The Development and Implementation of a Simulation Orientation Curriculum for Newly Hired Pediatric Emergency Medicine Attending Physicians

ABSTRACT Background The transition from trainee to new attending physician can be overwhelming. Simulation has been shown to be effective in orienting trainees to the emergency department (ED) but there is limited literature on simulation for the orientation of newly hired attending physicians. Objective of the Innovation The objective of this innovation was to develop, implement, and evaluate a simulation curriculum to supplement the orientation of newly hired attending physicians in our emergency department. Development Process and Implementation We developed a year‐long quarterly simulation curriculum guided by Kern's six‐step curricular design model. Based on a targeted needs assessment, nine scenarios were chosen for inclusion. These scenarios were arranged to start the curriculum with those simulation scenarios that highlight systems and processes particular to our institution, with a transition towards scenarios requiring more complex team leadership and medical management decisions in the latter portions of the curriculum. Outcomes We have completed two years of this curriculum and have had 14 participants in total. Thirteen participants completed the end‐of‐year evaluation. The curriculum has been well received by participants with unanimous agreement that the curriculum helped them lead acute patient scenarios in the resuscitation bay during their first year as a new hire. Conclusions Simulation for the orientation of new attending physicians can be implemented successfully and received well by the targeted learners and by leadership invested in supporting new attending physicians. While the specific scenario topics and institutional procedures are site‐specific, the approach to curricular design and implementation is widely generalizable to other EDs.

Benchmark Performance of Emergency Medicine Residents in Pediatric Resuscitation: Are We Optimizing Education and Does Length of Training Matter?

ABSTRACT Background Pediatric critical resuscitations are high‐acuity, low‐occurrence events for emergency medicine (EM) providers in the United States (US). Concerns exist regarding graduating US EM resident preparedness due to limited exposure to critically ill children and variability of pediatric EM (PEM) curricula. This study sought to benchmark EM resident performance during simulated pediatric resuscitations, correlate performance and self‐efficacy, and compare differences between three‐ and four‐year EM residencies. Methods This was a prospective, cross‐sectional, cohort study (2019–2024) across eight US EM residencies. Participants were graduating residents leading pediatric resuscitation simulations (septic shock, status epilepticus, and cardiac arrest) and completed a self‐efficacy survey before participating. Simulations were scored using case‐specific checklists. Primary outcome was Total Performance Score (TPS), percent compliance with established guidelines, for combined performance data. Secondary outcomes included the correlation between TPS and self‐efficacy and the comparison between 3‐ and 4‐year programs. Results Of 103 eligible residents, 69 (67%) participated (56% PGY3, 44% PGY4). Performance gaps were consistent across cohorts. For the sepsis case, 9% delivered 60 mL/kg fluid within 15 min, and 9% initiated vasopressors afterward. For the seizure case, 73% checked glucose appropriately and 61% dosed dextrose correctly. For cardiac arrest, the compression rate was correct in 48%, a backboard was used in 25%, and correct epinephrine dosing approximated 60% of simulations. Mean TPS was 60.5 (±9.8), with no difference between 3‐ and 4‐year programs ( p  = 0.956). Self‐efficacy scores reflected moderate confidence, with 3‐year residents reporting higher confidence in trauma ( p  = 0.031) and respiratory failure ( p  = 0.008). Correlations between self‐efficacy and performance did not meet statistical significance. Conclusions Graduating US EM residents demonstrated moderate pediatric resuscitation performance with critical deficits in basic life support, medication dosing, and hemodynamic management. Program length did not impact outcomes. Findings underscore the need for structured, simulation‐based PEM curricula to improve pediatric education during EM training.

Minority Tax in Emergency Medicine Resident Physicians

ABSTRACT Objective To explore the minority tax experienced by underrepresented in medicine (URiM) emergency medicine residents. We aimed to (1) compare diversity, equity and inclusion (DEI) activity involvement between URiM and non‐URiM residents, (2) describe the support received by URiM residents for DEI activities, and (3) analyze associations between minority tax burden and perceived mentorship, depressive and anxiety symptoms, burnout, workplace discrimination, and institutional alignment. Methods A cross‐sectional survey of emergency medicine residents was conducted from July 2023 to May 2024. Data were analyzed using descriptive statistics and multiple linear regressions to assess differences in outcomes for those with minority tax burden. Minority tax burden was defined as spending more than the median number of hours per week on DEI as reported by non‐URiM residents. Results A total of 150 URiM and 50 non‐URiM residents completed the survey. URiM residents reported spending more time per week on DEI work (5.0 vs. 0.0 h; p  < 0.01). Of the URiM residents involved in DEI work, 28.0% held titled positions; 2.4% received compensation; 5.4% had DEI‐related training opportunities. Residents with minority tax burden reported less effective mentorship relationships ( β  = −35.65, 95% CI (−40.81, −30.48); p  < 0.01), increased discrimination ( β  = 4.90, 95% CI (3.98, 5.8)); p  < 0.01), and decreased institutional alignment ( β  = −3.17, 95% CI (−4.93, −1.41); p  < 0.01). There was no statistically significant association between minority tax burden and depressive and anxiety symptoms or burnout. Conclusion URiM emergency medicine residents were more likely to experience a minority tax through substantial DEI work. This was associated with less time for other clinical and academic responsibilities and less favorable workplace experiences. Minority tax burden was not associated with depressive and anxiety symptoms or burnout.

