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Papers by Anne Chipman

Research paper thumbnail of Capstone Simulation: A Multipatient Simulation for Senior Emergency Medicine Residents

Research paper thumbnail of “Not just a checkbox”: A qualitative study of the resident scholarly experience

AEM Education and Training

ObjectivesScholarship is a requirement of residency training; however, the scholarly productivity... more ObjectivesScholarship is a requirement of residency training; however, the scholarly productivity of trainees is highly variable. The purpose of this study was to explore the perspectives of residents who have been highly productive in scholarship.MethodsWe performed a qualitative study using a constructivist–interpretivist paradigm and conducted semistructured interviews at seven Accreditation Council for Graduate Medical Education–accredited emergency medicine residency programs in the United States. We included sites of diverse locations and training formats (PGY‐1 to ‐4 vs. PGY‐1 to ‐3). Program leadership identified residents with high levels of scholarly productivity at their institutions. We used purposive sampling to seek out residents with diversity in gender and PGY level. Two researchers independently performed a thematic analysis of interview transcripts. Discrepancies were resolved through in‐depth discussion and negotiated consensus.ResultsWe invited 14 residents and a...

Research paper thumbnail of Does team leader gender matter? A Bayesian reconciliation of leadership and patient care during trauma resuscitations

Journal of the American College of Emergency Physicians Open, 2021

Team leadership facilitates teamwork and is important to patient care. It is unknown whether phys... more Team leadership facilitates teamwork and is important to patient care. It is unknown whether physician gender-based differences in team leadership exist. The objective of this study was to assess and compare team leadership and patient care in trauma resuscitations led by male and female physicians. Methods: We performed a secondary analysis of data from a larger randomized controlled trial using video recordings of emergency department trauma resuscitations at a Level 1 trauma center from April 2016 to December 2017. Subjects included emergency medicine and surgery residents functioning as trauma team leaders. Eligible resuscitations included adult patients meeting institutional trauma activation criteria. Two video-recorded observations for each participant were coded for team leadership quality and patient care by 2 sets of raters. Raters were balanced with regard to gender and were blinded to study hypotheses. We used Bayesian regression to determine whether our data supported gender-based advantages in team leadership. Results: A total of 60 participants and 120 video recorded observations were included. The modal relationship between gender and team leadership (β = 0.94, 95% highest density interval [HDI],-.68 to 2.52) and gender and patient care (β = 2.42, 95% HDI,-2.03 to 6.78) revealed a weak positive effect for female leaders on both outcomes. Gender-based advantages to team leadership and clinical care were not conclusively

Research paper thumbnail of Does team leader gender matter? A Bayesian reconciliation of leadership and patient care during trauma resuscitations

Journal of the American College of Emergency Physicians Open, 2021

Team leadership facilitates teamwork and is important to patient care. It is unknown whether phys... more Team leadership facilitates teamwork and is important to patient care. It is unknown whether physician gender-based differences in team leadership exist. The objective of this study was to assess and compare team leadership and patient care in trauma resuscitations led by male and female physicians. Methods: We performed a secondary analysis of data from a larger randomized controlled trial using video recordings of emergency department trauma resuscitations at a Level 1 trauma center from April 2016 to December 2017. Subjects included emergency medicine and surgery residents functioning as trauma team leaders. Eligible resuscitations included adult patients meeting institutional trauma activation criteria. Two video-recorded observations for each participant were coded for team leadership quality and patient care by 2 sets of raters. Raters were balanced with regard to gender and were blinded to study hypotheses. We used Bayesian regression to determine whether our data supported gender-based advantages in team leadership. Results: A total of 60 participants and 120 video recorded observations were included. The modal relationship between gender and team leadership (β = 0.94, 95% highest density interval [HDI],-.68 to 2.52) and gender and patient care (β = 2.42, 95% HDI,-2.03 to 6.78) revealed a weak positive effect for female leaders on both outcomes. Gender-based advantages to team leadership and clinical care were not conclusively

Research paper thumbnail of Academic springboard: The chief resident position correlates with career path in emergency medicine

AEM Education and Training, 2021

This article is protected by copyright. All rights reserved Background: The chief resident role o... more This article is protected by copyright. All rights reserved Background: The chief resident role often includes additional administrative and educational experiences beyond those of non-chief senior residents. It is unclear to what extent these experiences influence the post-residency career path of those selected as chief residents. The objective of this study was to evaluate the association of chief resident status on immediate post-residency career characteristics relative to non-chief residents in emergency medicine (EM). Methods: We retrospectively analyzed graduate data from 2016-2020 at six accredited EM residency programs. Participating sites were geographically diverse and included 3-and 4-year training formats. Each site abstracted data using a standardized form including: program, year of graduation, chief resident status, publications during residency, and immediate post-residency position (academic vs. non-academic). We calculated descriptive statistics and performed logistic regression to explore differences between the chief resident cohort and other graduates. Results: We gathered information on 365 total graduates (45.8% from 3-year programs and 54.2% from 4-year programs) including 93 (25.5%) chief residents. One hundred twenty-nine (35%) graduates assumed an academic position immediately following residency. Fifty-six (60%) out of 93 chief residents assumed an academic position immediately following residency, compared to 74 (27%) of 272 other graduates. After controlling for program, year of graduation, and number of publications completed during residency, chief resident status was a significant predictor of immediate post-residency academic career (odds ratio for a chief resident assuming an academic job 5.36, 95% CI [3.10, 9.27]). Conclusion: The chief resident role within EM is significantly associated with pursuit of an academic position immediately following residency compared to non-chiefs.

