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Bio

Holly Caretta-Weyer is currently�Assistant Residency Program Director�and Director of Evaluation and Assessment for�the Stanford University Emergency Medicine Residency Program as well as EPA Implementation Lead at the Stanford University School of Medicine. Dr. Caretta-Weyer attended medical school at the University of Wisconsin School of Medicine and Public Health where she graduated Alpha Omega Alpha with Honors in Research. She loved being a Badger so much that she stayed for her Emergency Medicine Residency at the University of Wisconsin where she was also Chief Resident. Dr. Caretta-Weyer then moved to the West Coast where she recently completed her Medical Education Scholarship Fellowship at Oregon Health & Science University (OHSU) and is�also finishing her thesis work for her Masters in Health Professions Education (MHPE) at the University of Illinois-Chicago. She will be beginning her PhD at Maastricht University studying residency selection in a competency-based system in 2021.

While at OHSU, Dr. Caretta-Weyer worked as a member of the Association of American Medical Colleges (AAMC) Core Entrustable Professional Activities for Entering Residency pilot team and was a founding member of the OHSU undergraduate medical education�entrustment committee. She continues to be involved with the national AAMC Core EPA Pilot through her continued collaboration with the OHSU team. Through this process she has gained valuable experience in working to define programmatic assessment, formulate summative entrustment decisions, and more seamlessly bridge the transition from undergraduate to graduate medical education, all of which are key initiatives within medical education.

Dr. Caretta-Weyer is also the PI on a $1.3M AMA Reimagining Residency Grant focused on redesigning assessment across the continuum of emergency medicine training and introducing predictive learning analytics to the process.�She is additionally a member of the International Competency-Based Medical Education (ICBME) Collaborators, a group that seeks to further research on CBME around the world.

Dr. Caretta-Weyer's education research interests focus on the implementation of competency-based education and assessment across the continuum of medical education, summative entrustment and promotion decision-making processes, coaching within medical education, residency selection in a competency-based system, and the development of learner handovers to span key transitions in the educational continuum. When not focusing on her administrative and education research interests, Dr. Caretta-Weyer can be found kayaking, hiking, cycling, playing volleyball, or cheering on her favorite sports teams including the Wisconsin Badgers and Milwaukee Brewers.

Clinical Focus

Emergency Medicine

Academic Appointments

Clinical Assistant Professor, Emergency Medicine

Administrative Appointments

Assistant Residency Program Director, Stanford University, Department of Emergency Medicine (2018 - Present)
Director of Evaluation and Assessment, Stanford University, Department of Emergency Medicine (2018 - Present)
Education Strategic Plan Lead, Stanford University Department of Emergency Medicine (2019 - Present)
EPA Implementation Lead, Stanford University School of Medicine (2018 - Present)
Medical Education Line Director, Stanford University, Department of Emergency Medicine (2018 - Present)

Honors & Awards

Top 3 Education Research Abstract, International Conference on Residency Education (ICRE) (2020)
Top 10 Education Research Abstract, Accreditation Council for Graduate Medical Education (ACGME) (2020)
Outstanding Educator Award, Stanford University Department of Emergency Medicine (2019)
Outstanding Peer Reviewer, Academic Emergency Medicine Education and Training (2019)
Academic Instructor of the Year Award, Oregon Health and Science University Department of Emergency Medicine (2018)
Resident Advocate Award, Oregon Health and Science University Department of Emergency Medicine (2018)
Best Poster Award - Education Research Category, Oregon Health & Science University Symposium on Educational Excellence (2018)
Academic Instructor of the Year Award, Oregon Health and Science University Department of Emergency Medicine (2017)
Gold Standard Peer Review Award, Western Journal of Emergency Medicine (WestJEM) Education Supplement (2017)
The Ripple Award for Excellence in Leadership and Service, University of Wisconsin Department of Emergency Medicine (2016)
Award for Excellence in Scholarship, Wisconsin Chapter of the American College of Emergency Physicians (2015)
Alpha Omega Alpha Honor Society Induction, University of Wisconsin School of Medicine (2012)

