Training our prevocational doctors

Enhancing intern emergency medicine education using a combined didactic and web-based learning curriculum: The EDGE programme

OBJECTIVE

To assess the effectiveness of an education programme that integrates web-based learning into classroom sessions.

METHODS

This prospective study involved a convenience sample of ED interns rotating at two study site hospitals between April 2015 and January 2017. Interns undertook weekly ED classroom-based education and were given access to a web-based learning resource with completion being voluntary. To assess change in medical knowledge multiple choice examinations were administered during week 1 and week 10 of the term. The study's primary end-point was the effect of the web-based resource on participants' knowledge. The median % of online modules completed by participants (75%) was used as a cut-off to create two groups. The % improvement between the test scores at week 1 and week 10 of each group were then compared. Intern satisfaction with the programme was also assessed using a satisfaction survey.

RESULTS

The average examination score for all participants was significantly higher at week 10 than week 1 (80% vs 68%; P < 0.001). The primary end-point, % improvement between the week 1 and week 10 scores of those that completed ≤75% of web-based modules (mean 16%; 95% CI 12-20%) and those that completed >75% of web-based modules (mean 27%; 95% CI 20-34%), showed a statistically significant difference (P = 0.03). Interns surveyed were also highly satisfied with programme.

CONCLUSIONS

This blended curriculum that integrates a web-based resource into classroom learning shows promise in enhancing intern emergency medicine education.

Mini-CEX as a workplace-based assessment tool for interns in an emergency department--does cost outweigh value?

BACKGROUND

The mini-clinical evaluation exercise (mini-CEX) has been proposed as a method to address the deficiencies of in-training assessment for junior doctors.

AIM

Our study aimed to determine the feasibility and value of adding mini-CEX assessments to the existing assessment processes for an intern cohort in the emergency department (ED).

METHODS

Interns undertook four mini-CEX assessments with senior ED medical officers, in addition to their standard in-training assessment processes. Assessment results and time taken to perform the mini-CEX assessments were recorded. Interns and assessors completed a survey regarding their perceptions of the mini-CEX assessment process.

RESULTS

The total time taken for mini-CEX assessments during the study period was 36.51 h. If extrapolated over a year this would represent an additional direct cost to the ED of more than $A 80,000 per year. No additional interns were identified as underperforming through the addition of the mini-CEX. The mini-CEX assessment process was perceived as generally positive. Both interns and assessors felt that it provided a valid assessment of intern performance, and enabled timely and specific feedback. Significant practical difficulties in arranging and conducting mini-CEX assessments in the workplace were identified.

CONCLUSION

There was a significant cost to the ED as a result of adding mini-CEX encounters to interns' performance assessment. No change in summative outcome occurred for this study cohort.