Tab. 1
Teaching shift curriculum
|
Day |
Activity |
Time (in h) |
|---|---|---|
|
1 |
Orientation to site 1 ED and emergency medicine rotation |
1 |
|
(at site 1) |
aAdvanced clinical skills – abdominal pain |
2 |
|
Lunch – psychosocial learning topics explained and assigned |
1 | |
|
aAdvanced clinical skills – abdominal pain |
1 | |
|
Suturing/wound care skills session |
2 | |
|
2 |
Orientation to site 2 ED |
0.5 |
|
(at site 2) |
Advanced clinical skills – musculoskeletal |
1.5 |
|
The first 10 minutes of trauma – simulation |
1 | |
|
Psychosocial topic discussion |
1 | |
|
3 | ||
|
(at site 2) |
aAdvanced clinical skills – chest pain and shortness of breath |
2 |
|
The first 10 minutes of cardiac emergency – simulation |
2 | |
|
Lunch – psychosocial topic discussion |
1 | |
|
aAdvanced clinical skills – chest pain and shortness of breath |
2 | |
|
Wrap up – evaluations |
1 |
aDuring the first hour of these morning advanced clinical skills sessions, one half of the group would see previously assessed ED patients for a brief history and focused physical exam while the other half participated in image interpretation independent learning modules. The groups would then come together for the case presentation and discussion in the second hour. In the afternoon, the process would be repeated with the groups reversed
Tab. 2
Emergency department length of stay (EDLOS)
|
EDLOS | ||||
|---|---|---|---|---|
|
Rotations |
n a |
Medianb |
Diffb |
95 % CI |
|
Block 1 | ||||
|
Clerks in ED |
5694 |
263 | ||
|
Clerks in teaching shifts |
5544 |
243 |
−20 |
−27.3, −12.7 |
|
Block 2 | ||||
|
Clerks in ED |
4466 |
245 | ||
|
Clerks in teaching shifts |
4533 |
250 |
5 |
−4.4, 14.4 |
|
Block 3 | ||||
|
Clerks in ED |
4606 |
233 | ||
|
Clerks in teaching shifts |
4749 |
240 |
7 |
4.4, 9.6 |
|
Block 4 | ||||
|
Clerks in ED |
5694 |
237 | ||
|
Clerks in teaching shifts |
5712 |
235.5 |
−1.5 |
−9.5, 6.5 |
|
Overall | ||||
|
Clerks in ED |
20,460 |
246 | ||
|
Clerks in teaching shifts |
20,538 |
241 |
−5 |
−8.8, −1.2 |
|
Total |
40,998 | |||
n number; diff difference; CI confidence interval
anumber of ED visits
btime measured in minutes
Tab. 3
Factor analysis of self-efficacy statements
|
Pre/Post survey | ||||
|---|---|---|---|---|
|
Included statement |
K-base |
Suturing |
Teams |
Trauma |
|
1. I know how to give a report to another member of the healthcare team who is about to take over the care of a patient I have looked after |
0.55/0.65 | |||
|
2. I am able to assess an acutely injured knee |
0.54/0.41 | |||
|
3. I know how to recognize and initiate treatment for hypovolaemic shock |
0.50/0.45 | |||
|
4. I am able to suture a simple skin laceration |
0.76/0.73 | |||
|
5. I am able to infiltrate a wound with local anaesthetic |
0.69/0.72 | |||
|
6. I know how to choose an appropriate local anaesthetic for suturing |
0.61/0.57 | |||
|
7. I know when a wound should NOT be sutured in the ED |
0.58/0.71 | |||
|
8. I am able to lead a team in a basic resuscitation situation |
0.79/0.98 | |||
|
9. I am able to communicate effectively as part of a resuscitation team |
0.75/0.61 | |||
|
10. I know how to call a ‘Code Blue’ in any London Hospital |
0.44/0.45 | |||
|
11. I am able to apply cervical spine precautions in a patient who may have a cervical spine fracture, both inside and outside of the hospital setting |
0.82/0.82 | |||
|
12. I am able to implement the Canadian C‑Spine rules |
0.59/0.50 | |||
|
13. I am able to direct and assist in log rolling a trauma patient |
0.44/0.55 | |||
|
Removed statement |
K-base |
Suturing |
Teams |
Trauma |
|
14. I am able to perform a primary survey in a trauma patient |
0.76/0.51 |
–/0.34 | ||
|
15. I am able to perform bag-valve mask ventilation |
0.58/– | |||
|
16. I know how to calculate a patient’s Glasgow Coma Score |
0.49/– | |||
|
17. I am able to generate an appropriate list of differential diagnoses in a patient with chest pain presenting to the ED |
–/– | |||
|
18. I know how to make a plan for the investigation and treatment of a patient presenting to the ED with abdominal pain |
0.43/– |
0.48/– | ||
|
19. I am able to defibrillate a patient in cardiac arrest at the appropriate time for the appropriate rhythm |
–/0.39 |
0.55/0.33 | ||
|
20. I am able to demonstrate all basic life support skills in the appropriate sequence |
0.53/– |
–/0.50 | ||
Factor loadings <0.30 are suppressed
K-base knowledge base
Tab. 4
Pretest/posttest self-efficacy dimensions
|
Pretest |
Posttest |
98.75 % CI for mean difference | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
|
Outcome |
M |
SD |
M |
SD |
n |
t |
df |
Cohen’s D | ||
|
Knowledge base |
4.71 |
1.02 |
5.86 |
0.56 |
122 |
0.92,1.37 |
13.11** |
121 |
1.19 | |
|
Suturing |
4.00 |
1.26 |
5.45 |
0.97 |
122 |
1.18,1.71 |
13.82** |
121 |
1.25 | |
|
Teams |
2.67 |
1.11 |
5.55 |
0.85 |
122 |
2.59,3.16 |
25.50** |
121 |
2.30 | |
|
Trauma |
3.31 |
1.33 |
5.54 |
0.83 |
122 |
1.93,2.56 |
18.04** |
121 |
1.63 | |
98.75 confidence interval calculated using Bonferroni adjusted alpha (0.05/4); ** p < 0.001
Fig. 1
Pre/post teaching shifts differential diagnosis paper-based case contrasts: Student A. (MSK musculoskeletal, MI myocardial infarction, resp respiratory, SOB shortness of breath, GI gastrointestinal, GERD gastroesophageal reflux disease, CAS[ACS] acute coronary syndrome, PE pulmonary embolus, pneumo pneumothorax)
Fig. 2
Pre/post teaching shifts differential diagnosis paper-based case contrasts: Student B. (MI myocardial infarction, PE pulmonary embolus, GERD gastroesophageal reflux disease)
