Impact of an end-of-fourth-year emergency medicine bootcamp

Abstract Background The final months of the fourth-year of medical school are variable in educational and clinical experience, and the effect on clinical knowledge and preparedness for residency is unclear. Specialty-specific “bootcamps” are a growing trend in medical education aimed at increasing clinical knowledge, procedural skills, and confidence prior to the start of residency. Methods We developed a 4-week Emergency Medicine (EM) bootcamp offered during the final month of medical school. At the conclusion of the course, participants evaluated its impact. EM residency-matched participants and non-participants were asked to self-evaluate their clinical knowledge, procedural skills and confidence 1 month into the start of residency. Program directors were surveyed to assess participants and non-participants across the same domains. A Fisher’s exact test was performed to test whether responses between participants and non-participants were statistically different. Results From 2015 to 2018, 22 students participated in the bootcamp. The majority reported improved confidence, competence, and procedural skills upon completion of the course. Self-assessed confidence was significantly higher in EM-matched participants 1 month into residency compared to EM-matched non-participants (p = 0.009). Self-assessed clinical knowledge and procedural skill competency was higher in participants than non-participants but did not reach statistical significance. Program directors rated EM-matched participants higher in all domains but this difference was also not statistically significant. Conclusions Participation in an EM bootcamp increases self-confidence at the start of residency among EM-matched residents. EM bootcamps and other specialty-specific courses at the end of medical school may ease the transition from student to clinician and may improve clinical knowledge and procedural skills.

Download Full-text

A comparison of orthopaedic surgery and internal medicine perceptions of USMLE Step 1 pass/fail scoring

BMC Medical Education ◽

10.1186/s12909-021-02699-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Frederick Mun ◽

Alyssa R. Scott ◽

David Cui ◽

Erik B. Lehman ◽

Seong Ho Jeong ◽

...

Keyword(s):

Internal Medicine ◽

Extracurricular Activities ◽

Residency Program ◽

Medical Schools ◽

Program Directors ◽

Program Director ◽

Personal Knowledge ◽

Clinical Knowledge ◽

Alpha Omega ◽

Residency Program Directors

Abstract Background United States Medical Licensing Examination Step 1 will transition from numeric grading to pass/fail, sometime after January 2022. The aim of this study was to compare how program directors in orthopaedics and internal medicine perceive a pass/fail Step 1 will impact the residency application process. Methods A 27-item survey was distributed through REDCap to 161 U.S. orthopaedic residency program directors and 548 U.S. internal medicine residency program directors. Program director emails were obtained from the American Medical Association’s Fellowship and Residency Electronic Interactive Database. Results We received 58 (36.0%) orthopaedic and 125 (22.8%) internal medicine program director responses. The majority of both groups disagree with the change to pass/fail, and felt that the decision was not transparent. Both groups believe that the Step 2 Clinical Knowledge exam and clerkship grades will take on more importance. Compared to internal medicine PDs, orthopaedic PDs were significantly more likely to emphasize research, letters of recommendation from known faculty, Alpha Omega Alpha membership, leadership/extracurricular activities, audition elective rotations, and personal knowledge of the applicant. Both groups believe that allopathic students from less prestigious medical schools, osteopathic students, and international medical graduates will be disadvantaged. Orthopaedic and internal medicine program directors agree that medical schools should adopt a graded pre-clinical curriculum, and that there should be a cap on the number of residency applications a student can submit. Conclusion Orthopaedic and internal medicine program directors disagree with the change of Step 1 to pass/fail. They also believe that this transition will make the match process more difficult, and disadvantage students from less highly-regarded medical schools. Both groups will rely more heavily on the Step 2 clinical knowledge exam score, but orthopaedics will place more importance on research, letters of recommendation, Alpha Omega Alpha membership, leadership/extracurricular activities, personal knowledge of the applicant, and audition electives.

Download Full-text

P033: Procedural skills training in emergency medicine physicians within the Edmonton zone: a needs assessment

CJEM ◽

10.1017/cem.2020.240 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S76-S76

Author(s):

R. Schonnop ◽

B. Stauffer ◽

A. Gauri ◽

D. Ha

Keyword(s):

