Residency Directors Research Articles

Impact of Advanced Pharmacy Practice Experiences on Residency Interview Invitations

Objective. To determine how postgraduate year one (PGY1) pharmacy residency program directors perceive factors related to advanced pharmacy practice experiences (APPEs) when selecting candidates for residency interviews. Methods. An online cross-sectional nationwide survey of 1,280 PGY1 residency program directors was conducted. Participants were asked to rank the overall influence of five APPE categories, including location, structure, elective type, timing, and preceptor references, as well as the desirability and necessity of APPE-related variables representing the five categories, in their assessment of residency candidates. Results. Program demographics and survey data were collected from 375 participants (29% response rate). The category most influential to program directors' decisions was APPE preceptor reference letters, while the category that was the least influential was APPE timing factors. An APPE's location, structure, and elective type ranked second, third, and fourth, respectively, as the most influential categories. Respondents perceived factors similar to their own residency environment as desirable, supporting the study's conceptual framework of person-environment fit. The variables that the majority of residency directors specifically desired were two reference letters from APPE preceptors and letter grades for each APPE completed. Completion of inpatient elective APPEs was considered more desirable than completion of a balanced mix of elective APPEs. Participants rarely indicated that a specific APPE variable was a necessity for a candidate to be considered. Conclusion. Applicants to pharmacy residency programs should consider the importance of person-environment fit when selecting APPEs and preparing applications as program directors desire candidates who possess attributes compatible with their organization and complete APPEs in settings similar to that of their organization. Conversely, the absence of desired APPE-related variables does not necessarily exclude an applicant from consideration.

Outcomes of a PharmD-Led Palliative Care Interprofessional Team Learning Model (QI626)

•Describe an interprofessional educational learning experience among physician hospice fellows and postgraduate year two (PGY2) pain management and palliative care pharmacy residents.•Explain tools utilized to evaluate the effectiveness of interprofessional learning. An interprofessional palliative care training model can increase the number of palliative care practitioners and improve palliative care team collaboration. The PGY2 pain management and palliative care (PMPC) pharmacy residency director collaborated with a hospice fellowship director to create an interprofessional outpatient palliative care direct patient care teaching clinic. The primary objective was to implement and evaluate learning outcomes of an interprofessional palliative care learning experience between medical fellows and PGY2 pharmacy residents. The interprofessional learners were two palliative care physician fellows and one PGY2 PMPC pharmacy resident per year. The core learning curriculum begins with self-directed completion of Interdisciplinary Curriculum for Oncology Palliative Care Education (iCOPE) modules, various preceptor-led didactic educational sessions, StrengthsFinder 2.0 assessment and team dysfunction didactic was completed at orientation to develop trust and prepare learners for team based-care. At baseline and at conclusion of the experience, quantitative evaluation and qualitative feedback were obtained from learners to assess the impact of the curriculum on palliative care knowledge and readiness for interprofessional practice. The clinical setting was an outpatient palliative care clinic a half-day per week, where the team developed interprofessional care plans, shared documentation, and resolved common palliative care patient issues. From July 2017 to June 2019, six female learners completed the 12-month interprofessional learning experience. Physician learners on average had higher exposure to interprofessional learning in comparison to pharmacists at baseline. Pharmacists' and physicians' scores for the end-of-life caregiver survey improved from 1.86 to 3.45 and from 2.84 to 3.80, respectively. Survey responses for the SEIEL and interprofessional socialization and valuing scale improved from baseline for pharmacists and physician fellows. The combination of PGY2 PMPC resident pharmacists and physician fellows demonstrated an objective increase in palliative care interprofessional learning after a longitudinal year-long palliative care curriculum.

What If I Do Not Match? Scrambling for a Spot and Going Outside the Match.

Matching into emergency medicine (EM) is getting progressively more competitive. Applicants must therefore prepare for the possibility of not matching and, accordingly, be ready to participate in the Supplemental Offer and Acceptance Program (SOAP). In this article, we elaborate on the SOAP and the options for applicants who fail to match during Match Week. Alternative courses of action include applying for a preliminary year, matching into a categorical residency program, or aiming to secure EM spots outside the Match through the Council of Emergency Medicine Residency Directors, Society for Academic Emergency Medicine, and American Association of Medical Colleges.

