Introduction:Point-of-care ultrasound (POCUS) is an integral component of patient care in the emergency department. However, there is wide variation in POCUS utilization among residents, with some struggling to achieve the amount required for their education. We conducted a qualitative study of emergency medicine residents to identify barriers and strategies for POCUS use. Methods:Using a constructivist approach with a deductive framework based on self-determination theory (SDT), we performed semi-structured qualitative interviews with 16 PGY 2-4 residents divided into high versus low utilizers from four different training programs. A codebook was iteratively developed with two coders, and thematic saturation was reached. Results:Both high and low utilizers experienced competence, autonomy, and relatedness, but also incompetence, feeling like a burden on the team, and lack of autonomy. Notably, respondents who experienced incompetence associated a lack of mentorship and exposure with this feeling. Low-utilizer participants who experienced incompetence suggested they would avoid opportunities for deliberate practice. Junior low-utilizer residents were concerned that they were a burden to the team if they asked for guidance, compounding feelings of incompetence and making the pursuit of feedback in deliberate practice less likely. However, learners acknowledged the importance of performing POCUS and the benefits it could bring to the team. Conclusions:Several key themes were identified regarding intrinsic motivation, with differences between high and low utilizers. Programs would benefit from tailoring POCUS curricula to bolster the SDT needs, with a focus on increased faculty support, hands-on experiences, and enhanced exposure to pathology, providing opportunities for deliberate practice.
Background:Airway management is a core competency for emergency medicine faculty and residents. Objective evaluation of procedural performance is crucial for assessment of competency and to guide further educational efforts. Here, we describe a dashboard capable of providing personalized, granular data specifically for airway management performance using the electronic medical record (EMR) to create a continuously updated database. Objective of Innovation:The objective of this innovation was to utilize data from the medical record to create a personalized, dynamic, and data-driven resource to allow quality and educational leaders within the department to promote excellence in airway management. Development Process and Implementation:Using concepts from other departmental dashboards, the author group collaborated with informatics experts to develop a data extraction tool to pull data from the EMR into a secure PowerBI platform that updates every 24 h. Key data elements include first attempt success, equipment utilization, and preoxygenation strategies. Dashboard data is currently being utilized for departmental airway quality monitoring, as well as individual performance assessment for both residents and faculty. Outcomes:Creation of the dashboard allowed for a departmental-level analysis of performance, which triggered a review of areas for potential quality improvement. This led to a department-wide initiative to address these areas for growth. Key components were the development of a standardized departmental approach to intubation and a structured strategy for coaching intubation disseminated to all faculty. Conclusion:In summary, utilization of an airway dashboard which pulls data directly from the EMR allows for the creation of a tool that provides precise, personalized data that has wide-ranging applications for quality improvement and education.
Objectives:To determine whether US emergency medicine (EM) postgraduate year 1 (PGY-1) resident salaries kept pace with inflation from 2021 and 2022 to 2025 and 2026 and to assess how adjustment for local cost of living altered their relative value. Methods:We conducted cross-sectional and longitudinal analyses of ACGME-accredited EM residency programs. Publicly reported 2025 and 2026 PGY-1 base salaries were collected from program websites, and paired 2021 and 2022 salaries were available for a subset. Salaries were adjusted using the Council for Community and Economic Research Cost of Living Index (C2ER COLI), Quarter 3 2025. Salary growth was compared with the 18.331% increase in CPI-U from July 2021 to July 2025. Regional differences were assessed using Kruskal-Wallis tests, and the relationship between COLI and nominal salary was evaluated using simple linear regression. Results:Of 295 programs identified, 271 had 2025 and 2026 salary data and 209 had paired salary data. Mean PGY-1 salary increased from $59,115 to $69,184, a mean increase of 17.0%, slightly below cumulative inflation. 70 programs (33.5%) met or exceeded the inflation benchmark, whereas 139 (66.5%) did not. Across all programs, mean nominal salary was $68,839 and mean COL-adjusted salary was $65,100. The West and Northeast had the highest nominal salaries but the lowest COL-adjusted salaries, whereas the Midwest and South showed the opposite pattern. Each 1-point increase in COLI was associated with a $212 increase in nominal salary (95% CI, $188-$236; R 2 = 0.53; p < 0.001). Adjusted mean salaries ranged from $37,510 for New York City programs in Manhattan to $82,600 in Akron, Ohio. Conclusions:Mean EM PGY-1 salary growth slightly lagged inflation, and two-thirds of programs did not meet the inflation benchmark. Although higher-COL markets paid higher nominal salaries, these increases did not fully offset local costs. COL-adjusted salary reporting may improve transparency and support more informed residency selection and compensation review.
