scholarly journals Assessment of emergency medicine residents: a systematic review

2017 ◽  
Vol 8 (1) ◽  
pp. e106-122 ◽  
Author(s):  
Isabelle N Colmers-Gray ◽  
Kieran Walsh ◽  
Teresa M Chan
Keyword(s):  
Emergency Medicine ◽  
Medical Education ◽  
Direct Observation ◽  
Full Text ◽  
Assessment Tools ◽  
Competency Based Medical Education ◽  
Mesh Terms ◽  
Competency Based ◽  
Resident Assessment ◽  
Assessment Frequency

Background: Competency-based medical education is becoming the new standard for residency programs, including Emergency Medicine (EM). To inform programmatic restructuring, guide resources and identify gaps in publication, we reviewed the published literature on types and frequency of resident assessment.Methods: We searched MEDLINE, EMBASE, PsycInfo and ERIC from Jan 2005 - June 2014. MeSH terms included “assessment,” “residency,” and “emergency medicine.” We included studies on EM residents reporting either of two primary outcomes: 1) assessment type and 2) assessment frequency per resident. Two reviewers screened abstracts, reviewed full text studies, and abstracted data. Reporting of assessment-related costs was a secondary outcome.Results: The search returned 879 articles; 137 articles were full-text reviewed; 73 met inclusion criteria. Half of the studies (54.8%) were pilot projects and one-quarter (26.0%) described fully implemented assessment tools/programs. Assessment tools (n=111) comprised 12 categories, most commonly: simulation-based assessments (28.8%), written exams (28.8%), and direct observation (26.0%). Median assessment frequency (n=39 studies) was twice per month/rotation (range: daily to once in residency). No studies thoroughly reported costs.Conclusion: EM resident assessment commonly uses simulation or direct observation, done once-per-rotation. Implemented assessment systems and assessment-associated costs are poorly reported. Moving forward, routine publication will facilitate transitioning to competency-based medical education.

Faculty development in the age of competency-based medical education: A needs assessment of Canadian emergency medicine faculty and senior trainees

CJEM ◽  
2019 ◽  
Vol 21 (4) ◽  
pp. 527-534 ◽  
Author(s):  
Alexandra Stefan ◽  
Justin N. Hall ◽  
Jonathan Sherbino ◽  
Teresa M. Chan
Keyword(s):  
Emergency Medicine ◽  
Medical Education ◽  
Faculty Development ◽  
Patient Care ◽  
Needs Assessment ◽  
Direct Observation ◽  
Senior Resident ◽  
Cross Sectional ◽  
Competency Based Medical Education ◽  
Competency Based

ABSTRACTObjectivesThe Royal College of Physicians and Surgeons of Canada (RCPSC) emergency medicine (EM) programs transitioned to the Competence by Design training framework in July 2018. Prior to this transition, a nation-wide survey was conducted to gain a better understanding of EM faculty and senior resident attitudes towards the implementation of this new program of assessment.MethodsA multi-site, cross-sectional needs assessment survey was conducted. We aimed to document perceptions about competency-based medical education, attitudes towards implementation, perceived/prompted/unperceived faculty development needs. EM faculty and senior residents were nominated by program directors across RCPSC EM programs. Simple descriptive statistics were used to analyse the data.ResultsBetween February and April 2018, 47 participants completed the survey (58.8% response rate). Most respondents (89.4%) thought learners should receive feedback during every shift; 55.3% felt that they provided adequate feedback. Many respondents (78.7%) felt that the ED would allow for direct observation, and most (91.5%) participants were confident that they could incorporate workplace-based assessments (WBAs). Although a fair number of respondents (44.7%) felt that Competence by Design would not impact patient care, some (17.0%) were worried that it may negatively impact it. Perceived faculty development priorities included feedback delivery, completing WBAs, and resident promotion decisions.ConclusionsRCPSC EM faculty have positive attitudes towards competency-based medical education-relevant concepts such as feedback and opportunities for direct observation via WBAs. Perceived threats to Competence by Design implementation included concerns that patient care and trainee education might be negatively impacted. Faculty development should concentrate on further developing supervisors’ teaching skills, focusing on feedback using WBAs.

scholarly journals Preparing for CBME: How often are faculty observing residents?

