Team leadership is a critical skill for emergency medicine physicians that directly affects team performance and the quality of patient care. There exists a robust body of team science research supporting team leadership conceptual models and behavioral skill sets. However, to date, this work has not been widely incorporated into health care team leadership education.Background

 This narrative review has 3 aims: (1) to synthesize the team science literature and to translate important concepts and models to health care team leadership; (2) to describe how team leadership is currently represented in the health care literature and in the Accreditation Council for Graduate Medical Education Milestones for emergency medicine; and (3) to propose a novel, evidence-based framework for the assessment of team leadership in emergency medicine.Objective

 We conducted a narrative review of the team science and health care literature. We summarized our findings and identified a list of team leadership behaviors that were then used to create a framework for team leadership assessment.Methods

 Current health care team leadership measurement tools do not incorporate evidence-based models of leadership concepts from other established domains. The emergency medicine milestones include several team leadership behaviors as part of a larger resident evaluation program. However, they do not offer a comprehensive or cohesive representation of the team leadership construct.Results

 Despite the importance of team leadership to patient care, there is no standardized approach to team leadership assessment in emergency medicine. Based on the results of our review, we propose a novel team leadership assessment framework that is supported by the team science literature.Conclusions

 Cardiology fellowship programs are at the interface of medical education and the care of patients suffering from the leading cause of mortality in the United States, yet there is an apparent lack of research guiding the effective education of fellows.Background

 We sought to quantify the number of publications in cardiology journals that pertained to the education of cardiology trainees and the number of cardiologists participating in education research.Objective

 For the period between January and December 2012, we cataloged cardiology-specific and general medical/medical education journals and sorted them by impact factor. Tables of content were reviewed for articles with an educational focus, a cardiology focus, or both. We recorded the authors' areas of medical training, and keywords from each cardiology journal's mission statement were reviewed for emphasis on education.Methods

 Twenty-six cardiology journals, containing 6645 articles, were reviewed. Only 4 articles had education themes. Ten general medical and 15 medical education journals contained 6810 articles. Of these, only 7 focused on medical education in cardiology, and none focused on cardiology fellowship training. Among the 4887 authors of publications in medical education journals, 25 were cardiologists (less than 1%), and among the 1036 total words in the mission statements of all cardiology journals, the term “education” appeared once.Results

 Published educational research is lacking in cardiology training, and few cardiologists appear to be active members of the education scholarship community. Cardiology organizations and academic journals should support efforts to identify target areas of study and publish scholarship in educational innovation.Conclusions

 Pediatric critical care medicine requires the acquisition of procedural skills, but to date no criteria exist for assessing trainee competence in central venous catheter (CVC) insertion.Background

 The goal of this study was to create and demonstrate validity evidence for a direct observation tool for assessing CVC insertion.Objective

 Ten experts used the modified Delphi technique to create a 15-item direct observation tool to assess 5 scripted and filmed simulated scenarios of CVC placement. The scenarios were hosted on a dedicated website from March to May 2013, and respondents recruited by e-mail completed the observation tool in real time while watching the scenarios. The goal was to obtain 50 respondents and a total of 250 scenario ratings.Methods

 A total of 49 pediatrics intensive care faculty physicians (6.3% of 780 potential subjects) responded and generated 188 scenario observations. Of these, 150 (79.8%) were recorded from participants who scored 4 or more on the 5 scenarios. The tool correctly identified the expected reference standard in 96.8% of assessments with an interrater agreement kappa (standard error) = 0.94 (0.07) and receiver operating characteristic = 0.97 (95% CI 0.94–0.99).Results

 This direct observation assessment tool for central venous catheterization demonstrates excellent performance in identifying the reference standard with a high degree of interrater reliability. These assessments support a validity construct for a pediatric critical care medicine faculty member to assess a provider placing a CVC in a pediatrics patient.Conclusions

 The in-training examination (ITE) offers formative assessments of residents' developing medical knowledge. Identification of an ITE performance level associated with success on the specialty board examination allows identification of “at risk” residents.Background

 This study sought to identify a threshold score for obstetrics and gynecology residents' performance on the Council on Resident Education in Obstetrics and Gynecology (CREOG) ITE that predicts successful performance on the American Board of Obstetrics and Gynecology (ABOG) written examination.Objective

 We analyzed ITE and ABOG results of 80 residents who completed 4 years of CREOG ITEs at 2 institutions between 2002 and 2012. We assessed the level of performance associated with successful performance on the ABOG written examination.Methods

