1. Deliberate practice and asynchronous video documentation of procedural competence and technical skill Jeremy Samuel Faust, MD MS, Kaushal Shah, MD Department of Emergency Medicine, The Mount Sinai Hospital, New York, NY INTRODUCTION In the past, technical and procedural competence in residents has been assessed either at the bedside or in teaching laboratory settings. These traditional settings do not typically assess for subsequent mastery of skills learned. Asynchronous learning and accurate documentation of achievement level is now possible using mobile technology. Asking residents to submit video evidence of competence of a technical skill may in part solve the problem of assessing both competence and excellence. Because video is a permanent document, video submissions in place of in-person testing may inspire more than competence, but excellence. March 6, 2016 Nashville, TN

2. Deliberate practice and asynchronous video documentation of procedural competence and technical skill Jeremy Samuel Faust, MD MS, Kaushal Shah, MD Department of Emergency Medicine, The Mount Sinai Hospital, New York, NY Educational Objectives To use asynchronous learning as a tool to encourage technical and procedural skill proficiency in resident education. To assess whether asking residents to submit asynchronously self-made videos demonstrating their ability to perform an assigned skill is an effective method for assessing resident technical and procedural skill proficiency.

3. Deliberate practice and asynchronous video documentation of procedural competence and technical skill Jeremy Samuel Faust, MD MS, Kaushal Shah, MD Department of Emergency Medicine, The Mount Sinai Hospital, New York, NY Curricular Design Residents were requested to asynchronously learn a pre-selected procedure every two months and demonstrate their competence via a self-made unedited video. In the first assignment/module, Emergency Medicine Residents were asked to film themselves performing a series of one-handed knots. Residents were sent a pre-survey and a 20-second video demonstration created by the residency director. Residents were asked (via survey) whether they could confidently perform a one-handed tie prior to the assignment.

4. Deliberate practice and asynchronous video documentation of procedural competence and technical skill Jeremy Samuel Faust, MD MS, Kaushal Shah, MD Department of Emergency Medicine, The Mount Sinai Hospital, New York, NY Figure 1. A composite image of nine videos asynchronously submitted by residents (selected from 54 submitted videos) demonstrating procedural competency in performing a one-handed knot.

5. Deliberate practice and asynchronous video documentation of procedural competence and technical skill Jeremy Samuel Faust, MD MS, Kaushal Shah, MD Department of Emergency Medicine, The Mount Sinai Hospital, New York, NY Impact/Effectiveness In the first module, 90% of residents responded to the pre- survey; of these, 100% completed the assignment by submitting videos demonstrating competence in the procedure. Prior to the assignment, 39% of all residents stated that they could not confidently perform a one-handed tie. Of the 39% who stated they could not perform the procedure prior to the assignment, 100% submitted videos demonstrating newly achieved competence/confidence. We believe that asynchronous video documentation of procedural competence and mastery is now possible and effective with minimal cost or oversight. Subsequent modules are currently underway to assess the the reproducibility and sustainability of this concept.