Assessment of emergency procedures training for french emergency medicine residents

Unprecedented Training: Experience of Residents During the COVID-19 Pandemic

To determine whether changes in graduate medical education (GME) funding have had an impact on emergency medicine (EM) residency training programs. A 34-question survey was mailed to the program directors (PDs) of all 115 Accreditation Council for Graduate Medical Education (ACGME)-accredited EM residency programs in the United States in the fall of 1998, requesting information concerning the impact of changes in GME funding on various aspects of the EM training. The results were then compared with a similar unpublished survey conducted in the fall of 1996. One hundred one completed surveys were returned (88% response rate). Seventy-one (70%) of the responding EM residency programs were PGY-I through PGY-III, compared with 55 (61%) of the responding programs in 1996. The number of PGY-II through PGY-IV programs decreased from 25 (28%) of responding programs in 1996 to 17 (16%). The number of PGY-I through PGY-IV programs increased slightly (13 vs 10); the number of EM residency positions remained relatively stable. Fifteen programs projected an increase in their number of training positions in the next two years, while only three predicted a decrease. Of the respondents, 56 programs reported reductions in non-EM residency positions and 35 programs reported elimination of fellowship positions at their institutions. Only four of these were EM fellowships. Forty-six respondents reported a reduction in the number of non-EM residents rotating through their EDs, and of these, 11 programs reported this had a moderate to significant effect on their ability to adequately staff the ED with resident physicians. Sixteen programs limited resident recruitment to only those eligible for the full three years of GME funding. Eighty-seven EM programs reported no change in faculty size due to funding issues. Sixty-two programs reported no change in the total number of hours of faculty coverage in the ED, while 34 programs reported an increase. Three EM programs reported recommendations being made to close their residency programs in the near future. Changes in GME funding have not caused a decrease in the number of existing EM residency and fellowship training positions, but may have had an impact in other areas, including: an increase in the number of EM programs structured in a PGY-I through PGY-III format (with a corresponding decrease in the number of PGY-II through PGY-IV programs); a decrease in the number of non-EM residents rotating through the ED; restriction of resident applicants who are ineligible for full GME funding from consideration by some EM training programs; and an increase in the total number of faculty clinical hours without an increase in faculty size.

I nternational P erspective International Perspective from Saudi Arabia on “Procedural Skills Training During Emergency Medicine Residency: Are We Teaching the Right Things?” Nadeem Qureshi, MD King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia Supervising Section Editor: Mark I. Langdorf, MD, MHPE Submission history: Submitted July 07, 2009; Revision Received June 20, 2009; Accepted July 22, 2009 Reprints available through open access at www.westjem.org [WestJEM. 2009;10:157-158.] Commentary This article illustrates the use of an essential post-residency survey to identify specific topic deficiencies in the emergency medicine (EM) residency curriculum. This method has been effectively used in other specialties. Lieberman et al. 1 used a post-residency survey in Canada to record opinions of 239 pediatricians for their preparedness for practice. Results showed trainees need more community and ambulatory pediatrics and less tertiary care exposure, and these were later incorporated in the curriculum. Khairy et al. 2 did a similar study to evaluate surgical residency training in Saudi Arabia. Ninety-six surgeons from different practice settings participated in the survey, which identified technical skills as the biggest training deficit. A structured skills training center for both junior and senior residents, especially outside the operating theater, was proposed. Aksay et al. 3 describes a 14-year experience in Turkey using a similar survey to guide developing their EM programs. They used three different surveys for residents, trainers, and department heads of 20 EDs and 261 physicians. One hundred eighty-five residents, 56 trainers and 20 department heads participated in the study. Comparison of resident and trainer views regarding various aspect of EM training program was presented. Resident views differed significantly from trainer views (expressed as sufficiency percentages) in the number of practical skills (29.6% vs. 67.3%), competency in practical skills (60% vs. 78.2%), literature update (21% vs 37%), and quality of education (44.3%.vs 76.8%). Similar observations were made when theoretical knowledge and practical skills were evaluated. The residents’ sufficiency level for different core content compared to trainer were as follows: cardiovascular, 74% vs. 91%; neurology, 68% vs. 86%; Western Journal of Emergency Medicine resuscitation, 83% vs. 98%; trauma, 76% vs. 87%; orthopedics 56% vs. 75%; pediatrics, 16% vs. 27%; and toxicology, 63% vs. 82% respectively. Resident and trainer views on practical skills were significantly different in all procedures except endotracheal intubation. For all other procedures the resident felt more under-prepared than the trainers reported. The authors concluded that while most of the departments have developed the basic components for residency training, significant gaps were identified in the curriculum taught and practical skills acquired. This important observation reminds educators of the need for post-training feedback to guide future training. The present study used a similar survey to address preparation for “twelve common procedures taught during EM training and their importance in practice.” Investigators used procedures considered important but not emergent, with the assumption that emergent procedures are routinely performed and well taught. The responses were classified in three groups: over or under-prepared and concordant. Slit lamp usage, computed tomography interpretation, transvenous pacing and procedural sedation were areas reported as under-prepared. The study limitations included small sample size, single residency program and lack of information on methods of instruction and intensity of training. The authors did not compare these results with emergent procedures preparation, which would have allowed better understanding of the cause of this perceived under-preparation. The significant message from this study is that this evaluation can help identify program-specific deficiencies and modify the residency accordingly. This study looks at the micro level of actual educational delivery to each resident rather than the macro view of curricular plan. Practice environments differ across the country. What may be important in one environment may not be in another setting. In the U.S., rural and community ED practices customarily have fewer on-call specialists than urban, academic ones. This, in turn, requires emergency Volume X, no . 3 : August 2009

