A comparison of Australasian and United States emergency medicine training programmes

Abstract Training in emergency medicine differs from country to country. This article compares the emergency medicine training programmes of Australasia and the United States of America. The perceived advantages of programmes are highlighted, but no attempt is made to determine which is the better programme. The Australasian programme is significantly longer and places greater emphasis on the basic clinical sciences, physical examination skills and academic output. Australasian College for Emergency Medicine regulations are relatively flexible, and allow trainees to design their own programmes. Australasian trainees are encouraged to arrange accredited positions in a variety of hospitals. Overseas and part-time training may be acceptable. In the US, trainees rotate within and from one parent institution which provides a rigid teaching structure for a ‘critical mass’ of trainees, based upon a core curriculum. Rotations tend to be much shorter than in the Australasian programme but ensure exposure to a broader range of clinical experience. In the US programme, evaluation of trainees and teaching faculty is more frequent and documentation of procedural and resuscitation skills is required. In addition, trainees are under the close supervision of the teaching faculty at all times when working in an emergency department.     

Interprofessional immersion: Use of interprofessional education collaborative competencies in side-by-side training of family medicine,pharmacy, nursing,and counselling psychology trainees

While supported by the Affordable Care Act, in the United States, interprofessional training often takes place after healthcare providers graduate and are practicing in the field. This article describes the implementation and evaluation of an interprofessional training for graduate-level healthcare trainees. A group of interprofessional healthcare faculty provided a weeklong interprofessional immersion for doctoral-level healthcare trainees (n = 24) in Pharmacy, Counselling Psychology, Nursing, and Family Medicine residents. Healthcare faculty and staff from each profession worked side-by-side to provide integrated training utilising the Interprofessional Education Collaborative core competency domains. Trainees were placed into small teams with representatives from each profession; each team observed, learned, and practiced working within teams to provide quality patient care. Qualitative and quantitative data were collected to identify the effect of the training on trainees’ self-reported team skills, as well as the extent to which the trainees learned and utilised the competencies. The results suggest that after completing the training, trainees felt more confident in their ability to work within an interprofessional team and more likely to utilise a team-based approach in the future.     

A survey to determine the prevalence and characteristics of training in Evidence-Based Medicine in emergency medicine residency programs

We conducted a survey to determine the prevalence, training methods, and allotment of time for teaching evidence-based medicine (EBM) skills within accredited Emergency Medicine (EM) residency programs in the United States. A survey was mailed to program directors of all 122 accredited Emergency Medicine residency programs. The survey was also sent to program directors using an e-mail listserv. Responses were obtained from 53% of programs; 80% (95% CI: 68-89) of EM programs reported teaching some EBM. Although respondents believed a median of 10 hours were required to adequately cover this topic, only 22% provided more than 5 hours per year. Sixtey-three percent (95% CI: 50-75) of respondents reported using the JAMA Users' Guides series in journal club and 83% reported efforts to link journal clubs to patient care. Perceived barriers to integrating EBM into teaching and patient care included lack of trained faculty, lack of time, lack of familiarity with EBM resources, insufficient funding, and lack of interested faculty. In summary, academic EM programs are attempting to train residents in EBM, but perceive a lack of trained faculty, time, and funding as barriers. Desired resources include a defined curriculum, on-line training for faculty, and defined strategies for integration of EBM into training and patient care.     

An alcoholism training program: its effect on trainees and faculty.

Evaluation of the effect of a three-year specialized training program in alcoholism on opinions and attitudes of trainees and faculty members at the University of Washington School of Nursing showed that the program influenced both trainees and faculty in a positive direction. Trainees were found to be more accepting of alcoholism as a disease and an increasing number of faculty believed alcoholism-related courses should be a part of the curriculum.     

Nursing information technology knowledge,skills, and preparation of student nurses,nursing faculty,and clinicians: a U.S. survey

Because health care delivery increasingly requires timely information for effective decision making, information technology must be integrated into nursing education curricula for all future nurse clinicians and educators. This article reports findings from an online survey of deans and directors of 266 baccalaureate and higher nursing programs in the United States. Approximately half of the programs reported requiring word processing and e-mail skill competency for students entering nursing undergraduate programs. Less than one third of the programs addressed the use of standardized languages or terminologies in nursing and telehealth applications of nursing. One third of the programs cited inclusion of evidence-based practice as part of graduate curricula. Program faculty, who were rated at the "novice" or "advanced beginner" level for teaching information technology content and using information technology tools, are teaching information literacy skills. The southeastern central and Pacific regions of the United States projected the greatest future need for information technology-prepared nurses. Implications for nurse educators and program directors are discussed.     

