study might show a greater increase in weight. Future studies might also

concentrate on standardizing the residency affect by correcting for exercise and

dietary outliers.

Conclusion: Emergency medicine faculty assessment of resident clinical

performance correlates with medical resident national in-service examination scores

and PGY level independently. The PGY level of training has a much higher degree of

correlation with clinical performance than the in-service examination score.

252 Do Learning Styles of Emergency Medicine Residents ReflectTheir Preference for Typical Teaching Modalities Offered inResidency Programs?

Barlas D, Gupta S, Lesser ML, Tai J/North Shore University Hospital, Manhasset, NY;

New York Hospital Queens, Flushing, NY

Study objectives: Many types of teaching modalities and techniques are offered in

emergency medicine training programs that are intended to give residents specific

cognitive and procedural skills, and each is met with various degrees of acceptance

and effectiveness. Emergency medicine residents exhibit a range of learning styles,

however, and we seek to determine whether a resident’s learning style is reflected in

his or her preference for particular teaching methods and, in turn, help guide

individuals and programs to the most effective methods.

Methods: Residents at an established postgraduate year 1 to 3 emergency

medicine program were asked to rank their preference for each of 21 offered

teaching modalities on a 5-point Likert scale (1=learn poorly and 5=learn well from

each modality). Each resident was assigned to 1 of 4 learning styles with a validated

tool based on the Kolb model of experiential learning that has been extensively used

in medical education research. The Wilcoxon test (with a=0.05) was used to

determine whether any differences were present in preferences across learning

styles.

Results: Data from 32 residents were obtained, with all 4 styles present.

‘‘Accommodators’’ learned best from patient interaction and procedures, as would be

expected. ‘‘Convergers’’ were similar because both styles prefer conceptualization

and applying ideas but preferred bedside discussion much more than did residents of

any other style (P\.04). ‘‘Assimilators’’ and ‘‘divergers’’ each preferred procedures

and hands-on laboratories primarily, as might be expected from their preference for

reflection on experiences. Residents of all styles disliked lectures, group book

review, and journal club, which probably reflects a relative lack of engagement in the

learning cycle (as proposed by Kolb) during these activities.

Conclusion: Learning style theory can provide a basis for determining which

R E S E A R C H F O R U M A B S T R A C T S

250 Resident Education Does Not Correlate With the Degree ofEmergency Department Crowding

Hoxhaj S, Moseley MG, Siler Fisher A, O’Connor RE/Christiana Care Health System,

Newark, DE

Study objectives: We study the effect of emergency department (ED) crowding on

medical student and emergency medicine resident perception of educational

interaction with attending physicians. Our hypothesis is that the perceived quality of

clinical teaching is decreased when crowding conditions exist in the ED.

Methods: An emergency medicine residency program (postgraduate years [PGYs]

1 to 3) with an annual census of 92,000 patient visits and 64 hours of attending

physician coverage at the primary hospital served as the study site. A 1-page survey

was completed by study participants at the close of their shift and was used to

quantify perception of the quality of teaching received, as well as crowding in the

ED. The surveys used a 10-cm visual analog scale evaluating whether the attending

physician was effective at didactic/bedside teaching, available/accessible, efficient in

patient management, approachable, and professional and provided adequate

supervision. Participants were asked to rate the value of the learning experience,

whether the ED seemed busy, and whether there was adequate time to spend with

patients. The data were analyzed using regression analysis.

Results: A total of 184 surveys were completed during a 3-month period,

representing a 42% return rate. The degree of actual and perceived ED crowding did

not correlate with effectiveness of didactic and bedside teaching, attending

availability, efficiency in patient management, approachability, professionalism, and

adequacy of supervision. Correlation coefficients ranged from r=–0.06 to 0.19.

Furthermore, study participants’ perceptions of ED crowding and actual daily ED

census did not correlate (r=0.06).

Conclusion: Medical students’ and emergency medicine residents’ perception of

teaching does not correlate with the degree of actual or perceived ED crowding.

Study participants could not consistently identify when ED crowding existed.

Educational interactions with attending physicians appear to be minimally affected

by fluctuations in patient care demands.

251 The Relationship of National Inservice Examination Scores,Emergency Medicine Faculty Evaluations, and Level of Trainingof Emergency Medicine Residents

Ryan JG, LaMantia J, Ward MF/New York Hospital Queens, Flushing, NY; North Shore

University Hospital, Manhasset, NY

Study objectives: We determine the relationship between national in-service

examination scores, level of training, and faculty assessment of emergency medicine

resident clinical performance.

Methods: This study was conducted at an academic emergency department that

has a postgraduate year (PGY) 1 to 3 emergency medicine residency with 24

emergency medicine residents and 25 board-certified or board-prepared emergency

medicine faculty who rate each of the residents quarterly using a standard form. The

form has 13 characteristics and a composite score. Each resident is rated on a 1-to-5

fixed-reference scale that rates the resident relative to the performance of an

attending physician. Each resident’s raw score from the national in-service

examination was used as the measure of medical knowledge. The composite score

for each resident was the variable used to measure resident clinical performance. We

performed a regression analysis to determine the relationship between the in-service

examination score, the PGY level, and the clinical evaluation by the faculty.

Results: During the 5 years of this study, 57 residents were included. These

residents had 2,095 total faculty evaluations, yielding 119 composite faculty

evaluations. Two residents missed the in-service examination, yielding 117 in-

service examination scores. The regression analysis found a strong overall

relationship between the faculty composite evaluation score and both the in-service

examination score and PGY variables (R=.86, P\.0001). The in-service examination

score and the PGY level were found to independently correlate with the faculty

evaluations. The PGY level was found to correlate more highly with the faculty

composite score (R=.73, P\.0001) than the in-service examination score correlated

with the faculty composite score(R=.57, P\.0001).

teaching modalities will be best accepted and most effective for emergency medicine

residents. It may also be helpful to emergency medicine programs, which may be

better able to design and individualize their curriculum offerings according to the

pattern of learning styles of the residents.

253 Evaluation of Traditional Lecture Versus Medical SimulationTraining in Airway Management

Vozenilek J, Cabel JA, Flaherty JJ/Evanston Northwestern Healthcare, Northwestern

University Feinberg School of Medicine, Evanston, IL

Study objectives: Traditional forms of medical education in airway management

have included topical lectures and practice using mannequins and handling of

equipment in an attempt to familiarize the trainees with the skills necessary to

manage an airway appropriately. However, retention of airway skills has been

unsatisfactory unless frequently reinforced and practiced. Quantification of the

percentage of retention from traditional methodology has not been previously

described. The purpose of this study is to try to quantify airway skills retention using

a traditional lecture model and then testing of the trainees using a high-fidelity

patient simulator.

Methods: One hundred sixty-eight medical students were enrolled in the study and

given a standard airway management lecture including handling of endotracheal

tubes, laryngoscopes, Ambu� bags, and oral and nasal airways. Intubation practice

was performed on standard and larger-than-life mannequins to facilitate the ability to

intubate. Approximately 1 week later, the students were tested on a clinical encounter

that involved airway compromise and the need for appropriate airway management.

These sessions were digitally recorded with the consent of the participants, and

analysis of airway management was obtained. The analysis was limited to practical

handling of the airway equipment. Students were given credit for correct airway

management if they knew and demonstrated appropriate use of an AMBU bag, correct

use of oral and nasal airways, and correct use of laryngoscopes and endotracheal

tubes. They were not given credit if they were unable to assemble the laryngoscope or

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