Although procedural training in family practice has recently received greater emphasis, the current status of this training in residency programs has not been reported. Considerable variation in procedural training among family practice residencies is allowed by the American Board of Family Practice and accreditation requirements. This study was performed to report the current status of procedural training in family practice residencies and to determine whether a correlation exists between the number of procedures taught in family practice residencies and successful resident recruitment. A one-page questionnaire was developed to determine availability of teaching and type of instructor for 24 selected procedures. This questionnaire was mailed to all 398 family practice residency directors in the United States. Data from the survey were compared with the published residency match results in 1993 and 1994. Questionnaires were received from 363 programs, for a response rate of 91 percent. The current status of training in these procedures, presented by program type and geographic region, reflects considerable regional variation. Training in colposcopy and in cardiac stress testing was reported to be available in a greater percentage of programs than in previous studies. A significant positive correlation was found between the number of procedures taught by family physicians and residency match results. The 91 percent response rate lends credibility to this status report and indicates that family practice program directors recognize procedural training as an important issue. The trend toward greater availability of procedural training in family practice residencies is confirmed for selected procedures. Emphasis on procedural training by family physicians has a positive correlation with successful resident recruiting. The impact on medical student interest in family practice deserves further study.

Asynchronous e-learning allows for targeted teaching, particularly advantageous when bedside and didactic education is insufficient. An asynchronous e-learning curriculum has not been studied across multiple centers in the context of a clinical rotation. We hypothesize that an asynchronous e-learning curriculum during the pediatric emergency medicine (EM) rotation improves medical knowledge among residents and students across multiple participating centers. Trainees on pediatric EM rotations at four large pediatric centers from 2012 to 2013 were randomized in a Solomon four-group design. The experimental arms received an asynchronous e-learning curriculum consisting of nine Web-based, interactive, peer-reviewed Flash/HTML5 modules. Postrotation testing and in-training examination (ITE) scores quantified improvements in knowledge. A 2 × 2 analysis of covariance (ANCOVA) tested interaction and main effects, and Pearson's correlation tested associations between module usage, scores, and ITE scores. A total of 256 of 458 participants completed all study elements; 104 had access to asynchronous e-learning modules, and 152 were controls who used the current education standards. No pretest sensitization was found (p = 0.75). Use of asynchronous e-learning modules was associated with an improvement in posttest scores (p < 0.001), from a mean score of 18.45 (95% confidence interval [CI] = 17.92 to 18.98) to 21.30 (95% CI = 20.69 to 21.91), a large effect (partial η(2) = 0.19). Posttest scores correlated with ITE scores (r(2) = 0.14, p < 0.001) among pediatric residents. Asynchronous e-learning is an effective educational tool to improve knowledge in a clinical rotation. Web-based asynchronous e-learning is a promising modality to standardize education among multiple institutions with common curricula, particularly in clinical rotations where scheduling difficulties, seasonality, and variable experiences limit in-hospital learning.

