This study assesses participants’ perceptions of long-term impacts of the Teachers of Quality Aca... more This study assesses participants’ perceptions of long-term impacts of the Teachers of Quality Academy, a medical school faculty development program designed to prepare faculty to both practice and teach health system science. A previously published 1-year evaluation of the first cohort of 27 participants showed improved perceived skills, with positive career and health system impacts. In this 5-year evaluation, a mixed-methods design included a questionnaire followed by semistructured interviews to assess perceived long-term impacts on participants. Quantitative and qualitative analyses were completed. Questionnaire response rate was 88% (N = 22), and 14 interviews were analyzed. Results demonstrated that participants had incorporated quality improvement concepts into their clinical work and teaching, better understood interprofessionalism, and observed continued improvements in care delivery. They felt the longitudinal training, delivered in a shared setting, created a learning community with lasting positive effects in institutional culture, supported long-term professional development, and had broader institutional impact. Advancements in clinical care, medical education, and professional and academic advancements were noted.
Western Journal of Emergency Medicine, Dec 17, 2015
Assessment of medical students' knowledge in clinical settings is complex yet essential to the le... more Assessment of medical students' knowledge in clinical settings is complex yet essential to the learning process. Clinical clerkships use various types of written examinations to objectively test medical knowledge within a given discipline. Within emergency medicine (EM), a new national standardized exam was developed to test medical knowledge in this specialty. Evaluation of the psychometric properties of a new examination is an important issue to address during test development and use. Studies have shown that student performance on selected standardized exams will reveal students' strengths and/or weaknesses, so that effective remedial efforts can be implemented. Our study sought to address these issues by examining the association of scores on the new EM national exam with other standardized exam scores. Methods: From August 2011 to April 2013, average National EM M4 examination scores of fourthyear medical students taken at the end of a required EM clerkship were compiled. We examined the correlation of the National EM M4 examination with the scores of initial attempts of the United States Medical Licensing Exam (USMLE) Step 1 and Step 2 Clinical Knowledge (CK) examinations. Correlation coefficients and 95% confidence intervals of correlation coefficients are reported. We also examined the association between the national EM M4 examination score, final grades for the EM rotation, and USMLE Step 1 and Step 2 CK scores. Results: 133 students were included in the study and achieved a mean score of 79.5 SD 8.0 on the National EM M4 exam compared to a national mean of 79.7 SD 3.89. The mean USMLE Step 1 score was 226.8 SD 19.3. The mean USMLE Step 2 CK score was 238.5 SD 18.9. National EM M4 examination scores showed moderate correlation with both USMLE Step 1 (mean score=226.8; correlation coefficient=0.50; 95% CI [0.28-0.67]) and USMLE Step 2 CK (mean score=238.5; correlation coefficient=0.47; 95% CI [0.25-0.65]). Students scoring below the median on the national EM M4 exam also scored well below their colleagues on USMLE exams. Conclusion: The moderate correlation of the national EM M4 examination and USMLE Step 1 and Step 2 CK scores provides support for the utilization of the CDEM National EM M4 examination as an effective means of assessing medical knowledge for fourth-year medical students. Identification of students scoring lower on standardized exams allows for effective remedial efforts to be undertaken throughout the medical education process. [
(BSOM) implemented a three-pronged strategy to implement an HSS curriculum for medical students i... more (BSOM) implemented a three-pronged strategy to implement an HSS curriculum for medical students in its Redesigning Education to Accelerate Change in Healthcare initiative (www. ecu.edu/reach). The strategy included a longitudinal curriculum in HSS for all students, a yearlong faculty professional development component, and the creation of a distinction track in health
Objectives: The emergency medicine (EM) job market is increasingly focused on incentive-based rei... more Objectives: The emergency medicine (EM) job market is increasingly focused on incentive-based reimbursement, which is largely based on relative value units (RVUs) and is directly related to documentation of patient care. Previous studies have shown a need to improve resident education in documentation. The authors created a focused educational intervention on billing and documentation practices to meet this identified need. The hypothesis of this study was that this educational intervention would result in an increase in RVUs generated by EM resident physicians and the average amount billed per patient. Methods: The authors used a quasi-experimental study design. An educational intervention included a 1-hour lecture on documentation and billing, biweekly newsletters, and case-specific feedback from the billing department for EM resident physicians. RVUs and charges generated per patient were recorded for all second-and third-year resident physicians for a 3-month period prior to the educational intervention and for a 3-month period following the intervention. Pre-and postintervention data were compared using Student's t-test and repeated-measures analysis of variance, as appropriate. Results: The evaluation and management (E ⁄ M) chart levels billed during each phase of the study were significantly different (p < 0.0001). The total number of RVUs generated per hour increased from 3.17 in the first phase to 3.71 in the second phase (p = 0.0001). During the initial 3-month phase, the average amount billed per patient seen by a second-or third-year resident was $282.82, which increased to $301.94 in the second phase (p = 0.0004). Conclusions: The educational intervention positively affected resident documentation resulting in greater RVUs ⁄ hour and greater billing performance in the study emergency department (ED).
