Physician-Rated Utility of Procedure Videos for Teaching Procedures in the Emergency Department, Overall and during Emergency Department Crowding

Clare L. Atzema, R. Alexandra Stefan, Refik Saskin, Greg Michlik, Peter C. Austin

Department of Emergency Services, Sunnybrook Health Sciences Centre, Toronto, Canada.
Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Canada.
The Institute for Clinical Evaluative Sciences, Toronto, Canada.

DOI: 10.4236/ijcm.2012.37A133                

Abstract

Background: Real-time use of procedure videos as educational tools has not been studied. We sought to determine whether viewing a video of a medical procedure prior to procedure performance in the emergency department improves the quality of teaching of procedures, and whether videos are particularly beneficial during periods of emergency department crowding. Methods: In this single-centre, prospective, before and after study standardized data collection forms were completed by both trainees and supervising emergency physicians (EPs) at the end of each emergency department shift in the before (August 2008-March 2009) and after (August 2009-March 2010) phase. Online procedure videos were introduced on emergency department computers in the after phase. The primary outcome measure was EP rating of the quality of teaching provided (5-point Likert scale). The interaction between crowding and videos was also assessed, to determine whether videos provide a specific additional benefit during periods of emergency department crowding. Results: There were 1159 procedures performed by 192 trainees. Median procedures performed per shift was 1.0 (IQR 0 - 2.0). Mean EP rating of teaching provided was significantly higher in the group that viewed videos, at 4.2 versus 3.7 (p < 0.001). In the adjusted analysis, EP ratings increased by 0.5 with a video (p < 0.001), while the odds of a score of 5.0 were 2.2 times greater if a video was viewed (p = 0.03). The interaction of crowding and procedure videos was not significant (the use of videos increased the average score by 0.24 in times of crowding compared to times of non-crowding, p = 0.19). Conclusions: Use of procedural videos was associated with EP perception of improved quality of teaching provided around procedures. While EPs rated the quality of their teaching as improved overall, the effect of videos on teaching quality was the same in crowded settings as it was in non-crowded setting.

