Assessment of Competence in Emergency Medicine among ...€¦ · five life-threatening diseases presenting frequently in emergency rooms of Cameroon. Response rate of the self-survey

© 2017 The Korean Academy of Medical Sciences.This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

pISSN 1011-8934eISSN 1598-6357

Assessment of Competence in Emergency Medicine among Healthcare Professionals in Cameroon

Development of a competence-based curriculum is important. This study aimed to develop competence assessment tools in emergency medicine and use it to assess competence of Cameroonian healthcare professionals. This was a cross-sectional, descriptive study. Through literature review, expert survey, and discrimination tests, we developed a self-survey questionnaire and a scenario-based competence assessment tool for assessing clinical knowledge and self-confidence to perform clinical practices or procedures. The self-survey consisted of 23 domains and 94 questionnaires on a 5-point Likert scale. Objective scenario-based competence assessment tool was used to validate the self-survey results for five life-threatening diseases presenting frequently in emergency rooms of Cameroon. Response rate of the self-survey was 82.6%. In this first half of competence assessment, knowledge of infectious disease had the highest score (4.6 ± 0.4) followed by obstetrics and gynecology (4.2 ± 0.6) and hematology and oncology (4.2 ± 0.5); in contrast, respondents rated the lowest score in the domains of disaster, abuse and assault, and psychiatric and behavior disorder (all of mean 2.8). In the scenario-based test, knowledge of multiple trauma had the highest score (4.3 ± 1.2) followed by anaphylaxis (3.4 ± 1.4), diabetic ketoacidosis (3.3 ± 1.0), ST-elevation myocardial infarction (2.5 ± 1.4), and septic shock (2.2 ± 1.1). Mean difference between the self-survey and scenario-based test was statistically insignificant (mean, −0.02; 95% confidence interval, −0.41 to 0.36), and agreement rate was 58.3%. Both evaluation tools showed a moderate correlation, and the study population had relatively low competence for specific aspects of emergency medicine and clinical procedures and skills.

Keywords: Professional Competence; Emergency Medicine; Developing Countries

Sang Chul Kim,1,2 Young Sun Ro,2 Sang Do Shin,2,3 Dae Han Wi,2,4 Joongsik Jeong,5 Ju Ok Park,2,6 Kyong Min Sun,2,3 and Kwangsoo Bae2,7

1Department of Emergency Medicine, Chungbuk National University Hospital, Cheongju, Korea;2Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea; 3Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea; 4Department of Emergency Medicine, Wonkwang University School of Medicine, Iksan, Korea; 5Korea International Cooperation Agency, Seongnam, Korea; 6Department of Emergency Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea; 7Department of Emergency Medicine, Andong Hospital, Andong, Korea

Received: 14 June 2017Accepted: 10 September 2017

Address for Correspondence:Young Sun Ro, MD, DrPH Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, 101 Daehak-ro, Jongno-gu, Seoul 03080, KoreaE-mail: [email protected]

Funding: This study was financially supported by the Korea International Cooperation Agency (KOICA).

https://doi.org/10.3346/jkms.2017.32.12.1931 • J Korean Med Sci 2017; 32: 1931-1937

INTRODUCTION

Infectious disease outbreaks such as malaria and human im-munodeficiency virus (HIV)/acquired immune deficiency syn-drome (AIDS) have resulted in growing demand for medical care in sub-Saharan Africa. In recent years, incidence of road traffic injuries and cardiovascular disease has also increased due to rapid urbanization, industrial development, and health behavior changes. However, emergency medical services (EMS) system is still underdeveloped, and mortality and disability from acute medical conditions and injuries are markedly higher com-pared to developed countries (1,2). The rising burden of acute medical conditions puts more emphasis on emergency medi-cal care in prehospital as well as hospital settings (3). In 2009, the African Federation for Emergency Medicine (AF-EM) was established with joint efforts of South Africa, Ghana, and Ethiopia, to develop emergency care system in partnership with advanced countries. In addition, countries including Mad-agascar, Rwanda, Sudan, Uganda, and Zambia developed resi-

dency training programs in emergency medicine (4). Through international partnerships, several African countries tried to strengthen emergency care system by training local directors in emergency medicine, developing training modules, establish-ing an emergency training center, and creating an academic training program for residents and nurses (4-7). Development of emergency care system in Cameroon, how-ever, is still in a nascent stage. Total health expenditure in Cam-eroon was a 5% of the gross domestic product during the past 10 years, and poor coordination between stakeholders imped-ed quality development of services in emergency departments (8). Recently, the Cameroonian government has taken an ini-tiative to establish training schools for emergency medicine to address lack of health resources, revise education curricula, pro-mote permanent employment of healthcare workers in the pub-lic sector, and increase funds from external sponsorships (9). Well-trained emergency physicians serve as key human re-sources in emergency care system. Emergency physicians should have well-rounded competence in both the diagnosis and treat-

ORIGINAL ARTICLEGlobal Health

1 / 1CROSSMARK_logo_3_Test

2017-03-16https://crossmark-cdn.crossref.org/widget/v2.0/logos/CROSSMARK_Color_square.svg

http://crossmark.crossref.org/dialog/?doi=10.3346/jkms.2017.32.12.1931&domain=pdf&date_stamp=2017-11-07

Kim SC, et al. • Competence Assessment in Emergency Medicine in Cameroon

1932 http://jkms.org https://doi.org/10.3346/jkms.2017.32.12.1931

ment of emergency patients, be able to manage patients, effec-tively utilize emergency resources, cooperate with local com-munity, and develop and collaborate with prehospital EMS sys-tem. In Cameroon, however, residency training program in emer-gency medicine has not yet been implemented, and develop-ment of a training curriculum to strengthen the competence of emergency physicians remains as an urgent task for providing reliable emergency care. Competence is the ability of an individual to apply one’s knowl-edge, understanding, skills, and judgment in performing effec-tively in the field of professional practice (10). Development of a competence-based curriculum has become central to the ed-ucation and training of healthcare professionals (11,12). How-ever, tools to evaluate competence of emergency personnel have not yet been developed. Therefore, this study aimed to develop a competence assessment tool in emergency medicine and to validate it by applying the tools to Cameroonian healthcare pro-fessionals.

MATERIALS AND METHODS

Study design and settingThis was a cross-sectional, descriptive study. The Korea Inter-national Cooperation Agency (KOICA), which is a government-run bilateral aid agency in Korea, has progressed a project with the Cameroon Ministry of Public Health to construct the Yaoun-dé National Emergency Center. Between October 27 and 31, 2014, a short-term educational program was provided to 58 health-care professionals (13 specialists, 10 general physicians, and 35 nurses) in the Central Hospital of Yaoundé who are expected to work at the Yaoundé National Emergency Center after its open-ing in 2015. The educational program for doctors included Ad-vanced Trauma Life Support (ATLS), emergency ultrasound, electrocardiogram course, etc. In Cameroon, medical student educational program is a 7-year course including a 1-year research activity at a college; and con-tinuous medical education programs are a 2-year general phy-sician training and a 4-year residency programs. For emergency medicine, a 2-year special training program is offered but is not recognized as a certified residency program.

