Emergency Medicine Programs Research Articles

Risk Stratifying Febrile Children in the Emergency Department: An Ongoing Challenge.

1 Division of Pediatric Emergency Medicine and Pediatric Sepsis Program, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine; Children's Hospital of Philadelphia, Philadelphia, PA 2 Division of Emergency Medicine, Department of Pediatrics, Feinberg School of Medicine at Northwestern University, Lurie Children's Hospital, Evanston, IL *See also p. 980. Dr. Balamuth’s institution received funding from several federal, foundational, and institutional grants to study sepsis and other infectious emergencies unrelated to this study. Dr. Florin’s institution received funding from the National Heart, Lung, and Blood Institute and the National Institute of Allergy and Infectious Diseases.

Impact of COVID-19 on emergency medicine resident procedure performance.

As a result of the COVID-19 pandemic, patterns of patient presentations and medical education have changed, potentially resulting in fewer and different types of patient encounters. Procedural proficiency is a cornerstone of emergency medicine (EM) training, and residents must meet Accreditation Council for Graduate Medical Education (ACGME) requirements to graduate. It is feared there may have been a pandemic-induced decrease in opportunities for residents to perform procedures. This study investigates the change in procedures performed by EM residents during the initial year of the pandemic. This study utilized a multicenter retrospective design. Across three EM residency programs, logs of 14 ACGME-required procedures performed by residents were reviewed. For each procedure, counts were compared prepandemic year (March 2019 to February 2020) to during pandemic year (March 2020 to February 2021). Procedures were further grouped into 4-month periods: March to June, July to October, and November to February. A total of 113 EM resident physicians were included in this study. Procedures performed by EM residents tended to decrease during the COVID-19 pandemic. There were statistically significant decreases in number of annual cricothyrotomies (2.4 vs. 0.9, p < 0.001) and pediatric trauma resuscitations (5.7 vs. 3.9, p=0.024). Comparing the first 4-month periods of each year, there were significant decreases in cardiac pacing (6.3 vs. 5.4, p=0.038), chest tubes (2.2 vs. 1.0, p < 0.001), cricothyrotomies (0.6 vs. 0.1, p=0.001), intubations (8.2 vs. 4.4, p=0.002), and pericardiocenteses (1.7 vs. 0.2, p < 0.001). The COVID-19 pandemic has led to a decrease in the number of procedures performed per EM resident in many of the domains required by the ACGME. Although only some procedures had statically significant decreases, it remains to be seen if this will lead to decreased resident procedural competency. Further research may be required in this area to determine any such effect.

Sustaining capacity building and practical skills training during the COVID-19 pandemic: Lessons from India.

The scale and duration of the COVID-19 pandemic posed a threat to provide the required support needed by emergency medicine (EM) trainees in India participating in the masters in EM program, a global partnership between the Ronald Reagan Institute for Emergency Medicine at the George Washington University and 14 institutions in India. While some of this support has been filled by remote education through thrice-weekly online video conferencing and webinars, the gap in procedural teaching posed a different challenge. We developed a two-part innovation to teach suture skills, a required procedure for EM trainees. The innovation consisted of a hands-on procedure lab with the opportunity for live feedback followed by an independent competitive skill demonstration. Trainees were notified in advance of materials needed for the procedure lab to encourage attendance and participation. A total of 160 trainees attended the virtual suture skills lab; 74 trainees (46% of attendees) submitted feedback back of whom 94% were able to practice skills in real time. Written feedback was overwhelmingly positive and included requests to implement this method for other procedural skills. Twenty-one residents participated in the Innovative Suture Challenge, with the top three submissions receiving accolades in the following grand rounds-style session. The combination of virtual teaching with the opportunity for real-time feedback and an integrated project to independently showcase skills learned is a way to continue procedural skills teaching in a remote environment. The aim of this innovation was to test the feasibility, acceptability, and level of engagement of conducting virtual, live supervised suturing remotely across multiple geographical locations. Our next step would be to gather pre and post data to measure the impact. Additionally, we believe this provides a proof-of-concept model to further explore sustainable, cost-effective, and scalable models for remote procedure-based teaching.

