Residency Directors Research Articles

Telesimulation Use in Emergency Medicine Residency Programs: National Survey of Residency Simulation Leaders

Introduction: Coronavirus 2019 (COVID-19) accelerated the need for virtual learning including telesimulation. Many emergency medicine (EM) programs halted in-person simulation and trialed telesimulation, but specifics on its utilization and plans for future use are unknown. Telesimulation has been defined as “a process by which telecommunication and simulation resources are utilized to provide education, training, and/or assessment to learners at an off-site location.” Our objective in this study was to describe the patterns of telesimulation usage in EM residency programs during COVID-19-induced learning restrictions as well as its anticipated future utility. Methods: We identified EM simulation leaders via the EMRA Match website, institutional websites, or personal contact with residency coordinators and directors, and invited them to participate by email. Participants completed a confidential, web-based survey consisting of multiple-choice items and one free-response question, developed by our study team with consideration of survey research best practices and Messick’s validity framework. We collected data between January–February 2022. We calculated descriptive statistics for multiple-choice items and examined the free-response answers for common themes. Results: We obtained contact information for simulation leaders at 139 EM residency programs. Survey response rate was 65% (91/139). During in-person restrictions, 62% (56/91) of programs used telesimulation. Assuming all restrictions lifted, 38% (34/90) of respondents planned to continue to use telesimulation, compared to 9% (8/91) using telesimulation before COVID-19. Most respondents planned to use telesimulation for medical knowledge (26/34, 76%) and communication/teamwork-focused cases (23/34, 68%). In response to the free-response question regarding experience with and plans for use, we identified three major themes: 1) telesimulation is a valuable alternative to in-person learning; 2) telesimulation is an option for learners unable to participate in person; and 3) telesimulation is challenging for procedural education. Conclusion: Despite the relatively limited use of telesimulation in EM residencies prior to COVID-19, an increased number of programs have plans to continue incorporating telesimulation into their curricula. This plan for continued use opens opportunities for further innovation and scholarship within simulation education.

Education Research: Burnout and Perception of Value in a Cross-Section of Neurology Residency Program Directors.

There are no dedicated studies specifically assessing burnout in neurology residency program directors (PDs). A study of residency and fellowship directors across specialties found neurology residency PDs had the highest work-related Copenhagen Burnout Inventory (CBI) score, which may reflect high-level burnout in neurology in general. Indeed, the American Academy of Neurology Burnout Task Force reported burnout in 60% of neurologists. The aims of this study are to determine the level of burnout in adult and pediatric neurology residency PDs, and to determine whether perception of value is related to burnout. In an IRB-approved study, 184 neurology residency PDs were emailed an anonymous survey consisting of the full CBI, demographic information, and 2 items addressing perception of value in the PD role: "I feel valued by my department in my educational role," to which the participant could respond "strongly disagree, disagree, agree, or strongly agree," and "satisfaction with current percent effort for the educational role," to which the participant could respond "very dissatisfied, dissatisfied, satisfied, or very satisfied." Data were analyzed through analysis of variance and ordinal logistic regression. A total of 85 PDs (46%) responded to the survey. The average ± SEM personal, work-related, and patient-related CBI scores were 41.8 ± 2.2, 39.7 ± 2.2, and 32.4 ± 2.2, respectively. Higher personal and work-related CBI scores were associated with less positive perception of value (proportional odds ratio 1.03, 95% CI 1.01-1.06, p = 0.004 and proportional odds ratio 1.04; 95% CI 1.01-1.06, p = 0.003, respectively). Higher personal and work-related CBI scores were also associated with greater dissatisfaction with percent effort granted for the PD role. Level of burnout did not differ between adult and pediatric PDs. Burnout was not related to sex, years in practice, years as PD, academic rank, or percentage effort granted for the PD role. Despite working in a field associated with high burnout, neurology residency PDs were found to have lower-level burnout than previously reported. Ninety-four percent of the PDs reported feeling valued in their role which was associated with lower-level personal and work-related burnout and may represent a key target for reflection and burnout intervention in the future.