Audit as a learning tool in postgraduate emergency medicine training

Objective: Educational activities for emergency medicine trainees need to be clinically focused, relevant, and ideally have the capacity to change practice and patient outcomes. It is proposed that the use of audit methods in educational sessions may address these learning needs. The aims of this project were to involve emergency medicine trainees in undertaking audits of ED patient care, and to evaluate the use of this technique in fulfilling training needs. Methods: Trainees were given clinical topics on which to develop a presentation at weekly education sessions within the ED. This presentation included a brief clinical audit concerning an aspect of the same topic. The audit question addressed one of the issues identified as standard of care in the trainee presentation and investigated our department's level of compliance with that standard. At the end of a 6‐month period, a questionnaire was given to all trainees involved, either as presenters or attendees at an audit presentation. Results: Trainees performing audits reported that this method was most useful for demonstrating the limitations of coding, giving a greater appreciation of poor documentation in medical records, and improving their presentation skills. Most trainees attending audit based presentations reported that this educational method gave them a greater appreciation of systems based practice, actually changed their clinical practice, and was more useful than traditional lectures. Conclusions: Audit should be a key component of emergency medicine education. Trainees perceive the technique as useful addressing a number of training needs in a clinical context.     

The Stanford faculty development program: A dissemination approach to faculty development for medical teachers

The Stanford Faculty Development Program, designed to improve the instructional skills of clinical teachers, uses a dissemination model to provide faculty development activities for medical schools across the country. Selected clinical faculty attend a month‐long training program at Stanford University Medical Center and then return to their home institutions to conduct seminars for their fellow faculty and for residents in one of three content areas: (a) principles and skills of clinical teaching, (b) the teaching of medical decision making, or (c) the teaching of clinical preventive medicine. Faculty from institutions affiliated with over one quarter of U.S. medical schools have participated in the program. From 1986 through 1991, the program has trained 67 seminar facilitators from 47 institutions who have then conducted training for over 500 faculty and 200 residents. The extent of dissemination indicates that this approach provides a feasible mechanism for delivering faculty development in a wide variety of institutions.     

Designing and Implementing INTREPID,an Intensive Program in Translational Research Methodologies for New Investigators

Senior housestaff and junior faculty are often expected to perform clinical research, yet may not always have the requisite knowledge and skills to do so successfully. Formal degree programs provide such knowledge, but require a significant commitment of time and money. Short‐term training programs (days to weeks) provide alternative ways to accrue essential information and acquire fundamental methodological skills. Unfortunately, published information about short‐term programs is sparse. To encourage discussion and exchange of ideas regarding such programs, we here share our experience developing and implementing INtensive Training in Research Statistics, Ethics, and Protocol Informatics and Design (INTREPID), a 24‐day immersion training program in clinical research methodologies. Designing, planning, and offering INTREPID was feasible, and required significant faculty commitment, support personnel and infrastructure, as well as committed trainees.     

Computer vocations for severely physically disabled persons: survey results

Clients with physical disabilities were assessed for their computer skills and other characteristics related to computer vocations. Then a series of surveys were undertaken to determine availability of computer programming jobs for properly trained students, the best training program to suit these jobs, the equipment to train persons with disabilities, and the numbers of qualified applicants to warrant establishment of such a program. Results indicated that while programming is not a good job prospect, terminal operations appear promising, and occupations related to microcomputers warranted further study. The IBM Personal Computer was recommended, and a sufficient interest was demonstrated to establish the program for one year. Training programs in the United States provided a basis for establishment of the training course for trainees with disabilities.     

造口治疗师学校办学实践与思考

中山大学造口治疗师学校创办于2001年初,是中国内地第一所造口治疗师学校,也是国内第一个规范培养专科护士(CNS)的办学机构,至今已培养了4期共47名造口治疗师,学员来自全国16个省(市)共37家医院。文章根据该校的办学经验及学员学成后开展工作的情况,并结合国外CNS培养和使用的经验,对我国CNS的培养与使用提出几点思考与建议:学员的选择应为学历与专科工作经验并重;作为专科证书课程,课程设置必须符合一定的标准,教学内容强调专科针对性和纵深度,培养方式强调理论与实践相结合,重视专科护理实际工作能力的培养;高水平、多学科协作的师资队伍、高师生比和良好的实践教学基地是教学质量的保证;用人单位应设立CNS工作岗位,重视发挥CNS的作用和在岗继续培养。     

