A Modified Delphi Study to Prioritize Content for a Simulation‐based Pediatric Curriculum for Emergency Medicine Residency Training Programs

We sought to assess the impact of procedural skills simulation training on residents’ competence in performing critical resuscitation skills. Our study was a prospective, cross-sectional study of residents from three residency training programs (Family Medicine, Emergency Medicine and Internal Medicine) at the University of Calgary. Participants completed a survey measuring competence in the performance of the procedural skills required to manage hemodynamic instability. The study intervention was an 8 hour simulation based training program focused on resuscitation procedure psychomotor skill acquisition. Competence was criterion validated at the Right Internal Jugular Central Venous Catheter Insertion station by an expert observer using a standardized checklist (Observed Structured Clinical Examination (OSCE) format). At the completion of the simulation course participants repeated the self-assessment survey. Descriptive Statistics, Cronbach’s alpha, Pearson’s correlation coefficient and Paired Sample t-test statistical tools were applied to the analyze the data. Thirty-five of 37 residents (9 FRCPC Emergency Medicine, 4 CCFP-Emergency Medicine, 17 CCFP, and 5 Internal Medicine) completed both survey instruments and the eight hour course. Seventy-two percent of participants were PGY-1 or 2. Mean age was 30.7 years of age. Cronbach’s alpha for the survey instrument was 0.944. Pearson’s Correlation Coefficient was 0.69 (p < 0.001) for relationship between Expert Assessment and Self-Assessment. The mean improvement in competence score pre- to post-intervention was 6.77 (p < 0.01, 95% CI 5.23-8.32). Residents from a variety of training programs (Internal Medicine, Emergency Medicine and Family Medicine) demonstrated a statistically significant improvement in competence with critical resuscitation procedural skills following an intensive simulation based training program. Self-assessment of competence was validated using correlation data based on expert assessments. Dawson S. Procedural simulation: a primer. J Vasc Interv Radiol. 2006; 17(2.1):205-13. Vozenilek J, Huff JS, Reznek M, Gordon JA. See one, do one, teach one: advanced technology in medical education. Acad Emerg Med. 2004; 11(11):1149-54. Ziv A, Wolpe PR, Small SD, Glick S. Simulation-based medical education: an ethical imperative. Acad Med. 2003; 78(8):783-8.

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A Canadian Perspective of simulation-based skill attainment in Internal Medicine Residency (Preprint)

10.2196/preprints.12260 ◽

2018 ◽

Author(s):

Tamer Abdel Moaein ◽

Chirsty Tompkins ◽

Natalie Bandrauk ◽

Heidi Coombs-Thorne

Keyword(s):

Internal Medicine ◽

Residency Training ◽

Training Programs ◽

Skill Training ◽

Skills Training ◽

Skill Learning ◽

Comfort Level ◽

Procedural Skills ◽

Internal Medicine Training ◽

Simulation Based

BACKGROUND Clinical simulation is defined as “a technique to replace or amplify real experiences with guided experiences, often immersive in nature, that evoke or replicate substantial aspects of the real world in a fully interactive fashion”. In medicine, its advantages include repeatability, a nonthreatening environment, absence of the need to intervene for patient safety issues during critical events, thus minimizing ethical concerns and promotion of self-reflection with facilitation of feedback [1] Apparently, simulation based education is a standard tool for introducing procedural skills in residency training [3]. However, while performance is clearly enhanced in the simulated setting, there is little information available on the translation of these skills to the actual patient care environment (transferability) and the retention rates of skills acquired in simulation-based training [1]. There has been significant interest in using simulation for both learning and assessment [2]. As Canadian internal medicine training programs are moving towards assessing entrustable professional activities (EPA), simulation will become imperative for training, assessment and identifying opportunities for improvement [4, 5]. Hence, it is crucial to assess the current state of skill learning, acquisition and retention in Canadian IM residency training programs. Also, identifying any challenges to consolidating these skills. We hope the results of this survey would provide material that would help in implementing an effective and targeted simulation-based skill training (skill mastery). OBJECTIVE 1. Appraise the status and impact of existing simulation training on procedural skill performance 2. Identify factors that might interfere with skill acquisition, consolidation and transferability METHODS An electronic bilingual web-based survey; Fluid survey platform utilized, was designed (Appendix 1). It consists of a mix of closed-ended, open-ended and check list questions to examine the attitudes, perceptions, experiences and feedback of internal medicine (IM) residents. The survey has been piloted locally with a sample of five residents. After making any necessary corrections, it will be distributed via e-mail to the program directors of all Canadian IM residency training programs, then to all residents registered in each program. Two follow up reminder e-mails will be sent to all participating institutions. Participation will be voluntarily and to keep anonymity, there will be no direct contact with residents and survey data will be summarized in an aggregate form. SPSS Software will be used for data analysis, and results will be shared with all participating institutions. The survey results will be used for display and presentation purposes during medical conferences and forums and might be submitted for publication. All data will be stored within the office of internal medicine program at Memorial University for a period of five years. Approval of Local Research Ethics board (HREB) at Memorial University has been obtained. RESULTS Pilot Results Residents confirmed having simulation-based training for many of the core clinical skills, although some gaps persist There was some concern regarding the number of sim sessions, lack of clinical opportunities, competition by other services and lack of bed side supervision Some residents used internet video to fill their training gaps and/or increase their skill comfort level before performing clinical procedure Resident feedback included desire for more corrective feedback, and more sim sessions per skill (Average 2-4 sessions) CONCLUSIONS This study is anticipated to provide data on current practices for skill development in Canadian IM residency training programs. Information gathered will be used to foster a discourse between training programs including discussion of barriers, sharing of solutions and proposing recommendations for optimal use of simulation in the continuum of procedural skills training.

