Schnapp, Benjamin

Introduction: Emergency medicine (EM) residents take the American Board of Emergency Medicine (ABEM) In-Training Examination (ITE) every year. This examination is based on the ABEM Model of Clinical Practice (Model). The purpose of this study was to determine whether a relationship exists between the number of patient encounters a resident sees within a specific clinical domain and their ITE performance on questions that are related to that domain. Methods: Chief complaint data for each patient encounter was taken from the electronic health record for EM residents graduating in three consecutive years between 2016-2021. We excluded patient encounters without an assigned resident or a listed chief complaint. Chief complaints were then categorized into one of 20 domains based on the 2016 Model. We calculated correlations between the total number of encounters seen by a resident for all clinical years and their ITE performance for the corresponding clinical domain from their third year of training. Results: Available for analysis were a total of 232,625 patient encounters and 69 eligible residents who treated the patients. We found no statistically significant correlations following Bonferroni correction for multiple analyses. Conclusion: There was no correlation between the number of patient encounters a resident has within a clinical domain and their ITE performance on questions corresponding to that domain. This suggests the need for separate but parallel educational missions to achieve success in both the clinical environment and standardized testing.

AbstractBackgroundEntrustable professional activities (EPAs) are a new tool for assessing learners that represents a significant movement in graduate medical education (GME) toward competency‐based assessment and serves as a bridge between milestones and clinical practice. Whenever a major change is implemented to any system, resistance to change is expected. Many change management models have been proposed to overcome this resistance; a newer model is outlined in the book Switch. The objective was to describe the change management principles used to institute an EPA.MethodsThe model introduced in Switch was used as a framework for implementing a trauma resuscitation EPA in a joint effort between the departments of surgery and emergency medicine (EM) at the University of Wisconsin Hospitals and Clinics. The Department of Emergency Medicine used the principles of change management, completing 295 faculty evaluations of trauma resuscitations compared to the Department of Surgery, whose faculty completed 50 evaluations between the study period of July 2018 through October 2019. A survey completed winter 2019 of EM faculty was used to determine the most important principles toward successful implementation.ResultsTwenty‐seven of 35 (78% response rate) of EM faculty identified key concepts from Switch as being instrumental in the successful implementation. Internal discussion of the implementation approach used by the Department of Surgery identified several limitations that would have been overcome by using these same change management principles.ConclusionWe conclude that the principles of change management provide a useful framework for successfully implementing EPAs into GME.