This is an open-access article distributed under the terms of the Creative Commons Attribution-No... more This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.
American Journal of Physical Medicine & Rehabilitation, Apr 27, 2022
ABSTRACT A required fourth-year advanced core Neurology-PM&R clerkship was adapted to hybrid ... more ABSTRACT A required fourth-year advanced core Neurology-PM&R clerkship was adapted to hybrid format (2 week remote; 2 week in-person) during the COVID-19 pandemic. With teaching of the neurological physical examination being shifted to the remote component, we sought to determine whether this negatively affected student performance on an Objective Structured Clinical Examination (OSCE), particularly the physical exam component. Mean pandemic-era total OSCE scores (n = 79; 85.1 ± 7.3) were similar to pre-pandemic era (n = 137; 83.5 ± 6.0; p = 0.082). Pandemic-era physical exam scores were slightly higher than pre-pandemic (86.9 ± 6.5 vs. 84.9 ± 6.6). Despite conversion of the clerkship to a hybrid curriculum, the performance of the students on the OSCE and the physical exam were unchanged. Reasons for this lack of change may include the constructiveness and integration of the case-based virtual demonstrations combined with in-person learning or the flexibility of the virtual course to allow students more time to prepare for the OSCE and the physical exam. Our findings demonstrate that a hybrid-virtual model can be used to teach foundational skills such as the basics of the physical examination, while allowing faculty to address higher order skills such as integration of clinical data with medical knowledge.
Abstract This problem-based learning (PBL) case is designed for second-year medical students and ... more Abstract This problem-based learning (PBL) case is designed for second-year medical students and focuses on the discussion of the presentation of a patient with methemoglobinemia and the underlying...
Background: Version 1 (V1) of the National Emergency Medicine Fourth-year Student (EM M4) Examina... more Background: Version 1 (V1) of the National Emergency Medicine Fourth-year Student (EM M4) Examination was released in 2011 and revised along with release of V2 in 2012. Each examination contains 50 multiplechoice questions designed to assess knowledge in the EM M4 clerkship curriculum. Development and initial performance data were described previously. Objective: To provide updated V1 performance data, describe development and revision of V2, and to compare performance between academic years and examination forms, and within academic years. Methods: Examinations are administered at www. saemtests.org with ongoing performance data provided. After 1 year of use, nine questions on V2 were revised, five because of low discriminatory ability and four because of excessive difficulty. Revision or replacement was done in accordance with the National Board of Medical Examiners (NBME) Item Writing Guidelines. Mean scores were compared for V1 between academic years (i.e., July 2011ÀJune 2012 vs. July 2012ÀJune 2013), V2 compared with V1, and for each examination version for early and late test takers. Results: V1 has been administered >10,000 times since its release, and the current form mean is 81.5% (SD 3.7). Average discriminatory value (rpb) is 0.204. V2 has been administered >1500 times, with a mean score of 78.4% (SD 4.4) and average rpb 0.253. V1 and V2 current means differ statistically. Scores from examinees completing V1 or V2 early vs. late in the academic year differ statistically. Conclusions: Performance data for V1 remain stable after 2 years. Revisions of poorly performing questions improved question performance on V2. Questions with low rpb or low pdiff will continue to be revised annually. While examination forms differ statistically, the practical utility of the differences is not defined. Ó 2015 Elsevier Inc.
Journal of Graduate Medical Education, Jun 1, 2021
Background The American Medical Association Accelerating Change in Medical Education (AMA-ACE) co... more Background The American Medical Association Accelerating Change in Medical Education (AMA-ACE) consortium proposes that medical schools include a new 3-pillar model incorporating health systems science (HSS) and basic and clinical sciences. One of the goals of AMA-ACE was to support HSS curricular innovation to improve residency preparation. Objective This study evaluates the effectiveness of HSS curricula by using a large dataset to link medical school graduates to internship Milestones through collaboration with the Accreditation Council for Graduate Medical Education (ACGME). Methods ACGME subcompetencies related to the schools' HSS curricula were identified for internal medicine, emergency medicine, family medicine, obstetrics and gynecology (OB/GYN), pediatrics, and surgery. Analysis compared Milestone ratings of ACE school graduates to non-ACE graduates at 6 and 12 months using generalized estimating equation models. Results At 6 months both groups demonstrated similar HSS-related levels of Milestone performance on the selected ACGME competencies. At 1 year, ACE graduates in OB/GYN scored minimally higher on 2 systems-based practice (SBP) subcompetencies compared to non-ACE school graduates: SBP01 (1.96 vs 1.82, 95% CI 0.03-0.24) and SBP02 (1.87 vs 1.79, 95% CI 0.01-0.16). In internal medicine, ACE graduates scored minimally higher on 3 HSS-related subcompetencies: SBP01 (2.19 vs 2.05, 95% CI 0.04-0.26), PBLI01 (2.13 vs 2.01; 95% CI 0.01-0.24), and PBLI04 (2.05 vs 1.93; 95% CI 0.03-0.21). For the other specialties examined, there were no significant differences between groups. Conclusions Graduates from schools with training in HSS had similar Milestone ratings for most subcompetencies and very small differences in Milestone ratings for only 5 subcompetencies across 6 specialties at 1 year, compared to graduates from non-ACE schools. These differences are likely not educationally meaningful.
