories, naïve realism and motivated reasoning, to describe common framing dynamics that lead to conflict during collective bargaining processes. They conclude by offering strategies that PDs may use to mitigate tensions that arise in contract negotiations, even without a direct seat at the table. Ultimately, PDs should anticipate continued growth of resident unions and prepare themselves and their programs for the tensions that may arise from this action. The PD role as a neutral third party ought to be preserved, which is possible if all parties set reasonable expectations for the changes in the PD's role and responsibilities under a union. PDs should understand the 3 core aspects of the educational alliance and the importance of establishing credibility with their residents early on to build a strong foundation.

  View details for DOI 10.1097/ACM.0000000000005649

  View details for PubMedID 38266206

• 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

• Trends in point-of-care ultrasound use among emergency medicine residency programs over a 10-year period. AEM education and training Gottlieb, M., Cooney, R., King, A., Mannix, A., Krzyzaniak, S., Jordan, J., Shappell, E., Fix, M. 2023; 7 (2): e10853

  Abstract

  Point-of-care ultrasound (POCUS) is increasingly utilized in emergency medicine (EM). While residents are required by the Accreditation Council for General Medical Education to complete a minimum of 150 POCUS examinations before graduation, the distribution of examination types is not well-described. This study sought to assess the number and distribution of POCUS examinations completed during EM residency training and evaluate trends over time.This was a 10-year retrospective review of POCUS examinations across five EM residency programs. The study sites were deliberately selected to represent diversity in program type, program length, and geography. Data from EM residents graduating from 2013 to 2022 were eligible for inclusion. Exclusion criteria were residents in combined training programs, residents who did not complete all training at one institution, and residents who did not have data available. Examination types were identified from the American College of Emergency Physicians guidelines for POCUS. Each site obtained POCUS examination totals for every resident upon graduation. We calculated the mean and 95% confidence interval for each procedure across study years.A total of 535 residents were eligible for inclusion, with 524 (97.9%) meeting all inclusion criteria. The mean number of POCUS examinations per resident increased by 46.9% from 277 in 2013 to 407 in 2022. All examination types had stable or increasing frequency. Focused assessment with sonography in trauma (FAST), cardiac, obstetric/gynecologic, and renal/bladder were performed most frequently. Ocular, deep venous thrombosis, musculoskeletal, skin/soft tissue, thoracic, and cardiac examinations had the largest percentage increase in numbers over the 10-year period, while bowel and testicular POCUS remained rare.There was an overall increase in the number of POCUS examinations performed by EM residents over the past 10 years, with FAST, cardiac, obstetric/gynecologic, and renal/bladder being the most common examination types. Among less common procedures, increased frequency may be needed to ensure competence and avoid skill decay for those examination types. This information can help inform POCUS training in residency and accreditation requirements.

  View details for DOI 10.1002/aet2.10853

  View details for PubMedID 37008649

  View details for PubMedCentralID PMC10061573

• Trends in emergency medicine resident procedural reporting over a 10-year period. AEM education and training Gottlieb, M., Jordan, J., Krzyzaniak, S., Mannix, A., King, A., Cooney, R., Fix, M., Shappell, E. 2023; 7 (1): e10841

  Abstract

  Procedural competency is expected of all emergency medicine (EM) residents upon graduation. The ACGME requires a minimum number of essential procedures to successfully complete training. However, data are limited on the actual number of procedures residents perform and prior studies are limited to single institutions over short time periods. This study sought to assess the number of Key Index Procedures completed during EM residency training and evaluate trends over time.We conducted a retrospective review of graduating EM resident procedure logs across eight ACGME accredited residency programs over the last 10 years (2013-2022). Sites were selected to ensure diversity of program length, program type, and geography. All data from EM residents graduating in 2013-2022 were eligible for inclusion. Data from residents from combined training programs, those who did not complete their full training at that institution (i.e., transferred in/out), or those who did not have data available were excluded. We determined the list of procedures based upon the ACGME Key Index Procedures list. Sites obtained totals for each of the identified procedures for each resident upon graduation. We calculated the mean and 95% CI for each procedure.We collected data from a total of 914 residents, with 881 (96.4%) meeting inclusion criteria. The most common procedures were point-of-care ultrasound, adult medical resuscitation, adult trauma resuscitation, and intubation. The least frequent procedures included pericardiocentesis, cricothyroidotomy, cardiac pacing, vaginal delivery, and chest tubes. Most procedures were stable over time with the exception of lumbar punctures (decreased) and point-of-care ultrasound (increased).In a national sample of EM programs, procedural numbers remained stable except for lumbar puncture and ultrasound. This information can inform residency training curricula and accreditation requirements.

  View details for DOI 10.1002/aet2.10841

  View details for PubMedID 36777101

  View details for PubMedCentralID PMC9899625

• Education Theory Made Practical: Creating open educational resources via an apprenticeship model AEM EDUCATION AND TRAINING Gottlieb, M., Krzyzaniak, S. M., Natesan, S., Quinn, A., Robinson, D., Fant, A., Sherbino, J., Chan, T. M. 2022; 6 (6): e10802

  Abstract

  Clinical faculty may have limited knowledge of education theories and best practices in health professions education. Many faculty development programs focus on passive learning with limited application to practice. There is a need for more active engagement for early career educators.We created an apprenticeship-based electronic book series focused on translating education theories into practical applications for clinician educators. Chapters were authored by teams of two to four geographically separated early career educators, who were tasked with explaining an education theory and relating it to their educational practice. The chapters underwent internal peer review, followed by open peer review as a blog post and eventual publication. Usage data were collected, and surveys were sent to authors and end-users.Six volumes (60 total chapters) have been created to date by 180 unique authors and 17 editors over a 6-year period. There have been 65,571 total blog page views and 17,180 total book downloads across the five published volumes. Authors reported an increase in their perceived knowledge (pre 2.6 ± 1.7 vs. post 7.2 ± 1.1, mean difference 4.5/9.0, 95% confidence interval [CI] 4.0-5.0, p < 0.001) after writing their chapter. Authors also reported career benefits including authorship for academic advancement/promotion and developing an area of education theory expertise. End-users also reported a mean increase in their perceived knowledge (pre 4.4 ± 2.5 vs. post 7.3 ± 1.4, mean difference 2.9/9.0, 95% CI 2.1-3.8, p < 0.001) after reading a chapter.The Education Theory Made Practical electronic book series represents a proof of concept for an apprenticeship-based model to teach education theory, while also creating scholarship and open access resources for the broader community.

