Over the last several years, there has been increasing interest in transitioning a portion of residency education from traditional, lecture-based format to more learner-centered asynchronous opportunities. These asynchronous learning activities were renamed in 2012 by the Accreditation Council for Graduate Medical Education (ACGME) as individualized interactive instruction (III). The effectiveness and applicability of III in residency education has been proven by multiple studies, and its routine use has been made officially acceptable as per the ACGME. This article provides a review of the current literature on the implementation and utilization of III in emergency medicine residency education. It provides examples of currently implemented and studied III curricula, identifies those III learning modalities that can be considered best practice, and provides suggestions for program directors to consider when choosing how to incorporate III into their residency teaching.

Objectives:The recent outbreak of the COVID-19 altered the traditional paradigm of clinical medical education. While individual clerkships have shared their curricular adaptations via social and academic networking media, there is currently no organizational standard in establishing a nonclinical, emergency medicine (EM) virtual rotation (VR). The primary objective of this study was to describe EM clerkship directors' (CDs) perspectives on their experience adapting an EM VR curriculum during the onset of the COVID-19 pandemic. Methods: A 21-item survey with quantitative and qualitative questions was disseminated between June and August 2020 to EM CDs via the Clerkship Director of Emergency Medicine Listserv to describe their experience and perspectives in adapting a VR during spring 2020. Results: We analyzed 59 of 77 EM clerkship survey responses. Among respondents, 52% adapted a VR while 47.5% did not. Of those who adapted a VR, 71% of CDs had 2 weeks or less to develop the new curriculum, with 84% reporting usual or increased clinical load during that time. Clerkships significantly diversified their asynchronous educational content and utilized several instructional models to substitute the loss of clinical experience. Reflecting on the experience, 71% of CDs did not feel comfortable writing a standardized letter of evaluation for students based on the VR, with the majority citing inability to evaluate students' competencies in a clinical context. Conclusion: A crisis such as COVID-19 necessitates change in all facets of medical education. While EM educators demonstrated the ability to create emergency remote learning with limited time, this was not equivalent to the formal development of preplanned VR experiences. Future faculty development and curriculum innovation are required to fully transition an in-person immersive experience to a noninferior virtual experience.

BACKGROUNDFeedback is an important tool within medical education for the improvement of clinical skills and professional development. 1 However, the emergency department (ED) presents a uniquely complex environment for feedback due to the rapid pace and workflow for patient care, relative lack of privacy, and need for constant task-switching. 1 Incorporating feedback into this environment can negatively impact an emergency medicine (EM) resident's training, with consistent reports of dissatisfaction regarding the quality of feedback received from faculty.

Introduction:The ability to appropriately seek help is a key skill for medical students transitioning to residency. We designed a simulation activity for senior medical students and became interested in studying help calling behaviors and attitudes. Methods: We collected quantitative data regarding help calling for 2 simulation cases and qualitative data using a survey. We undertook a structured thematic analysis based on grounded theory methodology. We identified and compared groups who did and did not call for help. Results: One hundred thirty-four students participated and 122 (91%) completed an evaluation. More students called for help without prompting in the second case (34/134, 25% in first case; 110/134, 82% in second case, P < 0.001). Most students did not call for help in the first case but called in the second case (81, 60%). Our qualitative analysis identified 5 themes: (1) students seek to avoid shame and burdening their team, (2) prior institutional simulation and testing experience may imprint help calling behaviors, (3) students view help calling primarily through an individual lens, (4) students overestimate the complexity of the help calling process, and (5) the simulation environment and intentional experimentation make it difficult to observe natural behavior. When compared with help callers, more non-help callers had phrases coded as "perception of expectations" (37% vs. 10%, P = 0.03). Conclusions: Learners participating in simulation exercises designed to promote helpcalling behaviors face training-based barriers related to shame and the desire for autonomy and simulation-based challenges related to assessment.

IntroductionOpportunities for chest tube placement in emergency medicine training programs have decreased, making competence development and maintenance with live patients problematic. Available trainers are expensive and may require costly maintenance.MethodsWe constructed an anatomically-detailed model using a Halloween skeleton thorax, dress form torso, and yoga mat. Participants in a trial session completed a survey regarding either their comfort with chest tube placement before and after the session or the realism of Yogaman vs. cadaver lab, depending on whether they had placed <10 or 10 or more chest tubes in live patients.ResultsInexperienced providers reported an improvement in comfort after working with Yogaman, (comfort before 47 millimeters [mm] [interquartile ratio {IQR}, 20–53 mm]; comfort after 75 mm [IQR, 39–80 mm], p=0.01). Experienced providers rated realism of Yogaman and cadaver lab similarly (Yogaman 79 mm [IQR, 74–83 mm]; cadaver lab 78 mm [IQR, 76–89 mm], p=0.67). All evaluators either agreed or strongly agreed that Yogaman was useful for teaching chest tube placement in a residency program.ConclusionOur chest tube trainer allowed for landmark identification, tissue dissection, pleura puncture, lung palpation, and tube securing. It improved comfort of inexperienced providers and was rated similarly to cadaver lab in realism by experienced providers. It is easily reusable and, at $198, costs a fraction of the price of available commercial trainers.