 Data analyzed included scores for 71 of 80 residents (89%), with an overall pass rate of 82%. A postgraduate year (PGY) 4 score of 200 on the CREOG ITE or twice in any of the PGY training years was associated with a 100% ABOG pass rate. Scoring ≥ 205 in any PGY also was associated with a 100% pass rate. Residents who did not attain a score of 200 had a 35% to 45% chance of failing the ABOG written examination, depending on the PGY of the ITE performance.Results

 Our findings suggest that a CREOG ITE score of at least 200 twice, or as a PGY-4, offers assurance of successful performance on the ABOG examination. Scores lower than this threshold may be used to identify “at risk” residents for added learning and provide program elements in need of improvement.Conclusions

 The Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) and the United States Medical Licensing Examination (USMLE) are recognized by all state medical licensing boards in the United States, and the Federation of State Medical Boards has supported the validity of both examinations for medical licensure. Many osteopathic medical students take both examinations.Background

 The purpose of this study was to investigate performance on COMLEX-USA Level 1 and USMLE Step 1 of students from colleges of osteopathic medicine where the majority of students took both examinations.Objective

 Data were collected on the entering classes of 2010 and 2011. Relationships between the COMLEX-USA Level 1 and the USMLE Step 1 were quantified using Pearson correlations. The correlation between outcomes on the 2 examinations was evaluated using the phi coefficient. A contingency table was constructed to look at first-attempt outcomes (pass/fail).Methods

 Data for 2010 and 2011 were collected from 3 osteopathic medical schools, with 795 of 914 students (87%) taking both examinations. The correlation between first-attempt COMLEX-USA Level 1 and USMLE Step 1 scores was statistically significant across and within all 3 schools. The overall correlation was r(795) = 0.84 (P < .001). Pass/fail status on the 2 examinations was moderately correlated (ϕ = 0.39, P < .01).Results

 Our study found a strong association between COMLEX Level 1 and USMLE Step 1 performance. Additional studies to accurately compare scores on these examinations are warranted.Conclusions

 Simulation-based training is currently embedded in most health professions education curricula. Without evidence for how trainees think about their simulation-based learning, some training techniques may not support trainees' learning strategies.Background

 This study explored how residents think about and self-regulate learning during a lumbar puncture (LP) training session using a simulator.Objective

 In 2010, 20 of 45 postgraduate year 1 internal medicine residents attended a mandatory procedural skills training boot camp. Independently, residents practiced the entire LP skill on a part-task trainer using a clinical LP tray and proper sterile technique. We interviewed participants regarding how they thought about and monitored their learning processes, and then we conducted a thematic analysis of the interview data.Methods

 The analysis suggested that participants considered what they could and could not learn from the simulator; they developed their self-confidence by familiarizing themselves with the LP equipment and repeating the LP algorithmic steps. Participants articulated an idiosyncratic model of learning they used to interpret the challenges and successes they experienced. Participants reported focusing on obtaining cerebrospinal fluid and memorizing the “routine” version of the LP procedure. They did not report much thinking about their learning strategies (eg, self-questioning).Results

 During simulation-based training, residents described assigning greater weight to achieving procedural outcomes and tended to think that the simulated task provided them with routine, generalizable skills. Over this typical 1-hour session, trainees did not appear to consider their strategic mindfulness (ie, awareness and use of learning strategies).Conclusions

 Educational conferences have long served as a foundation of medical education. Sending reminder text pages prior to the start of conferences is a method that may be employed to enhance conference attendance.Background

 The goal of our study was to determine if routine text paging before regularly scheduled conferences improves attendance among fellows in 3 internal medicine programs.Objective

 A prospective, randomized, crossover study included 3 fellowship programs: pulmonary and critical care, cardiovascular disease, and hematology-oncology. The study was performed between October 2014 and March 2015. All fellows were included and randomized to 1 of 2 groups (with subsequent crossover to opposite group): Pages or No Pages. Paging reminders, which included conference title, location, and time, were sent 30 minutes prior to every conference for those in the intervention arm. Attendance was collected through a standard attendance log using self-registration.Methods

 A total of 46 fellows and 156 conferences were included for analysis, with 75 during the first 3 months and 81 during the second 3 months. There were no differences in individual overall attendance between randomized groups for the entire study period (42.9% versus 46.5%, P = .46). Paging reminders had no effect on overall individual attendance (43.7% versus 45.6%, P = .50). In addition, no significant differences were identified for individuals within each fellowship and training year.Results

 Paging reminders prior to a regularly scheduled conference had no effect on overall attendance in this study. Fellows reported that clinical obligations were a major barrier to conference attendance.Conclusions

