- Email: [email protected]
78 A Novel Teaching Model: Intubation in a Simulated Angioedema Airway Using a Fresh Frozen Cadaver
Research Forum Abstracts flow or influenced people to visit the emergency department (ED) at our freestanding pediatric hospital. Methods: A phone survey was conducted following the announcement of school closures. The following eight days of the pediatric emergency department census data were used to select our survey population. Those with chief complaints that were consistent with media reports of Ebola symptoms (fever, headache, abdominal pain, etc) were selected as possible contacts. The potential subjects were then randomly selected to receive a phone call within seven days of their visit. Each participant was asked to answer five questions regarding the recent Ebola news and if that news influenced their decision to visit the emergency department. Results: A total of 730 patients visited the emergency department over the eight-day period. Of those visits, 228 (31.2%) met our inclusion criteria and 140 of those were randomly selected to receive phone calls. Overall, 81 surveys were completed. Of those contacted 77 (95.1%) had heard about the Ebola case in Texas prior to their visit. Only 64 (79.0%) had heard of the local exposure and 73 (90.1%) had heard about the school closures. Ultimately, 10 (12.3%) of those surveyed stated that the recent news influenced their decision to come to the emergency department. The most common sources of Ebola information were TV or Internet news agency 43 (53.1%), school newsletter 19 (23.5%), social media 15 (18.5%), radio, and word of mouth 1 patient each (1.2%). Two subjects (2.5%) had no source of information. Conclusions: Emergency medicine lore states that during times of perceived public health crises, visits to the ED greatly increase. We found this not to be the case in this instance. Although the majority of those surveyed were aware of the concern for Ebola exposure in the community, only a few people stated that it affected their decision to visit the ED. Institutionalized sources (news agencies, school bulletins) provided the majority of the information to our patients. Our study only highlights one high-profile event, and further study is needed to better describe this phenomenon.
76
Patterns of Pediatric Injury in the Setting of Armed Conflict: Results of a Randomized Cluster Survey in Baghdad, Iraq
Carlson LC, Lafta R, Esa Al Shatari SA, Stewart BT, Burnham G, Kushner AL/Brigham and Women’s Hospital and Massachusetts General Hospital, Boston, MA; Al Munstansiriya University, Baghdad, Iraq; Human Resources Development and Training Center, Iraq Ministry of Health, Baghdad, Iraq; University of Washington, Seattle, WA; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Surgeons OverSeas, New York, NY
Study Objectives: Injury accounts for over 11% of the total global burden of disease. This burden is greatest in low- and middle-income countries, where over 90% of deaths due to injury occur. In Iraq, this risk has been further compounded by ongoing conflict and violence since 2003. Children in such settings are particularly vulnerable, yet the epidemiology of pediatric injury during conflict has not been adequately assessed. This study aimed to characterize the pattern and outcomes of pediatric injury in Baghdad, Iraq from 2003 to 2014. Methods: Between March and June 2014, we conducted a cluster randomized, cross-sectional, community-based survey in Baghdad to determine the epidemiology and impact of injuries occurring among children (ie, under 18 years of age) between 2003 and 2014. Incidence, prevalence, hospitalization, procedures required and mortality were described. This study was approved by the University of Baghdad and the Iraqi Ministry of Health. Results: A total of 900 households representing 5,148 persons were surveyed. There were 152 reported pediatric injuries. Within this group, the mean age at the time of injury was 8.48 years (SD: 5.07) and 114 were male (75%). The most common cause of injury was falls (34%), and the majority of injuries occurred at home (45%). Road traffic injuries (RTIs) accounted for 22% of injuries; 65% (22 of 34 RTIs) were