Study Objectives: To evaluate clinical decisionmaking by emergency physicians using IVC US in chi... more Study Objectives: To evaluate clinical decisionmaking by emergency physicians using IVC US in children undergoing ED evaluation of dehydration from GI losses. Dehydration from gastroenteritis is a leading cause of death in children <5 years worldwide. US assessment of the IVC may correlate with severity of dehydration and assist in clinical decision making. Methods: We conducted a prospective cohort study of US imaging of the IVC in pediatric patients with suspected dehydration from vomiting and/or diarrhea. The IVC was imaged in the sagittal plane at the junction of the right atrium and along the length of the IVC extending into the liver, assessing for 100% collapse of the walls of the IVC with tidal breathing. Patients < 21 yrs. presenting with vomiting requiring ondansetron or diarrhea with concern for dehydration were eligible for study inclusion. Patients enrolled from 10/ 2015-12/2016. Clinical dehydration scores, pre-test (before IVC US) and post-test (after IVC US) probabilities of dehydration requiring IV fluids were recorded by 5 treating sonologists that enrolled patients into the study. Primary outcomes assessed included: IV vs PO fluid rehydration, ED length of stay (LOS) and disposition (admission or discharge). Results: One hundred twelve patients were enrolled, median age was 5 years (S.D +/-6), and 49.1% were female. By clinical dehydration score, 61.6% (n/N¼69/112; 95% CI: 51.9-70.6%), 36.6% (n/N¼41/112; 95% CI: 27.7-46.2%), and 0.01% (n/N¼2/112; 95% CI: 0.0-0.06%) were minimally, moderately and severely dehydrated respectively. The majority of patients received oral rehydration 79.4% (n/N 89/112; 95 CI: 70.8-86.5%) and 20.5% (n/N¼23/112; 95% CI: 13.5-29.2%) received IV fluid rehydration. Only 4.4% (n/N¼5/112; 95% CI: 0.1-8.3%) were admitted and no discharged patient returned to the ED for failure to rehydrate. The distribution of pre-test to post-test probabilities in children with suspected dehydration requiring IV fluids is presented in matrix Figure 1. Overall, IVC US altered pre-test probabilities for requiring IV fluid rehydration by decreasing in 51.8% (n/N¼58/112; 95% CI: 42.1-61.3%), increasing in 25% (n/N¼26/112; 95% CI: 17.3-34.1), and left unchanged in 23.2% (n/N¼28/112; 95% CI: 15.8-32.1%). IVC US was attributed to changing management in 15.2% (n/ N¼17/112; 95% CI: 9.1-23.2%) patients; from PO to IV fluid rehydration in 6.3% (n/ N¼7/112) children and from IV to PO rehydration in 8.9% (n/N¼10/112) patients. Conclusions: US changes pre-test to post-test probabilities for requiring IV fluid rehydration in the majority of children with suspected dehydration, but in a population of mildly to moderately dehydrated children actual management change with respect to IV vs PO rehydration was infrequent.
Conventional two-dimensional (2D) ultrasound imaging is a powerful diagnostic tool in the hands o... more Conventional two-dimensional (2D) ultrasound imaging is a powerful diagnostic tool in the hands of an experienced user, yet 2D ultrasound remains clinically underutilized and inherently incomplete, with output being very operator dependent. Volumetric ultrasound systems can more fully capture a three-dimensional (3D) region of interest, but current 3D systems require specialized transducers, are prohibitively expensive for many clinical departments, and do not register image orientation with respect to the patient; these systems are designed to provide improved workflow rather than operator independence. This work investigates whether it is possible to add volumetric 3D imaging capability to existing 2D ultrasound systems at minimal cost, providing a practical means of reducing operator dependence in ultrasound. In this paper, we present a low-cost method to make 2D ultrasound systems capable of quality volumetric image acquisition: we present the general system design and image acq...
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2016
We have constructed simple and inexpensive models for ultrasound-guided procedural training using... more We have constructed simple and inexpensive models for ultrasound-guided procedural training using synthetic ballistic gelatin. These models are durable, leak resistant, and able to be shaped to fit a variety of simulation scenarios to teach procedures. They provide realistic tactile and sonographic training for our learners in a safe, idealized setting.
