Identifying the Emergency Medicine Personality: A Multisite Exploratory Pilot Study

Differences in emergency medicine resident procedural reporting by race and ethnicity

Background

The recruitment, retention, and training of physicians from groups underrepresented in medicine (UiM) is critically important to the practice of emergency medicine (EM). Studies across specialties have demonstrated disparities in operative experiences among UiM resident learners who are UiM; however, there are limited data on procedural disparities in EM.

Objective

We sought to quantify the association between racial and ethnic identities that are UiM and the number of procedures reported among EM residents.

Methods

We conducted a retrospective review of procedural differences by UiM status (using self-identified race and ethnicity) among graduating EM residents at nine training programs over a 10-year period. Sites were selected to ensure diversity of program length, program type, and geography. Data from residents in combined training programs, those who did not complete their full training at that institution, and those with missing data or electing not to report race/ethnicity were excluded. We calculated median and interquartile ranges for each procedure by UiM status. We conducted multivariable regression analyses accounting for UiM status, gender, and site as well as a sensitivity analysis excluding values >3 standard deviations from the mean for each procedure.

Results

We collected data from 988 total residents, with 718 (73%) being non-UiM, 204 (21%) being UiM, 48 (5%) electing not to specific race/ethnicity, and 18 (2%) missing race/ethnicity data. While unadjusted data demonstrated a difference between UiM and non-UiM resident numbers across several procedures, there were no significant differences in procedures reported after accounting for gender and site in the primary or sensitivity analyses.

Conclusions

We did not identify a statistically significant difference in reported procedures between UiM and non-UiM residents in EM. Future work should include qualitative investigations of UiM resident experience surrounding procedures as well as mixed-methods studies to examine how these data interact.

The Standardized Letter of Evaluation: How We Perceive the Quiet Student

INTRODUCTION

The Standardized Letter of Evaluation (SLOE) is an emergency medicine (EM)-specific assessment designed to help EM residency programs differentiate applicants. We became interested in SLOE-narrative language referencing personality when we observed less enthusiasm for applicants described as "quiet" in their SLOEs. In this study our objective was to compare how quiet-labeled, EM-bound applicants were ranked compared to their non-quiet peers in the global assessment (GA) and anticipated rank list (ARL) categories in the SLOE.

METHODS

We conducted a planned subgroup analysis of a retrospective cohort study of all core EM clerkship SLOEs submitted to one, four-year academic EM residency program in the 2016-2017 recruitment cycle. We compared SLOEs of applicants who were described as "quiet," "shy," and/or "reserved" - collectively referred to as "quiet" - to SLOEs from all other applicants, referred to as "non-quiet." We compared frequencies of quiet to non-quiet students in GA and ARL categories using chi-square goodness-of-fit tests with a rejection criteria (alpha) of 0.05.

RESULTS

We reviewed 1,582 SLOEs from 696 applicants. Of these, 120 SLOEs described quiet applicants. The distributions of quiet and non-quiet applicants across GA and ARL categories were significantly different (P < 0.001). Quiet applicants were less likely than non-quiet applicants to be ranked in the top 10% and top one-third GA categories combined (31% vs 60%) and more likely to be in the middle one-third category (58% vs 32%). For ARL, quiet applicants were also less likely to be ranked in the top 10% and top one-third categories combined (33% vs 58%) and more likely to be in the middle one-third category (50% vs 31%).

CONCLUSION

Emergency medicine-bound students described as quiet in their SLOEs were less likely to be ranked in the top GA and ARL categories compared to non-quiet students. More research is needed to determine the cause of these ranking disparities and address potential biases in teaching and assessment practices.

Personality predictors of emergency department post-discharge outcomes

Personality traits are important predictors of health behaviors, healthcare utilization, and health outcomes. However, we know little about the role of personality traits for emergency department outcomes. The present study used data from 200 patients (effective Ns range from 84 to 191), who were being discharged from the emergency department at an urban hospital, to investigate whether the Big Five personality traits were associated with post-discharge outcomes (i.e., filling prescriptions, following up with primary care physician, making an unscheduled return to the emergency department). Using logistic regression, we found few associations among the broad Big Five domains and post-discharge outcomes. However, results showed statistically significant associations between specific Big Five items (e.g., “responsible”) and the three post-discharge outcomes. This study demonstrates the feasibility of assessing personality traits in an emergency medicine setting and highlights the utility of having information about patients’ personality tendencies for predicting post-discharge compliance.

