CJEM Articles: education
Displaying 1-10 of 20 results
Glen Bandiera, Jill McEwen, Richard Lee, Rick Penciner, Robert A. Woods, Trevor Langhan
There is no consensus on what constitutes the core competencies for emergency medicine (EM) clerkship rotations in Canada. Existing EM curricula have been developed through informal consensus and often focus on EM content to be known at the end of training rather than what is an appropriate focus for a time-limited rotation in EM. We sought to define the core competencies for EM clerkship in Canada through consensus among an expert panel of Canadian EM educators.
We used a modified Delphi method and the CanMEDS 2005 Physician Competency Framework to develop a consensus among expert EM educators from across Canada.
Thirty experts from nine different medical schools across Canada participated on the panel. The initial list consisted of 152 competencies organized in the seven domains of the CanMEDS 2005 Physician Competency Framework. After the second round of the Delphi process, the list of competencies was reduced to 62 (59% reduction). A complete list of competencies is provided.
This study established a national consensus defining the core competencies for EM clerkship in Canada.
Ignorance more frequently begets confidence than does knowledge.
Audit and feedback (A&F) is a powerful exercise for self-assessment of individual or group practice against best practice. Learning occurs through a structured process, starting by understanding the area of interest, conducting an audit, and then reflecting and creating solutions to identified gaps in care. Although current evidence is limited, the additional time and effort required are believed to result in greater rewards than traditional educational activities as the learning is more directly relevant to patient care.
Impact of a teaching attending physician on medical student, resident, and faculty perceptions and satisfactionJuly 2011 13 4Andrew L. Nyce, Brigitte M. Baumann, J. Hope Kilgannon, Michael E. Chansky, Tara N. Cassidy-Smith
Objectives: To determine if a dedicated teaching attending for medical student education improves medical student, attending physician, and resident perceptions and satisfaction.
Methods: Two dedicated teaching attending physician shifts were added to the clinical schedule each week. A before-after trial compared medical student evaluations from 2000 to 2004 (preteaching attending physician) to medical student evaluations from 2005 to 2006 (teaching attending physician). Attending physician and resident perceptions and satisfaction with the teaching attending physician shifts using a 5-point Likert-type scale (1 = poor to 5 = excellent) were also assessed.
Results: Eighty-nine (100%) medical students participated, with 63 preteaching attending physician and 26 teaching attending physician rotation evaluations. The addition of teaching attending physician shifts improved mean medical student satisfaction with bedside teaching (4.1 to 4.5), lecture satisfaction (4.2 to 4.8), preceptor scores (4.3 to 4.8), and perceived usefulness of the rotation (4.5 to 5.0) (all p < 0.05). Thirteen attending physicians (93%) participated in the cross-sectional questionnaire. The addition of teaching attending physician shifts improved faculty ratings of their medical student interactions by ≥ 1.5 points for all items (p ≤ 0.001). Faculty perceptions of their resident interactions improved for quality of bedside teaching (3.1 to 4.0), their availability to hear resident presentations (3.4 to 4.2), and their supervision of residents (3.4 to 4.1) (p ≤ 0.01). Residents (n = 35) noted minor improvements with the timeliness of patient dispositions, faculty bedside teaching, and attending physician availability.
Conclusions:The addition of select teaching attending physician shifts had the greatest effect on medical student and faculty perceptions and satisfaction, with some improvements for residents.
Assessing a learner in the course of a hectic emergency department (ED) rotation is a daunting task for both experienced and new supervisors. This is particularly true if the learner is not doing well. In light of numerous impediments provided by the modern ED environment, sticking to basic principles can result in marked improvement in both the process and the outcome of in-training assessment. This article addresses these important principles for assessment as they apply in the clinical realm of the ED, with a focus on matching expectations to both the trainee and the available assessment strategies. It is critical that teachers strive for clarity, consistency, honesty, and adherence to due process in their learner assessments. This article provides an evidence-informed approach to succeeding with such an approach to clinical assessment.
Daniel Howes, Ian J. Rigby, Ian W. Walker, Jason A. Lord, Trevor S. Langhan, Tyrone Donnon
Objective: Residents must become proficient in a variety of procedures. The practice of learning procedural skills on patients has come under ethical scrutiny, giving rise to the concept of simulation-based medical education. Resident training in a simulated environment allows skill acquisition without compromising patient safety. We assessed the impact of a simulation-based procedural skills training course on residents’ competence in the performance of critical resuscitation procedures.
Methods: We solicited self-assessments of the knowledge and clinical skills required to perform resuscitation procedures from a cross-sectional multidisciplinary sample of 28 resident study participants. Participants were then exposed to an intensive 8-hour simulation-based training program, and asked to repeat the self-assessment questionnaires on completion of the course, and again 3 months later. We assessed the validity of the self-assessment questionnaire by evaluating participants’ skills acquisition through an Objective Structured Clinical Examination station.
Results: We found statistically significant improvements in participants’ ratings of both knowledge and clinical skills during the 3 self-assessment periods (p <0.001). The participants’ year of postgraduate training influenced their self-assessment of knowledge (F2,25 = 4.91, p <0.01) and clinical skills (F2,25 = 10.89, p <0.001). At the 3-month follow-up, junior-level residents showed consistent improvement from their baseline scores, but had regressed from their posttraining measures. Senior-level residents continued to show further increases in their assessments of both clinical skills and knowledge beyond the simulation-based training course.