Pediatric Emergency Medicine Fellowships: Faculty and Resident Training Profiles

The objective of this study was to evaluate the faculty and graduate training profiles of Pediatric Emergency Medicine (PEM) fellowship training programs. An electronic 10-point questionnaire was sent to 57 PEM fellowship directors, with a 70% response rate. Analysis of the individual certification of faculty members in PEM training programs demonstrated that the largest represented training types were general pediatricians and pediatricians with PEM sub-certification (29% and 62% representation, respectively). The remaining faculty types consistently showed < 5% overall involvement. Reported estimates on faculty delivery of clinical training, didactic training, and procedural skills demonstrated that pediatricians sub-board certified in PEM consistently administered the highest percentage of these skill sets (74%, 68%, and 68%, respectively). Emergency Medicine-trained physicians showed a relative increase of involvement in fellowship programs administered by Emergency Medicine departments and in those programs located within adult hospitals. Yet, this involvement still remained substantially lower than that of the pediatric-type faculty. Program directors of fellowships within pediatric hospitals and those administered by Pediatric programs demonstrated a preference for general pediatricians with sub-board certification in PEM to improve their faculty pools. Program directors of fellowship programs located in adult hospitals and those administered by departments of EM demonstrated no preference in training type. Lastly, program directors report that 95% of past graduates received their primary board certification through Pediatrics and only 5% received their primary board certification through Emergency Medicine. There are currently many more pediatric-trained physicians among PEM fellowship faculty and graduates. This survey has demonstrated that there has been a decline in EM-trained physicians involved in PEM fellowships since 2000.     

Preferences for teaching methods in a baccalaureate nursing program: how second-degree and traditional students differ

Accelerated baccalaureate nursing programs are in great demand in the United States. Currently there are 197 such programs, but little research has been conducted on student characteristics and program outcomes. This quantitative study explores preferences of second-degree students and traditional generic students with regard to teaching methods and relationships with faculty. The results indicate that statistically significant differences exist between the two groups of students. Three areas of significance are ability for self-directed learning, expectations of faculty and classroom structure, and obtaining a grade that really matters.     

Mentoring in Clinical‐Translational Research: A Study of Participants in Master's Degree Programs

Research projects in translational science are increasingly complex and require interdisciplinary collaborations. In the context of training translational researchers, this suggests that multiple mentors may be needed in different content areas. This study explored mentoring structure as it relates to perceived mentoring effectiveness and other characteristics of master''s‐level trainees in clinical‐translational research training programs. A cross‐sectional online survey of recent graduates of clinical research master''s program was conducted. Of 73 surveys distributed, 56.2% (n = 41) complete responses were analyzed. Trainees were overwhelmingly positive about participation in their master''s programs and the impact it had on their professional development. Overall the majority (≥75%) of trainees perceived they had effective mentoring in terms of developing skills needed for conducting clinical‐translational research. Fewer trainees perceived effective mentoring in career development and work‐life balance. In all 15 areas of mentoring effectiveness assessed, higher rates of perceived mentor effectiveness was seen among trainees with ≥2 mentors compared to those with solo mentoring (SM). In addition, trainees with ≥2 mentors perceived having effective mentoring in more mentoring aspects (median: 14.0; IQR: 12.0–15.0) than trainees with SM (median: 10.5; IQR: 8.0–14.5). Results from this survey suggest having ≥2 mentors may be beneficial in fulfilling trainee expectations for mentoring in clinical‐translational training.     

Accident and emergency training perspectives in Scotland

Objective

To determine the perspectives of Scottish accident and emergency (A&E) trainees and trainers on current training in the speciality, in order to help develop a simulator based training programme to complement existing training.

Methods

Questionnaires were sent to all Scottish A&E trainees and consultants responsible for training. They were presented with various clinical challenges. Trainees were asked to rate their confidence, experience, knowledge, and training on a Likert scale of 1 to 5. Trainers were asked to identify those areas where they felt trainees'' performance consistently failed to meet a desired standard, and whether this was the result of lack of training, lack of exposure, or both.

Results

Trainees'' response rate was 75%; consultants'' was 59.4%. Overall trainees gave scores of 4/5 for confidence and knowledge, 3/5 for experience, and 2/5 for training. The highest scores were for medical, anaesthetics, and interpersonal skills. Consultants attributed lack of exposure to underperformance more frequently than lack of training.

Conclusions

Trainees and trainers agree on the level of exposure to various clinical challenges, but disagree on training. Trainees'' levels of confidence and knowledge outweigh their experience and training, suggesting that trainees associate knowledge with clinical competence.     