A consensus list of ultrasound competencies for graduating emergency medicine residents.

Emergency ultrasound (EUS) is a critical component of emergency medicine (EM) resident education. Currently, there is no consensus list of competencies for EUS training, and graduating residents have varying levels of skill and comfort. The objective of this study was to define a widely accepted comprehensive list of EUS competencies for graduating EM residents through a modified Delphi method. We developed a list of EUS applications through a comprehensive literature search, the American College of Emergency Physicians list of core EUS benchmarks, and the Council of Emergency Medicine Residency-Academy of Emergency Ultrasound consensus document. We assembled a multi-institutional expert panel including 15 faculty members from diverse practice environments and geographical regions. The panel voted on the list of competencies through two rounds of a modified Delphi process using a modified Likert scale (1=not at all important, 5=very important) to determine levels of agreement for each application-with revisions occurring between the two rounds. High agreement for consensus was set at >80%. Fifteen of 15 panelists completed the first-round survey (100%) that included 359 topics related to EUS. After the first round, 195 applications achieved high agreement, four applications achieved medium agreement, and 164 applications achieved low agreement. After the discussion, we removed three questions and added 13 questions. Fifteen of 15 panelists completed the second round of the survey (100%) with 209 of the 369 applications achieving consensus. Our final list represents expert opinion on EUS competencies for graduating EM residents. We hope to use this consensus list to implement a more consistent EUS curriculum for graduating EM residents and to standardize EUS training across EM residency programs.

A brief of critical care education in Cambodia

Cambodia's population is 16,7 million people (2020). From 1975 to 1979, Cambodia experienced a horrendous genocide; therefore, the country started to reconstruct from beginning. Health is a significant topic and priority in development. The healthcare system in Cambodia is undergoing reform. Currently, only one large public university provides postgraduate training in critical care medicine as part of a residency in anesthesiology, critical care, and emergency medicine. The combination of three skills would enable the nation to achieve its requirements despite limited resources. National and international educational collaboration in Cambodia encourages greater treatment for the critically ill, often as part of emergency medicine or anesthetic programs. In order to handle the magnitude of critical care medical difficulties, Cambodia's critical care medicine requires undergo significant improvement. Education should be the primary emphasis of this area's growth.

Emergency medicine resident involvement in emergency medical services

Introduction: Emergency medical services (EMS) are a critical component to Emergency Medicine (EM) residency training. In the United States, the Accreditation Council for Graduate Medical Education (ACGME) has established minimum training requirements for EM residency programs. Since the last study exploring resident EMS involvement was performed, there have been over 100 new EM resident programs started. Given the rapid increase in new EM programs, we sought to determine EMS experiences provided to current EM residents. Materials and Methods: A 22-question anonymous online survey was distributed through E-mail to program directors of approved EM residencies in October 2020. A follow-up reminder was sent 3 weeks later. Results: In total, 51 of 257 programs responded (20% response rate). Forty-five percent of EM residents experience between 10 and 25 EMS calls during their residency, 31% experience 26–50, and 20% experience &gt;50 calls. The majority of programs (53%) have a separate EMS rotation where residents function as observers, 24% of residents function as providers, and 25% also have residents respond in a dedicated physician response vehicle. Aeromedical exposure is limited (47% have none and 43% average only 1–9 flights). Two-thirds of programs (67%) have residents provide online medical command during their ED shifts and 61% require residents to provide didactics to EMS clinicians. Despite ACGME requirements, only two-thirds of programs (69%) provide training about disaster/mass casualty incident (MCI) management and 67% have them participate in a disaster/MCI drill. About one-third of programs (31%) have decreased EMS experiences due to limited time in the residency curriculum, and 20% of programs have limited EMS experiences due to the COVID pandemic. Conclusions: The majority of responding EM residency programs meet ACGME EMS-related requirements. There is an opportunity for improvement around disaster education based on these data. Limited time in the curriculum and the COVID pandemic were cited as reasons that programs have limited their EMS experiences. The following core competencies are addressed in this article: Practice-Based Learning and Improvement, Medical Knowledge.