Research paper thumbnail of Academic springboard: The chief resident position correlates with career path in emergency medicine

AEM Education and Training, 2021

This article is protected by copyright. All rights reserved Background: The chief resident role o... more This article is protected by copyright. All rights reserved Background: The chief resident role often includes additional administrative and educational experiences beyond those of non-chief senior residents. It is unclear to what extent these experiences influence the post-residency career path of those selected as chief residents. The objective of this study was to evaluate the association of chief resident status on immediate post-residency career characteristics relative to non-chief residents in emergency medicine (EM). Methods: We retrospectively analyzed graduate data from 2016-2020 at six accredited EM residency programs. Participating sites were geographically diverse and included 3-and 4-year training formats. Each site abstracted data using a standardized form including: program, year of graduation, chief resident status, publications during residency, and immediate post-residency position (academic vs. non-academic). We calculated descriptive statistics and performed logistic regression to explore differences between the chief resident cohort and other graduates. Results: We gathered information on 365 total graduates (45.8% from 3-year programs and 54.2% from 4-year programs) including 93 (25.5%) chief residents. One hundred twenty-nine (35%) graduates assumed an academic position immediately following residency. Fifty-six (60%) out of 93 chief residents assumed an academic position immediately following residency, compared to 74 (27%) of 272 other graduates. After controlling for program, year of graduation, and number of publications completed during residency, chief resident status was a significant predictor of immediate post-residency academic career (odds ratio for a chief resident assuming an academic job 5.36, 95% CI [3.10, 9.27]). Conclusion: The chief resident role within EM is significantly associated with pursuit of an academic position immediately following residency compared to non-chiefs.

Research paper thumbnail of Abstract 190: Does Gender Matter? Addressing the Question of Gender Superiority in Resuscitation Leadership

Circulation, 2019

Introduction: Effective team leadership is linked to better patient care during resuscitations. S... more Introduction: Effective team leadership is linked to better patient care during resuscitations. Several studies suggest a relationship between team leader gender and the quality of resuscitation leadership and clinical care. However, these studies have been either (1) retrospective investigations that do not capture clinical care processes or (2) simulation-based research involving novice medical student subjects. The objective of this study is to compare the quality of team leadership and clinical care between male- and female-led trauma resuscitation teams. Hypothesis: We hypothesize that team leader gender is not associated with differences in trauma team leadership and clinical care Methods: We performed a secondary analysis of prospectively acquired data by analyzing video recordings of trauma resuscitations at a Level 1 trauma center. Subjects (n=60) included 2 nd and 3 rd year emergency medicine and surgery residents functioning in the team leader role. Two video recorded obs...

Research paper thumbnail of Abstract 190: Does Gender Matter? Addressing the Question of Gender Superiority in Resuscitation Leadership

Circulation, 2019

Introduction: Effective team leadership is linked to better patient care during resuscitations. S... more Introduction: Effective team leadership is linked to better patient care during resuscitations. Several studies suggest a relationship between team leader gender and the quality of resuscitation leadership and clinical care. However, these studies have been either (1) retrospective investigations that do not capture clinical care processes or (2) simulation-based research involving novice medical student subjects. The objective of this study is to compare the quality of team leadership and clinical care between male- and female-led trauma resuscitation teams. Hypothesis: We hypothesize that team leader gender is not associated with differences in trauma team leadership and clinical care Methods: We performed a secondary analysis of prospectively acquired data by analyzing video recordings of trauma resuscitations at a Level 1 trauma center. Subjects (n=60) included 2 nd and 3 rd year emergency medicine and surgery residents functioning in the team leader role. Two video recorded obs...

Research paper thumbnail of Young Man with Cardiac Arrest Secondary to Undiagnosed Mediastinal Mass: A Case Report

Clinical Practice and Cases in Emergency Medicine, 2021

A 20-year-old man with a reported history of asthma presented to the emergency department in card... more A 20-year-old man with a reported history of asthma presented to the emergency department in cardiac arrest presumed to be caused by respiratory failure. Case Report: The patient was discovered to have central airway obstruction and concomitant superior vena cava compression caused by a large mediastinal mass-a condition termed mediastinal mass syndrome. While the patient regained spontaneous circulation after endotracheal intubation, he was challenging to ventilate requiring escalating interventions to maintain adequate ventilation. Conclusion: We describe complications of mediastinal mass syndrome and an approach to resuscitation, including ventilator adjustments, patient repositioning, double-lumen endotracheal tubes, specialty consultation, and extracorporeal life support.

