Medical Education Commons^™

Stroke Mimics And Stroke Chameleons: Leveraging The False Positive/False Negative Diagnostic Schema In Resident Teaching, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background

Stroke mimics and stroke chameleons contribute significantly to diagnostic uncertainty in Emergency Medicine. Traditional teaching often relies on enumerating examples, yet residents struggle to internalize these distinctions.

Objective

To present a conceptual teaching framework that maps stroke mimics to false positives and stroke chameleons to false negatives, leveraging pre-existing diagnostic schemas.

Methods

Using representative cases—including hypoglycemic hemiparesis and spinal epidural lipomatosis presenting as stroke mimic—we developed an explanation for residents involving framing mimics as false positives and chameleons as false negatives.

Results

Framing mimics as false positives and chameleons as false negatives activates existing learner schemas related to sensitivity …

A Conceptual Framework That Supports The Transition From Supervised Training To Independent Clinical Practice, Aligned With Acgme Milestones, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background: The transition from residency to independent attending practice represents a critical developmental inflection point. Although residents achieve competency-based milestones, many graduates report challenges related to decision ownership, uncertainty tolerance, and the assumption of final clinical authority. Traditional training emphasizes competence under supervision, while independent practice requires performance without supervision. Objective: To propose a conceptual framework that supports the transition from supervised training to independent clinical practice, aligned with ACGME Milestones. Methods: Conceptual synthesis of literature on preparedness for practice, entrustment, and professional identity formation, integrated with practical observations from graduate medical education. Results (Conceptual): Six domains central to transition …

Identifying And Generalizing Best Attending Teaching Practices: A Proposal For The Use Of Appreciative Inquiry To Enhance Emergency Medicine Residency Teaching Practices, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background

Teaching in the Emergency Department (ED) occurs within a complex adaptive system characterized by time pressure, interruptions, and high cognitive load. Studying what works well in clinical teaching , even in such a challenging  environment for  teaching, may reveal reproducible patterns that strengthen educational culture, enhance resident learning, and accelerate the development of teaching expertise. In complex clinical environments, excellence is often present but under-recognized; An approach called Appreciative Inquiry provides a structured method for making it visible.

Conceptual Framework

Appreciative Inquiry (AI) offers an alternative approach by systematically studying successful practices rather than failures. AI explores how and …

Medical Journals As Complex Adaptive System (Cas) Reports: Reframing Journals As Structured Detection, Interpretation, And Feedback Systems In Healthcare, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background Healthcare operates as a complex adaptive system (CAS) characterized by distributed agents, nonlinear interactions, and emergent behavior. Effective adaptation depends on mechanisms capable of detecting and redistributing signals from across the system.

Objective To conceptualize the medical journal as a structured CAS report and to examine its role in supporting system awareness among clinicians.

Conceptual Model Recurring journal sections—including original research, reviews, editorials, clinical cases, perspectives, humanities, and letters—function as distinct sensing and signaling channels. Together, they provide a multi-dimensional representation of system activity.

Implications Journals serve not only as repositories of knowledge but as adaptive communication nodes that …

A Systems-Based Approach To Supporting Resident Scholarly Productivity:Building A High-Throughput Academic Pipeline In Emergency Medicine Residency Training Through Poster Development Apprenticeship, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background:

Many residency programs require scholarly output; however, consistent and high-volume production of posters and publications can be challenging. Anecdotal evidence from a variety of programs suggests variability in outcomes across programs, often influenced by differences in mentorship, structure, and available scholarly infrastructure.

Objective: To describe a reproducible, systems-based model for generating high-volume resident scholarly output through alignment of expectations, culture, infrastructure, and faculty engagement.