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Strategies to Enhance Wellness in Emergency Medicine Residency Training Programs

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2017.07.007 ◽

2017 ◽

Vol 70 (6) ◽

pp. 891-897 ◽

Cited By ~ 14

Author(s):

Shana Ross ◽

E. Liang Liu ◽

Christian Rose ◽

Adaira Chou ◽

Nicole Battaglioli

Keyword(s):

Emergency Medicine ◽

Residency Training ◽

Training Programs

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Emergency medicine training demographics of physicians working in rural and regional southwestern Ontario emergency departments

CJEM ◽

10.1017/s1481803500015487 ◽

2007 ◽

Vol 9 (06) ◽

pp. 449-452 ◽

Cited By ~ 4

Author(s):

Munsif Bhimani ◽

Gordon Dickie ◽

Shelley McLeod ◽

Daniel Kim

Keyword(s):

Emergency Medicine ◽

Family Medicine ◽

Residency Training ◽

Emergency Departments ◽

Training Programs ◽

Family Physicians ◽

Demographic Information ◽

Trauma Resuscitation ◽

Curriculum Content

ABSTRACT Objectives: We sought to determine the emergency medicine training demographics of physicians working in rural and regional emergency departments (EDs) in southwestern Ontario. Methods: A confidential 8-item survey was mailed to ED chiefs in 32 community EDs in southwestern Ontario during the month of March 2005. This study was limited to nonacademic centres. Results: Responses were received from 25 (78.1%) of the surveyed EDs, and demographic information on 256 physicians working in those EDs was obtained. Of this total, 181 (70.1%) physicians had no formal emergency medicine (EM) training. Most were members of the College of Family Physicians of Canada (CCFPs). The minimum qualification to work in the surveyed EDs was a CCFP in 8 EDs (32.0%) and a CCFP with Advanced Cardiac and Trauma Resuscitation Courses (ACLS and ATLS) in 17 EDs (68.0%). None of the surveyed EDs required a CCFP(EM) or FRCP(EM) certification, even in population centres larger than 50 000. Conclusion: The majority of physicians working in southwestern Ontario community EDs graduated from family medicine residencies, and most have no formal EM training or certification. This information is of relevance to both family medicine and emergency medicine residency training programs. It should be considered in the determination of curriculum content and the appropriate number of residency positions.

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LO43: Simulation curricular content in postgraduate emergency medicine: a multicenter delphi study

CJEM ◽

10.1017/cem.2019.86 ◽

2019 ◽

Vol 21 (S1) ◽

pp. S23

Author(s):

N. Kester-Greene ◽

A. Hall ◽

C. Walsh

Keyword(s):

Emergency Medicine ◽

Delphi Study ◽

Clinical Training ◽

Medical Training ◽

Validity Evidence ◽

Delphi Methodology ◽

Curricular Content ◽

Simulation Based ◽

Em Simulation ◽

National Emergency

Introduction: There is increasing evidence to support the integration of simulation into medical training; however, no national emergency medicine (EM) simulation curriculum currently exists. Using Delphi methodology, we aimed to identify and establish content validity evidence for EM curricular content best suited for simulation-based training to inform national postgraduate EM training. Methods: A national panel of experts in EM simulation-related education iteratively rated potential curricular topics, on a 4-point scale, to determine those best suited for simulation-based training. After each round, responses were analyzed and topics scoring <2/4 were removed. Remaining topics were resent to the panel for further ratings until consensus was achieved, defined as Cronbach α ≥ 0.95. At conclusion of the Delphi process, topics that were rated ≥3.5/4 were considered core curricular topics, while those rated 3.0-3.5 were considered extended curricular topics. Results: Forty-four experts from 13 Canadian centres participated. Two hundred and eighty potential curricular topics, in 29 domains, were generated from a systematic review of the literature, analysis of relevant educational documents and a survey of Delphi panelists. Three rounds of Delphi surveys were completed before consensus was achieved, with response rates ranging from 93-100%. Twenty-eight topics, in 8 domains, reached consensus as core curricular topics. An additional 35 topics, in 14 domains, reached consensus as extended curricular topics. Conclusion: Delphi methodology allowed for achievement of expert consensus and content validation of EM curricular content best suited for simulation-based training. These results provide a foundation for improved integration of simulation into postgraduate EM training and can be used to inform a national simulation curriculum to supplement clinical training and optimize learning.

