Society For Academic Emergency Medicine Research Articles

Identifying the prevalence and characteristics of diversity, equity, and inclusion leaders in academic emergency medicine.

Our study aims to better understand and describe the current state of diversity, equity, and inclusion (DEI) leadership in emergency medicine (EM) by identifying the prevalence of department DEI leadership positions, their demographics, and their job duty characteristics. We disseminated an electronic survey from April to July 2022 to Society for Academic Emergency Medicine (SAEM) Association of Academic Chairs of Emergency Medicine, Academy for Diversity and Inclusion in Emergency Medicine, and the Equity and Inclusion Committee to identify department DEI leads. From July to August 2022, a 45-question survey was sent to all identified DEI leaders on individual characteristics, DEI experience, and DEI lead job description. We received a response from 79 out of 120 academic EM departments identified (65.8%). Of the responding institutions, 59 (74.7%) reported a DEI leader. A total of 74.6% of these DEI leaders responded at least partially to our survey and 57.6% responded in full. The most common titles were vice/associate chair of DEI (34.4%), director of DEI (28.1%), and DEI committee chair (18.8%). Most respondents (84.4%) were the inaugural DEI lead in their department and 84.4% of respondents did not have a formal DEI role in their department previously. On average, respondents have had their DEI title for 2 years (range 0-7 years) with an average of 7 years (range 0-30 years) of experience performing DEI work. Many (63.4%) do not receive any funded effort for their DEI roles. Most DEI leads were not tenure track (72.2%) and most commonly at the rank of assistant professor (47.2%) followed by associate professor (33.3%), full professor (16.7%), and instructor (2.8%). This is the first known study to assess the characteristics of DEI department leaders in EM. EM DEI leadership positions are new, common, and led by diverse personal identities and are often not funded. Future directions could gain qualitative insight into this workforce to guide best practices in EM DEI leadership.

Clinical duties and compensation for U.S. emergency medicine fellows at academic centers: A descriptive, cross-sectional survey.

Fellowship training is increasingly popular among residency graduates and critical to the advancement of academic emergency medicine (EM). Little is known about the clinical hours worked and financial compensation received by fellows during training. We sought to describe the clinical duties and financial compensation of EM fellows at U.S. academic centers. This cross-sectional study surveyed U.S. academic EM department administrators who were members of the Society for Academic Emergency Medicine's Academy of Administrators in Academic Emergency Medicine (AAAEM) regarding their fellowship programs and fellows. We electronically distributed the validated survey instrument to 73 member sites between October 2022 and January 2023. Survey domains included fellow and fellowship demographics, base and total annual clinical hours, and base and total annual compensation. We calculated descriptive statistics and compared fellows by accreditation (Accreditation Council for Graduate Medical Education [ACGME] or non-ACGME) using chi-square and Wilcoxon rank-sum testing. We conducted a secondary analysis of base and total salary by gender and accreditation using Wilcoxon rank-sum testing. We received 38 institutional responses (response rate 52%), which represented 217 individual fellows. Nearly three-fourths (n = 158, 72.8%) of fellows enrolled in non-ACGME fellowships, worked 33% more base hours annually than ACGME fellows (median 571 h vs. 768 h, p < 0.001), and received base compensation 20% higher than ACGME fellows ($88,540 vs. $70,777, p < 0.001). Accounting for additional compensation, the median total annual compensation for non-ACGME fellows remained 11% higher than ACGME fellows ($105,000 vs. $93,853, p = 0.004). We observed no significant differences salary when stratified by gender. Most EM fellows at U.S. academic institutions enrolled in non-ACGME fellowships with significantly higher base hours and financial compensation than ACGME fellowships. These results represent the first description of the clinical hours and financial compensation of academic EM fellows and should be considered in ongoing benchmarking efforts by AAAEM.

"I don't want to be the squeaky wheel": Addressing bias as a leader in emergency medicine.

