Elective rotations are valuable, allowing trainees to personalize their educational experience, focuson areas of weakness, and offer personal and professional development. Emergency medicine(EM) residency program elective rotations may be limited due to the absence of awareness ofopportunities and administrative support. We sought to increase the breadth of elective rotationopportunities, improve residents’ satisfaction with their elective rotations, and enhance theopportunities for clinical training. To increase the breadth of our elective rotation opportunities, weestablished an elective rotation director—a dedicated faculty member to aid in elective planningand provide administrative support. This faculty member met with all residents during their secondyear, coordinated new electives with the graduate medical education office, and assisted withadministrative tasks. Ten new rotations (two local, five domestic away, three international away)were established during the position’s first two years, increasing available rotations from nine to 19.A survey was sent to graduates of the program two years before and two years after the positionwas established to inquire about their elective experience. Of 64 graduates, 49 (76.6%) participatedin the survey. Graduates exposed to the dedicated faculty member reported increased exposure tonovel learning environments (p<0.001), improved wellness (p<0.001), and were more likely than predirectorgraduates to choose the same elective rotation (p=0.006). Programs with multiple electiverotations may benefit more from this position, but additional resources may be needed given theassociated increase in administrative time.

Introduction: Acute stress may impair cognitive performance and multitasking, both vital in the practice of emergency medicine (EM). Previous research has demonstrated that board-certified emergency physicians experience physiologic stress while working clinically. We sought to determine whether EM residents have a similar stress response, and hypothesized that residents experience acute stress while working clinically.

Methods: We performed a prospective observational study of physiologic stress including heart rate (HR), heart rate variability (HRV), and subjective stress in EM residents during clinical shifts in the emergency department. HR and HRV were measured via 3-lead Holter monitors and compared to baseline data obtained during weekly educational didactics. Subjective stress was assessed before and after clinical shifts via a Likert-scale questionnaire and written comments.

Results: We enrolled 21 residents and acquired data from 40 shifts. Residents experienced an increase in mean HR of eight beats per minute (P < 0.001) and decrease in HRV of 53.9 milliseconds (P = 0.005) while working clinically. Subjective stress increased during clinical work(P <0.001). HRV was negatively correlated with subjective stress, but this did not reach statistical significance (P = 0.09).

Conclusion: EM residents experience acute subjective and physiologic stress while working clinically. HR, HRV, and self-reported stress are feasible indicators to assess the acute stress response during residency training. These findings should be studied in a larger, more diverse cohort of residents and efforts made to identify characteristics that contribute to acute stress and to elicit targeted educational interventions to mitigate the acute stress response.