pedestrian injuries. Fifteen percent of injuries were conflict related, primarily due to gunshots (7; 32% of conflict-related injuries), shells fragments (32%) and explosives (18%). Conflict-related injuries most often occurred amongst individuals 13 to 18 years of age (15 of 22 conflict-related injuries). There were 11 reported deaths out of the 152 pediatric injuries (7%). Additionally, 59% of reported injuries required surgical care and 24% were hospitalized. Mean length of stay was 2.4 weeks (SD: 6.34). Conclusion: While traditional injury surveillance systems breakdown during times of armed conflict, this descriptive analysis provides novel insight into the patterns of pediatric injury amid insecurity. Conflict was responsible for one in
Volume 66, no. 4s : October 2015
six pediatric injuries during this time; however, falls and RTIs remained the most common causes of childhood injury. The need for surgical and hospitalbased care was substantial, highlighting the need for strengthened surgical and acute care services in low- and middle-income countries, particularly those affected by conflict. Furthermore, the proportion of pediatric injuries resulting in death detected here was far higher than those reported in previous studies in low- and middle-income countries unaffected by conflict, typically less than 12%. This finding warrants further empiric investigation and reflects the need for bolstered efforts to prevent and intervene upon pediatric injury in times of conflict. Pattern of pediatric injury by mechanism and age Age 0 - 3 (n [ 34) Fall Road traffic injury Mechanical Poisoning Electrical injury Conflict-related Others
77
15 4 4 2 0 3 6
(44.1%) (11.8%) (11.8%) (5.88%) (0%) (8.82%) (17.6%)
Age 4 - 8 (n [ 43) 16 12 4 1 0 2 8
(37.2%) (27.9%) (9.30%) (2.32%) (0%) (4.65%) (18.6%)
Age 9 - 12 (n [ 29)
Age 13 - 18 (n [ 46)
11 5 2 0 1 2 8
10 13 2 0 1 15 5
(37.9%) (17.2%) (6.90%) (0%) (3.45%) (6.90%) (27.6%)
(21.7%) (28.3%) (4.35%) (0%) (2.17%) (32.6%) (10.9%)
Perceived Retaliatory Evaluations of Faculty by Learners and Their Effect on the Culture of Feedback
Vora S, Williams S, De Boer K, Monrad S, Kamin C, Harris I/University of Illinois at Chicago, Chicago, IL; Stanford School of Medicine, Stanford, CA; University of California, San Francisco, San Francisco, CA; University of Michigan, Ann Arbor, MI
Study Objectives: Faculty feedback plays a critical role in the education of medical learners. The reverse, evaluation of faculty by learners, has become an important consideration for academic promotion, with the potentially significant repercussions. There is scant literature on perceived retaliatory evaluations of faculty by medical learners. Our study explores this issue and its impact on the bi-directional culture of feedback. Methods: A mixed-methods survey study was conducted with a purposive sample of faculty and learners from a wide range of institutions, specialties, and career stages. Open-ended question responses were analyzed to identify themes, using an inductive approach of constant comparative analysis associated with grounded theory. Trustworthiness was achieved by involving multiple coders and by including data from diverse specialties, career stages, and geographical regions. Structured question data were analyzed with descriptive statistics. Results: Twenty-three respondents represented 10 specialties from institutions from Canada and across the US. 76% were faculty, holding a range of leadership positions. 47% reported they or a colleague had received an evaluation perceived to be in retaliation for “negative feedback.” 50% indicated this perception made them or their colleagues less likely to give constructive feedback to learners. Three major themes focused on perceptions of retaliatory feedback were identified (with multiple subthemes): attributes of the learner, (eg, perceived motivations), teacher, (eg, emotional reaction), and the evaluation itself (eg, tone). Conclusion: Our study suggests the specter of perceived retaliatory evaluations has a major impact on faculty’s willingness to give constructive feedback. This threatens to undermine the culture of feedback necessary for effective medical education.
