Objective Workplace-based assessment (WBA) plays a crucial role in assessing entrustable professional activities (EPAs) in the competency-based medical education era. This pilot study explored the perceptions of residents and assessors of two WBAs for three Korean Society of Emergency Medicine EPAs.
Methods Eight emergency medicine (EM) residents underwent WBAs, with mini-clinical evaluation exercises (mini-CEX) conducted by nine EM faculty members and multisource feedback (MSF) provided by two internal medicine faculty members and four emergency room nurses, for a total of 69 assessments. We conducted an anonymous online survey to gather feedback on experiences, perceptions, and recommendations for improving WBA, such as mini-CEX and MSF, with responses scored on a 5-point Likert scale.
Results Of the 23 initial participants, 15 (65.2%) responded, including 5 residents and 10 assessors. EM faculty viewed mini-CEX favorably, noting its strong integration of supervision and effectiveness in assessing resident performance. EM residents reported comfort issues during assessments, preferring immediate feedback and multiple assessors. MSF was generally perceived positively but showed discrepancies in the utilities of rating scales and feedback types, indicating potential areas for improvement.
Conclusion Two WBAs for three Korean Society of Emergency Medicine EPAs were found to be feasible and acceptable in the context of Korean EM residency training. However, perceptions varied between assessors and residents, necessitating clear communication about WBA objectives and processes. Our findings are useful for shaping future EPA-based training programs, balancing traditional and WBA methods, and enhancing feedback quality.
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Objective Feedback is critical to the growth of learners. However, feedback quality can be variable in practice. Most feedback tools are generic, with few targeting emergency medicine. We created a feedback tool designed for emergency medicine residents, and this study aimed to evaluate the effectiveness of this tool.
Methods This was a single-center, prospective cohort study comparing feedback quality before and after introducing a novel feedback tool. Residents and faculty completed a survey after each shift assessing feedback quality, feedback time, and the number of feedback episodes. Feedback quality was assessed using a composite score from seven questions, which were each scored 1 to 5 points (minimum total score, 7 points; maximum, 35 points). Preintervention and postintervention data were analyzed using a mixed-effects model that took into account the correlation of random effects between study participants.
Results Residents completed 182 surveys and faculty members completed 158 surveys. The use of the tool was associated with improved consistency in the summative score of effective feedback attributes as assessed by residents (P=0.040) but not by faculty (P=0.259). However, most of the individual scores for attributes of good feedback did not reach statistical significance. With the tool, residents perceived that faculty spent more time providing feedback (P=0.040) and that the delivery of feedback was more ongoing throughout the shift (P=0.020). Faculty felt that the tool allowed for more ongoing feedback (P=0.002), with no perceived increase in the time spent delivering feedback (P=0.833).
Conclusion The use of a dedicated tool may help educators provide more meaningful and frequent feedback without impacting the perceived required time needed to provide feedback.
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Objective Team-based resuscitation in emergency departments (EDs) is an excellent opportunity for hot debriefs (HDBs). In creating a bespoke HDB model for emergency medicine resuscitations, we sought to optimize learning from clinical experience, identify team strengths, challenges, encourage honest reflection and focus on ways of improving future performance.
Methods Multidisciplinary ED focus groups reviewed existing models, identified benefits/barriers and created new frame works, testing and adapting further using fottage of a simulated complex resuscitation case. The new HDB tool was coined: “STOP5” (STOP for 5 minutes). Cases targeted were prehospital retrievals, major trauma, cardiac arrests, deaths in resuscitation, and staff-triggered. The framework details included a specifically scripted introduction followed by core elements that were S: summarize the case; T: things that went well; O: opportunities to improve; P: points to action and responsibilities. Staffs were surveyed at 1 month prior then 6 and 18 months post-introduction. Data collection forms were used to identify and track hard outcomes/system improvements resulting directly from HDBs.
Results Potential benefits identified by respondents included: improved staff morale; team cohesion; improved care for future patients; promoting a culture for learning, patient safety and quality improvement. Ten process and equipment changes resulted directly from STOP5 over 12 months.
Conclusion We anticipate the STOP5 framework to be globally generalizable and effective for many ED teams.
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Clin Exp Emerg Med 2014;1(2):101-108. Published online December 31, 2014
Objective We aimed to estimate the accuracy of visual estimation of chest compression depth and identify potential factors affecting accuracy.
Methods This simulation study used a basic life support mannequin, the Ambu man. We recorded chest compression with 7 different depths from 1 to 7 cm. Each video clip was recorded for a cycle of compression. Three different viewpoints were used to record the video. After filming, 25 clips were randomly selected. Health care providers in an emergency department were asked to estimate the depth of compressions while watching the selected video clips. Examiner determinants such as experience and cardiopulmonary resuscitation training and environment determinants such as the location of the camera (examiner) were collected and analyzed. An estimated depth was considered correct if it was consistent with the one recorded. A multivariate analysis predicting the accuracy of compression depth estimation was performed.
Results Overall, 103 subjects were enrolled in the study; 42 (40.8%) were physicians, 56 (54.4%) nurses, and 5 (4.8%) emergency medical technicians. The mean accuracy was 0.89 (standard deviation, 0.76). Among examiner determinants, only subjects’ occupation and clinical experience showed significant association with outcome (P=0.03 and P=0.08, respectively). All environmental determinants showed significant association with the outcome (all P<0.001). Multivariate analysis showed that accuracy rate was significantly associated with occupation, camera position, and compression depth.
Conclusions The accuracy rate of chest compression depth estimation was 0.89 and was significantly related with examiner’s occupation, camera view position, and compression depth.
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