Background:Emergency medicine faculty are expected to perform and supervise high-acuity, low-occurrence (HALO) procedures despite limited clinical opportunities, placing them at risk for procedural skill decay. Transvenous pacemaker (TVP) placement is a life-saving but infrequently performed intervention. While simulation is widely used for trainees, sustainable faculty development models for procedural maintenance remain limited. Methods:We developed a train-the-trainer, peer-led, simulation-based faculty development program focused on TVP placement within a single academic emergency department. Volunteer faculty trainers received focused preparation in TVP placement, simulator use, and facilitation strategies, and subsequently led small-group refresher sessions using a low-cost, reusable TVP simulator. The intervention was embedded within existing departmental educational venues and incentivized through continuing medical education credit and value-based compensation alignment. Over 1 year, 12 sessions (30-60 min each) were conducted, capped at four learners per session and facilitated by 10 faculty trainers. Faculty completed pre- and post-session surveys assessing prior experience and self-reported comfort with TVP placement. Paired pre- and post-intervention comfort scores were compared. Results:Fifty-four of 56 eligible faculty participated and completed paired surveys. Baseline exposure to TVP placement was limited, with 37% reporting no prior simulation experience and 24% reporting no prior live placement. Faculty reporting comfort or high comfort with independently placing a TVP increased from 14.8% pre-intervention to 83.3% post-intervention. Mean comfort scores improved from 2.1 ± 0.6 to 3.2 ± 0.6 on a 4-point Likert scale (p < 0.001). The sessions were rated as highly useful (mean 4.9 ± 0.3 on a 5-point Likert scale), and all participants would recommend the training to colleagues. Conclusion:A train-the-trainer, peer-led simulation model significantly improved faculty comfort with transvenous pacemaker placement while minimizing reliance on centralized simulation resources. Embedding brief, small-group sessions within existing educational structures offers a feasible and scalable approach for maintaining faculty competency in HALO procedures.
There is growing interest in coaching as a strategy to support competency-based medical education (CBME), individualized learning, development of Master Adaptive Learners, and precision education. Despite high enthusiasm, educators often struggle with how to begin developing an effective program. This educational blueprint describes two foundational decisions for launching a coaching program: defining program goals and selecting a theory of change with an aligned coaching model. We then examine contextual considerations, implementation challenges, and tradeoffs that influence these decisions. Grounding a program in explicit goals, educational theory and intentional model selection create a coherent foundation for subsequent design, implementation, and evaluation.
Standardized patients, simulated patients, and simulated participants (SPs) are widely integrated into medical education. With the American Board of Emergency Medicine adopting objective structured clinical examinations in its new Certifying Exam format, emergency medicine (EM) educators have new impetus to develop expertise in SP methodology and implement best practices for SP-based education within the unique context of EM residency programs. To address this need, the Society for Academic Emergency Medicine Simulation Academy convened a work group to review and synthesize best SP educational practices for EM residency programs. The work group consisted of EM faculty who oversee SP-based education in their respective residency programs, often as an extension of their expertise in simulation. Using the Association of SP Educators Standards of Best Practice as the organizing framework, the work group adapted its five domains-(1) safe work environment, (2) case development, (3) SP training, (4) program management, and (5) professional development-to the specific needs and challenges of EM residency education. The resulting recommendations are intended to help EM educators integrate SP methodology into a wide range of resource contexts, including programs with and without access to professionally trained SPs.
