Learning Objectives: The goal of this project was to promote early professional and clinical development of residents by creating a well-organized, visually-appealing roadmap of co-curricular requirements to augment resident training and provide a well-rounded residency experience.

Background: With the rapid growth of EM as a specialty and an increasing number of accredited residency programs, EM has become increasingly more competitive. EM physician workforce projections are daunting, particularly to current and future trainees. The prospect of securing a desirable and fulfilling job after residency is becoming exceedingly more uncertain, even with fellowship training. While there are evolving larger-scale initiatives to address this, an onus falls on individual trainees and their residency programs to improve resident skillset and marketability.

Curricular Design: Core faculty from various EM subspecialties proposed unique learning experiences within their respective areas of expertise to enhance resident training. Determined by educational benefit, feasibility, and potential impact, the co-curricular requirements were compiled into the Resident Citizenship Passport (Image 1), a visual roadmap organized by subspecialty and class year. This provides EM residents with opportunities to augment their skills as well-rounded EM physicians and educators. It includes elements of experiential learning through concrete learning experiences and encourages learners to reflect on their experiences to create new educational content. Social cognitive learning methods facilitate close interaction with faculty members and staff, leading to early mentorship and timely professional development. A slight modification of requirements was made for senior residents as this was implemented amidst their training. Progress is actively tracked through a google sheet, which residents can continually view.

Impact/Effectiveness: While still in a pilot phase, this innovation has been easily implemented and well-received by the residents, as it lays out the requirements in a centralized, organized, and visually-appealing graphic. This has also unexpectedly incentivized residents to fulfill requirements by inspiring an element of competition amongst one another.

Learning Objectives: Our goal was to address knowledge deficiencies encountered by residents on shift through a peer-to-peer didactic curriculum covering high-yield EM core content through a series of clinical images obtained in our ED.

Background: In an EM residency curriculum, there are clinical scenarios encountered by trainees that are not adequately addressed in a traditional didactic format. When residents encounter these scenarios, they have the opportunity to enhance their own clinical acumen with “just in time” learning but no organized way to share the new information with their peers. There is evidence showing that peer-to-peer teaching fosters a supportive learning environment while not sacrificing the integrity of content delivered. Additionally, this format solidifies the concepts for the teaching resident and promotes their development into a skilled educator.

Curricular Design: In order to address knowledge deficiencies encountered by residents on shift, we created Power Half Hour (PHH), a resident-led didactic series, presented bi-monthly in conference, that centers around a series of clinical images. The images, including a combination of physical exam findings, ECGs, and diagnostic images, are presented with high-yield, clinically relevant teaching pearls.

Impact/Effectiveness: Our PHH innovation was incorporated as a recurring series into the resident curriculum. After a year of implementation, residents were surveyed on how educationally beneficial they found PHH. Of the 28 residents who completed the survey, 13 residents (46%) found PHH very beneficial, 12 residents (43%) found PHH somewhat beneficial, and the remaining were neutral. By implementing a clinical image-based curriculum using a peer-to-peer teaching model, residency programs can address core content deficiencies, promote knowledge sharing amongst peers, and nurture resident development as educators.

Learning Objectives: We developed a curriculum using a high-fidelity model for residents to learn proper reduction of closed, stable distal radius fractures without orthopedic consultation.

Background: EM residents are expected by the ACGME to be competent in managing orthopedic injuries. Given that these injuries make up 20% of ED visits, it is essential that residents feel comfortable and competent in managing them. In a recent survey sent to alumni of several EM residencies, more than half of respondents reported feeling not at all or somewhat prepared to independently reduce closed fractures. They also stated seeing wrist and distal radius and ulna fractures most frequently. We also received resident feedback from our own program that they felt uncomfortable reducing these fractures without orthopedic consultation, even though it fell within their scope of practice.

Educational Objectives: We developed a curriculum using a high-fidelity model for residents to learn proper reduction of closed, stable distal radius fractures without orthopedic consultation.

Curricular Design: Residents were given pre-reading materials on distal radius fracture reduction. During the session, residents were shown a brief presentation on the finger trap reduction technique and relevant anatomy. They were then given a demonstration by faculty using a SawBones high-fidelity simulation arm model. The simulation arm bones are radiopaque, allowing for both pre- and post-reduction x-rays in order to display proper alignment. After demonstration of reduction and radiographic confirmation, residents were able to practice closed reduction and x-ray interpretation under direct supervision.

Impact/Effectiveness: We administered an identical six-question survey before and after in which we assessed residents’ current comfort level with distal radius fracture reduction and splinting. Few residents (17%) initially reported feeling comfortable reducing closed distal radius fractures. After the intervention, almost all residents (88%) reported feeling comfortable. We are currently collecting follow-up data on comfort and frequency of orthopedic consults in the ED.

Learning Objectives: To quantify individual differences in resident clinical exposure during training at a 3-year academic emergency medicine residency.Background: Experiential learning theory suggests that clinical exposures during residency are critical to developing expertise. Research in other specialties has shown significant individual differences in resident clinical exposures during training, but this has not been recently evaluated in emergency medicine (EM).

Objective: To quantify individual differences in resident clinical exposure during training at a 3-year academic emergency medicine residency.

Methods: We performed a retrospective review of electronic health records from 2013-2021 at our main clinical site (of four) to quantify the number and type of clinical encounters seen by each resident. Visits were attributed to the first assigned resident. We included data from residents who completed all three years of residency consecutively. We categorized primary patient chief complaints according to the 20 domains of the ABEM Model of Clinical Practice following a published consensus method with EM faculty. We calculated and reported descriptive statistics.