Use of the Behavior Assessment Tool in 18 Pilot Residency Programs

Background:The purpose of this study was to determine the feasibility and evaluate the effectiveness of the American Board of Orthopaedic Surgery Behavior Tool (ABOSBT) for measuring professionalism.Methods:Through collaboration between the American Board of Orthopaedic Surgery and American Orthopaedic Association's Council of Residency Directors, 18 residency programs piloted the use of the ABOSBT. Residents requested assessments from faculty at the end of their clinical rotations, and a 360° request was performed near the end of the academic year. Program Directors (PDs) rated individual resident professionalism (based on historical observation) at the outset of the study, for comparison to the ABOSBT results.Results:Nine thousand eight hundred ninety-two evaluations were completed using the ABOSBT for 449 different residents by 1,012 evaluators. 97.6% of all evaluations were scored level 4 or 5 (high levels of professional behavior) across all of the 5 domains. In total, 2.4% of all evaluations scored level 3 or below reflecting poorer performance. Of 431 residents, the ABOSBT identified 26 of 32 residents who were low performers (2 or more < level 3 scores in a domain) and who also scored “below expectations” by the PD at the start of the pilot project (81% sensitivity and 57% specificity), including 13 of these residents scoring poorly in all 5 domains. Evaluators found the ABOSBT was easy to use (96%) and that it was an effective tool to assess resident professional behavior (81%).Conclusions:The ABOSBT was able to identify 2.4% low score evaluations (<level 3) for all residents. The tool was concordant with the PD for 81% of the residents considered low performers or “outliers” for professional behavior. The 5-domain construct makes it an effective actionable tool that can be used to help develop performance improvement plans for residents.Level of Evidence:Level II

Left-Handedness Among Orthopaedic Surgeons and Trainees.

Background:The impact of left-handedness on orthopaedic surgeons and trainees has not been well described. We investigated the prevalence and perceived impact of left-handedness among orthopaedic surgeons and trainees.Methods:We distributed a survey regarding handedness to active members of the American Orthopaedic Association and the Council of Orthopaedic Residency Directors affiliates, including department chairs, program directors, and residency and fellowship program coordinators. Program coordinators were asked to distribute the survey to their current residents and fellows.Results:Of 510 survey respondents, 78 (15%) were identified as left hand dominant (LHD). Regarding scalpel/cautery use, 64% of LHD respondents reported using their left hand primarily and 10% reported using their right hand primarily; 26% of LHD respondents described themselves as ambidextrous in scalpel/cautery use, compared with 4.7% of right hand dominant (RHD) respondents (p < 0.001). Regarding suturing, 53% of LHD respondents reported using their left hand primarily and 38% reported using their right hand primarily; 9.0% of LHD respondents described themselves as ambidextrous when suturing, compared with 1.9% of RHD respondents (p = 0.012). Only 5.1% of LHD respondents reported having received laterality-specific psychomotor training, whereas 17% perceived a need for such training during residency; RHD respondents reported similar rates. Ambidexterity in scalpel/cautery use or suturing among LHD respondents was not associated with the perception that their left-handedness was advantageous. LHD attending surgeons were more likely than LHD trainees to perceive their handedness as advantageous (p = 0.007).Conclusions:Fifteen percent of orthopaedic surgeons and trainees who responded to our survey were LHD. LHD respondents reported significantly higher rates of ambidexterity in both scalpel/cautery use and suturing compared with RHD respondents. Ambidexterity was not associated with a self-perception that left-handedness was advantageous. LHD-attending surgeons were significantly more likely than LHD residents/fellows to perceive their left-handedness as advantageous. There may be benefits to pairing LHD residents with LHD faculty surgeons early in their training to provide mentorship and insight regarding performing surgical procedures left handed.Level of Evidence:Level IV.

