Background: There are different teaching methods; such as traditional lectures, bedside teach- ing, and workshops for clinical medical clerkships. Each method has advantages and disadvan- tages in different situations. EmergencyMedicine (EM) focuses on emergencymedical conditions and deals with several emergency procedures. This study aimed to compare traditional teaching methods with teaching methods involving workshops in the EM setting for medical students. Methods: Fifth year medical students (academic year of 2010) at Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand participated in the study. Half of students received traditional teaching, including lectures and bedside teaching, while the other half received traditional teaching plus three workshops, namely, airway workshop, trauma workshop, and emergencymedical services workshop. Student evaluations at the end of the clerkship were recorded. The evaluation form included overall satisfaction, satisfaction in overall teaching methods, and satisfaction in each teaching method.
While certain statistical analysis has been done on courses conducted in other countries, it has usually examined the acquisition of practical skills and knowledge by the use of pre and post tests on short-term and long-term skills [7–10]. Statistics looked at educational parameters, pre- and post-test scores and analyzed the program effectiveness by p values. The emergencymedicine literature does not describe an on-going process that would examine how international programs could be dynamically modified to maximize the transfer of knowledge and practices among international medical communities, al- though several of the adaptive principles have been recommended by researchers in the past [11, 12].
It has been discussed that teaching and learning through medical errors induces an emotional impact on the student; the use of simulation may help by learning from near misses and others’ errors . Evaluating malpractice cases and learning how to avert them, is a feasible approach for improving the standards in health care. Thus, common medical errors could be eliminated. The Lsim program has the capability to instantly evalu- ate the students’ medical approaches by performing on- line examinations. Through this program, students can realistically order all laboratory and radiological tests re- quired, evaluate the test results and radiologic images, plan the medical approach, and provide adequate treat- ment to the patient such as in a real life scenario.
The study has drawn attention to a few aspects of the institute that need to be revised in order to pro- vide a better student-centred educational atmosphere. The problematic aspects can be tackled by introdu- cing a curriculum that included problem-based learn- ing, structured bedside clinical teaching with the specific objective of mentoring students by faculties on a day-to-day basis, (like daily discussions, morn- ing meetings), so that students feel more free in ex- pressing their problems and things are tackled in a better way.
Lack of formal training in medical documentation con- tinues into various residency programs. Many residents felt that their documentation skills were inadequate . A survey of pediatric residents showed that residents val- ued billing and coding skills, but they did not have ad- equate knowledge . This sentiment is echoed across specialties including general surgery, family medicine and EM [19–21]. EM residents reported that the most com- mon teaching method in medical documentation was informal teaching even though they found that formal feedback was the most helpful strategy . We suggest that formal feedback could be given by the billing depart- ment, or medical students’ and residents’ charts could be sampled for review semi-annually or quarterly to minimize workload for teaching physicians. In addition, EM residents listed a lack of time as the greatest factor to limit proper education in documentation and coding strategies . Residency programs could arrange the training courses prior to the official training year i.e. during resident boot camps. Many residency programs offer intern boot camps, but the course mainly focuses on procedures and simulated patient encounters. The training content should cover the current billing guidelines and emphasize the necessity of completing review of systems, physical exam; and past medical, family, social history.
The body of validity evidence supporting simulation as a performance-based environment for assessment is con- stantly growing . There is evidence that simulation-based learning and assessment are effective in increasing medical expert knowledge , procedural skills [7, 8], learner confi- dence for real-life practice, discriminating the novice from expert learner , and improving patient outcomes [4, 10]. Activity patterns of physicians in clinical scenarios have been shown to be similar in both the simulated and real en- vironment , and acute care team performance in both settings has been shown to be similar as well . Further- more, there is evidence that simulation-based assessment outcomes correlate with residents’ scores on oral examina- tions  and portfolio-based assessment scores of medical expert and communication domains on in-training evalu- ation reports . What is missing is an understanding of the relationship between simulation performance and workplace-based clinical competence in more multifarious tasks such as resuscitation. There is a paucity of research in this area, with most studies focused on procedural tasks with limitations of small and biased sampling of subjects, incomplete reporting of methodology, and limited applic- ability outside of a particular simulation model or technical skill [15–18].