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Determining content for a simulation-based curriculum in pediatric emergency medicine: results from a national Delphi process

CJEM ◽

10.1017/cem.2015.11 ◽

2015 ◽

Vol 17 (6) ◽

pp. 662-669 ◽

Cited By ~ 14

Author(s):

Ilana Bank ◽

Adam Cheng ◽

Peter McLeod ◽

Farhan Bhanji

Keyword(s):

Emergency Medicine ◽

Delphi Study ◽

Formal Education ◽

National Curriculum ◽

Program Directors ◽

Pediatric Emergency ◽

Primary Objective ◽

Pediatric Emergency Medicine ◽

Core Content ◽

Simulation Based

ABSTRACTObjectivesBy the end of residency training, pediatric emergency medicine (PEM) residents are expected to have developed the confidence and abilities required to manage acutely ill children. Acquisition of competence requires exposure and/or supplemental formal education for critical and noncritical medical clinical presentations. Simulation can provide experiential learning and can improve trainees’ knowledge, skills, and attitudes. The primary objective of this project was to identify the content for a simulation-based national curriculum for PEM training.MethodsWe recruited participants for the Delphi study by contacting current PEM program directors and immediate past program directors as well as simulation experts at all of the Canadian PEM fellowship sites. We determined the appropriate core content for the Delphi study by combining the PEM core content requirements of the Royal College of Physicians and Surgeons of Canada (RCPSC) and the American Board of Pediatrics (ABP). Using the Delphi method, we achieved consensus amongst the national group of PEM and simulation experts. The participants completed a three-round Delphi (using a four-point Likert scale).ResultsResponse rates for the Delphi were 85% for the first round and 77% for second and third rounds. From the initial 224 topics, 53 were eliminated (scored <2). Eighty-five topics scored between 2 and 3, and 87 scored between 3 and 4. The 48 topics, which were scored between 3.5 and 4.0, were labeled as “key curriculum topics.”ConclusionWe have iteratively identified a consensus for the content of a national simulation-based curriculum.

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A Comparison between Emergency Medicine Residency Training Programs in the United States and Saudi Arabia from the Residents’ Perception

Emergency Medicine International ◽

10.1155/2014/362624 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Khaled Alghamdi ◽

Abdulaziz Alburaih ◽

Mary Jo Wagner

Keyword(s):

United States ◽

Emergency Medicine ◽

Saudi Arabia ◽

Residency Training ◽

Training Programs ◽

The United States ◽

Training Techniques ◽

Academic Activities ◽

The Usa ◽

Strongly Agree

Objectives. This study was designed to compare the trainees’ perception of emergency medicine (EM) training in the United States (US) and Saudi Arabia (SA) and to identify residents’ levels of confidence and points of satisfaction in education, procedural skills, and work environment.Method. An IRB-exempt anonymous web-based survey was distributed to five EM residency training programs in the USA and three residency regions in SA.Results. 342 residents were polled with a 20% response rate (16.8% USA and 25.8% SA). The Saudi residents responded less positively to the questions about preparation for their boards’ examinations, access to multiple educational resources, and weekly academic activities. The Saudi trainees felt less competent in less common procedures than US trainees. American trainees also more strongly agree that they have more faculty interest in their education compared to the Saudi trainees. The Saudi residents see more patients per hour compared to their US peers.Conclusion. These findings may be due to the differences in training techniques including less formal didactics and simulation experience in SA and more duty hour regulations in the USA.

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What is the impact of the COVID-19 Pandemic on Emergency Medicine Residency Training: An observational study

10.21203/rs.3.rs-42333/v2 ◽

2020 ◽

Author(s):

Hsiang-Yun Lo ◽

Shen-Che Lin ◽

Chung-Hsien Chaou ◽

Yu-Che Chang ◽

Chip-Jin Ng ◽

...

