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BACKGROUND: Mini Clinical Evaluation Exercise (Mini-CEX) has been adapted to different specialties in clinical practice but with very little evidence documented about its use for residency training in the emergency department (ED). This study aims to assess its acceptability and feasibility as a formative tool in the busy emergency department. MATERIALS AND METHODS: Both the faculty members and the emergency medicine residents were sent a validated questionnaire using Google forms, and the results were analyzed using simple statistical tools. RESULTS: Forty-nine residents and 58 faculty participated in the survey. The study was carried out over a period of 4 months. The resident's completion rate was 96% (49 out of 51), while faculty completion rate was 96% (58 out of 60). The time for Mini-CEX completion ranged from 10 to 20 minutes. Most of the residents were satisfied with Mini-CEX as an assessment tool. Twelve residents expressed their concern regarding available time during busy clinical shifts. Most of the faculty agreed with the benefits of using Mini-CEX as a formative assessment tool. Several of them commented that they need "protected time" and "more training" to use this tool to provide maximum benefit to the residents. CONCLUSION: Despite busy nature of ED, Mini-CEX has been identified as an acceptable learning tool for residents in emergency medicine. Based on the faculty's feedback and comments, several faculty development workshops were conducted to improve faculty skills in carrying assessments by using Mini-CEX, and protected time is provided to some faculty members to carry out these formative assessments for the benefit of the residents.
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Despite protective measures such as personal protective equipment (PPE) and a COVID airway management program (CAMP), some emergency physicians will inevitably test positive for COVID. We aim to develop a model predicting weekly numbers of emergency physician COVID converters to aid operations planning. The data were obtained from the electronic medical record (EMR) used throughout the national healthcare system. Hamad Medical Corporation's internal emergency medicine workforce data were used as a source of information on emergency physician COVID conversion and numbers of emergency physicians completing CAMP training. The study period included the spring and summer months of 2020 and started on March 7 and ran for 21 whole weeks through July 31. Data were extracted from the system's EMR database into a spreadsheet (Excel, Microsoft, Redmond, USA). The statistical software used for all analyses and plots was Stata (version 16.1 MP, StataCorp, College Station, USA). All data definitions were made a priori. A total of 35 of 250 emergency physicians (14.0%, 95% CI 9.9%-19.9%) converted to a positive real-time reverse transcriptase-polymerase chain reaction (PCR) during the study's 21-week period. Of these. only two were hospitalized for having respiratory-only disease, and none required respiratory support. Both were discharged within a week of admission. The weekly number of newly COVID-positive emergency physicians was zero and was seen in eight of 21 (38.1%) weeks. The peak weekly counts of six emergency physicians with new COVID-positive were seen in week 14. The mean weekly number of newly COVID-positive emergency physicians was 1.7 ± 1.9, and the median was 1 (IQR, 0 to 3). This study demonstrates that in the State of Qatar's Emergency Department (ED) system, knowing only four parameters allows the reliable prediction of the number of emergency physicians likely to convert COVID PCR tests within the next week. The results also suggest that attention to the details of minimizing endotracheal intubation (ETI) risk can eliminate the expected finding of the association between ETI numbers and emergency physician COVID numbers.
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BACKGROUND: The length of stay (LOS) is an important operational parameter closely followed in emergency department (ED). This study aims to assess operations impacts of a large postresidency EM Fellowship (EMF) program on LOS. METHODS: This was a retrospective database analysis of data collected automatically by the study ED's electronic medical record (EMR) for one full academic year, starting in September 2016. The main dependent variable was LOS for the cases discharged after EM-only evaluation (LOSDCEM), and the independent variable of interest was the proportion of EMFs as a % of all on-duty ED physicians during the shift the patient presented. RESULTS: During the study period, the ED census for patients discharged after EM-only evaluation was 327,527. Exclusion of 5,803 EMR-downtime cases (1.8% of 327,527) and 845 (0.3% of 327,527) cases with LOS exceeding 24 hours, the final study set comprised 320,879 LOSDCEM cases. The EMF proportion of on-duty ED physicians, was statistically significant at the lowest three τ levels but not significant at the higher six τ levels. For the 10th, 20th, and 30th percentiles of LOSDCEM, the % relative improvements in LOSDCEM achieved by increasing the EMF proportion 1% were, respectively, 13% (6.5/52), 8% (6.8/83), and 7% (8.1/115). CONCLUSIONS: The LOSDCEM does not appear to be unfavourably impacted by increasing the proportion of EMFs as a % of all on-duty ED physicians. The EMFs numbers (as a percentage of all on-duty physicians) disproportionately improves LOSDCEM for those patients with shorter LOS.