EM Faculty Research Articles

Diverse by Design: A Comprehensive Guide to Inclusive Hiring for EM Faculty

Diverse by Design: A Comprehensive Guide to Inclusive Hiring for EM Faculty

Assembling the Pediatric Emergency Medicine Social Care Toolkit: A Modified Delphi Study

BackgroundThe pediatric emergency department is a high-value site for screening and resource referral for health-related social needs. However, best practices for this unique environment remain unclear. This study’s objective was to introduce a consensus-based social care training toolkit for the pediatric emergency medicine (PEM) setting. MethodsWe conducted a modified Delphi study to establish consensus on social care practice and develop a user-friendly toolkit. Initially, five priority areas (sections) were identified. Participants reviewed literature and shared their expertise to draft preliminary sections of the toolkit. Two rounds of the modified Delphi process were conducted, involving a ranking system, significant qualitative feedback, and a final approval stage, resulting in the finalized toolkit. ResultsSeventeen participants were included in the Delphi process, including pediatric and general EM faculty and trainees, as well as a social worker and public health professor. Forty-two content items were ranked in the first Delphi round. Based on a combination of score cut-off and extensiveness of qualitative comments, items were either minorly edited and kept (29%) or sent back to their section for review (71%). The second Delphi round integrated further suggested edits, and all participants in this final round approved the publicly available version of the toolkit. ConclusionBy utilizing diverse sources of information and a consensus-driven process of the modified Delphi, we generated best practice recommendations for the design, implementation, and training of social care programs in the PEM setting.

What You Didn't Learn in Residency: A Collective Curriculum for New Academic EM Faculty and Fellows.

This curriculum is designed for emergency medicine fellows and first-year junior faculty. The curriculum covers core topics related to academic and professional success for an early career faculty member. The curriculum is designed as quarterly sessions over the course of one academic year. An increasing number of emergency medicine graduates are pursuing fellowship after completion of residency.1 Fellowship can be challenging as newly minted graduates begin to explore their academic niche, refine their clinical practice, and define their personal and professional spheres. We propose a structured curriculum to help guide fellows and new faculty to mitigate these challenges. The aim of this curriculum is to develop relevant skills to promote academic success for fellows and first-year faculty at the start of their academic career and which could be completed during a one-year training timeline. We included topics relevant to all fellow and new faculty's expected personal and professional journey during this first year, including time management, academic productivity, resilience/wellness, and developing a national reputation. The educational strategies used in this curriculum consist primarily of lecture seminars. There is one short individual activity associated with the lectures and one small group discussion. The course was assessed with pre- and post-test surveys following each lecture. Surveys assessed participants' reaction, learning, and behavior for each session. Evaluations were completed based on a 5-point Likert scale (1=strongly disagree, 5=strongly agree). Fifteen participants attended the seminar series encompassing fellows and first-year faculty/post-fellows from ten different fellowship subspecialities. Average pre-assessment scores were low for many of the self-reported skills and confidence throughout the seminar series. Overall, participants reported increased confidence on the post-test for each of the seminar topics. In addition, participants reported that they learned new skills and planned to use the new ideas presented. All participants reported they would recommend these seminars to someone else on their same career path. Overall, participants reported increased confidence, new skills, and plans to use the ideas presented in the seminar series. The content appears applicable to this learner set since all reported they would recommend the series to others on their career path. In conclusion, we believe our seminar series will build skills for fellows and first-year faculty which will promote academic success. Academic success, professional development, early career development.

The effect of increasing emergency department observation volumes on downstream admission rates

