Emergency Department Crowding: The Effect on Resident Education

Atzema, Clare L.; Bandıera, Glen; Schull, Michael J.; Coon, Troy P.; Milling, Truman J.

doi:10.1016/j.annemergmed.2004.12.011

Cited by 58 publications

(47 citation statements)

References 43 publications

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“…Thus, any new teaching initiative must be evaluated both overall and in this setting, which constitutes the "new normal" in emergency department-based medical education. It has been proposed that in a crowded emergency department the supervising physician has little time for the extensive oneon-one teaching that is required before an inexperienced trainee performs a procedure on a patient [10]. A similar concern has been raised in crowded outpatient clinics and family doctors' offices [20].…”

Section: Discussionmentioning

confidence: 99%

“…No studies have assessed the utility of using procedure videos in real time, in the setting of the emergency department. As well, emergency department crowding has been documented in North America, the United Kingdom, and much of the Western world [6][7][8][9], and concern has been raised over how crowding affects the quality of teaching received by future physicians [10]. Innovative approaches to teaching procedures have been proposed to mitigate some of the postulated negative effects of crowding [11]; however, no study, to our knowledge, has assessed whether procedure videos are an adaptive response to teaching in a crowded clinical environment.…”

Section: Introductionmentioning

confidence: 99%

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Physician-Rated Utility of Procedure Videos for Teaching Procedures in the Emergency Department, Overall and during Emergency Department Crowding

Atzema¹,

Stefan²,

Saskin³

et al. 2012

IJCM

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Background: Real-time use of procedure videos as educational tools has not been studied. We sought to determine whether viewing a video of a medical procedure prior to procedure performance in the emergency department improves the quality of teaching of procedures, and whether videos are particularly beneficial during periods of emergency department crowding. Methods: In this single-centre, prospective, before and after study standardized data collection forms were completed by both trainees and supervising emergency physicians (EPs) at the end of each emergency department shift in the before (August 2008-March 2009) and after (August 2009-March 2010) phase. Online procedure videos were introduced on emergency department computers in the after phase. The primary outcome measure was EP rating of the quality of teaching provided (5-point Likert scale). The interaction between crowding and videos was also assessed, to determine whether videos provided a specific additional benefit during periods of emergency department crowding. Results: There were 1159 procedures performed by 192 trainees. Median procedures performed per shift was 1.0 (IQR 0 -2.0). Mean EP rating of teaching provided was significantly higher in the group that viewed videos, at 4.2 versus 3.7 (p < 0.001). In the adjusted analysis, EP ratings increased by 0.5 with a video (p < 0.001), while the odds of a score of 5.0 were 2.2 times greater if a video was viewed (p = 0.03). The interaction of crowding and procedure videos was not significant (the use of videos increased the average score by 0.24 in times of crowding compared to times of non-crowding, p = 0.19). Conclusions: Use of procedure videos was associated with EP perception of improved quality of teaching provided around procedures. While EPs rated the quality of their teaching as improved overall, the effect of videos on teaching quality was the same in crowded settings as it was in non-crowded settings.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Physician-Rated Utility of Procedure Videos for Teaching Procedures in the Emergency Department, Overall and during Emergency Department Crowding

Atzema¹,

Stefan²,

Saskin³

et al. 2012

IJCM

View full text Add to dashboard Cite

show abstract

“…The ED, a difficult teaching environment at the best of times, is becoming more difficult because of problems such as overcrowding. 25 Finally, the Royal College of Physicians and Surgeons of Canada's CanMEDS framework specifies that residents must be trained communicators and scholars. 26 Teaching both of these competencies requires that teachers be effective role models during their teaching.…”

Section: Discussionmentioning

confidence: 99%

Faculty perceptions and practice impact of a faculty development workshop on emergency medicine teaching