Emergency Medicine ◽

Emergency Departments ◽

Continuing Professional Development ◽

Skills Training ◽

Procedural Skill ◽

Cross Sectional Survey ◽

Procedural Skills ◽

Cross Sectional ◽

Health Region ◽

Perceived Importance

Introduction: Procedural skills are a key component of an emergency physician's practice. The Edmonton Zone is a health region that comprises twelve tertiary, urban community and rural community emergency departments (EDs) and represents over three hundred emergency physicians. This study describes the current attitudes toward procedural skill competency, current procedural skill practices, and the role for educational skills training sessions among emergency medicine physicians within a geographical health region. Methods: Multicenter descriptive cross-sectional survey of all emergency medicine physicians working at 12 emergency departments within the Edmonton Zone in 2019 (n = 274). The survey underwent several phases of systematic review; including item generation and reduction, pilot testing, and clinical sensibility testing. Survey items addressed current procedural skill performance frequency, perceived importance and confidence, current methods to maintain competence, barriers and facilitating factors to participation in a curriculum, preferred teaching methods, and desired frequency of practice for each procedural skill. Results: Survey response rate was 53.6%. Variability in frequency of performed procedures was apparent across the type of hospital sites. For majority of skills, there was a significantly positive correlation between the frequency at which a skill was performed and the perceived confidence performing said skill. There was inconsistency and no significant correlation with perceived importance, perceived confidence, or frequency performing a given skill and the desired frequency of training for that skill. Course availability (76.2%) and time (72.8%) are the most common identified barriers to participation in procedural skills training. Conclusion: This study summarized the current emergency department procedural skill practices and attitudes toward procedural skill competency and an educational curriculum among emergency medicine physicians in Edmonton. This represents a step towards targeted continuing professional development in the growing realm of competency-based medical education.

Download Full-text

Emergency medicine procedural skills: what are residents missing?

CJEM ◽

10.2310/8000.2013.130897 ◽

2013 ◽

Vol 15 (04) ◽

pp. 241-248 ◽

Cited By ~ 7

Author(s):

Andrew Petrosoniak ◽

Jodi Herold ◽

Karen Woolfrey

Keyword(s):

Emergency Medicine ◽

Royal College ◽

Skills Training ◽

Program Directors ◽

Program Director ◽

Procedural Skills ◽

Web Based ◽

Residency Programs ◽

Current State ◽

Resident Competence

ABSTRACTObjective:This study sought to establish the current state of procedural skills training in Canadian Royal College emergency medicine (EM) residencies.Methods:A national Web-based survey was administered to residents and program directors of all 13 Canadian-accredited Royal College EM residency programs. Programdirectors rated the importance and experience required for competence of 45 EM procedural skills. EM residents reported their experience and comfort in performing the same procedural skills.Results:Thirteen program directors and 86 residents responded to the survey (response rate of 100% and 37%, respectively). Thirty-two (70%) procedures were considered important by > 70% of program directors, including all resuscitation and lifesaving airway procedures. Four procedures deemed important by program directors, including cricothyroidotomy, pericardiocentesis, posterior nasal pack for epistaxis, and paraphimosis reduction, had never been performed by the majority of senior residents. Program director opinion was used to categorize each procedure based on performance frequency to achieve competence. Overall, procedural experience correlated positively with comfort levels as indicated by residents.Conclusions:We established an updated needs assessment of procedural skills training for Canadian Royal College EM residency programs. This included program director opinion of important procedures and the performance frequency needed to achieve competence. However, we identified several important procedures that were never performed by most senior residents despite program director opinion regarding the experience needed for competence. Further study is required to better define objective measures for resident competence in procedural skills.

Download Full-text

P032: Video-based learning modules as an adjunct for teaching emergency medicine procedural skills

CJEM ◽

10.1017/cem.2019.223 ◽

2019 ◽

Vol 21 (S1) ◽

pp. S74

Author(s):

J. Dong ◽

S. Agarwal ◽

J. Wojtowicz ◽

E. Hanel

Keyword(s):

