MP18: Addressing unrealistic expectations: a novel transition to discipline curriculum in emergency medicine

Innovation Concept: Emergency medicine (EM) programs have restructured their training using a Competence by Design model. This model emphasizes entrustable professional activities (EPAs) that residents must fulfill before advancing in their training. The first EPA (EPA 1) for the transition to discipline (TTD) stage involves managing the unstable patient. Data from the University of Toronto (U of T) program suggests residents lack enough exposure to these patient presentations during TTD – creating a disconnect between anticipated clinical exposure and the expectation for residents to achieve competence in EPA 1. Methods: To overcome this gap, U of T EM faculty specifically targeted EPA 1 while designing the TTD curriculum. Kern's six-step approach to curriculum development in medical education was used. This six-step approach involves: problem identification, needs assessment, goals and objectives, education strategies, implementation and evaluation. To maximize feasibility of the new curriculum, existing sessions were mapped against EPAs and required training activities to identify synchrony where possible. Residents were scheduled on EM rotations with weekly academic days that included this novel curriculum. Curriculum, Tool or Material: Didactic lectures, procedural workshops and simulation were closely integrated in TTD to address EPA 1. Lectures introduced approaches to cardinal presentations. An interactive workshop introduced ACLS and PALS algorithms and defibrillator use. Three simulation sessions focused on ACLS, shock, airway, trauma and the altered patient. A final simulation session allowed spaced-repetition and integration of these topics. After the completion of TTD, residents participated in a six-scenario simulation OSCE directly assessing EPA 1. Conclusion: The curriculum was evaluated using a multifaceted approach including surveys, self-assessments, faculty feedback and OSCE performance. Overall, the curriculum achieved its goal in addressing EPA 1. It was well-received by faculty and residents. Residents rated the sessions highly, and self-reported improved confidence in assessing unstable patients and adhering to ACLS algorithms. The simulation OSCE demonstrated expected competency by residents in EPA 1. One limitation identified was the lack of a pediatric simulation session which has now been incorporated into the curriculum. Moving forward, this innovative curriculum will undergo continuous cycles of evaluation and improvement with a goal of applying a similar design to other stages of CBD.

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Pregraduate Training in Emergency Medicine

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00040048 ◽

1993 ◽

Vol 8 (1) ◽

pp. 69-75 ◽

Cited By ~ 5

Author(s):

Louis Binder ◽

Desmond Colohan ◽

Wolfgang Dick ◽

Bernard Nemitz ◽

Yoel Donchin ◽

...

Keyword(s):

Emergency Medicine ◽

Undergraduate Education ◽

Medical Center ◽

Disaster Medicine ◽

World Congress ◽

Medical Organization ◽

University Of Toronto ◽

Texas Tech University ◽

The University ◽

Seventh World

AbstractA panel session on undergraduate education in Emergency Medicine from a worldwide perspective was conducted at the Seventh World Congress of Emergency and Disaster Medicine in Montreal, in May, 1991. Desmond Colohan MD, of the University of Toronto (Canada) was the panel moderator. Panel speakers were: Louis Binder MD, Texas Tech University Health Services Center (USA); Wolfgang Dick MD, University of Mainz (Germany); Bernard Nemitz MD, Faculty de Medicine d'Ameins (France); Yoel Donchin MD, Hadassa Medical Organization (Israel); and Noriyoshi Ohashi MD, Tsukuba Medical Center (Japan).

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LO15: Not a hobby anymore: Establishment of the Global Health Emergency Medicine organization at the University of Toronto to facilitate academic careers in global health for faculty and residents

CJEM ◽

10.1017/cem.2017.77 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S32

Author(s):

C. Hunchak ◽

L. Puchalski Ritchie ◽

M. Salmon ◽

J. Maskalyk ◽

M. Landes

Keyword(s):