International Journal of Emergency Medicine, Oct 13, 2011
Background: Abdominal pain is a common complaint among emergency department patients, making it e... more Background: Abdominal pain is a common complaint among emergency department patients, making it essential to identify those with life-threatening etiologies. We report on the rare finding of atraumatic transvaginal bowel evisceration in a patient presenting to the emergency department with the primary complaint of abdominal pain. Case Description: A 63-year-old female presented ambulatory to the emergency department with abdominal pain and foreign body sensation in her vagina after coughing. Physical exam demonstrated evisceration of her small bowel through her vagina. During her clinical course, she rapidly deteriorated from appearing well without abdominal tenderness to hypotensive with frank peritonitis. Conclusion: This case demonstrates the need to perform a thorough physical exam on all patients with abdominal pain and details the management of vaginal evisceration. This case also highlights the difficulty of appropriate triage for patients with complaints not easily assessed in triage. In an era of emergency department crowding, emergency physicians should reevaluate nursing education on triaging abdominal pain to prevent delays in caring for well-appearing patients who have underlying life-threatening illnesses.
Health care delivery in the United States is fragmented, costly, and inefficient. 1-5 Faced with ... more Health care delivery in the United States is fragmented, costly, and inefficient. 1-5 Faced with increasing accountability for quality of care, payment reform, and the need to transform delivery processes, health care systems are transforming practice environments. 6 New care delivery models focus increasingly on interprofessional care teams to achieve the goals of the Institute for Healthcare Improvement's Triple Aim-to improve the patient experience and population health while reducing costs. 7 These changes bring new role expectations for physicians and, therefore, new expectations for medical education programs training the next generation of collaboratively effective, systems-based physicians. 8-13 To effectively prepare medical students to thrive in a 21st-century health care system, undergraduate medical education (UME) and graduate medical education (GME) programs must address trainees' knowledge, attitudes, and skills in systems-based practice (SBP). 11,14-19 The medical education community is working to address the transition from UME to GME in this facet of physician development via the Association of American Medical Colleges' Core Entrustable Professional Activities for Entering Residency (CEPAERs), which include the identification of system failures and contributing to a culture of safety and improvement, and the Accreditation Council for Graduate Medical Education's (ACGME's) inclusion of SBP as one of its six core competency domains. 20,21 U.S. medical students report inadequate education in health care systems, economics, managed care, and practice management. 22,23 Additionally, the literature regarding SBP-related curricula is fragmented and limited despite unified calls for expanded curricula in content areas that are broader than the current ACGME definitions of SBP and practice-based learning (PBL). 20 Several independent sources identify critical pieces of this systems-related content, including care transitions, teamwork and coordination, patient safety, policy, cost-conscious care, and public health. 6,18,21,24-27 Aligning expanded SBP and PBL content with the CEPAERs and current gaps in curricular content will help define the content of health systems science (HSS). 20 Viewed by medical educators as a potential "third science" that complements the basic and clinical sciences, HSS can be considered as the
Background: Due to the emergence of the COVID-19 pandemic in March 2020, the cancellation of in-p... more Background: Due to the emergence of the COVID-19 pandemic in March 2020, the cancellation of in-person learning activities forced every aspect of medical education and student engagement to pivot to a web-based format, including activities supporting the performance and dissemination of scholarly work. At that time, social media had been used to augment in-person conference learning, but it had not been used as the sole platform for scholarly abstract presentations. Objective: Our aim was to assess the feasibility of using Twitter to provide a completely web-based forum for real-time dissemination of and engagement with student scholarly work as an alternative to a traditional in-person poster presentation session. Methods: The Brody School of Medicine at East Carolina University launched an online Medical Student Scholarship Forum, using Twitter as a platform for students to present scholarly work and prepare for future web-based presentations. A single student forum participant created posts using a standardized template that incorporated student research descriptions, uniform promotional hashtags, and individual poster presentations. Tweets were released over 5 days and analytic data were collected from the Twitter platform. Outcome measures included impressions, engagements, retweets, likes, media engagements, and average daily engagement rate. Results: During the conference, the student leader published 63 tweets promoting the work of 58 students (55 medical and 3 dental students) over 5 days. During the forum and the following week, tweets from the @BrodyDistinctly Twitter account received 63,142 impressions and 7487 engagements, including 187 retweets, 1427 likes, and 2082 media engagements. During the 5 days of the forum, the average daily engagement rate was 12.72%. Conclusions: Using Twitter as a means of scholarly dissemination resulted in a larger viewing community compared to a traditional in-person event. Early evidence suggests that social media platforms may be an alternative to traditional scholarly presentations. Presenting via Twitter allowed students to receive instantaneous feedback and effectively network with wider academic communities. Additional research is needed to evaluate the effectiveness of knowledge uptake, feedback, and networking.