Prevalence of burnout of residents in oman medical specialty board: A cross-sectional study in Oman

Objective: Burnout is a state of physical and emotional exhaustion and a sense of low personal accomplishment. Our aim was to study the prevalence of burnout among all residents of Oman Medical Specialty Board (OMSB), to increase awareness of burnout among trainers and trainees not only within Oman but also in other countries with similar residency programs. This would help residency directors to increase the performance of their residents. Methods: This is a cross-sectional study with residents of OMSB involved in 17 training programs from April 2018 to April 2019. The residents were invited to answer a validated burnout questionnaire (Maslach Burnout Inventory). Only exclusion criteria were programs with at least three residents. Results: A total of 343 of 555 residents (61.8% of the total OMSB residents) participated in the study. The response rate was 100% of those who got the survey. The overall burnout rate was 16.6%. From postgraduate years (PGY) 1–5, there was a sudden spike of burnout at PGY 2 and PGY 5 at 17.6% and 25%, respectively. Emergency residents had the highest incidence of burnout at 46.2%. Burnouts among surgical, medical, and diagnostic specialties were 13.9%, 19.0%, and 12.8%, respectively. Chi-squared test showed no significant association between burnout and marital status, gender, or number of children at 0.18, 0.88, and 0.55, respectively. The percentage of residents who reported emotional exhaustion was 61.2%, while the highest percentage of depersonalization was 42.6%. Conclusion: Emergency medicine program burnout is alarming. PGY 2 and 5 show higher burnout. The overall burnout in OMSB is low.

A case of the blues: depression screenings in a community pharmacy

Theoretical basis This case builds on elements of project management (PM) – specifically project initiation – including the development of a project charter and stakeholder analysis. Research methodology The case was developed from secondary sources as well as first-hand knowledge of the project by one of the authors. This author was on faculty at a private university in the southeastern USA, teaching numerous courses in the pharmacy curriculum while also serving as the Community Practice Residency Director for community pharmacies around the state. While connecting with these organizations, additional revenue requirements and complementary services were frequent topics of attention, leading to a grant to assist pharmacies in building out such services. Through this grant, the author engaged in consultations with community pharmacies around the state, including the pharmacy highlighted via this case. Pseudonyms have been used for the business, and all individuals associated with it, to maintain anonymity. Secondary sources used for additional research include industry reports and related websites. Case overview/synopsis Richard has owned and operated a community pharmacy, Our Family Farmacy (OFF), for years. A changing industry climate has forced Richard to diversify the products and services he provides. In addition to the distribution of medicine and front-end sales of consumer goods, Richard is seeking to expand into a larger spectrum of healthcare services. After researching several different types of services, and after dealing with related personal family circumstances, Richard decided that OFF should begin their expansion by offering depression screening services. He turned initiation of the project over to his pharmacy intern, Caitlin. Complexity academic level This compact case is geared toward undergraduate- and graduate-level students taking courses in general management and, more specifically, PM. This case might also be used by students with a career focus in the healthcare sector, and could of particular interest for students in a pharmacy program. Classroom application should encompass discussions on the project initiation process group, particularly with the processes regarding the project charter deliverable and the identification and assessment of project stakeholders.

How Well Do Core Faculty Understand The Emergency Medicine Milestones?

IntroductionIt is unclear how emergency medicine (EM) programs educate core faculty about the use of milestones in competency-based evaluations. We conducted a national survey to profile how programs educate core faculty regarding their use and to assess core faculty’s understanding of the milestones.MethodsOur survey tool was distributed over six months in 2017 via the Council of Emergency Medicine Residency Directors (CORD) listserv. Responses, which were de-identified, were solicited from program directors (PDs), assistant/associate program directors (APDs), and core faculty. A single response from a program was considered sufficient.ResultsOur survey had a 69.7% response rate (n=140/201). 62.9% of programs reported educating core faculty about the EM Milestones via the distribution of physical or electronic media. Although 82.6% of respondents indicated that it was important for core faculty to understand how the EM Milestones are used in competency-based evaluations, respondents estimated that 48.6% of core faculty possess “fair or poor” understanding of the milestones. Furthermore, only 50.7% of respondents felt that the EM Milestones were a valuable tool.ConclusionThese data suggest there is sub-optimal understanding of the EM Milestones among core faculty and disagreement as to whether the milestones are a valuable tool.

