Motor vehicle incidents in postgraduate trainees in British Columbia.

INTRODUCTION: Postgraduate medical trainees frequently work ≥ 24- hour shifts causing fatigue and adverse consequences such as motor vehicle incidents (MVIs). We aim to determine the incidence of MVIs during the commutes of trainees in British Columbia (BC) in the preceding year. METHODS: We completed a retrospective, cross-sectional survey of trainees regarding work hours, shifts, and MVIs in the previous year. MVIs included falling asleep while driving, sudden braking or swerving to avoid a collision, unintentionally running a red light or stop sign, or collisions. RESULTS: Of 273 respondents, over half (54.6%) reported ≥1 MVI, one in 14 were in a collision (7.0%), and two thirds (66.3%) reported that the safety of their commute had been impacted by fatigue in the past year. After adjustment for road exposure and shift-related factors, every ten km increase in commute length was associated with an increased risk of MVI (aOR=1.54;95%CI:1.15-2.12). Reported attentional failures, such as unintentionally running a red light and/or stop sign, increased for every ten hours on-call (aOR=1.44;95%CI:1.03-2.04) and for every additional past-midnight shift worked (aOR=1.13;95%CI:1.01-1.26). DISCUSSION: Trainees with longer and more frequent commutes had an increased risk of MVIs. Trainees who worked more hours on-call and more past-midnight shifts reported significantly more attentional failures while commuting. This study helps us understand factors affecting trainee commuter safety and supports calls for the provision of safe alternatives to commuting for postgraduate trainees.

INTRODUCTION: Les résidents et moniteurs cliniques (fellows) en médecine travaillent souvent ≥ 24 heures d'affilée, ce qui entraîne de la fatigue et des conséquences néfastes comme les accidents de la route, parfois évités de justesse. Notre objectif était de déterminer la fréquence des accidents de la route et des incidents qui auraient pu entraîner un accident, survenus lors des déplacements des résidents ou moniteurs cliniques en Colombie-Britannique (C.-B.) au cours de l'année précédente. MÉTHODES: Nous avons réalisé une enquête rétrospective transversale auprès des résidents. Les questions portaient sur les heures travaillées, les quarts de travail et les accidents ou les incidents pouvant entraîner un accident de la route, au cours de l'année précédente. Les incidents et accidents visés comprenaient la somnolence au volant, le freinage brusque ou l'embardée pour éviter une collision, le non-respect involontaire d'un feu rouge ou d'un panneau d'arrêt, et la collision. RÉSULTATS: Pour l'année de référence, parmi les 273 répondants, plus de la moitié (54,6 %) ont signalé ≥1 accident, un répondant sur 14 a été impliqué dans une collision (7,0 %) et deux tiers (66,3 %) ont déclaré que la fatigue avait affecté la sécurité de leur déplacement. Après ajustement pour tenir compte de l'exposition à la route et des facteurs liés aux quarts de travail, chaque portion de 10 km qui s'ajoutait au trajet était associée à une augmentation du risque d'accident ou incident de la circulation (aOR=1.54;IC95%:1.15-2.12). Les baisses d'attention signalées, liées par exemple au franchissement involontaire d'un feu rouge ou d'un panneau d'arrêt, augmentaient pour chaque période de 10 heures de garde (aOR=1,44 ; 95 % IC:1,03-2,04) et pour chaque quart supplémentaire effectué après minuit (aOR=1,13 ; 95 % IC:1,01-1,26). DISCUSSION: Les stagiaires dont les trajets étaient plus longs et plus fréquents présentaient un risque plus élevé d'implication dans un accident ou incident de la route. Les stagiaires qui travaillaient plus d'heures de garde et plus de quarts de nuit ont signalé une fréquence considérablement plus élevée de pertes d'attention pendant les trajets. Cette étude nous aide à comprendre les facteurs qui affectent la sécurité des trajets domicile-travail des résidents et moniteurs cliniques et montre la pertinence des appels à la mise en place d'options sécuritaires pour les déplacements concernés.

The revised Approved Instructional Resources score: An improved quality evaluation tool for online educational resources.

BACKGROUND: Free Open-Access Medical education (FOAM) use among residents continues to rise. However, it often lacks quality assurance processes and residents receive little guidance on quality assessment. The Academic Life in Emergency Medicine Approved Instructional Resources tool (AAT) was created for FOAM appraisal by and for expert educators and has demonstrated validity in this context. It has yet to be evaluated in other populations. OBJECTIVES: We assessed the AAT's usability in a diverse population of practicing emergency medicine (EM) physicians, residents, and medical students; solicited feedback; and developed a revised tool. METHODS: As part of the Medical Education Translational Resources: Impact and Quality (METRIQ) study, we recruited medical students, EM residents, and EM attendings to evaluate five FOAM posts with the AAT and provide quantitative and qualitative feedback via an online survey. Two independent analysts performed a qualitative thematic analysis with discrepancies resolved through discussion and negotiated consensus. This analysis informed development of an initial revised AAT, which was then further refined after pilot testing among the author group. The final tool was reassessed for reliability. RESULTS: Of 330 recruited international participants, 309 completed all ratings. The Best Evidence in Emergency Medicine (BEEM) score was the component most frequently reported as difficult to use. Several themes emerged from the qualitative analysis: for ease of use-understandable, logically structured, concise, and aligned with educational value. Limitations include deviation from questionnaire best practices, validity concerns, and challenges assessing evidence-based medicine. Themes supporting its use include evaluative utility and usability. The author group pilot tested the initial revised AAT, revealing a total score average measure intraclass correlation coefficient (ICC) of moderate reliability (ICC = 0.68, 95% confidence interval [CI] = 0 to 0.962). The final AAT's average measure ICC was 0.88 (95% CI = 0.77 to 0.95). CONCLUSIONS: We developed the final revised AAT from usability feedback. The new score has significantly increased usability, but will need to be reassessed for reliability in a broad population.

Clinical Performance Feedback to Paramedics: What They Receive and What They Need.

OBJECTIVES: Performance feedback is not always well utilized in healthcare. To more effectively incorporate it, we used a discussion of current feedback systems to explore paramedics' perceived needs regarding feedback and to understand what feedback would improve their performance as healthcare providers. METHODS: We used a qualitative methodology with semistructured interviews of paramedics to explore perceptions and desires for feedback. Interpretive descriptive analysis was performed with continuous recruitment until thematic saturation was achieved. Themes were identified and a coding system was developed by two investigators separately and merged by consensus. The analysis was audited by a third investigator, and a member check was performed. RESULTS: Many different ideas were discussed that were analyzed to develop several major recurrent themes. One such theme was positive perception of feedback by paramedics. Despite the positive perceptions discussed, the shortcomings of current systems were also frequently discussed as were perceived barriers to receiving meaningful feedback. The idea of following up on patients' courses/outcomes also arose frequently during the interviews. In addition, feedback and its interaction with mental health emerged as a theme in terms of its potential for both positive and negative impact. Finally, suggestions about the future were also common with paramedics providing thoughts regarding what future systems could be developed or what changes could be made to provide them with meaningful feedback. CONCLUSIONS: Our findings show how paramedics perceive feedback, but still note how barriers may impair its uptake and how it may affect their mental health. Our participants also made recommendations about what they would want to see in future feedback systems. This information can provide the foundation to improve current feedback systems or structure new ones to allow paramedics to continue to develop themselves as healthcare professionals.