Background:Ongoing faculty development is essential in academic emergency medicine (EM) to ensure physicians remain clinically competent, educationally effective, and aligned with evolving healthcare demands. Despite this necessity, approaches to faculty development vary widely in structure, participation expectations, and underlying educational philosophy. Objectives:This paper explores the spectrum of faculty development models, including voluntary participation, asynchronous learning, and institutional mandates, examining how each aligns with learning theory and motivational frameworks such as Self-Determination Theory. Discussion:We discuss the benefits and limitations of different methods, including their impact on engagement, skill retention, accountability, and institutional culture. Drawing from both educational literature and implementation experience, we highlight the importance of intentional design, learner autonomy, and system-level alignment in promoting meaningful and sustainable faculty growth. Conclusion:Ultimately, the paper presents an expert-informed conceptual framework to guide academic departments in selecting and tailoring faculty development strategies that balance individual motivation with organizational responsibility.
Objectives:The serratus anterior plane block (SAPB) is an effective ultrasound-guided regional anesthesia technique for anterolateral rib fracture pain. Formal SAPB training in emergency medicine remains limited, contributing to inconsistent adoption and procedural confidence. This study evaluated whether a simulation-based curriculum improves emergency physicians' confidence, knowledge, retention, and simulated procedural competency. Methods:A prospective educational intervention was conducted at an urban academic center. Participants completed pre- and post-curriculum surveys assessing SAPB knowledge, procedural confidence, and barriers. Survey content was developed using a three-round Delphi process by emergency medicine ultrasound and simulation experts. The curriculum included didactic teaching and four simulation stations addressing consent, ultrasound-guided in-plane technique, anatomy, and SAPB performance using task trainers. Procedural competency was assessed using an ACEP-guidelines-based checklist. Pre- and post-curriculum outcomes were analyzed using paired t-tests (p < 0.05). Results:Thirty-six physicians participated, including attendings (19.4%), fellows (8.3%), and residents (72.2%) distributed evenly across PGY1 to PGY4 levels. Two participants (5.6%) had prior ultrasound fellowship training and 5 (13.9%) had previously performed a SAPB. Self-reported confidence increased significantly following the curriculum (1.81 ± 1.09 vs. 4.00 ± 0.72; p < 0.001), as did willingness to perform the block (3.31 ± 1.60 vs. 4.53 ± 0.70; p < 0.001). All participants achieved simulated procedural competency and demonstrated improved knowledge scores following the curriculum (p < 0.001). Five clinical bedside SAPBs were performed during the first 6 months following training. Among 32 participants (88.9%) completing the 4-6-week follow-up, mean cumulative knowledge scores were 92.9% ± 11.7 immediately after training and 90.9% ± 10.3 at follow-up. Reported barriers to SAPB performance included time constraints, patient refusal, and limited availability of appropriate patients. Conclusions:A simulation-based curriculum improved emergency physicians' self-reported confidence and knowledge regarding the SAPB, while supporting short-term stability of knowledge performance. These findings highlight the value of simulation as a scalable pathway to standardize ultrasound-guided regional anesthesia training and facilitate future evaluation of SAPB adoption in emergency medicine.
Background:Emergency medicine (EM) physicians must rapidly recognize and manage time-critical conditions; however, standardized methods to teach and assess competency in these scenarios remain limited and resource-intensive. Objective:To develop and implement a low-resource, standardized tabletop simulation to evaluate EM residents' ability to manage high-risk, time-sensitive pathologies. Methods:Twenty-five critical EM pathologies were identified through expert consensus. We designed "Do or Die" (DoD), a rapid-fire, case-based program grounded in progress testing principles that required a faculty facilitator, laptop and 25 index cards. Residents independently prepared using a provided pathology list. During timed sessions, residents completed five randomly assigned cases, each scored using dichotomous critical action checklists. Performance thresholds varied by postgraduate year (PGY). Results:The program was piloted with 54 residents during the 2025-2026 academic year. Fifty-six percent of residents passed on the first attempt with variation noted across training levels. Iterative attempts led to progressive improvement, and all residents ultimately achieved passing performance thresholds. The exercise identified both individual learner gaps and curricular opportunities. Conclusions:The DoD program is a feasible, low-resource innovation that provides standardized, formative evaluation of EM residents' management of time-critical conditions. It offers a reproducible and adaptable approach to educational assessment and curricular refinement.