Development of competence evaluation toolsWe developed a self-survey questionnaire and a scenario-based assessment tool to evaluate competence in clinical knowledge and self-confidence to perform clinical practices or procedures. The self-survey questionnaire was developed based on the European curriculum for emergency medicine, core curricu-lum of the International Federation for Emergency Medicine, learning objectives of the Korean Academy of Medical Sciences, and emergency resident training programs of Korean Society of Emergency Medicine (13,14). It is composed of a total of 113

questions: 17 domains with 82 questions about core clinical knowledge, 4 domains with 11 questions about specific aspects of emergency medicine, and 2 domains with 20 questions about clinical procedures and skills. A two-step pretest was conducted to improve the validity of the competence assessment tool. The first step involved an ex-pert consensus survey with 7 Korean emergency physicians who have previously contributed to the educational program for healthcare professionals in Yaoundé. Questions in which more than 4 emergency specialists reached consensus were se-lected as appropriate items for the survey, and those in which more than 4 emergency specialists found confusing were modi-fied as appropriate. As a result of the expert consensus survey, a total of 94 questions were selected as potential candidates of the competence assessment tool; seventeen questions on core clinical knowledge and two questions on clinical procedures and skills were excluded. The second step assessed the discrimi-nation power of each question between junior (1st or 2nd year) and senior (3rd or 4th year) emergency residents. Korean junior (n = 7) and senior (n = 5) emergency residents participated in the evaluation. All 94 questions in the 23 domains showed high discrimination power, and as a result, were selected for the com-petence assessment tool for emergency healthcare profession-als in Yaoundé (Table 1). Full results of the two-step pretest are reported in Supplementary Table 1. To test validity of the self-survey and to objectively assess com-petence in emergency medicine, we also developed a scenario-based competence assessment tool based on a simulation work-book and a relevant web site (15-17). Five life-threatening diag-noses frequently presenting in the emergency room of the Cen-tral Hospital of Yaoundé were selected as scenario topics: ST el-evation myocardial infarction (STEMI); diabetes ketoacidosis (DKA); septic shock due to necrotizing fasciitis; multiple trau-ma by road traffic injury; and anaphylaxis. For these scenarios, 14 questions were chosen among the self-survey questions, and a total of 26 sub-questions (3 for STEMI, 6 for DKA, 11 for septic shock, 3 for multiple trauma, and 3 for anaphylaxis) and answers were also developed to assess the competence in diagnosis and treatment of the 5 diseases. Detailed information of the scenar-io-based competence assessment tool is reported in Supple-mentary Table 2.

Study population and study protocolsEligible population was Cameroonian doctors (13 specialists and 10 general physicians) who had taken the education pro-gram in 2014. Competence was assessed in two steps with health-care professionals who agreed to participate in the study. The first step of competence assessment was conducted in November 2014 using a 17-page self-survey on clinical knowl-edge and self-confidence to perform clinical practices or proce-dures. The survey took roughly 40 minutes to complete includ-


http://jkms.org 1933https://doi.org/10.3346/jkms.2017.32.12.1931

ing an introduction to purpose and methods of the survey. Each question was answered in a 5-point Likert scale. All results were coded using Microsoft Excel (ver. 14.0, Microsoft®, Los Angeles, CA, USA) by an appointed data entry clerk. The second scenario-based assessment was conducted with 6 doctors (3 general physicians and 3 specialists) who had pre-viously participated in the self-survey on December 10 and 11, 2014, in the form of an individual interview with two Korean emergency physicians. One emergency physician explained a scenario, and the physicians evaluated the answers in which a Cameroonian respondent provided about his or her medical knowledge on patient assessment, interpretation, diagnosis, and treatment. For increased objectivity, both emergency phy-sicians independently assessed the respondent’s answers on a 5-point Likert scale.

Main outcomesMain outcome was competence in emergency medicine, cap-tured by self-survey and scenario-based competence assessment on a 5-point Likert scale: 1) don’t know at all; 2) don’t know; 3) average; 4) know; and 5) know well. Secondary outcomes were

agreement rate and difference of scores between the two meth-ods of self-survey and scenario-based competence assessment. Statistical analysisDescriptive statistics of the self-survey and scenario-based com-petence assessment results on a 5-point Likert scale were expre-ssed with means and standard deviations (SDs). Differences of assessment results between groups were compared using the Student’s t-test. The power of discrimination for the self-survey between ju-nior and senior residents was measured as the area under the generated receiver operating characteristic (ROC) area under curve (AUC); and AUC greater than 0.7 was said to have high discrimination power. For the scenario-based competence as-sessment, inter-rater reliability between the two Korean emer-gency physicians was analyzed using the weighted kappa. For every doctor participating in both competence assessment methods, we compared the score difference of all 14 questions between the first self-survey and the second scenario-based competence assessment. The difference between the two as-sessment results was analyzed using paired t-test, agreement

Table 1. Comparison of self-survey competency assessment results in Korean emergency residents and Cameroonian healthcare professionals

Topic-domainQuestion

No.

Korean emergency residents Cameroonian healthcare professionals

Junior (n = 7)

Senior (n = 5)

AUC (95% CI)

Total (n = 19)

GP (n = 9)

Specialist (n = 10)

P value

I. Core clinical knowledge 1. Cardiovascular 5 2.8 ± 0.2 4.2 ± 0.1 1.00 (1.00–1.00) 3.8 ± 0.6 3.4 ± 0.5 4.1 ± 0.5 0.007 2. Pulmonary 5 3.5 ± 0.2 4.2 ± 0.1 0.85 (0.61–1.00) 3.8 ± 0.5 3.6 ± 0.4 4.0 ± 0.5 0.114 3. Gastrointestinal 5 3.5 ± 0.3 4.2 ± 0.3 1.00 (1.00–1.00) 3.9 ± 0.6 3.9 ± 0.4 4.0 ± 0.7 0.753 4. Renal and genitourinary 6 2.8 ± 0.3 3.9 ± 0.2 1.00 (1.00–1.00) 3.7 ± 0.5 3.5 ± 0.5 3.9 ± 0.4 0.116 5. Obstetrics and gynecology 1 2.4 ± 0.3 3.9 ± 0.4 1.00 (1.00–1.00) 4.2 ± 0.6 4.4 ± 0.5 4.1 ± 0.6 0.275 6. Pediatrics 5 3.2 ± 0.2 3.9 ± 0.1 0.90 (0.69–1.00) 4.1 ± 0.4 4.1 ± 0.3 4.1 ± 0.5 0.692 7. Infectious disease 5 2.5 ± 0.4 3.5 ± 0.3 0.94 (0.78–1.00) 4.6 ± 0.4 4.6 ± 0.4 4.6 ± 0.4 0.629 8. Neurological disorder 6 3.1 ± 0.2 4.0 ± 0.1 0.92 (0.73–1.00) 4.0 ± 0.5 3.8 ± 0.5 4.2 ± 0.5 0.126 9. Toxicology 2 2.3 ± 0.3 3.6 ± 0.0 0.96 (0.84–1.00) 3.3 ± 0.6 3.2 ± 0.7 3.4 ± 0.5 0.51210. Endocrine and metabolic 3 2.5 ± 0.4 3.8 ± 0.3 1.00 (1.00–1.00) 4.0 ± 0.5 3.9 ± 0.6 4.1 ± 0.5 0.38411. Hematologic and oncologic 4 2.8 ± 0.5 3.8 ± 0.3 0.98 (0.90–1.00) 4.2 ± 0.5 4.0 ± 0.4 4.4 ± 0.5 0.10312. Eyes, ears, nose, throat, oral, and neck

