LO55: Signal & noise – do professionalism concerns impact decision-making of competence committees?

Introduction: Competence committees (CCs) struggle with incorporating professionalism issues into resident progression decisions. This study examined how professionalism concerns influence individual faculty decisions about resident progression using simulated CC reviews. Methods: In 2017, the investigators conducted a survey of 25 program directors of Royal College emergency medicine residency training programs in Canada and those faculty members who are members of the CCs (or equivalent) at their home institution. The survey contained twelve resident portfolios, each containing formative and summative information available to a CC for making progression decisions. Six portfolios outlined residents progressing as expected and six were not progressing as expected. Further, a professionalism variable (PV) was added to six portfolios, evenly split between those residents progressing as expected and not. Participants were asked to make progression decisions based on each portfolio. Results: Raters were able to consistently identify a resident needing an educational intervention versus those who did not. When a PV was added, the consistency among raters decreased by 34.2% in those residents progressing as expected, versus increasing by 3.8% in those not progressing as expected (p = 0.01). Conclusion: When using an unstructured review of a simulated resident portfolio, individual reviewers can better discriminate between trainees progressing as expected when professionalism concerns are added. Considering this, educators using a competence committee in a CBME program must have a system to acquire and document professionalism issues to make appropriate progress decisions.

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Outcome Feedback within Emergency Medicine Training Programs: An Opportunity to Apply the Theory of Deliberate Practice?

CJEM ◽

10.1017/cem.2014.47 ◽

2015 ◽

Vol 17 (4) ◽

pp. 367-373 ◽

Cited By ~ 1

Author(s):

Timothy R. Dalseg ◽

Lisa A. Calder ◽

Curtis Lee ◽

Jaymie Walker ◽

Jason R. Frank

Keyword(s):

Emergency Medicine ◽

Royal College ◽

Training Programs ◽

Program Directors ◽

Categorical Variables ◽

Continuous Variables ◽

Educational Value ◽

Exact Test ◽

Outcome Feedback

AbstractObjectivesOutcome feedback is the process of learning patient outcomes after their care within the emergency department. We conducted a national survey of Canadian Royal College emergency medicine (EM) residents and program directors to determine the extent to which active outcome feedback and follow-up occurred. We also compared the perceived educational value of outcome feedback between residents and program directors.MethodsWe distributed surveys to all Royal College-accredited adult and pediatric EM training programs using a modified Dillman method. We analyzed the data using student’s t-test for continuous variables and Fisher’s exact test for categorical variables.ResultsWe received 210 completed surveys from 260 eligible residents (80.8%) and 21 of 24 program directors (87.5%) (overall 81.3%). Mandatory active outcome feedback was not present in any EM training program for admitted or discharged patients (0/21). Follow-up was performed electively by 89.4% of residents for patients admitted to the hospital, and by 44.2% of residents for patients discharged home. A majority of residents (76.9%) believed that patient follow-up should be mandatory compared to 42.9% of program directors (p=0.002). The perceived educational value of outcome feedback was 5.8/7 for residents and 5.1/7 for program directors (difference 0.7; p=0.002) based on a seven-point Likert scale (1=not important; 7=very important).ConclusionWhile Canadian EM training programs do not mandate follow-up, it is performed electively by the majority of residents surveyed. Residents place a significantly greater educational value on outcome feedback than their program directors, and believe that follow-up should be a mandatory component of EM residencies.

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68. The resident experience in a large urban teaching setting: Results of the 2005-2006 resident exit survey, University of Torontos

Clinical & Investigative Medicine ◽

10.25011/cim.v30i4.2829 ◽

2007 ◽

Vol 30 (4) ◽

pp. 66

Author(s):

N. Tenn-Lyn ◽

S. Verma ◽

R. Zulla

Keyword(s):

