How to Cite Videos, Podcasts, Apps, Media, and Blogs in a Publication or CV (AMA style 11th edition)

cite AMA 11th edition reference blog media podcast

As medical education podcasts, videos, and blogs continue to grow in popularity it is crucial that we cite them correctly, both in publications and on our CVs. We also must recognize the important contributions of media such as clinical photographs, radiology images, and ECGs. The American Medical Association (AMA) Manual of Style released its 11th edition in 2020. This blog post provides an update to our 2018 blog articles to reflect these changes.

Video Publications

Last Name First Initial. Video Title. Publication Title. Year of publication. Date accessed. URL.

Example:

Podcasts and Other Audio

Last Name First Initial. Podcast Title. Episode Title. Date Published. Date Accessed. URL.

Example:

Apps

App Title app. Version number. Creator/Publisher. Date of last update.

Example:

    • CorePendium app. Version 1.24.2. EM:RAP. Updated February 2024.

Photographs, ECGs, Radiology Images

These fall into the category of “other multimedia” in the AMA Manual of Style, and here is my best attempt to interpret this to clinical media.

For Media Used as a Supplement in a Publication:

Last Name First Initial. Media title. Date Published. Date Accessed. URL. Brief Description for: Article Title. Publication. DOI (if available).

Example:

For Media Without an Associated Publication:

This type of citation may be helpful if the image is used in multiple places within a publication, or if it is not tied to a particular publication. In the example below, there is no specified date of publication for the image.

Last Name First Initial. Media title. Date Published. Date Accessed. (if available). URL.

Example:

Blogs

Last Name First Initial. Article Title. Blog Title blog. Date Published. Date Accessed. URL.

Example:

References

  1. Iverson C, ed. American Medical Association manual of style: a guide for authors and editors. 11th ed. Oxford University Press, 2020.

EM Match Advice 42: Mid Interview Season Check-In

EM Match Advice featuring Dr Aaron KrautDr. Sara Krzyzaniak (podcast host and Stanford University PD) and Dr. Michelle Lin (ALiEM Founder/UCSF) are joined by Dr. Aaron Kraut (University of Wisconsin PD) in this insightful, rapid-fire, practical episode through the lens of experienced residency program directors.

  • What does the Electronic Residency Application Service (ERAS) preliminary data show just far for the 2024 residency application season?
  • Has the program signaling option been working? 
  • Have there been any surprises or changes during interview season?
  • What should students think about in the post-interview stage? 

Episode 42: Mid Interview Season Check-In

 

Preliminary ERAS Data for Emergency Medicine Residency

Number of Applicants for EM Residency

Graduate TypeERAS 2023ERAS 2024
DO9441,340
IMG7631,437
MD1,4841,568
Overall3,1914,345

 

Average Number of Applications per Person*

Graduate TypeERAS 2023ERAS 2024
DO5950
IMG6348
MD4942
Overall5647

 

Average Number of Applicants per EM Residency Program*

Graduate TypeERAS 2023ERAS 2024
DO202239
IMG175245
MD265238
Overall642722

 

* Values were rounded to whole numbers

 

Mentioned Links

  1. Preiksaitis C, Krzyzaniak S, Bowers K, et al. Characteristics of Emergency Medicine Residency Programs With Unfilled Positions in the 2023 Match. Ann Emerg Med. 2023;82(5):598-607. doi:10.1016/j.annemergmed.2023.06.002. PMID 37436344
  2. Jewell C, David T, Kraut A, Hess J, Westergaard M, Schnapp BH. Post-interview Thank-you Communications Influence Both Applicant and Residency Program Rank Lists in Emergency Medicine. West J Emerg Med. 2019 Dec 9;21(1):96-101. doi: 10.5811/westjem.2019.10.44031. PMID: 31913827; PMCID: PMC6948692.

