Constructing a Shared Mental Model for Faculty Development for the Core Entrustable Professional Activities for Entering Residency

In 2014, the Association of American Medical Colleges identified 13 Core Entrustable Professional Activities for Entering Residency (Core EPAs), which are activities that entering residents might be expected to perform without direct supervision. This work included the creation of an interinstitutional concept group focused on faculty development efforts, as the processes and tools for teaching and assessing entrustability in undergraduate medical education (UME) are still evolving. In this article, the authors describe a conceptual framework for entrustment that they developed to better prepare all educators involved in entrustment decision making in UME. This framework applies to faculty with limited or longitudinal contact with medical students and to those who contribute to entrustment development or render summative entrustment decisions.The authors describe a shared mental model for entrustment that they developed, based on a critical synthesis of the EPA literature, to serve as a guide for UME faculty development efforts. This model includes four dimensions for Core EPA faculty development: (1) observation skills in authentic settings (workplace-based assessments), (2) coaching and feedback skills, (3) self-assessment and reflection skills, and (4) peer guidance skills developed through a community of practice. These dimensions form a conceptual foundation for meaningful faculty participation in entrustment decision making.The authors also differentiate between the UME learning environment and the graduate medical education learning environment to highlight distinct challenges and opportunities for faculty development in UME settings. They conclude with recommendations and research questions for future Core EPA faculty development efforts.

Curated Collections for Educators: Five Key Papers about Program Evaluation

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.

Academic Primer Series: Key Papers About Peer Review

Introduction

Peer review, a cornerstone of academia, promotes rigor and relevance in scientific publishing. As educators are encouraged to adopt a more scholarly approach to medical education, peer review is becoming increasingly important. Junior educators both receive the reviews of their peers, and are also asked to participate as reviewers themselves. As such, it is imperative for junior clinician educators to be well-versed in the art of peer reviewing their colleagues’ work. In this article, our goal was to identify and summarize key papers that may be helpful for faculty members interested in learning more about the peer-review process and how to improve their reviewing skills.

Methods

The online discussions of the 2016–17 Academic Life in Emergency Medicine (ALiEM) Faculty Incubator program included a robust discussion about peer review, which highlighted a number of papers on that topic. We sought to augment this list with further suggestions by guest experts and by an open call on Twitter for other important papers. Via this process, we created a list of 24 total papers on the topic of peer review. After gathering these papers, our authorship group engaged in a consensus-building process incorporating Delphi methods to identify the papers that best described peer review, and also highlighted important tips for new reviewers.

Results

We found and reviewed 24 papers. In our results section, we present our authorship group’s top five most highly rated papers on the topic of peer review. We also summarize these papers with respect to their relevance to junior faculty members and to faculty developers.

Conclusion

We present five key papers on peer review that can be used for faculty development for novice writers and reviewers. These papers represent a mix of foundational and explanatory papers that may provide some basis from which junior faculty members might build upon as they both undergo the peer-review process and act as reviewers in turn.

Telesimulation: An Innovative Tool for Health Professions Education

Telesimulation is a new and innovative concept and process that has been used to provide education, training, and assessment in health-related fields such as medicine. This new area of simulation, and its terminology, has its origins within the past decade. The face validity and ability to provide the benefits of simulation education to learners at off-site locations has allowed the wide and rapid adoption of telesimulation in the field of medical education. Telesimulation has been implemented in areas such as pediatric resuscitation, surgery, emergency medicine, ultrasound-guided regional anesthesia in anesthesiology, nursing, and neurosurgery. However, its rapid expansion and current use has outgrown its recent description less than a decade ago. To date, there is no unifying definition of telesimulation that encompasses all the areas where it has been used while simultaneously allowing for growth and expansion in this field of study. This article has two main objectives. The first objective is to provide a comprehensive and unifying definition of telesimulation that encompasses all the areas where it has been used while allowing for growth and expansion in the field of study. The secondary objective is to describe the utility of telesimulation for emergency medicine educators in the context of the current evidence to serve as a background and framework that educators may use when considering creating educational programs that incorporate telecommunication and simulation resources. This article is complementary to the large group presentation where this new comprehensive and unifying definition was introduced to the simulation community at the International Meeting on Simulation in Healthcare in January 2016.