Research paper thumbnail of Doubt and belief in physicians’ ability to prognosticate during critical illness: The perspective of surrogate decision makers

Critical Care Medicine, 2008

Objectives: Although discussing a prognosis is a duty of physicians caring for critically ill pat... more Objectives: Although discussing a prognosis is a duty of physicians caring for critically ill patients, little is known about surrogate decision-makers' beliefs about physicians' ability to prognosticate. We sought to determine: 1) surrogates' beliefs about whether physicians can accurately prognosticate for critically ill patients; and 2) how individuals use prognostic information in their role as surrogate decision-makers. Design, Setting, and Patients: Multicenter study in intensive care units of a public hospital, a tertiary care hospital, and a veterans' hospital. We conducted semistructured interviews with 50 surrogate decision-makers of critically ill patients. We analyzed the interview transcripts using grounded theory methods to inductively develop a framework to describe surrogates' beliefs about physicians' ability to prognosticate. Validation methods included triangulation by multidisciplinary analysis and member checking. Measurements and Main Results: Overall, 88% (44 of 50) of surrogates expressed doubt about physicians' ability to prognosticate for critically ill patients. Four distinct themes emerged that explained surrogates' doubts about prognostic accuracy: a belief that God could alter the course of the illness, a belief that predicting the future is inherently uncertain, prior experiences where physicians' prognostications were inaccurate, and experiences with prognostication during the patient's intensive care unit stay. Participants also identified several factors that led to belief in physicians' prognostications, such as receiving similar prognostic estimates from multiple physicians and prior experiences with accurate prognostication. Surrogates' doubts about prognostic accuracy did not prevent them from wanting prognostic information. Instead, most surrogate decision-makers view physicians' prognostications as rough estimates that are valuable in informing decisions, but are not determinative. Surrogates identified the act of prognostic disclosure as a key step in preparing emotionally and practically for the possibility that a patient may not survive.

Research paper thumbnail of Ischemic ECG Pattern Recognition to Facilitate Interpretation While Task Switching: A Parallel Curriculum

MedEdPORTAL

Introduction: Interruptions are an inevitable part of working as an emergency physician, yet thes... more Introduction: Interruptions are an inevitable part of working as an emergency physician, yet these can increase cognitive load and precipitate medical error. Emergency physicians learn to balance these responsibilities using a process called task switching. Yet residents have little exposure to exercises that purposefully integrate task switching during their training. We addressed this gap by exposing emergency medicine (EM) trainees to task-switching events in the form of critical ECG interpretation while they were engaged in concurrent, parallel activities. Methods: The curriculum was carried out in three phases. First, 12 PGY 2 residents engaged in a small-group session testing their baseline confidence and ECG interpretation skills. The second phase was longitudinal: During concurrent educational activities, investigators interrupted tasks and asked trainees to interpret ECGs in 10 seconds or less. The curriculum's final phase was used to review the ECGs and answer any questions. Results: Confidence and percentage of correct interpretations were compared from phase 1 to phase 2. Participants showed improved confidence (M = 2.5, SD = 0.6, to M = 2.9, SD = 0.6; p = .02; 5-point Likert scale) and increased mean percent correct (M = 0.7, SD = 0.1, to M = 0.8, SD = 0.1; p = .01) following the curriculum. Discussion: Our curriculum provides a pragmatic, reproducible approach to enhancing critical ECG interpretation with task switching in a way that mirrors the EM practice environment, promoting a reduction of cognitive load and highlighting the skills learners will need as they develop expertise.

Research paper thumbnail of Simulation-Based Team Leadership Training Improves Team Leadership During Actual Trauma Resuscitations

Research paper thumbnail of An Event‐based Approach to Measurement: Facilitating observational measurement in highly variable clinical settings

AEM Education and Training

Research paper thumbnail of Identification of processes that mediate the impact of workplace violence on emergency department healthcare workers in the USA: results from a qualitative study

BMJ Open

ObjectivesViolence towards emergency department healthcare workers is pervasive and directly link... more ObjectivesViolence towards emergency department healthcare workers is pervasive and directly linked to provider wellness, productivity and job satisfaction. This qualitative study aimed to identify the cognitive and behavioural processes impacted by workplace violence to further understand why workplace violence has a variable impact on individual healthcare workers.DesignQualitative interview study using a phenomenological approach to initial content analysis and secondary thematic analysis.SettingThree different emergency departments.ParticipantsWe recruited 23 emergency department healthcare workers who experienced a workplace violence event to participate in an interview conducted within 24 hours of the event. Participants included nurses (n=9; 39%), medical assistants (n=5; 22%), security guards (n=5; 22%), attending physicians (n=2; 9%), advanced practitioners (n=1; 4%) and social workers (n=1; 4%).ResultsFive themes emerged from the data. The first two supported existing repo...