Implicit bias poses a barrier to inclusivity in the health care workforce and is detrimental to patient care. While previous studies have investigated knowledge and training gaps related to implicit bias, emergency medicine (EM) leaders' self-awareness and perspectives on bias have not been studied. Using art to prompt reflections on implicit bias, this qualitative study explores (1) the attitudes of leaders in EM toward implicit bias and (2) individual or structural barriers to navigating and addressing bias in the workplace. Investigators facilitated an hour-long workshop in May 2022 for those with leadership positions in the Society for Academic Emergency Medicine (SAEM), a leading national EM organization, including 62 attending physicians, eight residents/fellows, and four medical students. The workshop utilized arts-based methods to generate a psychologically supportive space to lead conversations around implicit bias in EM. The session included time for individual reflection, where participants used an electronic platform to respond anonymously to questions regarding susceptibility, fears, barriers, and experiences surrounding bias. Two independent coders compiled, coded, and reviewed the responses using an exploratory constructivist approach. A total of 125 responses were analyzed. Four major themes emerged: (1) acceptance that bias exists; (2) individual barriers, including fear of negative reactions, often due to power dynamics between respondents and other members of the ED; (3) institutional barriers, such as insufficient funding and unprotected time committed to addressing bias; and (4) ambiguity about defining and prioritizing bias. This qualitative analysis of reflections from an arts-based workshop highlights perceived fears and barriers that may impact EM physicians' motivation and comfort in addressing bias. These results may help guide interventions to address individual and structural barriers to mitigating bias in the workplace.

Development and evaluation of a novel knowledge assessment tool for pediatric emergency medicine clerkships.

This study seeks to determine validity evidence for a newly developed multiple-choice examination (MCE) tool to assess retention and application of medical knowledge of students enrolled in a pediatric emergency medicine (PEM) clerkship. A team of PEM physicians created a 110-item MCE covering the range of clinical topics in PEM relevant for medical students. The researchers determined examination content using the report of Clerkship Directors in Emergency Medicine and PEM Interest Group of the Society for Academic Emergency Medicine (SAEM). The authors administered the MCE to fourth-year medical students at the end of their PEM rotation from May 2020 to April 2023 at four institutions and then analyzed the examination using four of Messick's five sources of validity evidence: content, response process, internal structure, and relation to other variables. A total of 158 students took the test. In academic year (AY)20-21, 47 students took the test and scored, on average, 81%. After revision of poor and indeterminate questions, the 111 medical students who took the revised version of the test in AY21-AY23 scored on average 77.3% with a standard deviation of 5.7% with a normal distribution in scores. The revised questions were rated as excellent (10.0%), good (26.4%), fair (34.5%), poor (24.5%), or indeterminate (4.5%) based on test item discrimination. There was a positive correlation between MCE scores and students' clinical evaluations but no correlation between MCE scores and scores that students received on their clinical notes or patient presentations during case conference. This novel PEM clerkship examination is a reliable test of medical knowledge. Future directions involve evaluating consequences of the MCE and offering the test to medical students in a dedicated PEM rotation at the national level.

Variability in Interpretation of Echocardiographic Signs of Tamponade: A Survey of Emergency Physician Sonographers

BackgroundCardiac tamponade is associated with high mortality, and making the diagnosis is a core skill of emergency physicians. Proper diagnosis relies on specific clinical and echocardiographic findings. It is not known whether expert sonographers consistently recognize echocardiographic signs of tamponade. ObjectivesTo assess whether expert sonographers agree on echocardiographic signs of tamponade. MethodsA 20-question survey consisting of 18 cine loops and 2 still images was distributed to the Academy of Emergency Ultrasound Section of the Society for Academic Emergency Medicine. Respondents answered “yes” or “no” to whether there was echocardiographic evidence of tamponade. Subgroup analyses of demographics and echocardiographic views were reported. The data were analyzed using Krippendorff's alpha (α) to assess interrater reliability (IRR) between respondents. ResultsEighty-four physicians responded and 56 completed the survey. All partial and completed surveys were analyzed. The overall IRR was poor (α = 0.60, 95% confidence interval [CI] 0.44–0.76). Residency graduation within 5 years (α = 0.66, 95% CI 0.5–0.8) was associated with higher IRR compared with those > 5 years (α = 0.53, 95% CI 0.37–0.69). The highest IRR was observed when images of mitral valve inflow pulse-wave Doppler (α = 0.81, CI 0.70–0.92) were used and the poorest IRR was on images from the parasternal short view (α = 0.28, 95% CI 0.05–0.49). ConclusionThere was poor agreement among expert emergency medicine sonographers in identifying echocardiographic signs of cardiac tamponade from a single cine loop or clip without clinical context. Further investigation is warranted to understand differences in recognition of clinical tamponade.