Emergency Medicine ◽

Global Health ◽

Academic Career ◽

Critical Mass ◽

Practice Research ◽

University Of Toronto ◽

Academic Benefits ◽

Seed Funding ◽

Academic Plan ◽

The University

Introduction/Innovation Concept: Demand for training in global health emergency medicine (EM) practice and education across Canada is high and increasing. For faculty with advanced global health EM training, EM departments have not traditionally recognized global health as an academic niche warranting support. To address these unmet needs, expert faculty at the University of Toronto (UT) established the Global Health Emergency Medicine (GHEM) organization to provide both quality training opportunities for residents and an academic home for faculty in the field of global health EM. Methods: Six faculty with training and experience in global health EM founded GHEM in 2010 at a UT teaching hospital, supported by the leadership of the ED chief and head of the Divisions of EM. This initial critical mass of faculty formed a governing body, seed funding was granted from the affiliated hospital practice plan and a five-year strategic academic plan was developed. Curriculum, Tool, or Material: GHEM has flourished at UT with growing membership and increasing academic outputs. Five governing members and 9 general faculty members currently run 18 projects engaging over 60 faculty and residents. Formal partnerships have been developed with institutions in Ethiopia, Congo and Malawi, supported by five granting agencies. Fifteen publications have been authored to date with multiple additional manuscripts currently in review. Nineteen FRCP and CCFP-EM residents have been mentored in global health clinical practice, research and education. Finally, GHEM’s activities have become a leading recruitment tool for both EM postgraduate training programs and the EM department. Conclusion: GHEM is the first academic EM organization in Canada to meet the ever-growing demand for quality global health EM training and to harness and support existing expertise among faculty. The productivity from this collaborative framework has established global health EM at UT as a relevant and sustainable academic career. GHEM serves as a model for other faculty and institutions looking to move global health EM practice from the realm of ‘hobby’ to recognized academic endeavor, with proven academic benefits conferring to faculty, trainees and the institution.

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Emergency medicine preclerkship observerships: evaluation of a structured experience

CJEM ◽

10.1017/s1481803500011258 ◽

2009 ◽

Vol 11 (03) ◽

pp. 235-239 ◽

Cited By ~ 7

Author(s):

Rick Penciner

Keyword(s):

Emergency Medicine ◽

Medical Students ◽

Medical School ◽

Role Models ◽

Online Survey ◽

Career Decisions ◽

Convenience Sample ◽

University Of Toronto ◽

Perceptions And Attitudes ◽

The University

ABSTRACT Objective: Medical students are expected to make residency and career decisions early in their undergraduate medical education. In medical school curricula, there is limited exposure to emergency medicine (EM) in the preclerkship years. The purpose of this study was to evaluate a structured EM observership program for preclerks by surveying the students’ perceptions and attitudes about the program following their participation. Methods: A structured observership program was developed and implemented at the University of Toronto Medical School in February 2007. All first- and second-year students were eligible to participate on a voluntary basis. Nine emergency department (ED) teaching sites were enlisted, with each site recruiting interested preceptors. The observership consisted of two 4-hour shifts with 1 preceptor at 1 site. Specific expectations were provided to the students at the start of the observership. A convenience sample was used for the period between Feb. 26 and Nov. 4, 2007, to conduct an anonymous online survey about the students' experience after the ob servership. Results: During the study period, 82 students completed 99 observerships at 9 sites with 54 different preceptors. Of the 82 students who completed the observerships, 70 students completed the survey. Overall, all the students (70/70) found the experience to be worthwhile. Most students (68/70) viewed the preceptors as good role models. As a result of the observership, 47 of 70 students reported that their attitudes about and interest in EM had changed and most (59/70) planned on exploring other opportunities in EM (e.g., electives). Conclusion: Structured EM observerships are viewed by medical students to be worthwhile. These observerships can change attitudes about and interest in EM and allow students to make more informed career choices.

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MP25: The quality improvement and patient safety curriculum for emergency medicine residents at the University of Toronto: results from the first cohort

CJEM ◽

10.1017/cem.2018.179 ◽

2018 ◽

Vol 20 (S1) ◽

pp. S49-S50

Author(s):

A. H Y. Cheng ◽

S. Vaillancourt ◽

M. McGowan ◽

A. Verma ◽

A. McDonald ◽

...

Keyword(s):