Personality Traits and the Sense of Self-Efficacy among Nurse Anaesthetists. Multi-Centre Questionnaire Survey

Introduction: Anaesthesia and intensive care units are specific workplaces. The purpose of this study was to evaluate the level of the sense of self-efficacy and the intensification of personality traits in a group of nurse anaesthetists and to develop a regression model explaining the sense of self-efficacy. Method: The population of the questionnaire survey included nurse anaesthetists from five hospitals in south-eastern Poland. The NEO-FFI was used in assessing their personality traits. The general self-efficacy scale was employed for the self-efficacy assessment. A total of 143 correctly filled surveys were analyzed. Results: The respondents typically perceived their own self-efficacy level as upper moderate. The nurse anaesthetists participating in the study revealed a tendency to high scores in conscientiousness and extraversion, and low scores related to neuroticism. The persons characterized by high conscientiousness, extraversion and openness to experience revealed a tendency to high scores related to the sense of self-efficacy. The relationship between personality traits and experiencing the nuisance of selected stressful job factors was demonstrated. Regression analysis showed that conscientiousness and extraversion are most closely related to the sense of self-efficacy. Conclusions: It seems to be beneficial to implement occupational consulting for nurses, who are starting their work or/and taking into consideration working in anesthesiology and intensive care units. The importance of personality traits and self- efficacy in relation with well-being of medical personnel needs deeper investigations.

The Use of Personality Assessment in Mentoring and to Aid in Self-reflection in Orthopaedic Surgery Residency Programs

Personality plays an important role in performance in medical education and mentorship. Personality assessment can aid in the ability to identify strengths and areas for development by understanding how one's personality influences their learning and interpersonal relationships. We sought to evaluate personality assessment as an effective tool in mentoring during orthopaedic residency in this prospective, cross-sectional study from two orthopaedic surgery residency programs using the Hogan Personality Inventory (HPI). Participants completed a survey regarding their experience with the assessment. Descriptive statistics were calculated, and two-sample t-tests were used to examine differences between groups. In total, thirty-four individuals completed the survey. Our results showed 82.4% reported that the HPI very accurately represented them and 58.8% reported better understanding potentially perceived strengths and weaknesses. In total, 75.7% and 72.7% were satisfied with their mentorship about development as a clinician and researcher, respectively. Significant differences were seen between participants who did and did not re-review their results, and participants who did and did-not believe their results profile was accurate. We conclude that personality assessments can be valuable in promoting introspection and strengthening relationships within orthopaedic surgery, particularly when they are valued and emphasized by the user. Our results suggest that use of the HPI provided participants with a better understanding of their perceived strengths and weaknesses as they progress through their orthopaedic residency training.

Assessment of physicians' resilience level during the COVID-19 pandemic

We aim to assess physicians' level of resilience and define factors that improve or decrease the resilience level during the COVID-19 pandemic. Physicians from hospitals located in areas with different COVID-19 caseload levels, were invited to participate in a national e-survey between April and May 2020. Study participants were mainly emergency physicians, and anaesthesiologists, infectious disease consultants, and intensive care. The survey assessed participant's characteristics, factors potentially associated with resilience, and resilience using the Connor-Davidson Resilience Scale (RISC-25), with higher scores indicative of greater resilience. Factors associated with the resilience score were assessed using a multivariable linear regression. Of 451 responding physicians involved in the care of COVID-19 patients, 442 were included (98%). Age was 36.1 ± 10.3 years and 51.8% were male; 63% worked in the emergency department (n = 282), 10.4% in anesthesiology (n = 46), 9.9% in infectious disease department (n = 44), 4.8% in intensive care unit (n = 21) or other specialties (n = 49). The median RISC-25 score was at 69 (IQR 62-75). Factors associated with higher RISC scores were anesthesia as a specialty, parenthood, no previous history of anxiety or depression and nor increased anxiety. To conclude, this study is the first to characterize levels of resilience among physicians involved in COVID-19 unit. Our data points to certain protective characteristics and some detrimental factors, such as anxiety or depression, that could be amenable to remediating or preventing strategies to promote resilience and support caregivers in a pandemic.

Reimagining Residency Selection: Part 3-A Practical Guide to Ranking Applicants in the Post-COVID-19 Era

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Lessons Learned in Teaching Battlefield (Ear) Acupuncture to Emergency Medicine Clinicians

Background: Acupuncture, in general, is being proclaimed as an alternative analgesic amid the opioid crisis, and along with this, within emergency departments (EDs) there is a specific interest in a form of ear acupuncture called Battlefield Acupuncture (BFA). It is expected that BFA will be used more widely in emergency medicine as it is easy to learn and can be applied both promptly and easily. Teaching programs will be required to sustain this increased demand and upskill emergency clinicians in this skill. Objectives: This article provides experiences and recommendations, based on faculty experiences from teaching BFA in Australia to ED clinicians combined with formal participant feedback. Main Points: BFA courses were adjusted to suit ED doctors and nurses, along with their unique case mix and associated challenging environment. The content of the BFA courses included evidence, pain indications, contraindications, application, safety, mechanism of action, and how to negotiate barriers of credentialing. Workshops used the latest and most effective teaching methods that encompassed problem-based learning, infotainment, simulation, "four stage skills teaching," and "teaching on the run." Conclusion: It is hoped that the experiences gained, and lessons learned in educating this new frontier of BFA to emergency clinicians will assist others in teaching BFA and its related techniques as a viable analgesic alternative in emergency medicine.

