Study Objectives

The objectives of this study were to determine the prevalence of fever in adult ED patients with skin and soft tissue infections (SSTI) and to determine which, if any, physical exam, x-ray and laboratory test findings were associated with fever.

Methods

We conducted a prospective, observational study at an urban county trauma center of adults who presented to the ED for evaluation of suspected SSTI. ED providers measured area of erythema and induration using a tape measure, and completed data sheets indicating comorbid conditions and the presence or absence of physical exam findings. Fever was defined as any recorded temperature > 38°C during the first 6 hours of ED evaluation.

Results

Of the 734 patients enrolled, 96 (13.1%) had fever.  Physical and laboratory exam findings associated with the presence of a fever in multivariable logistic regression were the area of erythema, particularly the largest quartile of area of erythema, 144 – 5000 cm², (odd ratio (OR) = 2.9; 95% confidence interval [CI] = 1.6 – 5.2) and leukocytosis (OR = 4.4, 95% CI = 2.7 – 7.0). Bullae, necrosis, streaks, adenopathy, and bone involvement on imaging were not associated with fever.

Conclusions

Fever is uncommon in patients presenting to the ED for evaluation of suspected SSTI. Area of erythema and leukocytosis were associated with fever and should be considered in future decision rules for the evaluation and treatment of SSTI.

Introduction: The Standardized Letter of Evaluation (SLOE) is an emergency medicine (EM)-specific assessment designed to help EM residency programs differentiate applicants. We became interested in SLOE-narrative language referencing personality when we observed less enthusiasm for applicants described as “quiet” in their SLOEs. In this study our objective was to compare how quiet-labeled, EM-bound applicants were ranked compared to their non-quiet peers in the global assessment (GA) and anticipated rank list (ARL) categories in the SLOE.

Methods: We conducted a planned subgroup analysis of a retrospective cohort study of all core EM clerkship SLOEs submitted to one, four-year academic EM residency program in the 2016-2017 recruitment cycle. We compared SLOEs of applicants who were described as “quiet,” “shy,” and/or “reserved” — collectively referred to as “quiet” — to SLOEs from all other applicants, referred to as “non-quiet.” We compared frequencies of quiet to non-quiet students in GA and ARL categories using chi-square goodness-of-fit tests with a rejection criteria (alpha) of 0.05.

Results: We reviewed 1,582 SLOEs from 696 applicants. Of these, 120 SLOEs described quiet applicants. The distributions of quiet and non-quiet applicants across GA and ARL categories were significantly different (P < 0.001). Quiet applicants were less likely than non-quiet applicants to be ranked in the top 10% and top one-third GA categories combined (31% vs 60%) and more likely to be in the middle one-third category (58% vs 32%). For ARL, quiet applicants were also less likely to be ranked in the top 10% and top one-third categories combined (33% vs 58%) and more likely to be in the middle one-third category (50% vs 31%).

Conclusion: Emergency medicine-bound students described as quiet in their SLOEs were less likely to be ranked in the top GA and ARL categories compared to non-quiet students. More research is needed to determine the cause of these ranking disparities and address potential biases in teaching and assessment practices.

Introduction: The Standardized Letter of Evaluation (SLOE) is designed to assist emergency medicine (EM) residency programs in differentiating applicants and in selecting those to interview. The SLOE narrative component summarizes the student’s clinical skills as well as their non-cognitive attributes. The purpose of this qualitative investigation was to explore how students described in the SLOE as quiet are perceived by faculty and to better understand how this may impact their residency candidacy.

Methods: This retrospective cohort study included all SLOEs submitted to one EM residency program during one application cycle. We analyzed sentences in the SLOE narrative describing students as “quiet,”“shy,” and/or “reserved.” Using grounded theory, thematic content analysis with a constructivist approach, we identified five mutually exclusive themes that best characterized the usage of these target words.

Results: We identified five themes: 1) quiet traits portrayed as implied-negative attributes (62.4%); 2) quiet students portrayed as overshadowed by more extraverted peers (10.3%); 3) quiet students portrayed as unfit for fast-paced clinical settings (3.4%); 4) “quiet” portrayed as a positive attribute(10.3%); and 5) “quiet” comments deemed difficult to assess due to lack of context (15.6%).

Conclusion: We found that quiet personality traits were often portrayed as negative attributes. Further, comments often lacked clinical context, leaving them vulnerable to misunderstanding or bias. More research is needed to determine how quiet students perform compared to their non-quiet peers and to determine what changes to instructional practices may support the quiet student and help create a more inclusive learning environment. [West J Emerg Med. 2023;24(4)1–4.]

Introduction: Competency-based medical education (CBME) presents a paradigm shift in medicaltraining. This outcome-based education movement has triggered substantive changes across the globe.Since this transition is only beginning, many faculty members may not have experience with CBMEnor a solid foundation in the grounding literature. We identify and summarize key papers to help facultymembers learn more about CBME.

Methods: Based on the online discussions of the 2016-2017 ALiEM Faculty Incubator program, a seriesof papers on the topic of CBME was developed. Augmenting this list with suggestions by a guest expertand by an open call on Twitter for other important papers, we were able to generate a list of 21 papers intotal. Subsequently, we used a modified Delphi study methodology to narrow the list to key papers thatdescribe the importance and significance for educators interested in learning about CBME. To determinethe most impactful papers, the mixed junior and senior faculty authorship group used three-round votingmethodology based upon the Delphi method.

Results: Summaries of the five most highly rated papers on the topic of CBME, as determined by thismodified Delphi approach, are presented in this paper. Major themes include a definition of core CBMEthemes, CBME principles to consider in the design of curricula, a history of the development of the CBMEmovement, and a rationale for changes to accreditation with CBME. The application of the study findingsto junior faculty and faculty developers is discussed.

Conclusion: We present five key papers on CBME that junior faculty members and faculty expertsidentified as essential to faculty development. These papers are a mix of foundational and explanatorypapers that may provide a basis from which junior faculty members may build upon as they help toimplement CBME programs.