CJEM Articles: evaluation

Displaying 1-6 of 6 results

  • Barriers and facilitators to the implementation of Ontario’s emergency department clinical decision unit pilot program: a qualitative study
    November 2011 13 6
    Anne Sales, Astrid Guttmann, Brian H. Rowe, Chad A. Leaver, Erin Salkeld, Marian J. Vermeulen, Michael J. Schull

    Objective: In Ontario, clinical decision units (CDUs) were implemented as a pilot project in 2008 by the Ministry of Health and Long-Term Care as part of its strategy to reduce emergency department (ED) waiting times. Our objective was to describe general characteristics of the program at each of the participating sites and to examine barriers and facilitators to integrating CDUs into practice.
    Methods: On-site small-group interviews were conducted in two phases with ED and hospital staff at participating sites, first at 8 to 12 weeks and again at 12 months postimplementation. Interview data were analyzed using the framework approach. Unstructured field notes and CDU clinical care protocols and documentation were also reviewed.
    Results: The qualitative analysis identified 10 key themes related to integrating CDUs into EDs: shift in clinical and operational practice; administrative aspects of implementation; team building and stakeholder involvement; use of clinical care protocols; physical or virtual model of care; responsive ancillary services; involvement of specialist services; coordination with hospital and community supports; appropriate use of the CDU; and ongoing evaluation and monitoring. Each theme represents an important insight from the perspective of clinical and administrative staff at participating sites.
    Conclusion: The implementation of CDUs is a complex process, with no single preferred clinical care or operational model. This study identifies a number of key considerations relevant to the future implementation of CDUs.

  • How do I improve the quality of in-training assessment of learners?
    July 2011 13 4
    Glen Bandiera

    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.

  • A new emergency medicine clerkship program: students' perceptions of what works
    May 2010 12 3
    A. Curtis Lee, Brian Weitzman, Janet Nuth, Jason R. Frank, Jennifer Beecker, Marianne Yeung, Meridith Marks

    Objective: Emergency medicine is an evolving discipline in Canadian medical schools. Little has been published regarding student preferences for emergency medicine training during the clerkship phase of MD programs. We assessed medical students' perceptions of a newly developed emergency medicine clerkship rotation involving multiple learning modalities. The evaluation process included assessment of the rotation's instructional elements and overall educational value.

    Methods: The first cohort of medical students to complete this new emergency medicine clerkship was invited to answer a questionnaire just before graduation. Students rated their preferences for components of the rotation using paired com­parisons. Open­ended questions explored students' satisfaction with the emergency medicine clerkship as well as perceptions of the rotation's impact on career development.

    Results: Of the 94 students in the first clerkship cohort, 81 (86%) responded to the survey. Students found the emergency medicine clerkship highly valuable, citing the broad range of cases seen, close supervision, and opportunities to develop clinical assessment, decision­making and procedural skills. Students' curricular preferences were for advanced cardiac life support (ACLS) (26.4%), clinical shifts (20.6%), supervised clinical shifts (17.8%), procedural skills laboratories (14.8%), tutorials (10.8%) and preceptor­assisted learning sessions (9.8%).

    Conclusion: This new emergency medicine clerkship program incorporated multiple learning methods within a 4­week rotation and was highly rated by students. Although clinical shifts and ACLS were generally preferred activities, students had varying individual preferences for specific learning activities. Multiple learning methods allowed all students to benefit from the rotation. This study makes a compelling case for including an emergency medicine rotation with multiple learning modalities as a core element of clerkship at every medical school.

  • Important returns on investment: an evaluation of a national research grants competition in emergency medicine
    January 2010 12 1
    B.H. Rowe, C. Villa-Roel, E. Grafstein, J. Bawden, N. Manouchehri

    Objective: We sought to examine scholarly outcomes of the projects receiving research grants from the Canadian Association of Emergency Physicians (CAEP) during the first 10 years of national funding (i.e., between 1996 and 2005). Methods: We sent email surveys to 62 emergency medicine (EM) researchers who received funding from CAEP. We focused our data collection on grant deliverables and opinions using a 1-7 Likert scale with regard to the value of the award. Results: Fifty eight recipients responded to our survey. Grants were most commonly awarded to residents (21 [36%]), followed by senior (16 [28%]) and junior (13 [22%]) emergency staff. Twenty six applicants from Ontario and 11 from Quebec received the majority of the grants. Overall, 51 projects were completed at the time of contact and, from these, 39 manuscripts were published or in press. Abstract presentations were more common, with a median of 2 abstracts presented per completed project. Abstract presentations for the completed projects were documented locally (23), nationally (39) and internationally (37). Overall, 19 projects received additional funding. The median amount funded was Can$4700 with an interquartile range of $3250-$5000. Respondents felt CAEP funding was critical to completing their projects and felt strongly that dedicated EM research funding should be continued to stimulate productivity. Conclusion: Overall, the CAEP Research Grants Competition has produced impressive results. Despite the small sums avail able, the grants have been important for ensuring study completion and for securing additional funding. CAEP and similar EM organizations need to develop a more robust funding approach so that larger grant awards and more researchers can be supported on an annual basis.

  • Daily encounter cards facilitate competency-based feedback while leniency bias persists
    January 2008 10 1
    David Lendrum, Glen Bandiera

    Objective: We sought to determine if a novel competency-based daily encounter card (DEC) that was designed to minimize leniency bias and maximize independent competency assessments could address the limitations of existing feedback mechanisms when applied to an emergency medicine rotation.

    Methods: Learners in 2 tertiary academic emergency departments (EDs) presented a DEC to their teachers after each shift. DECs included dichotomous categorical rating scales (i.e., "needs attention" or "area of strength") for each of the 7 CanMEDS roles or competencies and an overall global rating scale. Teachers were instructed to choose which of the 7 competencies they wished to evaluate on each shift. Results were analyzed using both staff and resident as the units of analysis.

    Results: Fifty-four learners submitted a total of 801 DECs that were then completed by 43 different teachers over 28 months. Teachers' patterns of selecting CanMEDS competencies to assess did not differ between the 2 sites. Teachers selected an average of 3 roles per DEC (range 0-7). Only 1.3% were rated as "needs further attention." The frequency with which each competency was selected ranged from 25% (Health Advocate) to 85% (Medical Expert).

    Conclusion: Teachers chose to direct feedback toward a breadth of competencies. They provided feedback on all 7 CanMEDS roles in the ED, yet demonstrated a marked leniency bias.

  • Disaster Medicine Online: evaluation of an online, modular, interactive, asynchronous curriculum
    November 2002 4 6
    Adam Lund, Kenneth Lam, Paul Parks

    Canada has no formal training program in disaster medicine for health care professionals. The University of Alberta's Division of Emergency Medicine has developed a means to fill the gap. Disaster Medicine Online (DMO) is an Internet-based, interactive, facilitator-guided distance-learning course on the fundamentals of disaster medicine. The 3-week pilot of DMO was offered in March 2002 and taken by a multidisciplinary group of 22 health care professionals, including resident and attending physicians, paramedics and nurses. Evaluation of the learning materials and educational methodology by experts and learners demonstrated a high degree of satisfaction with the Web interface, site usability, lesson content and format, and the interactive components of the online course. Learners reported spending a mean of 11.2 hours (range = 5-20) over the 3-week course period. Twenty of 22 learners completed the final assignment, and all 20 were successful in passing the course. Overall, 95% of learners said they would pursue another module if offered, and 100% would recommend DMO to their colleagues. DMO is a viable option for health care professionals who would like to pursue continuing medical education in this area without having to take time out of their personal and professional lives to travel to a face-to-face, traditional educational program.