8 3.1 ± 0.2 3.8 ± 0.1 0.79 (0.50–1.00) 3.2 ± 0.6 3.3 ± 0.5 3.1 ± 0.6 0.429

13. Dermatologic 1 3.4 ± 0.4 4.6 ± 0.4 0.92 (0.74–1.00) 4.1 ± 0.6 4.1 ± 0.5 4.2 ± 0.7 0.62614. Trauma 4 2.8 ± 0.3 3.9 ± 0.5 0.92 (0.74–1.00) 3.7 ± 0.5 3.5 ± 0.4 3.8 ± 0.5 0.19515. Musculoskeletal 2 2.9 ± 0.4 4.1 ± 0.3 0.98 (0.90–1.00) 3.8 ± 0.6 3.4 ± 0.6 4.1 ± 0.5 0.03216. Psychiatric and behavior 1 2.6 ± 1.0 3.6 ± 0.5 0.88 (0.65–1.00) 2.8 ± 1.0 3.0 ± 1.0 2.7 ± 0.9 0.51117. Resuscitation 2 3.0 ± 0.3 4.3 ± 0.3 0.94 (0.78–1.00) 3.3 ± 0.7 2.9 ± 0.6 3.7 ± 0.5 0.017

II. Specific aspects of emergency medicine18. Disaster 1 1.9 ± 0.9 3.0 ± 1.4 0.77 (0.43–1.00) 2.8 ± 1.1 2.6 ± 1.0 3.1 ± 1.1 0.27719. Abuse and assault 1 2.6 ± 1.0 3.5 ± 0.6 0.75 (0.44–1.00) 2.8 ± 1.0 2.4 ± 0.9 3.2 ± 1.0 0.10620. Environmental injuries 4 2.4 ± 0.3 3.6 ± 0.4 0.83 (0.57–1.00) 3.1 ± 0.6 2.8 ± 0.4 3.4 ± 0.6 0.04521. Prehospital care 5 1.6 ± 0.3 3.1 ± 0.2 0.79 (0.45–1.00) 3.2 ± 0.6 3.0 ± 0.4 3.3 ± 0.6 0.204

III. Clinical procedures and skills22. CPR skills 9 2.1 ± 0.3 4.3 ± 0.3 1.00 (1.00–1.00) 3.0 ± 0.7 2.6 ± 0.4 3.4 ± 0.7 0.00723. Procedure 9 2.4 ± 0.4 3.5 ± 0.1 0.92 (0.73–1.00) 3.5 ± 0.5 3.3 ± 0.5 3.8 ± 0.4 0.028

Total 94 2.7 ± 0.4 3.8 ± 0.3 1.00 (1.00–1.00) 3.6 ± 0.4 3.5 ± 0.3 3.8 ± 0.3 0.038

Values are presented as mean ± SD.SD = standard deviation, AUC = area under the curve, CI = confidence interval, GP = general physician, CPR = cardiopulmonary resuscitation.



rate, and weighted kappa. When the difference between the re-sult of the first self-survey and the second scenario-based as-sessment was within one point, it was said that the two results had an agreement. Level of statistical significance was defined as P < 0.05.

Ethics statementThe study received and approved by the Institutional Review Board of the Seoul National University Hospital (IRB No. E-1506-048-679). Written informed consent was obtained from all study participants.

RESULTS

The first competence assessment: self-survey Among a total of 23 doctors, 10 specialists and 9 general physi-cians participated in the first competence assessment (82.6%). Mean (SD) age of the 19 participants was 33.1 (5.6). And 6 (31.6%) were male. Main areas of practice for the 10 specialists included anesthesia (n = 3), internal medicine (n = 3), general surgery (n = 2), gynecology and emergency medicine (n = 1), and labo-ratory medicine (n = 1). In the self-survey competence assessment, the Cameroonian healthcare professionals scored the highest in the domain of infectious disease (mean ± SD, 4.6 ± 0.4), followed by obstetrics and gynecology (4.2 ± 0.6) and hematology and oncology (4.2 ± 0.5); in contrast, they scored the lowest grade in the domains of disaster, abuse and assault, and psychiatric and behavior disor-

der (each with a mean of 2.8). Domains of cardiovascular, mus-culoskeletal, procedure, resuscitation, cardiopulmonary resus-citation (CPR) skills, and environmental injuries had significant-ly higher scores in specialists compared to general physicians (all P < 0.05). The average scores in general physicians were high-er than specialists only in the 3 domains of obstetrics and gyne-cology; eyes, ear, nose, throat, oral, and neck; and psychiatric and behavior; however, the score differences were not statisti-cally significant (Table 1).

The second competence assessment: scenario-based For the 14 questions of the scenario-based competence assess-ment which were answered by the 6 study participants, the inter-rater reliability between the two interviewers had a weighted kappa 0.88 and 95% confidence interval (CI) 0.82–0.95 (Table 2). Highest scores of the scenario-based assessment were ob-served in the knowledge of multiple trauma (mean ± SD, 4.3 ± 1.2), followed by anaphylaxis (3.4 ± 1.4), DKA (3.3 ± 1.0), and STEMI (2.5 ± 1.4). Knowledge of septic shock scored the lowest in the scenario-based assessment (mean ± SD, 2.2 ± 1.1) (Table 3).

Comparison between first and second competence assessmentMean difference between the self-survey and scenario-based assessment was statistically insignificant (mean, −0.02; 95% CI, −0.41 to 0.36). In terms of individual participants, the mean dif-ference (95% CI) between the scenario-based assessment and the self-survey ranged from −1.21 (−2.15 to −0.28) to 0.64 (−0.25

Table 2. Inter-rater reliability between two interviewers (Korean emergency physicians)

Interviewer Interviewer 2

1 2 3 4 5 Total

Interviewer 1 1 12 2 0 1 0 152 1 12 3 0 0 163 0 2 13 2 0 174 0 0 2 18 0 205 0 0 0 0 16 16

Total 13 16 18 21 16 84*

Agreement rate, 84.5%; weighted kappa, 0.88; 95% CI, 0.82 to 0.95.*A total score of 84 was derived from 14 questions answered by 6 Cameroonian doc-tors.The gray color cells are the number of items that match the score of two reviewers.