Boards, Advisory Committees, Professional Organizations

Director of Grants, ARMED MedEd - SAEM (2020 - Present)
Member-at-Large, International Competency-Based Medical Education Collaborators (2019 - Present)
Grant Reviewer, Society for Academic Emergency Medicine (2019 - Present)
Section Editor, Western Journal of Emergency Medicine - Education Scholarship Section (2018 - Present)
Vice Chair of Education Toolkit Subcommittee, Council for Residency Directors in Emergency Medicine (CORD) Education Committee (2018 - Present)

Professional Education

Fellowship: Oregon Health and Science University Emergency Medicine Fellowships (2018) OR
Board Certification: American Board of Emergency Medicine, Emergency Medicine (2017)
Residency: University of Wisconsin Emergency Medicine Residency (2016) WI
Medical Education: University of Wisconsin School of Medicine and Public Health (2013) WI

Teaching

Publications

All Publications

Trends in medical students' stress, physical, and emotional health throughout training. Medical education online McKerrow, I., Carney, P. A., Caretta-Weyer, H., Furnari, M., Miller Juve, A. 2020; 25 (1): 1709278
Abstract

Background: Medical student wellness, including physical health, emotional health, and levels of perceived stress, appears to decline during training, with students reporting high levels of depression, anxiety, and burnout as early as the first year of medical school. The impact of curricular changes on health and stress remains unclear, and a modified curriculum that compresses training of the foundational sciences and its effect on wellness has not been studied. Oregon Health & Science University School of Medicine has recently instituted a unique competency-based model, which provides an important opportunity to assess the effects of curricular change on student wellness.Objective: Assess the effects of curricular change on student wellness.Design: Medical students at a single institution were administered the SF-8, an 8-item health-related quality of life survey, as well as the Perceived Stress Scale, a 10-item scale that measures the degree to which life situations are appraised as stressful, at baseline (matriculation) and at the end of Year 1, 2 and 3. Individual variables were assessed over time, as well as a trend analysis of summary domain scores over the 4 time periods.Results: Physical, emotional, and overall health were highest at baseline and lowest at the end of Year 1, after which they improved but never again reached baseline levels. Physical health declined less than emotional health. Perceived stress levels did not change over time but remained moderately high. There were no differences in health or perceived stress based on demographic variables.Conclusions: In a competency-based curriculum, physical, emotional and overall health significantly worsened during Year 1 but improved thereafter, while perceived stress remained unchanged. Early in training, stress and poor overall health may be related to concerns about self-efficacy and workload. Although advanced students show improved wellness, concerns remained about emotional difficulties, such as anxiety and irritability, and feeling a lack of control.

View details for DOI 10.1080/10872981.2019.1709278

View details for PubMedID 31902315
The Flipped Classroom: A Critical Appraisal. The western journal of emergency medicine Kraut, A. S., Omron, R., Caretta-Weyer, H., Jordan, J., Manthey, D., Wolf, S. J., Yarris, L. M., Johnson, S., Kornegay, J. 2019; 20 (3): 527?36
Abstract

Introduction: The objective of this study was to review and critically appraise the medical education literature pertaining to a flipped-classroom (FC) education model, and to highlight influential papers that inform our current understanding of the role of the FC in medical education.Methods: A search of the English-language literature querying Education Resources Information Center (ERIC), PsychINFO, PubMed, and Scopus identified 296 papers related to the FC using either quantitative, qualitative, or review methods. Two reviewers independently screened each category of publications using previously established exclusion criteria. Eight reviewers then independently scored the remaining 54 publications using either a qualitative, quantitative, or review-paper scoring system. Each scoring system consisted of nine criteria and used parallel metrics that have been previously used in critical appraisals of education research.Results: A total of 54 papers (33 quantitative, four qualitative, and 17 review) on FC met a priori criteria for inclusion and were critically appraised and reviewed. The top 10 highest scoring articles (five quantitative studies, two qualitative studies, and three review papers) are summarized in this article.Conclusion: This installment of the Council of Emergency Medicine Residency Directors (CORD) Academy Critical Appraisal series highlights 10 papers that describe the current state of literature on the flipped classroom, including an analysis of the benefits and drawbacks of an FC approach, practical implications for emergency medicine educators, and next steps for future research.