Read and Listen to the Other EM Match Advice Episodes

Blog posts: https://www.aliem.com/em-match-advice-series/

 

Coaching for Faculty: The Secret to Unlocking Professional Success

coaching for academic faculty unlock professional success

Dr. Garcia is a freshly minted faculty member at Big Name University Medical Center. She’s excited to have finally finished residency and dive into her career as a full time (and fully paid) attending. After spending her first year acclimating to the new department and achieving board certification, Dr. Garcia finds herself at a bit of a crossroad. She likes teaching, but are not sure residency or medical student education leadership is for her. The same goes for clinical operations and research – interesting, but there hasn’t been any “a ha” moment to illuminate her calling. She heard that “saying yes” to opportunities is important, but after a year of “saying yes,” Dr. Garcia feels swamped: she is serving on the residency clinical competency committee, a department committee for managing boarding, and collaborating on a departmental research initiative. Despite this, she receives no salary support to lower her clinical time, and is starting to feel like there is no real forward progress in her career.

It ain’t easy being an attending

Attending life has its challenges.

New residency graduates suddenly have to adjust to the daunting responsibility of independent practice and meeting clinical performance metrics. Those who take the academic route face unclear promotion expectations, uncertainty about their niche, and a double-whammy of high clinical burden and a tacit expectation that you “prove” your worth as a teacher by taking on more tasks before being rewarded with salary support. Senior faculty face entirely different challenges; once-sharp clinical skills may have dulled over time, or the academic career hits a dead end – be it through stagnation, boredom, or waning interests. And as study after study tells us, everyone is susceptible to burnout. It should be no surprise that academic clinical educators are at high risk for burnout, stalled career advancement, and abandonment of academic medicine altogether [1, 2].

Systemic changes are undoubtedly needed for these system-wide issues. But what can Dr. Garcia – or you – do? Well, instead of passively waiting for Godot, you can seize the initiative and bend the arc of your career into alignment with your values, strengths, and passions, and, by extension, toward fulfillment. And that’s exactly the purpose of a coach.

A coach? Aren’t they for learners, or leaders, or long-jumpers?

Yes… and also for faculty just like you. Each of those groups has their own flavor of coaching (academic, executive/leadership, and performance, respectively). But in your case, professional development coaching might be just what the doctor ordered.

Let’s start with the obligatory definition of coaching. The International Coaching Federation defines a coach as partnering with clients:

“…in a thought-provoking and creative process that inspires them to maximize their personal and professional potential. The process of coaching often unlocks previously untapped sources of imagination, productivity and leadership.”

Personally, I like keeping it simple:

When you’re stuck in life, a coach is a great tool to help you get unstuck.

By working in partnership with you, they ask thought-provoking reflective questions; help you discover your core values and develop valuable personal insights; guide you to creating authentic and actionable goals; and help you be accountable to achieving those goals. This Journal of Graduate Medical Education article “Choosing When to Advise, Coach, or Mentor” [PDF] provides a succinct review [3].

But isn’t coach just another name for “mentor?”

In short, no.

Mentorship can be incredibly beneficial to one’s career, and many mentors use coaching skills while guiding their mentees. But mentorship differs from coaching in a number of ways.

Mentors are typically senior, have shared expertise in a content domain, and serve as a font of knowledge for their benefit. Unfortunately, evidence shows that many, if not most, faculty struggle to find, receive, or maintain satisfactory mentorship [4, 5].  What’s more, what happens when you’re more established? When you’re advanced in your career, correct answers are less clear, and there might not be any senior mentor to guide your hand.

Coaching, by comparison, starts from the premise that you are the world’s foremost expert on your own life, and that within you lies all the creativity and resourcefulness to overcome any challenge. Sometimes, though, we can’t see the forest from the trees. A coach helps you gain insight and illuminate the obstacles in your way. Once your perspective is clear, you can create a plan to succeed. A coach, then, acts as a partner (not a guide), helping you think, reflect, and act. Figure 1 is a helpful idea of how a coaching partnership will look, but the key difference from mentorship is that you are the source of all insight and action, not the coach.

coaching analysis flowchart

Figure 1: The Coaching Partnership

Clearly there can be overlap between these important academic relationships, but, at its core, coaching is distinguished by: [3, 6]

  1. Being driven by an agentic coachee that is ultimately responsible for choosing to take action
  2. Not requiring the coach to be in the same field as the coachee
  3. Not being centered around transfer of expertise from a more knowledgeable or experienced party to the recipient

So what should coaching be used for?