Table 3. Scenario-based competency assessment between GPs and specialists in Cameroon

Clinical scenario Question No. Detailed item No. Total (n = 6) GP (n = 3) Specialist (n = 3) P value

1. Septic shock 3 11 2.2 ± 1.1 1.9 ± 0.8 2.6 ± 1.2 0.1862. Diabetes ketoacidosis 3 6 3.3 ± 1.0 2.8 ± 1.0 3.8 ± 0.7 0.0183. STEMI 3 3 2.5 ± 1.4 2.0 ± 1.3 3.0 ± 1.4 0.1364. Multiple trauma 2 3 4.3 ± 1.2 4.2 ± 1.6 4.5 ± 0.8 0.6565. Anaphylaxis 3 3 3.4 ± 1.4 3.6 ± 1.5 3.3 ± 1.3 0.740Total 14 26 3.1 ± 1.4 2.8 ± 1.5 3.4 ± 1.3 0.062

Values are presented as number or mean ± SD.STEMI = ST-elevation myocardial infarction, SD = standard deviation, GP = general physician.

Table 4. Difference between scenario-based test and self-survey test

Subjects Position Mean difference* 95% CI

Doctor 1 GP −0.50 −1.80 to 0.80Doctor 2 S 0.00 −0.82 to 0.82Doctor 3 S 0.36 −0.54 to 1.25Doctor 4 S 0.57 −0.43 to 1.58Doctor 5 GP 0.64 −0.25 to 1.54Doctor 6 GP −1.21 −2.15 to −0.28Total −0.02 −0.41 to 0.36

GP = general physician, S = specialist, CI = confidence interval.*Mean difference was calculated as the average of scenario-based scores subtracted by the average of self-survey score of 14 questions.



to 1.54) (Table 4). Results of the 14 questions in the self-survey and the scenario-based assessment showed 58.3% agreement rate, 17.9% under-estimation rate, and 23.8% over-estimation rate (Table 5).

DISCUSSION

This study involved development of a self-survey and a scenar-io-based competence assessment tool for emergency medicine using literature review, expert consensus, and a discrimination test with pilot survey. We administered the self-survey to Cam-eroonian healthcare professionals and later conducted an ob-jective, scenario-based competence assessment to test validity of the self-survey. Mean difference between the self-survey and scenario-based assessment was negligible, and scores between two assessments showed moderate agreement rate (58%). Com-petence-based education has become an important key of cur-riculum for healthcare professionals, which highlights the needs for reliable, valid, and feasible competence assessment tools in mid- and long-term education courses (18-20). The areas of prac-tice which showed poor competence in this study should com-prise the main contents of emergency medicine curriculum for the Cameroonian healthcare professionals. The self-survey competence assessment is one of the most formative and summative forms of evaluation. Repetitive self-surveys can benefit both learners and educators through con-tinuous monitoring of self-competence and education impacts, respectively. In this study, the Cameroonian participants showed high competence in the domains of infectious disease, obstet-rics and gynecology, hematology and oncology. Specialists who had completed advanced education and training showed high competence in the domains of clinical procedure, CPR skills, and resuscitation. However, all Cameroonian participants had relatively low competence in specific aspects of emergency med-icine including disasters and prehospital care. There are specific aspects of emergency medicine as well as clinical skills and pro-cedures which function as key competence of an emergency

physician (14); therefore, those domains which showed poor competence should be of particular interest for the development of emergency medicine curriculum for the Cameroonian health-care professionals. Furthermore, periodic monitoring of physi-cians’ competence can also be utilized to evaluate the effects of curriculum in the future. The self-survey has its advantage of convenience and cost-ef-fectiveness, but its results may be subjective. When the self-sur-vey is combined with objective assessment methods, we may expect to obtain more valid and practical results (14,21). In this study, we developed scenario-based assessment tools for the 5 life-threatening diseases which frequently present in the emer-gency rooms of Cameroon. When comparing results of the sub-jective self-survey and the objective scenario-based competence assessment, the scores were comparable with mean difference of −0.02 (−0.41 to 0.36) and had a moderate agreement rate of 58.3%. However, one of the study participants overrated his or her own competence with self-survey than did in the scenario-based assessment, and the calculated overestimation rate (23.8%) was higher than the underestimation rate (17.9%). In previous literature, the correlations between self-survey and externally observed measurement of competence had been controversial. Some studies reported that self-assessment for selected fields or categories was a reliable predictor of clinical performance (15,22-24). In another meta-analysis, however, only 35% of stud-ies showed positive correlation between self-assessments and external assessments (21,25). In our study, self-surveys had a moderate correlation with the externally observed measure-ment. Methodologic quality of a self-survey, knowledge level and training experience of a respondent, and quality and skills of an evaluator are important factors to consider for an accurate evaluation of competence using self-survey. Self-survey assessment in medical knowledge should accu-rately measure competence as well as actual performance as reflected by an external assessment (18). There are many exter-nal, objective competence assessment methods that compen-sate for the weaknesses of a self-survey, such as oral examina-tions, procedure tests, simulation examinations, objective struc-tured clinical examination (OSCE), standard patient examina-tions, and clinical record reviews (14,18). In this study, we de-veloped self-survey and scenario-based oral examination which were designed to assess competence of clinical performance in an environment which resembles an actual situation. Further-more, we applied both assessment tools to the Cameroonian healthcare providers, and results of the two showed a moderate correlation. Using the two competence assessment tools, we expect to develop curriculums for emergency medicine that fo-cuses on specific aspects of emergency medicine and clinical skills and procedures in which the Cameroonian healthcare professionals had poor competence on. There are several limitations in this study. First, only 14 se-

Table 5. Comparison of scores between self-survey and scenario-based competency assessments

Self-survey score

Scenario-based score

1 2 3 4 5 Total

1 4 2 0 2 1 92 0 5 3 3 4 153 6 2 6 9 5 284 3 4 6 5 5 235 2 3 2 1 1 9Total 15 16 17 20 16 84*

Agreement rate, 58.3%; under-estimation rate, 17.9%; over-estimation rate, 23.8%.*A total score of 84 was derived from 14 questions answered by 6 Cameroonian doc-tors.Gray color cells are the number of items with similar survey-based and scenario-based scores.