2020 ◽  
Author(s):  
Sheenagh J K George ◽  
Sarah Manos ◽  
Kenny K Wong
Keyword(s):  
Direct Observation ◽  
Assessment Tools ◽  
Inpatient Setting ◽  
Institutional Research ◽  
Professional Activities ◽  
Inpatient Settings ◽  
Competency Based ◽  
Resident Assessment ◽  
Outpatient Settings ◽  
Common Barriers

Abstract Background The Royal College of Physicians and Surgeons of Canada officially launched ‘Competence by Design’ in July 2017, moving from time-based to outcomes-based training. Transitioning to competency-based medical education (CBME) necessitates change in resident assessment. A greater frequency of resident observation will likely be required to adequately assess whether entrustable professional activities have been achieved. Purpose Characterize faculty and resident experiences of direct observation in a single paediatric residency program, pre-CBME implementation. Qualitatively describe participants’ perceived barriers and incentives to participating in direct observation. Methods Surveys were sent to paediatric residents and faculty asking for demographics, the frequency of resident observation during an average 4-week rotation, perceived ideal frequency of observation, and factors influencing observation frequency. Descriptive data were analyzed. Institutional research ethics board approval was received. Results The response rate was 54% (34/68 faculty and 16/25 residents). When asked the MAXIMUM frequency FACULTY observed a resident take a history, perform a physical examination, or deliver a plan, the median faculty reply was 1, 2, and 3, for outpatient settings and 0, 1, and 2, for inpatient settings. The median RESIDENT reply was 2, 4, and 10 for outpatient settings and 1, 2, and 20 for inpatient settings. When asked the MINIMUM frequency for each domain, the median FACULTY and RESIDENT reply was 0, except for delivering a plan in the inpatient setting. Faculty reported observing seniors delivering the plan more frequently than junior residents. Faculty and resident median replies for how frequently residents should be observed for each domain were the same, three to four, three to four, and five to six times. Four per cent of faculty reported regularly scheduling observations, and 77% of residents regularly ask to be observed. The most common barriers to observation were too many patients to see and both faculty and residents were seeing patients at the same time. Most faculty and resident responders felt that observation frequency could be improved if scheduled at the start of the rotation; faculty were provided a better tool for assessment; and if residents asked to be observed. Conclusions This study provides baseline data on how infrequent faculty observation is occurring and at a frequency lower than what faculty and residents feel is necessary. The time needed for observation competes with clinical service demands, but better scheduling strategies and assessment tools may help.

scholarly journals Scaffolding for assessment success: using gradual release of responsibility to support resident transition to competency-based medical education

2019 ◽  
Vol 10 (3) ◽  
pp. e110-112
Author(s):  
Rebecca P. Pero ◽  
Laura Marcotte
Keyword(s):  
Internal Medicine ◽  
Medical Education ◽  
Residency Training ◽  
Training Programs ◽  
Competency Based Medical Education ◽  
General Internal ◽  
Gradual Release Of Responsibility ◽  
Competency Based ◽  
Resident Assessment ◽  
Gradual Release

In competency-based medical education (CBME), assessment is learner-driven; learners may fail to progress if assessments are not completed. The General Internal Medicine (GIM) program at Queen’s University uses an educational technique known as scaffolding in its assessment strategy. The program applies this technique to coordinate early assessments with specific scheduled learning experiences and gradually releases the responsibility for assessment initiation to residents. Although outcomes of this innovation are still under investigation, we feel it has been valuable in supporting resident assessment capture and timely progression through stages of training.  Other residency training programs could easily implement this technique to support the transition to Competency by Design.

scholarly journals “It unsticks your mind”: Using a musicians’ masterclass to introduce oncology faculty and trainees to the practice of direct observation and coaching