Methods  and Conceptual Model: We outline a multi-domain framework derived from sustained programmatic experience, incorporating structural requirements, leadership alignment, cultural reinforcement, workflow standardization, and active faculty participation. The model is supported by practical tools including …

Effective Peer Feedback With The Situation-Behavior-Impact (Sbi) Model, Steven Garwood, Dawn Shell, Emily Hoffman

Rowan-Virtua Research Day

Providing effective peer feedback is an essential professional skill in medical education, yet students often receive limited formal training in how to deliver feedback constructively. This study describes the design, implementation, and outcomes of a one‑hour synchronous workshop introducing first‑year medical students to the Situation–Behavior–Impact (SBI) feedback model. The interactive session combined didactic instruction, large‑group discussion of effective feedback characteristics, and small‑group practice creating structured SBI feedback statements. Effectiveness was evaluated using pre‑ and post‑workshop confidence surveys and a rubric‑based analysis of 75 group‑generated feedback statements. Following the workshop, 98% of students agreed or strongly agreed they could apply the …

The Ed Is Inherently Interleaved: The Learning Theory Case For Hybrid Resident Conference Curriculum Design In Emergency Medicine: Block For Onboarding And For Specialized Topics With Predominant Interleaving For Intermediate And Advanced Residents, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background

Emergency medicine (EM) training occurs within a clinical environment characterized by rapid context switching, diagnostic uncertainty, and frequent transitions between unrelated clinical problems. Didactic curricula that rely only on block-based topic organization may not fully reflect the cognitive demands of real emergency department practice.

Objective

To propose a developmentally adaptive hybrid model of EM curricular design that integrates early block learning during the onboarding phase of new residents, progressing to a general approach of interleaved learning. Specialized topics,  can be introduced using block learning at any time during the residency years.

Methods / Conceptual Approach

This conceptual educational model …

Might Ite And Board Preparation Be Both Informative And Neurobiologically Formative? A Plausibility Argument Linking Study Processes To Hippocampal–Cortical Memory Consolidation, Pattern Recognition Networks, And Cognitive Efficiency, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background:  The in-service training exam ( ITE ) and board preparation are traditionally framed as processes of information acquisition and evaluation. Educational discussions typically focus on knowledge transfer, study strategies, and examination performance. However, modern neuroscience suggests that sustained, emotionally salient, and repetitive cognitive challenge in adulthood can produce durable neuroplastic adaptations. Might such residency training be not only informative but also formative?

Objective: To propose a conceptual framework in which board preparation may be both informative and neurobiologically formative, functioning as a training environment that promotes integration of neural systems involved in memory retrieval, pattern recognition, and decision-making under …

Assessing Medical Trainees Knowledge Of Secondary Traumatic Stress Before And After Clinical Experiences At The Cares Institute: A Literature Review, Anastasiya Matveyenko, Sarah Kleinle, Paul Furtaw, Rachel Silliman Cohen

Rowan-Virtua Research Day

Secondary Traumatic Stress (STS) has been positively correlated with burnout in healthcare professionals through numerous studies. It is defined as the natural consequent behaviors and emotions resulting from knowing about a traumatizing event experienced by another individual. Medical students experience high level of STS due to exposure to trauma during multiple clinical rotations. Child Abuse Research Education and Service (CARES) Institute treats children who have experiences of abuse, neglect, and other forms of trauma. As part of the current curriculum, Rowan SOM students rotate at the CARES Institute for at least a day for up to a month and might …

In The Era Of The Smartphone: The Case For The Continued Role Of Mnemonics As Cognitive Scaffolds That Support Encoding, Working Memory Efficiency, And Rapid Cue-Dependent Retrieval, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background: The ubiquity of smartphones and point-of-care digital references has prompted questions regarding the continued relevance of mnemonic devices in medical education. If information can be instantly retrieved, is memorization—and by extension mnemonic structure—still necessary? Objective: To reframe mnemonics not as relics of pre-digital pedagogy, but as cognitive scaffolds that support encoding, working memory efficiency, and rapid cue-dependent retrieval in time-pressured clinical environments. Discussion: Cognitive science demonstrates that working memory remains inherently limited regardless of technological access. Mnemonics function as structured chunks that reduce cognitive load, support pattern recognition, and facilitate transition from novice encoding to expert automaticity. In emergency …

Physician Bedside Communication Posture (Sitting Versus Standing) In Relation To Patient Satisfaction: A Focused Literature Review And Areas For Potential Research, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background:

Sitting during patient encounters is commonly recommended in communication training, with the assumption that it improves patient satisfaction. However, the empirical evidence supporting this recommendation in Emergency Department (ED) settings appears limited.