Western Journal of Emergency Medicine, Nov 12, 2015
, the National Board of Medical Examiners (NBME) released an Advanced Clinical Examination (ACE) ... more , the National Board of Medical Examiners (NBME) released an Advanced Clinical Examination (ACE) in emergency medicine (EM). In addition to this new resource, CDEM (Clerkship Directors in EM) provides two online, high-quality, internally validated examinations. National usage statistics are available for all three examinations, however, it is currently unknown how students entering an EM residency perform as compared to the entire national cohort. This information may help educators interpret examination scores of both EM-bound and non-EM-bound students. Objectives: The objective of this study was to compare EM clerkship examination performance between students who matched into an EM residency in 2014 to students who did not. We made comparisons were made using the EM-ACE and both versions of the National fourth year medical student (M4) EM examinations. Method: In this retrospective multi-institutional cohort study, the EM-ACE and either Version 1 (V1) or 2 (V2) of the National EM M4 examination was given to students taking a fourth-year EM rotation at five institutions between April 2013 to February 2014. We collected examination performance, including the scaled EM-ACE score, and percent correct on the EM M4 exams, and 2014 NRMP Match status. Student t-tests were performed on the examination averages of students who matched in EM as compared with those who did not. Results: A total of 606 students from five different institutions took both the EM-ACE and one of the EM M4 exams; 94 (15.5%) students matched in EM in the 2014 Match. The mean score for EM-bound students on the EM-ACE, V1 and V2 of the EM M4 exams were 70.9 (n=47, SD=9.0), 84.4 (n=36, SD=5.2), and 83.3 (n=11, SD=6.9), respectively. Mean scores for non-EM-bound students were 68.0 (n=256, SD=9.7), 82.9 (n=243, SD=6.5), and 74.5 (n=13, SD=5.9). There was a significant difference in mean scores in EM-bound and non-EM-bound student for the EM-ACE (p=0.05) and V2 (p<0.01) but not V1 (p=0.18) of the National EM M4 examination. Conclusion: Students who successfully matched in EM performed better on all three exams at the end of their EM clerkship. [
Western Journal of Emergency Medicine, Jan 18, 2018
Clinical assessment of medical students in emergency medicine (EM) clerkships is a highly variabl... more Clinical assessment of medical students in emergency medicine (EM) clerkships is a highly variable process that presents unique challenges and opportunities. Currently, clerkship directors use institution-specific tools with unproven validity and reliability that may or may not address competencies valued most highly in the EM setting. Standardization of assessment practices and development of a common, valid, specialty-specific tool would benefit EM educators and students. Methods: A two-day national consensus conference was held in March 2016 in the Clerkship Directors in Emergency Medicine (CDEM) track at the Council of Residency Directors in Emergency Medicine (CORD) Academic Assembly in Nashville, TN. The goal of this conference was to standardize assessment practices and to create a national clinical assessment tool for use in EM clerkships across the country. Conference leaders synthesized the literature, articulated major themes and questions pertinent to clinical assessment of students in EM, clarified the issues, and outlined the consensusbuilding process prior to consensus-building activities. Results: The first day of the conference was dedicated to developing consensus on these key themes in clinical assessment. The second day of the conference was dedicated to discussing and voting on proposed domains to be included in the national clinical assessment tool. A modified Delphi process was initiated after the conference to reconcile questions and items that did not reach an a priori level of consensus. Conclusion: The final tool, the National Clinical Assessment Tool for Medical Students in Emergency Medicine (NCAT-EM) is presented here. [
of a national tool. Conclusion: There is substantial variability in assessment practices between ... more of a national tool. Conclusion: There is substantial variability in assessment practices between EM clerkships, raising concern regarding the comparability of grades between institutions. CDs rely on shift cards in grading despite the lack of evidence of validity and inconsistent process variables. Standardization of assessment practices may improve the assessment of EM students.