Research paper thumbnail of Targeted Simulation-based Leadership Training for Trauma Team Leaders

Western Journal of Emergency Medicine

Introduction: Effective team leadership is linked to better teamwork, which in turn is believed t... more Introduction: Effective team leadership is linked to better teamwork, which in turn is believed to improve patient care. Simulation-based training provides a mechanism to develop effective leadership behaviors. Traditionally, healthcare curricula have included leadership as a small component of broader teamwork training, with very few examples of leadership-focused curricula. The objective of this work is to describe a novel simulation-based team leadership curriculum that easily adapts to individual learners. Methods: We created a simulation-based team leadership training for trauma team leaders in graduate medical education. Participants included second-and third-year emergency medicine and surgery residents. Training consisted of a single, four-hour session and included facilitated discussion of trauma leadership skills, a brief didactic session integrating leadership behaviors into Advanced Trauma Life Support®, and a series of simulations and debriefing sessions. The simulations contained adaptable components that facilitated individualized learning while delivering set curricular content. A survey evaluation was administered 7-24 months following the training to assess self-reported implementation of trained material. Results: A total of 36 residents participated in the training and 23 (64%) responded to the survey. The majority of respondents (n = 22, 96%) felt the training was a valuable component of their residency education and all respondents reported ongoing use of at least one behavior learned during the training. The most commonly cited skills for ongoing use included the pre-arrival brief (n = 21, 91%) and prioritization (n = 21, 91%). Conclusion: We delivered a leadership-focused, simulation-based training that 1) adapted to learners' individual needs, and 2) was perceived to impact practice up to 24 months post-training. More work is needed to understand the impact of this training on learner knowledge and behavior, as well as patient outcomes.

Research paper thumbnail of 3317 Translating simulation-based team leadership training into patient-centered outcomes

Journal of Clinical and Translational Science

OBJECTIVES/SPECIFIC AIMS: The objective of this research was to assess the clinical impact of sim... more OBJECTIVES/SPECIFIC AIMS: The objective of this research was to assess the clinical impact of simulation-based team leadership training on team leadership effectiveness and patient care during actual trauma resuscitations. This translational work addresses an important gap in simulation research and medical education research. METHODS/STUDY POPULATION: Eligible trauma team leaders were randomized to the intervention (4-hour simulation-based leadership training) or control (standard training) condition. Subject-led actual trauma patient resuscitations were video recorded and coded for leadership behaviors (primary outcome) and patient care (secondary outcome) using novel leadership and trauma patient care metrics. Patient outcomes for trauma resuscitations were obtained through the Harborview Medical Center Trauma Registry and analyzed descriptively. A one-way ANCOVA analysis was conducted to test the effectiveness of our training intervention versus a control group for each outcome ...

Research paper thumbnail of Promoting Workplace Safety: Teaching Conflict Management and De-Escalation Skills in Graduate Medical Education

Journal of graduate medical education, 2017

A patient with chronic pain presents to clinic requesting a refill of an opiate prescription. The... more A patient with chronic pain presents to clinic requesting a refill of an opiate prescription. The internal medicine resident recommends anti-inflammatories. The patient becomes agitated and paces the room.

Research paper thumbnail of Using Hackathons to Transform Complex Educational Problems Into Innovative Prototypes

Journal of graduate medical education, 2018

Successful hackathons have: 1. A thought-provoking question that piques participants' interest an... more Successful hackathons have: 1. A thought-provoking question that piques participants' interest and lacks an obvious solution. 2. A collaborative culture that encourages creativity, experimentation, and participation. 3. Diverse participant teams to leverage the power of divergent perspectives. 4. Scoring rubrics emphasizing deliverables that are innovative, feasible, sustainable, and relevant.

Research paper thumbnail of Randomised controlled trial to assess the effect of a Just-in-Time training on procedural performance: a proof-of-concept study to address procedural skill decay

BMJ Quality & Safety

Background A subset of high-risk procedures present significant safety threats due to their (1) i... more Background A subset of high-risk procedures present significant safety threats due to their (1) infrequent occurrence, (2) execution under time constraints and (3) immediate necessity for patient survival. A Just-in-Time (JIT) intervention could provide real-time bedside guidance to improve high-risk procedural performance and address procedural deficits associated with skill decay. Objective To evaluate the impact of a novel JIT intervention on transvenous pacemaker (TVP) placement during a simulated patient event. Methods This was a prospective, randomised controlled study to determine the effect of a JIT intervention on performance of TVP placement. Subjects included boardcertified emergency medicine physicians from two hospitals. The JIT intervention consisted of a portable, bedside computer-based procedural adjunct. The primary outcome was performance during a simulated patient encounter requiring TVP placement, as assessed by trained raters using a technical skills checklist. Secondary outcomes included global performance ratings, time to TVP placement, number of critical omissions and System Usability Scale scores (intervention only). Results Groups were similar at baseline across all outcomes. Compared with the control group, the intervention group demonstrated statistically significant improvement in the technical checklist score (11.45 vs 23.44, p<0.001, Cohen's d effect size 4.64), the global rating scale (2.27 vs 4.54, p<0.001, Cohen's d effect size 3.76), and a statistically significant reduction in critical omissions (2.23 vs 0.68, p<0.001, Cohen's d effect size −1.86). The difference in time to procedural completion was not statistically significant between conditions (11.15 min vs 12.80 min, p=0.12, Cohen's d effect size 0.65). System Usability Scale scores demonstrated excellent usability. Conclusion A JIT intervention improved procedure perfromance, suggesting a role for JIT interventions in rarely performed procedures.