Evaluating the 2023 Standardized Letter of Recommendation Form in Applications to Orthopaedic Surgery Residency.

Successfully matching into orthopaedic surgery residency is a challenging endeavor due to the limited number of available positions. Implementation of the Standard Letter of Recommendation (SLOR) in 2017 was intended to allow better comparisons between applicants; however, the form suffered from notable rank inflation ultimately requiring introduction of an updated SLOR for the 2023 to 2024 application cycle. The purpose of this study was to evaluate whether the 2023 SLOR improves on deficiencies of the 2017 SLOR. Applications submitted to our institution during the 2023 to 2024 orthopaedic surgery residency application cycle were analyzed. Applicant objective metrics were collected, including US Medical Licensing Exam scores, clerkship grades, AΩA status, and research productivity. Scores for each domain of the 2023 SLOR forms were recorded. Mean scores were calculated for each question, and cumulative scores per SLOR were determined. Intraclass correlation coefficients were determined per applicant and evaluator. The Spearman rank correlation coefficient was calculated for comparison of SLOR cumulative scores and objective metrics. Three hundred sixty-eight applications were reviewed, and 743 2023 SLORs were submitted in conjunction with these applications. Most of the 2023 SLORs (n = 399, 53.70%) had cumulative scores placing applicants in at least the 90th percentile. Furthermore, 267 evaluators (72.36%) consistently gave scores of 99s and 10s for each question. Intraclass correlation coefficients were rated as fair to moderate agreement between evaluators for each applicant. Objective applicant metrics did not meaningfully correlate with SLOR cumulative scores. The 2023 SLOR demonstrated notable rank inflation with only 22.7% of applicants receiving a score of less than 7 on any domain. By contrast, 69.9% of applicants received a score of "rare, perfect gem" on at least one domain of the form. We encourage the American Orthopaedic Association Council of Orthopaedic Residency Director to continue to improve the form and provide guidance to residency program leadership on proper use of the grading system.

Family Medicine Resident Remediation Compared Across Two CERA Studies.

From 2020 to 2022, multiple medical schools transitioned from teaching patient care directly to online electives. Family medicine program directors reported on these learners' abilities to meet the Accreditation Council of Graduate Medical Education (ACGME) core competencies during residency. The authors hypothesized an increased need for medical knowledge remediation in the 2023 Council of Academic Family Medicine Educational Research Alliance (CERA) study. Using the 2017 and 2023 CERA studies, the authors evaluated which factors were associated with residents requiring remediation, residents completing remediation, the duration of remediation, and the most remediated core competency. Compared to 2017, the percentage of residents who successfully remediated in the 2023 study increased (P=.006), while remediation duration stayed unchanged at 6 to 12 months. The top ACGME core competency needing remediation remained professionalism in both studies (2017: 38.1%; 2023: 45.1%; P=.10) with medical knowledge being second most common (2017: 30.2%; 2023: 25.2%; P=.20). We found no associations between non-U.S. medical graduate percentage, core faculty remediation training, professionalism training, or didactic hours and the number of residents undergoing remediation, the percentage of residents remediating successfully, or the most common competency remediated. Program director gender, degree, race, years of experience, underrepresented in medicine status, and remediation training were not associated with any resident remediation variables studied. Professionalism remains the top core competency requiring remediation. We found no associations between resident, program, training, or program director factors and the core competency requiring remediation, the number of residents needing remediation, or the percentage of residents who completed remediation.

Family Medicine Resident Scholarly Activity Infrastructure, Output, and Dissemination: A CERA Survey.