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, Jan 17, 2015
Computed tomography (CT) scanning is an essential diagnostic tool and has revolutionized care of ... more Computed tomography (CT) scanning is an essential diagnostic tool and has revolutionized care of patients in the acute care setting. However, there is widespread agreement that overutilization of CT, where benefits do not exceed possible costs or harms, is occurring. The goal was to seek consensus in identifying and prioritizing research questions and themes that involve the comparative effectiveness of "traditional" CT use versus alternative diagnostic strategies in the acute care setting. A modified Delphi technique was used that included input from emergency physicians, emergency radiologists, medical physicists, and an industry expert to achieve this.
Diagnostic Imaging for the Emergency Physician, 2011
ABSTRACT Imaging is basic in the orthopedic evaluation of hip disorders. For optimal evaluation o... more ABSTRACT Imaging is basic in the orthopedic evaluation of hip disorders. For optimal evaluation of these images, the orthopedic surgeon must not only correlate normal anatomy and pathology with radiographic findings, but must also be familiar with the newer modalities of CT, magnetic resonance imaging and ultrasound and the role and place of these studies in the evaluation of musculoskeletal disorders. This article correlates normal anatomy of the hip with these modalities and discusses the details of these techniques, particularly CT and MRI, that are pertinent to the orthopedic surgeon.
Background: Ultrasound guidance for insertion of a peripheral venous catheter is becoming common ... more Background: Ultrasound guidance for insertion of a peripheral venous catheter is becoming common practice in many emergency departments in the difficult-to-access patient, and simulation has become an important tool for health care practitioners to learn this technique. Commercial trainers are expensive, and low-cost alternatives described to date provide a suboptimal training experience. We introduce ballistics gel as a new material for the creation of simulating phantoms. Materials and Methods: Directions describe construction of a simulating phantom composed of 10% ballistic gelatin and commonly available latex tubing. The model's success as used by one residency training program and medical school is described. Results: Cost per phantom was $22.83, with less than an hour preparation time per phantom. We found these phantoms to offer a comparable user experience to commercially available products and better than other homemade products. Discussion: Ballistics gel is a novel material for production of simulation phantoms that provides a low-cost, realistic simulation experience. The clear gel material works well for novice learners, and opacifying agents can be added to increase difficulty for more advanced learners. The material offers flexibility in design to make models for a broad range of skill instruction. Conclusion: A relatively quick and easy process using ballistics gel allowed us to create a simulation experience similar to commercially available trainers at a fraction of the cost.
Emergency Medicine (EM) residency program directors and faculty spend significant time and effort... more Emergency Medicine (EM) residency program directors and faculty spend significant time and effort creating a residency rank list. To date, however, there have been few studies to assist program directors in determining which pre-residency variables best predict performance during EM residency. To evaluate which pre-residency variables best correlated with an applicant&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s performance during residency. This was a retrospective multicenter sample of all residents in the three most recent graduating classes from nine participating EM residency programs. The outcome measure of top residency performance was defined as placement in the top third of a resident&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s graduating class based on performance on the final semi-annual evaluation. A total of 277 residents from nine institutions were evaluated. Eight of the predictors analyzed had a significant correlation with the outcome of resident performance. Applicants&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; grade during home and away EM rotations, designation as Alpha Omega Alpha (AOA), U.S. Medical Licensing Examination (USMLE) Step 1 score, interview scores, &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;global rating&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;competitiveness&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; on nonprogram leadership standardized letter of recommendation (SLOR), and having five or more publications or presentations showed a significant association with residency performance. We identified several predictors of top performers in EM residency: an honors grade for an EM rotation, USMLE Step 1 score, AOA designation, interview score, high SLOR rankings from nonprogram leadership, and completion of five or more presentations and publications. EM program directors may consider utilizing these variables during the match process to choose applicants who have the highest chance of top performance during residency.
