Purpose Debriefing is necessary for effective simulation education. The PEARLS (Promoting Excellence and Reflective Learning in Simulations) is a scripted debriefing model that incorporates debriefing best practices. It was hypothesized that student simulation performance might impact facilitator adherence to the PEARLS debriefing model. There are no published findings on the effect of student performance on debriefer behavior. Methods Third-year medical students participated in a video-recorded, formative simulation to treat a high-fidelity mannequin for an asthma exacerbation. A faculty debriefer trained in the PEARLS model evaluated student performance with a standardized rubric and conducted a recorded debriefing. Debriefing recordings were analyzed for debriefer adherence to the PEARLS model. Debriefers were assigned a debriefing score (DS) from 0 to 13; 13 was perfect adherence to the model. Definitive intervention (DI) for asthma exacerbation was defined as bronchodilator therapy. Critical actions were as follows: a focused history, heart/lung exam, giving oxygen, and giving a bronchodilator. Results Mean DS for the debriefers of students who provided DI was 8.57; 9.14 for those students who did not (P = 0.25). Mean DS for debriefers of students who completed all critical actions was 8.68; 8.52 for those students who did not (P = 0.62). Analysis of elapsed time to DI showed no relationship between the time DI was provided and DS. Conclusions Student performance had no impact on debriefer performance, suggesting the PEARLS model is an effective aid for debriefers, regardless of learner performance. These findings suggest student performance may not bias facilitators’ ability to conduct quality debriefings.

Study Objectives: Studies have noted sex disparities in emergency medicine (EM) in which women are less likely to hold leadership positions and advance in academic ranks. The objective of this study was to explore whether women are treated differently from men during the residency recruitment process.Methods: This is a single center retrospective analysis of the recruitment data for Henry Ford Hospital EM (HFHEM) residency from 2015 to 2018. We included all United States (US) graduates who applied to our residency and stratified by sex. Data was abstracted from local databases of applicant scores related to their file score, interview score and composite scores (file score + interview score) as well as data related to their position on the final rank list. The file score is generated by a detailed review of all data in each applicant's file and primarily reflects their academic performance in medical school. The interview score reflects the applicant's communication and professionalism skill as assessed by multiple faculty interviewers. We additionally reviewed the Electronic Residency Application Service (ERAS) data regarding sex distribution for 2015 -2018 for benchmarking. We were primarily interested in the median position on the rank list of women versus men. Secondarily we compared the file, interview, and composite score of women versus men.Results: From 2015 through 2018, 224 (34.5%) women and 425 (65.5%) men were ranked and submitted to the National Residency Matching Program on behalf of our residency program. Nationally, during the same time period amongst all applicants, 5168 women (34.3%) applied to EM via ERAS compared to 9900 (65.7%) men. At HFHEM, taking into account all applicants, we had 1441 (33.5%) women and 2866 (66.5%) men. The median (IQR) position on the HFHEM rank order list for women was 72.5 (37 -111.5) and for men was 88 (43 -128), p ¼ 0.013. The average (AESD) interview score for women was 18.7 (AE2.2) and for men 18.1 (AE2.5), p ¼ 0.01. We did not find a statistically significant difference between the file scores for women compared to men (35.5 AE4.5 vs. 34.5 AE5.2, p ¼ 0.18).Conclusion: The HFHEM residency rank lists reflect similar distributions of women and men compared to the national applicant pool. Our recruitment process generates similar scores for the academic proficiency of both women and men and our scoring at the interview suggests a higher performance for women than men. Ultimately, women rank more competitively on our rank lists compared to men. Other residency programs may consider using this template to assess for bias in their recruitment process.