This study assesses participants’ perceptions of long-term impacts of the Teachers of Quality Aca... more This study assesses participants’ perceptions of long-term impacts of the Teachers of Quality Academy, a medical school faculty development program designed to prepare faculty to both practice and teach health system science. A previously published 1-year evaluation of the first cohort of 27 participants showed improved perceived skills, with positive career and health system impacts. In this 5-year evaluation, a mixed-methods design included a questionnaire followed by semistructured interviews to assess perceived long-term impacts on participants. Quantitative and qualitative analyses were completed. Questionnaire response rate was 88% (N = 22), and 14 interviews were analyzed. Results demonstrated that participants had incorporated quality improvement concepts into their clinical work and teaching, better understood interprofessionalism, and observed continued improvements in care delivery. They felt the longitudinal training, delivered in a shared setting, created a learning community with lasting positive effects in institutional culture, supported long-term professional development, and had broader institutional impact. Advancements in clinical care, medical education, and professional and academic advancements were noted.
Western Journal of Emergency Medicine, Dec 17, 2015
Assessment of medical students' knowledge in clinical settings is complex yet essential to the le... more Assessment of medical students' knowledge in clinical settings is complex yet essential to the learning process. Clinical clerkships use various types of written examinations to objectively test medical knowledge within a given discipline. Within emergency medicine (EM), a new national standardized exam was developed to test medical knowledge in this specialty. Evaluation of the psychometric properties of a new examination is an important issue to address during test development and use. Studies have shown that student performance on selected standardized exams will reveal students' strengths and/or weaknesses, so that effective remedial efforts can be implemented. Our study sought to address these issues by examining the association of scores on the new EM national exam with other standardized exam scores. Methods: From August 2011 to April 2013, average National EM M4 examination scores of fourthyear medical students taken at the end of a required EM clerkship were compiled. We examined the correlation of the National EM M4 examination with the scores of initial attempts of the United States Medical Licensing Exam (USMLE) Step 1 and Step 2 Clinical Knowledge (CK) examinations. Correlation coefficients and 95% confidence intervals of correlation coefficients are reported. We also examined the association between the national EM M4 examination score, final grades for the EM rotation, and USMLE Step 1 and Step 2 CK scores. Results: 133 students were included in the study and achieved a mean score of 79.5 SD 8.0 on the National EM M4 exam compared to a national mean of 79.7 SD 3.89. The mean USMLE Step 1 score was 226.8 SD 19.3. The mean USMLE Step 2 CK score was 238.5 SD 18.9. National EM M4 examination scores showed moderate correlation with both USMLE Step 1 (mean score=226.8; correlation coefficient=0.50; 95% CI [0.28-0.67]) and USMLE Step 2 CK (mean score=238.5; correlation coefficient=0.47; 95% CI [0.25-0.65]). Students scoring below the median on the national EM M4 exam also scored well below their colleagues on USMLE exams. Conclusion: The moderate correlation of the national EM M4 examination and USMLE Step 1 and Step 2 CK scores provides support for the utilization of the CDEM National EM M4 examination as an effective means of assessing medical knowledge for fourth-year medical students. Identification of students scoring lower on standardized exams allows for effective remedial efforts to be undertaken throughout the medical education process. [
(BSOM) implemented a three-pronged strategy to implement an HSS curriculum for medical students i... more (BSOM) implemented a three-pronged strategy to implement an HSS curriculum for medical students in its Redesigning Education to Accelerate Change in Healthcare initiative (www. ecu.edu/reach). The strategy included a longitudinal curriculum in HSS for all students, a yearlong faculty professional development component, and the creation of a distinction track in health
Objectives: The emergency medicine (EM) job market is increasingly focused on incentive-based rei... more Objectives: The emergency medicine (EM) job market is increasingly focused on incentive-based reimbursement, which is largely based on relative value units (RVUs) and is directly related to documentation of patient care. Previous studies have shown a need to improve resident education in documentation. The authors created a focused educational intervention on billing and documentation practices to meet this identified need. The hypothesis of this study was that this educational intervention would result in an increase in RVUs generated by EM resident physicians and the average amount billed per patient. Methods: The authors used a quasi-experimental study design. An educational intervention included a 1-hour lecture on documentation and billing, biweekly newsletters, and case-specific feedback from the billing department for EM resident physicians. RVUs and charges generated per patient were recorded for all second-and third-year resident physicians for a 3-month period prior to the educational intervention and for a 3-month period following the intervention. Pre-and postintervention data were compared using Student's t-test and repeated-measures analysis of variance, as appropriate. Results: The evaluation and management (E ⁄ M) chart levels billed during each phase of the study were significantly different (p < 0.0001). The total number of RVUs generated per hour increased from 3.17 in the first phase to 3.71 in the second phase (p = 0.0001). During the initial 3-month phase, the average amount billed per patient seen by a second-or third-year resident was $282.82, which increased to $301.94 in the second phase (p = 0.0004). Conclusions: The educational intervention positively affected resident documentation resulting in greater RVUs ⁄ hour and greater billing performance in the study emergency department (ED).