A Consensus Based Research Agenda for Faculty and Learner Development in Competency Based Medical Education

ABSTRACT Competency based medical education (CBME) is an outcome‐driven training model that assesses individual learners based on competencies and observable abilities. Although implementation of competencies and milestones by the Accreditation Council of Graduate Medical Education has provided some ground work, full adoption of CBME is in its infancy in emergency medicine. Successful implementation of CBME will require dedicated attention to faculty and learner development; however, there is limited data or best practices available for guidance. To address this need, the Society of Academic Emergency Medicine convened a consensus conference to establish a research agenda for CBME with one workgroup specifically focused on faculty and learner development. In this paper, we present a consensus research agenda for faculty and learner development in CBME designed to advance faculty development and learner engagement within CBME in EM over the next decade.

Using Large Language Model Artificial Intelligence to Enhance Clinical Competency Committee Insight

ABSTRACT Background Artificial intelligence, particularly large language models, has the potential to enhance the evaluation of residents, yet few studies have compared artificial intelligence to humans in the analysis of large volumes of clinical evaluations. The objective of this study was to evaluate the use of large language model (LLM) artificial intelligence (AI) on the evaluation of resident feedback. Methods The LLM Llama‐3.1 70B was used on a secure cluster to conduct an analysis of emergency medicine (EM) educator feedback for 31 EM residents at a residency program in the Southeastern United States. The large language model generated assessments summarizing resident strengths, weaknesses, and milestone‐based performance. Members of a clinical competency committee (CCC) blinded to the study hypothesis were surveyed to assess their perceptions on the quality, accuracy, specificity, and usefulness of the AI‐generated content compared to the human‐generated content. Results Human‐generated assessments averaged 79 words, while AI‐generated assessments averaged 391 words. Seventy percent of the CCC completed the survey, rating the AI‐generated content more favorably for quality, accuracy, and specificity compared to the human‐generated content. Usefulness of the human‐generated content was reported as good or very good by 71.4%, while usefulness of the AI‐generated content was rated as acceptable (54.1%) or unfavorable (28.6%). Conclusions Artificial intelligence can generate EM resident assessments with comparable or superior ratings of quality, accuracy, and specificity relative to human‐generated assessments. This highlights the potential of AI‐driven evaluations to streamline educator review processes, reducing workload without sacrificing integrity.

Antagonistic effect of rhizospheric bacteria against white rot ( Sclerotium cepivorum ) of garlic ( Allium sativum L.) under in vitro and in vivo conditions

Abstract Garlic ( Allium sativum) , a vegetable crop used for food, medicine, and condiments, is affected by white rot ( Sclerotium cepivorum ). Garlic yield reduction is influenced by several factors, with biotic stresses, particularly fungal pathogens, being among the most significant. The main aim of this work was to examine the effect of bacterial antagonists in preventing or controlling the attack of white rot. Bacterial antagonists and the phytopathogens were isolated and characterized using the serial dilution technique and standard microbiological procedures. The biocontrol properties of bacterial isolates, including fungal inhibition, production of hydrolytic enzymes, and bioactive compounds, were determined. Similarly, the in vivo inhibition potential of 10 selected antagonists was evaluated under greenhouse conditions. Eleven isolates, accounting for 47.8%, inhibited the radial growth of white rot at disease incidences of 1%–4% and 33.3%, respectively. Among the bacterial isolates, 10 (90.9%) showed cellulase activity, while 6 (54.6%) and 5 (45.5%) were positive for chitinase and protease production, respectively. Furthermore, 11 (100%) and 5 (45.5%) of the isolates were positive for ammonia and hydrogen cyanide production, respectively. Garlic plants treated with bacteria produced 135.0%–142.2%, and 291.7%–370.8% greater height and weight, respectively. The isolates exhibited 99% sequence homology with Pantoea species, including Pantoea agglomerans , as well as Enterobacter species, Enterococcus species, and E. gallinarum . The budget was one limitation to further evaluating the effect of bacterial antagonists against white rot affecting garlic under field conditions. This finding indicated that the application of potential microbial inoculants can control plant disease. Consequently, isolates WUGRB‐14 and ‐92 (where WUGRB is Wollo University Grasspea Rhizobacteria) can be recommended for field application as an alternative to chemical pesticides.