Research paper thumbnail of Dizziness

Emergency Medicine Oral Board Review Illustrated, 2015

Research paper thumbnail of Capstone Simulation: A Multipatient Simulation for Senior Emergency Medicine Residents

Research paper thumbnail of “Not just a checkbox”: A qualitative study of the resident scholarly experience

AEM Education and Training

ObjectivesScholarship is a requirement of residency training; however, the scholarly productivity... more ObjectivesScholarship is a requirement of residency training; however, the scholarly productivity of trainees is highly variable. The purpose of this study was to explore the perspectives of residents who have been highly productive in scholarship.MethodsWe performed a qualitative study using a constructivist–interpretivist paradigm and conducted semistructured interviews at seven Accreditation Council for Graduate Medical Education–accredited emergency medicine residency programs in the United States. We included sites of diverse locations and training formats (PGY‐1 to ‐4 vs. PGY‐1 to ‐3). Program leadership identified residents with high levels of scholarly productivity at their institutions. We used purposive sampling to seek out residents with diversity in gender and PGY level. Two researchers independently performed a thematic analysis of interview transcripts. Discrepancies were resolved through in‐depth discussion and negotiated consensus.ResultsWe invited 14 residents and a...

Research paper thumbnail of Does team leader gender matter? A Bayesian reconciliation of leadership and patient care during trauma resuscitations

Journal of the American College of Emergency Physicians Open, 2021

Team leadership facilitates teamwork and is important to patient care. It is unknown whether phys... more Team leadership facilitates teamwork and is important to patient care. It is unknown whether physician gender-based differences in team leadership exist. The objective of this study was to assess and compare team leadership and patient care in trauma resuscitations led by male and female physicians. Methods: We performed a secondary analysis of data from a larger randomized controlled trial using video recordings of emergency department trauma resuscitations at a Level 1 trauma center from April 2016 to December 2017. Subjects included emergency medicine and surgery residents functioning as trauma team leaders. Eligible resuscitations included adult patients meeting institutional trauma activation criteria. Two video-recorded observations for each participant were coded for team leadership quality and patient care by 2 sets of raters. Raters were balanced with regard to gender and were blinded to study hypotheses. We used Bayesian regression to determine whether our data supported gender-based advantages in team leadership. Results: A total of 60 participants and 120 video recorded observations were included. The modal relationship between gender and team leadership (β = 0.94, 95% highest density interval [HDI],-.68 to 2.52) and gender and patient care (β = 2.42, 95% HDI,-2.03 to 6.78) revealed a weak positive effect for female leaders on both outcomes. Gender-based advantages to team leadership and clinical care were not conclusively

Research paper thumbnail of Does team leader gender matter? A Bayesian reconciliation of leadership and patient care during trauma resuscitations

Journal of the American College of Emergency Physicians Open, 2021

Team leadership facilitates teamwork and is important to patient care. It is unknown whether phys... more Team leadership facilitates teamwork and is important to patient care. It is unknown whether physician gender-based differences in team leadership exist. The objective of this study was to assess and compare team leadership and patient care in trauma resuscitations led by male and female physicians. Methods: We performed a secondary analysis of data from a larger randomized controlled trial using video recordings of emergency department trauma resuscitations at a Level 1 trauma center from April 2016 to December 2017. Subjects included emergency medicine and surgery residents functioning as trauma team leaders. Eligible resuscitations included adult patients meeting institutional trauma activation criteria. Two video-recorded observations for each participant were coded for team leadership quality and patient care by 2 sets of raters. Raters were balanced with regard to gender and were blinded to study hypotheses. We used Bayesian regression to determine whether our data supported gender-based advantages in team leadership. Results: A total of 60 participants and 120 video recorded observations were included. The modal relationship between gender and team leadership (β = 0.94, 95% highest density interval [HDI],-.68 to 2.52) and gender and patient care (β = 2.42, 95% HDI,-2.03 to 6.78) revealed a weak positive effect for female leaders on both outcomes. Gender-based advantages to team leadership and clinical care were not conclusively

Research paper thumbnail of Academic springboard: The chief resident position correlates with career path in emergency medicine

AEM Education and Training, 2021

This article is protected by copyright. All rights reserved Background: The chief resident role o... more This article is protected by copyright. All rights reserved Background: The chief resident role often includes additional administrative and educational experiences beyond those of non-chief senior residents. It is unclear to what extent these experiences influence the post-residency career path of those selected as chief residents. The objective of this study was to evaluate the association of chief resident status on immediate post-residency career characteristics relative to non-chief residents in emergency medicine (EM). Methods: We retrospectively analyzed graduate data from 2016-2020 at six accredited EM residency programs. Participating sites were geographically diverse and included 3-and 4-year training formats. Each site abstracted data using a standardized form including: program, year of graduation, chief resident status, publications during residency, and immediate post-residency position (academic vs. non-academic). We calculated descriptive statistics and performed logistic regression to explore differences between the chief resident cohort and other graduates. Results: We gathered information on 365 total graduates (45.8% from 3-year programs and 54.2% from 4-year programs) including 93 (25.5%) chief residents. One hundred twenty-nine (35%) graduates assumed an academic position immediately following residency. Fifty-six (60%) out of 93 chief residents assumed an academic position immediately following residency, compared to 74 (27%) of 272 other graduates. After controlling for program, year of graduation, and number of publications completed during residency, chief resident status was a significant predictor of immediate post-residency academic career (odds ratio for a chief resident assuming an academic job 5.36, 95% CI [3.10, 9.27]). Conclusion: The chief resident role within EM is significantly associated with pursuit of an academic position immediately following residency compared to non-chiefs.