Trauma-Informed Care for Acute Care Settings: A Novel Simulation Training for Medical Students.

Physicians often care for patients who have experienced traumatic events including abuse, discrimination, and violence. Trauma-informed care (TIC) is a framework that recognizes the prevalence of trauma, promotes patient empowerment, and minimizes retraumatization. There are limited education curricula on how to apply TIC to acute care settings, with simulation-based training presenting a novel educational tool for this aim. Students participated in a didactic on TIC principles and its applications in acute care settings. Learners participated in three simulation cases where they performed physical exams and gathered history on patients with urgent medical needs related to intimate partner violence, transgender health, and health care discrimination. Debriefing followed each simulation. Seventeen medical students participated across four sessions. The sessions were evaluated with pre- and postparticipation surveys, including Likert scales and free-response questions. After participation, individuals' self-assessed confidence improved across multiple domains, including identifying situations for trauma screenings, inquiring about trauma, and responding as a bystander. Learners also felt more familiar with TIC-specific history taking and physical exam skills. Finally, simulation was perceived as a beneficial educational tool. All findings were statistically significant (p ≤ .01). Our simulation-based training enabled students to practice conversations and interventions related to trauma. This novel training represents a feasible and effective means for teaching TIC for acute care settings, including in the emergency department and in-patient settings. Development and evaluation were supported by the Society for Academic Emergency Medicine.

The role of emergency physicians in the fight against health misinformation: Implications for resident training.

Emergency physicians on the frontlines of the COVID-19 pandemic are first-hand witnesses to the direct impact of health misinformation and disinformation on individual patients, communities, and public health at large. Therefore, emergency physicians naturally have a crucial role to play to steward factual information and combat health misinformation. Unfortunately, most physicians lack the communications and social media training needed to address health misinformation with patients and online, highlighting an obvious gap in emergency medicine training. We convened an expert panel of academic emergency physicians who have taught and conducted research about health misinformation at the Society for Academic Emergency Medicine (SAEM) Annual Meeting in New Orleans, LA, on May 13, 2022. The panelists represented geographically diverse institutions including Baystate Medical Center/Tufts University, Boston Medical Center, Northwestern University, Rush Medical College, and Stanford University. In this article, we describe the scope and impact of health misinformation, introduce methods for addressing misinformation in the clinical environment and online, acknowledge the challenges of tackling misinformation from our physician colleagues, demonstrate strategies for debunking and prebunking, and highlight implications for education and training in emergency medicine. Finally, we discuss several actionable interventions that define the role of the emergency physician in the management of health misinformation.

2022 consensus conference on diversity, equity, and inclusion: Developing an emergency medicine research agenda for addressing racism through health care research.

Racism in emergency medicine (EM) health care research is pervasive but often underrecognized. To understand the current state of research on racism in EM health care research, we developed a consensus working group on this topic, which concluded a year of work with a consensus-building session as part of the overall Society for Academic Emergency Medicine (SAEM) consensus conference on diversity, equity, and inclusion: "Developing a Research Agenda for Addressing Racism in Emergency Medicine," held on May 10, 2022. In this article, we report the development, details of preconference methods and preliminary results, and the final consensus of the Healthcare Research Working Group. Preconference work based on literature review and expert opinion identified 13 potential priority research questions that were refined through an iterative process to a list of 10. During the conference, the subgroup used consensus methodology and a "consensus dollar" (contingent valuation) approach to prioritize research questions. The subgroup identified three research gaps: remedies for racial bias and systematic racism, biases and heuristics in clinical care, and racism in study design, and we derived a list of six high-priority research questions for our specialty.