78
A Novel Teaching Model: Intubation in a Simulated Angioedema Airway Using a Fresh Frozen Cadaver
Walsh RM, Bothwell JD/Madigan Army Medical Center, Tacoma, WA
Background: The difficult airway is a common and challenging scenario in emergency medicine (EM). As educators, we are charged with preparing EM residents for successfully intubating patients with even the most troublesome anatomy. This situation is frequently encountered during the intubation of patients with severe angioedema. Fortunately, these patients are uncommon in the emergency department (ED). As a result, however, it is difficult to ensure each EM
Annals of Emergency Medicine S27
Research Forum Abstracts resident is well trained in this intubation scenario prior to graduation. There are mannequins that allow for tongue swelling; however, it has been shown that cadaver training is more realistic. Study Objective: Our primary objective was to develop an angioedema teaching model to increase resident knowledge, confidence, and proficiency at intubating in this clinical setting. Methods: The angioedema model was implemented at our annual fresh frozen cadaver course. We found that angioedema can be easily simulated by injecting the lips, tongue, and larynx. Through trial and error and a multitude of different attempts including different needle sizes and injection materials, our most practical model came from the insufflation of air bilaterally near the sublingual glands. Using a 22 gauge spinal needle and a 60 cc syringe, we were able to easily cause realistic distention of the lips, tongue, and pharynx when we injected approximately 300ml of air. Leaking still occurred, but re-insufflation was rapidly performed anytime deflation was detected, and the leaking did not fill the airways with liquid unlike our saline and agave models. Participants performed both direct and video laryngoscopy on the simulated angioedema cadaver. At the conclusion of their intubation experience, participants completed a survey describing their impression of the angioedema model. Conclusion: Participants included 5 board-certified EM faculty and 29 EM residents, with participants from all year groups. In response to the statement, “The angioedema model was high fidelity,” 12 residents strongly agreed, while the remaining 17 respondents agreed. In response to the statement, “The angioedema model was a good training model for angioedema,” 13 residents strongly agreed, while the remaining 16 respondents agreed. None of the participants answered strongly disagree, disagree, or neutral to either question. When solicited for comments on the model one participant wrote, “Awesome opportunity, I will be markedly less terrified when I get an angioedema/anaphylaxis case.” As educators, we are always looking for more realistic training models for our residents. Because angioedema requiring intubation is an uncommon phenomenon, many residents will never encounter this scenario during their training. We have developed a simple angioedema training model using air insufflation in a fresh frozen cadaver. Our participants uniformly expressed positive impressions of both the fidelity and training quality of this model. Other EM residencies are encouraged to use this model in their own programs to facilitate training of the difficult airway in the angioedema patient.
79
Computer-Based Format Facilitates the Provision of Feedback During Mini-CEX Assessments in the Emergency Department
Chaou C-H, Chang Y-C, Chen C-K, Chen C-H, Lee C-H, Ng C-J, Chen J-C/Chang-Gung Memorial Hospital and Chang-Gung University, Taoyuan, Taiwan
Background: Mini-CEX is widely used in the clinical education system. Receiving appropriate feedback during mini-CEX assessments promotes the identification of strengths and weaknesses within trainees’ clinical competencies, which is crucial for effective learning. Our objective is to analyse the effect of digitalization on feedback provisions during mini-CEX assessments. Study Objective: This is a retrospective analysis of the documented feedback provided by assessors using mini-CEX in an emergency department (ED). The participants were post-graduate year-one (PGY1) doctors who were scheduled to undergo four mini-CEX assessments during their ED rotations. During the study period, the format was shifted from paper-based to computer-based according to the policy of the hospital management level. The contents were exactly the same between these two formats. The frequency of use and the word count for each feedback component (anything especially good, suggestions for development, and an agreed plan of action) were analysed. Results: A total of 899 mini-CEX assessments were collected and analyzed. The completion rate of all three feedback components (strengths, suggestions for development, and an agreed action plan) were 19.0 percent and 28.3 percent when using a paper-based format and a computer-based format, respectively (Table 1). The feedback-facilitating effect of the computer-based format was uneven among junior and senior emergency physicians (Table 2). In addition, the feedback completion showed a primacy effect that the assessors tend to provide the first one or two feedback components in a busy ED setting (Figure). Conclusion: A computer-based format facilitates the completion of the feedback, especially on the part of junior assessors.