The most supportive data for coaching in medicine is for physician wellness and mitigating burnout [7]. Beyond that, evidence suggests that coaching is positively associated with:

  • Achievement of professional goals and personal empowerment [8]
  • Self-confidence [9]
  • Stress management [9]
  • Reflective capacity for interpersonal interactions [9]
  • Better teaching skill transfer [10]
  • Teacher identity development [10]
  • Better learning environment [10]
  • Faculty academic productivity [11]

The breadth of associated outcomes here show the multifunctional and flexible nature of coaching. When you’re stuck, a coach is a great way to help you get unstuck.

What should I look for in a coach?

Before jumping into details, it’s important to share 2 important and interrelated points.

  1. The bedrock that undergirds the work of coaching is the relationship between the coach and coachee. Thus, think of a finding a coach as akin to finding a partner. You wouldn’t settle down with the first person you go on a date with, right? Seek out multiple coaches, talk about your needs with them, and see which one is the best fit for you specifically. Similarly, successful coaching requires you, as the coachee, to feel psychologically safe with your coach. Internal coaches may be free and easy to access, but you may not feel comfortable being truly vulnerable with someone at your institution or, worse, to whom you report. Conversely, external coaches may provide complete anonymity and psychological safety, but they will require some kind of financial remuneration – be it from you, your CME funds, or your department/institution.
  2. There is very little regulation in the coaching world. You, after reading this article, could think this coaching thing sounds swell and launch a business tomorrow calling yourself a coach. In order to make sure you’re working with someone who has received specialized training or has sufficient coaching experience, ask for a certificate from a training program and/or accreditation by one of the governing bodies of coaching, like the International Coaching Federation or Center for Credentialing and Education.

The following table provides a brief guide of the responsibilities that can also help guide your search for a prospective coach:

CoachCoachee
Communication StrategyPose probative, open-ended questions to build professional rapport and stimulate coachee reflection.Provide answers stemming from open, genuine, vulnerable self-reflection.
Goal SettingEncourage effective coachee goal-setting practices (e.g., SMART, WOOP).Assume responsibility for crafting and monitoring progress on their own goals.
OwnershipKeep the coachee at the center of the experience, striving to help them arrive at their own answers whenever possible.Acknowledge ownership and control over the quality and outcome of the experience
MindsetPositive psychology:

  • Provide nonjudgmental empathy
  • Encourage learners to identify and engage in their strengths
  • View coachee with positive regard

Acknowledge when an issue is outside of their skillset (and recommend appropriate assistance).

Continuously strive to be more self-aware and accountable.

Be open to new advice, suggestions, or input that may not immediately align with existing perspectives.

Reframe struggle as an indicator of growth and not failure.

Professionalism
  • No conflict of interest between parties (e.g., assessment, advancement, allocation of resources)
  • Open, honest, respectful communication
  • Meeting punctuality and responsiveness to communication
  • Commitment to tasks that are collectively agreed upon during sessions
  • Maintenance of confidentiality

Ok, I’ll bite. How do I go find a coach?

Because coaching is still in an “early adoption” phase within medicine, you’ll have to be proactive to find a suitable coach. This short Journal of Graduate Medical Education article, Coaching for Clinician Educators [PDF] covers how to prepare for, find, and succeed with a coach [12]. Full disclosure: I am one of the authors, so take my recommendation under advisement!

With that aside, here are some general tips for finding a coach:

  1. Look internally: Many institutions are starting internal coaching programs. Ask around within your department to see if this is an option.
  2. Contact a coach training programs: There are numerous coaching programs that train professional coaches, possibly even at your home institution. Coach trainees are required to accrue many hours of practice, and often do so at a discount from market rates. This could be an excellent way to have a coach outside of your immediate orbit, but also not have to pay a significant amount.
  3. Look online: A casual internet search will connect you to any number of coaches. You can seek coaches who are emergency physicians, physicians of other specialties, or have no affiliation or background within healthcare. The more you look, the more options you’ll find.
  4. Ask around: Some of your colleagues may have used a coach, know a coach, or are themselves a coach, without you ever knowing.
  5. Remember your CME stipend: Check with your institution, but in most instances coaching is an acceptable form of CME or professional developmet expenditure.