Meeting scholarly activity requirements continues to be a challenge in many family medicine (FM) residency programs. Studies comprehensively describing FM resident scholarship have been limited. We sought to identify institutional factors associated with increased scholarly output and meeting requirements of the Accreditation Council for Graduate Medical Education (ACGME). Our goals were to: (1) describe scholarly activity experiences among FM residents compared with ACGME requirements; (2) classify experiences by Boyer's domains of scholarship; and (3) associate experiences with residency program characteristics and scholarly activity infrastructure. This was a cross-sectional survey. The survey questions were part of an omnibus survey to FM residency program directors conducted by the Council of Academic Family Medicine Educational Research Alliance (CERA). All ACGME-accredited US FM residency program directors, identified by the Association of Family Medicine Residency Directors, were sampled. Of the 691 eligible program directors, 298 (43%) completed the survey. The respondents reported that 25% or more residents exceeded ACGME minimum output, 17% reported that 25% or more residents published their work, and 50% reported that 25% or more residents delivered conference presentations. Programs exceeding ACGME scholarship requirements exhibit robust infrastructure characterized by access to faculty mentorship, scholarly activity curricula, Institutional Review Board, medical librarian, and statistician. These findings suggest the need for codified ACGME requirements for scholarly activity infrastructure to ensure access to resources in FM residency programs. By fostering FM resident engagement in scholarly activity, programs help to create a culture of inquiry, and address discrepancies in funding and output among FM residency programs.

Development and implementation of just-in-time curricula for on-shift teaching during times of boarding.

Overcrowded emergency departments (EDs) due to boarding of inpatients can lead to fewer patients seen by residents and may negatively impact their education. The existing literature recommends providing educational resource banks to augment teaching during overcrowding. We aimed to develop and evaluate the use of an educational curriculum during times of boarding. Using Kern's model of curriculum development, we conducted local and national needs assessments to identify existing curricula. The final curriculum consisted of electrocardiogram (ECG) cases, procedural resources, journal articles, and oral boards style cases. The derived curriculum was implemented at the study site, where content was released weekly via email or Slack and via our departmental educational blog. Residents were asked to fill out a survey assessing their satisfaction with the resource, their current patient load, and current National Emergency Department Overcrowding Study score (NEDOCS). We compared clinician educator satisfaction with teaching before implementation and at 3 months after implementation using Wilcoxon rank-sum test. The national needs assessment was sent to the Council of Residency Directors (CORD) listserv. There were 36 unique program responses with only one program with resources for teaching during overcrowding. The derived curriculum was used seven times during the study period. The mean (±SD) NEDOCS at the time of resource use was 238.7 (±23.6). The median (range) number of active patients while using the resource was 4 (0-7). ECG cases were the most used resource. Mean (±SD) satisfaction with teaching before implementation was 2.8 (±0.9; Likert-type item scale 1 to 6 from not at all to a great deal satisfied). Satisfaction with teaching improved after implementation of the curriculum, with the mean (±SD) increasing to 3.5 (±1.0; p = 0.01). We report the development and implementation of a local educational curriculum for use during times of boarding. The curriculum was lightly used during the study period, but the availability of a curriculum may have increased satisfaction with teaching during boarding.

Departure Decisions: Exit Survey of Family Medicine Residency Directors.

Program director (PD) tenure, continuity, and stability may enhance residency program quality, yet many PDs do not stay long in their positions. No prior study has taken a comprehensive census of departing PDs to determine reasons for leaving the role. This study aimed to survey all exiting family medicine (FM) PDs to identify decision factors contributing to their departure. From October 2021 to October 2022, we sent a web-based exit survey to all departing FM PDs. The survey asked departing PDs to rate the strength of 36 factors in the decision to exit the PD role in terms of job satisfaction, accomplishments, career choices, workload, preparation, expectations, and support. We used the Fisher exact test to assess all 36 decision factors and PD characteristics for significant associations with shorter or longer PD tenures. PDs submitted 73 surveys out of 109 invitations (67.0% response). We analyzed 68 with complete data. The median PD tenure was 5.6 years (mean 6.9 years). Most respondents (66/68, 97.1%) identified three or more strong factors in their decision to leave. The strongest factors reflected stable residency programs, an established succession plan, a desire for more personal/family time, and a sense that the time was right. PDs with tenures longer than 3 years were more likely to have completed the National Institute for Program Director Development (P=.001). PDs leave the position for multiple reasons, often positive, and not necessarily due to lack of support and preparation. Further exploration of decision factors may inform strategies to support PDs in their positions.

