Article review: SAEM Tests

This is is a great look back at how SAEM Tests were developed and now used by EM clerkships across the country. Because EM does not have a National Board of Medical Examiners shelf exam, a tremendous effort was made by the authors to create a set of validated questions for clerkship directors to use.

Specifically point serial correlation coefficients (range -1 to +1) were calculated for each question. A high coefficient means a high correlation between the performance on the individual test question and the performance on the overall test. After rewriting 25% of the test questions because of poor correlation coefficients, all current test questions now have a point serial correlation coefficient >0.2. (more…)

By Michelle Lin, MD|2016-11-11T18:43:23-08:00Mar 1, 2010|Education Articles, Medical Education|

Hot off the press: Free EM Practice articles

Thanks to EB Medicine, “Emergency Medicine Practice” articles from 2007 and earlier are now free! This series is a well-written and practical evidence-based review resource for EM physicians. It’s a great place to start reading about bread-and-butter EM content, especially for medical students and junior residents. There haven’t been too much change in the past 3 years on many of the topics.

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By Michelle Lin, MD|2016-11-11T19:01:34-08:00Feb 25, 2010|Medical Education|

Trick of the trade: Spicing up your evidence-based lecture

Before I start creating a new talk, I ask myself 3 questions:

Who will be in the audience?
How can I make my talk more worthwhile to audience members, beyond their just reading the material/handout/articles on their own?
Am I giving a talk before or after Dr. Amal Mattu? If so, just be resigned to being second-best.

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By Michelle Lin, MD|2019-02-19T18:55:41-08:00Feb 24, 2010|Medical Education, Tricks of the Trade|

Article review: Glidescope success in difficult airway simulation

Since our department got a Glidescope, it has rapidly become a go-to difficult airway adjunct when intubating patients in the ED. Note: I have no financial ties to Glidescope.

This education article Sim Healthcare is a head-to-head comparison between video laryngoscopy (VL) versus direct laryngoscopy (DL) in a difficult airway simulation model. In this prospective, convenience sample of EM attendings and residents who were all novice operators of VL, the subjects were asked intubate 3 types of mannequin scenarios using a Macintosh curve laryngoscope for DL and a Glidescope for VL.

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By Michelle Lin, MD|2016-11-11T19:01:37-08:00Feb 8, 2010|Education Articles, Medical Education|

Article review: Feedback in the Emergency Department

Feedback is important in teaching and learning.

I am constantly surprised by medical student and resident comments that they rarely receive feedback. In contrast, seemingly on every shift, I hear faculty giving little nuggets of feedback – during the oral presentation, during the resuscitation, after a difficult interaction, etc. There must be some disconnect.

This multi-institutional, survey-based, observational study at 17 EM residency programs asked attending physicians and residents about feedback in the ED. The primary outcome measure was overall satisfaction with feedback.

Results

The response rate was 71% for attendings (373/525) and 60% for residents (356/596). Side note: Survey studies are generally inconclusive if response rates are

There was a statistically significant difference between the feedback satisfaction scores (on scale of 1-10 with 10 being highest satisfaction).

Attending physicians: 5.97
Resident physicians: 5.29

Furthermore, when evaluating the quality of different aspects of feedback delivery, there were statistically significant differences in the satisfaction ratings between the attendings and residents. Overall, attendings felt more satisfied with feedback delivery on various topics than residents were.

Quality of positive feedback (50% attendings, 36% residents)
” of constructive feedback (29% attendings, 22% residents)
” of feedback re: procedural skills (48% attendings, 34% residents)
” of documentation (36% attendings, 28% residents)
” of ED flow management (29% attendings, 21% residents)
” of evidence-based decision making (28% attendings, 18% residents)

What is more interesting to me is the discrepancy between what the attendings and residents perceived in frequency of feedback. Specifically, 42% of attendings stated that feedback delivery was being done on every shift. Contrast this to only 7% of residents who felt the same. Why the disconnect? Is it purely misperception?

In re-reading this article, I wonder how this question was phrased though. Was it indeed perception or fact?

Let’s say there are usually 5 residents per attending shift, and the attending gives feedback every shift to at least 1 person. When surveyed, the attending would answer – “Yes, I give daily feedback”. In contrast, because there are multiple learners, residents may not have received daily feedback. By law of averages, residents would have received feedback every 5 shifts.

The data showing that 42% of attendings and 7% of residents were involved in feedback delivery every shift may actually be true (rather than pure perception). This illustrates the trickiness of designing and writing surveys.

Bottom Line

We should be working to improve positive and constructive feedback delivery in the Emergency Department, despite the various obstacles.

Reference
Yarris L, et al. Attending and resident satisfaction with feedback in the emergency department. Acad Emerg Med. 2009; 16:S76–S8.

Also see previous post on Failing at Feedback in Medical Education.

By Michelle Lin, MD|2016-11-25T15:43:29-08:00Jan 18, 2010|Education Articles, Medical Education|

Article review: Conference attendance ≠ better test scores

Not all learners should be expected to have the same learning style.

This is exemplified in a recent multicenter study, which addresses whether attendance at weekly residency conferences correlates with a better in-service training examination (ITE) score. The ITE score was used as an outcome measure, because it correlates with the resident’s likelihood for passing the official ABEM Board Exams. Both tests draw from questions in the Model of the Clinical Practice of Emergency Medicine.

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By Michelle Lin, MD|2019-02-19T18:59:55-08:00Jan 11, 2010|Medical Education|

Top 10 tips when making your rank list

“How do I decide how to order the residency programs on my rank list?”

On Feb 24, 2010, every residency applicant will have a brief moment of panic as their rank list is submitted and officially certified.

Next week, I’ll be joining a group podcast with Dr. Rob Rogers (Maryland) and Dr. Dave Manthey (Wake Forest) for the next installment of EMRAcast. This new podcast series was created by Rob for EMRA for the specific purpose of providing advice to medical students. I still find it fascinating how much you can get done virtually. We’ll all be using Skype from our respective offices and recording our conversation.

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By Michelle Lin, MD|2019-02-19T18:08:25-08:00Jan 5, 2010|Medical Education|