  View details for DOI 10.1002/aet2.10802

  View details for Web of Science ID 000880440100001

  View details for PubMedID 36389649

  View details for PubMedCentralID PMC9646918

• The next generation of researchers: One-year outcome data from the SAEM Advanced Research Methodology Evaluation and Design in Medical Education (ARMED MedEd) program AEM EDUCATION AND TRAINING Gottlieb, M., Chan, T. M., Sebok-Syer, S. S., Krzyzaniak, S., Dubosh, N. M., Santen, S., Caretta-Weyer, H., Yarris, L., Coates, W. C., Emergency Med Hlth Profession 2022; 6 (6)

  View details for DOI 10.1002/aet2.10818

  View details for Web of Science ID 000887953700001

• PASS-A course in Pediatric Acute Surgical Support to build pediatric surgical emergencies capacity in developing countries. Journal of pediatric surgery Dinh, T., Khairallah, T., Nguyen, C., Deshpande, G., Krzyzaniak, S., Barton, G., Bohrensen, S., Vu, M. T., Holterman, A. 2022; 57 (12): 1018-1025

  Abstract

  The burden of pediatric trauma and emergency, including pediatric surgical emergencies in low middle income countries (LMIC) is high. The goal of Pediatric Acute Surgical Support (PASS) course is to prepare caregivers in LMIC for the acute management of life-threatening pediatric surgical emergencies. We aim to show the feasibility of its initial deployment.PASS was developed in 2016 with LMIC faculty from a teaching children hospital CH. The course contents consisted of a mix of didactic materials for serious general neonatal and pediatric surgery modified PALS/ATLS, in-person multidisciplinary team-based skill stations, interactive clinical scenarios and simulated trauma cases. The course was subsequently revised and delivered to 92 learners in four classes of 2.5-days sessions at two CHs between 2017 and 2019. Learners' demographics, written exams, team-based case performance, and post-course survey data were prospectively collected and retrospectively analyzed.Physician (60%) and nurse learners (40%) from pediatric critical care (36%), surgery (23%), emergency medicine (20%) and anesthesiology (9%) had 3.6 +/- 3.6 years of clinical practice; pre- and post-course written exam score of 55.4+/-15.5% vs 71.6+/-12.8%, team-based trauma scenario management 22.6 ± 7.8% vs 54.7 ± 16.6% and team-based dynamic scores 17+/- 10% vs 53.3+/- 15.5%, respectively (p<0.0001). Self-reported satisfaction scores were ≥ 95% for course method, level of difficulty, clinical applicability, and quality of instructors.PASS is well-received by LMIC learners, with short-term improvement in knowledge-, team-based management of acute pediatric surgery emergencies; and has the potential to be a model of horizontal capacity building for pediatric surgery in LMIC.II.

  View details for DOI 10.1016/j.jpedsurg.2022.03.004

  View details for PubMedID 35396086

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

  Abstract

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

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

  View details for PubMedID 36274773

• Creating Community and Exploring Identity: Integrating a Virtual "Museum Tour" Into Intern Orientation. Journal of graduate medical education Balhara, K. S., Weygandt, P. L., Caretta-Weyer, H., Krzyzaniak, S. M., Regan, L., Irvin, N. 2022; 14 (3): 335-336

  View details for DOI 10.4300/JGME-D-21-00994.1

  View details for PubMedID 35754653

  View details for PubMedCentralID PMC9200248

• Interactions in Sociotechnical Systems: Achieving Balance in the Use of an Augmented Reality Mobile Application HUMAN FACTORS Wooldridge, A. R., Morgan, J., Ramadhani, W. A., Hanson, K., Vazquez-Melendez, E., Kendhari, H., Shaikh, N., Riech, T., Mischler, M., Krzyzaniak, S., Barton, G., Formella, K. T., Abbott, Z. R., Farmer, J. N., Ebert-Allen, R., Croland, T. 2022: 187208221093830

  Abstract

  We explore relationships between barriers and facilitators experienced by users to understand dynamic interactions in sociotechnical systems and improve a mobile phone-based augmented reality application that teaches users about the contents of a standardized pediatric code cart.Understanding interactions between performance obstacles and facilitators can provide guidance to (re)designing sociotechnical systems to improve system outcomes. Clinicians should know about contents and organization of code carts, and an augmented reality mobile application may improve that knowledge but changes the sociotechnical system in which they learn. Prior work identified barriers and facilitators impacting the use of this application-participants described dimensions together, indicating interactions that are explored in the current study.We conducted four focus groups (number of clinicians = 18) and two interviews with clinicians who used the application. We performed a secondary analysis of focus group data exploring interactions between previously identified barriers and facilitators to application use. We used epistemic network analysis to visualize these interactions.Work system barriers interacted with barriers and facilitators interacted with facilitators to amplify cumulative negative or positive impact, respectively. Facilitators balanced barriers, mitigating negative impact. Facilitators also exacerbated barriers, worsening negative impact.Barriers and facilitators interact and can amplify, balance, and exacerbate each other-notably, positives are not always positive. To obtain desired outcomes, interactions must be further considered in sociotechnical system design, for example, the potential improvements to the application we identified.