Snapshot of Examination Usage in Emergency Medicine Clerkships.

Objective Emergency Medicine (EM) clerkships often use a written exam to assess the knowledge gained over the course of an EM rotation in medical school. Clerkship Directors (CDs) may choose the National Board of Medical Examiners (NBME) EM Advanced Clinical Science Subject Exam (ACE), the Society for Academic Emergency Medicine (SAEM) M4 exam, which has two versions, the SAEM M3 exam, or departmental exams. There are currently no published guidelines or consensus regarding their utility. This survey-based study was designed to collect data regarding current practices of EM clerkship exam usage to analyze trends and variability in what exams are used and how. Methods The authors designed a cross-sectional observational survey to collect data from EM CDs on exam utilization in clerkships. The survey population consisted of clerkship directors, assistant clerkship directors, or faculty familiar assessments in their EM clerkship. Initial dissemination was by electronic distribution to subscribers of the Clerkship Directors in Emergency Medicine (CDEM) list-serve on the SAEM website. Subsequently, contact information of CD's from institutions that had not responded was obtained by manual search of the Emergency Medicine Residents' Association (EMRA) Match website and individual correspondence was sent at regular intervals. Data obtained include clerkship characteristics, exam used, weight of the exam relative to the overall grade, and alternatives if the preferred exam was previously taken. Results Eighty-seven programs (42% response rate) completed the survey between August 2019 and February 2021. Of the 87 responses, 71 (82%) were completed by a CD. Forty-six (53%) institutions required an EM rotation. Students were tested in 34 (74%) required EM clerkships and 48 (69%) out of 70 EM electives. In required rotations that used an exam, 20 (59%) used the NBME EM ACE, while 28 of 46 (61%) of EM electives that reported an exam used the SAEM M4 Exam. Five (15%) of the required clerkships used a departmental exam. Of clerkships requiring an exam, 46 (57%) weighed the score at 11-30% of the final grade. Data for extramural rotations mirrored that of EM electives. One-third of respondents indicated they do not inquire about previously taken exams. Conclusion This survey demonstrates significant variability in the type of exam, the weighting of the score, and alternatives if the preferred exam was previously taken. The lack of a consistent approach in how these exams are used in determining students' final EM grades diminishes the reliability of the EM clerkship grade as a factor used by residency directors in choosing future residents. Further research on optimal usage of these exams is needed.

“A lot of moving parts”: Recovery home challenges linking and housing individuals with criminal legal system involvement

IntroductionThere are high rates of substance use disorder (SUD) among people released from carceral settings and, upon release, many of these people also face unstable housing situations, posing challenges to connecting with resources to facilitate SUD recovery. Recovery homes provide a temporary sober living environment for those seeking both SUD recovery and transition back to the community after carceral release. However, successful recovery home placement for this population can prove difficult, and there is a need for research to identify ways to overcome them. MethodsThe current qualitative study seeks to understand barriers to recovery home access for people leaving carceral settings and identify potential best practices for overcoming these barriers from the perspective of recovery home directors. The study conducted semi-structured interviews at two data collection points with eight recovery home directors from sites participating in a housing linkage and placement intervention pilot. The research team used qualitative software to identify and organize directors' experiences and practices in housing and supporting this population. ResultsRecovery home directors identified significant barriers to linkage from carceral settings, including difficulties communicating and coordinating placement with potential residents while still incarcerated. Interviews also revealed approaches recovery home directors take to improve recovery home placement, such as sharing information and resources with carceral settings prior to release and helping residents avoid reincarceration by managing relationships with court agents and parole. ConclusionRecovery resident directors have considerable insight into the most significant placement challenges faced by recovery homes upon carceral release as well as experience with potential solutions for overcoming them. Directors can be the key to direct seamless support and continuity of care for criminal legal system involved individuals through coordination with jails, prisons, and other community resources. Directors can also play a significant role in the successful completion of probation and parole by helping residents avoid further issues with the legal system. These directors view working cooperatively with residents as an effective approach to ensuring clients adhere to court orders and are successful in recovery and reentry.