Critical Electrocardiogram Curriculum: Setting the Standard for Flipped-Classroom EKG Instruction.

IntroductionElectrocardiogram (EKG) interpretation is integral to emergency medicine (EM).1 In 2003 Ginde et al. found 48% of emergency medicine (EM) residency directors supported creating a national EKG curriculum.2 No formal national curriculum exists, and it is unknown whether residents gain sufficient skill from clinical exposure alone.MethodsThe authors sought to assess the value of this EKG curriculum, which provides exposure to critical EKG patterns, a framework for EKG interpretation when the diagnosis is not obvious, and implementation guidelines and open access to any interested residency. The Foundations of Emergency Medicine (FoEM) EKG I course launched in January 2016, followed by EKG II in July 2017; they are benchmarked to post-graduate year 1 (PGY) and PGY2 level learners, respectively. Selected topics included 15 published critical EKG diagnoses and 33 selected by the authors.5 Cases included presenting symptoms, EKGs, and Free Open Access Medical Education (FOAM) links. Full EKG interpretations and question answers were provided.ResultsEnrollment during 2017–2018 included 37 EM residencies with 663 learners in EKG I and 22 EM residencies with 438 learners in EKG II. Program leaders and learners were surveyed annually. Leaders indicated that content was appropriate for intended PGY levels. Leaders and learners indicated the curriculum improved the ability of learners to interpret EKGs while working in the emergency department (ED).ConclusionThere is an unmet need for standardization and improvement of EM resident EKG training. Leaders and learners exposed to FoEM EKG courses report improved ability of learners to interpret EKGs in the ED.

Program Directors' Perception of Pregnancy and Parenthood in Orthopedic Surgery Residency.

Orthopedic surgery has one of the lowest percentages of women of all medical specialties. The purpose of this study was to determine the perception of pregnancy and parenthood during orthopedic surgery residency among program directors. An anonymous survey was distributed to all program directors who were members of the American Orthopaedic Association's Council of Orthopaedic Residency Directors. Twenty-six (53%) of 49 male program directors believed that pregnancy and parenthood negatively affected female residents' scholarly activities (P=.02), whereas 10 (83%) of 12 female program directors believed that it had no effect. Significantly more program directors believed that pregnancy and parenthood imposed a burden on fellow trainees for female residents than for male residents (77% vs 45.9%, respectively; P=.0004). This study demonstrated that orthopedic residency program directors perceive the effects of pregnancy and parenthood more negatively for female residents, especially related to scholarly activities and the burden placed on fellow residents. [Orthopedics. 2020; 43(2):e109-e113.].

American Orthopaedic Association's (AOA) Council of Orthopaedic Residency Directors (CORD) Summer 2018 Conference: Top Abstracts.

This article is a continuation of the collaboration between the American Orthopaedic Association's (AOA) Council of Orthopaedic Residency Directors (CORD) and JBJS to highlight selected abstracts presented at the CORD Conference held at the AOA's annual national meeting in June 2018. These abstracts are representative in advancing CORD's purpose and mission:"The American Orthopaedic Association 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 effectively teach residents in orthopaedic programs." The following studies were presented at the 2018 Summer CORD Conference in Boston, Massachusetts. They exemplify education-related research and are offered to inspire further inquiry to advance the development of future orthopaedic surgeons.

Common Data, Uncommon Use: Dining Hall Meal Swipes Predict Retention and Graduation

By the time “Mia” found her way to the resident director's office at the end of her first semester, it was too late: she had decided to leave the university. As her resident director listened, Mia ...

Use of the United States Medical Licensing Examination Step-1 Score as a Screening Tool for Orthopaedic Surgery Away Rotations.