Emergency Medicine ◽

Chest Tube ◽

Small Sample Size ◽

Small Sample ◽

Task Value ◽

Average Score ◽

Instructional Video ◽

Real Patient ◽

Procedural Skills ◽

Self Confidence

Innovation Concept: Competence in procedural skills is vital within the emergency department. Challenging procedures such as cricothyroidotomy are difficult to master as they are rare and hard to train for. Additionally, common procedures such as chest tube insertions require practice to become sufficiently competent. Opportunities to hone these skills are essential in residency training. This project aimed to create instructional video modules for specific emergency medicine (EM) procedures and to gauge its utility as an adjunctive resource for procedural learning in the EM residency curriculum. Methods: Tutorial videos for clamshell thoracotomy, cricothyroidotomy, and chest tube insertion were filmed within a cadaver lab with step-by-step instructions. The footage was edited and overlaid with a prepared audio narration using Camtasia®/Apple® Video Editing software. These videos were embedded within modules that included foundational knowledge relevant to the procedures including anatomy, physiology and pathophysiology. The modules were peer-edited by licensed EM staff physicians and distributed to EM residents and staff physicians for analysis. Qualitative and quantitative analysis relied upon participants’ answers to questions and a Modified Task Value Scale (measures the value of a module for overall learning), respectively. Curriculum, Tool or Material: Ten participants were included in the analysis, including EM residents (n = 6) and staff emergency physicians (n = 4). Qualitative feedback suggested that positive aspects of the modules included visuals, content, narration, and review of anatomy. Negative aspects included the lack of indications for procedures, technical details, real patient examples, and a speed up function. Quantitative feedback resulted in scores of 4 and above out of 5 (1 = lowest value, 5 = highest value) on the Motivated Task Value Scale across all aspects for all the modules. Furthermore, analysis revealed an average score of 3.9/5 for inclination to access more modules such as these, and a score of 4.4/5 for overall perception of the modules. Conclusion: Participants found the video modules valuable to their learning, both qualitatively and quantitatively. This study was limited by a small sample size of modules and a low number of participants. Furthermore, a more detailed analysis with further measures, including self-efficacy and self-confidence, would yield more comprehensive conclusions. However, video modules provide an effective and easily accessible adjunctive tool to acquire skill and confidence with EM procedures, for medical learners and staff physicians.

Download Full-text

Emergency medicine pharmacist market perceptions: Emergency medicine residency program directors and directors of pharmacy

Journal of the American Pharmacists Association ◽

10.1016/j.japh.2020.01.014 ◽

2020 ◽

Vol 60 (4) ◽

pp. 541-547.e2

Author(s):

Daniel Hu ◽

James Myres

Keyword(s):

Emergency Medicine ◽

Residency Program ◽

Program Directors ◽

Market Perceptions ◽

Residency Program Directors

Download Full-text

Questions Remain about Whether EBM Competencies Learned in Medical School are Retained in Residency

Evidence Based Library and Information Practice ◽

10.18438/b8gk5v ◽

2007 ◽

Vol 2 (3) ◽

pp. 111

Author(s):

Suzanne Lewis

Keyword(s):

Internal Medicine ◽

Medical School ◽

Residency Program ◽

Program Directors ◽

Convenience Sample ◽

Medicine Clerkship ◽

The Third ◽

Journal Clubs ◽

Residency Program Directors ◽

The Impact

Objective – To assess medical graduates’ use of evidence based medicine (EBM) in residency, self-perception of EBM skills, attitudes toward EBM, and the impact of a formal EBM curriculum in their third undergraduate year. Design – A longitudinal follow-up study by self-administered questionnaire. Setting – Internal medicine residency programs in US hospitals. Subjects – A convenience sample of 2001 and 2002 graduates of the University of Illinois College of Medicine at Peoria (UICOM-P) (n=78), and their respective residency program directors (n=72). Methods – A student graduate questionnaire (SGQ) was sent to all members of UICOM-P’s 2001 and 2002 graduating classes who had completed the EBM course during their M-3 Internal Medicine clerkship. A program director questionnaire (PDQ), similar to the SGQ, was sent to the graduates’ residency program directors. The research instrument was tested with a pilot group prior to use, but not validated. The questionnaires consisted of 4 main sections. The first section examined formal and informal EBM programs in the graduates’ residency curriculum. The second section consisted of a self-assessment of EBM skills by the residents and an assessment of those skills by their program directors. The third section asked graduates to compare their EBM skills to those of their fellow residents who had not been students at UICOM-P. Similarly, in the third section of the PDQ, program directors were asked to compare the EBM skills of UICOM-P graduates and non-UICOM-P graduates participating in the residency program. The last section concerned professional and demographic characteristics. Copies of the surveys were mailed out to non-responders after 6 weeks. Results were collated but statistical analysis was not applied. Main results – The response rate was 32% for residents and 35% for program directors. The number of incomplete surveys was not reported. Forty-four percent of all respondents reported having a formal EBM curriculum for residents, and 76% reported an informal curriculum. For both formal and informal programs, the most common teaching formats were journal clubs, followed by lectures, teaching rounds, morning reports, bedside consultations, ambulatory clinics and seminars. In section two of the questionnaires, both residents and program directors rated the residents’ EBM skills similarly. However, the residents rated their skills in searching the literature and application of findings to clinical practice higher than the program directors. Program directors also rated the residents’ skills in understanding statistics and tests higher than the residents themselves. Twenty-four percent of both residents and program directors rated the UICOM-P graduates as “very competent” or “extremely competent” in EBM skills (50). Only 35% of program directors and 27% of residents rated the UICOM-P graduates’ EBM skills as “usually better” or “always better” than their peers who were not UICOM-P graduates (50). Conclusion - The authors of this study conclude that, for UICOM-P graduates, “it might be implied from these results that the EBM skills gained during medical school were retained through their medical school graduation and into their residency training” (51). However, this study has methodological weaknesses which make it difficult to draw any definite conclusions from the results.