Feedback in Medical Education: A Critical Appraisal

OBJECTIVE

The objective was to review and critically appraise the medical education literature pertaining to feedback and highlight influential papers that inform our current understanding of the role of feedback in medical education.

METHODS

A search of the English language literature in querying Education Resources Information Center (ERIC), PsychINFO, PubMed, and Scopus identified 327 feedback-related papers using either quantitative (hypothesis-testing or observational investigations of educational interventions), qualitative methods (exploring important phenomena in emergency medicine [EM] education), or review methods.Two reviewers independently screened each category of publications using previously established exclusion criteria. Six reviewers then independently scored the remaining 54 publications using a qualitative, quantitative, or review paper scoring system. Each scoring system consisted of nine criteria and used parallel scoring metrics that have been previously used in critical appraisals of education research.

RESULTS

Fifty-four feedback papers (25 quantitative studies, 24 qualitative studies, five review papers) met the a priori criteria for inclusion and were reviewed. Eight quantitative studies, nine qualitative studies, and three review papers were ranked highly by the reviewers and are summarized in this article.

CONCLUSIONS

This inaugural Council of Emergency Medicine Residency Directors Academy critical appraisal highlights 20 feedback in medical education papers that describe the current state of the feedback literature. A summary of current factors that influence feedback effectiveness is discussed, along with practical implications for EM educators and the next steps for research.

Do Emergency Medicine Residency Graduates Feel Prepared to Manage Closed Fractures After Training?

OBJECTIVES

Fractures comprise 3% of all emergency department (ED) visits. Although emergency physicians are often responsible for managing most of the initial care of these patients, many report a lack of proficiency and comfort with these skills. The primary objective was to assess how prepared recent emergency medicine (EM) residency graduates felt managing closed fractures upon completion of residency. Secondary objectives included whether residency training or independent practice contributed most to the current level of comfort with these procedures and which fractures were most commonly reduced without orthopedic consultation.

METHODS

An anonymous online survey was sent to graduates from seven EM residency programs over a 3-month period to evaluate closed fracture reduction training, practice, and comfort level. Each site primary investigator invited graduates from 2010 to 2014 to participate and followed a set schedule of reminders.

RESULTS

The response rate was 287/384 (74.7%) and included 3-year (198/287, 69%) and 4-year (89/287, 31%) programs. Practice in community, academic, and hybrid ED settings was reported by 150/287 (52.3%), 64/287 (22.3%), and 73/287 (25.4%), respectively. It was indicated by 137/287 (47.7%) that they reduce closed fractures without a bedside orthopedic consultation greater than 75% of the time. The majority of graduates felt not at all prepared (35/287, 12.2%) or somewhat prepared (126/287, 43.9%) upon residency graduation. Postresidency independent practice contributed most to the current level of comfort for 156/287 (54.4%). The most common fractures requiring reduction were wrist/distal radius and/or ulna, next finger/hand, and finally, ankle/distal tibia and/or fibula.

CONCLUSIONS

Although most recent graduates feel at least "somewhat" prepared to manage closed fractures in the ED, most felt that independent practice was a greater contributor to their current level of comfort than residency training. Recent graduates indicate that fracture reduction without orthopedic consultation is common in today's clinical practice. This survey identifies common fractures requiring reduction which EM residencies may wish to consider prioritizing in their emergency orthopedic curricula to better prepare their residents for independent clinical practice.

Exploring Scholarship and the Emergency Medicine Educator: A Workforce Study

INTRODUCTION

Recent literature calls for initiatives to improve the quality of education studies and support faculty in approaching educational problems in a scholarly manner. Understanding the emergency medicine (EM) educator workforce is a crucial precursor to developing policies to support educators and promote education scholarship in EM. This study aims to illuminate the current workforce model for the academic EM educator.