Rising length of stay and inpatient boarding in emergency departments have directly affected patient satisfaction and nearly all provider-to-patient care metrics. Prior studies suggest that ED observation has significant clinical and financial benefits including decreasing hospitalization and length of stay. ED observation is one method long employed to shorten ED length of stay and to free up inpatient beds, yet many patients continue to be admitted to the hospital with an average hospital length of stay of only one day. The objectives of this study were to evaluate whether vigorous tracking and provider reviews of one day hospital admits affected the utilization of ED observation and whether this correlated with significant change in rates of admission from observation status.Between September 2020 and May 2021, in a tertiary care hospital with an annual ED volume of 55,0000, chart reviews of 24-h inpatient discharges were initiated by two senior EM faculty to determine perceived suitability for ED observation. Non-punitive email reviews were then initiated with ED attending providers in order to encourage evaluation of whether these patients would have benefitted from being placed into observation. We then analyzed ED observation patient volumes and subsequent admission rates to the hospital from ED observation and compared these numbers to baseline ED observation volume and admission rates between September 2018 and May 2019.A total of 1448 reviews were conducted on 24-h discharges which correlated with an increase in utilization of ED observation from 11.77% (95% CI [11.62, 12.31]) of total ED volume in our control period to 14.21% (95% CI [13.84, 14.58]) during the study period. We found that the overall admission rate from ED observation increased from 20.12% (95% CI [18.97, 21.26]) baseline to 23.80% (95% CI [22.60, 25.00]) during the same time periods.Our data suggest that increasing the total number of patients placed into observation by 21% correlated with a relative increase in admission rates from ED observation by 18%. This would suggest that our efforts to potentially include more patients into our observation program led to a significant increase in subsequent admission rates. There is likely a balance that must be struck between under- and over-utilization of ED observation, and expanding ED observation may be an effective solution to hospital boarding and ED overcrowding.

Virtual Shadowing: An Effective Approach to Gaining Exposure to the Field of Emergency Medicine.

Shadowing is an important part of medical student education. The COVID-19 pandemic limited medical students' hospital access. At the same time, virtual access to learning experiences has expanded greatly. In response, we implemented a novel virtual shadowing system to provide students with convenient and safe exposure to the Emergency Department (ED). Six EM faculty hosted 2-hour virtual shadowing for up to 10 students per experience. Students registered via signupgenius.com. Virtual shadowing was conducted using a HIPAA-compliant ZOOM account on an ED issued mobile telehealth Monitor/iPad. The physician would bring the iPad into the room, obtain consent from patients, and ensure students were able to see the encounter. Between visits, students were encouraged to ask questions using the chat function and microphone. A short de-briefing followed each shift. Each participant received a survey about the experience. The survey consisted of 4 questions for demographics, 9 Likert style questions to assess efficacy, and 2 free response sections for comments and feedback. All survey responses were anonymous. In total, 58 students participated in 18 virtual shadowing sessions with an average of 3-4 students per session. Survey responses were collected between October 20, 2020 and November 20, 2020. The overall response rate was 96.6% (56/58 surveys completed). Of respondents, 46 (82.1%) rated the experience as "effective" or "very effective" at providing exposure to Emergency Medicine. Fifty-three (94.6%) said they would participate in virtual shadowing in the ED again, and 48 (85.7%) would do virtual shadowing in another specialty were it available. We found virtual shadowing to be an easy to implement and effective way for students to shadow physicians in the ED. Even in post-pandemic times, virtual shadowing should be explored as an accessible and effective way to expose students to a broad array of specialties.