  View details for DOI 10.1177/00187208221093830

  View details for Web of Science ID 000798694000001

  View details for PubMedID 35549474

• United States 2020 Emergency Medicine Resident Workforce Analysis. Annals of emergency medicine Bennett, C. L., Clay, C. E., Espinola, J. A., Krzyzaniak, S. M., Egan, D. J., Camargo, C. A. 2022

  Abstract

  STUDY OBJECTIVE: To characterize the emergency medicine resident physician workforce and the residency programs training them.METHODS: We identified emergency medicine residents in the 2020 American Medical Association (AMA) Physician Masterfile, analyzed demographic information, mapped both county-level population-adjusted and hospital referral region densities, and compared 2020 versus 2008 resident physician densities. We also analyzed all Accreditation Council for Graduate Medical Education (ACGME)-accredited emergency medicine residency programs from 2013 to 2020, mapped state-level population-adjusted densities, and identified temporal trends in program location and state-level program densities. All population-adjusted densities were calculated using the US Census Bureau resident population estimates.RESULTS: There were 6,993 emergency medicine residents in the 2020 AMA dataset with complete information. Most of them (98%) were in urban areas. Compared with 2008, per 100,000 US population, this represents disproportionate increases in urban areas (total [0.5], urban [0.5], large rural [0.2] and small rural [0.05]). We further identified 160 (2013) to 265 (2020) residency programs using the ACGME data. The new programs were 3-year training programs that were disproportionately added to states with an already higher number of programs (Florida [5 to 19], Michigan [11 to 25], New York [21 to 31], Ohio [9 to 18], Pennsylvania [12 to 21], California [14 to 22]).CONCLUSION: The number of emergency medicine residency programs has increased; most new programs were added to the states that already had emergency medicine residency programs. There is an emergency physician "desert" in the rural United States, lacking both residents and residency training programs. This analysis provides essential context to the ongoing conversation about the future of the emergency physician workforce.

  View details for DOI 10.1016/j.annemergmed.2022.03.007

  View details for PubMedID 35570180

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

  Abstract

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

  View details for DOI 10.1002/aet2.10740

  View details for PubMedID 35493289

• Use of an augmented reality application for paediatric code cart training BMJ INNOVATIONS Hanson, K., Shaikh, N., Wooldridge, A., Kendhari, H., Krzyzaniak, S. M., Riech, T., Vazquez-Melendez, E., Mischler, M., Ebert-Allen, R., Barton, G., Formella, K., Abbott, Z., Wolfe, D., Croland, T. 2021; 7 (4): 632-636

  View details for DOI 10.1136/bmjinnov-2020-000628

  View details for Web of Science ID 000850831600008

• Unheard Voices: A Qualitative Study of Resident Perspectives on Remediation. Journal of graduate medical education Krzyzaniak, S. M., Kaplan, B., Lucas, D., Bradley, E., Wolf, S. J. 2021; 13 (4): 507-514

  Abstract

  Background: Remediation is an important component of residency training that ensures residents are progressing toward competency and unsupervised practice. There is literature describing educators' attitudes about remediation; however, little is known about residents' perspectives regarding peers who are struggling and remediation. Understanding this perspective is critical to supporting struggling residents and developing successful remediation programs.Objective: The objective of this study was to describe residents' perspectives on peers who are struggling and remediation processes within graduate medical education programs.Methods: In 2015, we conducted focus groups of residents in a multi-institutional exploratory qualitative study designed to investigate resident perspectives on remediation. Focus groups included questions on identification of residents who are struggling, reasons residents face difficulty in training, attitudes toward remediation, and understanding of the remediation process. Using conventional content analysis, we analyzed the focus group data to discover common themes.Results: Eight focus groups were performed at 3 geographically distinct institutions. A total of 68 residents participated, representing 12 distinct medical specialties. Four major themes emerged from the participants' discussion: lack of transparency, negative stigma, overwhelming emotions, and a need for change.Conclusions: Resident perspectives on remediation are affected by communication, culture, and emotions. The resident participants called for change, seeking greater understanding and transparency about what it means to struggle and the process of remediation. The residents also believed that remediation can be embraced and normalized.

  View details for DOI 10.4300/JGME-D-20-01481.1

  View details for PubMedID 34434511

• Walking the Line: Balancing Performance Barriers and Facilitators in an Augmented Reality Mobile Application for Pediatric Code Cart Training. Ergonomics Wooldridge, A. R., Ramadhani, W. A., Hanson, K., Vazquez-Melendez, E., Kendhari, H., Shaikh, N., Riech, T., Mischler, M., Krzyzaniak, S., Barton, G., Formella, K. T., Abbott, Z. R., Farmer, J. N., Ebert-Allen, R., Croland, T. 2021: 1-33

  Abstract

  An augmented reality (AR) mobile smartphone application was developed for clinicians to improve their knowledge about the contents and organization of a standardized pediatric code cart, an important tool in safe, effective pediatric resuscitations. This study used focus groups and interviews with 22 clinicians to identify work system barriers and facilitators to use of the application. We identified twelve dimensions of barriers and facilitators: convenience, device ownership, device size and type, gamification, interface design, movement/physical space, perception of others, spatial presence, technological experience, technological glitches, workload, and the perception and attitude towards code cart and resuscitation. These dimensions can guide improvement efforts, e.g., redesigning the interface, providing non-AR modes, improving the tutorial. We propose nine principles to guide the design of other digital health technologies incorporating AR. In particular, the workload demands created by using AR must be considered and accounted for in the design and implementation of such technologies.Practitioner summary: Augmented reality (AR) may prepare workers for situations that do not occur frequently. This study investigates barriers and facilitators to using an AR mobile smartphone application developed to improve clinician knowledge about code carts, leading to improvements to the application and principles to guide the design of other AR-based technologies.