METHODS

Program leadership at EM training programs completed an online survey consisting of multiple choice, completion, and free-response type items. We calculated and reported descriptive statistics.

RESULTS

112 programs participated. Mean number of core faculty/program: 16.02 ± 7.83 [14.53-17.5]. Mean number of faculty full-time equivalents (FTEs)/program dedicated to education is 6.92 ± 4.92 [5.87-7.98], including (mean FTE): Vice chair for education (0.25); director of medical education (0.13); education fellowship director (0.2); residency program director (0.83); associate residency director (0.94); assistant residency director (1.1); medical student clerkship director (0.8); assistant/associate clerkship director (0.28); simulation fellowship director (0.11); simulation director (0.42); director of faculty development (0.13). Mean number of FTEs/program for education administrative support is 2.34 ± 1.1 [2.13-2.61]. Determination of clinical hours varied; 38.75% of programs had personnel with education research expertise.

CONCLUSION

Education faculty represent about 43% of the core faculty workforce. Many programs do not have the full spectrum of education leadership roles and educational faculty divide their time among multiple important academic roles. Clinical requirements vary. Many departments lack personnel with expertise in education research. This information may inform interventions to promote education scholarship.

Creating a Cadre of Fellowship-Trained Medical Educators: A Qualitative Study of Faculty Development Program Leaders' Perspectives and Advice

PURPOSE

Well-trained educators fill essential roles across the medical education continuum. Some medical schools offer programs for existing faculty to enhance teaching and scholarship. No standard postgraduate training model exists for residency graduates to attain competency as faculty members before their first academic appointment. The objective of this study is to inform the development of postgraduate medical education fellowships by exploring perceptions of educational leaders who direct well-established faculty development programs.

METHOD

The authors undertook a qualitative study, using purposeful sampling to recruit participants and a constant comparative approach to identify themes. They conducted semistructured telephone interviews with directors of faculty development fellowships using an interpretivist/constructivist paradigm (November 2013). Questions addressed curricular and fiscal structure, perceived benefits and challenges, and advice for starting a postgraduate fellowship.

RESULTS

Directors reported institutional and participant benefits, notably the creation of a community of educators and pool of potential leaders. Curricular offerings focused on learning theory, teaching, assessment, leadership, and scholarship. Funding and protected time were challenges. Advice for new program directors included evaluating best practices, defining locally relevant goals; garnering sufficient, stable financial support; and rallying leaders' endorsement.

CONCLUSIONS

Medical education fellowships cultivate leaders and communities of trained educators but require participants to balance faculty responsibilities with professional development. Advice of current directors can inform the development of postgraduate programs modeled after accredited clinical specialty fellowships. Programs with the support of strategic partners, financial stability, and well-defined goals may allow new faculty to begin their careers with existing competency in medical education skills.

Development and implementation of an asynchronous emergency medicine residency curriculum using a web-based platform

The Residency Review Committee in Emergency Medicine requires residency programs to deliver at least 5 hours of weekly didactics. Achieving at least a 70 % average attendance rate per resident is required for residency program accreditation, and is used as a benchmark for residency graduation in our program. We developed a web-based, asynchronous curriculum to replace 1 hour of synchronous didactics, and hypothesized that the curriculum would be feasible to implement, well received by learners, and improve conference participation. This paper describes the feasibility and learner acceptability of a longitudinal asynchronous curriculum, and describes its impact on postgraduate year-1(PGY-1) resident conference participation and annual in-training examination scores. Using formal curriculum design methods, we developed modules and paired assessment exercises to replace 1 hour of weekly didactics. We measured feasibility (development and implementation time and costs) and learner acceptability (measured on an anonymous survey). We compared pre- and post-intervention conference participation and in-service training examination scores using a two sample t test. The asynchronous curriculum proved feasible to develop and implement. PGY-1 resident conference participation improved compared to the pre-intervention year (85.6 vs. 62 %; 95 % CI 0.295-0.177; p < 0.001). We are unable to detect a difference between in-training examination results in either the PGY-1 group or across all residents by the introduction of this intervention. 18/31 (58 %) residents completed the post-intervention survey. 83 % reported satisfaction with curriculum changes. Strengths of the curriculum included clarity and timeliness of assignments. Weaknesses included technical difficulties with the online platform. Our curriculum is feasible to develop and implement. Despite technical difficulties, residents report high satisfaction with this new curriculum. Among PGY-1 residents there is improved conference participation compared to the prior year.

