Introduction: Physicians dedicate substantial time to documentation. Scribes are sometimes used to improve efficiency by performing documentation tasks, although their impacts have not been prospectively evaluated. Our objective was to assess a scribe program's impact on emergency department (ED) throughput, physician time utilization, and job satisfaction in a large academic emergency medicine practice. Methods: We evaluated the intervention using pre-and post-intervention surveys and administrative data. All site physicians were included. Pre-and post-intervention data were collected in fourmonth periods one year apart. Primary outcomes included changes in monthly average ED length of stay (LOS), provider-specific average relative value units (RVUs) per hour (raw and normalized to volume), self-reported estimates of time spent teaching, self-reported estimates of time spent documenting, and job satisfaction. We analyzed data using descriptive statistics and appropriate tests for paired pre-post differences in continuous, categorical, and ranked variables. Results: Pre-and post-survey response rates were 76.1% and 69.0%, respectively. Most responded positively to the intervention, although 9.5% reported negative impressions. There was a 36% reduction (25%-50%; p<0.01) in time spent documenting and a 30% increase (11%-46%, p<0.01) in time spent in direct patient contact. No statistically significant changes were seen in job satisfaction or perception of time spent teaching. ED volume increased by 88 patients per day (32-146, p=0.04) pre-to post-and LOS was unchanged; rates of patients leaving against medical advice dropped, and rates of patients leaving without being seen increased. RVUs per hour increased 5.5% and per patient 5.3%; both were statistically significant. No statistically significant changes were seen in patients seen per hour. There was moderate correlation between changes in ED volume and changes in productivity metrics. Conclusion: Scribes were well received in our practice. Documentation time was substantially reduced and redirected primarily to patient care. Despite an ED volume increase, LOS was maintained, with fewer patients leaving against medical advice but more leaving without being seen. RVUs per hour and per patient both increased.
INTRODUCTION: In 2015, with a stated goal of disseminating best teaching practices and developing a community of educational scholars, the Council of Emergency Medicine Directors (CORD) and the Clerkship Directors of Emergency Medicine (CDEM) created an annual Special Issue in Educational Research and Practice (Special Issue) in cooperation with the Western Journal of Emergency Medicine. The intention of this study was to analyze the impact of this effort to date. METHODS: Bibliometric data was gathered on all four special issues, 2015-2019, from the Web of Science and then verified with the eScholarship website. Authorship, academic affiliation, date published, article type, and format were tabulated for descriptive analysis. Using metrics from Google Scholar, alternative scholarly impact metrics (altmetrics), and the eScholarship website, the authors identified top articles and grouped them into themes. RESULTS: Of the 136 articles included in the first four years of the Special Issue, 126 represented peer-reviewed publications with an overall acceptance rate of 25.0% (126/505). Authors from this cohort represented 103 of the 182 (56.6%) Accreditation Council for Graduate Medical Education (ACGME) programs in existence at the time of the inaugural issue. Multi-institutional studies represented 34.9% (44/126) of the peer-reviewed publications. Traditional and alternative publication metrics are reported to assess the impact of articles from the Special Issues. CONCLUSION: The Special Issue is a proven outlet to share best practices, innovations, and research related to education. Additionally, the infrastructure of this process promotes the development of individual faculty and a community of teaching scholars.
Background: Physician educators directing medical student programs face increasingly more complex challenges to ensure students receive appropriate preparation to care for patients. The Alliance for Clinical Education (ACE) defined expectations of and for clerkship directors in 2003. Since then, much has changed in medical education and health care. Methods: ACE conducted a panel discussion at the 2016 Association of American Medical Colleges Learn Serve Lead conference, soliciting input on these expectations and the changing roles of clerkship directors. Using workshops as a cross-sectional study design, participants reacted to roles and responsibilities of clerkship directors identified in the literature using an audience response system and completing worksheets. Results: The participants represented different disciplines of medicine and ranged from clerkship directors to deans of curriculum. Essential clerkship director qualifications identified by participants included: enthusiasm, experience teaching, and clinical expertise. Essential tasks included grading and assessment and attention to accreditation standards. Participants felt clerkship directors need adequate resources, including budget oversight, full-time clerkship support, and dedicated time to be the clerkship director. To whom clerkship directors report was mixed. Clerkship directors look to their chair for career advice, and they also report to the dean to ensure educational standards are being met. Expectations to meet accreditation standards and provide exemplary educational experiences can be difficult to achieve if clerkship directors’ time and resources are limited. Conclusions: Participant responses indicated the need for a strong partnership between department chairs and the dean’s office so that clerkship directors can fulfill their responsibilities. Our results indicate a need to ensure clerkship directors have the time and resources necessary to manage clinical medical student education in an increasingly complex health care environment. Further studies need to be conducted to obtain more precise data on the true amount of time they are given to do that role.