Quality Control ◽

Residency Training ◽

Royal College ◽

Online Survey ◽

Career Guidance ◽

Training Programs ◽

Program Planning ◽

Educational Experience ◽

Care Experience

We developed and implemented an annual online survey to administer to residents exiting residency training in order to (1) assess the quality of the residency experience and (2) identify areas of strength and areas requiring improvement. Long-term goals include program planning, policy-making and maintenance of quality control. Survey content was developed from an environmental scan, pre-existing survey instruments, examination of training criteria established by the CFPC and the CanMEDS criteria established by the RCPSC. The survey included evaluation benchmarks and satisfaction ratings of program director and faculty, preparation for certification and practice, quality of life, quality of education, and work environment. The response rate was 28%. Seventy-five percent of respondents were exiting from Royal College training programs. Results of descriptive statistics determined that the overall educational experience was rated highly, with 98.9% of respondents satisfied or very satisfied with their overall patient care experience. Ninety-six percent of respondents were satisfied or very satisfied with the overall quality of teaching. Preparation for practice was identified as needing improvement, with 26% and 34% of respondents giving an unsatisfactory rating to career guidance and assistance with finding employment, respectively. Although 80% of respondents reported receiving ongoing feedback and 84% discussed their evaluations with their supervisors, only 38% of evaluations were completed by the end of the rotation. The results indicate that residents are generally satisfied with their experiences during residency training, especially with their overall educational experience. Areas of improvement include preparation for practice and timeliness of evaluations. Further iterations of this survey are needed to refine the instrument, identify data trends and maintain quality control in residency training programs. Frank JR (ed.). The CanMEDS competency framework: better standards, better physicians, better care. Ottawa: The Royal College of Physicians and Surgeons of Canada, 2005. Merritt, Hawkins and Associates. Summary Report: 2003 Survey of final-year medical residents. http://www.merritthawkins.com/pdf/MHA2003residentsurv.pdf. Accessed May 1, 2006. Regnier K, Kopelow M, Lane D, Alden A. Accreditation for learning and change: Quality and improvement as the outcome. The Journal of Continuing Education in the Health Professions 2005; 25:174-182.

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

AEM Education and Training ◽

10.1002/aet2.10412 ◽

2019 ◽

Vol 4 (4) ◽

pp. 369-378

Author(s):

Jennifer Mitzman ◽

Ilana Bank ◽

Rebekah A. Burns ◽

Michael C. Nguyen ◽

Pavan Zaveri ◽

...

Keyword(s):

Emergency Medicine ◽

Residency Training ◽

Delphi Study ◽

Training Programs ◽

Modified Delphi ◽

Simulation Based

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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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Implementation of duty hour standards in otolaryngology-head and neck surgery residency training

Otolaryngology ◽

10.1016/j.otohns.2005.03.004 ◽

2005 ◽

Vol 132 (6) ◽

pp. 819-822 ◽

Cited By ~ 18

Author(s):

Todd A. Kupferman ◽

Tim S. Lian

Keyword(s):

Head And Neck ◽

Residency Training ◽

Training Programs ◽

Neck Surgery ◽

Program Directors ◽

The United States ◽

Head And Neck Surgery ◽

Training Experience ◽

Duty Hours ◽

Resident Duty

OBJECTIVE: To determine what impact, if any, of the recently implemented duty hour standards have had on otolaryngology-head and neck surgery residency programs from the perspective of program directors. We hypothesized that the implementation of resident duty hour limitations have caused changes in otolaryngology training programs in the United States. STUDY DESIGN AND SETTING: Information was collected via survey in a prospective, blinded fashion from program directors of otolaryngology-head and neck residency training programs in the United States. RESULTS: Overall, limitation of resident duty hours is not an improvement in otolaryngology-head and neck residency training according to 77% of the respondents. The limitations on duty hours have caused changes in the resident work schedules in 71% of the programs responding. Approximately half of the residents have a favorable impression of the work hour changes. Thirty-two percent of the respondents indicate that changes to otolaryngology support staff were required, and of those many hired physician assistants. Eighty-four percent of the respondents did not believe that the limitations on resident duty hours improved patient care, and 81% believed that it has negatively impacted resident training experience. Forty-five percent of the program directors felt that otolaryngology-head and neck faculty were forced to increase their work loads to accommodate the decrease in the time that residents were allowed to be involved in clinical activities. Fifty-four percent of the programs changed from in-hospital to home call to accommodate the duty hour restrictions. CONCLUSIONS: According to the majority of otolaryngology-head and neck surgery program directors who responded to the survey, the limitations on resident duty hours imposed by the ACGME are not an improvement in residency training, do not improve patient care, and have decreased the training experience of residents. SIGNIFICANCE: This study demonstrates that multiple changes have been made to otolaryngology-head and neck surgery training programs because of work hour limitations set forth by the ACGME.