Comment on “Navigating obstacles: Perspectives of US pharmacy residency directors on non‐US candidates for PGY‐1 residencies: A survey‐based research”

Comment on “Navigating obstacles: Perspectives of <scp>US</scp> pharmacy residency directors on non‐<scp>US</scp> candidates for <scp>PGY</scp>‐1 residencies: A survey‐based research”

Response to Comment on “Navigating obstacles: Perspectives of US pharmacy residency directors on non‐US candidates for PGY‐1 residencies: A survey‐based research”

Response to Comment on “Navigating obstacles: Perspectives of <scp>US</scp> pharmacy residency directors on non‐<scp>US</scp> candidates for <scp>PGY</scp>‐1 residencies: A survey‐based research”

Are Pre-clerkship Remediation, Grading, and Reporting Practices Equitable in the U.S.? A National Survey

Phenomenon: With the proliferation of pass/fail grading practices in the pre-clerkship phase of undergraduate medical education, questions arise about the transparency and variability of grading and grade reporting practices, raising issues of equity in assessment, particularly regarding residency matching. The purpose of this survey was to determine the remediation and academic performance reporting practices of United States (U.S.) allopathic medical schools in the pre-clerkship phase of their curricula. Approach: After an extensive literature search and feedback from curriculum deans and learning experts, we developed a survey that we sent in the Spring of 2022 to pre-clerkship curriculum officials at all 154 accredited U.S. allopathic medical schools. It addressed curriculum content and structure; pre-clerkship remediation (e.g., course retakes) and reporting (e.g., permanency of transcript notation) practices; documentation and reporting of nonacademic competencies; and participant opinions and recommendations regarding reporting, transparency, and equity. We generated descriptive statistics and did manifest coding of open-ended responses. Findings: We had a response rate of 40% (62/155), with over 71% indicating mainly organ systems-based curricula. Depending on the situation, there were a wide range of remediation approaches for single- and multiple-course failures, including tutoring or learning support, re-exams, and referrals to a promotion board. Professionalism concerns were a top priority to report to residency directors, with significant variability in respondent opinions and practices in reporting remedial activities. Respondents were concerned about equity, both in terms of flexible grading practices and transparency of reporting practices. Insights: The variability in reporting practices across schools, while allowing holistic and individualized approaches to academic support, also creates potential inequities. More work is needed to understand how different reporting practices across institutions may disadvantage marginalized and minoritized student groups at different points in their preparation.

Use of Signaling in Family Medicine Residency Interviewing.

Although signals have been used in the residency application process by other specialties, family medicine residency directors have not previously participated. With applicant signal information available for the first time in the 2023-2024 application cycle, the current study describes family medicine residency program directors' intended use of signals and provides benchmarking descriptive data that may help inform best practices and future studies. A total of 691 of the 745 family medicine program directors in US family medicine residency programs accredited by the Accreditation Council for Graduate Medical Education were surveyed. We used ꭓ2 and Pearson correlation analyses to examine how program directors of family medicine residency programs intended to use signaling and their perceived impact of signaling on the residency interviewing process. Most program directors indicated that applicant signals would assist them in deciding who to invite for an interview and would be a positive factor in a holistic review process. However, program directors also noted that rotation experience or geographic ties would be more powerful inducements to interview or rank a specific candidate. Program directors did not indicate a belief that signals would decrease interview season stress or workload. Signals may play an important role in the residency application process for family medicine in 2023-2024. While signals are not anticipated to decrease application workload or stress, a signal may be an important mechanism for a specific applicant to distinguish themselves with a program.