The literature search identified critical procedures and critical care management items [1, 2, 4, 5], which matched with PEM specific EPA ’s. All eight participants completed the learner needs assessment survey prior to participating in the curriculum. Several recurring needs such as procedural, CRM skills, and medical/trauma management of core PEM processes were discovered (Sample shown in Fig. 1). Open-ended survey ques- tions, in-service exam scores of the eight participants and the informal discussions did not add additional needs. The analysis process focused the curriculum into two general categories:  Procedural/task skills and  CRM/teamwork skills, with the goal of integrating both categories as often as possible.
Examinations are reviewed and evaluated on a regular basis as part of the overall QA and improvement program at each institution. The purpose of the QA process is to evaluate for maintenance of a minimum standard quality of image acquisition and accurate interpretation. An integral component to point-of-care US is the identiﬁcation of a person (or people) who will be responsible for ongoing monitoring and QA. This may consist of the US director or an equivalent person with requisite knowledge and experience. Assistance in this capacity may be obtained from physicians with requisite US experience who work outside the pediatric ED (eg, critical care, general emergencymedicine, radiology).
Transitions of care (ToCs), also referred to as handoffs or sign-outs, occur when the responsibility for a patient’s care transfers from 1 health care provider to another. Transitions are common in the acute care setting and have been noted to be vulnerable events with opportunities for error. Health care is taking ideas from other high-risk industries, such as aerospace and nuclear power, to create models of structured transition processes. Although little literature currently exists to establish 1 model as superior, multiorganizational consensus groups agree that standardization is warranted and that additional work is needed to establish characteristics of ToCs that are associated with clinical or practice outcomes. The rationale for structuring ToCs, speciﬁ cally those related to the care of children in the emergency setting, and a description of identiﬁ ed strategies are presented, along with resources for educating health care providers on ToCs. Recommendations for development, education, and implementation of transition models are included.
The KSA has reached nearly 100 years of providing healthcare to its people. However, the healthcare system in the KSA only reached modern standards of quality in the early 2000s. For the past 10+ years, the healthcare system has rapidly improved, reaching the level of qual- ity achieved by many healthcare systems in the West. In the coming years, an increasing emphasis on primary care is expected to begin to ameliorate the common problem of EDs being treated as the gateway to the hos- pital. Moreover, promising trends in the development of simulation-based education, improvements in residency programs and curricula, and diversification of healthcare providers indicate that the rapid progress experience over the course of the last decade is poised to continue for the next decade and beyond. Roadmaps like the National Transformation Plan 2020 and the Saudi Vision 2030 have also begun to pave the way for future devel- opments. It is now the task of Saudi EM physicians and healthcare policymakers to conduct practical research and implement data-drive, evidence-based policies, and procedures to continue to guide efforts to move towards a more preventive and primary care healthcare model.
This study aimed to evaluate the success of implementa- tion of the South African Triage Scale in KNH by (1) assessing the reliability of triage decisions by triage pro- viders following an educational intervention and (2) ana- lyzing the validity of the SATS at KNH’s A&E, comparing prior triage practice with the newly imple- mented triage protocol. Further, this project serves to address one of the four foundational challenges of acute care in sub-Saharan Africa, as outlined by consensus from the African Federation for EmergencyMedicine (AFEM), which is that “healthcare facilities often lack an in- tegrated approach to triage, resuscitation, and stabilization of acutely ill patients.”  To our knowledge, there is no published literature on the implementation of the SATS in Kenya or any public, tertiary A&E department with this high patient volume.