166 Barriers and Facilitators to Emergency Medicine Residency Program Development in Latin America and the Caribbean

Although EM is rapidly expanding in Latin America and the Caribbean, there has been no formal evaluation of the implementation of recently established EM training programs to guide the process in other countries. We aimed to describe the barriers and facilitators of developing an EM residency training program in Latin American and Caribbean countries to identify and disseminate the relevant “lessons learned.” Methods: Semi-structured, virtual, individual qualitative interviews with key stakeholders involved in the development of EM residency programs in Latin America and the Caribbean. Interviews were in English or Spanish, recorded and transcribed. The Consolidated Framework for Implementation Research (CFIR) guided the interview and analysis using 5 constructs applied systematically to the varying program implementations: inner setting, outer setting, individuals involved, implementation process, and intervention characteristics. Fourteen interviews were completed with physicians from Nicaragua, Guatemala, Chile, Mexico, Argentina, Haiti, Peru, and Brazil. Inner setting: Major barriers included lack of EM-trained physicians in the teaching faculty, resistance from other specialties, and lack of general support which caused feelings of isolation for the initial EM residents. Facilitators included the formation of national EM associations, cultivation of local EM-trained faculty as residents graduated, adapting curriculum to local needs, and formal feedback processes for program improvement. Outer setting: Barriers included lack of autonomy of the medical schools from the government and limited public and health system awareness of the role of EM. The COVID-19 pandemic was a facilitator as it brought recognition and legitimacy to EM due to the relevant skill sets of Emergency physicians. Financial help and additional educational opportunities from foreign organizations were helpful in some cases. Individuals involved: Key individuals served as champions who advocated for the implementation of the EM specialty and served as the catalyst for the program implementation in their countries. Some non-Emergency physicians were considered a barrier because of discouraging or luring residents away from EM. Implementation process: Barriers included lack of resources (functional equipment, textbooks), lack of program accreditation, and difficulty engaging applicants due to limited exposure of specialty. Facilitators included recognition and program approval from the Ministry of Health and “grandfathering” to establish first local EM faculty. Intervention characteristics: Barriers included the language of the available EM literature and lack of relevant language skills of the volunteer foreign EM faculty. Lack of funding to provide sufficient salary or any salary at all for the initial EM residents was another hurdle. Facilitators included funding from the government or external entities, and a curriculum document outlining EM-specific objectives enabled consistent, targeted training. Countries and organizations planning to initiate new EM training programs in Latin American and the Caribbean may benefit from the shared experience, including common barriers and facilitators to program establishment described by key stakeholders of recently developed programs in the region. Dissemination of these findings will avoid institutions “re-inventing the wheel”.

WOMen profEssioNal developmenT oUtcome Metrics in Academic Emergency Medicine: Results from the WOMENTUM Modified Delphi Study.

IntroductionTo address persistent gender inequities in academic medicine, women professional development groups (PDG) have been developed to support the advancement of women in medicine. While these programs have shown promising outcomes, long-term evaluative metrics do not currently exist. The objective of this study was to establish metrics to assess women’s PDGs.MethodsThis was a modified Delphi study that included an expert panel of current and past emergency department (ED) chairs and Academy for Women in Academic Emergency Medicine (AWAEM) presidents. The panel completed three iterative surveys to develop and rank metrics to assess women PDGs. Metrics established by the expert panel were also distributed for member-checking to women EM faculty.ResultsThe expert panel ranked 11 metrics with high to moderate consensus ranking with three metrics receiving greater than 90% consensus: gender equity strategy and plan; recruitment; and compensation. Members ranked 12 metrics with high consensus with three metrics receiving greater than 90% consensus: gender equity strategy and plan; compensation; and gender equity in promotion rates among faculty. Participants emphasized that departments should be responsible for leading gender equity efforts with PDGs providing a supportive role.ConclusionIn this study, we identified metrics that can be used to assess academic EDs’ gender equity initiatives and the advisory efforts of a departmental women’s PDG. These metrics can be tailored to individual departmental/institutional needs, as well as to a PDG’s mission. Importantly, PDGs can use metrics to develop and assess programming, acknowledging that many metrics are the responsibility of the department rather than the PDG.

EM faculty development: Keeping older patients safe.

EM faculty development: Keeping older patients safe.

Hot Off the Press: Addressing gender inequities: Creation of a multi-institutional consortium of women physicians in academic emergency medicine.

Hot Off the Press: Addressing gender inequities: Creation of a multi-institutional consortium of women physicians in academic emergency medicine.

After the Match

After the Match

An Innovative Inexpensive Portable Pulmonary Edema Intubation Simulator.

An Innovative Inexpensive Portable Pulmonary Edema Intubation Simulator.

TF7 Taking it to the Street: Emergency Medicine Street Medicine Elective

The “Street Medicine” elective will provide a broad experience for emergency medicine residents in the care of the homeless patient population. EM residents will provide care to patients on the streets and in camp sites. There will be opportunities to identify barriers and develop medical skills used in atypical social and environmental situations. Residents will also have the chance to manage problems related to mental health and addiction. They will work closely with EM faculty as well as members of a multi-disciplinary outreach health care team.