  View details for DOI 10.1080/00140139.2021.1954685

  View details for PubMedID 34253153

• Faculty development using a virtual community of practice: Three-year outcomes of the Academic Life in Emergency Medicine Faculty Incubator program. AEM education and training Gottlieb, M., Yarris, L. M., Krzyzaniak, S. M., Natesan, S., Sherbino, J., Lin, M., Chan, T. M. 2021; 5 (3): e10626

  Abstract

  Introduction: The Academic Life in Emergency Medicine (ALiEM) Faculty Incubator program is a longitudinal, 1-year, virtual faculty development program for early- and mid-career faculty members that crosses specialties and institutions. This study sought to evaluate the outcomes among 3years of participants.Methods: This cross-sectional survey study evaluated postcourse and 1-year outcomes from three graduated classes of the ALiEM Faculty Incubator program. The program evaluation survey was designed to collect outcomes across multiple Kirkpatrick levels using pre/post surveys and tracking of abstracts, publications, speaking opportunities, new leadership positions, and new curricula.Results: Over 3years, 89 clinician educators participated in the program. Of those, 59 (66%) completed the initial survey and 33 (37%) completed the 1-year survey. Participants reported a significant increase in knowledge (4.1/9.0 vs. 7.0/9.0). The number of abstracts, publications, and invited presentations significantly increased after course completion and continued postcourse. A total of 37 of 59 (62.7%) developed a new curriculum during the course and 19 of 33 (57.6%) developed another new curriculum after the course. A total of 29 of 59 (49.2%) began a new leadership position upon course completion with 15 of 33 (45.5%) beginning another new leadership position 1year later.Discussion: The ALiEM Faculty Incubator program demonstrated an increase in perceived knowledge and documented academic productivity among early- and mid-career medical educators.

  View details for DOI 10.1002/aet2.10626

  View details for PubMedID 34222756

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

  Abstract

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

  View details for DOI 10.1002/aet2.10607

  View details for PubMedID 34222747

• Peek at the glass ceiling: gender distribution of leadership among emergency medicine residency programs. Emergency medicine journal : EMJ Parsons, M., Krzyzaniak, S., Mannix, A., Rocca, N., Chan, T. M., Gottlieb, M. 2020

  Abstract

  BACKGROUND: A gender gap in faculty rank at academic institutions exists; however, data among graduate medical education (GME) programmes are limited. There is a need to assess gender disparities in GME leadership, as a lack of female leadership may affect recruitment, role modelling and mentorship of female trainees. This cross-sectional study aimed to describe the current state of gender in programme leadership (department chair, programme director (PD), associate/assistant PD (APD) and clerkship director (CD)) at accredited Emergency Medicine (EM) programmes in the USA to determine whether a gender gap exists.METHODS: A survey was distributed to EM residency programmes in the USA assessing demographics and gender distribution among programme leadership. If no response was received, information was collected via the programme's website. Data were organised by position, region and length of the programme. We obtained data on the number of female EM physicians in practice and in training/fellowship in 2017 from the Association of American Medical Colleges. Data analysis was completed using descriptive statistics and chi2 analysis.RESULTS: Of the 226 programmes contacted, 148 responded to the survey (66.3%). Among US EM residency programmes, 11.2% of chairs, 34.6% of PDs, 40.5% of APDs and 46.5% of CDs are women. The percentage of female chairs is significantly lower than the percentage of women in practice or in training in EM. The percentage of female PDs did not differ from the percentage of women in practice or in training in EM. The percentage of female APDs and CDs was significantly higher than the percentage of women in practice but did not differ from the percentage in training. There was wide variability across regions. Four-year programmes had more women in PD and APD positions compared with 3-year programmes (p=0.01).CONCLUSIONS: While the representation of women in educational roles is encouraging, the number of women holding the rank of chairperson remains disproportionately low. Further studies are needed to evaluate reasons for this and strategies to increase gender equality in leadership roles.

  View details for DOI 10.1136/emermed-2019-208951

  View details for PubMedID 33288521

• Rethinking the Approach to Continuing Professional Development Conferences in the Era of COVID-19. The Journal of continuing education in the health professions Gottlieb, M., Egan, D. J., Krzyzaniak, S. M., Wagner, J., Weizberg, M., Chan, T. 2020

  Abstract

  The COVID-19 pandemic has required a substantial change to the approach used for traditional, in-person continuing professional development (CPD) conferences. Running a virtual CPD conference will necessitate consideration of digital platforms and conversion of large group and small group sessions, abstract presentations, and networking events to a digital medium. This paper will discuss these challenges and present strategies to address them for CPD conference planning in the era of COVID-19.