Bandıera

Lee

Foote

2005

CJEM

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Background: Faculty development initiatives to improve emergency department (ED) teaching are compromised by the paucity of information about what behaviours and characteristics are desirable in an emergency medicine (EM) teacher. Objectives: To design and evaluate a learner-centred, interactive faculty development workshop based on original ED teaching research. Methods: Registrants for a university-based faculty development workshop on ED teaching completed a needs assessment and pre-workshop self-reflection exercise. Responses were grouped into 3 themes derived from the ambulatory teaching literature and a recent survey of expert clinical EM teachers and learners. Participants underwent a half-day workshop consisting of 1 large group interactive session and 3 small group sessions using role playing, practice reflection, real time review of hard copy resources, and brainstorming. Evaluation included a post-event ordinal scale questionnaire and a 4-month follow-up short answer survey, both measuring participants' perceptions of workshop effectiveness. Results: Fifteen faculty participated. The needs assessment identified "Common mistakes," "Teaching efficiently" and "Dealing with the difficult learner" as themes. All 15 completed evaluations, rating the workshop as relevant (4.6/5), specific to their needs (4.4/5) and useful (4.5/5). At 4 months, 10 out of 10 respondents reported success at implementing new techniques and 8 reported greater confidence in teaching. The most common new techniques were: setting better learning objectives, giving better feedback, actively seeking teaching opportunities, and identifying a teaching point. Conclusions: Learner-centred faculty development meets perceived needs of faculty and can result in participants trying new teaching strategies.

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“…3,[6][7][8][9][10] These challenges have led to increasing undergraduate and graduate trainee dissatisfaction with their clinical emergency medicine didactic experiences. 3,11,12 As with other institutions, our ED has experienced a dramatic increase in annual patient volume and acuity over the past decade. Accompanying these increases, there was a steep decline in fourth-year medical student rotation satisfaction, particularly regarding the paucity of attending physician-initiated bedside teaching.…”

Section: Ré Sumémentioning

confidence: 99%

Impact of a teaching attending physician on medical student, resident, and faculty perceptions and satisfaction

Cassidy-Smith

Kilgannon

Nyce

et al. 2011

CJEM

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Objectives: To determine if a dedicated teaching attending for medical student education improves medical student, attending physician, and resident perceptions and satisfaction. Methods: Two dedicated teaching attending physician shifts were added to the clinical schedule each week. A before-after trial compared medical student evaluations from 2000 to 2004 (preteaching attending physician) to medical student evaluations from 2005 to 2006 (teaching attending physician). Attending physician and resident perceptions and satisfaction with the teaching attending physician shifts using a 5-point Likert-type scale (1 5 poor to 5 5 excellent) were also assessed. Results: Eighty-nine (100%) medical students participated, with 63 preteaching attending physician and 26 teaching attending physician rotation evaluations. The addition of teaching attending physician shifts improved mean medical student satisfaction with bedside teaching (4.1 to 4.5), lecture satisfaction (4.2 to 4.8), preceptor scores (4.3 to 4.8), and perceived usefulness of the rotation (4.5 to 5.0) (all p , 0.05). Thirteen attending physicians (93%) participated in the crosssectional questionnaire. The addition of teaching attending physician shifts improved faculty ratings of their medical student interactions by $ 1.5 points for all items (p # 0.001). Faculty perceptions of their resident interactions improved for quality of bedside teaching (3.1 to 4.0), their availability to hear resident presentations (3.4 to 4.2), and their supervision of residents (3.4 to 4.1) (p # 0.01). Residents (n 5 35) noted minor improvements with the timeliness of patient dispositions, faculty bedside teaching, and attending physician availability. Conclusions: The addition of select teaching attending physician shifts had the greatest effect on medical student and faculty perceptions and satisfaction, with some improvements for residents. RÉ SUMÉObjectifs : Dé terminer si un enseignement spé cialisé destiné aux é tudiants en mé decine amé liore les perceptions et la satisfaction des é tudiants en mé decine, des mé decins traitants et des ré sidents en mé decine.

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Emergency Department Crowding: The Effect on Resident Education

Cited by 58 publications

References 43 publications

Physician-Rated Utility of Procedure Videos for Teaching Procedures in the Emergency Department, Overall and during Emergency Department Crowding

Physician-Rated Utility of Procedure Videos for Teaching Procedures in the Emergency Department, Overall and during Emergency Department Crowding

Faculty perceptions and practice impact of a faculty development workshop on emergency medicine teaching

Impact of a teaching attending physician on medical student, resident, and faculty perceptions and satisfaction

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