Objectives:The scholarly activity requirement by the Accreditation Council for Graduate Medical Education (ACGME) is broadly defined and variably applied by residency programs. The scholarly productivity of trainees is variable and it is unknown why some may struggle to meet this requirement. This study aims to explore the perspectives of residents who struggled in completing scholarship during residency. Methods:We performed a qualitative study using a constructivist paradigm and conducted semi-structured interviews at four ACGME-accredited emergency medicine residency programs. The programs reflect diverse locations and training formats. We invited residents who self-identified as struggling with scholarship. Two researchers independently performed a content analysis of interview transcripts. We resolved discrepancies through in-depth discussion and negotiated consensus. Results:We interviewed 13 residents (6 Male and 7 Female; median age 31; 7 PGY-3, 3 PGY-4, 3 post-graduation). Many participated in scholarship before residency. We identified three major themes: barriers/challenges to scholarly activity, recommendations to programs to support residents in scholarly work, and strategies for residents to mitigate challenges. Challenges to scholarly activity included lack of understanding of the scholarly project requirement, lack of time, lack of perceived value, and mentorship challenges. Participants recommended programs set clear expectations, provide infrastructure, and facilitate high-quality mentorship, including a faculty champion. Participants advised residents to start the project early, seek out good mentorship, and find a meaningful, but simple, project. Conclusions:Our study reveals that even residents with prior experience can struggle with scholarship and we identified multiple barriers trainees face. Strategically investing in infrastructure, clarifying expectations, and prioritizing mentorship represents an actionable roadmap that may transform the scholarly project from a burdensome requirement into a meaningful educational opportunity.
Background:Scholarship is essential for career progression within academic settings. Unfortunately, time pressures, uncertain processes, and unclear or absent resources remain barriers. We describe the development, implementation, and effectiveness of an internally funded scholarship program for EM faculty clinician educators led by the effort from 2 faculty physician scientists and a full-time Health Science Research Analyst. Methods:The program was developed through a needs assessment survey, discussions with faculty development leadership, and components of the PRISM implementation framework. Effectiveness was assessed using an interrupted time series (1 year pre- and 1 year post-implementation). Scholarship was defined a priori as manuscripts, abstract acceptances, regional/national presentations, book chapters, and online publications. The target audience was faculty, residents, fellows, attendings, and advanced practice providers. Results:Our needs assessment survey suggested deficiencies in mentorship, formal curriculum, academic writing, and navigating journal submissions. A conceptual framework for scholarship was developed with 4 domains: education, clinical trials and studies, administrative, and training. The program was implemented July 1, 2024, and adopted by 17% (n = 17) of the audience. Acceptability ratings were high, with over 88% of respondents selecting 4/5 or 5/5 (1-5 ordinal scale). Overall scholarship increased from pre-implementation (146 manuscripts, 69 abstracts, 54 presentations, 27 book chapters, 34 online publications; total 330) to post (195 manuscripts, 90 abstracts, 78 presentations, 28 book chapters, 57 online publications; total 448), representing a 35.8% growth. The most notable increases occurred in manuscripts, followed by abstracts and presentations. For adoptees, output increased from a mean of 0.4 to 0.58 per participant per year. Conclusion:A faculty scholarship program for EM clinician educators was successfully executed within an implementation science framework. Our program was well received by end users and displayed an increase in scholarly output. Future evaluations will focus on program sustainability, growth, and impact on promotion.