The Takeaway

Coaching is one of many tools at your disposal to unlocking success in your career. It’s especially useful when you’re stuck, be it through gaining a new perspective, making a hard choice, or breaking the paralysis of analysis. Give it a try and see if it can help you!

References

  1. Chapman AB, Guay-Woodford LM. Nurturing passion in a time of academic climate change: the modern-day challenge of junior faculty development. Clin J Am Soc Nephrol. 2008;3(6):1878-1883. PMID 18945997
  2. Elster MJ, O’Sullivan PS, Muller-Juge V, et al. Does being a coach benefit clinician-educators? A mixed methods study of faculty self-efficacy, job satisfaction and burnout. Perspect Med Educ. 2022; 11(1):45-52. PMID 34406613
  3. Marcdante K, Simpson D. Choosing When to Advise, Coach, or Mentor. J Grad Med Educ. 2018; 10(2):227-228. PMID 29686766
  4. Jordan J, Coates WC, Clarke S, et al. The Uphill Battle of Performing Education Scholarship: Barriers Educators and Education Researchers Face. West J Emerg Med. 2018 May;19(3):619-629. PMID 29760865
  5. Bentley S, Stapleton SN, Moschella PC, et al. Barriers and Solutions to Advancing Emergency Medicine Simulation-based Research: A Call to Action. AEM Educ Train. 2019 Nov 27;4(Suppl 1):S130-S139. PMID 32072117
  6. Wolff M, Deiorio NM, Juve AM, et al. Beyond advising and mentoring: Competencies for coaching in medical education. Med Teach. 2021; 43(10):1210-1213. PMID 34314291
  7. Boet S, Etherington C, Dion PM, et al. Impact of coaching on physician wellness: A systematic review. PLoS One. 2023 Feb 7;18(2):e0281406. PMID 36749760
  8. Pearce MJ. Professional Development Coaching for Health Professions Graduate Faculty: A Pilot Implementation. J Contin Educ Health Prof. 2022; 42(4):291-293. PMID 34966110
  9. McKnight R, Papanagnou D. Coaching junior faculty for the uncertainties of academic professional practice. Int J Med Educ. 2021;12:179-180. PMID 34592715
  10. Bajwa NM, De Grasset J, Audétat MC, et al. Training junior faculty to become clinical teachers: The value of personalized coaching. Med Teach. 2020; 42(6):663-672. PMID 32130055
  11. Schulte EE, Alderman E, Feldman J, et al. Using the “Coach Approach”: A Novel Peer Mentorship Program for Pediatric Faculty. Acad Pediatr. 2022;22(7):1257-1259. PMID 35381378
  12. Branzetti J, Love LM, Schulte EE. Coaching for Clinician Educators. J Grad Med Educ. 2023;15(2):261-262. PMID 37139204

Disclaimer: The author, Dr. Jeremy Branzetti, is the founder of Academic Educator Coaching and is a certified professional coach.

IDEA Series: Specialised Lectures in Emergency Medicine (SLEM) – A virtual conference to strengthen EM education in the developing world

Specialised lectures in emergency medicine, virtual conference, developing world
The Problem: Emergency Medicine (EM) in Pakistan has moved from developing to developed stage in the last decade [1]. As the specialty evolves in Pakistan and other countries, there is a need to improve and assimilate novel learning methods to elevate education standards. The COVID-19 pandemic catalyzed the routine use of video-conference platforms such as Zoom. Virtual educational programming offers the opportunity to leverage educational resources across space and time, foster collaborations, and improve knowledge, clinical and evidence-based practice globally.

The Innovation

Specialised Lectures in Emergency Medicine (SLEM) is a virtual program for learning, collaboration and social engagement. The program invited experts from internationally acclaimed institutes with varying interests to present their experiences, observations, opinions, and protocols. It is an innovation that is based on a community of practice merged with the need-based assessment of a young EM residency program in a developing country.