Conclusion: Significant improvement in self-assessed theoretical knowledge and procedural skill competence for residents can be achieved through participation in a simulation-based resuscitation course. Gains in perceived competence appear to be stable over time, with senior learners gaining further confidence at the 3-month follow-up. Our findings support the benefits of simulation-based training for residents.
Effectiveness of a novel training program for emergency medicine residents in ultrasound-guided insertion of central venous cathetersJuly 2009 11 4A. Curtis Lee, Calvin Thompson, Jason Frank, Jennifer Beecker, Marianne Yeung, Michael Y. Woo, Pierre Cardinal
Objective: Insertion of central venous catheters (CVCs) is an essential competency for emergency physicians. Ultrasound-guided (USG) insertion of CVCs has been shown to be safer than the traditional landmark technique. There is no clear consensus on effective methods for training physicians in USG insertion of CVCs. We developed and evaluated a novel educational training program in the USG technique for insertion of CVCs.
Methods: Sixteen emergency medicine residents volunteered for a pre- and postprogram evaluation study, which was approved by our research ethics board. After their previous experience was determined, each participant was videotaped inserting a USG CVC in the right internal jugular vein on models. Participants then reviewed a Web-based instructional module and had a practical session. Participants were again videotaped inserting a USG CVC. The primary outcome was the change in score before and after the training program, using an expert-validated performance evaluation tool used to review the videotaped performances in a blinded fashion. Participants also completed a questionnaire to measure their satisfaction with the training program and any change in their perceived competence.
Results: Participants ranged from residency year 1 to 5. Thirteen of 16 (81%) had never attempted USG insertion of a CVC. Participants reported that the models were realistic. Performance scores (12/19 to 13.2/19) and global ratings assessments (3.5/7 to 5.5/7) improved significantly (p < 0.01; the effect size, Cohen d = 1.12 before and 1.28 after) after the instruction. There was good interrater reliability between evaluators of the videotaped performances regarding performance scores (r = 0.68) and global rating scores (r = 0.75). All participants felt their confidence and technical skills were improved (p < 0.01) and all felt satisfied with the training program.
Conclusion: This brief innovative multimethod training program was effective in enhancing emergency medicine resident competence in USG insertion of CVCs.
Bruce J. Wright, Fraser R. Brenneis, Ian M. Scott, Margot C. Gowans, Riyad B. Abu-Laban
Background: Studies indicate that a student's career interest at medical school entry is related to his or her ultimate career. We sought to determine the level of interest in emergency medicine among students at the time of medical school entry, and to describe characteristics associated with students primarily interested in emergency medicine.
Methods: We surveyed students in 18 medical school classes from 8 Canadian universities between 2001 and 2004 at the commencement of their studies. Participants listed their top career choice and the degree to which a series of variables influenced their choices. We also collected demographic data.
Results: Of 2420 surveys distributed, 2168 (89.6%) were completed. A total of 6.1% (95% confidence interval 5.1%-7.1%) of respondents cited emergency medicine as their first career choice. When compared with students primarily interested in family medicine, those primarily interested in emergency medicine reported a greater influence of hospital orientation and a lesser influence of social orientation on their career choice. When compared with students primarily interested in the surgical specialties, those primarily interested in emergency medicine were more likely to report medical lifestyle and varied scope of practice as important influences. When compared with students primarily interested in the medical specialties, those who reported interest in emergency medicine were more likely to report that a hospital orientation and varied scope of practice were important influences, and less likely to report that social orientation was important.
Conclusion: Students primarily interested in emergency medicine at medical school entry have attributes that differentiate them from students primarily interested in family medicine, the surgical specialties or the medical specialties. These findings may help guide future initiatives regarding emergency medicine education.
Self-reported experience and competence in core procedures among Canadian pediatric emergency medicine fellowship traineesNovember 2008 10 6David Warren, Jamie A. Seabrook, Majid Al-Eissa, Michael J. Rieder, Rodrick Lim, Simon Chu, Timothy Lynch
Objective: We sought to determine the frequency with which fellows in accredited Canadian pediatric emergency medicine (PEM) fellowships perform specific procedures, the level of confidence fellows have in their abilities and whether there are differences in self-perceived success between first- and second-year fellows.
Methods: A national survey was developed that focused on 24 PEM procedural skills. The survey asked respondents how many times they had performed these procedures within the past 12 months and within the past 3 years. Respondents were then asked to rate their confidence in successfully performing each of the 24 procedures.
Results: Of the 46 surveys sent to PEM fellows, 32 (70%) were returned. Most respondents were in their second year of training and the vast majority had previous training in pediatrics. In order of frequency, the most common procedures performed were closed reduction of fractures, peripheral intravenous insertion, complex laceration repair and endotracheal intubation. Of the surveyed skills, oropharyngeal/nasopharyngeal airway insertion was deemed the most successful (100% success rate for second-year fellows v. 92.5% success rate for first-year fellows, p = 0.01). Similarly, second-year fellows had a higher self-perceived success rate for intraosseous line insertion than did first-year fellows (95.0% v. 80.0% for second- and first-year fellows, respectively, p < 0.001).
Conclusion: In surveying PEM trainees across Canada, we have described the frequency and self-perceived success rate for 24 important procedures. This information may be helpful for program directors in evaluating future directions and opportunities for training of their PEM trainees.