Keyword(s):

Emergency Medicine ◽

Residency Training ◽

Training Programs ◽

Primary Objective ◽

Clinical Exposure ◽

Number Of Patients ◽

Tertiary Teaching ◽

Epidemic Period ◽

Methods Of Learning ◽

The Impact

Abstract Background The coronavirus disease 2019 (COVID-19) pandemic has engendered difficulties for health systems globally; however, the effect of the pandemic on emergency medicine (EM) residency training programs is unknown. The pandemic has caused reduced volumes of emergency department (ED) patients, except for those with COVID-19 infections, and this may reduce the case exposure of EM residents. The primary objective of this study was to compare the clinical exposure of EM residents between the prepandemic and pandemic periods. Methods This was a retrospective study of EM resident physicians’ training in a tertiary teaching hospital with two branch regional hospitals in Taiwan. We retrieved data regarding patients seen by EM residents in the ED between September 1, 2019, and April 30, 2020. The first confirmed COVID-19 case in Taiwan was reported on January 11, so the pandemic period in our study was defined as spanning from February 1, 2020, to April 30, 2020. The number and characteristics of patients seen by residents were recorded. We compared the data between the prepandemic and pandemic periods.Results The mean number of patients per hour (PPH) seen by EM residents in the adult ED decreased in all three hospitals during the pandemic. The average PPH of critical area of medical ED was 1.68 in the pre-epidemic period and decreased to 1.33 in the epidemic period (p value < 0.001). The average number of patients managed by residents decreased from 1.24 to 0.82 in the trauma ED (p value= 0.01) and 1.56 to 0.51 in the pediatric ED (p value=0.003) during the pandemic, respectively. The severity of patient illness did not change significantly between the periods. Conclusions The COVID-19 pandemic engendered a reduced ED volume and decreased EM residents’ clinical exposure. All portion of EM residency training were affected by the pandemic, with pediatric EM being the most affected. The patient volume reduction may persist and in turn reduce patients’ case exposure until the pandemic subsides. Adjustment of the training programs may be necessary and ancillary methods of learning should be used to ensure adequate EM residency training.

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A Modified Delphi Study for Development of a Pediatric Curriculum for Emergency Medicine Residents

AEM Education and Training ◽

10.1002/aet2.10021 ◽

2017 ◽

Vol 1 (2) ◽

pp. 140-150 ◽

Cited By ~ 5

Author(s):

Jennifer Mitzman ◽

Andrew M. King ◽

Rebecca K. Fastle ◽

Laura R. Hopson ◽

John D. Hoyle ◽

...

Keyword(s):

Emergency Medicine ◽

Delphi Study ◽

Modified Delphi

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What is the Impact of the COVID-19 Pandemic on Emergency Medicine Residency Training: An Observation Study

10.21203/rs.3.rs-42333/v1 ◽

2020 ◽

Author(s):

Hsiang-Yun Lo ◽

Shen-Che Lin ◽

Chung-Hsien Chaou ◽

Yu-Che Chang ◽

Chip-Jin Ng ◽

...

Keyword(s):

Emergency Medicine ◽

Residency Training ◽

Training Programs ◽

Working Hours ◽

Primary Objective ◽

Observation Study ◽

Clinical Exposure ◽

Number Of Patients ◽

Methods Of Learning ◽

The Impact

Abstract BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has engendered difficulties for health systems globally; however, the effect of the pandemic on emergency medicine (EM) residency training programs is unknown. The pandemic has engendered reduced volumes of emergency department (ED) patients, except for those with COVID-19 infections, and this may reduce the case exposure of EM residents. The primary objective of this study was to compare the clinical exposure of EM residents between the prepandemic and pandemic periods. MethodsThis was a retrospective study of EM resident physicians in Taiwan. We performed a medical record review and retrieved data regarding patients seen by EM residents in the ED between September 1, 2019, and April 30, 2020. The number and characteristics of patients seen by residents were recorded, and the training schedules, including clinical working hours, of EM residents were determined. We compared the data between the prepandemic and pandemic periods.ResultsA total of 51,337 patients were managed by 36 EM residents during the 8-month study period. The mean number of patients per hour (PPH) seen by EM residents decreased significantly during the pandemic period. The PPH seen by residents in the adult ED decreased in all three hospitals during the pandemic. The average number of patients managed by residents decreased by 50% and 70% in the trauma ED and pediatric ED during the pandemic, respectively. The severity of patient illness did not change significantly between the periods. ConclusionsThe COVID-19 pandemic engendered a reduced ED volume and decreased EM residents’ clinical exposure. All portion of EM residency training were affected by the pandemic, with pediatric EM being the most affected. The patient volume reduction may persist and in turn reduce patients’ case exposure until the pandemic subsides. Adjustment of the training programs may be necessary and ancillary methods of learning should be used to ensure adequate EM residency training.

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