Orthopaedic surgery has become an increasingly competitive specialty for medical students applying to residency. Aside from residency interviews, away rotations are one of the only opportunities for residency programs to qualitatively evaluate an applicant. The purpose of this study was to determine if residency program directors (PDs) use a minimum United States Medical Licensing Examination (USMLE) Step-1 score as a screening tool for students applying for away rotations at their institution. An anonymous 12-question survey about residency selection criteria and which criteria are used to select applicants for away rotations was distributed to PDs at U.S. allopathic orthopaedic surgery residency programs who are members of the Council of Orthopaedic Residency Directors (CORD). Questions included information on minimum USMLE Step-1 scores, the number of students who complete away rotations at the program each year, and how applicants are selected for rotations. Survey responses were received from 87 (58%) of 149 PDs. Seventy-one (82%) of these PDs reported that their program uses a minimum Step-1 score for residency applications, with the most common cutoff score being between 231 and 240 (as answered by 33 [46%] of 72 PDs). Twenty-seven (31%) of 87 PDs reported that if a student does not meet their residency minimum Step-1 score, he or she is not offered the opportunity to rotate at the program. Eleven (25%) of 44 PDs reported that they do not inform students when their score is below the program's minimum. A substantial proportion of orthopaedic surgery residency PDs use the USMLE Step-1 score as a screening tool for students interested in doing away rotations at their programs. If a student's Step-1 score does not meet the program's minimum, the majority of programs still will allow the student to rotate at their institution. Students should take this information into account when selecting away rotations in order to maximize their chances of matching into an orthopaedic surgery program.

Barriers to Utilizing Social Media Platforms in Emergency Medicine Residency Programs.

BackgroundResidency programs seek to incorporate various social media (SoMe) platforms into their educational curricula, yet little is known regarding the potential roadblocks towards implementation. Our objective was to assess the current utilization of SoMe platforms and identify common barriers to implementation by emergency medicine (EM) residency programs.MethodsMembers of the Council of Emergency Medicine Residency Directors (CORD) Information Technology (IT) Committee developed an anonymous survey distributed to representatives from EM residency programs using the “CORD Community” internet forum. Descriptive statistics including percentages for numerical data as well as Fisher’s exact test for categorical data were used to report results.ResultsWe received 116 individual responses from faculty, fellows, and residents of EM residency programs. The most common institutional, departmental, technological and knowledge barriers identified were restricted access to blogs (12.9%), insufficient protected time (17.2%), insufficient IT support to host the platform (16.4%), and a lack of knowledge among faculty of how to utilize blogs (23.3%) respectively.Ten respondents (8.6%) reported that their programs had not attempted to utilize any SoMe platforms. Community-based programs and smaller programs (<24 residents) were significantly more likely to identify barriers to SoMo use among this cohort.ConclusionUtilization of SoMe platforms for resident education by EM residency programs is increasingly common, but significant obstacles exist on many levels that prevent programs from leveraging these innovations for knowledge translation. This is particularly common for community-based and small residency programs. Awareness of these common barriers will allow institutions and programs to better anticipate and design solutions to overcome these obstacles.

