Introduction: There is significant variability in the preparedness of incoming interns at the start of residency training with regard to medical knowledge, procedural skills, and attitudes. Specialty-specific preparatory courses aimed at improving clinical skills exist; however, no preparatory courses targeting wellness promotion or burnout prevention have previously been described. Resident well-being has gained increasing attention from the Accreditation Council for Graduate Medical Education, and numerous studies have demonstrated high levels of burnout among resident physicians. The American Medical Association (AMA) divides resident well-being into the following six categories: nutrition, fitness, emotional health, financial health, preventative care, and mindset and behavioral adaptability. Using the AMA’s conceptual framework for well-being in residency, we performed a targeted needs assessment to support the development of a “pre-residency” well-being curriculum. Our aim was to discover what current residents and faculty felt were the perceived areas of under-preparedness, in relation to resident well-being, for incoming interns at the start of their residency training.

Methods: Using a grounded theory approach, we conducted a series of semi-structured, focus group interviews. Focus groups consisted of junior residents (postgraduate years [PGY] 1-3), senior residents (PGY-4), and current faculty members. A standardized interview guide was used to prompt discussion and themes were identified from audio recording. We modified theories based on latent and manifest content analysis, and we performed member checking and an external audit to improve validity.

Results: Participants noted variable exposure to both formal and informal well-being training prior to residency. Regardless, participants uniformly agreed that their past experiences did not adequately prepare them for the challenges, specific to burnout prevention, faced during residency training. Of the six domains of resident well-being described by the AMA, emotional health, mindset and behavioral adaptability, and financial health were the domains most cited for interns to be underprepared for at the start of residency training.

Conclusion: Despite variability in prior medical school and life experiences, incoming interns were underprepared in several domains of well-being, including emotional health, mindset and behavioral adaptability, and financial health. Targeted interventions toward these areas of well-being should be piloted and studied further for their potential to mitigate effects of burnout among resident physicians.

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Learning Objectives: The goal of this study is to characterize the roles, responsibilities, and support for MedEd fellowship directors.

Introduction: Despite Medical Education (MedEd) Fellowships increasing in number, the position of MedEd fellowship director remains poorly defined.

Methods: We developed and piloted an anonymous electronic survey, consisting of 32 Likert-type and free response items, that we distributed via the CORD MedEd Fellowship Community of Practice listserv. We used descriptive statistics to analyze data from items with discrete answer choices. Chi-squared testing was used to evaluate differences between programs. Using a constructivist paradigm, we performed a thematic analysis of free response data.

Results: Thirty-five of 44 MedEd fellowship directors (80%) completed the survey. Thirty-seven percent of respondents were female (13/35). Fifty-one percent earned Master’s degrees in education and 37% completed a MedEd fellowship. Many respondents held other education leadership roles, including program director (PD) (26%), associate/assistant PD (26%), vice chair (23%), and clerkship director (9%). Sixty-three percent (22/35) receive support, including clinical buy-down (18/22, 82%), administrative (11/22, 50%), and salary (1/22, 5%). There was no difference (X2 (2, N=33) = 2.07, p = 0.36) between support and type of hospital (community, academic, or county). Responsibilities of MedEd fellowship directors include education (median 35% of time), administration (25%), research mentorship (20%), and recruitment (14%). Priorities of MedEd fellowship directors fall into three categories, including fellow, fellowship, and institution (Table 1). Factors promoting and inhibiting success of fellowship programs are presented in Table 2.

Conclusions: This study provides insight into the position of the MedEd fellowship director. We hope it will allow for role clarity as well as national and local advocacy as the demand for MedEd fellowship directors increases.

Learning Objective: Our objective was to explore the impact of medical education fellowship training on the careers of graduates.

Background: Medical education fellowships in emergency medicine provide training in teaching, assessment, educational program administration, and scholarship. The longitudinal impact of this training is unknown.

Objective: To explore the impact of medical education fellowships on the careers of graduates.

Methods: We performed a qualitative study with a constructivist-interpretivist paradigm using semi-structured interviews. We used a purposeful randomized stratified sampling strategy of graduates to ensure diversity of representation (gender, region, fellowship duration, and career stage). Subjects were invited by email to participate in semi-structured video interviews. Interviews were recorded and transcribed. Two researchers independently analyzed the data using a modified grounded theory approach and resolved discrepancies through in-depth discussion. Inter-rater agreement was 93.7%.

Results: The characteristics of the 10 participants are displayed in Table 1. Participants sought fellowship training because of their passion for education, for career preparation, and at the advice of mentors. Participants felt that fellowships provided formal training and important relationships in a supportive learning environment. Fellowship training gave fellows a community, helped them develop expertise, influenced their mindset and impacted careers in both the short and long term. Participants noted that fellowship enhanced their self-efficacy, broadened their educational world view, shaped their professional identity, validated their skill set, and prepared them for job tasks. Participants felt that fellowship increased their competitiveness in the job market, focused the direction of their career, helped develop their niche, and positively affected their career trajectory (Table 2).

Conclusion: Fellowship training in medical education broadly influenced the short and long-term mindset and careers of graduates.

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.

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