The ideal applicant to emergency medicine residency programs in Saudi Arabia; Program directors’ view

Objective: Emergency medicine (EM) is considered a competitive specialty worldwide with an acceptance rate of 57% in Canada, but it is even more competitive in Saudi Arabia with 18.7% acceptance. Factors that may influenced the applicant’s acceptance into residency programs included letters of recommendation, interview performance, research experience, and gender. This study aims to determine the factors playing a role in applicants matching to EM residency programs in Saudi Arabia from the viewpoint of program directors.&#x0D; Methods: A pilot study was done using a self-administered questionnaire distributed to EM residency program directors (PDs) in Saudi Arabia during the period of 16-21 November 2021. The data were analyzed using SPSS, and all ethical considerations were observed.&#x0D; Results: Twenty-seven PDs participated in the study, 19 (70.4%) were male, and most were former PDs (59.3%). The most crucial aspect in the applicant’s acceptance was the excellent impression in the interview (4.00 ± 1.00). The most crucial aspect of recommendation letters was a recommendation from a program director (29.6%). In addition, total duration of electives in EM (40.7%) was important, quality in EM research (29.6%) played a critical role, and professionalism (29.6%) was the factor sought during the interview. The PD’s gender or status or the region of the program did not significantly affect the preference of the applicant’s gender.&#x0D; Conclusion: For those considering EM residency programs in Saudi Arabia, the chance of getting accepted can be increased by getting a recommendation from a program director, increasing the duration of electives in EM, focusing on the research quality, and showing professionalism during the interview.

The Current State of Pediatric Emergency Medicine Training in Emergency Medicine Residencies.

Several studies show that emergency medicine (EM) physicians are less comfortable caring for pediatric patients than adults. The state of pediatric training has not been comprehensively evaluated since 2000. We sought to describe current pediatric education in EM residencies and to evaluate EM Program Director (PD) confidence in graduating trainees' abilities to care for pediatric patients. We conducted an anonymous, cross-sectional survey study of EM PDs in August 2020. We collected program demographics, clinical rotations, and didactic methods. We used Likert scales to measure PD confidence in graduating residents' competence to care for pediatric and adult patients. We found e-mail addresses for 249 (93%) of 268 EM programs. One hundred nineteen (48%) PDs completed the survey. We include denominators to account for unanswered questions. Sixty-eight (59%) of 116 programs spend 10% to 20% of clinical time seeing pediatric patients. One hundred ten (91%) of 119 require a pediatric emergency medicine (PEM) rotation, 88/119 (83%) require pediatric intensive care, and 34/119 (29%) require neonatal intensive care. Seventy (62%) of 113 have curricula designed by PEM-trained faculty, 96/113 (85%) have PEM attendings teach lectures, and 77/113 (68%) spend 10% to 20% of didactic time on pediatric topics. Twenty-three (23%) of 106 PDs stated not all residents graduate with competence in pediatric resuscitation compared with 2/106 (2%) for adult resuscitation ( P < 0.05). Program directors report less confidence in graduating residents' competence in caring for pediatric patients compared with adult patients. We propose ideas to strengthen the quality of pediatric education in EM residencies.

Facilitating Residents' Understanding of Electronic Health Record Report Card Data Using Faculty Feedback and Coaching.