Guidelines for reasonable and appropriate care in the emergency department 3 (GRACE‐3): Acute dizziness and vertigo in the emergency department

This third Guideline for Reasonable and Appropriate Care in the Emergency Department (GRACE-3) from the Society for Academic Emergency Medicine is on the topic adult patients with acute dizziness and vertigo in the emergency department (ED). A multidisciplinary guideline panel applied the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to assess the certainty of evidence and strength of recommendations regarding five questions for adult ED patients with acute dizziness of less than 2 weeks' duration. The intended population is adults presenting to the ED with acute dizziness or vertigo. The panel derived 15 evidence-based recommendations based on the timing and triggers of the dizziness but recognizes that alternative diagnostic approaches exist, such as the STANDING protocol and nystagmus examination in combination with gait unsteadiness or the presence of vascular risk factors. As an overarching recommendation, (1) emergency clinicians should receive training in bedside physical examination techniques for patients with the acute vestibular syndrome (AVS; HINTS) and the diagnostic and therapeutic maneuvers for benign paroxysmal positional vertigo (BPPV; Dix-Hallpike test and Epley maneuver). To help distinguish central from peripheral causes in patients with the AVS, we recommend: (2) use HINTS (for clinicians trained in its use) in patients with nystagmus, (3) use finger rub to further aid in excluding stroke in patients with nystagmus, (4) use severity of gait unsteadiness in patients without nystagmus, (5) do not use brain computed tomography (CT), (6) do not use routine magnetic resonance imaging (MRI) as a first-line test if a clinician trained in HINTS is available, and (7) use MRI as a confirmatory test in patients with central or equivocal HINTS examinations. In patients with the spontaneous episodic vestibular syndrome: (8) search for symptoms or signs of cerebral ischemia, (9) do not use CT, and (10) use CT angiography or MRI angiography if there is concern for transient ischemic attack. In patients with the triggered (positional) episodic vestibular syndrome, (11) use the Dix-Hallpike test to diagnose posterior canal BPPV (pc-BPPV), (12) do not use CT, and (13) do not use MRI routinely, unless atypical clinical features are present. In patients diagnosed with vestibular neuritis, (14) consider short-term steroids as a treatment option. In patients diagnosed with pc-BPPV, (15) treat with the Epley maneuver. It is clear that as of 2023, when applied in routine practice by emergency clinicians without special training, HINTS testing is inaccurate, partly due to use in the wrong patients and partly due to issues with its interpretation. Most emergency physicians have not received training in use of HINTS. As such, it is not standard of care, either in the legal sense of that term ("what the average physician would do in similar circumstances") or in the common parlance sense ("the standard action typically used by physicians in routine practice").

ACEP-SAEM response to the National Institutes of Health (NIH) proposal to simplify the review framework for research project grant applications.