Hainan Longevity Model, Senile Degeneration, Cognitive Disability and Healthy Longevity

ABSTRACT The aging process is an inevitable and universal phenomenon characterized by a decline in function that all living organisms must undergo. The challenges posed by population aging, along with senile degeneration and cognitive disability, have emerged as pressing public health issues that require urgent attention on a global scale. The ability of older adults to maintain robust physiological function may confer resistance against the risk factors associated with senile degeneration and cognitive disability. Investigating centenarians who exemplify healthy longevity and their underlying mechanisms of functional resilience can aid in formulating preventive strategies aimed at achieving health, extending the lifespan, and identifying the pathways for promoting healthy longevity in the context of population aging. Hainan is the province in China where the largest number of centenarians and the highest density of centenarians are distributed. There are unique advantages to studying the centenarian population in Hainan. Hainan centenarians not only live in the natural environment with high oxygen concentration and dense greenery coverage but also inherit favorable genetic traits and adopt healthy lifestyles, including social participation, good education, stable emotion, balanced nutrition, moderate exercise, reasonable sleep, optimized senses, coordinated metabolism, improved immunity, prevention and treatment of chronic diseases, and joint treatment of comorbidities. These factors work together to form the Hainan longevity model (HLM), which is expected to play key roles in promoting healthy longevity and provide scientific evidence for achieving healthy longevity in the older populations. It will also contribute to the construction of a healthy human society and has important social value and practical significance.

Patient Satisfaction With Medication Pricing in Community Pharmacy Settings: A Cross‐Sectional Study of Individuals With Comorbidities

ABSTRACT Objectives The affordability of medication is a crucial factor influencing individual adherence to prescribed treatments. Fluctuating medication prices at community pharmacies can negatively affect long‐term adherence and contribute to poor health outcomes. Therefore, this study was conducted to evaluate public satisfaction with medication pricing at community pharmacies and to explore public perceptions of Malaysia's medication pricing policies. Methods A cross‐sectional study was conducted nationwide using a validated questionnaire and convenience sampling over 1 year. Participants with at least one comorbidity who purchased medications from community pharmacies were included in the study. Results Of the 438 respondents, 385 met the inclusion criteria, comprising 198 females and 187 males, with the majority aged 21–30 years ( n  = 121; 31.4%) and a mean age of 41 years (±15.8). Dizziness ( n  = 26; 6.8%) and asthma ( n  = 19; 4.9%) were the most common single medical conditions, while 73 respondents (18.96%) reported multiple conditions. Paracetamol ( n  = 51; 13.2%) was the most frequently prescribed monotherapy, while Amlodipine with Metformin ( n  = 6; 1.6%) was the most common combination therapy. The majority ( n  = 287; 74.5%) could afford medications comfortably, but 25.5% ( n  = 98) encountered challenges due to high costs, price discrepancies, and financial obligations. Most respondents ( n  = 275; 71.4%) believed that community pharmacy pricing was fair, while 28.6% ( n  = 110) disagreed due to high costs and inconsistencies. Overall, satisfaction with community pharmacy pricing was moderate (3.06 ± 0.93, p  = 0.207). Conclusions Strict enforcement of pricing controls is essential in the country to ensure life‐saving medications remain accessible to all economic groups and to promote adherence to prescribed treatments.

Overcoming Brain Healthism: Providing Support for Healthy Lifestyles

Prevalence and Correlates of Geriatric Depression: A Community‐Based Cross‐Sectional Study in Bangladesh

ABSTRACT Objectives This study aimed to estimate the prevalence of geriatric depression and identify its associated socio‐demographic, lifestyle, health, and psychosocial determinants among community‐dwelling older adults in Bangladesh. Methods A community‐based cross‐sectional study was conducted between April and December 2024 among 719 adults aged ≥ 60 years, selected by multistage random sampling across four administrative divisions. Data were collected using interviewer‐administered questionnaires. Depression was assessed using the GDS‐15 (cut‐off ≥ 5). Logistic regression models were applied to identify determinants, and adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported. Results The prevalence of geriatric depression was 35.2%. Poor family bonding (AOR = 6.580, 95% CI = 3.540–12.210, p  < 0.001), financial instability (AOR = 3.660, 95% CI = 2.550–5.260, p  < 0.001), dissatisfaction with lifestyle (AOR = 3.590, 95% CI = 2.240–5.770, p  < 0.001), and daily life stress (AOR = 3.640, 95% CI = 2.560–5.190, p  < 0.001) were significant predictors. Comorbidities, lack of regular exercise, mobility, and hearing problems also increased depression risk. Conclusion Geriatric depression is common in Bangladesh and influenced by multidimensional determinants. Integrating geriatric mental health services into primary care and strengthening family and social support systems are essential for prevention and early management.