A National Faculty Development Needs Assessment in Emergency Medicine.

OBJECTIVES: Emergency physicians who work in academic settings enjoy an expanding number of roles beyond that of the skilled clinician. Faculty development (FD) encompasses the broad range of activities that institutions use to renew skill-sets and assist faculty members in these multiple roles. This study seeks to define the current FD needs and interests of Canadian academic emergency physicians (AEPs). METHODS: An online survey was administered to 943 AEPs in eight centers across Canada to determine their current FD activities, provide a detailed understanding of their FD needs and interests, elucidate the perceived barriers to and motivation for engaging in FD, and identify preferred methods of delivery for FD activities. RESULTS: This national, cross-sectional survey was completed by 336 respondents. It shows that need for FD is universally high, particularly in traditional domains of scholarship, leadership and education (79%, 80%, 87% overall interest, respectively). However, the study also suggests that there is increasing need for FD in areas where current participation is lowest, namely research and social accountability (12% and 13% more interest, respectively). Senior and junior faculty evince equivalent overall FD interest (p>0.05), whereas female AEPs expressed greater overall FD needs in leadership (1.82 vs 1.44 activities, p=0.003) than males. Continued participation in FD activities is best promoted by offering relevant topics, at convenient times and locations. CONCLUSIONS: This study reports the first comprehensive national FD needs assessment of Canadian academic emergency physicians.

Resident evaluation of clinical teachers based on teachers' certification.

OBJECTIVE: To examine the influence of emergency medicine (EM) certification of clinical teaching faculty on evaluations provided by residents. METHODS: A prospective cohort analysis was conducted of assessments between July 1994 and July 2000 on residents' evaluations of EM faculty at the University of Alberta, Edmonton, Canada. Resident- and faculty-related variables were entered anonymously using the validated evaluation tool (ER Scale). Credentialing and demographic information on EM faculty was supplemented by data obtained through a nine-question survey. Groups were compared using ANOVA. RESULTS: The 562 residents returned 705 (91%) valid evaluation sheets on 115 EM faculty members. The four domains of didactic teaching, clinical teaching, approachability, and helpfulness were assessed. The majority of ratings were in the very good or superb categories for each domain. Instructors with certification in EM had higher scores in didactic, clinical teaching compared with others, and teachers without national certification scored lower in the helpful and approachable categories (p < 0.05). The route of obtaining EM certifications either through training or practice eligibility did not affect scores. Instructors under the age of 40 years had higher scores than the older age groups in three of four categories (p < 0.05). Instructors working at the teaching sites on a half-time basis received higher scores than those working full-time, and scores varied based on site. Overall, teaching ratings improved over the study period (p < 0.05). CONCLUSIONS: Significant differences exist among instructors in the EM setting that affect their teaching rating scores. National certification in EM, academic track, rotation year, and site are all correlated with better teaching performance.

Analysis of factors influencing length of stay in the emergency department.

OBJECTIVES: Length of stay (LOS) is a key measure of emergency department (ED) throughput and a marker of overcrowding. Time studies that assess key ED processes will help clarify the causes of patient care delays and prolonged LOS. The objectives of this study were to identify and quantify the principal ED patient care time intervals, and to measure the impact of important service processes (laboratory testing, imaging and consultation) on LOS for patients in different triage levels. METHODS: In this retrospective review, conducted at a large urban tertiary care teaching hospital and trauma centre, investigators reviewed the records of 1047 consecutive patients treated during a continuous 7-day period in January 1999. Key data were recorded, including patient characteristics, ED process times, tests performed, consultations and overall ED LOS. Of the 1047 patient records, 153 (14.6%) were excluded from detailed analysis because of incomplete documentation. Process times were determined and stratified by triage level, using the Canadian Emergency Department Triage and Acuity Scale (CTAS). Multiple linear regression analysis was performed to determine which factors were most strongly associated with prolonged LOS. RESULTS: Patients in intermediate triage Levels III and IV generally had the longest waiting times to nurse and physician assessment, and the longest ED lengths of stay. CTAS triage levels predicted laboratory and imaging utilization as well as consultation rate. The use of diagnostic imaging and laboratory tests was associated with longer LOS, varying with the specific tests ordered. Specialty consultation was also associated with prolonged LOS, and this effect was highly variable depending on the service consulted. CONCLUSIONS: Triage level, investigations and consultations are important independent variables that influence ED LOS. Future research is necessary to determine how these and other factors can be incorporated into a model for predicting LOS. Improved information systems will facilitate similar ED time studies to assess key processes, lengths of stay and clinical efficiency.

Impact of a triage liaison physician on emergency department overcrowding and throughput: a randomized controlled trial.

BACKGROUND: Triage liaison physicians (TLPs) have been employed in overcrowded emergency departments (EDs); however, their effectiveness remains unclear. OBJECTIVES: To evaluate the implementation of TLP shifts at an academic tertiary care adult ED using comprehensive outcome reporting. METHODS: A six-week TLP clinical research project was conducted between December 9, 2005, and February 9, 2006. A TLP was deployed for nine hours (11 AM to 8 PM) daily to initiate patient management, assist triage nurses, answer all medical consult or transfer calls, and manage ED administrative matters. The study was divided into three two-week blocks; within each block, seven days were randomized to TLP shifts and the other seven to control shifts. Outcomes included patient length of stay, proportion of patients who left without complete assessment, staff satisfaction, and episodes of ambulance diversion. RESULTS: TLPs assessed a median of 14 patients per shift (interquartile range, 13-17), received 15 telephone calls per shift (interquartile range, 14-20), and spent 17-81 minutes per shift consulting on the telephone. The number of patients and their age, gender, and triage score during the TLP and control shifts were similar. Overall, length of stay was decreased by 36 minutes compared with control days (4:21 vs. 4:57; p = 0.001). Left without complete assessment cases decreased from 6.6% to 5.4% (a 20% relative decrease) during the TLP coverage. The ambulance wait time and number of episodes of ambulance diversion were similar on TLP and control days. CONCLUSIONS: A TLP improved important outcomes in an overcrowded ED and could improve delivery of emergency medical care in similar tertiary care EDs.

The influence of residents training level on their evaluation of clinical teaching faculty.

BACKGROUND: Evaluations by learners are the most common sources of information on teaching. There is some debate about the role of these assessments, but the overall evaluation of faculty by learners was found to be valid and reliable. PURPOSE: The purpose of this study was to examine the relationship between the level of training of family medicine residents and their evaluation of emergency medicine clinical teachers over time. METHODS: A prospective cohort analysis of 6 years of faculty evaluation of 115 teachers was conducted. RESULTS: The 562 residents returned 3,046 valid individual evaluations. There was no significant association between the level of residents' training and the ratings for clinical instruction (p > .05). Resident evaluations did not vary by time of year (p > .05); however, they did significantly differ by year of evaluation, showing that ratings increased over the 6 years of the study (p < .0001). CONCLUSIONS: Neither the residents' level of training nor the timing during the academic year were significant independent predictors of perceived superior teaching performance, although ratings increased over the 6 years of the study.