S28 Annals of Emergency Medicine
Table 1. Demographics and comparison of mini-CEX components by different formats.
Mean age of patients% Senior doctor (>10 years) Observation time (min)% Feedback time (min)% Clinical Domains measured§ Medical interview Physical examination Technical skills Counselling skills Clinical judgment 600 (99.3)
878 (97.7) 877 (97.6)
803 (89.3) 536 (59.6) 299 (33.3)
803 (89.3) 536 (59.6) 299 (33.3)
Paper format (n[295)
Computer format (n[604)
P-value
Total (n[899)
55.1 20.3
54.3 19.3
0.583
54.5 19.5
9.46 4.9
7.80 4.6
<.001*
8.34 4.7
14.0 6.4
14.8 8.6
0.140
14.5 8.0
10.5 6.7
11.1 5.0
0.169
10.9 5.6
294 (99.7)
603 (99.8)
0.549
897 (99.8)
291 (98.6)
600 (99.4)
0.450
891 (99.1)
144 (48.8) 265 (89.8)
72 (11.9) 533 (88.3)
0.580
Efficiency / Organized Professionalism Word counts for each component% Anything especially good Suggestions for development Agreed action plan Feedback components used§ Anything especially good Suggestions for development Agreed action plan All three aspects of feedback provided§
<.001* 216 (24.0) 0.480 798 (88.8) 292 (98.9) 892 (99.2) 199 (98.5) 0.403 279 (94.6) 599 (99.2) <.001* 277 (93.9) 600 (99.3)
<.001*
11.4 7.3
<.001*
9.0 6.6
11.0 6.2 10.6 7.6
0.504
9.2 5.1 12.8 8.9
<.001*
263 (89.2) 540 (89.4)
0.910
168 (57.0) 368 (60.9)
0.254
83 (28.1) 56 (19.0)
0.023* 0.003*
216 (35.8) 171 (28.3)
227 (25.3) §
Data presented as number (%). Data presented as mean SD. * Statistically significant.
%
Table 2. The subgroup analysis of feedback using computer-based format miniCEX, stratified by seniority of 10 years.
Mini-CEX time (in minutes)* Observation time Feedback time The frequency of each component utilized for feedback§ Anything especially good Suggestions for development Agreed action plan All three aspects of feedback provided§
Junior EPs
Senior EPs
N[418
N[186
P value
14.9 9.6 11.6 5.2
14.4 5.7 9.93 4.4
0.347 <0.001
375 (89.7) 289 (69.1) 170 (40.7) 155 (37.1)
165 (88.7) 79 (42.5) 46 (24.7) 16 (8.60)
0.712 <0.001 <0.001 <0.001
*Data presented as mean SD. § Data presented as number (%).
