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Emergency physicians often need to control agitated patients who present a danger to themselves and hospital personnel. Commonly used medications have limitations. Our primary objective was to compare the time to a defined reduction in agitation scores for ketamine versus benzodiazepines and haloperidol, alone or in combination. Our secondary objectives were to compare rates of medication redosing, vital sign changes, and adverse events in the different treatment groups. We conducted a single-center, prospective, observational study examining agitation levels in acutely agitated emergency department patients between the ages of 18 and 65 who required sedation medication for acute agitation. Providers measured agitation levels on a previously validated 6-point sedation scale at 0-, 5-, 10-, and 15-min after receiving sedation. We also assessed the incidence of adverse events, repeat or rescue medication dosing, and changes in vital signs. 106 patients were enrolled and 98 met eligibility criteria. There was no significant difference between groups in initial agitation scores. Based on agitation scores, more patients in the ketamine group were no longer agitated than the other medication groups at 5-, 10-, and 15-min after receiving medication. Patients receiving ketamine had similar rates of redosing, changes in vital signs, and adverse events to the other groups. In highly agitated and violent emergency department patients, significantly fewer patients receiving ketamine as a first line sedating agent were agitated at 5-, 10-, and 15-min. Ketamine appears to be faster at controlling agitation than standard emergency department medications.

Emergency medicine (EM) educational podcasts have become increasingly popular. Residents spend a greater percentage of their time listening to podcasts than they do using other educational materials. Despite this popularity, research into podcasting in the EM context is sparse. We aimed to determine EM residents' consumption habits, optimal podcast preferences, and motivation for listening to EM podcasts. We created a survey and emailed it to EM residents at all levels of training at 12 residencies across the United States from September 2015 to June 2016. In addition to demographics, the 20-question voluntary survey asked questions exploring three domains: habits, attention, and motivation. We used descriptive statistics to analyze results. Of the 605 residents invited to participate, 356 (n= 60.3%) completed the survey. The vast majority listen to podcasts at least once a month (88.8%). Two podcasts were the most popular by a wide margin, with 77.8% and 62.1% regularly listening to ( ) and the , respectively; 84.6% reported the ideal length of a podcast was less than 30 minutes. Residents reported their motivation to listen to EM podcasts was to \"Keep up with current literature\" (88.5%) and \"Learn EM core content\" (70.2%). Of those responding, 72.2% said podcasts change their clinical practice either \"somewhat\" or \"very much.\" The results of this survey study suggest most residents listen to podcasts at least once a month, prefer podcasts less than 30 minutes in length, have several motivations for choosing podcasts, and report that podcasts change their clinical practice.

Twitter has recently gained popularity in emergency medicine (EM). Opinion leaders on Twitter have significant influence on the conversation and content, yet little is known about these opinion leaders. We aimed to describe a methodology to identify the most influential emergency physicians (EP) on Twitter and present a current list. We analyzed 2,234 English-language EPs on Twitter from a previously published list of Twitter accounts generated by a snowball sampling technique. Using NodeXL software, we performed a network analysis of these EPs and ranked them on three measures of influence: in-degree centrality, eigenvector centrality, and betweenness centrality. We analyzed the top 100 users in each of these three measures of influence and compiled a list of users found in the top 100 in all three measures. Of the 300 total users identified by one of the measures of influence, there were 142 unique users. Of the 142 unique users, 61 users were in the top 100 on all three measures of influence. We identify these 61 users as the most influential EM Twitter users. We both describe a method for identifying the most influential users and provide a list of the 61 most influential EPs on Twitter as of January 1, 2016. This application of network science to the EM Twitter community can guide future research to better understand the networked global community of EM.

As scholarship moves into the digital sphere, applicant and promotion and tenure (P&T) committee members lack formal guidance on evaluating the impact of digital scholarly work. The P&T process requires the appraisal of individual scholarly impact in comparison to scholars across institutions and disciplines. As dissemination methods evolve in the digital era, we must adapt traditional P&T processes to include emerging forms of digital scholarship. We conducted a blended, expert consensus procedure using a nominal group process to create a consensus document at the Council of Emergency Medicine Residency Directors Academic Assembly on April 1, 2019. We discussed consensus guidelines for evaluation and promotion of digital scholarship with the intent to develop specific, evidence-supported recommendations to P&T committees and applicants. These recommendations included the following: demonstrate scholarship criteria; provide external evidence of impact; and include digital peer-review roles. As traditional scholarship continues to evolve within the digital realm, academic medicine should adapt how that scholarship is evaluated. P&T committees in academic medicine are at the epicenter for supporting this changing paradigm in scholarship. P&T committees can critically appraise the quality and impact of digital scholarship using specific, validated tools. Applicants for appointment and promotion should highlight and prepare their digital scholarship to specifically address quality, impact, breadth, and relevance. It is our goal to provide specific, timely guidance for both stakeholders to recognize the value of digital scholarship in advancing our field.

Per the CDEM/CORD guidelines, submissions to Brief Educational Advances do not require an .

The development of clinical reasoning abilities is a core competency of emergency medicine (EM) resident education and has historically been accomplished through case conferences and clinical learning. The advent of the SARS-CoV-2 pandemic has fundamentally changed these traditional learning opportunities by causing a nationwide reliance on virtual education environments and reducing the clinical diversity of cases encountered by EM trainees.We propose an innovative case conference that combines low-fidelity simulation with elements of gamification to foster the development of clinical reasoning skills and increase engagement among trainees during a virtual conference. After a team of residents submits a real clinical case that challenged their clinical reasoning abilities, a different team of residents \"plays\" through a gamified, simulated version of the case live on a video conference call. The case concludes with a facilitated debriefing led by a simulation-trained faculty, where both the resident teams and live virtual audience discuss the challenges of the case. Participants described how the Challenging Case Conference improved their perceptions of their clinical reasoning skills. Audience members reported increased engagement compared to traditional conferences. Participants also reported an unexpected, destigmatizing effect on the discussion of medical errors produced by this exercise. Residency programs could consider implementing a similar case conference as a component of their conference curriculum.