  View details for DOI 10.1097/CEH.0000000000000310

  View details for PubMedID 32658014

• Clinical Teaching: An Evidence-based Guide to Best Practices from the Council of Emergency Medicine Residency Directors WESTERN JOURNAL OF EMERGENCY MEDICINE Natesan, S., Bailitz, J., King, A., Krzyzaniak, S. M., Kennedy, S. K., Kim, A. J., Byyny, R., Gottlieb, M. 2020; 21 (4): 985-998

  Abstract

  Clinical teaching is the primary educational tool use to train learners from day one of medical school all the way to the completion of fellowship. However, concerns over time constraints and patient census have led to a decline in bedside teaching. This paper provides a critical review of the literature on clinical teaching with a focus on instructor teaching strategies, clinical teaching models, and suggestions for incorporating technology. Recommendations for instructor-related teaching factors include adequate preparation, awareness of effective teacher attributes, using evidence-based-knowledge dissemination strategies, ensuring good communication, and consideration of environmental factors. Proposed recommendations for potential teaching strategies include the Socratic method, the One-Minute Preceptor model, SNAPPS, ED STAT, teaching scripts, and bedside presentation rounds. Additionally, this article will suggest approaches to incorporating technology into clinical teaching, including just-in-time training, simulation, and telemedical teaching. This paper provides readers with strategies and techniques for improving clinical teaching effectiveness.

  View details for DOI 10.5811/westjem.2020.4.46060

  View details for Web of Science ID 000567058700046

  View details for PubMedID 32726274

  View details for PubMedCentralID PMC7390547

• Sex Distribution of Editorial Board Members Among Emergency Medicine Journals. Annals of emergency medicine Gottlieb, M., Krzyzaniak, S. M., Mannix, A., Parsons, M., Mody, S., Kalantari, A., Ashraf, H., Chan, T. M. 2020

  Abstract

  Previous studies have demonstrated that a sex disparity exists in the editorial boards of select specialties. However, there are limited data with respect to emergency medicine. We seek to determine the sex distribution of editors in chief and editorial board members among emergency medicine journals.In this cross-sectional survey, we compiled a list of all emergency medicine journals, using the Scimago Journal & Country Rank on August 13, 2019. We excluded journals that were no longer published, were not emergency medicine journals, had rotating editorial boards for each issue, or had no first names listed. We obtained the sex and editorial board role by using publicly available data on the journal Web sites. We assigned sex according to knowledge of the member or his or her online faculty profile and used the Genderize program (Genderize.io, Roskilde, Denmark) when sex could not be determined with the above-mentioned approach. We report descriptive statistics for the categoric data, stratified by position (editor in chief, editorial board member, social media editor, resident/fellow member) and country.We identified 73 journals in Scimago; 37 met inclusion criteria, with data available to determine the sex in 99.5% of cases. There were 46 total editors in chief, with only 4 (8.7%) being women. Of 1,477 total editorial board members, only 241 were women (16.3%), with a range of 0% to 33.3% per journal. We found that 28.6% of social media editors (2/7) at 4 journals and 70% of resident or fellow editors (7/10) at 5 journals were women.There is a notable sex disparity among emergency medicine journals' editors in chief and editorial board members. Efforts should be made to improve sex distribution among editorial boards.

  View details for DOI 10.1016/j.annemergmed.2020.03.027

  View details for PubMedID 32376090

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

  View details for DOI 10.1002/aet2.10436

• What Emergency Medicine Rewards: Is There Implicit Gender Bias in National Awards? Annals of emergency medicine Krzyzaniak, S. M., Gottlieb, M., Parsons, M., Rocca, N., Chan, T. M. 2019; 74 (6): 753-758

  Abstract

  Multiple studies have demonstrated a gender gap in the percentage of women recognized in national awards, but to our knowledge this gap has not been studied within emergency medicine. This study is designed to evaluate the presence of a gender gap in female representation in awards from national emergency medicine organizations in the United States and Canada.The awards from 5 national organizations during the past 5 years were reviewed. We developed a data extraction tool to identify and categorize the awards and recipients. Data were grouped according to gender distribution and assessed with respect to emergency medicine organization, year of award, category of award, and career phase specified by award.The overall percentage of female awardees across all 5 organizations from 2014 to 2018 was 28%. Only 16% of all named awards were named after women, and female awardees were more likely to be recognized early in their career for advocacy and work pertaining to the advancement of women, whereas men were favored for awards recognizing mentorship and organizational contributions.Emergency medicine is unique among other specialties in that the percentage of women represented in national awards (28%) closely mirrors the overall representation of women in emergency medicine (27.6% in the United States, 31% in Canada). This is in contrast to the documented leadership gap in academic medicine and emergency medicine, which may reflect a lag time between receiving national awards and earning academic and professional promotion. Although some organizations had significantly lower representation of female awardees, the overall trends indicate that women have closed the gender gap in award representation. This may signal a forthcoming change in other domains with established gaps in emergency medicine; specifically, in leadership and pay.

  View details for DOI 10.1016/j.annemergmed.2019.04.022

  View details for PubMedID 31229389

• Curated Collections for Educators: Five Key Papers about Receiving Feedback in Medical Education. Cureus Natesan, S., Stehman, C., Shaw, R., Story, D., Krzyzaniak, S. M., Gottlieb, M. 2019; 11 (9): e5728

  Abstract

  Introduction Feedback is a complex, multi-component interaction that is essential for academic development and advancement. Successful feedback requires active involvement from both the giver and receiver. However, research and guidance on the subject mostly center on the role of the provider of feedback. But the receiver of feedback holds the true power in this interaction, choosing how to interpret the information and deciding whether or not to incorporate the feedback to instill behavioral change. In this article, the authors aim to summarize five key papers related to receiving feedback, in order to outline both relevant information for emerging clinician-educators and discern ways to use this information for faculty development. Methods In order to generate a list of key papers that describe the importance of receiving feedback, the authors conducted a consensus-building process informed by social media sources. Key articles on receiving feedback were aggregated through a literature search. This list was further augmented via an open call on Twitter for important papers regarding receiving feedback. Through these processes, a list of 43 papers was created on the topic of receiving feedback in medical education. After compiling this preliminary list, the authorship group engaged in a modified Delphi approach to build consensus on selecting papers that best described the process of receiving feedback. Results We present the group's five most highly rated papers on the topic of receiving feedback in medical education. These papers were deemed essential and have also been summarized based on their relevance to junior faculty members and faculty developers. Conclusion While giving and receiving feedback are both vital for growth and development, much of the research focuses solely on giving feedback. However, receiving feedback is equally, if not more, important for instilling change in the learner. We explore the power of receiving feedback in medical education through five key papers that analyze the subject. We believe these papers can serve as great learning resources for both junior faculty members and faculty developers. They can assist the junior faculty to cultivate the ability to receive feedback and also serve as resources to aid senior faculty in building faculty-development sessions.