The Society for Academic Emergency Medicine (SAEM) and American College of Emergency Physicians (ACEP) are responding jointly to this request for information. SAEM and ACEP promote innovative and imaginative strategy development that will transform prehospital and emergent patient care. The National Institutes of Health (NIH) proposal to modify the current grant scoring system to prioritize these principles is a welcome change and we are supportive of these efforts. Focusing on research importance, feasibility, and scientific rigor will make it easier to interpret reviewer critiques and provide investigators with clearer information on score driving factors related to the science itself. While investigator and environment are important factors for successfully conducting research, reducing their overall importance may help with reducing bias and expanding the pool of meritorious applications. We also support combining significance and innovation into a single “importance” score, as the current format gives equal weight to innovation even though related sections tend to be brief. Furthermore, the existing significance section focuses largely on perceived need and scientific rationale with lesser consideration of the true magnitude of impact. Our societies are hopeful that by broadening the concept of overall importance, this new section can better weight funding decisions toward injuries and illnesses where improved outcomes would benefit the greatest number of people. We also agree that the current scoring system overly emphasizes an investigator's prior grant success and institutional reputation in determining an application's merit. Reliance on these factors detracts from the proposal's true “importance” and may perpetuate existing and ongoing challenges with the development and retention of junior investigators, including investigators from historically underrepresented groups. The proposed changes in this area will allow for increased emphasis on the development of highly novel or paradigm-shifting approaches to problems. Nonetheless, consideration of the capacity to execute the proposed work remains a critically important factor. The proposed method of scoring using a descriptive range of “fully capable” to “additional resources needed” deemphasizes quantitative scoring and we believe accomplishes the stated goals. However, we recommend specific clarification that the proposed scale reflects the entirety of the investigatory team (with due consideration of experience with prior collaboration). An important component of the current scoring system not addressed in the proposed changes is the handling of grant resubmissions. It is not clear why resubmissions have a written narrative that is score-driving and subject to bias. We recommend amending this process for each additional criteria to be marked yes or no as to “all major/moderate concerns appropriately addressed.” Reviewers could also have the option of describing “any new major/moderate concerns identified” in the resubmission process. Finally, while we recognize that these scoring revisions are important, we suggest that the NIH consider a more direct acknowledgment of our nation's need to fund a diverse pool of grant applicants. We believe the approach of the three-factor scoring system that emphasizes capability to perform the work is well aligned with this goal, but we would encourage the NIH to consider an explicit acknowledgment of ongoing disparities in our nation's health research programs addressed by these changes.

Changes in application of the Society for Academic Emergency Medicine's abstract scoring criteria, 2020 versus 2021.

Changes in application of the Society for Academic Emergency Medicine's abstract scoring criteria, 2020 versus 2021.

Executive summary of the SAEM 2022 consensus conference to address racism in emergency medicine clinical research, training, and leadership.

Racism has not only contributed to disparities in health care outcomes, but also has negatively impacted the recruitment, retention, and promotion of historically excluded groups in academic medicine. The 2022 Society for Academic Emergency Medicine (SAEM) consensus conference, "Diversity, Equity, and Inclusion: Developing a Research Agenda for Addressing Racism in Emergency Medicine," convened a diverse group of researchers, educators, administrative leaders, and health care providers to help address the impact of racism in three domains in academic emergency medicine: clinical research, education and training, and academic leadership. The main goals of the consensus process were to identify current knowledge gaps and create a research agenda within each domain using an iterative consensus-building methodology. The planning committee identified three fundamental domains to develop a research agenda and created workgroups who completed a literature search to identify gaps in knowledge. After a consensus building process, potential questions were presented at the in-person consensus conference. Ninety SAEM members representing faculty and trainees participated in breakout groups in each domain to generate consensus recommendations for priority research. For clinical research, three research gaps with six questions (n) were identified: remedies for bias and systematic racism (3), biases and heuristics in clinical care (2), and racism in study design (1). For education and training, three research gaps with seven questions were identified: curriculum and assessment (2), recruitment (1), and learning environment (4). For academic leadership, three research gaps with five questions were identified: understanding the current diversity, equity, and inclusion (DEI) landscape and culture (1), analyzing programs that improve DEI and identifying factors that lead to improved diversity (3), and quantifying the value of professional stewardship activities (1). This article reports the results of the consensus conference with the goal of influencing emergency care research, education, and policy and facilitating collaborations, grant funding, and publications in these domains.