84 Students Get Involved: A Novel Approach to Process Improvement Evaluation in Acute Care

Our objective is to describe a model for process improvement evaluation that utilizes trained undergraduate student research assistants to collect provider-patient encounter data in the acute care environment. Process evaluation is imperative when making changes in a complex environment. This is especially true when the overall goal is to improve process efficiency and outcomes for critically ill and injured patients. The department of emergency medicine at the University of New Mexico uses an iterative approach to evaluate protocol changes in its Emergency Department Resuscitation Unit (EDRU), a nine-bed acute care unit internal to our emergency department. The collection of provider-patient encounter data by our student research assistants provides department leadership with evidence for assessing implementation problems and evaluating outcomes for protocol and practice changes. As part of a multi-semester course entitled Research in Acute Care, students collect data on provider-patient encounters in the EDRU on a secure electronic tool. Findings from the data collection are compiled and regularly presented to a workgroup of EM clinical faculty who in turn make recommendations on protocol revisions and continued education and training for personnel in the EDRU. In 2018, student research assistants spent over 1500 hours in the EDRU. This resulted in the collection of data on 1327 provider-patient encounters, including 26 instances of cardiopulmonary resuscitation (CPR), 418 of high acuity trauma, 112 strokes, and 164 cases of sepsis. During this same time period, the workgroup met 9 times to review findings from this and other data collections. The program has resulted in recommendations for additional training activities, identification and solutions for protocol related tools and missing equipment in the EDRU, and the identification of areas for research on patient-provider encounters. Our dynamic program is capable of meeting many of the department’s process improvement data gathering needs. The program provides invaluable experience in emergency medicine to future health care professionals through clinical environment exposure and first-hand experience in quality improvement research. We will continue to adapt our data collection program as existing protocols are revised and new protocols are implemented. We hope to expand our program and its data collection capabilities through increasing student coverage in the EDRU and possibly expanding to other units in the emergency department.

LO53: The correlation of workplace-based assessments with periodic performance assessment of emergency medicine residents

Introduction: Competency-based medical education (CBME) relies on pragmatic assessment to inform trainee progression decisions. It is unclear whether face-to-face workplace-based assessment (WBA) scoring by faculty reflects their true perception of trainee competence, as many factors influence individual assessments. To better defend competence committee decisions, it is critical to understand how accurately WBAs reflect the faculty's honest perception of resident competence and entrustment. Methods: To best capture faculty perception of trainee competence, we created a periodic performance assessment (PPA) tool for anonymous faculty assessment of residents after repeated clinical interactions. PPA surveys were distributed to full-time EM faculty at a single Canadian FRCPC-EM training site. Faculty were asked to score residents on entrustable professional activities (EPAs) based on encounters over the previous 6-months, and were advised that all data would be anonymized. All WBA scores for FRCPC-EM residents (N = 21) were collected from the 6-months preceding PPA completion. Analysis compared paired WBA and PPA entrustment scores for an individual resident, faculty, and EPA using Wilcoxon Signed Ranks tests and Spearman correlations. Data were analyzed across faculty, EPAs, and both faculty and EPA. Results: About half (17/33) of all invited full-time EM faculty participated. Overall, anonymous PPAs had a significantly lower mean score compared to face-to-face WBAs (3.61-3.69 vs. 3.92-4.06, p < 0.001 for all) across all groupings. Individual WBAs had a low-moderate correlation with individual PPAs (rho = 0.44). When scores were averaged across 1) faculty or 2) EPA, there was an increase in correlation, but it remained moderate (rho = 0.53 and 0.54, respectively). When scores were averaged for an individual resident across 3) faculty and EPA, there was a strong correlation between WBA and PPA (rho = 0.86). Conclusion: There is only moderate correlation between an individual faculty's WBAs and their anonymous longitudinal entrustment for a given resident on a specific EPA. These results may signal caution when interpreting WBA scores in the context of high stakes decisions. Aggregated scores from multiple faculty and/or multiple EPAs substantially increased the correlation between WBA and PPA. These findings highlight the importance of using aggregated WBA scores across multiple assessors and EPA for high-stakes resident progression decisions, to minimize the noise and bias in individual assessment.