Introduction: Interprofessional communication failures are estimated to be a factor in two-thirds of serious health care-related accidents. Using a standardized communication protocol during transfer of patient information between providers improves patient safety. An interprofessional education (IPE) event for first-year health professions students was designed using the Situation, Background, Assessment, Recommendation (SBAR) tool as a structured communication framework. IPE literature, including a valid measurement tool specifically tailored for SBAR, was utilized to design the Interprofessional Team Training Day (ITTD) and evaluate learner gains in SBAR skills. Methods: Learners from six educational programs participated in ITTD, which consisted of didactics, small-group discussion, and role-play using the SBAR protocol. Individual learners were assessed using the SBAR Brief Assessment Rubric for Learner Assessment (SBAR-LA) on SBAR communication skills before and after the ITTD event. Learners received a written clinical vignette and submitted video recordings of themselves simulating the use of SBAR to communicate to another health care professional. Pre- and postrecordings were scored using the SBAR-LA rubric. Normalized gain scores were calculated to estimate the improvement attributable to ITTD. Results: SBAR-LA scores increased for 60% of participants. For skills not demonstrated before the event, the average learner acquired 44% of those skills from ITTD. Learners demonstrated statistically significant increases for five of 10 SBAR-LA skills. Discussion: The value to patient safety of utilizing structured communication between health care providers is proven; however, evaluating IPE teaching of communication skills effectiveness is challenging. Using SBAR-LA, communication skills were shown to improve following ITTD.
Introduction
Structured communication tools are associated with improvement in information transfer and lead to improved patient safety. Situation, Background, Assessment, Recommendation (SBAR) is one such tool. Because there is a paucity of instruments to measure SBAR effectiveness, we developed and validated an assessment tool for use with prepractice health professions students.
Methods
We developed the SBAR Brief Assessment Rubric for Learner Assessment (SBAR-LA) by starting with a preliminary list of items based on the SBAR framework. During an interprofessional team training event, students were trained in the use of SBAR. Subsequently, they were assigned to perform a simulated communication scenario demonstrating use of SBAR principles. We used 10 videos from these scenarios to refine the items and scales over two rounds. Finally, we applied the instrument on another subset of 10 students to conduct rater calibration and measure interrater reliability.
Results
We used a total of 20 out of 225 videos of student performance to create the 10-item instrument. Interrater reliability was .672, and for eight items, the Fleiss’ kappa was considered good or fair.
Discussion
We developed a scoring rubric for teaching SBAR communication that met criteria for validity and demonstrated adequate interrater reliability. Our development process provided evidence of validity for the content, construct, and response process used. Additional evidence from the use of SBAR-LA in settings where communication skills can be directly observed, such as simulation and clinical environments, may further enhance the instrument's accuracy. The SBAR-LA is a valid and reliable instrument to assess student performance.
Introduction Recent findings suggest that process and outcome-based efficacy beliefs are factorially distinct with differential effects for team performance. This study extends this work by examining process and outcome efficacy (TPE, TOE) of interprofessional (IP) care teams over time. Methods A within-team, repeated measures design with survey methodology was implemented in a sample of prelicensure IP care teams performing over three consecutive clinical simulation scenarios. TPE and TOE were assessed before and after each performance episode. Results Initial baseline results replicated the discriminant validity for TPE and TOE separate factors. Further findings from multilevel modelling indicated significant time effects for TPE convergence, but not TOE convergence. However, a cross-level interaction effect of € TOE (Start-Mean) ×Time' strengthened TOE convergence over time. A final follow-up analysis of team agreement's substantive impact was conducted using independent faculty-observer ratings of teams' final simulation. Conclusion Independent sample t-tests of high/low-agreement teams indicated support for agreement's substantive impact, such that high-agreement teams were rated as significantly better performers than low-agreement teams during the final simulation training. We discuss the substantive merit of methodological within-team agreement as an indicator of team functionality within IP and greater healthcare-simulation trainings at-large.