 Female residents in surgical training may face stereotype threat. The awareness of negative stereotypes about surgical ability based on gender may heighten stress and thus reduce performance.Background

 The main objective of this study was to assess the effectiveness of a brief stress-reducing writing exercise, known as a values affirmation, to mitigate the negative effects of stereotype threat on the performance of female surgical residents.Objective

 This is a randomized, controlled trial in which 167 residents were invited to participate. A total of 45 resident volunteers, including 18 women, were randomized to the affirmation condition or the no-affirmation condition. We administered a values affirmation intervention and measured clinical evaluations data both prior to and 6 months after the intervention.Methods

 Women benefited from the affirmation. Women who had participated in the affirmation exercise earned higher clinical evaluation scores than those in the control condition (B = 0.34, P < .05). For men, performance did not differ by affirmation condition (B = –0.20, P = .35).Results

 Our findings suggest a benefit of values affirmation for women in surgical training, as measured by performance on clinical evaluations. This suggests that a brief psychological intervention may improve on-the-job performance for women in surgery, an underrepresented group.Conclusions

 The Accreditation Council for Graduate Medical Education (ACGME) requires programs to engage annually in program evaluation and improvement.Background

 We assessed the value of creating educational competency committees (ECCs) that use successful elements of 2 established processes—institutional special reviews and institutional oversight of annual program evaluations.Objective

 The ECCs used a template to review programs' annual program evaluations. Results were aggregated into an institutional dashboard. We calculated the costs, sensitivity, specificity, and predictive value by comparing programs required to have a special review with those that had ACGME citations, requests for a progress report, or a data-prompted site visit. We assessed the value for professional development through a participant survey.Methods

 Thirty-two ECCs involving more than 100 individuals reviewed 237 annual program evaluations over a 3-year period. The ECCs required less time than internal reviews. The ECCs rated 2 to 8 programs (2.4%–9.8%) as “noncompliant.” One to 13 programs (1.2%–14.6%) had opportunities for improvement identified. Institutional improvements were recognized using the dashboard. Zero to 13 programs (0%–16%) were required to have special reviews. The sensitivity of the decision to have a special review was 83% to 100%; specificity was 89% to 93%; and negative predictive value was 99% to 100%. The total cost was $280 per program. Of the ECC members, 86% to 95% reported their participation enhanced their professional development, and 60% to 95% believed the ECC benefited their program.Results

 Educational competency committees facilitated the identification of institution-wide needs, highlighted innovation and best practices, and enhanced professional development. The cost, sensitivity, specificity, and predictive value indicated good value.Conclusions

 Internal medicine residents care for a sizable number of patients with chronic pain. Programs need educational strategies to promote safe opioid prescribing.Background

 To describe a safe opioid prescribing education program utilizing an objective structured clinical examination (OSCE) and report the resulting impact on residents' knowledge, confidence, and self-reported practices.Objective

 Using a quasi-experimental design, 39 internal medicine residents from an urban academic medical center were assigned to 1 of 4 groups: 1-hour lecture only, lecture followed by immediate OSCE, lecture followed by 4-month delayed OSCE, and control. Safe opioid prescribing knowledge, confidence, and self-reported practices were assessed at baseline and at 8 months.Methods

 At 8 months, knowledge, confidence, and self-reported practices improved in the control and in all 3 intervention groups. The immediate OSCE group had the greatest improvements in combined confidence scores within group (0.74, P = .01) compared to controls (0.52, P = .05), using a 5-point scale. This group also had the greatest improvement in self-reported practice changes (1.04, P = .04), while other groups showed nonsignificant improvements—delayed OSCE (0.43, P = .44), lecture only (0.66, P = .24), and control (0.43, P = .19).Results

 Safe opioid prescribing education that includes a lecture immediately followed by an OSCE had an impact on residents' confidence and self-reported practices greater than those for delayed OSCE or lecture only groups. There was no difference in knowledge improvement among the groups. Lecture followed by an OSCE was highly regarded by residents, but required additional resources.Conclusions

 Musculoskeletal (MSK) problems are common, and a recent US Bone and Joint Initiative calls for new models of education and professional collaboration. Evidence of feasibility and acceptability of innovative methods are needed.Background

 We assessed if an experimental immersion interdisciplinary MSK curriculum would be acceptable to residents from different specialties, be feasible within existing rotations, and be effective in strengthening clinical skills.Objective