Gulf Coast Hurricane Sinks New Texas Emergency Medicine Residency

In reply

BackgroundThe 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.MethodsThis 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.ResultsThe 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.ConclusionsThe 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.

After the Match

The emergency department (ED) is a high-stakes training environment for emergency medicine (EM) residents and residents' ability to reflect and self-evaluate patient care is of critical importance. Patient care dashboards have been shown to increase adherence to quality guidelines and improve patient outcomes. The objectives of this study were: (1) to create a comprehensive list of evidence-based, psychologically safe patient care and quality metrics to include in a patient care dashboard for EM residents; (2) to design an EM patient care residency dashboard in a secure, cloud-based environment integrated with the electronic health record (EHR); and (3) to pilot the usability and acceptability of the dashboard among EM residents. We created a list of potential EM resident patient care metrics using ACGME Emergency Medicine Defined Key Index Procedure Minimums, leading EM quality indicators, and current EM dashboard literature. We surveyed PGY-1 to -4 EM residents at a single residency program for their recommendations about inclusion, exclusion, and the psychological safety of each metric. We then developed a dashboard utilizing Power BI software integrated with Epic EHR. After development, we conducted a 2-month pilot evaluation for usability and acceptability among EM residents utilizing a mixed-methods approach. We identified 41 metrics within five domains (productivity metrics, patient safety and leading quality indicators, key procedures, complex/high-acuity cases, and uncertain diagnosis) to consider for inclusion in the dashboard. Residents (n = 32/68; 47% survey completion rate) recommended inclusion of 33 metrics; among these, three were identified as moderate-high psychological risk (ED length of stay, patients per hour, death within 24 h) whereas the rest were considered low psychological risk. Based on these survey results, we created an EM resident patient dashboard using Microsoft Power BI. Over a 2-month pilot period with 16 residents, user data showed a change between each resident's prior patient care review practices and review practices when using a dashboard; specifically, there were notable variations in frequency of use, time spent per review session, number of patients reviewed per session, and data categories reviewed. Eleven of 16 residents completed the technology usability and acceptability survey, with general acceptability and few concerns on usability. Our dashboard provides individualized patient care data to EM residents related to productivity, patient safety and quality, key procedures, complex/high-acuity cases, and uncertain diagnoses. A pilot group of EM residents found the dashboard acceptable and useable. Continued research is needed to explore ideal implementation and integration of patient care dashboards in residency training.

In-training examinations (ITEs), arranged during residency training, evaluate the residents’ performances periodically. There is limited literature focusing on the effectiveness of resident ITEs in the format of simulation-based examinations, as compared to traditional oral or written tests. Our primary objective is to investigate the effectiveness and discriminative ability of high-fidelity simulation compared with other measurement formats in emergency medicine (EM) residency training program.This is a retrospective cohort study. During the 5-year study period, 8 ITEs were administered to 68 EM residents, and 253 ITE measurements were collected. Different ITE scores were calculated and presented as mean and standard deviation. The ITEs were categorized into written, oral, or high-fidelity simulation test forms. Discrimination of ITE scores between different training years of residency was examined using a one-way analysis of variance test.The high-fidelity simulation scores correlated to the progression of EM training, and residents in their fourth training year (R4) had the highest scores consistently, followed by R3, R2, and then R1. The oral test scores had similar results but not as consistent as the high-fidelity simulation tests. The written test scores distribution failed to discriminate the residents’ seniority. The high-fidelity simulation test had the best discriminative ability and better correlation between different EM residency training years comparing to other forms.High-fidelity simulation tests had the good discriminative ability and were well correlated to the EM training year. We suggest high-fidelity simulation should be a part of ITE in training programs associated with critical or emergency patient cares.