Emergency Medicine ◽

Patient Safety ◽

Quality Improvement ◽

Practical Skills ◽

Absolute Increase ◽

Educational Methods ◽

University Of Toronto ◽

Curriculum Changes ◽

The University ◽

The Impact

Introduction: The 2015 CanMEDS framework requires all residency programs to increase their focus on Quality Improvement and Patient Safety (QIPS). We created a longitudinal (4-year), modular QIPS curriculum for FRCP emergency medicine residents at the University of Toronto (UT) using multiple educational methods. The curriculum addresses three levels of QIPS training: knowledge, practical skills at the microsystem level, and practical skills at the organization level. Aim Statement: To increase the UT FRCP emergency medicine residents absolute score on the QIKAT-R (Quality Improvement Knowledge Application Tool Revised) by 10% after the completion of the QIPS curriculum. Methods: Physicians and other healthcare professionals with QI expertise collaboratively designed and taught the curriculum. We used the QIKAT-R as the outcome measure to evaluate QI knowledge and its applicability. The QIKAT-R is a validated measure that assesses an individuals ability to decipher a QI issue within the healthcare context, and propose a change initiative to address it. The first cohort of residents completed the QIKAT-R prior to the first session in 2014 (pre) and at the completion of the curriculum in 2017 (post). Each response was anonymized and scored by physicians with QI expertise. The QIKAT-R scores and comments from course evaluations are used to make yearly iterative curriculum changes. Results: The QIPS curriculum was implemented in September 2014. All nine residents in the first cohort completed the curriculum; they demonstrated an absolute increase of 19.6% (5.3/27) in the mean QIKAT-R score (13.0 +/− 3.3 pre vs. 18.3 +/− 3.8 post, p=0.001). Of the pre-test responses, 26% were categorized as poor, 70% as good, and 4% as excellent, whereas of the post-test 11% of responses were categorized as poor, 37% as good, and 52% as excellent (p<0.001). Two iterative curriculum changes were made at the end of each academic year since 2014: (1) The time between sessions were decreased to promote knowledge retention, and (2) different PGY3 QI practical project options were provided to suit residents individual QI interests. QIKAT-R scores and resident feedback were used to evaluate the impact of the curriculum changes. Conclusion: A collaborative, modular, longitudinal QIPS curriculum for UT FRCP emergency medicine residents that met CanMEDS requirements was created using multiple educational methods. The first resident cohort that completed the curriculum demonstrated an absolute increase in QI knowledge and its applicability (as measured by the QIKAT-R) by 19.6%. Two PDSA cycles were completed to improve the curriculum with the change ideas generated from resident feedback. Ongoing challenges include limited staff availability to teach and supervise resident QI projects. Future directions include incentivising staff participation and providing mentorship for residents with a career interest in QI beyond what is offered by the curriculum.

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P079: Transition to practice: evaluating the need for formal training in supervision and assessment techniques among senior emergency medicine residents and new to practice emergency physicians

CJEM ◽

10.1017/cem.2018.277 ◽

2018 ◽

Vol 20 (S1) ◽

pp. S84-S85 ◽

Cited By ~ 1

Author(s):

S. Kilbertus ◽

K. Pardhan ◽

G. Bandiera ◽

J. Zaheer

Keyword(s):

Emergency Medicine ◽

Structured Interview ◽

Formal Training ◽

Independent Practice ◽

Formal Curriculum ◽

University Of Toronto ◽

Constructive Feedback ◽

Interview Guide ◽

The University ◽

Mcmaster University

Introduction: Final year emergency medicine residents may be transitioning to practice with little to no training on how to effectively supervise and assess trainees. It remains unclear how comfortable final year residents and new-to-practice physicians are with these competencies. The goal of our study was to examine physician comfort with supervision and assessment, whether there was a perceived need for formal training in these areas, and what gaps, barriers and enablers would exist in implementing it. Methods: Qualitative data were collected in two phases during September 2016-November 2017 through interviews of PGY5 emergency residents and new-to-practice staff at the University of Toronto and McMaster University in Ontario, Canada. A semi-structured interview guide was developed and used during the first round of interviews at the University of Toronto during phase one. Results from phase one were used to refine the interview guide, to be used in phase two, to ensure that all potential areas of thematic generation were touched upon. Phase two occurred at the University of Toronto and McMaster University using the refined interview guide. All transcripts were coded, analyzed, and collapsed into themes. Data analysis was guided by a constructivist grounded theory based in a relativist paradigm. Results: Thematic analysis revealed five themes. Residents and staff alike described acquiring the skills of supervision and assessment passively, primarily through modeling the behaviours of others; the training that is available in these areas is variably used, creating a diversity of physician comfort levels within these two competencies; the many competing priorities in the emergency department represent significant barriers to improving supervision and assessment; providing negative feedback is universally difficult and often avoided, sometimes resulting in struggling trainees not being identified until late in residency; the move towards competency based education (CBE) will act as an impetus for more formal curriculum being required in these areas. Conclusion: As residency programs transition to a CBE model, there will be a greater need for formal training in supervision and assessment to achieve a standard level of comfort and competence among senior residents physicians in independent practice. These competencies will also need an emphasis on how to identify struggling trainees, and how to approach negative and constructive feedback.

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Firsthand Experience in Graduating Three Cohorts of Forensic Pathologists Trained With Competency by Design (CBD) Curriculum

Academic Forensic Pathology ◽

10.1177/19253621211063104 ◽

2021 ◽

pp. 192536212110631

Author(s):

Jayantha C. Herath

Keyword(s):