 Through funding from the Veterans Affairs Office of Academic Affiliations and the Office of Specialty Care, we developed a Center of Excellence in MSK Care and Education. A core element is the monthly MSK Education Week, which teaches skills and provides opportunities to apply these in clinical settings. Participants include internal medicine, physical medicine and rehabilitation, and orthopaedic surgery residents, as well as students and residents from other health professions programs. All were assigned to the MSK week in lieu of other clinical experiences. Faculty encompassed primary care, rheumatology, endocrinology, orthopaedics, and physical medicine and rehabilitation. Assessments include surveys and a 2-station objective structured clinical examination (OSCE).Methods

 Since 2012, a total of 176 trainees have participated. Percentage of trainees reporting ability to evaluate and manage MSK complaints increased (9% to 87% for shoulder; 18% to 86% for knee), and confidence performing MSK injections increased from 10% to 70%. Competency in evaluation of shoulder and knee pain was confirmed by OSCEs.Results

 The MSK week program was accepted by residents from the 3 specialties, with learners reporting improved ability to perform shoulder and knee examinations, as demonstrated by OSCEs.Conclusions

 Quality improvement (QI) is essential in clinical practice, requiring effective teaching in residency. Barriers include lack of structure, mentorship, and time.Background

 To develop a longitudinal QI curriculum for an internal medicine residency program with limited faculty resources and evaluate its effectiveness.Objective

 All medicine residents were provided with dedicated research time every 8 weeks during their ambulatory blocks. Groups of 3 to 5 residents across all postgraduate year levels were formed. Two faculty members and 1 chief resident advised all groups, meeting with each group every 8 weeks, with concrete expectations for each meeting. Residents were required to complete didactic modules from the Institute for Healthcare Improvement. Current residents and alumni were surveyed for feedback.Methods

 Over 3 years, all eligible residents (92 residents per year in 2012–2014, 102 in 2014–2015) participated in the curriculum. Residents worked on 54 quality assessment and 18 QI projects, with 6 QI projects showing statistically significant indicator improvements. About 50 mentoring hours per year were contributed by 2 faculty advisors and a chief resident. No other staff or IT support was needed. A total of 69 posters/abstracts were produced, with 13 projects presented at national or regional conferences. Survey respondents found the program useful; most (75% residents, 63% alumni) reported it changed their practice, and 71% of alumni found it useful after residency.Results

 Our longitudinal QI curriculum requires minimal faculty time and resulted in increased QI-related publications and measurable improvements in quality indicators. Alumni reported a positive effect on practice after graduation.Conclusions

 A robust selection process is critical to residents' “cultural fit” and success in their program. Traditional selection methods have shortcomings.Background

 We describe a novel residency interview process for obstetrics-gynecology residents that incorporates behavioral, group, and surgical simulation multiple mini interviews (MMIs).Objective

 In 2010, the Cedars-Sinai Medical Center obstetrics-gynecology residency program developed surgical simulation, role play, ethics group interview, and Accreditation Council for Graduate Medical Education competency-based behavioral interview stations.Methods

 From 2010 to 2012, a total of 199 applicants were interviewed, 62 ranked in the top 20, and 18 matched into the program. The MMI scores for interview stations were used in compiling our rank list and were found to adequately differentiate candidates. The MMI mean scores for role play, ethics interview, surgical simulation, and the behavioral interview for the top 20 ranked candidates were statistically significantly higher than those for other applicants. Standardized tests minimally correlated with various interview modalities. Applicants found the interview process acceptable. Implementing these MMI stations increased the total applicant interview time for the day by 15% (from 5.5 to 6.5 hours) and increased the face-to-face interview time from 2 to 4 hours. Approximately 42 hours of coordinator time was required for the yearly interview cycle.Results

 A multifaceted interview process utilizing MMI, group interview, and surgical simulation MMI is feasible and acceptable. The approach may decrease subjectivity and reliance on traditional interview methods and facilitate the selection of “compatible” residents into the program.Conclusions

 It is difficult to assess applicants' higher-order cognitive thinking skills during conventional resident interviews. Application metrics currently employed are useful indicators of academic and personal success in targeted areas, yet value of this information in predicting future clinical performance is limited.Background

 We developed an assessment tool to evaluate higher-order cognitive function in real time during anesthesiology resident applicant interviews.Objective

 During the 2014–2015 residency interview season, we integrated simulation training into applicant interviews to evaluate higher-order cognitive skills. Our 5-minute simulation emphasized the Team STEPPS 2-Challenge Rule and explored candidates' critical thinking, analytical decision making, and response to stress. Participating applicants were evaluated using an outcomes-based checklist targeting desired responses. We also sent applicants a post-National Resident Matching Program survey to assess their perceptions of the simulation's value and educational utility.Methods