This is an open-access article distributed under the terms of the Creative Commons Attribution-No... more This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.
American Journal of Physical Medicine & Rehabilitation, Apr 27, 2022
ABSTRACT A required fourth-year advanced core Neurology-PM&R clerkship was adapted to hybrid ... more ABSTRACT A required fourth-year advanced core Neurology-PM&R clerkship was adapted to hybrid format (2 week remote; 2 week in-person) during the COVID-19 pandemic. With teaching of the neurological physical examination being shifted to the remote component, we sought to determine whether this negatively affected student performance on an Objective Structured Clinical Examination (OSCE), particularly the physical exam component. Mean pandemic-era total OSCE scores (n = 79; 85.1 ± 7.3) were similar to pre-pandemic era (n = 137; 83.5 ± 6.0; p = 0.082). Pandemic-era physical exam scores were slightly higher than pre-pandemic (86.9 ± 6.5 vs. 84.9 ± 6.6). Despite conversion of the clerkship to a hybrid curriculum, the performance of the students on the OSCE and the physical exam were unchanged. Reasons for this lack of change may include the constructiveness and integration of the case-based virtual demonstrations combined with in-person learning or the flexibility of the virtual course to allow students more time to prepare for the OSCE and the physical exam. Our findings demonstrate that a hybrid-virtual model can be used to teach foundational skills such as the basics of the physical examination, while allowing faculty to address higher order skills such as integration of clinical data with medical knowledge.
Abstract This problem-based learning (PBL) case is designed for second-year medical students and ... more Abstract This problem-based learning (PBL) case is designed for second-year medical students and focuses on the discussion of the presentation of a patient with methemoglobinemia and the underlying...
Background: Version 1 (V1) of the National Emergency Medicine Fourth-year Student (EM M4) Examina... more Background: Version 1 (V1) of the National Emergency Medicine Fourth-year Student (EM M4) Examination was released in 2011 and revised along with release of V2 in 2012. Each examination contains 50 multiplechoice questions designed to assess knowledge in the EM M4 clerkship curriculum. Development and initial performance data were described previously. Objective: To provide updated V1 performance data, describe development and revision of V2, and to compare performance between academic years and examination forms, and within academic years. Methods: Examinations are administered at www. saemtests.org with ongoing performance data provided. After 1 year of use, nine questions on V2 were revised, five because of low discriminatory ability and four because of excessive difficulty. Revision or replacement was done in accordance with the National Board of Medical Examiners (NBME) Item Writing Guidelines. Mean scores were compared for V1 between academic years (i.e., July 2011ÀJune 2012 vs. July 2012ÀJune 2013), V2 compared with V1, and for each examination version for early and late test takers. Results: V1 has been administered >10,000 times since its release, and the current form mean is 81.5% (SD 3.7). Average discriminatory value (rpb) is 0.204. V2 has been administered >1500 times, with a mean score of 78.4% (SD 4.4) and average rpb 0.253. V1 and V2 current means differ statistically. Scores from examinees completing V1 or V2 early vs. late in the academic year differ statistically. Conclusions: Performance data for V1 remain stable after 2 years. Revisions of poorly performing questions improved question performance on V2. Questions with low rpb or low pdiff will continue to be revised annually. While examination forms differ statistically, the practical utility of the differences is not defined. Ó 2015 Elsevier Inc.
Journal of Graduate Medical Education, Jun 1, 2021
Background The American Medical Association Accelerating Change in Medical Education (AMA-ACE) co... more Background The American Medical Association Accelerating Change in Medical Education (AMA-ACE) consortium proposes that medical schools include a new 3-pillar model incorporating health systems science (HSS) and basic and clinical sciences. One of the goals of AMA-ACE was to support HSS curricular innovation to improve residency preparation. Objective This study evaluates the effectiveness of HSS curricula by using a large dataset to link medical school graduates to internship Milestones through collaboration with the Accreditation Council for Graduate Medical Education (ACGME). Methods ACGME subcompetencies related to the schools' HSS curricula were identified for internal medicine, emergency medicine, family medicine, obstetrics and gynecology (OB/GYN), pediatrics, and surgery. Analysis compared Milestone ratings of ACE school graduates to non-ACE graduates at 6 and 12 months using generalized estimating equation models. Results At 6 months both groups demonstrated similar HSS-related levels of Milestone performance on the selected ACGME competencies. At 1 year, ACE graduates in OB/GYN scored minimally higher on 2 systems-based practice (SBP) subcompetencies compared to non-ACE school graduates: SBP01 (1.96 vs 1.82, 95% CI 0.03-0.24) and SBP02 (1.87 vs 1.79, 95% CI 0.01-0.16). In internal medicine, ACE graduates scored minimally higher on 3 HSS-related subcompetencies: SBP01 (2.19 vs 2.05, 95% CI 0.04-0.26), PBLI01 (2.13 vs 2.01; 95% CI 0.01-0.24), and PBLI04 (2.05 vs 1.93; 95% CI 0.03-0.21). For the other specialties examined, there were no significant differences between groups. Conclusions Graduates from schools with training in HSS had similar Milestone ratings for most subcompetencies and very small differences in Milestone ratings for only 5 subcompetencies across 6 specialties at 1 year, compared to graduates from non-ACE schools. These differences are likely not educationally meaningful.