  View details for DOI 10.7759/cureus.5728

  View details for PubMedID 31723492

  View details for PubMedCentralID PMC6825441

• Curated Collections for Educators: Eight Key Papers about Feedback in Medical Education. Cureus Natesan, S. M., Krzyzaniak, S. M., Stehman, C., Shaw, R., Story, D., Gottlieb, M. 2019; 11 (3): e4164

  Abstract

  Feedback is an essential part of learning, growth, and academic success. Junior faculty members are often unfamiliar with the grounding literature that defines feedback. Many times they receive little education on providing and receiving feedback, resulting in unhelpful "feedback" for both learners and program leadership alike. This article aims to summarize eight key papers on feedback, to outline relevant information for emerging clinician educators, and identify ways to use these resources for the faculty development.  In order to generate a list of key papers that describes the importance and significance of feedback, the authors conducted a consensus-building process to identify the top papers. In August and September, 2018, the 2018-2019 Academic Life in Emergency Medicine (ALiEM) Faculty Incubator program discussed the topic of feedback in medical education. A number of papers on the topic was highlighted. This list of papers was further augmented using the suggestions and expertise of guest experts who are leaders in the field of medical education and feedback. The authors also used social media to conduct an open call on Twitter for important papers regarding feedback (utilizing #meded, #Feedback hashtags). Via this process, a list of 88 key papers was identified on the topic of feedback in medical education. After compiling these papers, the authorship group engaged in a modified Delphi approach to build consensus on the top eight papers on feedback. These papers were deemed essential by the authors and have been summarized with respect to their relevance to junior faculty members and to faculty developers. In this manuscript, we present eight key papers addressing feedback in medical education with discussions and applications for junior faculty members and faculty developers. This list of articles that can serve to help junior clinician educators grow in their ability to give effective feedback and also serve as resources upon which senior faculty can design the faculty development sessions.

  View details for DOI 10.7759/cureus.4164

  View details for PubMedID 31065470

  View details for PubMedCentralID PMC6497184

• Simulation-based Remediation in Emergency Medicine Residency Training: A Consensus Study. The western journal of emergency medicine Nadir, N. A., Hart, D., Cassara, M., Noelker, J., Moadel, T., Kulkarni, M., Sampson, C. S., Bentley, S., Naik, N. K., Hernandez, J., Krzyzaniak, S. M., Lai, S., Podolej, G., Strother, C. 2019; 20 (1): 145-156

  Abstract

  Resident remediation is a pressing topic in emergency medicine (EM) training programs. Simulation has become a prominent educational tool in EM training and been recommended for identification of learning gaps and resident remediation. Despite the ubiquitous need for formalized remediation, there is a dearth of literature regarding best practices for simulation-based remediation (SBR).We conducted a literature search on SBR practices using the terms "simulation," "remediation," and "simulation based remediation." We identified relevant themes and used them to develop an open-ended questionnaire that was distributed to EM programs with experience in SBR. Thematic analysis was performed on all subsequent responses and used to develop survey instruments, which were then used in a modified two-round Delphi panel to derive a set of consensus statements on the use of SBR from an aggregate of 41 experts in simulation and remediation in EM.Faculty representing 30 programs across North America composed the consensus group with 66% of participants identifying themselves as simulation faculty, 32% as program directors, and 2% as core faculty. The results from our study highlight a strong agreement across many areas of SBR in EM training. SBR is appropriate for a range of deficits, including procedural, medical knowledge application, clinical reasoning/decision-making, communication, teamwork, and crisis resource management. Simulation can be used both diagnostically and therapeutically in remediation, although SBR should be part of a larger remediation plan constructed by the residency leadership team or a faculty expert in remediation, and not the only component. Although summative assessment can have a role in SBR, it needs to be very clearly delineated and transparent to everyone involved.Simulation may be used for remediation purposes for certain specific kinds of competencies as long as it is carried out in a transparent manner to all those involved.

  View details for DOI 10.5811/westjem.2018.10.39781

  View details for PubMedID 30643618

  View details for PubMedCentralID PMC6324703

• Curated Collections for Educators: Five Key Papers about Residents as Teachers Curriculum Development. Cureus Krzyzaniak, S. M., Cherney, A., Messman, A., Natesan, S., Overbeck, M., Schnapp, B., Boysen-Osborn, M. 2018; 10 (2): e2154

  Abstract

  The Accreditation Council for Graduate Medical Education (ACGME) requires residency programs to prepare residents to teach and assess medical students and other learners. In order to achieve this, many programs develop formal residents as teachers (RAT) curricula. Medical educators may seek the guidance of previously published literature during the development of RAT programs at their institutions. The authors sought to identify key articles published on the subject of RAT programs over the last 10 years. The authors utilized a formal literature search with the help of a medical librarian and identified additional articles from virtual discussions among the author group and an open call for articles on Twitter using the hashtag #MedEd. Virtual discussions occurred within an online community of practice, the Academic Life in Emergency Medicine (ALiEM) Faculty Incubator. The lead author conducted a four-round modified Delphi process among the author group in order to narrow the broad article list to five key articles on RAT programs. The authors summarize each article and provide considerations for junior faculty as well as faculty developers. Curriculum development and program evaluation should utilize established frameworks and evidence-based approaches. The papers identified by this Delphi process will help faculty use best practices when creating or revising new RAT curriculum. In addition, faculty tasked with guiding junior faculty in this process or creating faculty development programs around curriculum development will find these articles to be a great resource for building content.