The Learners

The target learners were EM residents and physicians practicing in the emergency department. The presenters were selected based on their experience, Free Open Access Medical (FOAM) educational materials, research, blog posts, and presentations from reputable conferences.

Group Size

SLEM accommodated 50-100 participants.

Materials

Our activity utilized simple, readily available resources. The following materials are needed:

  1. Video-conference platform: We used Zoom, a proprietary video-conferencing software program. The free plan allows up to 100 concurrent participants, with a 40-minute time restriction. Users have the option to upgrade by subscribing to a paid plan. The highest plan supports up to 1,000 concurrent participants for meetings lasting up to 30 hours. For SLEM, the paid subscription was necessary to accommodate up to 1 hour long lectures for some topics. Because of the risk of disruptive, non-invited participated, we recommend enabling the waiting room function, whereby only registered participants could join.
  2. Internet connection: A stable internet connection is a must. In order to avoid connectivity issues with Wifi, the event administrators broadcasted from an ethernet-connected computer.
  3. Engagement team: We formed a team including 5-6 residents to engage other participants and ask questions of the speakers relevant to local practice. This effort enhanced psychological safety for other participants to speak up, ask questions, and participate in the conversation following lectures.
  4. Security squad: We formed a separate team of 4 residents to oversee any non-registered participants joining the video-conference, who may generate security issues.
  5. Video library: All the lectures were recorded so that they can be referenced later by the residents.

Description of the Innovation

Speaker Identification: SLEM lecture presenters were individually approached through a defined methodology depicted in Figure 1. The program started in April 2021. The selection of the presenters was based on their published FOAM resources and scores of each were reviewed on an objective grading system that was adopted from Academic Life in Emergency Medicine (ALiEM) [2]. In addition to their content, additional factors considered included: the supporting evidence cited in their content, the referencing of their content in peer and non-peer reviewed publications, their content gradation as per the Social Media Index, and review of their faculty profiles and areas of expertise from the university website. The presenters also recommended their peer faculty who were similarly reviewed and assessed prior to the designation of the topic followed by the talk.

Topic Selection: Topics were selected based on the speaker’s previous academic lectures and area of expertise, although occasionally the presenter chose a different topic approved by the organizers based on their academic profile. Topics were selected based on disease prevalence in Pakistani EDs, published literature describing gaps in resident education and expertise, and gaps identified during academic core meetings. The presenters were then approached through either their official email address, the email address from their FOAM website, Twitter, Facebook, publications, or institution website. Upon confirmation of the lecture, an online calendar invitation including a Zoom link was shared with the presenter.

Publicity: The conference was widely advertised with promotional materials [brochure, video]via Twitter, WhatsApp, and the national EM society listserv.

Video-conference Schedule: Sessions took place virtually, starting with a 5-minute introduction of the presenter, followed by a 45-minute talk, and closing with a 15-minute question and answer session.

Lecture Evaluation: Post-session evaluation forms were shared with the residents and faculty after each session to gather feedback. Each SLEM lecture’s quality was evaluated through the internationally validated, reduced version of the Students’ Evaluation of Educational Quality (SEEQ) [3]. Originally developed by Marsh et al., this tool assesses the level of student satisfaction with teacher effectiveness to improve teaching quality. It has an excellent reliability, internal consistency, validity, and quality and has the flexibility to fit into individual teaching contexts. Reduced SEEQ is useful for quickly gathering data and decreasing the risks of item nonresponse and has been extensively studied at the postgraduate level. The variables weighted most heavily for SLEM included:

  • Learning
  • Individual rapport
  • Enthusiasm
  • Organization
  • Breadth
  • Group interaction
  • Overall rating

At the conclusion of the overall event, each participant had the opportunity to complete an online evaluation developed using Google Forms to provide feedback to the organizers. Several participants were selected for a brief, follow-up interview to explore their reactions and gain additional feedback.

The first SLEM virtual conference was successfully held July 20, 2023. Additional materials for the activity are available upon request by contacting Dr. Shahan at [email protected].