Volume 66, no. 4s : October 2015
76
Patterns of Pediatric Injury in the Setting of Armed Conflict: Results of a Randomized Cluster Survey in Baghdad, Iraq
Carlson LC, Lafta R, Esa Al Shatari SA, Stewart BT, Burnham G, Kushner AL/Brigham and Women’s Hospital and Massachusetts General Hospital, Boston, MA; Al Munstansiriya University, Baghdad, Iraq; Human Resources Development and Training Center, Iraq Ministry of Health, Baghdad, Iraq; University of Washington, Seattle, WA; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Surgeons OverSeas, New York, NY
Study Objectives: Injury accounts for over 11% of the total global burden of disease. This burden is greatest in low- and middle-income countries, where over 90% of deaths due to injury occur. In Iraq, this risk has been further compounded by ongoing conflict and violence since 2003. Children in such settings are particularly vulnerable, yet the epidemiology of pediatric injury during conflict has not been adequately assessed. This study aimed to characterize the pattern and outcomes of pediatric injury in Baghdad, Iraq from 2003 to 2014. Methods: Between March and June 2014, we conducted a cluster randomized, cross-sectional, community-based survey in Baghdad to determine the epidemiology and impact of injuries occurring among children (ie, under 18 years of age) between 2003 and 2014. Incidence, prevalence, hospitalization, procedures required and mortality were described. This study was approved by the University of Baghdad and the Iraqi Ministry of Health. Results: A total of 900 households representing 5,148 persons were surveyed. There were 152 reported pediatric injuries. Within this group, the mean age at the time of injury was 8.48 years (SD: 5.07) and 114 were male (75%). The most common cause of injury was falls (34%), and the majority of injuries occurred at home (45%). Road traffic injuries (RTIs) accounted for 22% of injuries; 65% (22 of 34 RTIs) were pedestrian injuries. Fifteen percent of injuries were conflict related, primarily due to gunshots (7; 32% of conflict-related injuries), shells fragments (32%) and explosives (18%). Conflict-related injuries most often occurred amongst individuals 13 to 18 years of age (15 of 22 conflict-related injuries). There were 11 reported deaths out of the 152 pediatric injuries (7%). Additionally, 59% of reported injuries required surgical care and 24% were hospitalized. Mean length of stay was 2.4 weeks (SD: 6.34). Conclusion: While traditional injury surveillance systems breakdown during times of armed conflict, this descriptive analysis provides novel insight into the patterns of pediatric injury amid insecurity. Conflict was responsible for one in
Volume 66, no. 4s : October 2015
six pediatric injuries during this time; however, falls and RTIs remained the most common causes of childhood injury. The need for surgical and hospitalbased care was substantial, highlighting the need for strengthened surgical and acute care services in low- and middle-income countries, particularly those affected by conflict. Furthermore, the proportion of pediatric injuries resulting in death detected here was far higher than those reported in previous studies in low- and middle-income countries unaffected by conflict, typically less than 12%. This finding warrants further empiric investigation and reflects the need for bolstered efforts to prevent and intervene upon pediatric injury in times of conflict. Pattern of pediatric injury by mechanism and age Age 0 - 3 (n [ 34) Fall Road traffic injury Mechanical Poisoning Electrical injury Conflict-related Others
77
15 4 4 2 0 3 6
(44.1%) (11.8%) (11.8%) (5.88%) (0%) (8.82%) (17.6%)
Age 4 - 8 (n [ 43) 16 12 4 1 0 2 8
(37.2%) (27.9%) (9.30%) (2.32%) (0%) (4.65%) (18.6%)
Age 9 - 12 (n [ 29)
Age 13 - 18 (n [ 46)
11 5 2 0 1 2 8
10 13 2 0 1 15 5
(37.9%) (17.2%) (6.90%) (0%) (3.45%) (6.90%) (27.6%)
(21.7%) (28.3%) (4.35%) (0%) (2.17%) (32.6%) (10.9%)
Perceived Retaliatory Evaluations of Faculty by Learners and Their Effect on the Culture of Feedback
Vora S, Williams S, De Boer K, Monrad S, Kamin C, Harris I/University of Illinois at Chicago, Chicago, IL; Stanford School of Medicine, Stanford, CA; University of California, San Francisco, San Francisco, CA; University of Michigan, Ann Arbor, MI
Study Objectives: Faculty feedback plays a critical role in the education of medical learners. The reverse, evaluation of faculty by learners, has become an important consideration for academic promotion, with the potentially significant repercussions. There is scant literature on perceived retaliatory evaluations of faculty by medical learners. Our study explores this issue and its impact on the bi-directional culture of feedback. Methods: A mixed-methods survey study was conducted with a purposive sample of faculty and learners from a wide range of institutions, specialties, and career stages. Open-ended question responses were analyzed to identify themes, using an inductive approach of constant comparative analysis associated with grounded theory. Trustworthiness was achieved by involving multiple coders and by including data from diverse specialties, career stages, and geographical regions. Structured question data were analyzed with descriptive statistics. Results: Twenty-three respondents represented 10 specialties from institutions from Canada and across the US. 76% were faculty, holding a range of leadership positions. 47% reported they or a colleague had received an evaluation perceived to be in retaliation for “negative feedback.” 50% indicated this perception made them or their colleagues less likely to give constructive feedback to learners. Three major themes focused on perceptions of retaliatory feedback were identified (with multiple subthemes): attributes of the learner, (eg, perceived motivations), teacher, (eg, emotional reaction), and the evaluation itself (eg, tone). Conclusion: Our study suggests the specter of perceived retaliatory evaluations has a major impact on faculty’s willingness to give constructive feedback. This threatens to undermine the culture of feedback necessary for effective medical education.