  View details for DOI 10.7759/cureus.2154

  View details for PubMedID 29637035

  View details for PubMedCentralID PMC5884573

• Education Theory Made Practical Vol. 2 edited by Gottlieb, M., Chan, T. M., Krzyzaniak, S. M., Grossman, C., Robinson, D., Papanagnou, D. 2018
• A qualitative study of medical educators' perspectives on remediation: Adopting a holistic approach to struggling residents. Medical teacher Krzyzaniak, S. M., Wolf, S. J., Byyny, R., Barker, L., Kaplan, B., Wall, S., Guerrasio, J. 2017; 39 (9): 967-974

  Abstract

  During residency, some trainees require the identification and remediation of deficiencies to achieve the knowledge, skills and attitudes necessary for independent practice. Given the limited published frameworks for remediation, we characterize remediation from the perspective of educators and propose a holistic framework to guide the approach to remediation.We conducted semistructured focus groups to: explore methods for identifying struggling residents; categorize common domains of struggle; describe personal factors that contribute to difficulties; define remediation interventions and understand what constitutes successful completion. Data were analyzed through conventional content analysis.Nineteen physicians across multiple specialties and institutions participated in seven focus groups. Thirteen categories emerged around remediation. Some themes addressed practical components of remediation, while others reflected barriers to the process and the impact of remediation on the resident and program. The themes were used to inform development of a novel holistic framework for remediation.The approach to remediation requires comprehensive identification of individual factors impacting performance. The intervention should not only include a tailored learning plan but also address confounders that impact likelihood of remediation success. Our holistic framework intends to guide educators creating remediation plans to ensure all domains are addressed.

  View details for DOI 10.1080/0142159X.2017.1332362

  View details for PubMedID 28562135

• Curated Collections for Educators: Five Key Papers about Program Evaluation. Cureus Thoma, B., Gottlieb, M., Boysen-Osborn, M., King, A., Quinn, A., Krzyzaniak, S., Pineda, N., Yarris, L. M., Chan, T. 2017; 9 (5): e1224

  Abstract

  The evaluation of educational programs has become an expected part of medical education. At some point, all medical educators will need to critically evaluate the programs that they deliver. However, the evaluation of educational programs requires a very different skillset than teaching. In this article, we aim to identify and summarize key papers that would be helpful for faculty members interested in exploring program evaluation. In November of 2016, the 2015-2016 Academic life in emergency medicine (ALiEM) Faculty Incubator program highlighted key papers in a discussion of program evaluation. This list of papers was augmented with suggestions by guest experts and by an open call on Twitter. This resulted in a list of 30 papers on program evaluation. Our authorship group then engaged in a process akin to a Delphi study to build consensus on the most important papers about program evaluation for medical education faculty. We present our group's top five most highly rated papers on program evaluation. We also summarize these papers with respect to their relevance to junior medical education faculty members and faculty developers. Program evaluation is challenging. The described papers will be informative for junior faculty members as they aim to design literature-informed evaluations for their educational programs.

  View details for DOI 10.7759/cureus.1224

  View details for PubMedID 28589073

  View details for PubMedCentralID PMC5453746

• Academic Primer Series: Eight Key Papers about Education Theory. The western journal of emergency medicine Gottlieb, M., Boysen-Osborn, M., Chan, T. M., Krzyzaniak, S. M., Pineda, N., Spector, J., Sherbino, J. 2017; 18 (2): 293-302

  Abstract

  Many teachers adopt instructional methods based on assumptions of best practices without attention to or knowledge of supporting education theory. Familiarity with a variety of theories informs education that is efficient, strategic, and evidence-based. As part of the Academic Life in Emergency Medicine Faculty Incubator Program, a list of key education theories for junior faculty was developed.A list of key papers on theories relevant to medical education was generated using an expert panel, a virtual community of practice synthetic discussion, and a social media call for resources. A three-round, Delphi-informed voting methodology including novice and expert educators produced a rank order of the top papers.These educators identified 34 unique papers. Eleven papers described the general use of education theory, while 23 papers focused on a specific theory. The top three papers on general education theories and top five papers on specific education theory were selected and summarized. The relevance of each paper for junior faculty and faculty developers is also presented.This paper presents a reading list of key papers for junior faculty in medical education roles. Three papers about general education theories and five papers about specific educational theories are identified and annotated. These papers may help provide foundational knowledge in education theory to inform junior faculty teaching practice.

  View details for DOI 10.5811/westjem.2016.11.32315

  View details for PubMedID 28210367

  View details for PubMedCentralID PMC5305140

• Transition of Care Practices from Emergency Department to Inpatient: Survey Data and Development of Algorithm. The western journal of emergency medicine Lee, S., Jordan, J., Hern, H. G., Kessler, C., Promes, S., Krzyzaniak, S., Gallahue, F., Stettner, T., Druck, J. 2017; 18 (1): 86-92