Study Objectives: To evaluate clinical decisionmaking by emergency physicians using IVC US in chi... more Study Objectives: To evaluate clinical decisionmaking by emergency physicians using IVC US in children undergoing ED evaluation of dehydration from GI losses. Dehydration from gastroenteritis is a leading cause of death in children <5 years worldwide. US assessment of the IVC may correlate with severity of dehydration and assist in clinical decision making. Methods: We conducted a prospective cohort study of US imaging of the IVC in pediatric patients with suspected dehydration from vomiting and/or diarrhea. The IVC was imaged in the sagittal plane at the junction of the right atrium and along the length of the IVC extending into the liver, assessing for 100% collapse of the walls of the IVC with tidal breathing. Patients < 21 yrs. presenting with vomiting requiring ondansetron or diarrhea with concern for dehydration were eligible for study inclusion. Patients enrolled from 10/ 2015-12/2016. Clinical dehydration scores, pre-test (before IVC US) and post-test (after IVC US) probabilities of dehydration requiring IV fluids were recorded by 5 treating sonologists that enrolled patients into the study. Primary outcomes assessed included: IV vs PO fluid rehydration, ED length of stay (LOS) and disposition (admission or discharge). Results: One hundred twelve patients were enrolled, median age was 5 years (S.D +/-6), and 49.1% were female. By clinical dehydration score, 61.6% (n/N¼69/112; 95% CI: 51.9-70.6%), 36.6% (n/N¼41/112; 95% CI: 27.7-46.2%), and 0.01% (n/N¼2/112; 95% CI: 0.0-0.06%) were minimally, moderately and severely dehydrated respectively. The majority of patients received oral rehydration 79.4% (n/N 89/112; 95 CI: 70.8-86.5%) and 20.5% (n/N¼23/112; 95% CI: 13.5-29.2%) received IV fluid rehydration. Only 4.4% (n/N¼5/112; 95% CI: 0.1-8.3%) were admitted and no discharged patient returned to the ED for failure to rehydrate. The distribution of pre-test to post-test probabilities in children with suspected dehydration requiring IV fluids is presented in matrix Figure 1. Overall, IVC US altered pre-test probabilities for requiring IV fluid rehydration by decreasing in 51.8% (n/N¼58/112; 95% CI: 42.1-61.3%), increasing in 25% (n/N¼26/112; 95% CI: 17.3-34.1), and left unchanged in 23.2% (n/N¼28/112; 95% CI: 15.8-32.1%). IVC US was attributed to changing management in 15.2% (n/ N¼17/112; 95% CI: 9.1-23.2%) patients; from PO to IV fluid rehydration in 6.3% (n/ N¼7/112) children and from IV to PO rehydration in 8.9% (n/N¼10/112) patients. Conclusions: US changes pre-test to post-test probabilities for requiring IV fluid rehydration in the majority of children with suspected dehydration, but in a population of mildly to moderately dehydrated children actual management change with respect to IV vs PO rehydration was infrequent.
Conventional two-dimensional (2D) ultrasound imaging is a powerful diagnostic tool in the hands o... more Conventional two-dimensional (2D) ultrasound imaging is a powerful diagnostic tool in the hands of an experienced user, yet 2D ultrasound remains clinically underutilized and inherently incomplete, with output being very operator dependent. Volumetric ultrasound systems can more fully capture a three-dimensional (3D) region of interest, but current 3D systems require specialized transducers, are prohibitively expensive for many clinical departments, and do not register image orientation with respect to the patient; these systems are designed to provide improved workflow rather than operator independence. This work investigates whether it is possible to add volumetric 3D imaging capability to existing 2D ultrasound systems at minimal cost, providing a practical means of reducing operator dependence in ultrasound. In this paper, we present a low-cost method to make 2D ultrasound systems capable of quality volumetric image acquisition: we present the general system design and image acq...
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2016
We have constructed simple and inexpensive models for ultrasound-guided procedural training using... more We have constructed simple and inexpensive models for ultrasound-guided procedural training using synthetic ballistic gelatin. These models are durable, leak resistant, and able to be shaped to fit a variety of simulation scenarios to teach procedures. They provide realistic tactile and sonographic training for our learners in a safe, idealized setting.
