Health research methodology education in Canadian emergency medicine residency programs: A national environmental scan.

OBJECTIVES: Our objective was to describe the variability of research methodology teaching among English-speaking Royal College of Physicians and Surgeons of Canada emergency medicine (RCPSC-EM) residency programs. We also aimed to identify barriers to teaching research methodology curricula. METHODS: An electronic survey was sent by email to program directors and residents of English-speaking RCPSC-EM training programs countrywide. Reminder emails were sent after two, four, and eight weeks. Quantitative, descriptive statistics were prepared, and qualitative data and themes were identified. RESULTS: We received a total of seven responses from the possible 12 program directors (response rate = 58.3%). Out of 354 potential resident respondents, 82 (23.2%) completed the survey. There was disparity between resident and program director responses with respect to the existence of curricula, preparation for Royal College exams, and usefulness for future practice. Barriers to teaching a research methodologies curriculum included lack of time, support, educated faculty, and finances. CONCLUSION: This survey demonstrates that Canadian EM residency programs vary with respect to research methodology curriculum, and discrepancies exist between residents' and program directors' perceptions of the curriculum. Given the lack of a standardized research methodology curriculum for these programs, there is an opportunity to improve training in research methodology.

OBJECTIFS: Notre objectif vise à décrire la variabilité de l'enseignement des méthodologies de la recherche entre les programmes anglophones de résidence en médecine d'urgence du Collège royal des médecins et chirurgiens du Canada (MU - CRMCC). Nous avions également pour but de déterminer les obstacles qui entravent l'enseignement des cursus de méthodologie de la recherche. MÉTHODES: On a transmis par courriel un sondage électronique aux directeurs de programme et résidents des programmes anglophones de formation MU - CRMCC dans tout le pays. Des courriels de rappel ont été envoyés après deux, quatre et huit semaines. On a ensuite préparé des statistiques descriptives quantitatives et identifié des données et thèmes qualitatifs. RÉSULTATS: Nous avons reçu un total de sept réponses des 12 directeurs de programme actuels (taux de réponse = 58,3 %). Quatre-vingt-deux des 354 résidents potentiels, soit 23,2 %, ont répondu au sondage. Nous avons relevé une disparité entre les réponses des résidents et celles des directeurs de programme en ce qui a trait à l'existence du cursus, la préparation en vue des examens du Collège royal et l'utilité dans la pratique future. Parmi les obstacles entravant l'enseignement des cursus de méthodologie de la recherche, on retrouvait le manque de temps, de soutien, de corps professoral qualifié et de fonds. CONCLUSION: Ce sondage démontre que les cursus de méthodologie de la recherche des programmes de résidence en médecine d'urgence varient dans l'ensemble du Canada et que des divergences existent entre le point de vue des résidents et celui des directeurs de programme sur ces cursus. Étant donné l'absence d'un cursus uniforme de méthodologie de la recherche pour ces programmes, ceci nous offre une occasion d'améliorer la formation en méthodologie de la recherche.

Evaluation of a National Competency-Based Assessment System in Emergency Medicine: A CanDREAM Study.

BACKGROUND: In 2018, Canadian postgraduate emergency medicine (EM) programs began implementing a competency-based medical education (CBME) assessment program. Studies evaluating these programs have focused on broad outcomes using data from national bodies and lack data to support program-specific improvement. OBJECTIVE: We evaluated the implementation of a CBME assessment program within and across programs to identify successes and opportunities for improvement at the local and national levels. METHODS: Program-level data from the 2018 resident cohort were amalgamated and analyzed. The number of entrustable professional activity (EPA) assessments (overall and for each EPA) and the timing of resident promotion through program stages were compared between programs and to the guidelines provided by the national EM specialty committee. Total EPA observations from each program were correlated with the number of EM and pediatric EM rotations. RESULTS: Data from 15 of 17 (88%) programs containing 9842 EPA observations from 68 of 77 (88%) EM residents in the 2018 cohort were analyzed. Average numbers of EPAs observed per resident in each program varied from 92.5 to 229.6, correlating with the number of blocks spent on EM and pediatric EM (r = 0.83, P < .001). Relative to the specialty committee's guidelines, residents were promoted later than expected (eg, one-third of residents had a 2-month delay to promotion from the first to second stage) and with fewer EPA observations than suggested. CONCLUSIONS: There was demonstrable variation in EPA-based assessment numbers and promotion timelines between programs and with national guidelines.

Reducing length of stay and satisfying learner needs.

A complicated relationship exists between emergency department (ED) learner needs and patient flow with solutions to one issue often negatively affecting the other. Teaching shifts that allow clinical teachers and learners to interact without the pressure of patient care may offer a mutually beneficial solution. This study investigated the relationship between teaching shifts on ED length of stay, student self-efficacy and knowledge application.In 2012-2013, a prospective, cohort study was undertaken in a large Canadian acute-care teaching centre. All 132 clinical clerks completing their mandatory two-week emergency medicine rotation participated in three teaching shifts supervised by one faculty member without patient care responsibilities. The curriculum emphasized advanced clinical skills and included low fidelity simulation exercises, a suturing lab, image interpretation modules and discussion about psychosocial issues in emergency medicine. The clerks then completed seven clinical shifts in the traditional manner caring for patients under the supervision of an ED attending physician. Length of stay was compared during and one week following teaching shifts. A self-efficacy questionnaire was validated through exploratory factor analysis. Pre/post knowledge application was assessed using a paper-based clinical case activity.Across 40.998 patient visits, median length of stay was shortened overall by 5 minutes (95 % CI:1.2, 8.8) when clerks were involved in their teaching shifts. In the first academic block, median length of stay was reduced by 20 minutes per patient (95 % CI:12.7, 27.3). Self-efficacy showed significant improvement post teaching shifts (p < 0.001) with large effect sizes (d > 1.25) on dimensions of knowledge base, suturing, trauma and team efficacy. Students' knowledge application scores improved from pre to post (p < 0.01), with notable gains in the generation of differential diagnoses.Teaching shifts are an effective educational intervention that has a positive relation to ED patient flow while successfully attending to learner needs. Teaching shifts for the most naïve clerks in the first academic block appear to maximally benefit length of stay. Students demonstrated improved self-efficacy and knowledge application after their teaching shifts.