SLEM virtual conference flowchart design

Figure 1: SLEM Conference Planning and Design

Lessons Learned

SLEM has played an important role in strengthening the academic component of our developing residency. Despite the sessions being held virtually and after hours, the resident and faculty were engaged and reported increased knowledge and clinical practice improvement. Our target audience of trainees and junior to mid-level faculty especially appreciated the SLEM conference, as they appreciated tips from more senior clinicians. Additionally, the planning team developed strong bonds through the process, paving the way for future collaboration. The sessions overall contributed to the formation of a global community of practice by engaging speakers at different institutions around the world.

During planning, we faced challenges coordinating across time zones. Sending electronic calendar invitations explicitly stating the time zone along with the time was important for avoiding errors. Deploying our security teams, a robust registration system, and the waiting room function in Zoom were important strategies for avoiding disturbances to the event. Our engagement team also helped keep our participants active despite the large audience and virtual format.

IDEA series SLEM organizers

Figure 2. Team SLEM after successfully executing the SLEM conference

Theory behind the innovation

The educational theory supporting our initiative was community of practice [4]. The underlying principle highlights that learning occurs through social engagement in authentic contexts. The SLEM presenters and audiences (EM residents and faculty) were all individuals with shared interests and personal experiences relevant to the practice of EM.

Closely related, social cognitive theory also underpins the SLEM innovation. This theory postulates that learning occurs in social contexts and involves the reciprocal interaction of the individual, behavior, and the environment [5]. SLEM provided learners with the opportunity to receive experiential and tacit knowledge directly from clinical experts, which can then be applied, tested, and adjusted in their own environments. SLEM created a venue for dissemination of perspectives, discussion, and international practice change.

References

  1. Waheed S, Ali N. Chief Resident Election of Emergency Department (CREED)–An innovative approach to fair and bias-free chief resident selection in a residency program. Pakistan Journal of Medical Sciences. 2022;38(6):1717. PMID 35991269
  2. Brindley PG, Byker L, Carley S, Thoma B. Assessing on-line medical education resources: A primer for acute care medical professionals and others. Journal of the Intensive Care Society. 2022;23(3):340-4. PMID 36033246
  3. Coffey M, Gibbs G. The evaluation of the student evaluation of educational quality questionnaire (SEEQ) in UK higher education. Assessment & Evaluation in Higher Education. 2001;26(1):89-93.
  4. Schwen TM, Hara N. Community of practice: A metaphor for online design? The Information Society. 2003;19(3):257-70.
  5. Bandura A. Social cognitive theory of self-regulation. Organizational behavior and human decision processes. 1991;50(2):248-87.

EM Match Advice 41: The 2024 ERAS Application – New and Improved

em match advice podcast new eras applicationDr. Sara Krzyzaniak (EM program director at Stanford) hosts this episode with Dr. Michelle Lin (ALiEM/UCSF) featuring all-star guests Dr. Alexis Pelletier-Bui (EM associate program director at Cooper University Hospital) and Dr. Elizabeth Werley (Chair of CORD Application Process Improvement Committee, Penn State Hershey). Both our guests serve as key representatives on behalf of the EM specialty on the AAMC ERAS Supplemental Application Working Group and provide you with a sneak peek behind what is coming for the totally revamped ERAS application for the new 2024 application season.

It will be helpful to download and view the advanced copy of the entire ERAS application while listening to this episode, as we dive into the nuts and bolts of completing the application. 

Episode 41: New ERAS Application

 

Useful Links

Read and Listen to the Other EM Match Advice Episodes

Blog posts: https://www.aliem.com/em-match-advice-series/


 

By |2024-01-04T16:11:31-08:00Jul 24, 2023|EM Match Advice, Medical Student, Podcasts|

Mismatch: Why were there so many unfilled emergency medicine residency positions in 2023?

The Study

In an Annals of Emergency Medicine paper, Preiksaitis et al. sought to identify program factors associated with unfilled post-graduate year 1 (PGY-1) emergency medicine (EM) positions in the 2023 Match [1]. The authors completed a cross-sectional, observational study using National Residency Matching Program (NRMP) data and examined 9 variables as potential predictors of unfilled PGY1 positions using regression analyses [2].