150 American College of Emergency Physician Clinical Policy Guidelines: Close Friends or Aloof Strangers?

Clinical practice policies have been supported and encouraged by the Joint Commission as a method of quality assurance. Clinical policies are an effort to standardize care, ideally reduce costs, and set a general standard of care that may prove useful in medicolegal suits. The objective of this study was to discover what percentage of emergency physicians (EPs) are knowledgeable about current American College of Emergency Physicians (ACEP) clinical policy guidelines. The study was a convenience sample of emergency physicians and emergency medicine residents distributed via electronic survey through the University of Maryland network, a consortium of 14 emergency departments (ED) classified as university (hospital sponsoring an emergency medicine residency program), community teaching (ED where emergency residents train), non-teaching community hospital, as well as via the Consortium of Resident Directors list serve. Emergency physicians and residents were asked their familiarity with ACEP clinical policy guidelines based on a 100-point visual analog scale and then were given a 19-question quiz. After the quiz was completed, participants were asked to review the answers and then asked again to evaluate their familiarity with ACEP clinical policy guidelines and if the change in their understanding of clinical policies would change their practice pattern or documentation. Study groups were compared with the use of paired student’s t test and confidence intervals (CI) were calculated. 86 EPs participated in the survey and 41 EPs fully completed the survey. 65% of participants were American Board of Emergency Medicine board certified, and 87% of participants were members of ACEP. 20% of participants were still training in residency or fellowship. Regarding physician familiarity of ACEP clinical practice policies, the pretest mean score was a 56. For the 41 physicians that fully completed the survey the pre-test mean score was 58 (95% CI 50–66) and the post-test mean was 48 (95% CI 41–55) with a difference of means of 9 (CI 95% 2–21 p<0.05). Over 30% of physicians noted on the post-test that they would change the way they would practice in the future, and over 50% of physicians noted on the post-test they would change the way they document in the future. Over 90% of participants would be interested in a concise didactic review of ACEP practice guidelines and newly emerging guidelines. Over 75% of participants would be interested in receiving CME credit for this update on clinical policy guidelines. Familiarity with current ACEP clinical policy guidelines is generally poor amongst this small sampling of EPs. A concise didactic review of ACEP practice guidelines, potentially with CME incentive, would be well received by EPs seeking to remain up to date on ACEP clinical policy guidelines.

Standardized Letters of Concern and Remediation Contracts: Templates for Program Directors.

Remediation of the struggling resident is a universal phenomenon, and the majority of program directors will remediate at least 1 resident during their tenure. The goal of this project was to create a standardized template for program directors to use at all stages of remediation. Between 2017 and 2018, the Council of Residency Directors in Emergency Medicine (CORD-EM) Remediation Committee searched for best practices in the medical literature and compiled a survey that was e-mailed to the CORD-EM listserv. After reviewing all information, a standardized remediation contract was created, reviewed by legal counsel, and distributed to members. Forty-two percent (110 of 263) of program directors or assistant program directors on the CORD-EM listserv answered the initial survey and provided guidance on current remediation practices. The committee created formal and informal standard remediation contracts as both fillable templates and alterable documents. These were reviewed by CORD-EM general legal counsel and approved by the CORD-EM Board of Directors for distribution. The project took approximately 20 hours to complete over 8 months and involved a cost of $480 for legal fees. With program director input and legal counsel review, the CORD-EM Remediation Committee produced standardized remediation contracts, which can be used by all emergency medicine programs after comparison to local institutional policy and local legal review. This process was feasible and can be replicated by other specialties.

Female Representation in Otolaryngology Leadership Roles.

Characterization of leadership within otolaryngology is key to evaluating trends and promoting program advancement. This study evaluates representation of women in otolaryngology holding residency and fellowship directorships, or chair positions, comparing sex differences in academic rank, years in practice, and scholarly activity. Cross sectional analysis. A comprehensive list of otolaryngology residency and fellowship directors from Accreditation Council for Graduate Medical Education-accredited programs in 2017 to 2018 was compiled. Academic rank and years in practice were determined from departmental websites, with online search tools used as secondary resources. The h-index was utilized as a measure of research productivity. Regression analysis was performed to analyze these variables. Among the 306 directorships, women held 57 (18.6%) of these positions, 27 (26.5%) residency and 30 (14.7%) fellowship directorships. Of the 99 chair positions, five (5.1%) were held by women. The majority (53.6%) of male directors were full professors, whereas only 26.3% of females were full professors (P = .04). Mean years in practice for female directors (13.9 ± 6.8) was less than that of male directors (20.3 ± 9.4, P < .0001). Similarly, mean h-index for female directors (11 ± 7.2) was lower than for males (17.5 ± 12.5, P = .0001). After controlling for academic rank and years of practice in a multivariable regression, the h-index remained lower for women than for men (P = .03). Women are disproportionately underrepresented in positions of residency and fellowship directorships, and chair positions, consistent with other specialties. Women in leadership had lower academic ranks, fewer years of practice, and lower h-indices than their male counterparts. This may represent a shift in academic otolaryngology as female otolaryngologists seek early involvement in leadership. 4 Laryngoscope, 130:1664-1669, 2020.