P124: Canadian faculty experience of participating in a global health partnership working to build emergency medicine capacity in Ethiopia

Introduction: Global health partnerships (GHPs) between high income and low income countries are a means of capacity building in education. Literature often focuses on the GHP structure and output, along with retention and experience of local trainees, but neglects the experience of involved faculty. Here, we survey Canadian teaching faculty participating in the Toronto Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM) to describe characteristics of participants and their experience in the program. Methods: EM faculty participating in TAAAC-EM teaching trips from 2011-2016 were invited to complete an online survey in February 2017. Teaching faculty travel for one month and undergo an extensive selection process, pre-departure training and post-trip debriefing. Quantitative and qualitative data were collected and analyzed using basic statistics and inductive thematic analyses respectively. Results: Overall, 19 (N = 30, 63.3%) faculty completed the survey, of which 13 had prior global health experiences (range 1 to > 12 months). On a scale of 1-7, participants rated their mean overall experience as a 5.9 and preparation as a 5.7. Among respondents, 79% would participate in future TAAAC-EM activities, 79% would engage in future global health endeavours, 95% said the experience improved their satisfaction of practicing clinical medicine and 89% said it improved their enjoyment of teaching medicine. However, while 58% stated they would recommend this experience without hesitation to colleagues, the remaining 42% said they would recommend this experience with caveats. This latter group had a lower rated preparedness (MD = 1.398, p = 0.003) and TAAAC-EM experience (MD = 1.545, p = 0.001). Major themes in qualitative responses included that the participants felt that intrinsic motivation and flexible predispositions were necessary to participate. Intrinsic motivation for global health involvement included appreciation and impact for GH, and personal growth. Regarding flexibility, respondents highlighted the importance of having a flexible demeanor to understand, accommodate and ethically address cultural differences and practicing in another context. Conclusion: The type of faculty to recruit for GHPs may require flexible predispositions and intrinsic motivation for GH. These qualities combined with adequate preparation can facilitate overall faculty experiences on global health trips.

234 Feasibly Mitigating Provider Terror: Introducing a High-Fidelity, Tissue-Based Task Trainer for the Deliberate Practice of Emergent Hysterotomies

Simulation has become a standard pedagogy for training emergency medicine providers by offering the opportunity to deliberately practice procedural skills and prepare for low frequency, life-threatening clinical events. Resuscitative hysterotomy is perhaps the most daunting and infrequently performed procedure in the emergency department (ED). Given the paucity of clinical exposure to this intervention, resuscitative hysterotomy is an ideal candidate for simulation-mediated deliberate practice. To date, there are only a few resuscitative hysterotomy task-trainers available for training; further complicated by costly components and maintenance fees. To address this problem, the authors: 1) developed a homegrown, hybrid, high-fidelity, tissue-based simulation task trainer that can easily insert into any childbirth task-trainer to enhance procedural training of resuscitative hysterotomies; and 2) tested the feasibility of using this simulation model for hands-on, rapid cycle training with emergency medicine residents. Two high-fidelity, tissue-based task-trainer models were constructed and tested on a convenience sample of 14 emergency medicine residents. The simulated human placenta, bladder and uterus were constructed through the use of porcine skin, stomach, and a squid mantle, and secured in place with nylon sutures. The amniotic sac was constructed with a transparent plastic bag that contained a flexible Sim Baby and filled with warm water (ie, amniotic fluid) through a Foley catheter. Each model was placed into a Guamard S500 Childbirth Simulator with an overlying porcine belly to simulate a gravid abdomen. Each model required <1 hour for assembly. Emergent hysterotomy was first demonstrated by the EM faculty facilitator and followed by hands-on deliberate practice. Formal quantitative and qualitative feedback were solicited at the end using a previously validated survey for low-fidelity resuscitative hysterotomy. Quantitative evaluation of the simulated training session was extracted through a 5-item questionnaire using a 5-point Likert-type scale. The response rate was 100% from participants (5 PGY-1 residents, 6 PGY-2s, 3 PGY-3s). Responses were overwhelmingly positive [24.13 (+/- 1.36)]. Nearly all residents indicated the model was a good representation of human anatomy [4.63 (+/- 0.62)] that helped them become more familiar [4.94 (+/- 0.25)] and prepared [4.88 (+/- 0.34)] to perform resuscitative hysterotomy. Qualitative feedback highlighted learners’ appreciation for hands-on practice and the development of a novel, tissue-based simulation task trainer. All participants recommended the training session be available to future learners. Resuscitative hysterotomy is a high-stakes, low-frequency procedure that demands provider practice and confidence. Review of procedural steps, indications, and materials needed is imperative to the success of this procedure in pregnant patients in extremis. Our hybrid, tissue-based hysterotomy model represents a feasible opportunity for training. The model is cost conscious, easily reproducible, and portable, and allows for ample deliberate practice of the procedure.