The Findings

The authors identified 6 program characteristics associated with unfilled EM PGY-1 positions in the 2023 Match:, smaller program size (< 8 residents), Mid-Atlantic or East North Central location in the United States, prior accreditation by the American Osteopathic Association, unfilled positions in the 2022 Match, and corporate ownership structure. Program type, length, proximity to other programs, and first accreditation year were not predictive characteristics. Many of these findings were similar to a study of the 2022 EM Match results by Murano et al., as well as an analysis of the 2023 Match by Pupazan and Cook in Emergency Medicine News [3,4].

Match 2023, mismatch, emergency medicine residency programs unfilled positions

Match Data

The unprecedented numbers of unfilled PGY-1 EM residency training positions in the NRMP Match results shocked the specialty these last two years. In 2022, unfilled PGY-1 positions totaled 219 (7.9%), and 554 (18.4%) positions were unfilled in 2023 [2,5]. In contrast, the greatest number of unfilled PGY-1 positions in the last decade was 30 (1.2%) in 2019 [6]. A staggering 131 (47%) EM residency programs had unfilled PGY-1 positions among in 2023 [7].

What does this mean for the future of EM?

Who knows? We can’t make such predictions based on data from only 1 Match cycle. We need to closely follow these numbers in the coming years to fully understand trends in student behavior and program expansion. EM was once considered a competitive specialty, but the current supply/demand mismatch of positions to applicants now suggests otherwise. Without a significant influx of additional applicants, the high unfilled rate for EM is likely to continue for the next several years. This has implications for the composition of the EM physician workforce and its adequacy to meet the rising demand for emergency services.

Is student disinterest the problem?

Many have focused on changes to specialty preferences by students as the major driver in these dramatic Match results. However, the decrease in applicants to EM programs may not be the whole story. 2021 was an unusual outlier in the EM Match, likely fueled by the unique circumstances surrounding the COVID pandemic. Comparison of today’s applicant numbers to data from 2021 gives a false impression of applicant numbers. In fact, the average number of applicants between 2015-2020 and 2022-2023 were relatively similar, with the latter demonstrating 122 more applicants (2,801 vs 2,923). However, between 2015 and 2023, the number of available EM positions grew, with an annual addition of 149 PGY1 positions. Although the establishment of new EM programs is often cited as the source of this growth, anywhere from 25-50% of these new positions were due to the expansion of existing residency programs over several different years. With these data in mind, it makes sense to consider the program factors associated with unfilled residency positions and ensure that we don’t exclusively focus on improving recruitment.

What can residency programs do in this upcoming Match cycle?

Programs that have one or more of the characteristics identified in this study are at risk of being unfilled in the Match once again in the next cycle. Many of these characteristics are immutable. Deliberate actions are required to mitigate the risk:

    • Interview more candidates
    • Submit a longer Rank Order List
    • Optimize program website and digital presence
    • Broaden online recruitment efforts to target students in other regions of the country
    • Enhance marketing efforts for medical students at nearby schools
    • Improve the ‘brand experience’ for visiting students and applicants on interview day

What can we do to help recruitment for our specialty?

Excerpted from the paper, “The most impactful elements of student recruitment to our specialty remain unchanged: student mentorship and exposure to the elements of emergency medicine that make for a rewarding career.”

  • Mentor pre-clinical medical students to build early interest in the field
  • Describe your love for the specialty during ED shifts with students
  • Remain positive when interacting with students
  • Don’t role model burnout on shift
  • Explain the limitations of recent EM workforce projections

Conclusion

In conclusion, the landscape of the EM Match is shifting, evidenced by the startling numbers of unfilled PGY-1 positions in recent years. Our deep dive into the factors contributing to these outcomes shed light on several program characteristics associated with unfilled positions. It’s important, however, not to let these figures contribute to a panic regarding the future of EM.