 A total of 90 applicants (75% of all applicants) participated in the simulation, which taught residents about important patient safety concepts and provided the program with real time information about their critical thinking ability. All applicants were confident or very confident that they would both speak up and know what to say if they encountered a patient safety breach as a result of participating in this exercise. Simulation performance affected desirability status for 35% of participating applicants, where 23% of applicants ranked higher, and 12% ranked lower compared to baseline application status.Results

 Cognitive simulation training was useful in assessing resident applicant higher-order thinking skills and in helping stratify candidates in conjunction with standard application metrics.Conclusions

 Effective adolescent (10 to 19 years) interviewing by physicians is an essential skill that many trainees can find challenging.Background

 We assessed whether structured adolescent interviewing using standardized patients (SPs) and feedback in undergraduate medical education (UME) has a sustained effect on residents' skills.Objective

 Postgraduate year (PGY) 1 residents conducted interviews with a SP adolescent–mother pair. The SPs independently scored each PGY-1 interview using the structured communication adolescent guide (SCAG). Unpaired t tests were conducted comparing “Total-Item” and “Global” scores of PGY-1s who received structured SP adolescent interviewing with feedback in UME (“structured training” group) to those who had not (“no structured training” group).Methods

 PGY-1s in the structured training group (n = 23) received significantly higher mean Total-Item scores from both the SP adolescent (40.78 ± 7.04 and 32.41 ± 10.12, respectively; P = .001) and the SP mother (40.48 ± 7.90 and 33.34 ± 10.90, respectively; P = .01) than those without structured training (n = 29). Statistically significant results favoring PGY-1s with prior training were also seen with the SP adolescent and mother total Global SCAG scores.Results

 Structured training in adolescent interviewing with SPs and feedback in UME appears to have a sustained effect on residents' adolescent interviewing skills. PGY-1s will interview adolescents and may benefit from structured adolescent SP interviewing with feedback, especially individuals who did not have this experience during their medical school training.Conclusions

 The value of care, defined as the relationship of cost, harm, and benefit, has garnered increased focus in recent years. Program directors (PDs) can provide information about resident skill and institutional priorities related to high-value care.Background

 The objective of the study was to evaluate changes between 2012 and 2014 in PD-reported resident skills and institutional priorities related to high-value care.Objective

 We performed annual surveys of US internal medicine PDs from 2012–2014 and evaluated responses to identical questions related to high care value. The survey was developed by the American College of Physicians and the Alliance for Academic Internal Medicine.Methods

 Response rates were 235 of 378 (62.2%) in 2012, 213 of 380 (56.1%) in 2013, and 215 of 391 (54.9%) in 2014. The majority of PDs reported that balancing benefits, harms, and costs was (1) a teaching priority; (2) the subject of didactics; (3) discussed by residents; and (4) emphasized by institutional leadership. Approximately one-third reported that unnecessary ordering occurred most or all the time, with no changes in the survey period. When asked about resident ordering compared to 3 years ago, 42.5% (88 of 207) of PDs reported residents ordering fewer unnecessary tests most or all the time in 2014, compared to 28.1% (63 of 224) in 2012 (P = .002).Results

 Internal medicine PDs reported high levels of institutional interest in and teaching of care value between 2012 and 2014, but responses for later years suggest improvement in trainees avoiding unnecessary testing.Conclusions

 Little is known about residents' performance on the milestones at the institutional level. Our institution formed a work group to explore this using an institutional-level curriculum and residents' evaluation of the milestones.Background

 We assessed whether beginner-level milestones for interpersonal and communication skills (ICS) related to observable behaviors in ICS-focused objective structured clinical examinations (OSCEs) for postgraduate year (PGY) 1 residents across specialties.Objective

 The work group compared ICS subcompetencies across 12 programs to identify common beginner-level physician-patient communication milestones. The selected ICS milestone sets were compared for common language with the ICS-OSCE assessment tool—the Kalamazoo Essential Elements of Communication Checklist–Adapted (KEECC-A). To assess whether OSCE scores related to ICS milestone scores, all PGY-1 residents from programs that were part of Next Accreditation System Phase 1 were identified; their OSCE scores from July 2013 to June 2014 and ICS subcompetency scores from December 2014 were compared.Methods

 The milestones for 10 specialties and the transitional year had at least 1 ICS subcompetency that related to physician-patient communication. The language of the ICS beginner-level milestones appears similar to behaviors outlined in the KEECC-A. All 60 residents with complete data received at least a beginner-level ICS subcompetency score and at least a satisfactory score on all 3 OSCEs.Results

 The ICS-OSCE scores for PGY-1 residents appear to relate to beginner-level milestones for physician-patient communication across multiple specialties.Conclusions