Perception of the compatibility of Quebec residency program characteristics with the advanced access model: a cross-sectional study

BackgroundThe advanced access (AA) model is among the most recommended innovations for improving timely access in primary care (PC). AA is based on core pillars such as comprehensive planning for care needs and supply, regularly adjusting supply to demand, optimizing appointment systems, and interprofessional collaborative practices. Exposure of family medicine residents to AA within university-affiliated family medicine groups (U-FMGs) is a promising strategy to widen its dissemination and improve access. Using four AA pillars as a conceptual model, this study aimed to determine the theoretical compatibility of Quebec’s university-affiliated clinics’ residency programs with the key principles of AA.MethodsA cross-sectional online survey was sent to the chief resident and academic director at each participating clinic. An overall response rate of 96% (44/46 U-FMGs) was obtained.ResultsNo local residency program was deemed compatible with all four considered pillars. On planning for needs and supply, only one quarter of the programs were compatible with the principles of AA, owing to residents in out-of-clinic rotations often being unavailable for extended periods. On regularly adjusting supply to demand, 54% of the programs were compatible. Most (82%) programs’ appointment systems were not very compatible with the AA principles, mostly because the proportion of the schedule reserved for urgent appointments was insufficient. Interprofessional collaboration opportunities in the first year of residency allowed 60% of the programs to be compatible with this pillar.ConclusionsOur study highlights the heterogeneity among local residency programs with respect to their theoretical compatibility with the key principles of AA. Future research to empirically test the hypotheses raised by this study is warranted.

Surveying the Knowledge and Practices of Primary Care Residents in Managing Adult Patients with Obesity.

The prevalence of obesity is increasing worldwide at an alarming rate, yet obesity remains under-addressed during clinic encounters. A lack of training in how to treat obesity is one crucial factor contributing to this deficiency. This study explored resident physicians' perceptions of their education on obesity and its relationship with confidence and practice behaviors when caring for patients with obesity. A survey was distributed to residency directors to share with residents in their programs. Participation was voluntary and anonymous. Data was collected over a 3-month period. Residents in Family Medicine and Internal Medicine programs in West Virginia and Indiana who saw adult patients in an ambulatory care setting. The electronic survey queried the presence of a formal curriculum on Obesity Medicine (OM) and each resident's knowledge, confidence, practice behaviors, and attitudes pertaining to OM. The survey was distributed to 490 residents in 12 programs. Response rate was 22.9% (112 resident physicians). All respondents felt that medical training in obesity should be strengthened. Residents who reported having a formal curriculum on OM were more likely than those without a curriculum to rate their confidence as "high" when discussing weight (35.0% vs. 16.7%, p = 0.03) and when counseling patients about diet and nutrition (37.5% vs. 18.1%, p = 0.02). They also more frequently reported learning enough from faculty to manage obesity (65.0% vs. 29.2%, p < 0.001). Residents with an OM curriculum reported discussing obesity as a problem with patients (100.0% vs. 86.1%, p = 0.01), and completing motivational interviews (90.0% vs. 58.3%, p = < 0.001), more frequently than their peers without a curriculum. Residents with a formal OM curriculum were more confident in addressing and discussing obesity with patients. Formal training in OM will strengthen resident training to better address and treat patients with obesity.

How Prominent Are Gender Bias, Racial Bias, and Score Inflation in Orthopaedic Surgery Residency Recommendation Letters? A Systematic Review.

