Objectives: Nursing evaluations are an important component of residents' professional development as nurses are present for interactions with patients and nonphysician providers. Despite this, there has been few prior studies on the benefits, harms, or effectiveness of using nursing evaluations to help guide emergency medicine residents' development. We hypothesized that gender bias exists in nursing evaluations and that female residents, compared to their male counterparts, would receive more negative feedback on the perception of their interpersonal communication skills.Methods: Data were drawn from nursing evaluations of residents between March 2013 and April 2016. All comments were coded if they contained words falling into four main categories: standout, ability, grindstone, and interpersonal. This methodology and the list of words that guided coding were based on the work of prior scholars. Names and gendered pronouns were obscured and each comment was manually reviewed and coded for valence (positive, neutral, negative) and strength (certain or tentative) by at least two members of the research team. Following the qualitative coding, quantitative analysis was performed to test for differences. To evaluate whether any measurable differences in ability between male and female residents existed, we compiled and compared American Board of Emergency Medicine in-training examination scores and relevant milestone evaluations between female and male residents from the same period in which the residents were evaluated by nursing staff.Results: Of 1,112 nursing evaluations, 30% contained comments. Chi-square tests on the distribution of valence (positive, neutral, or negative) indicated statistically significant differences in ability and grindstone categories based on the gender of the resident. A total of 51% of ability comments about female residents were negative compared to 20% of those about male residents (v 2 = 11.83, p < 0.01). A total of 57% of grindstone comments about female residents were negative as opposed 24% of those about male residents (v 2 = 6.03, p < 0.01).Conclusions: Our findings demonstrate that, despite the lack of difference in ability or competence as measured by in-service examination scores and milestone evaluations, nurses evaluate female residents lower in their abilities and work ethic compared to male residents.From the

Teaching advocacy communication to pediatric residents: the efficacy of applied improvisational theater (AIT) as an instructional tool. Communication Education, 67(4), 438-459.

IntroductionPatients with limited English proficiency may be at risk for incomplete history collection, potentially a patient safety issue. While federal law requires qualified medical interpreters be provided for these patients, little is known about the quality of information obtained in these encounters. Our study compared the medical histories obtained by physicians in the emergency department (ED) based on whether the patients primarily spoke English or Spanish.MethodsThis was a prospective, observational study conducted at a single, urban, academic ED during a six-month time period. Resident and faculty physicians caring for adult patients with a chief complaint of chest or abdominal pain were eligible for participation. Patient encounters were directly observed by medical students who had been trained using simulated encounters. Observers documented which key historical data points were obtained by providers, including descriptions of pain (location, quality, severity, radiation, alleviating/aggravating factors), past medical/family/surgical history, and social history, in addition to the patient’s language in providing history. Providers, interpreters, and observers were blinded to the nature of the study. We used chi-square analyses to examine differences in whether specific elements were collected based on the primary language of the patient.ResultsEncounters with 753 patients were observed: 105 Spanish speaking and 648 English speaking. Chi-square analyses found no statistically significant differences in any history questions between Spanish-speaking and English-speaking patients, with the exception that questions regarding alleviating factors were asked more often with Spanish-speaking patients (45%) than English-speaking patients (30%, p=.003). The average percentages of targeted history elements obtained in Spanish and English encounters were 60% and 57%, respectively.ConclusionIn this study at a large, urban, academic ED, the medical histories obtained by physicians were similar between English-speaking and Spanish-speaking patients. This suggests that the physicians sought to obtain medical histories at the same level of detail despite the language barrier. One limitation to consider is the Hawthorne effect; however, providers and observers were blinded to the nature of the study in an attempt to minimize the effect.

Teaching advocacy communication to pediatric residents: the efficacy of applied improvisational theater (AIT) as an instructional tool. Communication Education, 67(4), 438-459.

Introduction: Consultation of another physician for his or her specialized expertise regarding a patient’s care is a common occurrence in most physicians’ daily practice, especially in the emergency department (ED). Therefore, the ability to communicate effectively with another physician during a patient consultation is an essential skill. However, there has been limited research on a standardized method for a physician to physician consultation with little guidance on teaching consultations to physicians in training. The objective of our study was to measure the effect of a structured consultation intervention on both content standardization and quality of medical student consultations. Methods: Senior medical students were assessed on a required emergency medicine rotation with a physician phone consultation during a standardized, simulated chest pain case. The intervention groups received a standard consult checklist as part of their orientation to the rotation, followed by a video recording of a good consult call and a bad consult call with commentary from an emergency physician. The intervention was given to students every other month, alternating with a control group who received no additional education. Recordings were reviewed by three second-year internal medicine residents pursuing a fellowship in cardiology. Each recording was evaluated by two of the three reviewers and scored using a standardized checklist. Results: Providing a standardized consultation intervention did not improve students’ ability to communicate with consultants. In addition, there was variability between evaluators in regards to how they received the same information and how they perceived the quality of the same recorded consultation calls. Evaluator inter-rater reliability (IRR) was poor on the questions of 1) would you have any other questions of the student calling the consult and 2) did the student calling the consult provide an accurate account of information and case detail. The IRR was also poor on objective data such as whether the student stated their name. Conclusions: A brief intervention may not be enough to change complex behavior such as a physician to physician consultant communication. Importantly, despite consultants listening to the same audio recordings, the information was processed differently. Future investigations should focus on both those delivering as well as those receiving a consultation.