Objective:

To review the existing literature examining physician posture (sitting versus standing) and its association with patient satisfaction and perceived communication quality.

Methods:

Narrative review of ED and non-ED studies evaluating posture during clinical encounters, with attention to study design, sample size, setting, and outcome measures.

Results:

ED-specific evidence remains heterogeneous. Some studies demonstrate that sitting increases patients’ perception of time spent at bedside without increasing actual …

Rowan-Virtua School Of Osteopathic Medicine’S Planetary Pulse: Charting A Course For Planetary Health Excellence, Hope A. Beyer, Deborah Podolin

Rowan-Virtua Research Day

Objective: Despite international acceptance of climate change as the largest threat towards human health, American osteopathic institutions fall short of their allopathic colleagues in adopting a planetary health curriculum. This study (1) evaluates the desire of Rowan-Virtua School of Osteopathic Medicine (Rowan-Virtua SOM) students to learn about planetary health within their medical education, (2) assesses the current planetary health infrastructure supported by Rowan-Virtua SOM and their parent institution, Rowan University, and (3) proposes an adapted planetary health equity curriculum.

Methods: Medical student interest was gauged by use of a Qualtrics survey modeled off of Dr. Karly Hampshire’s 2020 survey of …

Determinants Of Successful Completion In The Rowan-Virtua Dual Cprs/Chw Program: Literature Review & A Work In Progress, Timothy Breiner, Donato F. Tassoni, Richard Jermyn, Venkat Venkataraman, Alexander Abbott, Kenneth Stagliano

Rowan-Virtua Research Day

Background: Certified Peer Recovery Specialists (CPRS) and Community Health Workers (CHWs) expand access to behavioral health and social care through training, credentialing, and community-based support. Although these programs improve knowledge, skills, and workforce readiness, retention and completion remain important barriers to program scale-up. Evidence on predictors of successful completion in dual-role CPRS/CHW pathways is limited.

Objective: To identify participant, programmatic, and contextual factors associated with successful completion of the Rowan-Virtua Dual CPRS/CHW Program.

Methods: This work-in-progress combines a focused literature review with ongoing program analysis. The review examined English-language studies from 2010 onward related to CPRS and CHW training, program …

Towards More Effective And Efficient Ite And Board Preparation In Emergency Medicine: A Conceptual Framework Using Personality Preferences (Mbti) To Inform Study And Test-Taking Behaviors, James Espinosa, Robin Lahr, James Lee, Alan Lucerna

Rowan-Virtua Research Day

Background: Preparation for high-stakes examinations in Emergency Medicine (EM) relies heavily on question-bank practice, rapid decision-making, and targeted review. Despite standardized board-preparation resources, trainees demonstrate substantial variability in study behaviors and perceived efficiency. The Myers-Briggs Type Indicator (MBTI), widely used in medical education for communication and self-reflection, may offer a framework for understanding differences in study and test-taking behaviors, though it is not designed as a predictive psychometric tool.

Objective: To review existing literature relating MBTI preferences to learning behaviors and academic performance, and to propose a conceptual framework linking personality preferences to board-style test-taking patterns in EM trainees.

Methods: …

From Lists To Landscapes And Locations: Spatial Memory And Schema Formation (Memory Palace Adaptation) As A Neurobiologically Informed Strategy For Teaching Environmental And Toxicology Emergencies Ite And Board Review In Emergency Medicine Residency, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background:

Most emergency medicine board domains inherit spatial scaffolding from foundational anatomy education (e.g., neuroanatomy, gastrointestinal tract, cardiopulmonary structures). Environmental emergencies lack an inherent anatomic anchor and are frequently taught as disconnected lists, increasing cognitive load and impairing schema formation. Similarly, toxicology crosses age, and specialty without an inherent anatomic structural anchor.

Objective:

To describe a scene-based, learner-generated landscape model designed to reintroduce spatial structure into environmental emergency education and to situate the model within contemporary neurobiology and learning science.