Introduction The setting demands imposed by performing in new, interdisciplinary cultures is common for modern healthcare workers. Both health science students and evidence-based workers are required to operate in professional cultures that differ from their own. As health organisations have placed increasing value on mindfulness for improving performance outcomes, so too have educational administrators embraced common, mindful competencies for improving training for improved patient outcomes. The training of future clinicians for diversified care. teams and patient populations has become known as interprofessional education (IPE). Although the goals for IPE suggest that individual differences in trait mindfulness may serve an important determinant for training effectiveness, it has gone unstudied in extant simulation training research. MethodsTo fill this gap, in this paper, we examine trait mindfulness' predictive power for training outcomes across two IPE cohort samples using two, prospective observational designs. Results Study 1's Findings supported trait mindfulness' prediction of perceived teamwork behaviours in training simulations between medical and nursing students (n=136). In study 2's expanded sample to five health professions (n=232), findings extended trait mindfulness' prediction of team efficacy and skill transfer, assessed 1 month after training. Conclusion A final, follow-up assessment 16 months later extended mindfulness' predictive validity to knowledge retention and teamwork attitudes. We discuss the theoretical and practical implication of our findings for advancing mindfulness research and IPE effectiveness assessment.
INTRODUCTION: The emergency medicine clerkship director serves an important role in the education of medical students. The authors sought to update the demographic and academic profile of the emergency medicine clerkship director.METHODS: We developed and implemented a comprehensive questionnaire, and used it to survey all emergency medicine clerkship directors at United States allopathic medical schools accredited by the Liaison Committee on Medical Education. We analyzed and interpreted data using descriptive statistics.RESULTS: One hundred seven of 133 (80.4%) emergency medicine clerkship directors completed the survey. Clerkship Director's mean age was 39.7 years (SD-7.2), they were more commonly male 68.2%, of Caucasian racial backgrounds and at the instructor or assistant professor (71.3%) level. The mean number of years of experience as clerkship director was 5.5 (SD-4.5). The mean amount of protected time for clerkship administration reported by respondents was 7.3 hours weekly (SD-5.1), with the majority (53.8%) reporting 6 or more hours of protected time per week. However, 32.7% of emergency medicine clerkship directors reported not having any protected time for clerkship administration. Most clerkship directors (91.6%) held additional teaching responsibilities beyond their clerkship and many were involved in educational research (49.5%). The majority (79.8%), reported being somewhat or very satisfied with their job as clerkship director.CONCLUSION: Most clerkship directors were junior faculty at the instructor or assistant professor rank and were involved with a variety of educational endeavors beyond the clerkship.
OBJECTIVE: To use 360-degree evaluations within an Observed Structured Clinical Examination (OSCE) to assess medical student comfort level and communication skills with intimate partner violence (IPV) patients. METHODS: We assessed a cohort of fourth year medical students' performance using an IPV standardized patient (SP) encounter in an OSCE. Blinded pre- and post-tests determined the students' knowledge and comfort level with core IPV assessment. Students, SPs and investigators completed a 360-degree evaluation that focused on each student's communication and competency skills. We computed frequencies, means and correlations. RESULTS: Forty-one students participated in the SP exercise during three separate evaluation periods. Results noted insignificant increase in students' comfort level pre-test (2.7) and post-test (2.9). Although 88% of students screened for IPV and 98% asked about the injury, only 39% asked about verbal abuse, 17% asked if the patient had a safety plan, and 13% communicated to the patient that IPV is illegal. Using Likert scoring on the competency and overall evaluation (1, very poor and 5, very good), the mean score for each evaluator was 4.1 (competency) and 3.7 (overall). The correlations between trainee comfort level and the specific competencies of patient care, communication skill and professionalism were positive and significant (p<0.05). CONCLUSION: Students felt somewhat comfortable caring for patients with IPV. OSCEs with SPs can be used to assess student competencies in caring for patients with IPV.