2020 ◽  
Author(s):  
Michael Sanatani ◽  
Kylea Potvin
Keyword(s):  
Medical Education ◽  
Direct Observation ◽  
Teaching Practices ◽  
Competency Based Medical Education ◽  
Major Task ◽  
Self Reflection ◽  
Effective Catalyst ◽  
Highly Effective ◽  
Competency Based

Bringing faculty to a realization of the importance of direct observation is a major task during the transition to competency-based medical education. Musicians generally already endorse a strong coaching culture. We included a live cello masterclass in an oncology faculty and trainee workshop in order to demonstrate coaching and feedback. Based on participant post-event interviews, the musical masterclass was a highly effective catalyst for self-reflection in regards to teaching practices and lead to new and revised perspectives on observation and coaching in medicine.  With just a musician-trainee, music coach, and faculty moderator, this effective demonstration can be easily replicated.

scholarly journals Teaching and assessing intra-operative consultations in competency-based medical education: development of a workplace-based assessment instrument

2021 ◽  
Author(s):  
Marcio M. Gomes ◽  
David Driman ◽  
Yoon Soo Park ◽  
Timothy J. Wood ◽  
Rachel Yudkowsky ◽  
...  
Keyword(s):  
Medical Education ◽  
Assessment Tools ◽  
Assessment Instrument ◽  
Professional Activity ◽  
Cultural Issues ◽  
Education Development ◽  
Competency Based Medical Education ◽  
Workplace Based Assessment ◽  
Competency Based ◽  
Validity Theory

AbstractCompetency-based medical education (CBME) is being implemented worldwide. In CMBE, residency training is designed around competencies required for unsupervised practice and use entrustable professional activities (EPAs) as workplace “units of assessment”. Well-designed workplace-based assessment (WBA) tools are required to document competence of trainees in authentic clinical environments. In this study, we developed a WBA instrument to assess residents’ performance of intra-operative pathology consultations and conducted a validity investigation. The entrustment-aligned pathology assessment instrument for intra-operative consultations (EPA-IC) was developed through a national iterative consultation and used clinical supervisors to assess residents’ performance at an anatomical pathology program. Psychometric analyses and focus groups were conducted to explore the sources of evidence using modern validity theory: content, response process, internal structure, relations to other variables, and consequences of assessment. The content was considered appropriate, the assessment was feasible and acceptable by residents and supervisors, and it had a positive educational impact by improving performance of intra-operative consultations and feedback to learners. The results had low reliability, which seemed to be related to assessment biases, and supervisors were reluctant to fully entrust trainees due to cultural issues. With CBME implementation, new workplace-based assessment tools are needed in pathology. In this study, we showcased the development of the first instrument for assessing resident’s performance of a prototypical entrustable professional activity in pathology using modern education principles and validity theory.

The competency-based medical education evolution of Canadian emergency medicine specialist training

CJEM ◽  
2019 ◽  
Vol 22 (1) ◽  
pp. 95-102 ◽  
Author(s):  
Jonathan Sherbino ◽  
Glen Bandiera ◽  
Ken Doyle ◽  
Jason R. Frank ◽  
Brian R. Holroyd ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Medical Education ◽  
Residency Education ◽  
Multiple Sources ◽  
High Stakes ◽  
Competency Based Medical Education ◽  
Professional Activities ◽  
Local Resources ◽  
Education Design ◽  
Competency Based

ABSTRACTCanadian specialist emergency medicine (EM) residency training is undergoing the most significant transformation in its history. This article describes the rationale, process, and redesign of EM competency-based medical education. The rationale for this evolution in residency education includes 1) improved public trust by increasing transparency of the quality and rigour of residency education, 2) improved fiscal accountability to government and institutions regarding specialist EM training, 3) improved assessment systems to replace poor functioning end-of-rotation assessment reports and overemphasis on high-stakes, end-of-training examinations, and 4) and tailored learning for residents to address individualized needs. A working group with geographic and stakeholder representation convened over a 2-year period. A consensus process for decision-making was used. Four key design features of the new residency education design include 1) specialty EM-specific outcomes to be achieved in residency; 2) designation of four progressive stages of training, linked to required learning experiences and entrustable professional activities to be achieved at each stage; 3) tailored learning that provides residency programs and learner flexibility to adapt to local resources and learner needs; and 4) programmatic assessment that emphasizes systematic, longitudinal assessments from multiple sources, and sampling sentinel abilities. Required future study includes a program evaluation of this complex education intervention to ensure that intended outcomes are achieved and unintended outcomes are identified.