Letters of recommendation are considered an important factor in the holistic ranking of orthopaedic residency applications. The standardized letter of recommendation (SLOR) was introduced in 2017 in response to the inherent bias and limited comparative value of traditional LORs. It includes standardized questions about an applicant's orthopaedic qualifications, designed to enable fair comparisons among candidates. However, disparate and inconsistent findings have made it difficult to draw meaningful conclusions from individual studies on the SLOR and narrative letter of recommendation. In this systematic review we asked: (1) What is the distribution of applicant SLOR rating among nine domains and summative scores? (2) Are there applicant characteristics associated with SLOR ratings? (3) Is there gender and racial bias in the SLOR and narrative letter of recommendation? PubMed, EBSCO, and Google Scholar electronic databases were queried on March 20, 2023, to identify all studies evaluating SLOR and narrative letter of recommendations between January 1, 2017, and March 20, 2023. Articles that evaluated orthopaedic SLOR or narrative LORs were included. Systematic reviews, case reports, duplicate studies between databases, and grey literature such as abstracts and articles on preprint servers were excluded. Eight studies including 6179 applicants and 18,987 letters of recommendation were included in the final analysis. The applicant classes ranged from years 2014 to 2020. Two reviewers independently evaluated the quality of the included studies using the Joanna Briggs Institute (JBI) tool for cross-sectional studies. The mean JBI score of included studies was 7.4 out of a maximum of 8, with higher scores indicating better quality. The primary outcome was to determine the distribution of applicant SLOR rankings in their summative score. Summative scores were separated into ranked to match, top one-third, middle one-third, lower one-third, and not a fit. Four studies reported the summative SLOR scores of applicants. Our secondary study goal was to assess applicant characteristics associated with SLOR summative scores and assess any bias present in the SLOR or narrative recommendation. Five studies compared SLOR ratings across applicant characteristics including gender, race, USMLE Step 1 score, USMLE Step 2 score, Alpha Omega Alpha (AΩA) membership, clerkship grades, and publications. Gender and racial bias were also assessed across five studies. Four studies utilized a linguistic analysis software to search letters of recommendation for differences in word category use by gender and race. Studies consistently found that a higher percentage of candidates were identified in the top percentile blocks than is mathematically possible. For example, the two studies that tallied the proportion of candidates ranking in the top 10% of applicants found that 36% and 42% were rated as being in the top 10%. Similarly, articles found more than 87% of applicants scored in the top one-third. Studies had mixed results, but in general, they suggested that AΩA status, higher Step 1 scores, and more research publications have a slightly positive association with increased SLOR scores. We found no evidence of gender bias against women, and in fact, most studies evaluating word choices found word choices for women candidates generally were stronger. Similarly, no consistent disparities were identified in word categories utilized in SLORs based on applicant race. Most notably, a mathematically impossible proportion of applicants were counted in the top percentiles in letters of recommendation. This compromises readers' abilities to differentiate candidates. Factors like AOA status and research publications displayed a modest positive correlation with SLOR scores. Gender bias against women or candidates from racial minority groups was not evident. We suggest that group SLOR authorship, with a consensus assessment by clerkship or residency directors, should be considered. We also recommend the incorporation of mean and SD scores for each letter writer (or group) alongside their letters. Furthermore, studies indicate that submitting all four SLOR letters can substantially improve an applicant's chances of success. We advise students to choose strategically and submit the maximum allowable number of SLORs.

Attitudes on data reuse among internal medicine residents.

NYU Langone Health offers a collaborative research block for PGY3 Primary Care residents that employs a secondary data analysis methodology. As discussions of data reuse and secondary data analysis have grown in the data library literature, we sought to understand what attitudes internal medicine residents at a large urban academic medical center had around secondary data analysis. This case report describes a novel survey on resident attitudes around data sharing. We surveyed internal medicine residents in three tracks: Primary Care (PC), Categorical, and Clinician-Investigator (CI) tracks as part of a larger pilot study on implementation of a research block. All three tracks are in our institution's internal medicine program. In discussions with residency directors and the chief resident, the term "secondary data analysis" was chosen over "data reuse" due to this being more familiar to clinicians, but examples were given to define the concept. We surveyed a population of 162 residents, and 67 residents responded, representing a 41.36% response rate. Strong majorities of residents exhibited positive views of secondary data analysis. Moreover, in our sample, those with exposure to secondary data analysis research opined that secondary data analysis takes less time and is less difficult to conduct compared to the other residents without curricular exposure to secondary analysis. The survey reflects that residents believe secondary data analysis is worthwhile and this highlights opportunities for data librarians. As current residents matriculate into professional roles as clinicians, educators, and researchers, libraries have an opportunity to bolster support for data curation and education.

Preference Signaling in the Orthopaedic Surgery Match: Applicant and Residency Program Attitudes, Behaviors, and Outcomes.