View details for DOI 10.5811/westjem.2019.2.40979

View details for PubMedID 31123556
Curated Collections for Clinician Educators: Five Key Papers on Graduated Responsibility in Residency Education CUREUS Schnapp, B. H., Caretta-Weyer, H. A., Cortez, E., Heinrich, S. A., Kraut, A. S., Lloyd, C. M., Silvester, C., Sorge, R. M., Wain, A., Gottlieb, M. 2019; 11 (4)
View details for DOI 10.7759/cureus.4383

View details for Web of Science ID 000463376000002
Design Your Clinical Workplace to Facilitate Competency-Based Education. The western journal of emergency medicine Caretta-Weyer, H. A., Gisondi, M. A. 2019; 20 (4): 651?53
View details for DOI 10.5811/westjem.2019.4.43216

View details for PubMedID 31316706

View details for PubMedCentralID PMC6625682
Critical Electrocardiogram Curriculum: Setting the Standard for Flipped-Classroom EKG Instruction. The western journal of emergency medicine Burns, W. P., Hartman, N. D., Weygandt, P. L., Jones, S. C., Caretta-Weyer, H. n., Moore, K. G. 2019; 21 (1): 52?57
Abstract

Electrocardiogram (EKG) interpretation is integral to emergency medicine (EM). In 2003 Ginde et al. found 48% of emergency medicine (EM) residency directors supported creating a national EKG curriculum. No formal national curriculum exists, and it is unknown whether residents gain sufficient skill from clinical exposure alone.The authors sought to assess the value of this EKG curriculum, which provides exposure to critical EKG patterns, a framework for EKG interpretation when the diagnosis is not obvious, and implementation guidelines and open access to any interested residency. The Foundations of Emergency Medicine (FoEM) EKG I course launched in January 2016, followed by EKG II in July 2017; they are benchmarked to post-graduate year 1 (PGY) and PGY2 level learners, respectively. Selected topics included 15 published critical EKG diagnoses and 33 selected by the authors. Cases included presenting symptoms, EKGs, and Free Open Access Medical Education (FOAM) links. Full EKG interpretations and question answers were provided.Enrollment during 2017-2018 included 37 EM residencies with 663 learners in EKG I and 22 EM residencies with 438 learners in EKG II. Program leaders and learners were surveyed annually. Leaders indicated that content was appropriate for intended PGY levels. Leaders and learners indicated the curriculum improved the ability of learners to interpret EKGs while working in the emergency department (ED).There is an unmet need for standardization and improvement of EM resident EKG training. Leaders and learners exposed to FoEM EKG courses report improved ability of learners to interpret EKGs in the ED.

View details for DOI 10.5811/westjem.2019.11.44509

View details for PubMedID 31913819
Transition to Practice: A Novel Life Skills Curriculum for Emergency Medicine Residents. The western journal of emergency medicine Caretta-Weyer, H. 2019; 20 (1): 100?104
View details for PubMedID 30643610
Curated Collections for Clinician Educators: Five Key Papers on Graduated Responsibility in Residency Education. Cureus Schnapp, B. H., Caretta-Weyer, H. A., Cortez, E. n., Heinrich, S. A., Kraut, A. S., Lloyd, C. M., Silvester, C. n., Sorge, R. M., Wain, A. n., Gottlieb, M. n. 2019; 11 (4): e4383
Abstract

Introduction The Accreditation Council for Graduate Medical Education calls graduated responsibility "one of the core tenets of American graduate medical education." However, there is no clear set of resources for programs to implement a system of progressively increasing responsibilities for trainees. This project aimed to identify a set of high-yield papers on graduated responsibility for junior faculty members. Methods A study group of Academic Life in Emergency Medicine Faculty Incubator participants identified relevant literature on graduated responsibility via a comprehensive literature search and a call to the online medical education community; 59 total papers were identified. The most relevant and applicable were selected by the study group via a three-round modified Delphi process. Results Five key articles for junior faculty interested in implementing more robust�graduated responsibility at their residency training program were selected and described here. Summaries of key points, along with considerations for faculty developers and relevance to junior faculty, are presented for each article. Conclusions The articles presented here provide a solid theoretical and practical basis for junior faculty to explore graduated responsibility. The five articles presented here provide the junior faculty with a toolkit to examine and improve their systems for assigning responsibilities in a graded fashion at their own institutions.