Proposed Curriculum for an "Observational" International Emergency Medicine Fellowship Program

This article presents information on considerations involved in setting up and conducting fellowship training programs in emergency medicine (EM) for physicians from other countries. General goals for these programs are to assist in providing physicians from other countries with the knowledge and skills needed to further develop EM in their home countries. The authors report their opinions, based on their cumulative extensive experiences, on the necessary and optional structural elements to consider for international EM fellowship programs. Because of U.S. medical licensing restrictions, much of the proposed programs' content would be "observational" rather than involving direct "hands-on" clinical EM training. Due to the very recent initiation of these programs in the United States, there has not yet been reported any scientific evaluation of their structure or efficacy. International EM fellowship programs involving mainly observational EM experience can serve as one method to assist in EM development in other countries. Future studies should assess the impact and efficacy of these programs.     

Procedural skills quality assurance among Australasian College for Emergency Medicine fellows and trainees

Objective: Presently, no objective quality control mechanism exists for monitoring procedural skills among Australasian College for Emergency Medicine trainees. The present study examined trainee and fellow procedural experience and perceived competency, participation in accredited training courses and support for a procedural logbook. Methods: A cross‐sectional mail survey of Australasian College for Emergency Medicine advanced trainees and fellows was performed. Experience and perceived competency in 23 common and important ED procedures were examined. Results: In total, 202 fellows and 264 trainees responded (overall response rate 39.0%). Overall, fellow procedural experience and perceived competency were reasonable. However, some fellows had never performed a number of procedures including some common procedures (e.g. nasal packing, fracture reduction) and there were reports of ‘very poor’ competency for 17 (73.9%) procedures. Trainee experience and perceived competency were less than the fellows but showed similar patterns. Perceived numbers of each procedure required to achieve competency varied considerably between the procedures and among the respondents. However, there were no significant differences in the perceived numbers reported by the trainees and the fellows (P > 0.05). Variable proportions of trainees and fellows had undertaken courses that incorporated procedural skills training. More fellows (75.7%, 95% confidence interval 69.1–81.4) than trainees (59.9%, 95% confidence interval 53.6–65.8) supported the use of a procedural logbook (P = 0.003). Conclusions: Lack of experience in some procedures among some fellows, especially commonly performed procedures, might represent a deficiency in existing quality assurance mechanisms for procedural skills training. Greater participation in skills courses, to improve experience in difficult and uncommonly encountered procedures, is recommended. Improved quality assurance mechanisms, including a procedural logbook, should be considered.     

The effect of medication management training on community mental health nurse's clinical skills

Background. There is evidence that compliance therapy improves treatment adherence and clinical outcomes in patients with schizophrenia. Community Mental Health Nurses (CMHNs) are ideally placed to deliver compliance therapy but require training to develop the necessary clinical skills.Aim. To explore whether a brief medication management training package is effective in developing the compliance therapy skills of CMHNs.Method. The study had a within subjects repeated measures design. A representative sample of 52 CMHNs entered the study. They performed a role-play task pre- and post-training that was videotaped and blind rated by an independent rater using the Cognitive Therapy Scale (CTS). Knowledge was assessed pre- and post-training using a knowledge about medication management questionnaire. Trainees also completed a satisfaction with training questionnaire at the end of the course.Results. Following training there was a statistically significant improvement in mean scores on the primary measure of skills, the CTS (mean pre-training CTS-total score 13.88, mean post-training CTS-total score 31.12; p<0.01). There was also a significant categorical improvement in the number of trainees who demonstrated satisfactory skills. Knowledge about medication management was significantly improved and trainees reported that training was acceptable and relevant to their clinical practice.Conclusions. In this uncontrolled study training improved the medication management skills of CMHNs.     

Baccalaureate nursing faculty performance of nursing computer literacy skills and curriculum integration of these skills through teaching practice.

This article describes a cross-sectional survey research study designed to collect data from nurse educators regarding their self-reported competence in the performance of 60 nursing computer literacy skills, as well as self-reported levels of integration of these skills, through teaching practice, into the curricula of their respective baccalaureate nursing programs. Data were received from 184 respondents representing 18 publicly funded, National League for Nursing-accredited, college and university generic baccalaureate degree programs in the New England region of the United States. Study findings revealed that 21 of the 60 skills were being performed "well" or "very well" as reported by 50% or more of respondents, while in the area of curriculum integration through teaching practice, only 3 of the 60 skills were being integrated into teaching practice either "moderately" or "extensively" as reported by 50% or more of respondents. Another major finding of this research study strongly suggested that faculty who have the ability to perform requisite nursing computer literacy skills comfortably are more likely to integrate these skills into the curriculum through their teaching practices (r = .76; p<.01). This article concludes with a discussion of the implications of the study findings for nursing education.