Procedural Skills Training in Emergency Medicine Physicians Within the Edmonton Zone: A Needs Assessment.
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ABSTRACT: Objectives
The objectives were to describe the current procedural skill practices, attitudes toward procedural skill competency, and the role for educational skills training sessions among emergency medicine (EM) physicians within a geographic health zone.Methods
This is a multicenter descriptive cross-sectional survey of all EM physicians working at 12 emergency departments (EDs) within the Edmonton Zone in 2019. 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 seen across the type of hospital sites. For the 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.Conclusions
This study summarized the current ED procedural skill practices among EM physicians in the Edmonton Zone and attitudes toward an educational curriculum for procedural skill competency. This represents a step toward targeted continuing professional development in staff physicians.
SUBMITTER: Schonnop R
PROVIDER: S-EPMC8019211 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BACKGROUND: There is an increasing use of electronic health records in hospitals across the United States. The speed and accuracy of residents in documenting electronic health records has been insufficiently addressed. METHODS: We studied resident typing skills at New York Methodist Hospital. Participating residents typed a standard 100-word alphanumerical paragraph of a patient's medical history. Typing skills were assessed by calculating the net words per minute (WPM). Typing skills were categorized as follows: (1) fewer than 26 net WPM as very slow; (2) 26 to 35 net WPM as slow; (3) 35 to 45 net WPM as intermediate; and (4) greater than 45 net WPM as fast. Residents were further categorized into (1) American medical graduates; (2) American international medical graduates; and (3) non-American international medical graduates. RESULTS: A total of 104 of 280 residents (37%) participated in the study. There was equal representation from various specialties, backgrounds, and all postgraduate levels of training. The median typing speed was 30.4 net WPM. Typing skills were very slow (34 of 104, 33%), slow (28 of 104, 27%), intermediate (29 of 104, 28%), and fast (13 of 104, 12%) among the residents. Typing skills of non-American international medical graduates (mean net WPM of 25.9) were significantly slower than those of American medical graduates (mean net WPM of 35.9) and American international medical graduates (mean net WPM of 33.5). CONCLUSIONS: Most residents (60%, 62 of 104) who participated in the study at our institute lacked typing skills. As the use of electronic health records increases, a lack of typing skills may impact residents' time for learning and patient care.
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Project description:BackgroundFeeding and eating disorders present with a variety of medical complications, some of which may be life-threatening. Emergency Medicine (EM) physicians may interact with patients with eating disorders, however, EM physicians' knowledge and perceptions of resources for treating patients with eating disorders have not been examined. The purpose of this study was to explore previous training/education, perceptions of available resources, and educational needs in treating eating disorders in practicing EM physicians.MethodsAn investigator-developed survey was used in this cross-sectional pilot study, distributed to EM Residency Program Coordinators in the United States to distribute to EM physicians and residents. The survey assessed EM physicians' previous training and education in treating and diagnosing eating disorders. The primary outcomes assessed were participants' previous training/education in eating disorders, knowledge of local resources for patients, and educational needs on a variety of topics related to adult and adolescent eating disorders. Data were described descriptively and SAS 9.4 was used to analyze data.ResultsOf the 162 participants, just 1.9% completed a rotation on eating disorders during residency. Ninety-three percent were unfamiliar with the American Psychiatric Association's Practice Guideline for the Treatment of Patients with Eating Disorders; 95% were unfamiliar with the publication, "Emergency Department management of patients with eating disorders" by Trent et al. The majority were not aware of resources for patients with eating disorders including community and online support groups, the National Eating Disorders Association, and local treatment programs. At least 50% agreed additional education on 15 of the 19 topics examined would be useful; 85% agreed to wanting education on the assessment of patients with eating disorders in the Emergency Department.ConclusionsMost EM physicians lack training in eating disorders and knowledge of resources available for patients post-Emergency Department discharge. EM physicians agree additional education on a number of topics would be beneficial, particularly assessment of eating disorders in the Emergency Department, medical complications of eating disorders, and hospital admission criteria for those with eating disorders.
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Project description:BackgroundSkilled physician communication is a key component of patient experience. Large-scale studies of exposure to communication skills training and its impact on patient satisfaction have not been conducted.ObjectiveWe aimed to examine the impact of experiential relationship-centered physician communication skills training on patient satisfaction and physician experience.DesignThis was an observational study.SettingThe study was conducted at a large, multispecialty academic medical center.ParticipantsParticipants included 1537 attending physicians who participated in, and 1951 physicians who did not participate in, communication skills training between 1 August 2013 and 30 April 2014.InterventionAn 8-h block of interactive didactics, live or video skill demonstrations, and small group and large group skills practice sessions using a relationship-centered model.Main measuresHospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CGCAHPS), Jefferson Scale of Empathy (JSE), Maslach Burnout Inventory (MBI), self-efficacy, and post course satisfaction.Key resultsFollowing the course, adjusted overall CGCAHPS scores for physician communication were higher for intervention physicians than for controls (92.09 vs. 91.09, p < 0.03). No significant interactions were noted between physician specialty or baseline CGCAHPS and improvement following the course. Significant improvement in the post-course HCAHPS Respect domain adjusted mean was seen in intervention versus control groups (91.08 vs. 88.79, p = 0.02) and smaller, non-statistically significant improvements were also seen for adjusted HCAHPS communication scores (83.95 vs. 82.73, p = 0.22). Physicians reported high course satisfaction and showed significant improvement in empathy (116.4 ± 12.7 vs. 124 ± 11.9, p < 0.001) and burnout, including all measures of emotional exhaustion, depersonalization, and personal accomplishment. Less depersonalization and greater personal accomplishment were sustained for at least 3 months.ConclusionsSystem-wide relationship-centered communication skills training improved patient satisfaction scores, improved physician empathy, self-efficacy, and reduced physician burnout. Further research is necessary to examine longer-term sustainability of such interventions.