  Abstract

  We aimed to assess the current scope of handoff education and practice among resident physicians in academic centers and to propose a standardized handoff algorithm for the transition of care from the emergency department (ED) to an inpatient setting.This was a cross-sectional survey targeted at the program directors, associate or assistant program directors, and faculty members of emergency medicine (EM) residency programs in the United States (U.S.). The web-based survey was distributed to potential subjects through a listserv. A panel of experts used a modified Delphi approach to develop a standardized algorithm for ED to inpatient handoff.121 of 172 programs responded to the survey for an overall response rate of 70.3%. Our survey showed that most EM programs in the U.S. have some form of handoff training, and the majority of them occur either during orientation or in the clinical setting. The handoff structure from ED to inpatient is not well standardized, and in those places with a formalized handoff system, over 70% of residents do not uniformly follow it. Approximately half of responding programs felt that their current handoff system was safe and effective. About half of the programs did not formally assess the handoff proficiency of trainees. Handoffs most commonly take place over the phone, though respondents disagree about the ideal place for a handoff to occur, with nearly equivalent responses between programs favoring the bedside over the phone or face-to-face on a computer. Approximately two-thirds of responding programs reported that their residents were competent in performing ED to inpatient handoffs. Based on this survey and on the review of the literature, we developed a five-step algorithm for the transition of care from the ED to the inpatient setting.Our results identified the current trends of education and practice in transitions of care, from the ED to the inpatient setting in U.S. academic medical centers. An algorithm, which guides this process, is proposed to address the current gap in the standardized approach to ED to inpatient handoffs that were identified in the survey's assessment of needs.

  View details for DOI 10.5811/westjem.2016.9.31004

  View details for PubMedID 28116015

  View details for PubMedCentralID PMC5226771

• False-Negative FAST Examination: Associations With Injury Characteristics and Patient Outcomes ANNALS OF EMERGENCY MEDICINE Laselle, B. T., Byyny, R. L., Haukoos, J. S., Krzyzaniak, S. M., Brooks, J., Dalton, T. R., Gravitz, C. S., Kendall, J. L. 2012; 60 (3): 326-334

  Abstract

  Focused assessment with sonography in trauma (FAST) is widely used for evaluating patients with blunt abdominal trauma; however, it sometimes produces false-negative results. Presenting characteristics in the emergency department may help identify patients at risk for false-negative FAST result or help the physician predict injuries in patients with a negative FAST result who are unstable or deteriorate during observation. Alternatively, false-negative FAST may have no clinical significance. The objectives of this study are to estimate associations between false-negative FAST results and patient characteristics, specific abdominal organ injuries, and patient outcomes.This was a retrospective cohort study including consecutive patients who presented to an urban Level I trauma center between July 2005 and December 2008 with blunt abdominal trauma, a documented FAST, and pathologic free fluid as determined by computed tomography, diagnostic peritoneal lavage, laparotomy, or autopsy. Physicians blinded to the study purpose used standardized abstraction methods to confirm FAST results and the presence of pathologic free fluid. Multivariable modeling was used to assess associations between potential predictors of a false-negative FAST result and false-negative FAST result and adverse outcomes.During the study period, 332 patients met inclusion criteria. Median age was 32 years (interquartile range 23 to 45 years), 67% were male patients, the median Injury Severity Score was 27 (interquartile range 17 to 41), and 162 (49%) had a false-negative FAST result. Head injury was positively associated with false-negative FAST result (odds ratio [OR] 4.9; 95% confidence interval [CI] 1.5 to 15.7), whereas severe abdominal injury was negatively associated (OR 0.3; 95% CI 0.1 to 0.5). Injuries to the spleen (OR 0.4; 95% CI 0.24 to 0.66), liver (OR 0.36; 95% CI 0.21 to 0.61), and abdominal vasculature (OR 0.17; 95% CI 0.07 to 0.38) were also negatively associated with false-negative FAST result. False-negative FAST result was not associated with mortality (OR 0.89; 95% CI 0.42 to 1.9), prolonged ICU length of stay (relative risk 0.88; 95% CI 0.69 to 1.12), or total hospital length of stay (relative risk 0.92; 95% CI 0.76 to 1.12). However, patients with false-negative FAST results were substantially less likely to require therapeutic laparotomy (OR 0.31; 95% CI 0.19 to 0.52).Patients with severe head injuries and minor abdominal injuries were more likely to have a false-negative than true-positive FAST result. On the other hand, patients with spleen, liver, or abdominal vascular injuries are less likely to have false-negative FAST examination results. Adverse outcomes were not associated with false-negative FAST examination results, and in fact patients with false-negative FAST result were less likely to have a therapeutic laparotomy. Further studies are needed to assess the strength of these findings.

  View details for DOI 10.1016/j.annemergmed.2012.01.023

  View details for Web of Science ID 000308620500014

  View details for PubMedID 22512989

• Completed suicides in Colorado: differences between Hispanics and non-Hispanic Whites. Suicide & life-threatening behavior Betz, M. E., Krzyzaniak, S. M., Hedegaard, H., Lowenstein, S. R. 2011; 41 (4): 445-52

  Abstract

  All suicides by Hispanics (n = 434) and non-Hispanic Whites (n = 3,370) in Colorado from 2004 to 2008 using the Violent Death Reporting System were examined. Hispanic victims were significantly younger. Adjusting for age and gender, Hispanic victims were less likely to have reported depressed mood [odds ratio (OR) 0.78; 95% confidence interval (CI) 0.63-0.97], mental health diagnosis (OR 0.53; 95% CI 0.41-0.7), or current psychiatric treatment (OR 0.47; 95% CI 0.43-0.77). There were no differences in reports of financial, relationship, job, or legal stresses. Hispanic suicides were equally likely to be by overdose, firearm, or hanging, but more likely to be in jail (OR 2.68; 95% CI 1.55-4.65). To prevent suicides, stronger partnerships are needed among public health, medical, mental health, and criminal justice professionals.

  View details for DOI 10.1111/j.1943-278X.2011.00044.x

  View details for PubMedID 21631574