78
A Novel Teaching Model: Intubation in a Simulated Angioedema Airway Using a Fresh Frozen Cadaver
Walsh RM, Bothwell JD/Madigan Army Medical Center, Tacoma, WA
Background: The difficult airway is a common and challenging scenario in emergency medicine (EM). As educators, we are charged with preparing EM residents for successfully intubating patients with even the most troublesome anatomy. This situation is frequently encountered during the intubation of patients with severe angioedema. Fortunately, these patients are uncommon in the emergency department (ED). As a result, however, it is difficult to ensure each EM
Annals of Emergency Medicine S27
Research Forum Abstracts resident is well trained in this intubation scenario prior to graduation. There are mannequins that allow for tongue swelling; however, it has been shown that cadaver training is more realistic. Study Objective: Our primary objective was to develop an angioedema teaching model to increase resident knowledge, confidence, and proficiency at intubating in this clinical setting. Methods: The angioedema model was implemented at our annual fresh frozen cadaver course. We found that angioedema can be easily simulated by injecting the lips, tongue, and larynx. Through trial and error and a multitude of different attempts including different needle sizes and injection materials, our most practical model came from the insufflation of air bilaterally near the sublingual glands. Using a 22 gauge spinal needle and a 60 cc syringe, we were able to easily cause realistic distention of the lips, tongue, and pharynx when we injected approximately 300ml of air. Leaking still occurred, but re-insufflation was rapidly performed anytime deflation was detected, and the leaking did not fill the airways with liquid unlike our saline and agave models. Participants performed both direct and video laryngoscopy on the simulated angioedema cadaver. At the conclusion of their intubation experience, participants completed a survey describing their impression of the angioedema model. Conclusion: Participants included 5 board-certified EM faculty and 29 EM residents, with participants from all year groups. In response to the statement, “The angioedema model was high fidelity,” 12 residents strongly agreed, while the remaining 17 respondents agreed. In response to the statement, “The angioedema model was a good training model for angioedema,” 13 residents strongly agreed, while the remaining 16 respondents agreed. None of the participants answered strongly disagree, disagree, or neutral to either question. When solicited for comments on the model one participant wrote, “Awesome opportunity, I will be markedly less terrified when I get an angioedema/anaphylaxis case.” As educators, we are always looking for more realistic training models for our residents. Because angioedema requiring intubation is an uncommon phenomenon, many residents will never encounter this scenario during their training. We have developed a simple angioedema training model using air insufflation in a fresh frozen cadaver. Our participants uniformly expressed positive impressions of both the fidelity and training quality of this model. Other EM residencies are encouraged to use this model in their own programs to facilitate training of the difficult airway in the angioedema patient.