International Journal of Emergency Medicine, Oct 13, 2011
Background: Abdominal pain is a common complaint among emergency department patients, making it e... more Background: Abdominal pain is a common complaint among emergency department patients, making it essential to identify those with life-threatening etiologies. We report on the rare finding of atraumatic transvaginal bowel evisceration in a patient presenting to the emergency department with the primary complaint of abdominal pain. Case Description: A 63-year-old female presented ambulatory to the emergency department with abdominal pain and foreign body sensation in her vagina after coughing. Physical exam demonstrated evisceration of her small bowel through her vagina. During her clinical course, she rapidly deteriorated from appearing well without abdominal tenderness to hypotensive with frank peritonitis. Conclusion: This case demonstrates the need to perform a thorough physical exam on all patients with abdominal pain and details the management of vaginal evisceration. This case also highlights the difficulty of appropriate triage for patients with complaints not easily assessed in triage. In an era of emergency department crowding, emergency physicians should reevaluate nursing education on triaging abdominal pain to prevent delays in caring for well-appearing patients who have underlying life-threatening illnesses.
Health care delivery in the United States is fragmented, costly, and inefficient. 1-5 Faced with ... more Health care delivery in the United States is fragmented, costly, and inefficient. 1-5 Faced with increasing accountability for quality of care, payment reform, and the need to transform delivery processes, health care systems are transforming practice environments. 6 New care delivery models focus increasingly on interprofessional care teams to achieve the goals of the Institute for Healthcare Improvement's Triple Aim-to improve the patient experience and population health while reducing costs. 7 These changes bring new role expectations for physicians and, therefore, new expectations for medical education programs training the next generation of collaboratively effective, systems-based physicians. 8-13 To effectively prepare medical students to thrive in a 21st-century health care system, undergraduate medical education (UME) and graduate medical education (GME) programs must address trainees' knowledge, attitudes, and skills in systems-based practice (SBP). 11,14-19 The medical education community is working to address the transition from UME to GME in this facet of physician development via the Association of American Medical Colleges' Core Entrustable Professional Activities for Entering Residency (CEPAERs), which include the identification of system failures and contributing to a culture of safety and improvement, and the Accreditation Council for Graduate Medical Education's (ACGME's) inclusion of SBP as one of its six core competency domains. 20,21 U.S. medical students report inadequate education in health care systems, economics, managed care, and practice management. 22,23 Additionally, the literature regarding SBP-related curricula is fragmented and limited despite unified calls for expanded curricula in content areas that are broader than the current ACGME definitions of SBP and practice-based learning (PBL). 20 Several independent sources identify critical pieces of this systems-related content, including care transitions, teamwork and coordination, patient safety, policy, cost-conscious care, and public health. 6,18,21,24-27 Aligning expanded SBP and PBL content with the CEPAERs and current gaps in curricular content will help define the content of health systems science (HSS). 20 Viewed by medical educators as a potential "third science" that complements the basic and clinical sciences, HSS can be considered as the
Background: Due to the emergence of the COVID-19 pandemic in March 2020, the cancellation of in-p... more Background: Due to the emergence of the COVID-19 pandemic in March 2020, the cancellation of in-person learning activities forced every aspect of medical education and student engagement to pivot to a web-based format, including activities supporting the performance and dissemination of scholarly work. At that time, social media had been used to augment in-person conference learning, but it had not been used as the sole platform for scholarly abstract presentations. Objective: Our aim was to assess the feasibility of using Twitter to provide a completely web-based forum for real-time dissemination of and engagement with student scholarly work as an alternative to a traditional in-person poster presentation session. Methods: The Brody School of Medicine at East Carolina University launched an online Medical Student Scholarship Forum, using Twitter as a platform for students to present scholarly work and prepare for future web-based presentations. A single student forum participant created posts using a standardized template that incorporated student research descriptions, uniform promotional hashtags, and individual poster presentations. Tweets were released over 5 days and analytic data were collected from the Twitter platform. Outcome measures included impressions, engagements, retweets, likes, media engagements, and average daily engagement rate. Results: During the conference, the student leader published 63 tweets promoting the work of 58 students (55 medical and 3 dental students) over 5 days. During the forum and the following week, tweets from the @BrodyDistinctly Twitter account received 63,142 impressions and 7487 engagements, including 187 retweets, 1427 likes, and 2082 media engagements. During the 5 days of the forum, the average daily engagement rate was 12.72%. Conclusions: Using Twitter as a means of scholarly dissemination resulted in a larger viewing community compared to a traditional in-person event. Early evidence suggests that social media platforms may be an alternative to traditional scholarly presentations. Presenting via Twitter allowed students to receive instantaneous feedback and effectively network with wider academic communities. Additional research is needed to evaluate the effectiveness of knowledge uptake, feedback, and networking.