Feedback continues to present a challenge for competency-based medical education. Clear, consistent, and credible feedback is vital to supporting one's ongoing development, yet it can be difficult to gather clinical performance data about residents. This study sought to determine whether providing residents with electronic health record (EHR)-based report cards, as well as an opportunity to discuss these data with faculty trained using the R2C2 model, can help residents understand and interpret their clinical performance metrics. Using action research methodology, the author team collected EHR data from July 2017 to February 2020, for all residents (n = 21) in one 5-year Emergency Medicine program and created personalized report cards for each resident. During October 6-17, 2020, 8 out of 17 eligible residents agreed to have their feedback conversations recorded and participate in a subsequent interview with a nonphysician member of the research team. Data were analyzed using thematic analysis, and the authors used inductive analysis to identify themes in the data. In analyzing both the feedback conversations as well as the individual interviews with faculty and residents, the authors identified 2 main themes: (1) Reactions and responses to receiving personalized EHR data and (2) The value of EHR data for assessment and feedback purposes. All participants believed that EHR data metrics are useful for prompting self-reflection, and many pointed to their utility in providing suggestions for actionable changes in their clinical practice. For faculty, having a tool through which underperforming residents can be shown "objective" data about their clinical performance helps underscore the need for improvement, particularly when residents are resistant. The EHR is a valuable source of educational data, and this study demonstrates one of the many thoughtful ways it can be used for assessment and feedback purposes.

Pediatric Interfacility Transport Curriculum: Its Impact on the Pediatric Intensive Care and Emergency Medicine Fellows’ Performance and Confidence

ObjectivePediatric interfacility transports are frequent. Despite the absence of a formal pediatric transport curriculum in eastern Canada, directly managing patients during transport and medical direction of the referring center and transport team are part of the pediatric critical care medicine (PCCM) and pediatric emergency medicine (PEM) program requirements. The authors developed a pediatric interfacility transport curriculum and measured its impact on fellows’ confidence and performance. MethodsThis was a pilot interventional prospective study in Montreal, Canada. Postcurriculum surveys were used to measure confidence, and high-fidelity simulations were used to measure performance. A target threshold for confidence was defined before implementation, and pre- and post values were compared. The simulation scenario and assessment checklist were locally developed. ResultsThe participants were 11 PCCM and 3 PEM fellows. The content of the curriculum and educational methods were selected based on the literature and a needs assessment survey. All participants rated themselves as confident at the end of the curriculum. Eighty-three percent of the participants were deemed proficient with a perfect interrater agreement. ConclusionThe pediatric transport curriculum had a positive impact on PEM and PCCM fellows’ confidence and performance in transport. Further studies should look at the impact of such a curriculum on participants’ real-life performance and patient care.

Pediatric emergency department organization and social care practices among U.S. fellowship programs.

Social care has become increasingly relevant to the emergency physician and includes activities that address health-related social risk and social needs. The literature has consistently documented substantial health care provider challenges in incorporating social care into routine practice. Yet, interventions on the health care organizational level hold promise to bring about more widespread, sustainable impact. This study was a subanalysis of the 2021 National Social Care Practices Survey data set among pediatric emergency medicine (PEM) program directors (PDs) and fellows. The purpose was to investigate the association between health care organizational factors and PEM physician social care practices and perceptions among PEM PDs and fellows. We performed binary and ordinal logistic regressions of organizational factors and five specific PEM physician social care perspective and practice outcomes. The sample population included 153 physicians-44 PDs (49% response rate) and 109 fellows (28%). PDs and fellows with access to a social care systematic workflow in their pediatric emergency department (PED) had higher odds of comfort assessing social risk (odds ratio [OR] 2.1%, 95% confidence interval [CI] 1.1-4.0), valuation of social care (OR 3.2, 95% CI 1.3-7.9), preparedness to assist families (OR 2.4, 95% CI 1.1-5.2), screening tendency (OR 2.2, 95% CI 1.1-4.5), and ability to refer to community resources (OR 2.3, 95% CI 1.2-4.6). A similarly directed, but less pronounced pattern was noted with access to a community resource database for referrals and 24-h access to a social worker in the PED. PED organizational factors-particularly access to a social care systematic workflow-appear positively associated with PEM physician practices and perceptions of social care delivery. Further research is under way to advance understanding of PEM training factors in social care.

Growth of for-profit involvement in emergency medicine graduate medical education and association between for-profit affiliation and resident salary.