TF-16 Innovation Per Diem: Design in Emergency Medicine

Innovations that revolutionize health care are typically derived from non-traditional research and collaboration from seemingly disparate disciplines. The use of design principles in tackling complex health issues is gaining significant traction. If the inclusion of design in health care is to become a new standard, medical education, too, must evolve to prepare future clinicians on design thinking methods. The objective of this curriculum is 1) To introduce both medical students and EM faculty to design thinking methods; 2) To apply design thinking to address common clinical and workflow challenges that are intrinsic to the ED; 3) To create a “design in medicine” curriculum that exposes clinicians to real-world design experience that can be adopted at other institutions. Twenty first-year medical students from the Sidney Kimmel Medical College were enrolled in eight 3-hour experiential design didactics in 2017. Student teams were matched with emergency physician-mentors, acting as stakeholders and content experts in their respective academic interest (ie, education, clinical operations, ultrasound). Didactic content includes: 1) empathy building; 2) idea generation; 3) prototyping; 4) testing; 5) the user experience; 6) service design; 7) business canvas planning; 8) idea presentation Teams were tasked with applying design thinking methods to specific ED problems (ie, patient-physician identification, managing patient expectation, point-of-care ultrasound). Each team project was evaluated using the Kirkpatrick Model through self-evaluation, group presentations, essays, and conceptual project deliverables (Table 1). Innovation per DiEM concluded with an interdisciplinary presentation session to hospital administrative stakeholders and design experts. Each team delivered a concise design presentation utilizing tangible artifacts and a visualization board to a real ED problem, such as patient-physician identification, managing patient expectation, point-of-care ultrasound is a unique design curriculum. Both students and faculty mentors report new senses of accomplishment and better understanding of design through the application of novel frameworks (ie, user/patient experience design, clinical workflow optimization). Innovation per DiEM is a unique design curriculum that focuses on EM challenges with active EM clinician mentorship. The authors plan to evaluate each project longitudinally with the long-term goal of achieving level 4 of the Kirkpatrick Model through organizational outcomes such as 1) improved patient satisfaction; 2) decreased resource utilization; 3) formal design curriculum in medical education.

ALiEM Blog and Podcast Watch: Toxicology.

IntroductionThe WestJEM Blog and Podcast Watch presents high-quality open-access educational blogs and podcasts in emergency medicine based on the ongoing Academic Life in Emergency Medicine (ALiEM) Approved Instructional Resources (AIR) and AIR-Professional (Pro) series. Both series critically appraise open-access educational blogs and podcasts in EM using an objective scoring instrument. This installment of the blog and podcast watch series curated and scored relevant posts in the specific topic of toxicology emergencies from the AIR-Pro Series.MethodsThe AIR-Pro Series is a continuously building curriculum covering a new subject area every two months. For each area, eight EM chief residents identify 3–5 advanced clinical questions. Using FOAMsearch.net and FOAMSearcher to search blogs and podcasts, relevant posts are scored by eight reviewers from the AIR-Pro editorial board, which is comprised of EM faculty and chief residents at various institutions across North America. The scoring instrument contains five measurement outcomes based on seven-point Likert scales: recency, accuracy, educational utility, evidence based, and references. The AIR-Pro label is awarded to posts with a score of ≥28 (out of 35) points. An “honorable mention” label is awarded if board members collectively felt that the blogs were valuable and the scores were > 25.ResultsA total of 31 blog posts and podcasts were included. Key educational pearls from the six high-quality AIR-Pro posts and four honorable mentions are summarized.ConclusionThe WestJEM ALiEM Blog and Podcast Watch series is based on the AIR and AIR-Pro Series, which attempts to identify high-quality educational content on open-access blogs and podcasts. This series provides an expert-based, crowdsourced approach towards critically appraising educational social media content for EM clinicians. This installment focuses on toxicology emergencies.