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LO093: A national needs assessment survey for the development of a quality improvement and patient safety curriculum for Canadian emergency medicine residents

CJEM ◽

10.1017/cem.2016.130 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S62-S62 ◽

Cited By ~ 1

Author(s):

L.B. Chartier ◽

S. Vaillancourt ◽

M. McGowan ◽

K. Dainty ◽

A.H. Cheng

Keyword(s):

Emergency Medicine ◽

Medical Education ◽

Patient Safety ◽

Quality Improvement ◽

Needs Assessment ◽

Residency Training ◽

Royal College ◽

Assessment Tool ◽

Postgraduate Medical Education ◽

Clinical Scenarios

Introduction: The Canadian Medical Education Directives for Specialists (CanMEDS) framework defines the competencies that postgraduate medical education programs must cover for resident physicians. The 2015 iteration of the CanMEDS framework emphasizes Quality Improvement and Patient Safety (QIPS), given their role in the provision of high value and cost-effective care. However, the opinion of Emergency Medicine (EM) program directors (PDs) regarding the need for QIPS curricula is unknown, as is the current level of knowledge of EM residents in QIPS principles. We therefore sought to determine the need for a QIPS curriculum for EM residents in a Canadian Royal College EM program. Methods: We developed a national multi-modal needs assessment. This included a survey of all Royal College EM residency PDs across Canada, as well as an evaluative assessment of baseline QIPS knowledge of 30 EM residents at the University of Toronto (UT). The resident evaluation was done using the validated Revised QI Knowledge Application Tool (QIKAT-R), which evaluates an individual’s ability to decipher a systematic quality problem from short clinical scenarios and to propose change initiatives for improvement. Results: Eight of the 13 (62%) PDs responded to the survey, unanimously agreeing that QIPS should be a formal part of residency training. However, challenges identified included the lack of qualified and available faculty to develop and teach QIPS material. 30 of 30 (100%) residents spanning three cohorts completed the QIKAT-R. Median overall score was 11 out of 27 points (IQR 9-14), demonstrating the lack of poor baseline QIPS knowledge amongst residents. Conclusion: QIPS is felt to be a necessary part of residency training, but the lack of available and qualified faculty makes developing and implementing such curriculum challenging. Residents at UT consistently performed poorly on a validated QIPS assessment tool, confirming the need for a formal QIPS curriculum. We are now developing a longitudinal, evidence-based QIPS curriculum that trains both residents and faculty to contribute to QI projects at the institution level.

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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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Respirology Manpower in Canada -- A Report for the Canadian Thoracic Society Education Committee

Canadian Respiratory Journal ◽

10.1155/2000/704369 ◽

2000 ◽

Vol 7 (6) ◽

pp. 451-455 ◽

Cited By ~ 3

Author(s):

Donald W Cockcroft ◽

David Wensley

Keyword(s):

Royal College ◽

Sleep Problems ◽

Training Programs ◽

Program Directors ◽

Waiting Lists ◽

Education Committee ◽

Data Support

A report on adult and pediatric respirology manpower in Canada was prepared from data supplied by the Royal College of Physicians and Surgeons of Canada (RCPSC), and from program directors (and other colleagues) at universities across Canada. The data support a significant deficiency of adult respirologists in Canada, which is estimated to be from 10%, based on a 10-year-old outdated RCPSC recommendation, to 20%, based on equalization with the 'best' province, to as high as 50%, based on long waiting lists, particularly for respiratory sleep problems, and estimates obtained from academic centres across Canada. Although there are less data available for pediatric respirology, a similar approach suggests a 50% to 100% shortfall in pediatric respirologists. Output from Canadian training programs in adult and pediatric respirology is not likely to meet this need. We recommend that steps be taken urgently to provide sufficient resources for training adult and pediatric respirologists, and to ensure that funding is provided for subspecialist positions in the community.

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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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