lected questions among the 94 self-survey questions were used in the scenario-based test. Although the selected topics were based on their high frequency of incidence in Cameroon, not all questions in the self-survey were evaluated with the objec-tive scenario-based assessment, resulting in limited validity of the self-survey. Second, since Korea and Cameroon have differ-ent medical environment, there is a possibility that some ques-tions were not considered as important and were excluded dur-ing the process of expert consensus and discrimination test in Korea. Supplementary assessment such as clinical behavior observation might be helpful to improve the validity of compe-tence evaluation tool. Third, there was a one month gap between the administration of self-survey and scenario-based assessment. Therefore, we could not measure if there had been any individ-ual efforts to improve competence in the interim. In conclusion, we developed and administered self-survey and objective scenario-based competence assessment tools to evaluate the competence in emergency medicine among Cam-eroonian healthcare professionals. Results of the two evaluation tools showed a moderate correlation, and study participants showed relatively low competence in specific aspects of emer-gency medicine and clinical procedures and skills. Results of this assessment can be used to develop curriculums for emer-gency medicine which is tailored to the needs of Cameroonian healthcare professionals. The assessment tools can be used as valuable resources for assessing competence and developing need-based curriculum for emergency medicine in developing countries including those in Africa.

DISCLOSURE

The authors have no potential conflicts of interest to disclose. The funders had no role in study design, data collection and anal-ysis, decision to publish, or preparation of the manuscript.

AUTHOR CONTRIBUTION

Conceptualization: Kim SC, Ro YS, Shin SD, Wi DH, Jeong J, Park JO. Data curation: Kim SC, Ro YS, Sun KM, Bae K. Formal anal-ysis: Kim SC, Ro YS. Funding acquisition: Shin SD, Jeong J. In-vestigation: Kim SC, Sun KM, Bae K. Resources: Sun KM, Bae K. Supervision: Ro YS, Shin SD, Wi DH, Jeong J. Writing - original draft: Kim SC, Ro YS. Writing - review & editing: Shin SD, Jeong J.

ORCID

Sang Chul Kim https://orcid.org/0000-0001-9377-4993Young Sun Ro https://orcid.org/0000-0003-3634-9573Sang Do Shin https://orcid.org/0000-0003-4953-2916Dae Han Wi https://orcid.org/0000-0002-5658-1137Joongsik Jeong https://orcid.org/0000-0003-1682-0161

Ju Ok Park https://orcid.org/0000-0002-1024-3626Kyong Min Sun https://orcid.org/0000-0002-2977-0880Kwangsoo Bae https://orcid.org/0000-0001-5140-4601

REFERENCES

1. Alagappan K, Holliman CJ. History of the development of international

emergency medicine. Emerg Med Clin North Am 2005; 23: 1-10.

2. Ro YS, Shin SD, Jeong J, Kim MJ, Jung YH, Kamgno J, Alain EM, Hollong B.

Evaluation of demands, usage and unmet needs for emergency care in

Yaoundé, Cameroon: a cross-sectional study. BMJ Open 2017; 7: e014573.

3. Terry B, Bisanzo M, McNamara M, Dreifuss B, Chamberlain S, Nelson SW,

Tiemeier K, Waters T, Hammerstedt H. Task shifting: meeting the human

resources needs for acute and emergency care in Africa. Afr J Emerg Med

2012; 2: 182-7.

4. Aufderheide TP, Nolan JP, Jacobs IG, van Belle G, Bobrow BJ, Marshall J,

Finn J, Becker LB, Bottiger B, Cameron P, et al. Global health and emer-

gency care: a resuscitation research agenda--part 1. Acad Emerg Med

2013; 20: 1289-96.

5. Busse H, Azazh A, Teklu S, Tupesis JP, Woldetsadik A, Wubben RJ, Tefera G.

Creating change through collaboration: a twinning partnership to streng-

then emergency medicine at Addis Ababa University/Tikur Anbessa Spe-

cialized Hospital--a model for international medical education partner-

ships. Acad Emerg Med 2013; 20: 1310-8.

6. Osei-Ampofo M, Oduro G, Oteng R, Zakariah A, Jacquet G, Donkor P. The

evolution and current state of emergency care in Ghana. Afr J Emerg Med

2013; 3: 52-8.

7. Reynolds TA, Mfinanga JA, Sawe HR, Runyon MS, Mwafongo V. Emer-

gency care capacity in Africa: a clinical and educational initiative in Tan-

zania. J Public Health Policy 2012; 33 Suppl 1: S126-37.

8. The World Bank. Health expenditure, total (% of GDP): Cameroon [Inter-

net]. Available at https://data.worldbank.org/indicator/SH.XPD.TOTL.ZS

[accessed on 27 September 2017].

9. Kingue S, Rosskam E, Bela AC, Adjidja A, Codjia L. Strengthening human

resources for health through multisectoral approaches and leadership:

the case of Cameroon. Bull World Health Organ 2013; 91: 864-7.

10. Kane MT. The assessment of professional competence. Eval Health Prof

1992; 15: 163-82.

11. Epstein RM, Hundert EM. Defining and assessing professional compe-

tence. JAMA 2002; 287: 226-35.

12. Jung HY, Kim JW, Lee S, Yoo SH, Jeon JH, Kim TW, Park JS, Jeong SY, Oh

SJ, Kim EJ, et al. A study of core humanistic competency for developing

humanism education for medical students. J Korean Med Sci 2016; 31:

829-35.

13. Hsia RY, Mbembati NA, Macfarlane S, Kruk ME. Access to emergency

and surgical care in sub-Saharan Africa: the infrastructure gap. Health

Policy Plan 2012; 27: 234-44.

14. International EM Core Curriculum and Education Committee for the In-

ternational Federation for Emergency Medicine. International Federa-

tion for Emergency Medicine model curriculum for emergency medicine

specialists. CJEM 2011; 13: 109-21.

15. Jansen JJ, Tan LH, van der Vleuten CP, van Luijk SJ, Rethans JJ, Grol RP.

Assessment of competence in technical clinical skills of general practitio-

ners. Med Educ 1995; 29: 247-53.



16. Thoureen TL, Scott SB. Emergency Medicine Simulation Workbook: a

Tool for Bringing the Curriculum to Life. Chichester, Wiley-Blackwell, 2013.

17. Howard Z, Siegelman J, Guterman E, Hayden EM, Gordon JA. Simulation

casebook [Internet]. Available at http://mycourses.med.harvard.edu/Re-

sUps/GILBERT/pdfs/HMS_7607.pdf [accessed on 27 September 2017].

18. Wass V, Van der Vleuten C, Shatzer J, Jones R. Assessment of clinical com-

petence. Lancet 2001; 357: 945-9.

19. Sherbino J, Bandiera G, Frank JR. Assessing competence in emergency

medicine trainees: an overview of effective methodologies. CJEM 2008;

10: 365-71.

20. Epstein RM. Assessment in medical education. N Engl J Med 2007; 356:

387-96.

