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Transition to practice: Evaluating the need for formal training in supervision and assessment among senior emergency medicine residents and new to practice emergency physicians

  • Sarah Kilbertus (a1), Kaif Pardhan (a2) (a3), Juveria Zaheer (a4) and Glen Bandiera (a1) (a5)
Abstract
Objectives

Emergency medicine residents may be transitioning to practice with minimal training on how to supervise and assess trainees. Our study sought to examine: 1) physician comfort with supervision and assessment, 2) what the current training gaps are within these competencies, and 3) what barriers or enablers might exist in implementing curricular improvements.

Methods

Qualitative data were collected in two phases through individual interviews from September 2016 to November 2017, at the University of Toronto and McMaster University after receiving ethics approval from both sites. Eligible participants were final year emergency medicine residents, residents pursuing an enhanced skills program in emergency medicine, and attendings within their first 3 years of practice. A semi-structured interview guide was developed and refined after phase one, to reflect content identified in the first set of interviews. All interviews were recorded, transcribed, coded, and collapsed into themes. Data analysis was guided by constructivist grounded theory.

Results

A thematic analysis revealed five themes: 1) Supervision and assessment skills were acquired passively through modelling, 2) the training available in these areas is variably used, creating a diversity of comfort levels, 3) competing priorities in the emergency department represent significant barriers to improving supervision and assessment; 4) providing negative feedback is difficult and often avoided; and 5) competence by design will act as an impetus for formal curriculum development in these areas.

Conclusions

As programs transition to competence by design, there will be a need for formal training in supervision and assessment, with a focus on negative feedback, to achieve a standardized level of competence among emergency physicians.

Objectifs

Les résidents en médecine d'urgence (MU) peuvent passer de la formation à la pratique en recevant une formation minimale dans la supervision et l’évaluation des stagiaires. Aussi l’étude visait-elle à examiner : a) le degré d'aisance des médecins à superviser et à évaluer des étudiants; b) les lacunes actuelles en matière de formation en ce qui concerne ces deux compétences; c) les obstacles à la mise en œuvre des améliorations à apporter au programme, ou encore les facteurs de facilitation.

Méthode

L’étude consistait en la collecte de données qualitatives faite en deux étapes, au cours d'entretiens individuels menés de septembre 2016 à novembre 2017, à l'Université de Toronto et à l'Université McMaster, après l'approbation du projet par les comités d’éthique des deux établissements. Étaient admissibles à l’étude les résidents en dernière année de formation en MU, les résidents poursuivant une formation avancée en MU et les médecins traitants en pratique depuis 3 ans ou moins. Un guide d'entretien semi-dirigé a d'abord été élaboré, puis amélioré après la première phase afin de mieux refléter les contenus relevés au cours de la première série d'entretiens. Ceux-ci ont tous été enregistrés, transcrits, codés et divisés en thèmes. L'analyse des données a été réalisée selon la théorie fondée sur le constructivisme.

Résultats

Se sont dégagés de l'analyse thématique cinq grands thèmes : l'acquisition passive des compétences en matière de supervision et d’évaluation à l'aide de modèles; la formation offerte dans ces compétences varie énormément, ce qui entraîne des écarts importants du degré d'aisance en la matière; les priorités concurrentes au service des urgences représentent une source importante d'obstacles à l'amélioration de la supervision et de l’évaluation; la difficulté à exprimer de mauvaises rétroactions se traduit souvent par une tendance à les éviter; et l'approche selon la compétence par conception imprimera une impulsion à l’élaboration d'un programme structuré dans ces deux domaines.

Conclusion

Comme les différents programmes passeront progressivement à la formule de la compétence par conception, la nécessité d'une formation structurée en matière de supervision et d’évaluation, notamment de mauvaises rétroactions, s'imposera d'elle-même, ce qui permettra aux urgentologues d'acquérir un degré comparable de compétences.

Copyright
Corresponding author
Correspondence to: Dr. Sarah Kilbertus, Department of Medicine, University of Toronto, 190 Elizabeth Street, R. Fraser Elliott Bldg. Rm. 3-805, Toronto, ON M5 G 2C4; Email: Skilb086@uottawa.ca
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Canadian Journal of Emergency Medicine
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  • EISSN: 1481-8035
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