Maggots, Mucous and Monkey Meat: Does Disgust Sensitivity Affect Case Mix Seen During Residency?

Introduction

Emergency physicians encounter scenarios daily that many would consider “disgusting,” including exposure to blood, pus, and stool. Physicians in procedural specialties such as surgery and emergency medicine (EM) have lower disgust sensitivity overall, but the role this plays in clinical practice is unclear. The objective of this study was to determine whether emergency physicians with higher disgust sensitivity see fewer “disgusting” cases during training.

Methods

All EM residents at a midsize urban EM program were eligible to complete the Disgust Scale Revised (DS-R). We preidentified cases as “disgust elicitors” based on diagnoses likely to induce disgust due to physician exposure to bodily fluids, anogenital anatomy, or gross deformity. The “disgust elicitor” case percent was determined by “disgust elicitor” cases seen as the primary resident divided by the number of cases seen thus far in residency. We calculated Pearson’s r, t-tests and descriptive statistics on resident and population DS-R scores and “disgust elicitor” cases per month.

Results

Mean DS-R for EM residents (n = 40) was 1.20 (standard deviation [SD] 1.24), significantly less than the population mean of 1.67 (SD 0.61, p<0.05). There was no correlation (r = −0.04) between “disgust elicitor” case (n = 2191) percent and DS-R scores. There was no significant difference between DS-R scores for junior residents (31.1, 95% confidence interval [CI], 26.8–35.4) and for senior residents (29.0, 95%CI, 23.4–34.6).

Conclusion

Higher disgust sensitivity does not appear to be correlated with a lower percentage of “disgust elicitor” cases seen during EM residency.

A comparison of temperament and character among psychiatry, internal medicine, and surgery residents at Iran University of Medical Sciences in the academic year 2013-2014

Background: This study was conducted to compare temperament and character among psychiatry residents, internal medicine, and surgery residents in hospitals affiliated to Iran University of Medical Sciences in the academic year 2013-2014. Methods: This cross sectional analytical study was conducted on 201 residents using the non-probability method of convenience sampling. Cloninger's 125-item Temperament and Character Inventory (TCI) and Maslach's Burnout Inventory (MBI) were distributed among all the residents in their morning session. Once the questionnaires were completed and submitted, the data were analyzed in SPSS 16. The frequency of different personality traits was analyzed among the selected residents. Results: A total of 49.8% of the respondents were female (n=100) and 50.2% were male (n=101). The results of data analysis showed more novelty seeking, reward dependence, and harm avoidance and less persistence (33.93, p=0.006; 9.00, p=0.056; 32.55, p=0.021; and 2.48, p=0.028, respectively) in psychiatry residents than in surgery residents (31.97, 7.87, 30.74, and 3.12 respectively). Reward dependence was more frequent in internal medicine residents than in surgery residents (9.44 and 7.87 respectively, p=0.002). The self-directedness score was lower in psychiatry residents than in internal medicine residents (p=0.761) and higher than in surgery residents (17.96, 18.30, and 17.57 respectively, p=0.824). The cooperativeness and self-transcendence scores were higher in psychiatry residents than in internal medicine (p=0.943, p=0.199, respectively) and surgery residents (p=0.105, p=0.069 respectively). Conclusion: The different dimensions of personality varied between the surgery, internal medicine, and psychiatry residents. Particularly, this study did not show statistically significant differences in dimensions of character (cooperativeness, self-directedness, and self-transcendence) among surgery, internal medicine, and psychiatry residents. The selection of medical specialties based on character traits significantly contributes to more effective treatment of patients and higher satisfaction of the residents.

Thematic Analysis of Emergency Medicine Applicants' Personal Statements

BACKGROUND

The personal statement is an important part of the residency application. Although guidance exists, the composition of personal statements is not standardized; each statement reflects an applicant's unique personality. In emergency medicine (EM), the personal statement could thus provide insight into why applicants are choosing EM and what they hope to accomplish in the field that could guide advisors and applicants.

OBJECTIVE

To perform a thematic analysis of personal statements from applicants accepted into an academic EM residency program to gain insight into what successful applicants include in their personal statements, why applicants are pursuing careers in emergency medicine, and anticipated career goals.

METHODS

Thematic analysis was performed on ten randomly selected personal statements from matched allopathic, U.S. applicants at a single, large, urban 3-year EM residency program between 2008 and 2015. Themes and sub-themes were identified and analyzed for frequency.

RESULTS

Ten personal statements were analyzed. Thirty-one (31) unique themes were identified and grouped into five main themes: personal characteristics related to a career in EM (38.3%, 116/303), why I love EM (36%, 109/303), my story (13.5%, 41/303), my career in EM (8.9%, 27/303), and ideal characteristics of a residency program (3.3%, 10/303). The most common personal characteristics described were altruism and the ability to work well under pressure. Applicants love EM due to the diversity of patients and disease presentations and the ability to perform procedures.

CONCLUSIONS

Thematic analysis of EM applicants' personal statements highlights the uniqueness of EM as a specialty and what draws applicants to EM.