Residency Applicant Preferences of Online Systems for Scheduling Interviews

BACKGROUND

Residency applicants often have difficulty coordinating interviews with multiple programs. An online scheduling system might improve this process.

OBJECTIVE

The authors sought to determine applicant mean time to schedule interviews and satisfaction using online scheduling compared with manual scheduling.

METHODS

An electronic survey was sent to US graduates applying to any of 6 emergency medicine programs in the 2014-2015 application cycle. Of the participant programs, 3 used an online system and 3 did not. Applicants were asked to report estimated time to schedule with the online system compared to their average time using other methods, and to rate their satisfaction with the scheduling process.

RESULTS

Of 1720 applicants to at least 1 of the 6 programs, 856 completed the survey (49.8%). Respondents reported spending less time scheduling interviews using the online system compared to other systems (median of 5 minutes [IQR 3-10] versus 60 minutes [IQR 15-240], respectively, P < .0001). In addition, applicants preferred using the online system (93.6% versus 1.4%, P < .0001.) Applicants were also more satisfied with the ease of scheduling their interviews using the online system (91.5% versus 11.0%, P < .0001) and felt that the online system aided them in coordinating travel arrangements (74.7% versus 41.5%, P < .01.).

CONCLUSIONS

An online interview scheduling system is associated with time savings for applicants as well as higher satisfaction among applicants, both in ease of scheduling and in coordinating travel arrangements. The results likely are generalizable to other medical and surgical specialties.

Adapting the I-PASS Handoff Program for Emergency Department Inter-Shift Handoffs

INTRODUCTION

Academic emergency department (ED) handoffs are high-risk transfer of care events. Emergency medicine residents are inadequately trained to handle these vital transitions. We aimed to explore what modifications the I-PASS (illness severity, patient summary, action list, situation awareness and contingency plans, and synthesis by receiver) handoff system requires to be effectively modified for use in ED inter-shift handoffs.

METHODS

This mixed-method needs assessment conducted at an academic ED explored the suitability of the I-PASS system for ED handoffs. We conducted a literature review, focus groups, and then a survey. We sought to identify the distinctive elements of ED handoffs and discern how these could be incorporated into the I-PASS system.

RESULTS

Focus group participants agreed the patient summary should be adapted to include anticipated disposition of patient. Participants generally endorsed the order and content of the other elements of the I-PASS tool. The survey yielded several wording changes to reflect contextual differences. Themes from all qualitative sources converged to suggest changes for brevity and clarity. Most participants agreed that the I-PASS tool would be well suited to the ED setting.

CONCLUSION

With modifications for context, brevity, and clarity, the I-PASS system may be well suited for application to the ED setting. This study provides qualitative data in support of using the I-PASS tool and concrete suggestions for how to modify the I-PASS tool for the ED. Implementation and outcome research is needed to investigate if the I-PASS tool is feasible and improves patient outcomes in the ED environment.

Academic Primer Series: Five Key Papers Fostering Educational Scholarship in Junior Academic Faculty

INTRODUCTION

Scholarship is an essential part of academic success. Junior faculty members are often unfamiliar with the grounding literature that defines educational scholarship. In this article, the authors aim to summarize five key papers which outline education scholarship in the setting of academic contributions for emerging clinician educators.