BackgroundFollowing projections of an emergency medicine (EM) physician oversupply, the growth of EM residency programs affiliated with for‐profit hospitals has been subject to increased attention and speculation. However, essentially no literature exists regarding these programs. Resident pay is one area where these programs could differ from nonprofit‐affiliated programs, as investor obligations could make for‐profit corporations more likely to reduce resident salaries to increase profit margins. Here, we aim to quantify the growth of EM for‐profit affiliated residency programs from 2001–2021 and determine if PGY1 salaries differ between these program types.MethodsMedicare and ACGME accreditation data were used to determine the profit status of hospitals affiliated with EM residency programs. ACGME new accreditation data from 2001–2021 were used to quantify the growth of both for‐profit and nonprofit affiliated programs over this period. We searched program websites and called programs to determine 2021–2022 PGY1 salary. Multiple regression was used to model the relationship between profit status and salary using program characteristic covariates to control for confounding variables.ResultsThe number of EM programs increased from 117 to 276 from 2001–2021 while the number of for‐profit affiliated EM residency programs increased from 1 to 29 during this period. Most (85.7%, [24/29]) for‐profit affiliated programs were accredited from 2016–2021. Mean for‐profit affiliated program salary ($55,658, n = 24) was $3840 lower than mean nonprofit affiliated program salary ($59,498, n = 203). For‐profit affiliation was a significant predictor of lower 2021–2022 PGY1 salary after controlling for other program characteristics using multiple regression ( ß = −1919.88, P = 0.010).ConclusionsWe found a substantial growth of newly ACGME accredited for‐profit affiliated EM residency programs from 2016–2021. We also found for‐profit affiliated programs pay lower PGY1 salaries than nonprofit–affiliated programs after controlling for potential confounding variables, which suggests more oversight over the salary determination process could be necessary to prevent resident underpayment.

Competency based medical education (CBME) in CCFP(EM) programs.

It is postulated that implementation of Competency by Design (CBD) in Royal College of Physicians and Surgeons of Canada (RCPSC) programs has helped enhanced skills programs in emergency medicine (CCFP(EM)) move towards a more competency-based residency. The objectives of the study were to identify major competency-based medical educational (CBME) components of CCFP(EM) programs across the country; and determine how programs are delivering these components. After a rigorous development process (expert content development, and pilot testing), a survey questionnaire was administered to all 17 CCFP(EM) program directors using a modified Dillman technique. Questions were structured and framed using the core components framework of CBME. The final survey included a total of 44 questions under six sections. There was a 100% response rate. Only 65% of programs currently map their program's curriculum to an explicit outcomes-based framework. All but one program plan to map their program's curriculum to Core Professional Activities that were released by the College of Family Physicians of Canada (CFPC) in May 2021. In 35% of programs, a curriculum is organized around developmental competencies that support resident progression. Individual coaches or a coaching team follow residents longitudinally in 65% of programs. In 81% of programs, the program meets with a resident at regular, pre-defined intervals to discuss their progression. In terms of assessment: data from direct observations are incorporated 94% of the time; 29% of programs have specific criteria for advancement; and all programs have a Competence Committee. With the introduction of CBD in RCPSC programs, 71% of program directors felt there was less understanding of the unique needs of CCFP(EM) residents. This study summarizes the current state of CBME in CCFP(EM) programs. While many components of CBME are incorporated, further development and innovation is needed to fully adapt CBME to a 1-year training program.

Evaluation of a Hands-On Wrist Fracture Simulator for Fracture Management Training in Emergency Medicine Residents.