View details for DOI 10.7759/cureus.4383

View details for PubMedID 31218147

View details for PubMedCentralID PMC6553674
Transition to Practice: A Novel Life Skills Curriculum for Emergency Medicine Residents WESTERN JOURNAL OF EMERGENCY MEDICINE Caretta-Weyer, H. 2019; 20 (1): 100?104
View details for DOI 10.5811/westjem.2018.10.39868

View details for Web of Science ID 000465023000019
Curated Collections for Educators: Five Key Papers on Evaluating Digital Scholarship. Cureus Quinn, A. n., Chan, T. M., Sampson, C. n., Grossman, C. n., Butts, C. n., Casey, J. n., Caretta-Weyer, H. n., Gottlieb, M. n. 2018; 10 (1): e2021
Abstract

Traditionally, scholarship that was recognized for promotion and tenure consisted of clinical research, bench research, and grant funding. Recent trends have allowed for differing approaches to scholarship, including digital publication. As increasing numbers of trainees and faculty turn to online educational resources, it is imperative to critically evaluate these resources. This article summarizes five key papers that address the appraisal of digital scholarship and describes their relevance to junior clinician educators and faculty developers. In May 2017, the Academic Life in Emergency Medicine Faculty Incubator program focused on the topic of digital scholarship, providing and discussing�papers relevant to the topic. We augmented this list of papers with further suggestions by guest experts and by an open call via Twitter for other important papers. Through this process, we created a list of 38 papers in total on the topic of evaluating digital scholarship. In order to determine which of these papers best describe how to evaluate digital scholarship, the authorship group assessed the papers using a modified Delphi approach to build consensus. In this paper we present the five most highly rated papers from our process about evaluating digital scholarship. We summarize each paper and discuss its specific relevance to junior faculty members and to faculty developers. These papers provide a framework for assessing the quality of digital scholarship, so that junior faculty can recommend high-quality educational resources to their trainees. These papers help guide educators on how to produce high quality digital scholarship and maximize recognition and credit in respect to receiving promotion and tenure.

View details for PubMedID 29531874
The View From Over Here: A Framework for Multi-Source Feedback. Journal of graduate medical education Caretta-Weyer, H. A., Kraut, A. S., Kornegay, J. G., Yarris, L. M. 2017; 9 (3): 367?68
View details for DOI 10.4300/JGME-D-17-00200.1

View details for PubMedID 28638519

View details for PubMedCentralID PMC5476390
Feedback in Medical Education: A Critical Appraisal. AEM education and training Kornegay, J. G., Kraut, A. n., Manthey, D. n., Omron, R. n., Caretta-Weyer, H. n., Kuhn, G. n., Martin, S. n., Yarris, L. M. 2017; 1 (2): 98?109
Abstract

The objective was to review and critically appraise the medical education literature pertaining to feedback and highlight influential papers that inform our current understanding of the role of feedback in medical education.A search of the English language literature in querying Education Resources Information Center (ERIC), PsychINFO, PubMed, and Scopus identified 327 feedback-related papers using either quantitative (hypothesis-testing or observational investigations of educational interventions), qualitative methods (exploring important phenomena in emergency medicine [EM] education), or review methods.Two reviewers independently screened each category of publications using previously established exclusion criteria. Six reviewers then independently scored the remaining 54 publications using a qualitative, quantitative, or review paper scoring system. Each scoring system consisted of nine criteria and used parallel scoring metrics that have been previously used in critical appraisals of education research.Fifty-four feedback papers (25 quantitative studies, 24 qualitative studies, five review papers) met the a priori criteria for inclusion and were reviewed. Eight quantitative studies, nine qualitative studies, and three review papers were ranked highly by the reviewers and are summarized in this article.This inaugural Council of Emergency Medicine Residency Directors Academy critical appraisal highlights 20 feedback in medical education papers that describe the current state of the feedback literature. A summary of current factors that influence feedback effectiveness is discussed, along with practical implications for EM educators and the next steps for research.