METHODS

The authors conducted a consensus-building process to generate a list of key papers that describe the importance and significance of academic scholarship, informed by social media sources. They then used a three-round voting methodology, akin to a Delphi study, to determine the most useful papers.

RESULTS

A summary of the five most important papers on the topic of academic scholarship, as determined by this mixed group of junior faculty members and faculty developers, is presented in this paper. These authors subsequently wrote a summary of these five papers and discussed their relevance to both junior faculty members and faculty developers.

CONCLUSION

Five papers on education scholarship, deemed essential by the authors' consensus process, are presented in this paper. These papers may help provide the foundational background to help junior faculty members gain a grasp of the academic scholarly environment. This list may also inform senior faculty and faculty developers on the needs of junior educators in the nascent stages of their careers.

Approved Instructional Resources Series: A National Initiative to Identify Quality Emergency Medicine Blog and Podcast Content for Resident Education

Background Emergency medicine (EM) residency programs can provide up to 20% of their planned didactic experiences asynchronously through the Individualized Interactive Instruction (III) initiative. Although blogs and podcasts provide potential material for III content, programs often struggle with identifying quality online content. Objective To develop and implement a process to curate quality EM content on blogs and podcasts for resident education and III credit. Methods We developed the Approved Instructional Resources (AIR) Series on the Academic Life in Emergency Medicine website. Monthly, an editorial board identifies, peer reviews, and writes assessment questions for high-quality blog/podcast content. Eight educators rate each post using a standardized scoring instrument. Posts scoring ≥ 30 of 35 points are awarded an AIR badge and featured in the series. Enrolled residents can complete an assessment quiz for III credit. After 12 months of implementation, we report on program feasibility, enrollment rate, web analytics, and resident satisfaction scores. Results As of June 2015, 65 EM residency programs are enrolled in the AIR Series, and 2140 AIR quizzes have been completed. A total of 96% (2064 of 2140) of participants agree or strongly agree that the activity would improve their clinical competency, 98% (2098 of 2140) plan to use the AIR Series for III credit, and 97% (2077 of 2140) plan to use it again in the future. Conclusions The AIR Series is a national asynchronous EM curriculum featuring quality blogs and podcasts. It uses a national expert panel and novel scoring instrument to peer review web-based educational resources.

A Novel Specialty-Specific, Collaborative Faculty Development Opportunity in Education Research: Program Evaluation at Five Years

PURPOSE

For the busy clinician-educator, accessing opportunities that develop the skills and knowledge necessary to perform education research can be problematic. The Medical Education Research Certification at Council of Emergency Medicine Residency Directors (MERC at CORD) Scholars' Program is a potential alternative. The current study evaluates the program's outcomes after five years.

METHOD

The authors employed a quasi-experimental design in this study. The study population consisted of the initial five MERC at CORD cohorts (2009-2013). Development of a logic model informed Kirkpatrick-level outcomes. Data from annual pre/post surveys, an alumni survey (2014), and tracking of national presentations/peer-reviewed publications resulting from program projects served as outcome measurements.

RESULTS

Over the first five years, 149 physicians participated in the program; 97 have completed six MERC workshops, and 63 have authored a national presentation and 30 a peer-reviewed publication based on program projects. Of the 79 participants responding to the pre- and postsurveys from the 2011-2013 cohorts, 65 (82%) reported significant improvement in skills and knowledge related to education research and would recommend the program. Of the 61 graduates completing the alumni survey, 58 (95%) indicated their new knowledge was instrumental beyond educational research, including promotion to new leadership positions, and 28 (47% of the 60 responding) reported initiating a subsequent multi-institutional education study. Of these, 57% (16/28) collaborated with one or more peers/mentors from their original program project.

CONCLUSIONS

Kirkpatrick-level outcomes 1, 2, 3, and perhaps 4 demonstrate that the MERC at CORD program is successful in its intended purpose.