BackgroundFractures are common in the emergency department, and fracture management training poses certain challenges. Recent emergency medicine (EM) residency graduates feel only somewhat prepared to manage fractures. In this study, our objectives were to determine the effect of introducing a wrist fracture simulator (Sawbones®) to traditional EM fracture management education and to assess resident attitudes, comfort with fracture management, and perceptions of the simulator.MethodologyThis six-month prospective study involved postgraduate year one residents at two academic EM programs. For convenience, each residency was considered as one test group. One residency group was deemed the traditional group (n = 10), while the other was the intervention simulator group (n = 16). Identical traditional lectures and buddy splinting workshops were provided. The simulator group received supplemental training with the Sawbones® simulator. Groups were filmed using this simulator for fracture management before the teaching sessions and at six months. Grading utilized a 27-point scale, with a subscale covering reduction. Data were collected regarding attitudes, comfort with fracture management, and perceptions of the simulator.ResultsIn total, 26 residents participated in the study. There was no significant difference between groups at six months in overall fracture management scores (traditional group: 15.8 ± 3.1; simulator group: 15.4 ± 3.9; p = 0.92). On the subscale of fracture reduction skills, the simulator group showed significant improvement (p = 0.0078), while the traditional training group did not (p = 0.065). Both groups reported satisfaction with the simulator, improved comfort, and knowledge of fracture management.ConclusionsFracture management is an essential competency, and prior research has shown that most graduating EM residents do not feel comfortable with these skills. All participating residents in this study struggled with adequate fracture management, even after the teaching session. Our study suggests that there is a benefit to supplementing traditional training with a fracture simulator.

An Evaluation of Non-Uniform Grade Distribution with the Emergency Medicine Off-Service Standardized Letters of Evaluation.

Introduction: Standardized Letters of Evaluation (SLOEs) are designed to objectively compare medical students to their peers for completed emergency medicine (EM) rotations to be used in the EM residency match. In an attempt to adapt quickly to the lack of availability of in-person EM rotations due to COVID restrictions, “off-service” SLOEs (OSLOEs) were allowed in place of traditional SLOEs. The purpose of this study was to assess the utility of OSLOEs for candidate selection during the 2020-21 application cycle at a single EM residency.Methods: A retrospective cohort review of all OSLOEs submitted during the 2020-21 academic year to an EM residency program was performed. A total of 270 OSLOES were eligible for review. Summary statistics were calculated for the study variables recorded, including global rank, grade, categorical details, and rank.Results: Of the 270 OSLOEs reviewed, 61.9% ranked candidates in the top 10% of their class, with 95% being ranked in the top two categories. Over 90% of students were graded as honors or high pass and over 75% of students were ranked in the top 1/3 for each specific OSLOE category.Conclusion: Our findings reveal questionable utility of the objective measures in the OSLOE as there are signs it may suffer from non-uniform grade distribution, leading to low utility for candidate selection. Our data shows marked over-ranking within the highest 2 categories. EM program directors and faculty should use caution as the OSLOE may not carry the same weight as a traditional SLOE when objectively evaluating prospective students for a match into EM.

Acute Flaccid Myelitis.

Acute Flaccid Myelitis.

From the ground up: Creating and leading fellowship programs in emergency medicine.

A methodical and evidence-based approach to the creation and implementation of fellowship programs is not well described in the graduate medical education literature. The Society for Academic Emergency Medicine (SAEM) convened an expert panel to promote standardization and excellence in fellowship training. The purpose of the expert panel was to develop a fellowship guide to give prospective fellowship directors the necessary skills to successfully implement and maintain a fellowship program. Under direction of the SAEM Board of Directors, SAEM Education Committee, and SAEM Fellowship Approval Committee, a panel of content experts convened to develop a fellowship guide using an evidence-based approach and best practices content method. The resource guide was iteratively reviewed by all panel members. Utilizing Kern's six-step model as a conceptual framework, the fellowship guide summarizes the construction, implementation, evaluation, and dissemination of a novel fellowship curriculum to meet the needs of trainees, educators, and sponsoring institutions.Other key areas addressed include Accreditation Council for Graduate Medical Education and nonaccredited fellowships, programmatic assessment, finances, and recruitment. The fellowship guide summarizes the conceptual framework, best practices, and strategies to create and implement a new fellowship program.

Making emergency medicine accessible for all: The what, why, and how of providing accommodations for learners and physicians with disabilities.