Taking More Society for Academic Emergency Medicine Practice Tests Does Not Lead to Improved National EM-M4 Exam Scores

Emergency medicine (EM) is a required clerkship for third-year medical students, and an elective EM acting internship (AI) is available to fourth-year students at our institution. The Society for Academic Emergency Medicine's (SAEM) National Emergency Medicine M4 Examination (EM-M4) is administered to students at the end of the EM AI experience. To prepare for the exam, students gain access to 23 practice tests available from SAEM. In this study we investigate the correlation between the number of practice tests taken and EM-M4 performance. We collected data for EM-M4 and the US Medical Licensing Exam (USMLE) Step 2 Clinical Knowledge (CK) from students completing a MS4 EM clerkship in consecutive medical school classes from 2014-2017 at a private medical school. In addition, we collected data during the clerkship on the number of practice exams taken and whether a comprehensive practice exam was taken. We analyzed the study population three ways to determine whether the number of practice tests impacted final exam results: a binary distribution (1-11 or 12-23 tests taken); quaternary distribution (1-6, 7-12, 13-18, or 19-23 tests taken); and individual test variability (1,2,3,…22,23 tests taken). Complete data for 147 students was used for data analysis. The EM-M4 showed moderate (r = 0.49) correlations with USMLE Step 2 CK. There was no significant difference in EM-M4 performance in the binary analysis (P ≤ 0.09), the quaternary analysis (P ≤ 0.09), or the continuous variable analysis (P ≤ 0.52). Inclusion of a comprehensive practice test also did not correlate with EM-M4 performance (P ≤ 0.78). Degree of utilization of SAEM practice tests did not seem to correlate with performance on the EM-M4 examination at our institution. This could be due to many factors including that the question bank is composed of items that had poor item discrimination, possible inadequate coverage of EM curriculum, and/or use of alternative study methods. While further investigation is needed, if our conclusions prove generalizable, then using the SAEM practice tests is an extraneous cognitive load from a modality without proven benefit.

Trends in female first-author abstracts at the Society for Academic Emergency Medicine Annual Meeting, 1990–2020

ObjectivesTo describe first author gender differences and characteristics in 1) Society for Academic Emergency Medicine (SAEM) Annual Meeting abstracts and 2) resulting manuscript publications. MethodsWe performed cross-sectional evaluation of SAEM abstracts from 1990, 1995, 2000, 2005, 2010, 2015, and 2020, compiling and reviewing a random sample of 100 abstracts for each year (total n = 700 abstracts). We documented abstract characteristics, including first author gender, and used the 2020 SAEM scoring rubric. We then searched PubMed to identify manuscript publications resulting from abstracts from 1990 to 2015 (n = 600). Finally, among abstracts that resulted in manuscript publication, we identified first and last author gender on both the abstracts and the resulting publication. ResultsOverall, 29% (202/695; n = 5 missing gender) of abstracts had female first authors. Female first authors increased over time (e.g., 17% in 1990 to 35% in 2020). Abstract quality scores were similar (both median [interquartile range] of 11 ([9–12]). Overall, 42% (n = 254/600) of abstracts resulted in a manuscript publication, 39% (n = 65/202) with female and 44% (n = 189/493) with male first authors (p = 0.26). The median time (IQR) from abstract to manuscript publication was longer for abstracts with female first authors vs. those with male first authors (2 [1–3] years and 1 [1, 2] years, p < 0.02); 77% and 78% of publications resulting from abstracts with female and male first authors, respectively, had the same first author. Female first author abstracts more often converted to a male first author manuscript publication (18%, n = 12/65) compared to male first author abstracts converting to female first author publications (7%, n = 14/189). ConclusionsA minority of SAEM abstracts, and manuscript publications resulting from them, had female first authors. Abstracts with female first authors took longer to achieve manuscript publication, and almost a fifth of female first author abstracts resulted in male first author manuscript publication.

Pharmacist authors of emergency medicine organization work products pertaining to pharmacotherapy.