Research paper thumbnail of Academic springboard: The chief resident position correlates with career path in emergency medicine

AEM Education and Training, 2021

This article is protected by copyright. All rights reserved Background: The chief resident role o... more This article is protected by copyright. All rights reserved Background: The chief resident role often includes additional administrative and educational experiences beyond those of non-chief senior residents. It is unclear to what extent these experiences influence the post-residency career path of those selected as chief residents. The objective of this study was to evaluate the association of chief resident status on immediate post-residency career characteristics relative to non-chief residents in emergency medicine (EM). Methods: We retrospectively analyzed graduate data from 2016-2020 at six accredited EM residency programs. Participating sites were geographically diverse and included 3-and 4-year training formats. Each site abstracted data using a standardized form including: program, year of graduation, chief resident status, publications during residency, and immediate post-residency position (academic vs. non-academic). We calculated descriptive statistics and performed logistic regression to explore differences between the chief resident cohort and other graduates. Results: We gathered information on 365 total graduates (45.8% from 3-year programs and 54.2% from 4-year programs) including 93 (25.5%) chief residents. One hundred twenty-nine (35%) graduates assumed an academic position immediately following residency. Fifty-six (60%) out of 93 chief residents assumed an academic position immediately following residency, compared to 74 (27%) of 272 other graduates. After controlling for program, year of graduation, and number of publications completed during residency, chief resident status was a significant predictor of immediate post-residency academic career (odds ratio for a chief resident assuming an academic job 5.36, 95% CI [3.10, 9.27]). Conclusion: The chief resident role within EM is significantly associated with pursuit of an academic position immediately following residency compared to non-chiefs.

Research paper thumbnail of Abstract 190: Does Gender Matter? Addressing the Question of Gender Superiority in Resuscitation Leadership

Circulation, 2019

Introduction: Effective team leadership is linked to better patient care during resuscitations. S... more Introduction: Effective team leadership is linked to better patient care during resuscitations. Several studies suggest a relationship between team leader gender and the quality of resuscitation leadership and clinical care. However, these studies have been either (1) retrospective investigations that do not capture clinical care processes or (2) simulation-based research involving novice medical student subjects. The objective of this study is to compare the quality of team leadership and clinical care between male- and female-led trauma resuscitation teams. Hypothesis: We hypothesize that team leader gender is not associated with differences in trauma team leadership and clinical care Methods: We performed a secondary analysis of prospectively acquired data by analyzing video recordings of trauma resuscitations at a Level 1 trauma center. Subjects (n=60) included 2 nd and 3 rd year emergency medicine and surgery residents functioning in the team leader role. Two video recorded obs...

Research paper thumbnail of Abstract 190: Does Gender Matter? Addressing the Question of Gender Superiority in Resuscitation Leadership

Circulation, 2019

Introduction: Effective team leadership is linked to better patient care during resuscitations. S... more Introduction: Effective team leadership is linked to better patient care during resuscitations. Several studies suggest a relationship between team leader gender and the quality of resuscitation leadership and clinical care. However, these studies have been either (1) retrospective investigations that do not capture clinical care processes or (2) simulation-based research involving novice medical student subjects. The objective of this study is to compare the quality of team leadership and clinical care between male- and female-led trauma resuscitation teams. Hypothesis: We hypothesize that team leader gender is not associated with differences in trauma team leadership and clinical care Methods: We performed a secondary analysis of prospectively acquired data by analyzing video recordings of trauma resuscitations at a Level 1 trauma center. Subjects (n=60) included 2 nd and 3 rd year emergency medicine and surgery residents functioning in the team leader role. Two video recorded obs...

Research paper thumbnail of Young Man with Cardiac Arrest Secondary to Undiagnosed Mediastinal Mass: A Case Report

Clinical Practice and Cases in Emergency Medicine, 2021

A 20-year-old man with a reported history of asthma presented to the emergency department in card... more A 20-year-old man with a reported history of asthma presented to the emergency department in cardiac arrest presumed to be caused by respiratory failure. Case Report: The patient was discovered to have central airway obstruction and concomitant superior vena cava compression caused by a large mediastinal mass-a condition termed mediastinal mass syndrome. While the patient regained spontaneous circulation after endotracheal intubation, he was challenging to ventilate requiring escalating interventions to maintain adequate ventilation. Conclusion: We describe complications of mediastinal mass syndrome and an approach to resuscitation, including ventilator adjustments, patient repositioning, double-lumen endotracheal tubes, specialty consultation, and extracorporeal life support.

