Writing practices that integrate dynamic and interactive strategies into the making and reading of digital texts are proliferating as more of our reading experiences are mediated through the screen. In this paper we argue that rarely do current approaches to creating digital texts operate at the basic textual level, that of the letterform itself. We argue further that such neglect is partially the result of the fact that current font technology is based on print paradigms that make it difficult to work programmatically at the level of individual letters. We then discuss work that has been made with software produced in our lab that suggests the creative possibilities in being able to easily specify behaviours at such a level. We conclude by proposing that writers, typographers and programmers start thinking beyond Postscript-like formats such as OpenType or TrueType to collaboratively develop a new ComplexType format (or formats) that is designed for the twentyfirst century as opposed to a simulation of the fifteenth.

Introduction: Appendicitis is a common disease, and as we have improved in early diagnosis and management of this disease process, late stage complications have become extremely rare, but can have indolent presentations.

Case Report: A 37-year-old male with no past medical history presented to the emergency department (ED) with vague abdominal pain as well as 12 days of cyclical fever. He had no significant findings on laboratory workup with the exception of a mild aspartate transaminase and alanine transaminase and relative neutrophilia between outpatient, urgent care, and ultimate ED visit. His ED workup included cross-sectional imaging of his abdomen revealing multiple liver abscesses and septic thrombophlebitis secondary to ruptured appendicitis.

Conclusion: Liver abscesses and septic thrombophlebitis are an extremely rare complication of appendicitis that has only been documented twice previously.

Learning Objective: To determine how attending and patient assessment of medical student communication skills correlate.

Background: Accurately assessing medical student (MS) patient communication skills is an essential component of undergraduate medical education. There are different methods used to evaluate MSs, including supervising attending physician ratings as well as patient assessment. However, it is unclear how these distinct types of evaluators compare with each other.

Objectives: To determine how attending and patient assessment of MS communication skills correlate. We hypothesized the two would closely correlate.

Methods: This was a retrospective study of rotating fourth-year MSs on an elective EM clerkship. From 7/16–10/17, ED attending physicians and patients assessed MS communication skills during the students’ ED shifts. Attendings rated MS communication skills with patients using a 1-5 Likert scale. Patients evaluated MSs using the modified Communication Assessment Tool (CAT), a 14-item questionnaire based on a 1-5 Likert scale. Mean attending ratings and patient CAT scores were calculated for each MS. Due to nonparametric distribution, means were divided into tertiles and scores weighted to assign adjacent tertiles partial agreement. Agreement between attending and CAT scores was measured using a Cohen’s kappa.

Results: 25 MSs were included. A total of 217 supervising attending evaluations with a median of 9 evaluations per MS (interquartile range (IQR) 8-10, min 6) and 102 CAT questionnaires with a median of 4 evaluations per MS (IQR 3-5, min 3) were completed. Attending and CAT scores showed slight agreement (k 0.196).

Conclusions: Attending and patient ratings of MS communication skills show only slight agreement. It is possible that utilizing only one type of evaluator during a clerkship may miss important communication issues that could be addressed with the MS. Utilizing a multimodal approach that includes both attending and patient evaluations may be beneficial in fully assessing and subsequently educating MSs on their patient communication skills.

Learning Objectives: To describe a novel simulation training developed to teach Trauma-Informed Care principles and applications for patient care in Emergency Medicine. To present results from pre- and post-surveys about effectiveness of simulations to learn and apply Trauma-Informed Care in acute-care settings.

Introduction/Background: Emergency Medicine physicians often care for patients experiencing direct sequelae from traumatic events including abuse, discrimination, and violence. Trauma-Informed Care (TIC) is a framework that recognizes the prevalence of trauma, promotes patient empowerment, and aims to minimize retraumatization. Limited curriculum on TIC in acute-care settings exists despite its widespread utility, with medical simulations (SIM) presenting a novel educational opportunity for this aim.

Educational Objectives: Describe principles of TIC and its importance in clinical practice. Present strategies for performing TIC-guided history taking and physical exams. Discuss situations when trauma screenings are indicated for patient safety and care. Facilitate the practice of TIC in acute-care settings.

Curricular Design: An SIM workshop reproducing relevant clinical encounters was developed for medical students to practice implementing TIC in the Emergency Department (ED). Students attended a didactic on TIC fundamentals and its applications in clinical care. Small groups then interacted with three SIM cases caring for patients with urgent medical needs and pertinent history related to intimate partner violence, transgender health, and discrimination in the healthcare system.

Impact/Effectiveness: Application of TIC principles is essential to providing patient-centered care in the ED. A pilot group of 12 students participated in these SIM sessions. The workshop was well-received, as 100% of participants found simulation training “Very” or “Extremely Useful” in preparing to apply TIC in patient interactions, compared to 42% prior to the session (p<0.05). Students also developed relevant skills, as 42% of students felt “Very” or “Extremely Confident” in using appropriate TIC language during physical exams, compared to 0% initially (p<0.05). Overall, this novel intervention represents a feasible and effective session for teaching TIC skills in Emergency Medicine.

Introduction The structure of the interview day affects applicant interactions with faculty and residents, which can influence the applicant's rank list decision. We aim to determine if there was a difference in matched residents between those interviewing on a day on which didactics were held and had increased resident and faculty presence (Didactic Day) versus an interview day with less availability for applicant interactions with residents and faculty (Non-Didactic Day).

Methods Retrospective study reviewing interview dates of matched residents from 2009-2015.

Results 42 (61.8%) matched residents interviewed on a Didactic Day with increased faculty and resident presence versus 26 (38.2%) on a Non-Didactic interview day with less availability for applicant interactions (p=0.04).

Conclusion There is an association between interviewing on a Didactic Day with increased faculty and resident presence and matching in our program.

Introduction: Patient handoffs from emergency physicians (EP) to internal medicine (IM) physicians may be complicated by conflict with the potential for adverse outcomes. The objective of this study was to identify the specific types of, and contributors to, conflict between EPs and IM physicians in this context. 

Methods: We performed a qualitative focus group study using a constructivist grounded theory approach involving emergency medicine (EM) and IM residents and faculty at a large academic medical center. Focus groups assessed perspectives and experiences of EP/IM physician interactions related to patient handoffs. We interpreted data with the matrix analytic method.

Results: From May to December 2019, 24 residents (IM = 11, EM = 13) and 11 faculty (IM = 6, EM = 5) from the two departments participated in eight focus groups and two interviews. Two key themes emerged: 1) disagreements about disposition (ie, whether a patient needed to be admitted, should go to an intensive care unit, or required additional testing before transfer to the floor); and 2) contextual factors (ie, the request to discuss an admission being a primer for conflict; lack of knowledge of the other person and their workflow; high clinical workload and volume; and different interdepartmental perspectives on the benefits of a rapid emergency department workflow). 

Conclusions: Causes of conflict at patient handover between EPs and IM physicians are related primarily to disposition concerns and contextual factors. Using theoretical models of task, process, and relationship conflict, we suggest recommendations to improve the EM/IM interaction to potentially reduce conflict and advance patient care.