Characteristics of Emergency Medicine Residency Programs in Colombia.

IntroductionEmergency medicine (EM) is in different stages of development around the world. Colombia has made significant strides in EM development in the last two decades and recognized it as a medical specialty in 2005. The country now has seven EM residency programs: three in the capital city of Bogotá, two in Medellin, one in Manizales, and one in Cali. The seven residency programs are in different stages of maturity, with the oldest founded 20 years ago and two founded in the last two years. The objective of this study was to characterize these seven residency programs.MethodsWe conducted semi-structured interviews with faculty and residents from all the existing programs in 2013–2016. Topics included program characteristics and curricula.ResultsColombian EM residencies are three-year programs, with the exception of one four-year program. Programs accept 3–10 applicants yearly. Only one program has free tuition and the rest charge tuition. The number of EM faculty ranges from 2–15. EM rotation requirements range from 11–33% of total clinical time. One program does not have a pediatric rotation. The other programs require 1–2 months of pediatrics or pediatric EM. Critical care requirements range from 4–7 months. Other common rotations include anesthesia, general surgery, internal medicine, obstetrics, gynecology, orthopedics, ophthalmology, radiology, toxicology, psychiatry, neurology, cardiology, pulmonology, and trauma. All programs offer 4–6 hours of protected didactic time each week. Some programs require Advanced Cardiac Life Support, Pediatric Advanced Life Support and Advanced Trauma Life Support, with some programs providing these trainings in-house or subsidizing the cost. Most programs require one research project for graduation. Resident evaluations consist of written tests and oral exams several times per year. Point-of-care ultrasound training is provided in four of the seven programs.ConclusionAs emergency medicine continues to develop in Colombia, more residency programs are expected to emerge. Faculty development and sustainability of academic pursuits will be critically important. In the long term, the specialty will need to move toward certifying board exams and professional development through a national EM organization to promote standardization across programs.

P063: Perceptions and reflections of Ethiopian emergency medicine graduates regarding the Toronto Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM) Curriculum: a qualitative evaluation study

Introduction: The first-ever EM postgraduate training program in Ethiopia was launched at Addis Ababa University in 2010. EM faculty from the University of Toronto were invited to design and implement an EM rotation-based curriculum with tri-annual teaching trips to support the overall AAU EM program. To date, three cohorts of EM specialists (n=15) have graduated from the three-year program. After six years of implementation, we undertook a qualitative evaluation of the TAAAC-EM curriculum. Methods: Data collection took place in 2016 in Ethiopia via in-person graduate interviews (n=12). Participants were interviewed by a trained research assistant who used a semi-structured interview guide. Standard interview, transcription and analysis protocols were utilized. Qualitative software (QSR-NVIVO 9) was used for thematic grouping and analysis. Results: Graduates of AAU’s EM residency training program reported very positive experiences with the TAAAC-EM curriculum overall. All graduates acknowledged the positive impact of TAAAC-EM’s emphasis on bedside teaching, a unique component of the TAAAC-EM model compared to traditional teaching methods at AAU. Graduates felt that TAAAC-EM teachers were effective in creating a novel culture of EM at AAU and in role-modeling ethical, evidence-based EM practice. When asked about specific areas for program improvement, the following themes emerged: 1) a desire to shift delivery of the didactic clinical epidemiology curriculum to the senior residency years (PGY2-3) to coincide with completion of a required residency research project; 2) a desire for increased simulation and procedural teaching sessions and 3) the need for more nuanced context specificity in the curriculum delivery to incorporate local guidelines and practice patterns. A lack of educational supports during non-TAAAC-EM visits was also identified as an area for further work. Conclusion: Interviewing graduates of AAU’s EM residency training program proved important for determining areas of curriculum improvement for future trainees. It also provided critical input to TAAAC-EM strategic planning discussions as the partnership considers expanding its scope beyond Addis Ababa.