Availability of Emergency Medicine Away Rotations.

ORIGINAL CONTRIBUTION Availability of Emergency Medicine Away Rotations Michael Kiemeney, MD1 , and Doug Franzen, MD, MEd2 ABSTRACT Objectives: Residency directors in emergency medicine (EM) have been placing increased value on the Standardized Letter of Evaluation to evaluate the escalating numbers of residency applications received each year. This has placed added significance on EM away rotations (ARs). We sought to determine the overall availability of ARs in EM. Methods: We surveyed clerkships sites at the end of 2018–2019 application season. The survey requested data about maximum rotation spots available, actual number of students that rotated, and data about application processing and rotation offer decision making. Results: We received 190 responses, of which 129 (49% of 262 clerkship sites surveyed) provided data regarding available positions and student rotators. A total of 3,472 ARs were completed at the responding sites. The average capacity ratio (CR; maximum available AR spots divided by AR completed by students) for responding sites was 1.57. AR availability varied by time and geography. Most AR positions were filled during peak season (CR = 1.22); however, many went unfilled outside of this time frame (CR = 2.41). Geographic data showed some locations had significant unfilled AR availability. Conclusions: Our survey data show that there are at least 1.5 AR positions per applicant. Students can be reasonably expected to complete one AR and, in select cases, a second. CR during peak season indicates nearly saturated AR positions. Flexibility of rotation timing and tools to link open AR positions with students needing to complete a rotation will help optimize filling available AR positions. Continued effort in application advising from home clerkships and processes to ensure equitable distribution of AR positions among students will help ensure interested students obtain a position. I n recent years, completing an emergency medicine (EM) rotation at another program, also known as an “away rotation” (AR), has become increasingly important for applicants to EM residency programs.1–4 The clerkship grade and Standardized Letter of Evaluation (SLOE) from ARs offer program directors an objective second opinion of a student’s performance and are highly valued by PDs when reviewing applications.1–4 Students are advised, both formally and by peers, to complete at least one AR.5–7 Although a third rotation is not recommended in most cases, some students are completing multiple ARs.6,8,9 Students and their advisers have reported difficulty obtaining ARs. In a recent study, students reported applying to an average of 15 ARs.10 Given the importance of the AR in the EM application process, we sought to determine if sufficient ARs exist to meet student needs. We hypothesized sufficient AR availability but that other factors including application processing, competition among students, and timing create an impression of limited supply. From the 1Department of Emergency Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USA; and the 2Department of Emergency Medicine, University of Washington, Seattle, WA, USA. Received March 6, 2020; revision received May 21, 2020; accepted May 28, 2020. Presented at the Council of Residency Directors (CORD) Academic Assembly, Seattle, WA, April 2019. The authors have no relevant financial information or potential conflicts of interest to disclose. Author contributions: study concept and design—MK and DF; critical revision of the manuscript—MK and DF; statistical expertise—MK and DF; and acquisition of funding—none. Supervising Editor: Daniel P. Runde, MD. Address for correspondence and reprints: Michael Kiemeney, MD; e-mail: . AEM EDUCATION AND TRAINING 2021;5:1–5 © 2020 by the Society for Academic Emergency Medicine doi: 10.1002/aet2.10487 ISSN 2472-5390 1 2 METHODS We created an 18-item survey (Data Supplement S1, available as supporting information in the online version of this paper, which is available at http://online library.wiley.com/doi/10.1002/aet2.10487/full) using Qualtrics software, Version February 2019. The survey started with a brief project summary and was organized in three sections. Questions about application processing (i.e., who selects students to complete an AR?) were multiple choice. The second section asked the number of applications received, maximum number of visiting students, and actual number of rotating students. The third part inquired about subspecialty SLOEs. The survey was pilot tested by the Council of Residency Directors (CORD) Application Process Improvement Task Force and VSAS subcommittees and revised as needed. The survey was administered from February to April 2019. The authors identified 262 unique clerkship rotation sites by reviewing the SAEM and EMRA clerkship directories and all SLOEs for standard EM rotations submitted to their programs in the 2018– 2019 application season. Reviewing SLOEs identified 22 sites that were not included in either clerkship directory. SLOEs written from non-EM residency sites were counted but subspecialty SLOEs were not.11 The survey was sent directly to all 262 clerkship directors and additionally distributed via CORD and CDEM listservs. Self-reported data using a survey were chosen over collecting data from a central source (i.e., VSAS) as not all clerkship sites use VSAS. Loma Linda University Health Institutional Review Board determined that the project was not subject to review. Data analysis was performed using Excel 2010 Version 14.0 (Microsoft Corporation). RESULTS Survey invitations were sent to all 262 unique EM clerkship rotation sites identified for the 2018–2019 application cycle. We received 190 responses. Twentysix responses were excluded due to duplication of previous entries or providing identification information only. These 164 responses provided the data for analysis of application processing. Nine of the 164 clerkship sites were not affiliated with a residency program. Of the 164 responses, 35 did not provide rotation availability data or did not accept visiting students. The remaining 129 (49%) sites are the basis of our Kiemeney and Franzen • AWAY ROTATIONS analysis of AR capacity. Four sites were nonresidency affiliated, the remaining 125 sites were affiliated with a residency program. Each of the seven geographic regions in the United States are represented in the analysis, including 36 states and the District of Columbia.12 A total of 3,472 ARs were completed at 129 sites during the 2018–2019 application cycle, resulting in 3,222 SLOEs authored. The average number of rotators per site was 27.3 (range = 0–101). An average of 25.1 (range = 0–84) SLOEs were authored by rotation sites. Some responses only partially completed the first survey section with multiple-choice questions about application processing. Data are reported as the number of affirmative responses for that item (n) and the percentage of all responses (...truncated)