79
Computer-Based Format Facilitates the Provision of Feedback During Mini-CEX Assessments in the Emergency Department
Chaou C-H, Chang Y-C, Chen C-K, Chen C-H, Lee C-H, Ng C-J, Chen J-C/Chang-Gung Memorial Hospital and Chang-Gung University, Taoyuan, Taiwan
Background: Mini-CEX is widely used in the clinical education system. Receiving appropriate feedback during mini-CEX assessments promotes the identification of strengths and weaknesses within trainees’ clinical competencies, which is crucial for effective learning. Our objective is to analyse the effect of digitalization on feedback provisions during mini-CEX assessments. Study Objective: This is a retrospective analysis of the documented feedback provided by assessors using mini-CEX in an emergency department (ED). The participants were post-graduate year-one (PGY1) doctors who were scheduled to undergo four mini-CEX assessments during their ED rotations. During the study period, the format was shifted from paper-based to computer-based according to the policy of the hospital management level. The contents were exactly the same between these two formats. The frequency of use and the word count for each feedback component (anything especially good, suggestions for development, and an agreed plan of action) were analysed. Results: A total of 899 mini-CEX assessments were collected and analyzed. The completion rate of all three feedback components (strengths, suggestions for development, and an agreed action plan) were 19.0 percent and 28.3 percent when using a paper-based format and a computer-based format, respectively (Table 1). The feedback-facilitating effect of the computer-based format was uneven among junior and senior emergency physicians (Table 2). In addition, the feedback completion showed a primacy effect that the assessors tend to provide the first one or two feedback components in a busy ED setting (Figure). Conclusion: A computer-based format facilitates the completion of the feedback, especially on the part of junior assessors.
S28 Annals of Emergency Medicine
Table 1. Demographics and comparison of mini-CEX components by different formats.
Mean age of patients% Senior doctor (>10 years) Observation time (min)% Feedback time (min)% Clinical Domains measured§ Medical interview Physical examination Technical skills Counselling skills Clinical judgment 600 (99.3)
878 (97.7) 877 (97.6)
803 (89.3) 536 (59.6) 299 (33.3)
803 (89.3) 536 (59.6) 299 (33.3)
Paper format (n[295)
Computer format (n[604)
P-value
Total (n[899)
55.1 20.3
54.3 19.3
0.583
54.5 19.5
9.46 4.9
7.80 4.6
<.001*
8.34 4.7
14.0 6.4
14.8 8.6
0.140
14.5 8.0
10.5 6.7
11.1 5.0
0.169
10.9 5.6
294 (99.7)
603 (99.8)
0.549
897 (99.8)
291 (98.6)
600 (99.4)
0.450
891 (99.1)
144 (48.8) 265 (89.8)
72 (11.9) 533 (88.3)
0.580
Efficiency / Organized Professionalism Word counts for each component% Anything especially good Suggestions for development Agreed action plan Feedback components used§ Anything especially good Suggestions for development Agreed action plan All three aspects of feedback provided§
<.001* 216 (24.0) 0.480 798 (88.8) 292 (98.9) 892 (99.2) 199 (98.5) 0.403 279 (94.6) 599 (99.2) <.001* 277 (93.9) 600 (99.3)
<.001*
11.4 7.3
<.001*
9.0 6.6
11.0 6.2 10.6 7.6
0.504
9.2 5.1 12.8 8.9
<.001*
263 (89.2) 540 (89.4)
0.910
168 (57.0) 368 (60.9)
0.254
83 (28.1) 56 (19.0)
0.023* 0.003*
216 (35.8) 171 (28.3)
227 (25.3) §
Data presented as number (%). Data presented as mean SD. * Statistically significant.
%
Table 2. The subgroup analysis of feedback using computer-based format miniCEX, stratified by seniority of 10 years.
Mini-CEX time (in minutes)* Observation time Feedback time The frequency of each component utilized for feedback§ Anything especially good Suggestions for development Agreed action plan All three aspects of feedback provided§
Junior EPs
Senior EPs
N[418
N[186
P value
14.9 9.6 11.6 5.2
14.4 5.7 9.93 4.4
0.347 <0.001
375 (89.7) 289 (69.1) 170 (40.7) 155 (37.1)
165 (88.7) 79 (42.5) 46 (24.7) 16 (8.60)
0.712 <0.001 <0.001 <0.001
*Data presented as mean SD. § Data presented as number (%).
Volume 66, no. 4s : October 2015