Educational Innovation:

Residents construct a large-format landscape diagram (sun–water–mountain schema) during live instruction. Environmental conditions are spatially anchored in ecologically …

The Ones That Got Away:Shared Misses, Shared Mastery — A Proposal For Leveraging Spaced Retrieval, Variable Reinforcement, And Collective Learning In Emergency Medicine Residency, James Espinosa D, Robin Lahr, James Lee, Swet M. Patel, Alan Lucerna

Rowan-Virtua Research Day

Background

Residents frequently engage in individual question-bank study for board preparation; however, missed questions are typically processed in isolation. Educational psychology demonstrates that spaced retrieval and variable reinforcement enhance durable learning. Psychological safety further supports collective sense-making in professional education . The addition of a periodic, structured, collective shared-review process model may leverage these principles within residency training.

Objective

To propose a resident-driven educational initiative that transforms individually missed board-style questions into a shared, psychologically safe learning stream that promotes durable knowledge retention and community-based mastery.  The movement of this stream could be a chief resident responsibility, or could be …

Detecting Early Operational Turbulence In The Emergency Department Using Fourier And Wavelet Analysis: A Conceptual Framework For Signal-Informed Anticipation And Prediction In The Ed Complex Adaptive System, James Espinosa, David Ho, Alan Lucerna

Rowan-Virtua Research Day

Background:

We theorize that Emergency Departments (EDs) function as complex adaptive systems characterized by nonlinear interactions, oscillatory demand patterns, and abrupt phase transitions from stable flow to turbulent states. Traditional dashboards rely on threshold metrics that detect instability after degradation becomes visible. Many ED data streams are significantly retrospective as well as compression-averaged into temporal systems such as days, months, quarters or even years. Signal processing methods—particularly Fourier and wavelet analysis—offer the  framework for detecting latent oscillatory shifts preceding overt operational change from laminar to transitional to turbulent flow states. This could lead to better methods of adaptation.

Conceptual Framework: …

Beyond Traditional Emergency Medicine Residency Match Interviews: Behavioral Questions As Stress Tests For Resident Selection A Theory-Driven Micro-Assessment Framework For Detecting High-Value Traits, Alan Lucerna, James Lee, Robin Lahr, James Espinosa

Rowan-Virtua Research Day

Background: Traditional residency selection metrics incompletely capture behavioral traits essential for emergency medicine (EM) performance.

Objective: To propose a theory-driven framework using structured behavioral questions as stress tests to detect high-value traits.

Methods: Conceptual analysis of three standardized behavioral prompts assessing execution, systems thinking, and team orientation.

Results: Distinct response patterns align with observable domains associated with reliability, performance, and leadership.

Conclusion: Behavioral stress test questions offer a scalable, low-cost method to enhance residency selection processes.

Helping Waldo (The Poster) Be Found: Teaching Search Literacy, Discoverability And Search Engine Optimization As Core Scholarly Skills In Graduate Medical Education, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background: In modern academic medicine, trainees are taught how to search the biomedical literature but rarely taught how to structure their own scholarly work so that it can be discovered. This creates a diffusion gap in which high‑quality educational innovations, case reports, and operational insights remain difficult to locate despite being presented or archived.

Objective: To propose a concise educational module that teaches residents the principles of search literacy and scholarly discoverability.

Methods: A conceptual curriculum framework was developed drawing on literature from information science, medical education, and diffusion theory. The module introduces the paired competencies of 'Finding Waldo' (literature …

Constructive Affirmation: Proposing An Empowering Term For What Good Teaching Attendings Already Do-- Integrating Affirmation And Constructive Criticism Through Learning Science, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background

Feedback is central to residency training, and quite naturally many educational cultures emphasize corrective feedback and error identification. Learning science suggests that reinforcement of correct cognitive patterns is equally essential for expertise development. This paper introduces the concept of constructive affirmation as an integrated feedback model combining affirmation and constructive criticism.

Objective

To propose a learning science framework for clinical feedback in residency training centered on the concept of constructive affirmation.

Methods

This conceptual analysis synthesizes literature from medical education, cognitive psychology, neurobiology of learning, and complexity science to examine how different feedback types influence pattern recognition, cognitive load, …