ABSTRACT Background Grant writing is a valuable skill for academic advancement in emergency medicine (EM). Yet, the high rejection rate can contribute to stress, burnout, and disengagement among early‐ and mid‐career faculty. While extensive literature exists on the technical aspects of grant writing, there is a notable gap in guidance on the emotional and psychological dimensions of navigating rejection. This conceptual paper explores resilience strategies, reflective self‐assessment, constructive feedback processes, and approaches to resubmission that support scholarly persistence in the face of grant rejection. Methods We used a narrative conceptual approach, drawing on a panel discussion titled “Rejection, Resilience, and Resubmission: Learning from Grant Failure,” presented at the 2025 Society for Academic Emergency Medicine Annual Meeting. The panel featured experienced EM education scholars and funded investigators who shared personal experiences and insights. We analyzed session notes to identify recurring themes, which we reviewed with the panelists to refine the concepts. Results Insights from the panel highlighted the value of individual resilience strategies, the importance of a strong support network, diverse external input, and the need for strategic self‐assessment. The discussion also underscored the need for resilience training and managing rejection, the need for greater transparency in academic narratives, and potential reconsideration of promotion and tenure criteria. Conclusion The findings suggest a need for a cultural shift in academic EM, one that embraces persistence and transparency as core tenets of scholarly excellence. We recommend incorporating resilience training into faculty development and residency training programs to provide scholars with the tools to navigate challenges both academically and emotionally throughout the submission and resubmission process.
ABSTRACT Introduction Clinical teaching in the emergency department (ED) continues to be an essential component of medical education but is increasingly constrained by time pressure, competing clinical demands, and variability in educator experience. Generative artificial intelligence (AI), particularly large language models (LLMs), offers new opportunities to support learner‐centered clinical education; AI can assist educators with the preparation, organization, and provision of feedback during an educational encounter while preserving the central human elements of teaching. Approach This article reflects best practices as outlined by both the literature and the expert perspectives of academic emergency medicine (EM) physicians from multiple institutions who facilitated the “Be the Best Teacher: Clinical Teaching Educational Bootcamp” at the 2025 Society for Academic Emergency Medicine (SAEM) pre‐conference. Drawing on their collective experience as clinical educators, the authors review current applications of generative AI in medical education and present practical, clinically grounded examples of how LLMs can be incorporated into everyday teaching activities in the ED. Educational Uses Three key domains were identified using the Self‐Regulated Learning theory, in which LLMs may support time‐constrained educators on a clinical shift with learners. (1) LLMs can help both educators and learners with Forethought ( “before” learning ) for the clinical shift by generating learner‐specific goals and objectives. (2) LLMs can assist educators in preparing learners to Perform (“during” learning) clinical duties by guiding procedural preparation and augmenting efficiency with patient‐facing tasks. (3) Educators can use LLMs to help shape Self‐Reflection ( “after” learning ) by guiding effective feedback between educators and learners. This paper provides a practical, learner‐centered, theory‐based framework for incorporating AI into clinical teaching while upholding the principles of evidence‐based, humanistic medical education. Considerations and Challenges AI works best as a tool to supplement self‐directed learning rather than a replacement for clinical preparation, observation, or teaching. Important limitations remain with the integration of AI in the medical education setting, including data privacy concerns, potential biases, inaccurate or incomplete outputs, and the risk of overreliance that may undermine clinical reasoning or educator engagement. Conclusion When integrated thoughtfully in the Self‐Directed Learning framework, generative AI tools (such as LLMs) can help EM educators overcome long‐standing barriers to clinical teaching by enhancing the structure and delivery of educational sessions while maintaining the primacy of human judgment and interaction. Educators play a critical role in modeling ethical, transparent, and reflective use of AI tools for learners who are already encountering them in clinical environments.
