The Extended Supervised Learning Event (ESLE): Assessing Nontechnical Skills in Emergency Medicine Trainees in the Workplace - 25/10/19
, Alan Gopal, MBBS, MSc b, Lynsey Flowerdew, MD, FRCEM c, Amanda Farrow, FRCEM d, James Crossley, MBBS, DM eAbstract |
Study objective |
The contribution of emergency medicine clinicians’ nontechnical skills in providing safe, high-quality care in the emergency department (ED) is well known. In 2015, the UK Royal College of Emergency Medicine introduced explicit validated descriptors of nontechnical skills needed to function effectively in the ED. A new nontechnical skills assessment tool that provided a score for 12 domains of nontechnical skills and detailed narrative feedback, the Extended Supervised Learning Event (ESLE), was introduced and was mandated as part of the Royal College of Emergency Medicine assessment schedule. We aim to evaluate the psychometric reliability of the ESLE in its first year of use.
Methods |
ESLEs were mandated for all UK emergency medicine trainees in the final 4 years of a 6-year national training program from August 2015. The completed assessments were uploaded to the Royal College of Emergency Medicine e-portfolio. All assessments recorded in the Royal College of Emergency Medicine e-portfolio database between August 2015 and August 2016 were anonymized and analyzed for psychometric reliability, using generalizability theory. Decision analysis was used to model the effect of altering the number of episodes and assessors on reliability.
Results |
A total of 1,390 ESLEs were analyzed. The majority (62%) of the variation in nontechnical skills scores was attributable to the trainee’s ability. The circumstances of the event (eg, case complexity, workload) accounted for 21% and the stringency or leniency of assessors the remaining 16%. Decision analysis suggests that 3 ESLEs by 2 or more assessors, as currently recommended in the Royal College of Emergency Medicine curriculum, provide an assessment with a reliability coefficient of 0.8.
Conclusion |
Board-certified-equivalent emergency medicine supervisors are able to provide reliable assessments of emergency medicine trainees’ nontechnical skills in the workplace by using the ESLE.
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| Please see page 671 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Peter C. Wyer, MD. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: WT, LF, and AF developed the tool and took it through a pilot phase. WT and JC designed the study. WT and AG collated data. WT, AG, and JC analyzed the data and conducted the generalizability analyses. WT wrote the first draft of the article and all authors contributed significantly to its editing. WT takes responsibility for the paper as a whole. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). Dr Townend has received payment to work for the Royal College of Emergency Medicine on curriculum development, but was not paid in relation to this current study. Dr. Crossley reports having undertaken paid educational consultancy work for the Royal College of Emergency Medicine but not in connection with the current study. |
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Vol 74 - N° 5
P. 670-678 - novembre 2019 Retour au numéro
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