Making Sense of Family Medicine Resident Wellness Curricula: A Delphi Study of Content Experts.

The Association of Family Medicine Residency Directors (AFMRD) Physician Wellness Task Force released a comprehensive Well-Being Action Plan as a guide to help programs create a culture of wellness. The plan, however, does not offer a recommendation as to which elements may be most important, least resource intensive, or most feasible. This study sought to identify the most essential components of the AFMRD's Well-Being Action Plan, as rated by expert panelists using a modified Delphi technique. Sixty-eight selected experts were asked to participate; after three rounds of surveys, the final sample included 27 participants (7% residents, 38% MD faculty, 54% behavioral science faculty). Fourteen elements were rated as essential by at least 80% of the participants. These components included interventions at both the system and individual level. Of those elements ranked in the top five by a majority of the panel, all but one do not mention specific curricular content, but rather discusses the nature of a wellness curriculum. The expert consensus was that an essential curriculum should begin early, be longitudinal, identify a champion, and provide support for self-disclosure of struggles.

Letters of Recommendation.

Letters of recommendation (LORs) are a central element of an applicant's portfolio for the National Resident Matching Program (known as the "Match"). This is especially true when applying to competitive specialties like emergency medicine (EM). LORs convey an applicant's potential for success, and also highlight an applicant's qualities that cannot always be recognized from a curriculum vitae, test scores, or grades. Traditional LORs, also called narrative LORs, are written in prose and are therefore highly subjective. This led to the establishment of a task force by the Council of Emergency Medicine Residency Directors in 1995 to develop a standardized LOR. Revisions of this form are now referred to as a standardized letter of evaluation. These evaluations in this format have proven to increase inter-rater reliability, decrease interpretation time, and standardize the process used by EM faculty to prepare evaluations for EM applicants. In this article, we will discuss LORs; address applicants' concerns, including from whom to request LORs (EM faculty vs. non-EM faculty vs. non-clinical faculty), number of LORs an applicant should include in his or her application materials, the preferred manner of requesting and the timing in which to ask for an LOR, as well as the philosophy behind waiving the right to see the letter.

Urology Residency Directors' Awareness of Association between α-Adrenergic Antagonists and Floppy Iris Syndrome and Practice Patterns Regarding Prophylactic α-Adrenergic Antagonists

Purpose The use of prophylactic α-adrenergic receptor antagonists prior to surgery is associated with reduced postoperative urinary retention. However, α-adrenergic receptor antagonists have been associated with intraoperative floppy iris syndrome (IFIS). Studies have shown that IFIS is correlated with higher rates of cataract surgery complications. The purpose of this study is to investigate United States urology residency program directors' (1) awareness of the association between α-adrenergic receptor antagonists and IFIS and (2) practice patterns regarding the use of prophylactic α-adrenergic receptor antagonists prior to surgery. Materials and Methods An anonymous, online survey was sent to the program director of each of the 138 urology residency programs accredited by the Accreditation Council for Graduate Medical Education. The survey assessed program directors' knowledge regarding the association between α-adrenergic receptor antagonists and IFIS, and practice patterns regarding the use of prophylactic α-adrenergic receptor antagonists prior to surgery. Results Sixty-nine of the 138 (50%) residency directors responded. Forty percent of respondents believe that tamsulosin (Flomax) does not increase the risk of IFIS. Fifty-two percent of respondents prescribe or consider prescribing prophylactic α-adrenergic blockers prior to surgery, with tamsulosin being the most preferred α-adrenergic blocking agent. Of the prescribing urologists, only 58% counsel most of their patients regarding the association between the prescribed drug and IFIS, 28% never ask patients whether they have had cataract surgery, and 56% would change the drug or dosage used if they learned that a patient had not yet had cataract surgery. Conclusion The results of this study demonstrate the potential to decrease the risk of IFIS through education of urologists regarding the association of α-adrenergic antagonists with IFIS.