Training Program ◽

Royal College ◽

Forensic Pathology ◽

Training Experience ◽

Professional Activities ◽

University Of Toronto ◽

The Third ◽

Stage Transition ◽

The University ◽

Pathology Training

Introduction: The University of Toronto experienced graduating three cohorts of forensic pathologists trained with Competency by Design (CBD) curriculum. We achieved this as a result of multiyear development of Entrustable Professional Activities (EPAs), Required Training Experience (RTEs), and Specialty Competency Requirements (SCRs) by the Royal College of Physicians and Surgeons of Canada’s Forensic Pathology Speciality Committee, the Ontario Forensic Pathology Service, and the University of Toronto. Method: Our academic year is comprised of 13 blocks. We divided the 13-block period into 4 stages to map all the EPAs and RTEs. The first stage, Transition to Discipline, is 1 block, the second stage, Foundation of Discipline, consists of 3 blocks; the third stage, Core of Discipline, consists of 6 blocks, and the final fourth stage, Transition to Practice, consists of 3 blocks. Board-certified faculty members in Forensic Pathology with more than five years of experience supervised the trainees. We graduated 5 Canadian and 4 international trainees at the end of the third cycle of CBD-based training program. Conclusion: Using the Royal College Speciality Committee blueprint, the University of Toronto started in 2016 planning the CBD curriculum in the forensic pathology training program. By the end of June 2021, we graduated nine trainees from our CBD-based Forensic Pathology training program. We are training the fourth cohort, and they will be graduating at the end of June 2022. This article aims to share our firsthand experiencing in CBD training in forensic pathology.

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Developing a dashboard to meet the needs of residents in a competency-based training program: A design-based research project

Canadian Medical Education Journal ◽

10.36834/cmej.69682 ◽

2020 ◽

Author(s):

Robert Carey ◽

Grayson Wilson ◽

Venkat Bandi ◽

Debajyoti Mondal ◽

Lynsey Martin ◽

...

Keyword(s):

Emergency Medicine ◽

Focus Groups ◽

Residency Program ◽

Research Process ◽

Theory Approach ◽

Assessment Data ◽

Design Based Research ◽

Professional Activities ◽

Competency Based ◽

The University

Background: Canadian specialty programs are implementing Competence By Design, a competency-based medical education (CBME) program which requires frequent assessments of entrustable professional activities. To be used for learning, the large amount of assessment data needs to be interpreted by residents, but little work has been done to determine how visualizing and interacting with this data can be supported. Within the University of Saskatchewan emergency medicine residency program, we sought to determine how our residents’ CBME assessment data should be presented to support their learning and to develop a dashboard that meets our residents’ needs. Methods: We utilized a design-based research process to identify and address resident needs surrounding the presentation of their assessment data. Data was collected within the emergency medicine residency program at the University of Saskatchewan via four resident focus groups held over 10 months. Focus group discussions were analyzed using a grounded theory approach to identify resident needs. This guided the development of a dashboard which contained elements (data, analytics, and visualizations) that support their interpretation of the data. The identified needs are described using quotes from the focus groups as well as visualizations of the dashboard elements. Results: Resident needs were classified under three themes: (1) Provide guidance through the assessment program, (2) Present workplace-based assessment data, and (3) Present other assessment data. Seventeen dashboard elements were designed to address these needs. Conclusions: Our design-based research process identified resident needs and developed dashboard elements to meet them. This work will inform the creation and evolution of CBME assessment dashboards designed to support resident learning.

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Can Teachers Distinguish Competencies From Entrustable Professional Activities?

PRiMER ◽

10.22454/primer.2019.433736 ◽

2019 ◽

Vol 3 ◽

Author(s):

Mark Broussenko ◽

Sarah Burns ◽

Fok-Han Leung ◽

Diana Toubassi

Keyword(s):

Medical Education ◽

Entrustable Professional Activities ◽

Convenience Sample ◽

Education Assessment ◽

Survey Tool ◽

Professional Activities ◽

University Of Toronto ◽

Clinical Educators ◽

University Of Calgary ◽

The University

Introduction: There has been a recent transition from the use of “competencies” to “entrustable professional activities” (EPAs) in medical education assessment paradigms. Although this transition proceeds apace, few studies have examined these concepts in a practical context. Our study sought to examine how distinct the concepts of competencies and EPAs were to front-line clinical educators. Methods: A 20-item survey tool was developed based on the University of Calgary Department of Family Medicine’s publicly available lists of competencies and EPAs. This tool required participants to identify given items as either a competency or an EPA, after reading a description of each. The tool was administered to a convenience sample of consenting clinical educators at 5 of the 14 training sites at the University of Toronto Department of Family and Community Medicine in 2018. We also collected information on years in practice, hours spent supervising per week, and direct involvement in medical education. Results: We analyzed a total of 60 surveys. The mean rate of correct responses was 45.3% (+/- 21.8%). Subgroup analysis failed to reveal any correlation between any of the secondary characteristics and correct responses. Conclusion: Clinical educators in our study were not able to distinguish between competencies and EPAs. Further research is recommended prior to intensive curricular changes.

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