Despite the expertise that emergency medicine (EM) pharmacists bring to multidisciplinary teams in the emergency department (ED) setting, they are not commonly present on writing groups for guidelines, policies, or task forces pertaining to EM pharmacotherapy. The purpose of this article is to quantify EM pharmacist involvement on author bylines of guidelines, position statements, and other official documents that specifically encompass EM pharmacotherapy. Official work products released between January 1, 2010, and May 1, 2021, were collected from the American College of Emergency Physicians (ACEP), Society for Academic Emergency Medicine (SAEM), and American Academy of Emergency Medicine (AAEM) and the table of contents of the following journals: Annals of Emergency Medicine, Academic Emergency Medicine, and Journal of Emergency Medicine. A modified Delphi approach was used to gain consensus amongst the authors on which work products to include in the initial review and which works pertained to pharmacotherapy. The primary endpoint was the percentage of pharmacists listed as authors on EM work products pertaining to pharmacotherapy. Overall, 76 EM work products were identified. Forty-seven work products with a total of 248 authors contained at least 1 recommendation pertaining to pharmacotherapy. Of these 47 EM work products, 23 (49%) were from AAEM, 16 (34%) were from Annals of Emergency Medicine (published on behalf of ACEP), 5 (11%) were from Journal of Emergency Medicine (published on behalf of AAEM), and 3 (6%) were from SAEM. The median number of authors per work product was 4. There were 5 pharmacists listed on work products (2% of the total of 248 authors). Additionally, there were 9 nonpharmacist/nonphysician authors (4% of the total). Pharmacist inclusion on author lists of recently published EM work products pertaining to pharmacotherapy is extremely low. Given their unique knowledge pertaining to EM pharmacotherapy, an effort should be made to increase inclusion of pharmacists as authors of EM work products with recommendations that pertain to pharmacotherapy.

Changes in scientific characteristics of abstracts accepted to the Society for Academic Emergency Medicine Annual Meeting, 1990-2020.

Since its founding in 1989, the Society for Academic Emergency Medicine (SAEM) has accepted thousands of abstracts for presentation at its annual meeting. We reviewed abstracts to characterize temporal changes in study design, abstract topics, quality scores, and proportion of abstracts published as manuscripts. In this serial cross-sectional study, we compiled accepted SAEM abstracts at 5-year intervals (1990, 1995, 2000, 2005, 2010, 2015, 2020) and then randomly selected 100 abstracts from each year for review by two investigators. We documented each abstract's study design, sample size, and whether it was a single-center or multicenter study. We assigned each abstract to the most appropriate topic category. Applying SAEM's abstract scoring system from 2020, we calculated the mean overall quality score per year. Finally, we searched PubMed to determine if abstracts from 1990-2015 meetings were published as manuscripts. The number of accepted abstracts increased from 180 in 1990 to 879 in 2020 (+388%). The most common study design changed from laboratory study in 1990 (22%) to cohort study in 2020 (44%; p< 0.001). The median study sample size increased over time, from 105 (interquartile range [IQR] 25-389) in 1990 to 544 (IQR 102-2067) in 2020 (p< 0.001). Multicenter studies have become more common (19% in 1990 vs. 40% in 2020; p= 0.001). The most common topic categories also changed from cardiology/pulmonary/airway (40%) and orthopedic/trauma/burn (17%) in 1990 to health services research/health policy/operations (25%) and cardiology/pulmonary/airway (22%) in 2020. There was a 20% increase in overall quality scores (p< 0.001). Between 37% and 49% of the abstracts reviewed from each year were later published as manuscripts, with no significant change over time (p= 0.33). Over the past 30 years, there have been significant changes to the study designs, topics, and quality scores of SAEM meeting abstracts. However, conversion of abstracts to published manuscripts remains a challenge.

How we compare: Society for Academic Emergency Medicine faculty membership demographics.

