Can J Emerg Med
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ABSTRACTObjectives:To identify factors known prior to triage that might have predicted hospital admission for patients triaged by the Canadian Triage Acuity Scale (CTAS) as level 5 (CTAS 5, nonurgent) and to determine whether inappropriate triage occurred in the admitted CTAS 5 patients. Methods:We reviewed the triage records of patients triaged as CTAS 5 at the emergency departments (EDs) of three tertiary care hospitals between April 2002 and September 2009. Two triage nurses unaware of the study objective independently assigned the CTAS level in 20% of randomly selected CTAS 5 patients who were admitted. ⋯ Conclusions:Most of the CTAS 5 patients who were subsequently admitted to hospital may have qualified for a higher triage category. Two potential modifiers, age over 65 and arrival by ambulance, may have improved the prediction of admission in CTAS 5 patients. However, the consistent application of existing CTAS criteria may also be important to prevent incorrect triage.
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ABSTRACTObjectives:Cognitive forcing strategies (CFS) may reduce error arising from cognitive biases. This is the first experimental test to determine the effect of CFS training in medical students. Methods:Students were allocated to CFS training or control during a 4-week emergency medicine rotation (n = 191). ⋯ There were no significant differences between groups (χ2 = 2.38, df = 1, p = 0.12). In the AB cases, only 45% in each group identified the uncommon correct diagnosis (χ2 = 0.001, df = 1, p = 0.98). Conclusions:The educational interventions suggested by experts in clinical reasoning and employed in our study to teach CFS failed to show any reduction in diagnostic error by novices.
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ABSTRACTBackground: There is a question of whether a single assessment tool can assess the key competencies of residents as mandated by the Royal College of Physicians and Surgeons of Canada CanMEDS roles framework. Objective:The objective of the present study was to investigate the reliability and validity of an emergency medicine (EM) in-training evaluation report (ITER). Method:ITER data from 2009 to 2011 were combined for residents across the 5 years of the EM residency training program. ⋯ The factor solution accounted for 79% of the variance, and reliability coefficients (Cronbach alpha) ranged from α = 0.90 to 0.95 for each subscale and α = 0.97 overall. The combined, 24-item ITER used to assess residents' competencies in the EM residency program showed strong reliability and evidence of construct validity for assessment of the CanMEDS roles. Conclusion:Further research is needed to develop and test ITER items that will differentiate each CanMEDS role exclusively.
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ABSTRACTObjectives:The level of expertise and degree of training in neonatal resuscitation (NNR) of emergency physicians is not standardized and has not been measured. We sought to determine the self-reported comfort with, knowledge of, and experience with NNR of emergency department (ED) staff in a general ED prior to the opening of a new neonatal intensive care unit (NICU) and to explore factors associated with NNR comfort. Methods:Using Dillman methodology, we electronically surveyed full-time emergency physicians and nurses. ⋯ Conclusions:Perceived comfort with, knowledge of, and preparedness for NNR were poor in an urban, general ED prior to the opening of an NICU. Recent neonatal clinical encounter and participation in the NRP course were the strongest predictors of improved NNR comfort. In future work, we intend to assess the impact of simulation-based training on comfort with NNR among ED staff who primarily treat adults.
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ABSTRACTIntroduction:The Royal College of Physicians and Surgeons of Canada requires emergency medicine (EM) residency programs to meet training objectives relating to administration and leadership. The purpose of this study was to establish a national consensus on the competencies for inclusion in an EM administration and leadership curriculum. Methods:A modified Delphi process involving two iterative rounds of an electronic survey was used to achieve consensus on competencies for inclusion in an EM administration and leadership curriculum. ⋯ Fifty-nine of 109 (54.1%) competencies achieved consensus for inclusion. Conclusions:Based on a national modified Delphi process, we describe 59 competencies for inclusion in an EM administration and leadership curriculum that was arranged by CanMEDS Role. EM educators may consider these competencies when designing local curricula.