Research paper thumbnail of Doubt and belief in physicians’ ability to prognosticate during critical illness: The perspective of surrogate decision makers

Critical Care Medicine, 2008

Objectives: Although discussing a prognosis is a duty of physicians caring for critically ill pat... more Objectives: Although discussing a prognosis is a duty of physicians caring for critically ill patients, little is known about surrogate decision-makers' beliefs about physicians' ability to prognosticate. We sought to determine: 1) surrogates' beliefs about whether physicians can accurately prognosticate for critically ill patients; and 2) how individuals use prognostic information in their role as surrogate decision-makers. Design, Setting, and Patients: Multicenter study in intensive care units of a public hospital, a tertiary care hospital, and a veterans' hospital. We conducted semistructured interviews with 50 surrogate decision-makers of critically ill patients. We analyzed the interview transcripts using grounded theory methods to inductively develop a framework to describe surrogates' beliefs about physicians' ability to prognosticate. Validation methods included triangulation by multidisciplinary analysis and member checking. Measurements and Main Results: Overall, 88% (44 of 50) of surrogates expressed doubt about physicians' ability to prognosticate for critically ill patients. Four distinct themes emerged that explained surrogates' doubts about prognostic accuracy: a belief that God could alter the course of the illness, a belief that predicting the future is inherently uncertain, prior experiences where physicians' prognostications were inaccurate, and experiences with prognostication during the patient's intensive care unit stay. Participants also identified several factors that led to belief in physicians' prognostications, such as receiving similar prognostic estimates from multiple physicians and prior experiences with accurate prognostication. Surrogates' doubts about prognostic accuracy did not prevent them from wanting prognostic information. Instead, most surrogate decision-makers view physicians' prognostications as rough estimates that are valuable in informing decisions, but are not determinative. Surrogates identified the act of prognostic disclosure as a key step in preparing emotionally and practically for the possibility that a patient may not survive.

Research paper thumbnail of Ischemic ECG Pattern Recognition to Facilitate Interpretation While Task Switching: A Parallel Curriculum

MedEdPORTAL

Introduction: Interruptions are an inevitable part of working as an emergency physician, yet thes... more Introduction: Interruptions are an inevitable part of working as an emergency physician, yet these can increase cognitive load and precipitate medical error. Emergency physicians learn to balance these responsibilities using a process called task switching. Yet residents have little exposure to exercises that purposefully integrate task switching during their training. We addressed this gap by exposing emergency medicine (EM) trainees to task-switching events in the form of critical ECG interpretation while they were engaged in concurrent, parallel activities. Methods: The curriculum was carried out in three phases. First, 12 PGY 2 residents engaged in a small-group session testing their baseline confidence and ECG interpretation skills. The second phase was longitudinal: During concurrent educational activities, investigators interrupted tasks and asked trainees to interpret ECGs in 10 seconds or less. The curriculum's final phase was used to review the ECGs and answer any questions. Results: Confidence and percentage of correct interpretations were compared from phase 1 to phase 2. Participants showed improved confidence (M = 2.5, SD = 0.6, to M = 2.9, SD = 0.6; p = .02; 5-point Likert scale) and increased mean percent correct (M = 0.7, SD = 0.1, to M = 0.8, SD = 0.1; p = .01) following the curriculum. Discussion: Our curriculum provides a pragmatic, reproducible approach to enhancing critical ECG interpretation with task switching in a way that mirrors the EM practice environment, promoting a reduction of cognitive load and highlighting the skills learners will need as they develop expertise.

Research paper thumbnail of Simulation-Based Team Leadership Training Improves Team Leadership During Actual Trauma Resuscitations

Research paper thumbnail of An Event‐based Approach to Measurement: Facilitating observational measurement in highly variable clinical settings

AEM Education and Training

Research paper thumbnail of Identification of processes that mediate the impact of workplace violence on emergency department healthcare workers in the USA: results from a qualitative study

BMJ Open

ObjectivesViolence towards emergency department healthcare workers is pervasive and directly link... more ObjectivesViolence towards emergency department healthcare workers is pervasive and directly linked to provider wellness, productivity and job satisfaction. This qualitative study aimed to identify the cognitive and behavioural processes impacted by workplace violence to further understand why workplace violence has a variable impact on individual healthcare workers.DesignQualitative interview study using a phenomenological approach to initial content analysis and secondary thematic analysis.SettingThree different emergency departments.ParticipantsWe recruited 23 emergency department healthcare workers who experienced a workplace violence event to participate in an interview conducted within 24 hours of the event. Participants included nurses (n=9; 39%), medical assistants (n=5; 22%), security guards (n=5; 22%), attending physicians (n=2; 9%), advanced practitioners (n=1; 4%) and social workers (n=1; 4%).ResultsFive themes emerged from the data. The first two supported existing repo...