The Society for Academic Emergency Medicine (SAEM) has a core value to promote a diverse workforce for patients, providers, and learners. Understanding the organization's membership demographics and how that compares to the academic emergency medicine (EM) workforce is prerequisite to the success of this core value. We obtained 2020 faculty membership data sets from the Association of American Medical Colleges (AAMC) and SAEM; data included self-reported sex, race and ethnicity, and academic rank (professor, associate professor, assistant professor, and instructor). We employed standardized mean difference (SMD) to quantify difference in proportions between data sets. We identified 5874 (AAMC) and 2785 (SAEM) faculty. The AAMC (38.3%) and the SAEM (41.3%) had similar proportions of overall female faculty (SMD 0.063) although SAEM (compared to AAMC) had a higher proportion of female full (25.5% vs. 20.5%, SMD 0.121) and assistant (46.5% vs. 41.2%, SMD 0.106) professors. With the exception of Hispanic instructors, SAEM (compared to AAMC) also had higher proportions of Black and Hispanic female faculty at all ranks (SMD ranging from 0.109 to 0.777). SAEM faculty demographics generally reflect that of the academic EM workforce demographics reported in the AAMC database and that overall, the proportions of female, Black, and Hispanic faculty in SAEM are slightly larger than those in the AAMC database. However, faculty who identify as Black or Hispanic in both the AAMC and the SAEM databases (compared to the overall U.S. population) are dramatically underrepresented.

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.

Factors driving burnout and professional fulfillment among emergency medicine residents: A national wellness survey by the Society for Academic Emergency Medicine.

This study aimed to identify rates of and contributors to burnout and professional fulfillment among emergency medicine (EM) resident physicians. This was a cross-sectional, national survey of resident members of the Society for Academic Emergency Medicine (SAEM). Primary outcomes were burnout and professional fulfillment measured using a previously validated instrument with additional domains pertaining to the academic environment. The survey included question domains examining organizational factors (e.g., academic work environment, satisfaction with training, electronic health records, values alignment, and control over schedule) and individual factors (e.g., self-compassion, meaningfulness of clinical work, impact of work on health and personal relationships, perceived appreciation, thoughts of attrition, and expectations of the field of EM). Logistic regression was performed to determine the relationships between the primary outcomes and each domain. The survey was sent electronically to 2641 SAEM resident members. A total of 275 residents completed the survey with a response rate of 10.4%. A total of 151 (55%) respondents were male, and 210 (76%) were White. A total of 132 (48%) residents reported burnout, and 75 (28%) reported professional fulfillment. All organizational and individual factors were significantly associated with both primary outcomes. EM residents reported that meaningfulness of clinical work had the most significant positive association with professional fulfillment (adjusted odds ratio [OR] 2.2 [95% confidence interval {CI} 1.8-2.7]) and negative association with burnout (adjusted OR 0.46 [95% CI 0.37-0.56]). Thoughts of attrition from academics and accurate expectations of EM were also associated with both primary outcomes, with adjusted ORs (95% CIs) of 0.40 (0.21-0.72) and 5.6 (1.9-23.8) for professional fulfillment and 4.1 (2.5-7.1) and 0.19 (0.08-0.40) for burnout, respectively. This study found a high prevalence of burnout and a low prevalence of professional fulfillment among EM residents. Multiple factors were significantly associated with each occupational phenomenon, with meaningfulness of clinical work demonstrating the strongest relationships with burnout and professional fulfillment.

From intern to "accepted": A guide to preparing for fellowship in emergency medicine.

The number of fellowship options for emergency medicine (EM) physicians continues to expand. While guides exist to help residents explore individual fellowship pathways, we aimed to create a comprehensive guide for all residents considering fellowship. At the direction of the Society for Academic Emergency Medicine (SAEM) Board, 9members of the Fellowship Guide Workgroup, including members of the Fellowship Approval Committee, and 2 members of SAEM Residents and Medical Students (RAMS) group collaboratively developed the guide using available evidence and expert opinion when high-quality evidence was unavailable. The guide was reviewed and approved by all members. The guide offers advice to EM residents on how to conceptualize key aspects of their training with respect to preparation for fellowship, including scholarship, teaching, leadership, and electives. Additionally, it offers perspective on selecting a fellowship that matches the resident's interests and goals and successfully applying. This fellowship guide for EM residents considering fellowship summarizes the best currently available advice for residents considering fellowship training after residency.