Sure, the increase in vacant spots seems unnerving at first glance, but there’s context to be considered. The surge in EM positions and the relatively steady number of applicants speaks volumes about the supply-demand dynamics at play, something that will require a detailed exploration in its own right. Data points like these do not exist in a vacuum. They’re part of a larger, interconnected system influenced by myriad factors — from medical school experiences to external forces like the pandemic, the changes in the employment structure of many emergency departments, and the current landscape of the healthcare system in general.

Absolutely, the key mission of EM – providing quality care to everyone, at any time – stays constant even as we face these challenges. Remember, even though there were 554 unfilled positions from the 2023 Match, an impressive 90.4% (501 positions) were filled during the Supplemental Offer Acceptance Program (SOAP) [5].  For now, the current workforce and pipeline of new emergency physicians appears stable.

While it’s important to understand and address the dynamics of recruitment, our main goal should always be the training of new doctors. Right now, there are 2,957 interns just starting out who need our guidance and support. They’re the future of our specialty, and our priority should be to help them become the best emergency physicians they can be. Despite the ups and downs of the Match process, let’s not lose sight of our most important job: training the next generation of EM physicians.

References:

  1. Preiksaitis C, Krzyzaniak S, Bowers K, Little A, Gottlieb M, Mannix A, Gisondi MA, Chan TM, Lin M. Characteristics of Emergency Medicine Residency Programs With Unfilled Positions in the 2023 Match. Ann Emerg Med. 2023 Jul 11:S0196-0644(23)00429-8. PMID: 37436344.
  2. National Resident Matching Program. 2023 Main Residency Match: Advanced-Data Tables. Published March 17, 2023.
  3. Murano T, Weizberg M, Burns B, Hopson LR. Deciphering a Changing Match Environment in Emergency Medicine and Identifying Residency Program Needs. West J Emerg Med. 2023;24(1):1-7. PMID: 36735008.
  4. Pupazan, Ionut MD; Cook, Thomas P. MD. Unfilled Residencies were Newer, Rural. Emergency Medicine News 45(7):p 1,22, July 2023.
  5. National Resident Matching Program. 2022 Main Residency Match: Results and Data. Published May 2022.
  6. National Resident Matching Program. 2023 Main Residency Match By the Numbers. Published March 2023.
  7. National Resident Matching Program. NRMP Program Results 2019-2023 Main Residency Match. Published March 2023.

EM Match Advice 40: Program Directors Reflect on the 2023 Match

em match advice series - episode 40 PD's reflect on 2023 match

The 2023 Emergency Medicine Match was an unprecedented year that took many of us in the education community by surprise. There were 132 (46%) EM residency programs with at least one unfilled PGY-1 position, and there were 554 (18.4%) overall unfilled EM positions. Dr. Sara Krzyzaniak (EM program director at Stanford) hosts this important episode with Dr. Michelle Lin (ALiEM/UCSF), reflecting on the whys, hows, and what nexts. Fortunately we have experts Dr. Abra Fant (Northwestern PD) and Dr. Richard Church (University of Massachusetts PD) to help us with a deeper dive and forecasting the future.

Episode 40: Reflections on 2023 Match



The Slide: How Competitive was the 2023 EM Match?

The Slide: EM Match 2023 and Historical Data

How Competitive Were Other Specialties in the 2023 Match?

EM Match Advice Competitive of Other Specialties 2023

References

  • Marco CA, Courtney DM, Ling LJ, et al. The Emergency Medicine Physician Workforce: Projections for 2030. Ann Emerg Med. 2021;78(6):726-737. doi:10.1016/j.annemergmed.2021.05.029
  • Gettel CJ, Courtney DM, Janke AT, Rothenberg C, Mills AM, Sun W, Venkatesh AK. The 2013 to 2019 Emergency Medicine Workforce: Clinician Entry and Attrition Across the US Geography. Ann Emerg Med. 2022 Sep;80(3):260-271. doi: 10.1016/j.annemergmed.2022.04.031. Epub 2022 Jun 16. PMID: 35717274; PMCID: PMC9398978.

 

Read and Listen to the Other EM Match Advice Episodes

Blog posts: https://www.aliem.com/em-match-advice-series/


 

By |2023-05-16T15:24:48-07:00May 17, 2023|EM Match Advice|
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