21. Davis DA, Mazmanian PE, Fordis M, Van Harrison R, Thorpe KE, Perrier

L. Accuracy of physician self-assessment compared with observed mea-

sures of competence: a systematic review. JAMA 2006; 296: 1094-102.

22. Kramer AW, Jansen JJ, Zuithoff P, Düsman H, Tan LH, Grol RP, van der

Vleuten CP. Predictive validity of a written knowledge test of skills for an

OSCE in postgraduate training for general practice. Med Educ 2002; 36:

812-9.

23. Ram P, van der Vleuten C, Rethans JJ, Schouten B, Hobma S, Grol R. As-

sessment in general practice: the predictive value of written-knowledge

tests and a multiple-station examination for actual medical performance

in daily practice. Med Educ 1999; 33: 197-203.

24. Remmen R, Scherpbier A, Denekens J, Derese A, Hermann I, Hoogen-

boom R, van Der Vleuten C, van Royen P, Bossaert L. Correlation of a writ-

ten test of skills and a performance based test: a study in two traditional

medical schools. Med Teach 2001; 23: 29-32.

25. Liaw SY, Scherpbier A, Rethans JJ, Klainin-Yobas P. Assessment for simu-

lation learning outcomes: a comparison of knowledge and self-reported

confidence with observed clinical performance. Nurse Educ Today 2012;

32: e35-9.


http://jkms.org https://doi.org/10.3346/jkms.2017.32.12.1931

Supp

lem

enta

ry T

able

1. S

elf-

surv

ey c

ompe

tenc

y as

sess

men

t too

l and

its

resu

lts in

Kor

ean

emer

genc

y re

side

nts

and

Cam

eroo

nian

doc

tors

Topi

cs a

nd q

uest

ions

Kore

an e

mer

genc

y re

side

nts

Cam

eroo

nian

doc

tors

Juni

or

(n=

7)Se

nior

(n

=5)

AUC

(9

5%CI

)To

tal

(n=

19)

GP

(n=

9)Sp

ecia

list

(n=

10)

P va

lue

I. Co

re c

linic

al k

now

ledg

e

1. C

ardi

ovas

cula

r1

Can

diffe

rent

iate

the

follo

win

g illn

esse

s of

che

st p

ain:

acu

te c

oron

ary

synd

rom

es, s

tabl

e an

gina

, aor

tic d

isse

ctio

n/an

eu-

rysm

rupt

ure,

and

pul

mon

ary

embo

lism

3.3

4.3

0.88

(0.6

5–1.

00)

3.9

±0.

73.

6±

0.5

4.2

±0.

60.

028

2Kn

ow th

e tre

atm

ent o

f car

diog

enic

sho

ck2.

14.

31.

00 (1

.00–

1.00

)3.

8±

1.0

3.4

±1.

04.

2±

0.9

0.10

63

Can

inte

rpre

t ECG

3.0

4.0

0.92

(0.7

2–1.

00)

3.1

±1.

02.

6±

0.7

3.5

±1.

00.

052

4Ca

n m

ake

a di

agno

sis

of tr

aum

atic

car

diac

tam

pona

de2.

74.

30.

85 (0

.61–

1.00

)3.

5±

0.8

2.9

±0.

84.

1±

0.3

0.00

15

Can

iden

tify

hype

rtens

ive e

mer

genc

ies

and

know

the

rele

vant

pha

rmac

othe

rapy

2.7

4.3

0.88

(0.6

5–1.

00)

4.5

±0.

54.

4±

0.5

4.6

±0.

50.

525

*Ca

n di

ffere

ntia

te th

e fo

llow

ing

infla

mm

ator

y ca

rdia

c di

seas

e: e

ndoc

ardi

tis, m

yoca

rditi

s, a

nd p

eric

ardi

tis

2. P

ulm

onar

y6

Can

diffe

rent

iate

the

follo

win

g illn

esse

s of

dys

pnea

: ast

hma,

COP

D, a

nd c

onge

stive

hea

rt fa

ilure

3.4

4.0

0.75

(0.4

4–1.

00)

4.5

±0.

54.

6±

0.5

4.5

±0.

50.

821

7Kn

ow th

e ca

use

and

treat

men

t of h

emop

tysi

s3.

14.

00.

77 (0

.46–

1.00

)3.

9±

0.7

4.0

±0.

93.

8±

0.6

0.57

08

Know

the

diag

nose

s an

d tre

atm

ent o

f tra

umat

ic p

ulm

onar

y di

sord

er: h

emot

hora

x, te

nsio

n pn

eum

otho

rax,

and

pne

umo-

med

iast

inum

3.0

4.0

0.77

(0.4

6–1.

00)

3.9

±0.

84.

0±

0.5

3.9

±1.

00.

789

9Kn

ow th

e di

agno

ses

and

treat

men

t of s

pont

aneo

us p

neum

otho

rax

4.3

4.5

0.58

(0.2

0–0.

96)

3.7

±1.

13.

1±

0.9

4.2

±0.

90.

020

10Ca

n in

terp

ret A

BGA

3.4

4.0

0.75

(0.4

4–1.

00)

2.9

±1.

12.

3±

0.7

3.5

±1.

10.

014

*Kn

ow th

e di

agno

ses

and

treat

men

t of i

nfec

tious

pul

mon

ary

diso

rder

: bro

nchi

tis, b

ronc

hiol

itis,

pne

umon

ia, t

uber

culo

sis,

em

pyem

a, lu

ng a

bsce

ss, p

leur

isy

and

pleu

ral e

ffusi

on, a

nd p

ulm

onar

y fib

rosi

s

3. G

astro

inte

stin

al11

Can

diffe

rent

iate

the

follo

win

g illn

esse

s of

acu

te a

bdom

en: a

ppen

dici

tis, c

hole

cyst

itis,

cho

lang

itis,

dive

rticu

litis

, exa

cerb

a-tio

ns a

nd c

ompl

icat

ions

of i

nflam

mat

ory

bow

el d

isea

ses,

gas

tritis

, gas

troen

terit

is, g

astro

esop

hage

al re

flux

dise

ase,

he

patit

is, p

ancr

eatit

is, p

eptic

ulc

er, p

erito

nitis

, int

ussu

scep

tion,

bow

el p

erfo

ratio

n, a

nd is

chem

ic c

oliti

s

3.4

4.0

0.83

(0.5

7–1.

00)

4.1

±0.

74.

1±

0.6

4.1

±0.

70.

972

12Kn

ow th

e di

agno

ses

and

treat

men

t of d

iffer

ent i

llnes

ses

of u

pper

GI b

leed

ing

3.7

4.3

0.75

(0.4

4–1.

00)

4.1

±0.

74.

1±

0.6

4.1

±0.

90.

975

13Kn

ow th

e di

agno

ses

and

treat

men

t of d

iffer

ent i

llnes

ses

of lo

wer

GI b

leed

ing

3.6

4.3

0.75

(0.4

4–1.