View details for PubMedID 30051017

View details for PubMedCentralID PMC6001508
Determining breast cancer axillary surgery within the surveillance epidemiology and end results-Medicare database JOURNAL OF SURGICAL ONCOLOGY Schmocker, R. K., Caretta-Weyer, H., Weiss, J. M., Ronk, K., Havlena, J., Loconte, N. K., Decker, M., Smith, M. A., Greenberg, C. C., Neuman, H. B. 2014; 109 (8): 756-759
Abstract

Use of sentinel lymph node biopsy (SLNB) is under-reported by cancer registries' "Scope of Regional Lymph Node Surgery" variable. In 2011, the Surveillance Epidemiology and End Results (SEER) Program recommended against its use to determine extent of axillary surgery, leaving a gap in the utilization of claims data for breast cancer research. The objective was to develop an algorithm using SEER registry and claims data to classify extent of axillary surgery for breast cancer.We analyzed data for 24,534 breast cancer patients. CPT codes and number of examined lymph nodes classified the extent of axillary surgery. The final algorithm was validated by comparing the algorithm derived extent of axillary surgery to direct chart review for 100 breast cancer patients treated at our breast center.Using the algorithm, 13% had no axillary surgery, 56% SLNB and 31% axillary lymph node dissection (ALND). SLNB was performed in 77% of node negative patients and ALND in 72% of node positive. In our validation study, concordance between algorithm and direct chart review was 97%.Given recognized inaccuracies in cancer registries' "Scope of Regional Lymph Node Surgery" variable, these findings have high utility for health services researchers studying breast cancer treatment.

View details for DOI 10.1002/jso.23579

View details for Web of Science ID 000335369700003

View details for PubMedID 24643795

View details for PubMedCentralID PMC4227499
Impact of the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial on Clinical Management of the Axilla in Older Breast Cancer Patients: A SEER-Medicare Analysis ANNALS OF SURGICAL ONCOLOGY Caretta-Weyer, H., Greenberg, C. G., Wilke, L. G., Weiss, J., Loconte, N. K., Decker, M., Steffens, N. M., Smith, M. A., Neuman, H. B. 2013; 20 (13): 4145-4152
Abstract

American College of Surgeons Oncology Group (ACOSOG) Z0011 demonstrated that eligible breast cancer patients with positive sentinel lymph nodes (SLN) could be spared an axillary lymph node dissection (ALND) without sacrificing survival or local control. Although heralded as a ??practice-changing trial,?? some argue that the stringent inclusion criteria limit the trial?s clinical significance. The objective was to assess the potential impact of ACOSOG Z0011 on axillary surgical management of Medicare patients and examine current practice patterns.Medicare beneficiaries aged C66 years with nonmetastatic invasive breast cancer diagnosed from 2001 to 2007 were identified from the Surveillance, Epidemiology and End Results-Medicare database (n = 59,431). Eligibility for ACOSOG Z0011 was determined: SLN mapping, tumor\5 cm, no neoadjuvant treatment, breast conservation; number of positive nodes was determined. Actual surgical axillary management for eligible patients was assessed.Twelve percent (6,942/59,431) underwent SLN mapping and were node positive. Overall, 2,637 patients (4.4 % (2,637/59,431) of the total cohort, but 38 % (2,637/6,942) of patients with SLN mapping and positive nodes) met inclusion criteria for ACOSOG Z0011, had 1 or 2 positive lymph nodes, and could have been spared an ALND. Of these 2,637 patients, 46 % received a completion ALND and 54 % received only SLN biopsy.Widespread implementation of ACOSOG Z0011 trial results could potentially spare 38 % of older breast cancer patients who undergo SLN mapping with positive lymph nodes an ALND. However, 54 % of these patients are already managed with SLN biopsy alone, lessening the impact of this trial on clinical practice in older breast cancer patients.