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, Jan 17, 2015
Computed tomography (CT) scanning is an essential diagnostic tool and has revolutionized care of ... more Computed tomography (CT) scanning is an essential diagnostic tool and has revolutionized care of patients in the acute care setting. However, there is widespread agreement that overutilization of CT, where benefits do not exceed possible costs or harms, is occurring. The goal was to seek consensus in identifying and prioritizing research questions and themes that involve the comparative effectiveness of "traditional" CT use versus alternative diagnostic strategies in the acute care setting. A modified Delphi technique was used that included input from emergency physicians, emergency radiologists, medical physicists, and an industry expert to achieve this.
Diagnostic Imaging for the Emergency Physician, 2011
ABSTRACT Imaging is basic in the orthopedic evaluation of hip disorders. For optimal evaluation o... more ABSTRACT Imaging is basic in the orthopedic evaluation of hip disorders. For optimal evaluation of these images, the orthopedic surgeon must not only correlate normal anatomy and pathology with radiographic findings, but must also be familiar with the newer modalities of CT, magnetic resonance imaging and ultrasound and the role and place of these studies in the evaluation of musculoskeletal disorders. This article correlates normal anatomy of the hip with these modalities and discusses the details of these techniques, particularly CT and MRI, that are pertinent to the orthopedic surgeon.
Background: Ultrasound guidance for insertion of a peripheral venous catheter is becoming common ... more Background: Ultrasound guidance for insertion of a peripheral venous catheter is becoming common practice in many emergency departments in the difficult-to-access patient, and simulation has become an important tool for health care practitioners to learn this technique. Commercial trainers are expensive, and low-cost alternatives described to date provide a suboptimal training experience. We introduce ballistics gel as a new material for the creation of simulating phantoms. Materials and Methods: Directions describe construction of a simulating phantom composed of 10% ballistic gelatin and commonly available latex tubing. The model's success as used by one residency training program and medical school is described. Results: Cost per phantom was $22.83, with less than an hour preparation time per phantom. We found these phantoms to offer a comparable user experience to commercially available products and better than other homemade products. Discussion: Ballistics gel is a novel material for production of simulation phantoms that provides a low-cost, realistic simulation experience. The clear gel material works well for novice learners, and opacifying agents can be added to increase difficulty for more advanced learners. The material offers flexibility in design to make models for a broad range of skill instruction. Conclusion: A relatively quick and easy process using ballistics gel allowed us to create a simulation experience similar to commercially available trainers at a fraction of the cost.
Emergency Medicine (EM) residency program directors and faculty spend significant time and effort... more Emergency Medicine (EM) residency program directors and faculty spend significant time and effort creating a residency rank list. To date, however, there have been few studies to assist program directors in determining which pre-residency variables best predict performance during EM residency. To evaluate which pre-residency variables best correlated with an applicant&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s performance during residency. This was a retrospective multicenter sample of all residents in the three most recent graduating classes from nine participating EM residency programs. The outcome measure of top residency performance was defined as placement in the top third of a resident&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s graduating class based on performance on the final semi-annual evaluation. A total of 277 residents from nine institutions were evaluated. Eight of the predictors analyzed had a significant correlation with the outcome of resident performance. Applicants&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; grade during home and away EM rotations, designation as Alpha Omega Alpha (AOA), U.S. Medical Licensing Examination (USMLE) Step 1 score, interview scores, &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;global rating&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;competitiveness&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; on nonprogram leadership standardized letter of recommendation (SLOR), and having five or more publications or presentations showed a significant association with residency performance. We identified several predictors of top performers in EM residency: an honors grade for an EM rotation, USMLE Step 1 score, AOA designation, interview score, high SLOR rankings from nonprogram leadership, and completion of five or more presentations and publications. EM program directors may consider utilizing these variables during the match process to choose applicants who have the highest chance of top performance during residency.
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Papers by Joshua Broder