| S-EPMC4907940 | biostudies-literature
Project description:ObjectivesProcedural competency is an essential prerequisite for the independent practice of emergency medicine. Multiple studies demonstrate that simulation-based procedural training (SBPT) is an effective method for acquiring and maintaining procedural competency and preferred over traditional paradigms ("see one, do one, teach one"). Although newer paradigms informing SBPT have emerged, educators often face circumstances that challenge and undermine their implementation. The goal of this paper is to identify and report on best practices and theory-supported solutions to some of these challenges as derived using a process of expert consensus building and reviews of the existing literature on SBPT.MethodsThe Society for Academic Emergency Medicine (SAEM) Simulation Academy SBPT Workgroup convened approximately 8 months prior to the 2019 SAEM Annual Meeting to perform a review of the literature and participate in a consensus-building process to identify solutions (in the form of best practices and educational theory) to these challenges faced by educators engaging in SBPT.Results and analysisThirteen distinct educational challenges to SBPT emerged from the expert group's primary literature reviews and consensus-building processes. Three domains emerged upon further analysis of the 13 challenges: learner, educator, and curriculum. Six challenges within the "learner" domain were selected for comprehensive discussion in this paper, as they were deemed representative of the most common and most significant threats to ideal SBPT. Each of the six challenges aligns with one of the following themes: 1) maximizing active learning, 2) maintaining learner engagement, 3) embracing learner diversity, 4) optimizing cognitive load, 5) promoting mindfulness and reflection, and 6) emphasizing deliberate practice for mastery learning. Over 20 "special treatments" for mitigating the impact of the 13 challenges were derived from the secondary literature search and consensus-building process prior to and during the preconference workshop; 11 of these that best address the six learner-centered challenges are explored, including implications for educators involved in SBPT.Conclusions/implications for educatorsWe propose multiple consensus-generated solutions (in the form of best practices and applied educational theory) that we believe are suitable and well aligned to overcome commonly encountered learner-centered challenges and threats to optimal SBPT.
| S-EPMC7011411 | biostudies-literature
Project description:ObjectiveWhile short-term gains in performance of critical emergency procedures are demonstrated after simulation, long-term retention is relatively uncertain. Our objective was to determine whether simulation of critical emergency procedures promotes long-term retention of skills in nonsurgical physicians.MethodsWe searched multiple electronic databases using a peer-reviewed strategy. Eligible studies 1) were observational cohorts, quasi-experimental or randomized controlled trials; 2) assessed intubation, cricothyrotomy, pericardiocentesis, tube thoracostomy, or central line placement performance by nonsurgical physicians; 3) utilized any form of simulation; and 4) assessed skill performance immediately after and at ≥ 3 months after simulation. The primary outcome was skill performance at or above a preset performance benchmark at ≥ 3 months after simulation. Secondary outcomes included procedural skill performance at 3, 6, and ≥ 12 months after simulation.ResultsWe identified 1,712 citations, with 10 being eligible for inclusion. Methodologic quality was moderate with undefined primary outcomes; inadequate sample sizes; and use of nonstandardized, unvalidated tools. Three studies assessed performance to a specific performance benchmark. Two demonstrated maintenance of the minimum performance benchmark while two demonstrated significant skill decay. A significant decline in the mean performance scores from immediately after simulation to 3, 6, and ≥ 12 months after simulation was observed in four of four, three of four, and two of five studies, respectively. Scores remained significantly above baseline at 3, 6, and ≥ 12 months after simulation in three of four, three of four, and four of four studies, respectively.ConclusionThere were a limited number of studies examining the retention of critical skills after simulation training. While there was some evidence of skill retention after simulation, overall most studies demonstrated skill decline over time.
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Project description:BackgroundCritical appraisal of medical research is a valuable skill set that emergency physicians must learn in order to become competent clinicians. Despite the need for effective critical appraisal skills training, these skills have remained difficult to teach and assess. This study aimed to explore emergency physicians' perceptions of the barriers and motivations for learning critical appraisal skills in order to develop more successful critical appraisal training methods for Emergency Medicine (EM) residents.MethodsThis qualitative study involved in-depth, semi-structured interviews with emergency physicians interested in education and administration at an urban academic hospital. Transcribed interviews were descriptively coded by three main reviewers. A coding template was developed after coding an initial set of interviews and used to code the remaining transcripts. A thematic analysis of the codes was conducted to create a summary report which was given to the interviewees as part of a member checking process to further solidify themes.ResultsFourteen emergency physicians participated in the study. They described time limitations, perceived difficulty, and disinterest as major barriers to learning critical appraisal. Physicians noted patient care as well as professional identity goals of being a good educator or researcher as motivations for developing critical appraisal skills.ConclusionThere remain significant challenges to learning critical appraisal skills as well as an increasing need to build these skills during residency. Educational theories and a greater emphasis on professional identity formation during residency can be incorporated to create a more effective approach to teaching critical appraisal skills despite these barriers.
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