00)

4.0

±0.

63.

9±

0.3

4.1

±0.

70.

442

14Kn

ow h

ow to

trea

t for

eign

bod

y in

upp

er G

I3.

34.

30.

88 (0

.65–

1.00

)3.

5±

0.8

3.4

±0.

73.

6±

1.0

0.69

9*

Know

the

stag

e an

d tre

atm

ent o

f her

nia

*Kn

ow th

e di

agno

ses

and

treat

men

t of i

ntes

tinal

obs

truct

ion

4.

Ren

al a

nd g

enito

urin

ary

15Ca

n di

agno

se a

nd tr

eat a

cid-

base

dis

turb

ance

2.6

4.0

0.92

(0.7

2–1.

00)

3.2

±0.

72.

9±

0.8

3.5

±0.

50.

060

16Ca

n di

agno

se a

nd tr

eat e

lect

rolyt

e di

sord

ers

2.7

3.8

0.85

(0.6

1–1.

00)

3.6

±0.

53.

3±

0.5

3.8

±0.

40.

018

17Ca

n di

ffere

ntia

te th

e ca

use

of in

fect

ious

illn

esse

s re

late

d to

gen

itour

inar

y tra

ct a

nd tr

eat a

ccor

ding

ly: a

cute

pye

lone

phrit

is,

pros

tatit

is, s

exua

lly tr

ansm

itted

dis

ease

s, a

nd u

rinar

y tra

ct in

fect

ions

3.0

4.0

0.83

(0.5

7–1.

00)

4.7

±0.

54.

9±

0.3

4.5

±0.

50.

071

18Ca

n di

ffere

ntia

te a

nd tr

eat u

rinar

y m

etab

olic

dis

orde

rs: a

cute

rena

l fai

lure

, nep

hrot

ic s

yndr

ome,

and

ure

mia

2.4

4.0

1.00

(1.0

0–1.

00)

3.6

±0.

73.

3±

0.5

3.8

±0.

80.

147

19Ca

n di

agno

se a

nd tr

eat u

rolit

hias

is3.

74.

50.

75 (0

.44–

1.00

)3.

9±

0.9

3.6

±0.

94.

2±

0.8

0.17

220

Know

the

indi

catio

n of

rena

l rep

lace

men

t tre

atm

ent:

hem

odia

lysis

, CAP

D, a

nd h

emop

erfu

sion

2.4

4.0

0.92

(0.7

2–1.

00)

3.3

±0.

83.

0±

0.9

3.5

±0.

70.

184

*Ca

n ev

alua

te a

nd tr

eat d

ehyd

ratio

n*

Can

diffe

rent

iate

and

trea

t tes

ticul

ar p

ain:

epi

didy

mo-

orch

itis

and

test

icul

ar to

rsio

n

(Con

tinue

d to

the

next

pag

e)


http://jkms.orghttps://doi.org/10.3346/jkms.2017.32.12.1931

(Con

tinue

d to

the

next

pag

e)

Topi

cs a

nd q

uest

ions

Kore

an e

mer

genc

y re

side

nts

Cam

eroo

nian

doc

tors

Juni

or

(n=

7)Se

nior

(n

=5)

AUC

(9

5%CI

)To

tal

(n=

19)

GP

(n=

9)Sp

ecia

list

(n=

10)

P va

lue

5.

Obs

tetri

cs a

nd g

ynec

olog

y21

Know

the

follo

win

g illn

esse

s of

low

er a

bdom

inal

pai

n: p

elvic

infla

mm

ator

y di

seas

e an

d ov

aria

n to

rsio

n2.

64.

00.

92 (0

.72–

1.00

)4.

3±

0.7

4.4

±0.

54.

1±

0.7

0.26

322

Know

illn

esse

s of

vag

inal

ble

edin

g2.

14.

01.

00 (1

.00–

1.00

)4.

2±

0.5

4.3

±0.

54.

1±

0.6

0.35

7*

Know

the

defin

ition

of f

ollo

win

g gy

neco

logi

c di

sord

ers:

abr

uptio

pla

cent

ae, e

clam

psia

, ect

opic

pre

gnan

cy, e

mer

genc

y

deliv

ery,

HELL

P sy

ndro

me

durin

g pr

egna

ncy,

hype

rem

esis

gra

vidar

um, p

lace

nta

prae

via, p

ost-

partu

m h

emor

rhag

e,

and

uter

ine

aton

y

6. P

edia

trics

23Ca

n di

ffere

ntia

te th

e ca

uses

of d

ehyd

ratio

n in

ped

iatri

c pa

tient

s an

d tre

at a

ccor

ding

ly3.

34.

30.

81 (0

.54–

1.00

)4.

4±

0.6

4.3

±0.

54.

4±

0.7

0.81

624

Can

diffe

rent

iate

the

caus

es o

f fev

er in

ped

iatri

c pa

tient

s3.

64.

30.

75 (0

.44–

1.00

)4.

5±

0.5

4.6

±0.

54.

5±

0.5

0.82

125

Can

diffe

rent

iate

the

caus

es o

f dys

pnea

in p

edia

tric

patie

nts

2.9

3.8

0.73

(0.3

9–1.

00)

4.2

±0.

64.

1±

0.3

4.2

±0.

80.

750

26Ca

n di

ffere

ntia

te th

e ca

uses

of a

cute

abd

omen

in p

edia

tric

patie

nts

incl

udin

g in

tuss

usce

ptio

n3.

44.

30.

75 (0

.44–

1.00

)4.

2±

0.5

4.2

±0.

44.

1±

0.6

0.61

027

Know

SID

S3.

03.

50.

63 (0

.27–

0.98

)3.

3±

0.7

3.1

±0.

33.

4±

0.9

0.31

3*

Can

diffe

rent

iate

the

caus

es o

f sei

zure

and

trea

t in

pedi

atric

pat

ient

s

7. In

fect

ious

dis

ease

28Kn

ow th

e di

agno

sis

and

treat

men

t of m

alar

ia2.

73.

50.

75 (0

.43–

1.00

)4.

9±

0.2

5.0

±0.

04.

9±

0.3

0.34

329

Know

the

com

plic

atio

ns o

f AID

S2.

33.

00.

81 (0

.51–

1.00

)4.

8±

0.4

4.8

±0.

44.

8±

0.4

0.91

230

Know

the

diag

nosi

s an

d tre

atm

ent o

f par

asito

sis

2.1

2.8

0.69

(0.3

2–1.

00)

4.6

±0.

64.

9±

0.3

4.3

±0.

70.

029

31Kn

ow th

e di

agno

ses

and

treat

men

t of s

epsi

s an

d se

ptic

sho

ck2.

74.

50.

96 (0

.84–

1.00

)4.

4±

0.6

4.3

±0.

74.

