The Eight Cs: a guide to success in an international emergency medicine educational collaboration

Effective teaching and feedback skills for international emergency medicine "train the trainers" programs

BACKGROUND

As the specialty of Emergency Medicine (EM) develops around the world, it has become common for practitioners from countries with mature EM systems to assist those in regions with developing systems. One effective and frequently used model is "train the trainers," in which a group of consultant teachers instructs a cadre of clinicians in the host region to then become the future teachers of EM in that area. This model has the advantage of overcoming cultural barriers to instruction and can lead to providing a lasting training infrastructure in the region. A key to a successful program is the use of effective and culturally appropriate teaching and feedback skills.

OBJECTIVES

The goal of this article is to bring together experts in adult education with experts in training in the international setting to present teaching and feedback skills and how they can be applied in different settings and cultures.

DISCUSSION

Cutting edge instruction and evaluation techniques that can be employed in intercultural "train the trainers" programs will be presented. The characteristics of successful programs, using specifics from actual programs, will also be shared.

CONCLUSION

Applying the described teaching and evaluation skills with modifications based on local culture will help empower newly trained teachers who will contribute in turn to the longevity of EM in the region and set a high teaching standard that will benefit generations of future colleagues.

Descriptive analysis of a bilingual and cross-cultural introductory ultrasound course facilitated by simultaneous translation

Study objective

The increasing use of focused ultrasonography by non-specialists emphasizes the need for standardized trainings. We analyze physicians’ skill acquisition after the implementation of an ultrasound introductory course. As part of an international educational collaboration, we also investigate the impact on training efficiency of language and cultural differences.

Methods

We organized a 2-day training for emergency physicians. Lectures were given in French with simultaneous Chinese translation. At the end of the training, physicians were asked to conduct, on healthy live models, a complete ultrasound examination including 11 images and two procedures (cardiac, abdominal, vascular and bone ultrasonography). Quality was assessed by two independent observers and a 60-s time limit per view/procedure was set. Ultrasound examination was successful only if both quality and length objectives were achieved.

Results

Seventeen attending emergency physicians participated in the study. None withdrew from the training. The overall success rate of image and procedure acquisition was 97.3% (364 out of 374). Six physicians had failed cases and mainly on cardiac examination (eight failures out of ten). Failure rate for the complete sequence (1 or more failure out of the 11 images/procedure) was 24% (8/34). Median time to capture a single image was 13 s (5–24), while the whole examination took 182 s (141–238) excluding time for probe change.

Conclusion

A 2-day introductory course on focused ultrasonography leads to very good skill acquisition. Language and cultural differences do not seem to alter training efficiency.

Characterizing emergency departments to improve understanding of emergency care systems

International emergency medicine aims to understand different systems of emergency care across the globe. To date, however, international emergency medicine lacks common descriptors that can encompass the wide variety of emergency care systems in different countries. The frequent use of general, system-wide indicators (e.g. the status of emergency medicine as a medical specialty or the presence of emergency medicine training programs) does not account for the diverse methods that contribute to the delivery of emergency care both within and between countries. Such indicators suggest that a uniform approach to the development and structure of emergency care is both feasible and desirable. One solution to this complex problem is to shift the focus of international studies away from system-wide characteristics of emergency care. We propose such an alternative methodology, in which studies would examine emergency department-specific characteristics to inventory the various methods by which emergency care is delivered. Such characteristics include: emergency department location, layout, time period open to patients, and patient type served. There are many more ways to describe emergency departments, but these characteristics are particularly suited to describe with common terms a wide range of sites. When combined, these four characteristics give a concise but detailed picture of how emergency care is delivered at a specific emergency department. This approach embraces the diversity of emergency care as well as the variety of individual emergency departments that deliver it, while still allowing for the aggregation of broad similarities that might help characterize a system of emergency care.

Learner perception of oral and written examinations in an international medical training program

Background

There are an increasing number of training programs in emergency medicine involving different countries or cultures. Many examination types, both oral and written, have been validated as useful assessment tools around the world; but learner perception of their use in the setting of cross-cultural training programs has not been described.

Aims

The goal of this study was to evaluate learner perception of four common examination methods in an international educational curriculum in emergency medicine.

Methods

Twenty-four physicians in a cross-cultural training program were surveyed to determine learner perception of four different examination methods: structured oral case simulations, multiple-choice tests, semi-structured oral examinations, and essay tests. We also describe techniques used and barriers faced.

Results

There was a 100% response rate. Learners reported that all testing methods were useful in measuring knowledge and clinical ability and should be used for accreditation and future training programs. They rated oral examinations as significantly more useful than written in measuring clinical abilities (p < 0.01). Compared to the other three types of examinations, learners ranked oral case simulations as the most useful examination method for assessing learners’ fund of knowledge and clinical ability (p < 0.01).

Conclusions

Physician learners in a cross-cultural, international training program perceive all four written and oral examination methods as useful, but rate structured oral case simulations as the most useful method for assessing fund of knowledge and clinical ability.

Electronic supplementary material

The online version of this article (doi:10.1007/s12245-009-0147-2) contains supplementary material, which is available to authorized users.

International emergency medicine: a review of the literature from 2008

As the specialty of emergency medicine (EM) continues to evolve in countries around the world, and as interest in international emergency medicine (IEM) continues to grow within the United States, the IEM Literature Review Group recognizes a need for a high-quality, consolidated, and easily accessible evidence base of literature. In response to that need, the group created an annual publication that strives to provide readers with access to the highest quality and most relevant IEM research. This publication represents our fourth annual review, covering the top 26 IEM research articles published in 2008. Articles were selected for the review according to explicit, predetermined criteria that include both methodologic quality and perceived impact of the research. It is our hope that this annual review will act as a forum for disseminating best practices while also stimulating further research in the field of IEM.