Introduced by Cruess et al., P-MEX measures four areas of professionalism skills: doctor-patient relationship, reflective skills, time management, and inter- professional relationship skills (6). The necessity to reevaluate professionalism assessment scales before application in a new country has been emphasized due to cultural and contextual differences (7,8). For instance, Tsugawa modified the instrument so that it could be applied to Japanese medical students (9,10). Unfortunately, no observational instrument has been validated for the assessment of the professionalism of emergencymedicine (EM) residents (11,12). Working as a resident in the EM department is more stressful compared to other departments due to the unique features of this ward, e.g. heavy workload, uncontrolled environment, and an unlimited number of
By-person factor analysis, or Q-methodology, avoids many of the limitations of other modalities by allowing the grouping of participants based on their subjective responses to an issue while preventing investigator pre- conceptions from influencing the grouping structure. In a letter to Nature in 1935, physicist and psychologist Wil- liam Stephenson introduced by-person factor analysis as a means for the scientific study of subjectivity . The methodology uses a unique combination of qualitative and quantitative methods to subdivide a study popula- tion, evaluate the degree of consensus among the partici- pants, and identify any discordant opinions. The process begins by creating a concourse, or collection, of opinions and perceptions toward the subject of interest – in this case, emergencymedicine in Serbia. From this concourse, the investigators develop statements representing the spectrum of opinion and request that respondents assign each statement to a position within a quasi-normal grid distribution as to whether they completely disagree with,
Tanzania’s health care system is provided in a pyramidal system beginning with dispensaries at the lowest level, which refers patients to health centers, and then district hospitals, and regional and tertiary referral hospitals. There is a variable level of emergency care capacity with no EM specialists or formal full-capacity emergency departments (EDs) except for MNH which has a full capacity EMD . Until the inception of emergencymedicine, hospitals in Tanzania, like many low- and middle-income countries (LMICs) have handled emergencies through designated acute areas (commonly referred as casualty). These are out- patient departments (OPDs), usually minimally equipped and staffed with HCPs with no or little emergency care training. They largely channel patients to wards, theaters, and clinics and provide little or no emergency stabilization. As a result, EM graduates from Muhimbili practicing out- side of MNH have encountered many challenges in their
This is a descriptive study and is thus limited in its scope. The small number of study hospitals limits the generalizability of the conclusions of this study. The characteristics of each site may not represent the typical OU for that country. There is also a systematic bias in the data, as all institutions are tertiary care and teaching hospitals, which is not typical of an average hospital and patient population throughout their respective countries. Furthermore, the study collected a snapshot of data at the time of survey administration and patient data was aggregated to means. In addition, OU directors self- reported OU data, which are not publically available and thus we are unable to verify their accuracy. Due to the small number of study hospitals (n = 6), we were unable
Our multi-disciplinary group team of surgeons, nurses, pharmacists, scientists, emergency physicians, and geriatricians have started to study medication rec- onciliation in trauma because we have recognized the demographic changes in the USA leading to increasing rates of elderly trauma patients who tend to be on multiple medications at baseline. This, coupled with the increasing availability of medications such as dir- ect anticoagulants, which cannot be clinically detected at this time, makes accurate medication reconciliation in trauma vital and any errors, potentially high risk. In this systematic review, all four articles demonstrated poor accuracy of medication reconciliation in the trauma setting — 4% accuracy  and high discrepancy rate . Congruence of anticoagulant medication lists determined by EMS or hospital providers was also low , and
Project HOPE was evolving their volunteer platform within the organization to begin integrating HOPE vol- unteers into existing programs. Emergency physicians had rotated at another Ghanaian hospital and, in a trip report, had expressed their observed need for systems changes that were not possible with short-term rotations as they did not allow adequate time for the volunteers to understand Ghanaian culture, the way the department was run, or to develop a level of trust with emergency department (ED) staff and management. Most import- antly, these other hospitals were functioning not as true emergency departments with emergency physicians and nurses but rather as acute medical and surgical wards. This setup did not allow for the introduction of emer- gency medicine processes. Out of leadership interest at Project HOPE and a desire to integrate into ongoing, sustainable programs, through which the needed systems changes were more likely, a partnership with GEMC be- came attractive.
Though residents were satisfied with their training program overall, there are various areas for improve- ment. Our most remarkable finding was that even though residents thought that the curriculum was too short, they nonetheless expected to be able to function effectively in their future roles as EPs. It is not yet known whether they will maintain this view once they have started as EPs. Future research should examine whether international comparisons of either emergencymedicine alone or residents ’ perspectives on it are possible. We in- tend to adjust our questionnaire and examine how emer- gency physicians assess their own performance. It is essential for subsequent research to explore whether Dutch EPs meet international standards.
Results: The survey was sent to the leadership of 15 EMRPs in 12 different African countries and 11 (73%) responded. Five (46%) of the responding programs were started by local non-EM trained faculty, two (18%) were started by international partners, and the remainder by a combination of local non-EM faculty and international partners. Overall, Seven (64%) of the countries offer a 4-year EMRP. In General, 40% of curriculums are influenced the contents developed by African Federation for EmergencyMedicine. All programs offer resident led-didactics, with a median of 12 h (Interquartile range 9 – 6 h) per month. All EMRPs have a mandatory research requirement. All EMRPs offer clinical rotations in the ED, Paediatrics, and Obstetrics and Gynaecology, while only 2 programs offer rotations in radiology and neonatal intensive care units. Only 46% of EMRPs have in-ED clinical supervision by specialist.