scholarly journals PREPARING FOR CBME: HOW OFTEN ARE FACULTY OBSERVING RESIDENTS?

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e50-e50 ◽  
Author(s):  
Sheenagh George ◽  
Sarah Manos ◽  
Kenny Wong
Keyword(s):  
Physical Examination ◽  
Direct Observation ◽  
Assessment Tools ◽  
Inpatient Setting ◽  
Institutional Research ◽  
Professional Activities ◽  
Inpatient Settings ◽  
Competency Based ◽  
Resident Assessment ◽  
Outpatient Settings

Abstract BACKGROUND Transitioning to competency-based medical education (CBME) necessitates change in resident assessment. A greater frequency of resident observation will be required to adequately assess whether entrustable professional activities have been achieved. OBJECTIVES Characterize faculty and resident experiences of direct observation in a single Canadian Paediatric Residency program, pre-CBME implementation. Describe faculty and residents’ perceived barriers and incentives to participating in direct observation. DESIGN/METHODS Surveys were sent to faculty and residents asking for demographic information, the frequency of resident observation during an average 4-week rotation in several domains (taking a history, performing a physical examination, delivering a plan,...), perceived ideal frequency of observation, and factors influencing observation frequency. Descriptive data was analyzed. Institutional research ethics board approval was received. RESULTS The response rate was 54% (34/68 faculty and 16/25 residents). When asked the MAXIMUM frequency faculty observed a resident take a history, perform a physical examination, or deliver a plan, the median FACULTY reply was 1, 2, and 3, for outpatient settings and 0, 1, and 2, for inpatient settings, respectively. The median RESIDENT reply was 2, 4, and 10 for outpatient settings and 1, 2, and 20 for inpatient settings, respectively. When asked the MINIMUM frequency for each domain, the median FACULTY AND RESIDENT reply was 0, except for delivering a plan in the inpatient setting (median RESIDENT reply was 2). FACULTY and RESIDENT median replies for how frequently residents should ideally be observed for each domain were the same, 3–4, 3–4, and 5–6 times. 4% of faculty reported regularly scheduling observations, and 77% of residents regularly ask to be observed. The most common responses to barriers to observation were too many patients to see and that both faculty and residents were seeing patients at the same time. Most faculty and resident responders felt that observation frequency could be improved if they were scheduled at the start of the rotation, if faculty were provided a better tool for assessment, and if residents asked to be observed. CONCLUSION This study provides baseline data on how infrequent faculty observation of residents is occurring and at a frequency lower than what faculty and residents feel is necessary. The time needed for observation is felt to compete with clinical service demands, but better scheduling strategies and assessment tools may help increase the frequency of resident observation.

scholarly journals A Systematic Scoping Review on Pedagogical Strategies of Interprofessional Communication for Physicians in Emergency Medicine

2021 ◽  
Vol 8 ◽  
pp. 238212052110417
Author(s):  
Zhi H. Ong ◽  
Lorraine H. E. Tan ◽  
Haziratul Z. B. Ghazali ◽  
Yun T. Ong ◽  
Jeffrey W. H. Koh ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Scoping Review ◽  
Full Text ◽  
Assessment Tools ◽  
Interprofessional Communication ◽  
Pedagogical Strategies ◽  
Research Teams ◽  
Competency Based ◽  
Longitudinal Support ◽  
Host Organization