Introduction: Emergency medical services (EMS) are a critical component to Emergency Medicine (EM) residency training. In the United States, the Accreditation Council for Graduate Medical Education (ACGME) has established minimum training requirements for EM residency programs. Since the last study exploring resident EMS involvement was performed, there have been over 100 new EM resident programs started. Given the rapid increase in new EM programs, we sought to determine EMS experiences provided to current EM residents. Materials and Methods: A 22-question anonymous online survey was distributed through E-mail to program directors of approved EM residencies in October 2020. A follow-up reminder was sent 3 weeks later. Results: In total, 51 of 257 programs responded (20% response rate). Forty-five percent of EM residents experience between 10 and 25 EMS calls during their residency, 31% experience 26–50, and 20% experience &gt;50 calls. The majority of programs (53%) have a separate EMS rotation where residents function as observers, 24% of residents function as providers, and 25% also have residents respond in a dedicated physician response vehicle. Aeromedical exposure is limited (47% have none and 43% average only 1–9 flights). Two-thirds of programs (67%) have residents provide online medical command during their ED shifts and 61% require residents to provide didactics to EMS clinicians. Despite ACGME requirements, only two-thirds of programs (69%) provide training about disaster/mass casualty incident (MCI) management and 67% have them participate in a disaster/MCI drill. About one-third of programs (31%) have decreased EMS experiences due to limited time in the residency curriculum, and 20% of programs have limited EMS experiences due to the COVID pandemic. Conclusions: The majority of responding EM residency programs meet ACGME EMS-related requirements. There is an opportunity for improvement around disaster education based on these data. Limited time in the curriculum and the COVID pandemic were cited as reasons that programs have limited their EMS experiences. The following core competencies are addressed in this article: Practice-Based Learning and Improvement, Medical Knowledge.

Prior literature has demonstrated incongruities among faculty evaluation of male and female residents' procedural competency during residency training. There are no known studies investigating gender differences in the assessment of procedural skills among emergency medicine (EM) residents, such as those required by ultrasound. The objective of this study was to determine if there are significant gender differences in ultrasound milestone evaluations during EM residency training. We used a stratified, random cluster sample of Accreditation Council for Graduate Medical Education (ACGME) EM residency programs to conduct a longitudinal, retrospective cohort analysis of resident ultrasound milestone evaluation data. Milestone evaluation data were collected from a total of 16 ACGME-accredited EM residency programs representing a 4-year period. We stratified milestone data by resident gender, date of evaluation, resident postgraduate year, and cohort (residents with the same starting date). A total of 2,554 ultrasound milestone evaluations were collected from 1,187 EM residents (750 men [62.8%] and 444 women [37.1%]) by 104 faculty members during the study period. There was no significant overall difference in mean milestone score between female and male residents [mean difference= 0.01 (95% confidence interval {CI}= -0.04 to 0.05)]. There were no significant differences between female and male residents' mean milestone scores at the first (baseline) PGY1 evaluation (mean difference= -0.04 [95% CI= -0.09 to 0.003)] or at the final evaluation during PGY3 (mean difference= 0.02 [95% CI= -0.03 to 0.06)]. Despite prior studies suggesting gender bias in the evaluation of procedural competency during residency training, our study indicates that there were no significant gender-related differences in the ultrasound milestone evaluations among EM residents within training programs throughout the United States.

Managing STEMIs without a Catheterization Lab: A Simulated Scenario to Improve Emergency Clinician Recognition and Execution of Thrombolysis in the Setting of Rural STEMI Management.

The first case of COVID-19 was reported in March 2020 in Turkey. Following the countrywide restrictions, residency lectures and meetings were suspended. Emergency medicine (EM) residency training was uniquely disturbed because the medical care provided by the hospitals during pandemics was restricted to only emergency admissions. Our hospital is a state-owned Training and Research Academic Centre. Regular scientific conferences and postgraduate training courses are organized by specialty societies and academic staff. We aimed to describe the challenges of residency training during COVID restrictions and reflect the opinions of the emergency medicine residents through an online survey study. Survey results revealed that WhatsApp Group announcements were preferred to email for rapid information distribution. A major challenge during the initial period was following the weekly scientific board meeting guidelines and distributing the updated documents within the department. Adaptation to the online lectures was also challenging. Practical sessions were found to be the most challenging and unattainable by the residents. One-on-one sessions were preferred especially for surgical procedures and ultrasound training. Online courses prepared by the specialty societies were useful for specialty-focused information sharing. WhatsApp is the preferred way for fast information sharing including educational materials and guidelines. Specialty societies are important stakeholders in improving up-to-date materials for distance learning within the EM residency training.