The orthopaedic surgery match has experienced a consistent increase in both the number of applicants and applications submitted per applicant. Preference signaling was implemented during the 2022 to 2023 application cycle in part to curtail the rising application burden on both applicants and residency programs. Our aim was to explore the impact of the preference signaling system on applicant and residency program leader attitudes, behaviors, and outcomes. We distributed surveys to American Orthopaedic Association/Council of Orthopaedic Residency Directors member program leaders (program directors, assistant program directors, and program coordinators) and applicants registered for the Electronic Standardized Letter of Recommendation after Universal Interview Offer Day 2022 (Fall Survey) and Match Day 2023 (Spring Survey). The surveys contained multiple-choice and numeric response questions on attitudes, behaviors, and outcomes that were analyzed and reported as percentages and medians, respectively. Open-text responses were reviewed for dominant themes. One hundred program leaders and 378 applicants (47%) completed the Fall Survey, and 146 program leaders and 290 applicants (36%) completed the Spring Survey. A majority of applicants (71%) and program leadership (91%) support the continued use of signaling. Applicants reported a 16% reduction in the number of programs to which they applied. Program directors largely used signaling as a tool for screening applications (75%), with few programs using signaling in the ranking process (20%). Applicants reported that 81% of their interviews were from programs they signaled. Slightly more than half of programs (53%) reported filling their last slot at a higher rank order position than the average of the previous 5 years. Qualitative analysis suggests a need for more transparency in the use of signals, consideration of application and/or interview caps, and reconsideration of the other components of the application. Preference signaling in the orthopaedic surgery match was met with positive feedback and led to a reduction in the number of applications. Future research will examine the continued impact of preference signaling and assess alterations for optimizing the match process.

American Orthopaedic Association's (AOA) Council of Orthopaedic Residency Directors (CORD) 2022 Summer Conference: Top Abstracts

In a continuing collaboration between the American Orthopaedic Association's (AOA) Council of Orthopaedic Residency Directors (CORD) and JBJS, the following 10 abstracts highlight the scientific research presented at AOA's annual national meeting held in June 2022. These abstracts embody CORD's purpose and mission:“The American Orthopaedic Association's Council of Orthopaedic Residency Directors (CORD) program strives to recognize best practices in orthopaedic residency education and fellowship education based on ACGME [Accreditation Council for Graduate Medical Education]-defined essential knowledge and skills in each of the residency education competency areas. CORD provides a forum for academic orthopaedic leaders to exchange ideas, discuss solutions to challenges, and find ways to teach residents in orthopaedic programs effectively.” We hope this education-related research will inspire further inquiry to advance the development of future orthopaedic surgeons.

Creation of a National Emergency Medicine Medical Education Journal Club.

Background There are a relatively limited number of emergency medicine (EM) medical education (MedEd) fellowships with few trainees at each program, creating barriers to local collaboration and networking. While best practices for developing MedEd journal clubs exist, there has not been an established national EM MedEd journal club. To address this need, we created a national journal club, the Council of Residency Directors (CORD) MedEd Journal Club (MEJC), to facilitate collaboration and networking opportunities by providing a synchronous online journal club. Objectives Our primary objective was to create a network for collaboration across geographical barriers to form a virtual community of practice (CoP) around the shared domain of evidence-based MedEd. Our secondary objective was to improve MedEd fellows' knowledge, skills, and attitudes surrounding MedEd research. Tertiary objectives included (1) broadening fellow exposure to key topics within MedEd, (2) describing how to develop scholarly work within MedEd, and (3) filling a perceived need for building a national MedEd virtual CoP. Curricular design The concept and objectives of the CORD MEJC were introduced to fellows and fellowship directors through a national listserv in March of 2022. Fellows volunteered to lead virtual sessions via Zoom on a monthly basis. Session fellow leaders independently chose the topics and were asked to submit two to three journal club articles discussing the topic at least two weeks in advance of each session. No topics were repeated throughout the academic year. Impact/effectiveness Our quality improvement survey results indicated that the CORD MEJC is meeting its primary and secondary objectives. Survey results will be utilized as part of a continuous quality improvement initiative to enhance our program structure and curricula for the 2023-2024 academic year.