Background:Effective clinical educators are essential to emergency medicine (EM) residency training, and the pace and dynamics of the emergency department require them to have a unique educational skillset. Most existing literature defining educational excellence in EM reflects educator rather than learner perspectives, and there is limited contemporary, resident-centered work that describes the teaching practices of exceptional EM educators. This study aimed to identify EM resident-defined practices that characterize the "best" EM educators. Methods:We performed a qualitative thematic analysis to analyze open-ended survey responses from residents at a large, urban, 3 year EM residency program. All 78 residents were invited to complete an anonymous survey containing a single prompt to describe their best EM educator. Data were collected over 72 h in March 2025. Three investigators performed iterative open coding and applied constant comparative methods to identify themes. Postgraduate year (PGY) class was unblinded after analysis to explore patterns by training level. Results:Thirty-eight residents responded (48.7% response rate). Five themes emerged: (1) growth orientation, (2) psychological safety, (3) shares clinical burden, (4) educational expertise, including optimal timing and setting of teaching, knowledge translation, and fostering independence; and (5) clinical expertise, including content expertise and role modeling. In a secondary descriptive analysis, PGY-1s emphasized psychological safety, growth-oriented feedback, and autonomy, while PGY-2 and PGY-3 residents prioritized approachability, timely teaching, shared workload, and clinical expertise. Conclusions:Residents identified outstanding EM educators as growth-oriented, supportive, skilled teachers and expert clinicians, with preferences varying by training level. These themes may guide faculty development, coaching, and feedback as well as future studies on resident-centered educator training.
Background:Emergency medicine sub-internships traditionally occur in summer months to facilitate letters of recommendation for residency applications, although it is unknown whether sub-internship timing impacts course outcomes. The purpose of this study was to identify seasonal trends in course outcomes. Methods:This retrospective observational study examined 84 EM-bound medical students during a 4-week EM sub-internship between 2021 and 2024. During the rotation, students received on-shift evaluations graded on a Likert scale from 0 (inadequate) to 4 (outstanding) and completed an online SAEM exam (scored 0-100), both of which contributed to the final course grade. Course outcomes included the number of evaluations, average evaluation score, SAEM score and final course grade. Outcomes were compared between students rotating in May-July (25 students) and August-October (59 students). Analysis was completed in SPSS using independent t-tests, Mann-Whitney U tests and regression analysis to adjust for confounders. Results:There were no significant differences in outcomes between the May-July and August-October subgroups when comparing average evaluation score (p = 0.11), SAEM score (p = 0.32) and final course score (p = 0.21). Conclusion:No performance differences were observed between early summer (May-July) and fall (August-October) rotations. These findings suggest that early summer rotations do not offer a significant advantage over fall rotations. Limitations include a single site study. Future research is needed to investigate factors contributing to seasonal variation in sub-internship performance.
Objectives:Faculty development (FD) programs provide faculty with knowledge and skills to succeed in their roles. There is limited data to guide FD in emergency medicine (EM), especially in hospital systems that include diverse sites. We sought to identify the needs and preferences of EM faculty within a hospital system with multiple sites. Methods:This was a cross-sectional survey of EM faculty at four different sites (one academic, two community, one rural). Participants completed an online survey consisting of multiple choice, completion, and scale items that was piloted prior to use. We calculated descriptive statistics. We used multivariate general linear model (MANOVA) to examine differences in optimal time allocation across FD domains by site type, gender, and career stage. Results:Eighty-five (75%) faculty participated across all ranks. The mean optimal percentage of time for various FD domains was 36% to Clinical skills, 15% to Education skills, 18% to Scholarship skills, 17% to career development and promotion skills, and 15% to personal development and wellness skills. The greatest barriers to participation in FD activities were timing of the activity and faculty workload. To promote engagement, participants supported ensuring FD activities are integrated into career goal discussions. The three-way interaction between site type, gender, and career stage was not significant (p = 0.178). In the adjusted main-effects model, there was a significant effect of primary clinical site type on optimal percentage of time allocation across FD domains (p = 0.008). There was no significant effect of gender or career stage. Conclusion:Participants identified FD needs as well as motivators and barriers to participation. Perceived FD domain needs varied by type of practice site. These findings can inform the development and refinement of faculty development programs in EM as well as serve as a model for FD needs assessments in healthcare systems.