Keywords

Teaching; Education; Procedures; Emergency Department; Video

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Accreditation Council for Graduate Medical Education (ACGME), 2011. http://www.acgme.org/acWebsite/navPages/nav_PDcoord.asp
[2]	E. L. Einspruch, B. Lynch, T. P. Aufderheide, G. Nichol and L. Becker, “Retention of CPR Skills Learned in a Traditional AHA Heartsaver Course versus 30-Min Video Self-Training: A Controlled Randomized Study,” Resuscitation, Vol. 74, No. 3, 2007, pp. 476-486. doi:10.1016/j.resuscitation.2007.01.030
[3]	J. C. Lee, R. Boyd and P. Stuart, “Randomized Controlled Trial of an Instructional DVD for Clinical Skills Teaching,” Emergency Medicine Australasia, Vol. 19, No. 3, 2007, pp. 241-245. doi:10.1111/j.1742-6723.2007.00976.x
[4]	P. Sookpotarom, T. Siriarchawatana, Y. Jariya and P. Vejchapipat, “Demonstration of Nasogastric Intubation Using Video Compact Disc as an Adjunct to the Teaching Processes,” Journal of the Medical Association of Thai- land, Vol. 90, No. 3, 2007, pp. 468-472.
[5]	I. Treadwell, T. W. de Witt and S. Grobler, “The Impact of a New Educational Strategy on Acquiring Neonatology Skills,” Medical Education, Vol. 36, No. 5, 2002, pp. 441-448. doi:10.1046/j.1365-2923.2002.01201.x
[6]	Institute of Medicine, “Hospital-Based Emergency Care: At the Breaking Point,” National Academy Press, Washington DC, 2006.
[7]	N. C. Proudlove, K. Gordon and R. Boaden, “Can Good Bed Management Solve the Overcrowding in Accident and Emergency Departments?” Emergency Medicine Journal, Vol. 20, No. 2, 2003, pp. 149-155. doi:10.1136/emj.20.2.149
[8]	M. J. Schull, J. P. Szalai, B. Schwartz and D. A. Redelmeier, “Emergency Department Overcrowding Following Systematic Hospital Restructuring: Trends at Twenty Hospitals over Ten Years,” Academic Emergency Medicine, Vol. 8, No. 11, 2001, pp. 1037-1043. doi:10.1111/j.1553-2712.2001.tb01112.x
[9]	F. Y. Shih, M. H. Ma, S. C. Chen, H. P. Wang, C. C. Fang, R. S. Shyu, G. T. Huang and S. M. Wang, “ED Overcrowding in Taiwan: Facts and Strategies”, American Journal of Emergency Medicine, Vol. 17, No. 2, 1999, pp. 198-202. doi:10.1016/S0735-6757(99)90061-X
[10]	C. Atzema, G. Bandiera and M. J. Schull, “Emergency Department Crowding: The Effect on Resident Education,” Annals of Emergency Medicine, Vol. 45, No. 3, 2005, pp. 276-281. doi:10.1016/j.annemergmed.2004.12.011
[11]	G. Bandiera, S. Lee and R. Tiberius, “Creating Effective Learning in Today’s Emergency Departments: How Accomplished Teachers Get It Done,” Annals of Emergency Medicine, Vol. 45 No. 1, 2005, pp. 253-261. doi:10.1016/j.annemergmed.2004.08.007
[12]	G. Bandiera and D. Lendrum, “Daily Encounter Cards Facilitate Competency-Based Feedback While Leniency Bias Persists,” Canadian Journal of Emergency Medicine, Vol. 10, No. 1, 2008, pp. 44-50.
[13]	N. L. Dudek, M. B. Marks and G. Regehr, “Failure to Fail: The Perspectives of Clinical Supervisors,” Academic Medicine, Vol. 80, Suppl. 10, 2005, pp. S84-S87. doi:10.1097/00001888-200510001-00023
[14]	U. Hwang, M. L. McCarthy, D. Aronsky, B. Asplin, P. W. Crane, C. K. Craven, S. K. Epstein, C. Fee, D. A. Handel, J. M. Pines, N. K. Rathlev, R. W. Schafermeyer, F. L. Zwemer Jr and S. L. Bernstein, “Measures of Crowding in the Emergency Department: A Systematic Review,” Academic Emergency Medicine, Vol. 18, No. 5, 2011, pp. 527-538. doi:10.1111/j.1553-2712.2011.01054.x
[15]	J. M. Pines, A. R. Localio, J. E. Hollander, W. G. Baxt, H. Lee, C. Phillips and J. P. Metlay, “The Impact of Emergency Department Crowding Measures on Time to Antibiotics for Patients with Community-Acquired Pneumonia,” Annals of Emergency Medicine, Vol. 50, No. 5, 2007, pp. 510-516. doi:10.1016/j.annemergmed.2007.07.021
[16]	M. J. Schull, A. Kiss and J. P. Szalai, “The Effect of Low-Complexity Patients on Emergency Department Waiting Times,” Annals of Emergency Medicine, Vol. 49, No. 3, 2007, pp. 257-264. doi:10.1016/j.annemergmed.2006.06.027
[17]	M. L. McCarthy, S. L. Zeger, R. Ding, S. R. Levin, J. S. Desmond, J. Lee and D. Aronsky, “Crowding Delays Treatment and Lengthens Emergency Department Length of Stay, Even among High-Acuity Patients,” Annals of Emergency Medicine, Vol. 54, No. 4, 2009, pp. 492-503. doi:10.1016/j.annemergmed.2009.03.006
[18]	G. Norman, “Likert Scales, Levels of Measurement and the ‘Laws’ of Statistics,” Advances in Health Sciences Education: Theory and Practice, Vol. 15, No. 5, 2010, pp. 625-632. doi:10.1007/s10459-010-9222-y
[19]	B. Rowe, K. Bond, B. Ospina, S. Blitz, M. Afilalo, S. Campbell and M. Schull, “Frequency, Determinants, and Impact of Overcrowding on Emergency Departments in Canada: A National Survey of Emergency Department Directors,” Technology Report No. 67.3, Canadian Agencies for Drugs and Technologies in Health, Ottawa, 2006.
[20]	K. M. Skeff, J. L. Bowen and D. M. Irby, “Protecting Time for Teaching in the Ambulatory Care Setting,” Academic Medicine, Vol. 72, No. 8, 1997, pp. 694-697. doi:10.1097/00001888-199708000-00014
[21]	S. M. Berenholtz, P. J. Pronovost, P. A. Lipsett, D. Hobson, K. Earsing, J. E. Farley, S. Milanovich, E. Garrett-Mayer, B. D. Winters, H. R. Rubin, T. Dorman and T. M. Perl, “Eliminating Catheter-Related Bloodstream Infections in the Intensive Care Unit,” Critical Care Medicine, Vol. 32, No. 10, 2004, pp. 2014-2020.