Critical Appraisal of Emergency Medicine Education Research: The Best Publications of 2014

OBJECTIVES

The objective was to critically appraise and highlight rigorous education research study articles published in 2014 whose outcomes advance the science of emergency medicine (EM) education.

METHODS

A search of the English language literature in 2014 querying Education Resources Information Center (ERIC), PsychINFO, PubMed, and Scopus identified 243 EM-related articles using either quantitative (hypothesis-testing or observational investigations of educational interventions) or qualitative (exploring important phenomena in EM education) methods. Two reviewers independently screened all of the publications using previously established exclusion criteria. Six reviewers then independently scored the 25 selected publications using either a qualitative or a quantitative scoring system. Each scoring system consisted of nine criteria. Selected criteria were based on accepted educational review literature and chosen a priori. Both scoring systems use parallel scoring metrics and have been used previously within this annual review.

RESULTS

Twenty-five medical education research papers (22 quantitative, three qualitative) met the criteria for inclusion and were reviewed. Five quantitative and two qualitative studies were ranked most highly by the reviewers as exemplary and are summarized in this article.

CONCLUSIONS

This annual critical appraisal series highlights seven excellent EM education research studies, meeting a priori criteria and published in 2014. Methodologic strengths in the 2014 papers are noted, and current trends in medical education research in EM are discussed.

Teaching and Assessing ED Handoffs: A Qualitative Study Exploring Resident, Attending, and Nurse Perceptions

INTRODUCTION

The Accreditation Council for Graduate Medical Education requires that residency programs ensure resident competency in performing safe, effective handoffs. Understanding resident, attending, and nurse perceptions of the key elements of a safe and effective emergency department (ED) handoff is a crucial step to developing feasible, acceptable educational interventions to teach and assess this fundamental competency. The aim of our study was to identify the essential themes of ED-based handoffs and to explore the key cultural and interprofessional themes that may be barriers to developing and implementing successful ED-based educational handoff interventions.

METHODS

Using a grounded theory approach and constructivist/interpretivist research paradigm, we analyzed data from three primary and one confirmatory focus groups (FGs) at an urban, academic ED. FG protocols were developed using open-ended questions that sought to understand what participants felt were the crucial elements of ED handoffs. ED residents, attendings, a physician assistant, and nurses participated in the FGs. FGs were observed, hand-transcribed, audio-recorded and subsequently transcribed. We analyzed data using an iterative process of theme and subtheme identification. Saturation was reached during the third FG, and the fourth confirmatory group reinforced the identified themes. Two team members analyzed the transcripts separately and identified the same major themes.

RESULTS

ED providers identified that crucial elements of ED handoff include the following: 1) Culture (provider buy-in, openness to change, shared expectations of sign-out goals); 2) Time (brevity, interruptions, waiting); 3) Environment (physical location, ED factors); 4) Process (standardization, information order, tools).

CONCLUSION

Key participants in the ED handoff process perceive that the crucial elements of intershift handoffs involve the themes of culture, time, environment, and process. Attention to these themes may improve the feasibility and acceptance of educational interventions that aim to teach and assess handoff competency.

An Extended Validity Argument for Assessing Feedback Culture

NEGEA 2015 CONFERENCE ABSTRACT (EDITED): Measuring an Organization's Culture of Feedback: Can It Be Done? Steven Rougas and Brian Clyne. CONSTRUCT: This study sought to develop a construct for measuring formative feedback culture in an academic emergency medicine department. Four archetypes (Market, Adhocracy, Clan, Hierarchy) reflecting an organization's values with respect to focus (internal vs. external) and process (flexibility vs. stability and control) were used to characterize one department's receptiveness to formative feedback. The prevalence of residents' identification with certain archetypes served as an indicator of the department's organizational feedback culture.