Research paper thumbnail of Targeted Simulation-based Leadership Training for Trauma Team Leaders

Western Journal of Emergency Medicine

Introduction: Effective team leadership is linked to better teamwork, which in turn is believed t... more Introduction: Effective team leadership is linked to better teamwork, which in turn is believed to improve patient care. Simulation-based training provides a mechanism to develop effective leadership behaviors. Traditionally, healthcare curricula have included leadership as a small component of broader teamwork training, with very few examples of leadership-focused curricula. The objective of this work is to describe a novel simulation-based team leadership curriculum that easily adapts to individual learners. Methods: We created a simulation-based team leadership training for trauma team leaders in graduate medical education. Participants included second-and third-year emergency medicine and surgery residents. Training consisted of a single, four-hour session and included facilitated discussion of trauma leadership skills, a brief didactic session integrating leadership behaviors into Advanced Trauma Life Support®, and a series of simulations and debriefing sessions. The simulations contained adaptable components that facilitated individualized learning while delivering set curricular content. A survey evaluation was administered 7-24 months following the training to assess self-reported implementation of trained material. Results: A total of 36 residents participated in the training and 23 (64%) responded to the survey. The majority of respondents (n = 22, 96%) felt the training was a valuable component of their residency education and all respondents reported ongoing use of at least one behavior learned during the training. The most commonly cited skills for ongoing use included the pre-arrival brief (n = 21, 91%) and prioritization (n = 21, 91%). Conclusion: We delivered a leadership-focused, simulation-based training that 1) adapted to learners' individual needs, and 2) was perceived to impact practice up to 24 months post-training. More work is needed to understand the impact of this training on learner knowledge and behavior, as well as patient outcomes.

Research paper thumbnail of 3317 Translating simulation-based team leadership training into patient-centered outcomes

Journal of Clinical and Translational Science

OBJECTIVES/SPECIFIC AIMS: The objective of this research was to assess the clinical impact of sim... more OBJECTIVES/SPECIFIC AIMS: The objective of this research was to assess the clinical impact of simulation-based team leadership training on team leadership effectiveness and patient care during actual trauma resuscitations. This translational work addresses an important gap in simulation research and medical education research. METHODS/STUDY POPULATION: Eligible trauma team leaders were randomized to the intervention (4-hour simulation-based leadership training) or control (standard training) condition. Subject-led actual trauma patient resuscitations were video recorded and coded for leadership behaviors (primary outcome) and patient care (secondary outcome) using novel leadership and trauma patient care metrics. Patient outcomes for trauma resuscitations were obtained through the Harborview Medical Center Trauma Registry and analyzed descriptively. A one-way ANCOVA analysis was conducted to test the effectiveness of our training intervention versus a control group for each outcome ...

Research paper thumbnail of Promoting Workplace Safety: Teaching Conflict Management and De-Escalation Skills in Graduate Medical Education

Journal of graduate medical education, 2017

A patient with chronic pain presents to clinic requesting a refill of an opiate prescription. The... more A patient with chronic pain presents to clinic requesting a refill of an opiate prescription. The internal medicine resident recommends anti-inflammatories. The patient becomes agitated and paces the room.

Research paper thumbnail of Using Hackathons to Transform Complex Educational Problems Into Innovative Prototypes

Journal of graduate medical education, 2018

Successful hackathons have: 1. A thought-provoking question that piques participants' interest an... more Successful hackathons have: 1. A thought-provoking question that piques participants' interest and lacks an obvious solution. 2. A collaborative culture that encourages creativity, experimentation, and participation. 3. Diverse participant teams to leverage the power of divergent perspectives. 4. Scoring rubrics emphasizing deliverables that are innovative, feasible, sustainable, and relevant.

Research paper thumbnail of Randomised controlled trial to assess the effect of a Just-in-Time training on procedural performance: a proof-of-concept study to address procedural skill decay

BMJ Quality & Safety

Background A subset of high-risk procedures present significant safety threats due to their (1) i... more Background A subset of high-risk procedures present significant safety threats due to their (1) infrequent occurrence, (2) execution under time constraints and (3) immediate necessity for patient survival. A Just-in-Time (JIT) intervention could provide real-time bedside guidance to improve high-risk procedural performance and address procedural deficits associated with skill decay. Objective To evaluate the impact of a novel JIT intervention on transvenous pacemaker (TVP) placement during a simulated patient event. Methods This was a prospective, randomised controlled study to determine the effect of a JIT intervention on performance of TVP placement. Subjects included boardcertified emergency medicine physicians from two hospitals. The JIT intervention consisted of a portable, bedside computer-based procedural adjunct. The primary outcome was performance during a simulated patient encounter requiring TVP placement, as assessed by trained raters using a technical skills checklist. Secondary outcomes included global performance ratings, time to TVP placement, number of critical omissions and System Usability Scale scores (intervention only). Results Groups were similar at baseline across all outcomes. Compared with the control group, the intervention group demonstrated statistically significant improvement in the technical checklist score (11.45 vs 23.44, p<0.001, Cohen's d effect size 4.64), the global rating scale (2.27 vs 4.54, p<0.001, Cohen's d effect size 3.76), and a statistically significant reduction in critical omissions (2.23 vs 0.68, p<0.001, Cohen's d effect size −1.86). The difference in time to procedural completion was not statistically significant between conditions (11.15 min vs 12.80 min, p=0.12, Cohen's d effect size 0.65). System Usability Scale scores demonstrated excellent usability. Conclusion A JIT intervention improved procedure perfromance, suggesting a role for JIT interventions in rarely performed procedures.

Research paper thumbnail of Dizziness

Emergency Medicine Oral Board Review Illustrated, 2015