Individuals with disabilities comprise a substantial portion of the U.S. population but make up only a small subset of medical students and health care providers. Both the Association of American Medical Colleges and the Accreditation Council for Graduate Medical Education have called for increased diversity in the physician workforce, to more closely represent the U.S. patient population and provide culturally effective care. Yet the barriers to disclosure and inclusion for individuals with disabilities in health care are significant, including attitudinal barriers such as stigma and bias, organizational barriers in policies and procedures, and environmental barriers such as resources and physical space. Lack of experience providing accommodations and a lack of knowledge of both what is legally required and what is possible also prevent programs from creating access. Realizing inclusion for individuals with disabilities in a diverse workforce requires emergency medicine programs to be proactive and deliberate in their approach to recruiting, accommodating, and retaining students, residents, and faculty with disabilities. Such efforts are likely to provide benefits that extend beyond those who receive the accommodations.

Developing a dashboard for program evaluation in competency-based training programs: a design-based research project.

BackgroundCanadian specialist residency training programs are implementing a form of competency-based medical education (CBME) that requires the assessment of entrustable professional activities (EPAs). Dashboards could be used to track the completion of EPAs to support program evaluation.MethodsUsing a design-based research process, we identified program evaluation needs related to CBME assessments and designed a dashboard containing elements (data, analytics, and visualizations) meeting these needs. We interviewed leaders from the emergency medicine program and postgraduate medical education office at the University of Saskatchewan. Two investigators thematically analyzed interview transcripts to identify program evaluation needs that were audited by two additional investigators. Identified needs were described using quotes, analytics, and visualizations.ResultsBetween July 1, 2019 and April 6, 2021 we conducted 17 interviews with six participants (two program leaders and four institutional leaders). Four needs emerged as themes: tracking changes in overall assessment metrics, comparing metrics to the assessment plan, evaluating rotation performance, and engagement with the assessment metrics. We addressed these needs by presenting analytics and visualizations within a dashboard.ConclusionsWe identified program evaluation needs related to EPA assessments and designed dashboard elements to meet them. This work will inform the development of other CBME assessment dashboards designed to support program evaluation.

Increased Fellow Scholarly Publication Rate After Implementation of a Comprehensive Research Curriculum and Milestone-Based Research Timeline for Pediatric Emergency Medicine Fellows.

Pediatric subspecialty fellows are required to complete a scholarly product during training; however, many do not bring the work to publication. To amplify our fellows' publication success, our pediatric emergency medicine fellowship program implemented a comprehensive research curriculum and established a milestone-based research timeline for each component of a project. Our objective was to assess whether these interventions increased the publication rate and enhanced the graduated fellows' perceived ability to perform independent research. Our study was conducted at a tertiary children's hospital affiliated with an academic university, enrolling 3 fellows each year in its pediatric emergency medicine program. A comprehensive research curriculum and a milestone-based research timeline were implemented in 2011. We analyzed the publication rate of our graduating fellows before (2004-2011) and after (2012-2016) our intervention. In addition, in 2017 we surveyed our previous fellows who graduated from 2004 to 2016 and analyzed factors favoring manuscript publication and confidence with various research skills. During the study period, 38 trainees completed the fellowship program. Publication rate increased from 26% ± 17% to 87% ± 30 % ( P < 0.05). When scoring the importance of various factors, fellows most valued mentorship (5 ± 0 vs 4.3 ± 1.0, P < 0.05, postintervention vs preintervention) for the completion of the fellowship study and manuscript. Fellows after the intervention reported greater confidence in performing an analysis of variance (89% vs 36%, odds ratio, 6.3; 95% confidence interval, 1.4-150.1). Implementation of a comprehensive research curriculum and a milestone-based research timeline was associated with an increase in the publication rate within 3 years of graduation of our pediatric emergency medicine fellows. After implementation, fellows reported an increased importance of mentorship and greater confidence in performing an analysis of variance. We provide a comprehensive curriculum and a research timeline that may serve as a model for other fellowship programs.