CJEM Articles: Danielle Blouin
Displaying 1-3 of 3 results
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November
2008
10
6
Danielle Blouin, Jeffrey Damon Dagnone
Objective: A major role of admission interviews is to assess a candidate's suitability for a residency program. Structured interviews have greater reliability and validity than do unstructured ones. The development of content for a structured interview is typically based on the dimensions of performance that are perceived as important to succeed in a particular line of work. A formal job analysis is normally conducted to determine these dimensions. The dimensions essential to succeed as an emergency medicine (EM) resident have not yet been studied. We aimed to analyze the work of EM residents to determine these essential dimensions.
Methods: The "critical incident technique" was used to generate scenarios of poor and excellent resident performance. Two reviewers independently read each scenario and labelled the performance dimensions that were reflected in each. All labels assigned to a particular scenario were pooled and reviewed again until a consensus was reached.
Results: Five faculty members (25% of our total faculty) comprised the subject experts. Fifty-one incidents were generated and 50 different labels were applied. Eleven dimensions of performance applied to at least 5 incidents. "Professionalism" was the most valued performance dimension, represented in 56% of the incidents, followed by "self-confidence" (22%), "experience" (20%) and "knowledge" (20%).
Conclusion: "Professionalism," "self-confidence," "experience" and "knowledge" were identified as the performance dimensions essential to succeed as an EM resident based on our formal job analysis using the critical incident technique. Performing a formal job analysis may assist training program directors with developing admission interviews.
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January
2006
8
1
Danielle Blouin, Luigi Eugene Dagnone, Robert McGraw
Objectives: In 2004, the format of the Royal College of Physicians and Surgeons of Canada certification exam in Emergency Medicine was modified to include an audiovisual session. Residents' performance on such stimuli is unknown. This study aims to determine the performance of Emergency Medicine postgraduate year 5 (PGY-5) on a novel practice examination using visual stimuli, in an effort to guide residents' preparatory study, and to help educators focus the teaching related to visual stimuli.
Methods: In this prospective observational study, 30 PGY-5 residents from 12 Emergency Medicine programs across Canada participated in a practice examination in which they had to answer 133 questions related to 80 visual stimuli. The stimuli included electrocardiograms, medical imaging and clinical photographs. Three experienced faculty provided "reference standard" answers for the visual stimuli. For analysis purpose, stimuli were classified into 9 clinical domains, outlined in The Model of the Clinical Practice of Emergency Medicine.
Results: Insufficient question numbers in 3 domains prevented reliable inferences. Correct answers were given for 65% of remaining questions, with the following domain distribution: 69% respiratory, 64% trauma, 73% cardiovascular, 62% head–eyes–ears–nose–throat (HEENT), 63% musculoskeletal and 69% cutaneous. Seventy-four percent of ECGs, 64% of imaging, and 62% of photograph-related questions were answered correctly. Incorrect answers were related to a lack of knowledge as well as imprecise or incomplete responses.
Conclusions: PGY-5 subjects scored lowest in the HEENT and musculoskeletal domains. Medical educators should emphasize these domains in their teaching, and insist on precision and completeness of answers. -
September
2004
6
5
Danielle Blouin, François Dufresne, Marc Afilalo, Xiaoqing Xue
Objective: Acetylsalicylic acid (ASA) is a simple and cost-effective treatment for acute coronary syndromes (ACS). Our objectives were to determine the frequency of ASA administration in the emergency department (ED) for patients with acute myocardial infarction or unstable angina, and to identify patient characteristics associated with its administration.
Methods: This is a retrospective chart review of patients discharged with a final diagnosis of ACS. Data on age, gender, mode of presentation, presence of chest pain at triage, administration of ASA or not in the ED, dosage and form of ASA received, timing of administration, presence of contraindications to ASA and use of regular ASA prior to ED presentation were recorded.
Results: Six hundred and one charts were analyzed. Five hundred and fifty patients (91.5%) received ASA. Only 444 (73.9%) of these 550 patients were administered the ASA appropriately, according to the American Heart Association / American College of Cardiology (AHA/ACC) guidelines. Univariate analysis showed that chart notes "Transport by ambulance," "Allergy to ASA" and "Gastrointestinal bleed" were associated with a lower probability of the patient being administered ASA. If a patient was noted as taking ASA regularly, it increased the chance of this patient being administered ASA in the ED.
Conclusion: Although the study ED performed well, administering ASA to 91.5% of patients with ACS, only 73.9% of the patients who received ASA were administered the ASA appropriately, as recommended in the AHA/ACC guidelines. Educational strategies and system changes are necessary to increase the proportion of eligible ACS patients who receive appropriate ASA therapy.