Introduction: Twitter is growing in popularity and influence among emergency physicians (EP), with over 2200 self-identified EP users. As Twitter’s popularity has increased among EPs so too has its influence. While there has been debate about the value of Twitter as an effective educational delivery tool, little attention has been paid to the nature of the conversation occurring on Twitter. We aim to describe how influential EPs use Twitter by characterizing the language, purpose, frequencies, content, and degree of engagement of their tweets. Methods: We performed a mixed-methods analysis following a combined content analysis approach. We conducted qualitative and quantitative analyses of a sample of tweets from the 61 most influential EPs on Twitter. We present descriptive tweet characteristics and noteworthy themes. Results: We analyzed 1375 unique tweets from 57 unique users, representing 93% of the influential Twitter EPs. A majority of tweets (1104/1375, 80%) elicited some response in the form of retweets, likes, or replies, demonstrating community engagement. The qualitative analysis identified 15 distinct categories of tweets. Conclusion: Influential EPs on Twitter were engaged in largely medical conversations in which most messages generated some form of interaction. They shared resources and opinions while also building social rapport in a community of practice. This data can help EPs make informed decisions about social media engagement.

Introduction: Social media is a novel medium to host reflective writing (RW) essays, yet its impact on depth of students’ reflection is unknown. Shifting reflection on to social platforms offers opportunities for students to engage with their community, yet may leave them feeling vulnerable and less willing to reflect deeply. Using sociomateriality as a conceptual framework, we aimed to compare the depth of reflection in RW samples submitted by medical students in a traditional private essay format to those posted on a secure social media platform. Methods: Fourth-year medical students submitted a RW essay as part of their emergency medicine clerkship, either in a private essay format (academic year [AY] 2015) or onto a closed, password-protected social media website (AY 2016). Five raters used the Reflection Evaluation for Learners’ Enhanced Competencies Tool (REFLECT) to score 122 de-identified RW samples (55 private, 67 social media). Average scores on two platforms were compared. Students were also surveyed regarding their comfort with the social media experience. Results: There were no differences in average composite REFLECT scores between the private essay (14.1, 95% confidence interval [CI], 12.0-16.2) and social media (13.7 95% CI, 11.4-16.0) submission formats (t [1,120] = 0.94, p = 0.35). Of the 73% of students who responded to the survey, 72% reported feeling comfortable sharing their personal reflections with peers, and 84% felt comfortable commenting on peers’ writing. Conclusion: Students generally felt comfortable using social media for shared reflection. The depth of reflection in RW essays was similar between the private and social media submission formats.

Introduction: Evaluators use assessment data to make judgments on resident performance within the Accreditation Council for Graduate Medical Education (ACGME) milestones framework. While workplace-based narrative assessments (WBNA) offer advantages to rating scales, validity evidence for their use in assessing the milestone sub-competencies is lacking. This study aimed to determine the frequency of sub-competencies assessed through WBNAs in an emergency medicine (EM) residency program. Methods: We performed a retrospective analysis of WBNAs of postgraduate year (PGY) 2-4 residents. A shared mental model was established by reading and discussing the milestones framework, and we created a guide for coding WBNAs to the milestone sub-competencies in an iterative process. Once inter-rater reliability was satisfactory, raters coded each WBNA to the 23 EM milestone sub-competencies. Results: We analyzed 2517 WBNAs. An average of 2.04 sub-competencies were assessed per WBNA. The sub-competencies most frequently identified were multitasking, medical knowledge, practice-based performance improvement, patient-centered communication, and team management. The sub-competencies least frequently identified were pharmacotherapy, airway management, anesthesia and acute pain management, goal-directed focused ultrasound, wound management, and vascular access. Overall, the frequency with which WBNAs assessed individual sub-competencies was low, with 14 of the 23 sub-competencies being assessed in less than 5% of WBNAs. Conclusion: WBNAs identify few milestone sub-competencies. Faculty assessed similar sub-competencies related to interpersonal and communication skills, practice-based learning and improvement, and medical knowledge, while neglecting sub-competencies related to patient care and procedural skills. These findings can help shape faculty development programs designed to improve assessments of specific workplace behaviors and provide more robust data for the summative assessment of residents.

Introduction Podcasts are increasingly being used for medical education. Studies have found that the assessment of the quality of online resources can be challenging. We sought to determine the reliability of gestalt quality assessment of education podcasts in emergency medicine. Methods An international, interprofessional sample of raters was recruited through social media, direct contact, and the extended personal network of the study team. Each participant listened to eight podcasts (selected to include a variety of accents, number of speakers, and topics) and rated the quality of that podcast on a seven-point Likert scale. Phi coefficients were calculated within each group and overall. Decision studies were conducted using a phi of 0.8. Results A total of 240 collaborators completed all eight surveys and were included in the analysis. Attendings, medical students, and physician assistants had the lowest individual-level variance and thus the lowest number of required raters to reliably evaluate quality (phi >0.80). Overall, 20 raters were required to reliably evaluate the quality of emergency medicine podcasts. Discussion Gestalt ratings of quality from approximately 20 health professionals are required to reliably assess the quality of a podcast. This finding should inform future work focused on developing and validating tools to support the evaluation of quality in these resources.