BACKGROUND

New regulations have forced academic institutions to implement wide-ranging changes to accommodate competency-based milestones and their assessment. These changes challenge residencies that use formative feedback from faculty as a major source of data for determining training advancement. Though various approaches have been taken to improve formative feedback to residents, there currently exists no tool to objectively measure the organizational culture that surrounds this process. Assessing organizational culture, commonly used in the business sector to represent organizational health, may help residency directors gauge their program's success in fostering formative feedback. The Organizational Culture Assessment Instrument (OCAI) is widely used, extensively validated, applicable to survey research, and theoretically based and may be modifiable to assess formative feedback culture in the emergency department.

APPROACH

Using a modified Delphi technique and several iterations of focus groups amongst educators at one institution, four of the original six OCAI domains (which each contain 4 possible responses) were modified to create a 16-item Formative Feedback Culture Tool (FFCT) that was administered to 26 residents (response rate = 55%) at a single academic emergency medicine department. The mean score of each item on the FFCT (range = 0-100) was analyzed. Convergent and divergent properties of the four archetypes were assessed using a multitrait-multimethod matrix of Pearson's coefficients. Expecting that items in one archetype would diverge from the others, whereas items within an archetype should have strong convergent properties, convergent validity was assessed by comparing items across domains that all related to the same archetype. Similarly, divergent validity was assessed by comparing the correlation of items within an archetype to the correlations of those items within a hetero-domain block (i.e., to other items within the same domain).

RESULTS

Three of the four domains of the FFCT (Overall Departmental Characteristics 35.4 ± 15.4, Departmental Foundation of Feedback 46.1 ± 16.7, and Departmental Emphasis of Feedback 30.3 ± 17.7) had the highest mean in the Market archetype (results/achievement oriented), whereas the final domain (Departmental Definition of Successful Feedback 34.8 ± 22.1) had the highest mean in the Clan archetype (personal growth/team achievement). Item responses in the Clan and Hierarchy archetypes had the strongest convergent and divergent validity, respectively. Item responses in the Adhocracy archetype had the weakest convergent and divergent validity.

CONCLUSIONS

Although the sample size was small, this initial study demonstrates that a modified organizational culture assessment tool can feasibly be utilized to identify the primary formative feedback archetype of a cohort of residents. This may have future implications for measuring changes in culture after the implementation of strategic programs to address formative feedback. Future studies should examine the generalizability of the FFCT to other institutions, as well as address the weak validity evidence of the Adhocracy archetype in the FFCT.

Educating Emergency Medicine Residents in Emergency Department Administration and Operations: Needs and Current Practice

BACKGROUND

Emergency medicine (EM) residents are expected to develop competence in emergency department (ED) administration and operations.

OBJECTIVES

We assessed current needs and educational practices related to preparing EM residents for their role in ED operations, and explored whether there was an association between program characteristics and the presence of ED operations education in US EM residency programs.

METHODS

We conducted a cross-sectional needs assessment, using a web-based survey sent to all US EM residency programs to assess program characteristics, provision of ED operations-related lectures, availability of an ED administrative fellowship, and presence of a formal ED operations curriculum. Logistic regression was used to determine if any program characteristics were associated with the presence of lectures and a formal operations curriculum.

RESULTS

Of the 158 Accreditation Council for Graduate Medical Education-accredited EM programs, 117 (74%) responded. Of these, 109 (93%) respondents had at least 1 lecture on ED operational topics. Sixty programs (54%) measured resident productivity. Knowledge of Centers for Medicaid & Medicare Services reimbursement guidelines was significantly positively associated with presence of an ED operations curriculum (OR, 3.52, P  =  .009) and with lectures on patient satisfaction (OR, 3.99, P  =  .006). Measuring resident productivity was positively associated with having lectures on productivity (OR, 2.50, P  =  .02) and with ED throughput (OR, 2.32, P  =  .03). No 2 variables were simultaneously significant in the model.

CONCLUSIONS

Most EM programs had at least 1 lecture on ED operations topics. Roughly half of the programs measured resident productivity and half had a formal ED operations curriculum.