Download Full-text

The use of free online educational resources by Canadian emergency medicine residents and program directors

CJEM ◽

10.1017/cem.2014.73 ◽

2015 ◽

Vol 17 (2) ◽

pp. 101-106 ◽

Cited By ~ 58

Author(s):

Eve Purdy ◽

Brent Thoma ◽

Joseph Bednarczyk ◽

David Migneault ◽

Jonathan Sherbino

Keyword(s):

Emergency Medicine ◽

Resource Selection ◽

Online Survey ◽

Skills Training ◽

File Sharing ◽

Program Directors ◽

Educational Resources ◽

Exact Test ◽

Online Educational Resources ◽

Entertainment Value

AbstractIntroductionOnline educational resources (OERs) are increasingly available for emergency medicine (EM) education. This study describes and compares the use of free OERs by the Royal College of Physicians and Surgeons of Canada (RCPSC) EM residents and program directors (PDs) and investigates the relationship between the use of OERs and peer-reviewed literature.MethodsA bilingual, online survey was distributed to RCPSC-EM residents and PDs using a modified Dillman method. The chi-square test and Fisher’s exact test were used to compare the responses of residents and PDs.ResultsThe survey was completed by 214/350 (61%) residents and 11/14 (79%) PDs. Free OERs were used by residents most frequently for general EM education (99.5%), procedural skills training (96%), and learning to interpret diagnostic tests (92%). OER modalities used most frequently included wikis (95%), file-sharing websites (95%), e-textbooks (94%), and podcasts (91%). Residents used wikis, podcasts, vodcasts, and file-sharing websites significantly more frequently than PDs. Relative to PDs, residents found entertainment value to be more important for choosing OERs (p<0.01). Some residents (23%) did not feel that literature references were important, whereas all PDs did. Both groups reported that OERs increased the amount of peer-reviewed literature (75% and 60%, respectively) that they read.ConclusionsEM residents make extensive use of OERs and differ from their PDs in the importance that they place on their entertainment value and incorporation of peer-reviewed references. OERs may increase the use of peer-reviewed literature in both groups. Given the prevalence of OER use for core educational goals among RCPSC-EM trainees, future efforts to facilitate critical appraisal and appropriate resource selection are warranted.

Download Full-text

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.

Download Full-text

LO21: Mentorship in Canadian emergency medicine residency training programs: a needs assessment

CJEM ◽

10.1017/cem.2017.83 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S34 ◽

Cited By ~ 1

Author(s):

K.A. Sutherland ◽

C. Pham ◽

C. La Riviere ◽

E. Weldon

Keyword(s):

Emergency Medicine ◽

Needs Assessment ◽

Personal Development ◽

Training Programs ◽

Program Directors ◽

Future Research ◽

Mentorship Program ◽

Exact Test ◽

The Past ◽

Mentorship Programs

Introduction: Research supports the role of mentors in the personal development and career advancement of medical trainees. Compared to non-mentored peers, mentored residents are nearly twice as likely to describe excellent career preparation and demonstrate objective career success. In prior research, only 65% of training programs in Canada had a mentorship program, and 40% indicated a need for more formal mentorship models. Methods: A needs assessment survey was distributed to RCPSC Emergency Medicine (EM) Program Directors across Canada regarding mentorship available to resident physicians training at their centers. Additionally, all EM resident and staff physicians involved in mentorship were surveyed on their perceptions of current models at their institutions. Both surveys were comprised of binary, open ended, and 5 point likert scale questions. Responses were analyzed using Fisher’s exact test. Results: Eleven Program Directors responded to the survey. Formal mentorship programs were found in 82% of training centers, with 77% of programs instituted within the past 5 years. Half of resident/mentor pairings were based on a combination of identified career goals, participant personality traits, or resident request. Other pairing methods included perceived resident needs or attending physician request. Most meetings are face-to-face, with one program requiring mutual scheduled shifts. Residents identified that mentorship was significantly associated with benefits to career (p=0.0016) and niche (p=0.0019) development. Formal mentorship was felt to have a significant association with resident academic development (p=0.05) and lower rates of burnout (p=0.0018) by staff physicians. Staff mentors also associated a personal development benefit related to involvement in a mentorship relationship (p=0.0355). Conclusion: The majority of EM programs have adopted formal mentorship programs within the past 5 years. Residents and staff identify that mentorship relationships are associated with improved career and niche development as well as academic advancement. Future research will include a before and after study of the implementation of a formal mentorship program within the RCPSC-EM program at the University of Manitoba.

Download Full-text