View details for DOI 10.1245/s10434-013-3193-1

View details for Web of Science ID 000328256600016

View details for PubMedID 23959051

View details for PubMedCentralID PMC3874252
Impact of axillary ultrasound and core needle biopsy on the utility of intraoperative frozen section analysis and treatment decision making in women with invasive breast cancer AMERICAN JOURNAL OF SURGERY Caretta-Weyer, H., Sisney, G. A., Beckman, C., Burnside, E. S., Salkowsi, L. R., Strigel, R. M., Wilke, L. G., Neuman, H. B. 2012; 204 (3): 308-314
Abstract

Our objective was to evaluate the impact of preoperative axillary ultrasound and core needle biopsy (CNB) on breast cancer treatment decision making. A secondary aim was to evaluate the impact on the utility of intraoperative sentinel lymph node (SLN) frozen section.A review of 84 patients with clinically negative axilla who underwent axillary ultrasound was performed. Sensitivity, specificity, and positive/negative predictive value for axillary ultrasound with CNB was calculated.Thirty-one (37%) had suspicious nodes. Of 27 amenable to CNB, 12 (14%) were malignant, changing treatment plans. The sensitivity of ultrasound and CNB was 54% and specificity 100%; the positive and negative predictive values were 100% and 80%, respectively. In 41 patients with normal ultrasounds who underwent SLN frozen section, 10 (24%) were positive.Preoperative axillary ultrasound impacts treatment decision making in 14%. With a sensitivity of 54%, it is a useful adjunct to, but not replacement for, SLN biopsy. Frozen section remains of utility even after a negative axillary ultrasound.

View details for DOI 10.1016/j.amjsurg.2011.10.016

View details for PubMedID 22483606
Involvement of Noradrenergic Neurotransmission in the Stress- but not Cocaine-Induced Reinstatement of Extinguished Cocaine-Induced Conditioned Place Preference in Mice: Role for beta-2 Adrenergic Receptors NEUROPSYCHOPHARMACOLOGY Mantsch, J. R., Weyer, A., Vranjkovic, O., Beyer, C. E., Baker, D. A., Caretta, H. 2010; 35 (11): 2165-2178
Abstract

The responsiveness of central noradrenergic systems to stressors and cocaine poses norepinephrine as a potential common mechanism through which drug re-exposure and stressful stimuli promote relapse. This study investigated the role of noradrenergic systems in the reinstatement of extinguished cocaine-induced conditioned place preference by cocaine and stress in male C57BL/6 mice. Cocaine- (15?mg/kg, i.p.) induced conditioned place preference was extinguished by repeated exposure to the apparatus in the absence of drug and reestablished by a cocaine challenge (15?mg/kg), exposure to a stressor (6-min forced swim (FS); 20-25�C water), or administration of the ?-2 adrenergic receptor (AR) antagonists yohimbine (2?mg/kg, i.p.) or BRL44408 (5, 10?mg/kg, i.p.). To investigate the role of ARs, mice were administered the nonselective ?-AR antagonist, propranolol (5, 10?mg/kg, i.p.), the ?-1 AR antagonist, prazosin (1, 2?mg/kg, i.p.), or the ?-2 AR agonist, clonidine (0.03, 0.3?mg/kg, i.p.) before reinstatement testing. Clonidine, prazosin, and propranolol failed to block cocaine-induced reinstatement. The low (0.03?mg/kg) but not high (0.3?mg/kg) clonidine dose fully blocked FS-induced reinstatement but not reinstatement by yohimbine. Propranolol, but not prazosin, blocked reinstatement by both yohimbine and FS, suggesting the involvement of ?-ARs. The ?-2 AR antagonist ICI-118551 (1?mg/kg, i.p.), but not the ?-1 AR antagonist betaxolol (10?mg/kg, i.p.), also blocked FS-induced reinstatement. These findings suggest that stress-induced reinstatement requires noradrenergic signaling through ?-2 ARs and that cocaine-induced reinstatement does not require AR activation, even though stimulation of central noradrenergic neurotransmission is sufficient to reinstate.

View details for DOI 10.1038/npp.2010.86

View details for Web of Science ID 000281821200003

View details for PubMedID 20613718

View details for PubMedCentralID PMC2939933

Holly Caretta-Weyer

Clinical Assistant Professor, Emergency Medicine

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