Background Interprofessional communication (IPC) is integral to interprofessional teams working in the emergency medicine (EM) setting. Yet, the coronavirus disease 2019 pandemic has laid bare gaps in IPC knowledge, skills and attitudes. These experiences underscore the need to review how IPC is taught in EM. Purpose A systematic scoping review is proposed to scrutinize accounts of IPC programs in EM. Methods Krishna's Systematic Evidence-Based Approach (SEBA) is adopted to guide this systematic scoping review. Independent searches of ninedatabases (PubMed, Embase, CINAHL, Scopus, PsycINFO, ERIC, JSTOR, Google Scholar and OpenGrey) and “negotiated consensual validation” were used to identify articles published between January 1, 2000 and December 31, 2020. Three research teams reviewed the data using concurrent content and thematic analysis and independently summarized the included articles. The findings were scrutinized using SEBA's jigsaw perspective and funneling approach to provide a more holistic picture of the data. Results In total 18,809 titles and abstracts were identified after removal of duplicates, 76 full-text articles reviewed, and 19 full-text articles were analyzed. In total, four themes and categories were identified, namely: (a) indications and outcomes, (2) curriculum and assessment methods, (3) barriers, and (4) enablers. Conclusion IPC training in EM should be longitudinal, competency- and stage-based, underlining the need for effective oversight by the host organization. It also suggests a role for portfolios and the importance of continuing support for physicians in EM as they hone their IPC skills. Highlights • IPC training in EM is competency-based and organized around stages. • IPC competencies build on prevailing knowledge and skills. • Longitudinal support and holistic oversight necessitates a central role for the host organization. • Longitudinal, robust, and adaptable assessment tools in the EM setting are necessary and may be supplemented by portfolio use.

scholarly journals Outcomes in the age of competency-based medical education: Recommendations for emergency medicine training in Canada from the 2019 symposium of academic emergency physicians

CJEM ◽  
2020 ◽  
Vol 22 (2) ◽  
pp. 204-214 ◽  
Author(s):  
Teresa M. Chan ◽  
Quinten S. Paterson ◽  
Andrew K. Hall ◽  
Fareen Zaver ◽  
Robert A. Woods ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Medical Education ◽  
Clinical Outcomes ◽  
Online Survey ◽  
Emergency Physicians ◽  
Competency Based Medical Education ◽  
Canadian Association ◽  
National Implementation ◽  
Competency Based ◽  
The Impact

ABSTRACTObjectivesThe national implementation of competency-based medical education (CBME) has prompted an increased interest in identifying and tracking clinical and educational outcomes for emergency medicine training programs. For the 2019 Canadian Association of Emergency Physicians (CAEP) Academic Symposium, we developed recommendations for measuring outcomes in emergency medicine training in the context of CBME to assist educational leaders and systems designers in program evaluation.MethodsWe conducted a three-phase study to generate educational and clinical outcomes for emergency medicine (EM) education in Canada. First, we elicited expert and community perspectives on the best educational and clinical outcomes through a structured consultation process using a targeted online survey. We then qualitatively analyzed these responses to generate a list of suggested outcomes. Last, we presented these outcomes to a diverse assembly of educators, trainees, and clinicians at the CAEP Academic Symposium for feedback and endorsement through a voting process.ConclusionAcademic Symposium attendees endorsed the measurement and linkage of CBME educational and clinical outcomes. Twenty-five outcomes (15 educational, 10 clinical) were derived from the qualitative analysis of the survey results and the most important short- and long-term outcomes (both educational and clinical) were identified. These outcomes can be used to help measure the impact of CBME on the practice of Emergency Medicine in Canada to ensure that it meets both trainee and patient needs.

scholarly journals Competency based medical education in gastrointestinal motility

2016 ◽  
Vol 28 (10) ◽  
pp. 1460-1464 ◽  
Author(s):  
R. Yadlapati ◽  
R. N. Keswani ◽  
J. E. Pandolfino
Keyword(s):  
Medical Education ◽  
Gastrointestinal Motility ◽  
Competency Based Medical Education ◽  
Competency Based
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