Results: We collected data from 70 residents. Means and ranges of exposures in the top 10 most commonly identified domains are displayed in Figure 1.

Conclusions: We found variability in resident clinical exposures at our primary training site. Residencies may benefit from examining resident clinical exposures to identify opportunities for individual resident improvements.

Learning Objectives: Investigate medical student perceptions of the virtual interview process.

Background: In the setting of the Covid-19 pandemic, emergency medicine (EM) residency programs engaged an unprecedented transition to virtual interviews. The use of virtual interviews and their impact on medical students had not been previously studied in the published literature.

Objectives: We aimed to investigate medical student perceptions of the virtual interview process.

Methods: We conducted a cross-sectional survey-based study of EM applicants who interviewed at our community teaching hospital during the 2020-21 season. The survey was sent electronically to all interviewees following Match Day, excluding applicants who had completed a clinical rotation in our department. The survey consisted of 8 Likert scale questions assessing specific components of the interview and overall impressions of the virtual interview format.

Results: A total of 113 surveys were distributed with 34 (30%) interviewees completing the survey. Overall, respondents were 32.4% Female and the mean number of virtual interviews attended was 15.3 (SD = 4.8). Responses to questions regarding overall impression and specific components of the virtual interview are reported in Table 1. Regarding how the nationwide transition to a virtual interview process affected their match, 32% responded negatively, 41% responded neutral, 26% responded positively. Most interviewees (71.9%) agreed that virtual interviews should be offered as part of the traditional residency interview cycle.

Conclusion: Medical students felt that our virtual interview process benefited their experience overall. While the nationwide transition is not thought to have benefitted their match, students feel that virtual interviews should be offered as an option moving forwards. The study was limited by small sample size and single-center setting.

Learning Objective: We aimed to evaluate the use of a differential diagnosis tool by emergency medicine residents in the critical care area of an emergency department to determine patient presentations where the tool would be most valuable and widely used.

Background: Generating a differential diagnosis (DDx) is a vital skill for emergency medicine (EM) residents to develop in their care of critically ill patients. Electronic DDx tools allow a physician DDx to be cross-checked with artificial intelligence to broaden the DDx in complex cases, and may assist in resident DDx generation. Currently, DDx tools have not been well studied in EM high-acuity scenarios. It is unclear which patient presentations challenge EM residents most in their DDx generation.

Objective: We aimed to evaluate the use of a DDx tool by EM residents in the critical care area of an emergency department (ED) to determine patient presentations where the tool would be most valuable.

Methods: We performed a prospective observational study of usage of a DDx tool in an academic ED. The tool was evaluated in the high-acuity area of the ED in patients requiring immediate evaluation. A resuscitation resident rotates each month in the area and evaluates each patient. The resident queried the DDx tool on the patient’s symptoms and completed a data collection tool. Data was summarized by frequencies for use in DDx creation with attention to body system categories. Chi-squared or Fisher’s exact tests were employed on comparison.

Results: The DDx tool was used for 98 patients, of whom 60.2% were female and 7% were pediatric. The tool was not used for 87 patients seen by the resident. Compared with non-DDx tool use, the DDx tool was used significantly for more patients with gastroenterology (GI), infectious disease (ID), metabolic/renal, and neuropsych complaints, and significantly less for trauma patients (Table 1).

Conclusions: A DDx tool has potential to enhance DDx generation in the resuscitation setting for EM residents, particularly for assessing patients with chief complaints consisting of GI, ID, metabolic/renal, and neuropsych involvement. It has less utility for trauma diagnosis, likely because trauma protocols follow strict, stepwise management.

Background: In January 2022, USMLE Step 1 scoring will be pass/fail (P/F). Although this change aims to decrease applicant stress, it will impact the way EM program directors (PDs) review applications. Little research exists on how the transition will impact applicants.

Objectives: The purpose of this study was to determine if a change in Step 1 scoring will affect the likelihood to interview (LTI) an applicant. We hypothesized that transitioning to P/F scoring may negatively impact the LTI for students from less prominent schools.

Methods: A survey of mock residency applications from strong, fair, and poor applicants was distributed to EM PDs via the CORD list serve. Respondents rated the LTI of applicants on a 5-point Likert scale. Applications from allopathic (MD), osteopathic (DO), and international medical graduates (IMG) were included. School prominence was determined by the 2020 US News & World Report rankings. Survey respondents were randomized to review applications with either numeric or P/F scores. Independent sample t-tests were calculated in SPSS 23.0 to compare mean ratings for applications based on scored or P/F scenarios for MD, DO, and IMG groups separately. This study was approved by the institutional review board at the study site.

Results: Of 149 responses, poor performing MD students from highly prominent schools had a higher LTI with P/F scoring than poor performing students from less prominent schools (2.03 vs. 1.55, p < .01). For strong and fair performing MD students, no significant difference in LTI existed amongst high and less prominent schools with P/F scoring (Table 1). Strong DO (p<.01) and IMG (p<.001) applicants had higher LTI with P/F, while fair DO (p<.01) and IMG (p<.001) applicants had higher LTI with a numeric score (Table 2).

Conclusions: When only P/F scoring is reported, poor performing students from low prominence schools have a significantly lower LTI than poor performing peers from high prominence schools.27 The Impact of Medical Education Fellowships on the Careers of Graduates