Western Journal of Emergency Medicine, Nov 12, 2015
, the National Board of Medical Examiners (NBME) released an Advanced Clinical Examination (ACE) ... more , the National Board of Medical Examiners (NBME) released an Advanced Clinical Examination (ACE) in emergency medicine (EM). In addition to this new resource, CDEM (Clerkship Directors in EM) provides two online, high-quality, internally validated examinations. National usage statistics are available for all three examinations, however, it is currently unknown how students entering an EM residency perform as compared to the entire national cohort. This information may help educators interpret examination scores of both EM-bound and non-EM-bound students. Objectives: The objective of this study was to compare EM clerkship examination performance between students who matched into an EM residency in 2014 to students who did not. We made comparisons were made using the EM-ACE and both versions of the National fourth year medical student (M4) EM examinations. Method: In this retrospective multi-institutional cohort study, the EM-ACE and either Version 1 (V1) or 2 (V2) of the National EM M4 examination was given to students taking a fourth-year EM rotation at five institutions between April 2013 to February 2014. We collected examination performance, including the scaled EM-ACE score, and percent correct on the EM M4 exams, and 2014 NRMP Match status. Student t-tests were performed on the examination averages of students who matched in EM as compared with those who did not. Results: A total of 606 students from five different institutions took both the EM-ACE and one of the EM M4 exams; 94 (15.5%) students matched in EM in the 2014 Match. The mean score for EM-bound students on the EM-ACE, V1 and V2 of the EM M4 exams were 70.9 (n=47, SD=9.0), 84.4 (n=36, SD=5.2), and 83.3 (n=11, SD=6.9), respectively. Mean scores for non-EM-bound students were 68.0 (n=256, SD=9.7), 82.9 (n=243, SD=6.5), and 74.5 (n=13, SD=5.9). There was a significant difference in mean scores in EM-bound and non-EM-bound student for the EM-ACE (p=0.05) and V2 (p<0.01) but not V1 (p=0.18) of the National EM M4 examination. Conclusion: Students who successfully matched in EM performed better on all three exams at the end of their EM clerkship. [
Western Journal of Emergency Medicine, Jan 18, 2018
Clinical assessment of medical students in emergency medicine (EM) clerkships is a highly variabl... more Clinical assessment of medical students in emergency medicine (EM) clerkships is a highly variable process that presents unique challenges and opportunities. Currently, clerkship directors use institution-specific tools with unproven validity and reliability that may or may not address competencies valued most highly in the EM setting. Standardization of assessment practices and development of a common, valid, specialty-specific tool would benefit EM educators and students. Methods: A two-day national consensus conference was held in March 2016 in the Clerkship Directors in Emergency Medicine (CDEM) track at the Council of Residency Directors in Emergency Medicine (CORD) Academic Assembly in Nashville, TN. The goal of this conference was to standardize assessment practices and to create a national clinical assessment tool for use in EM clerkships across the country. Conference leaders synthesized the literature, articulated major themes and questions pertinent to clinical assessment of students in EM, clarified the issues, and outlined the consensusbuilding process prior to consensus-building activities. Results: The first day of the conference was dedicated to developing consensus on these key themes in clinical assessment. The second day of the conference was dedicated to discussing and voting on proposed domains to be included in the national clinical assessment tool. A modified Delphi process was initiated after the conference to reconcile questions and items that did not reach an a priori level of consensus. Conclusion: The final tool, the National Clinical Assessment Tool for Medical Students in Emergency Medicine (NCAT-EM) is presented here. [
of a national tool. Conclusion: There is substantial variability in assessment practices between ... more of a national tool. Conclusion: There is substantial variability in assessment practices between EM clerkships, raising concern regarding the comparability of grades between institutions. CDs rely on shift cards in grading despite the lack of evidence of validity and inconsistent process variables. Standardization of assessment practices may improve the assessment of EM students.
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