5±

0.5

0.56

532

Know

the

appr

opria

te re

spon

se a

nd p

reve

ntive

stra

tegy

for a

ccid

enta

l exp

osur

e of

the

follo

win

g illn

esse

s: H

BV, H

CV, A

IDS,

sy

philis

, rab

ies,

and

teta

nus

2.9

3.5

0.67

(0.3

2–1.

00)

4.3

±0.

74.

2±

1.0

4.3

±0.

50.

832

8.

Neu

rolo

gica

l dis

orde

r33

Can

diag

nose

pat

ient

s ad

mitt

ed fo

r men

tal c

hang

e as

a c

hief

com

plai

nt2.

74.

00.

92 (0

.72–

1.00

)3.

4±

0.8

3.0

±0.

73.

8±

0.8

0.03

334

Know

the

diag

nosi

s an

d tre

atm

ent o

f stro

ke3.

34.

00.

69 (0

.33–

1.00

)4.

3±

0.8

4.1

±0.

94.

5±

0.7

0.31

635

Know

the

diag

nosi

s of

dizz

ines

s2.

94.

00.

83 (0

.56–

1.00

)3.

6±

0.7

3.7

±0.

53.

5±

0.8

0.61

536

Know

the

treat

men

t of c

onvu

lsio

n2.

73.

80.

83 (0

.56–

1.00

)4.

4±

0.6

4.4

±0.

54.

3±

0.7

0.61

337

Know

the

diag

nosi

s an

d tre

atm

ent o

f hea

dach

e3.

44.

00.

75 (0

.44–

1.00

)4.

4±

0.5

4.3

±0.

54.

4±

0.5

0.77

938

Can

inte

rpre

t CT

imag

e of

trau

mat

ic h

ead

inju

ries:

sub

arac

hnoi

d he

mor

rhag

e, s

ubdu

ral a

nd e

xtra

dura

l hem

atom

ata

3.4

4.5

0.81

(0.4

7–1.

00)

4.1

±1.

03.

4±

0.9

4.6

±0.

70.

005

*Kn

ow th

e de

finiti

on a

nd tr

eatm

ent o

f fol

low

ing

neur

olog

ic d

isor

der:

Guilla

in-B

arrè

syn

drom

e, m

enin

gitis

, and

per

iphe

ral

faci

al p

alsy

(Bel

l’s p

alsy

)

9. T

oxic

olog

y39

Know

the

gene

ral t

reat

men

t of p

oiso

ned

patie

nts:

ant

idot

e, u

rine

alka

lizat

ion,

and

dia

lysis

2.4

3.8

0.88

(0.6

5–1.

00)

3.1

±0.

73.

0±

0.7

3.1

±0.

70.

767

40Kn

ow th

e tre

atm

ent o

f cau

stic

inju

ry2.

13.

80.

98 (0

.90–

1.00

)3.

8±

0.7

3.3

±0.

93.

6±

0.5

0.42

0*

Know

the

treat

men

t of s

peci

fic d

rug

into

xicat

ion:

par

acet

amol

, sal

icyla

tes,

am

phet

amin

e, a

ntic

holin

ergi

cs, a

ntic

onvu

l-sa

nts,

tric

yclic

ant

idep

ress

ants

, ant

ihyp

erte

nsive

, ben

zodi

azep

ines

, dig

italis

, mon

oam

ine

oxid

ase

inhi

bito

rs, n

euro

lept

ics,

ag

ricul

tura

l pes

ticid

es, a

nd p

lant

s &

mus

hroo

ms

10.

End

ocrin

e an

d m

etab

olic

41Kn

ow th

e di

agno

ses

and

treat

men

t of D

KA, H

HS, a

nd A

KA2.

64.

00.

92 (0

.72–

1.00

)4.

0±

0.7

3.9

±0.

64.

1±

0.7

0.50

642

Know

the

diag

nose

s an

d tre

atm

ent o

f hyp

oglyc

emia

2.7

4.0

1.00

(1.0

0–1.

00)

4.7

±0.

54.

7±

0.5

4.8

±0.

40.

537

43Kn

ow a

dren

al c

risis

and

insu

ffici

ency

2.1

3.5

0.96

(0.8

4–1.

00)

3.2

±0.

93.

0±

1.1

3.3

±0.

70.

483

*Kn

ow th

e em

erge

ncy

diso

rder

abo

ut th

yroi

d: h

yper

thyr

oidi

sm, h

ypot

hyro

idis

m, m

yxed

ema

com

a, a

nd th

yroi

d st

orm

Supp

lem

enta

ry T

able

1. C

ontin

ued



Topi

cs a

nd q

uest

ions

Kore

an e

mer

genc

y re

side

nts

Cam

eroo

nian

doc

tors

Juni

or

(n=

7)Se

nior

(n

=5)

AUC

(9

5%CI

)To

tal

(n=

19)

GP

(n=

9)Sp

ecia

list

(n=

10)

P va

lue

11.

Hem

atol

ogic

and

onc

olog

ic44

Know

the

caus

e an

d di

agno

sis

of a

nem

ia3.

14.

00.

83 (0

.57–

1.00

)4.

6±

0.5

4.6

±0.

54.

6±

0.5

0.85

545

Know

tran

sfus

ion

reac

tion

3.0

4.0

0.83

(0.5

7–1.

00)

4.4

±0.

74.

2±

0.7

4.6

±0.

70.

246

46Kn

ow th

e fo

llow

ing

vasc

ular

dis

orde

rs (i

sche

mia

and

ble

edin

g): a

cqui

red

blee

ding

dis

orde

rs (c

oagu

latio

n fa

ctor

defi

cien

cy,

diss

emin

ated

intra

vasc

ular

coa

gula

tion)

, dru

g in

duce

d bl

eedi

ng (a

ntic

oagu

lant

s, a

ntip

late

let a

gent

s, fi

brin

olyt

ic),

id

iopa

thic

thro

mbo

cyto

peni

c pu

rpur

a, a

nd th

rom

botic

thro

mbo

cyto

peni

c pu

rpur

a

2.3

3.8

0.96

(0.8

4–1.

00)

3.6

±0.

73.

2±

0.7

3.9

±0.

60.

028

*Kn

ow h

emat

olog

ic c

onge

nita

l dis

orde

r: he

mop

hilia

and

VW

D, h

ered

itary

hem

olyt

ic a

nem

ia, a

nd s

ickl

e ce

ll di

seas

e*

Know

infla

mm

ator

y an

d in

fect

ious

dis

orde

rs a

bout

hem

atol

ogy:

neu

trope

nic

feve

r and

infe

ctio

ns in

imm

uno-

com

prom

ised

pa

tient

s 1

2. E

yes,

ear

s, n

ose,

thro

at, o

ral,

and

neck

47Kn

ow h

ow to

rem

ove

fore

ign

bodi

es o

f mou

th a

nd n

asal

cav

ity3.

44.

00.

65 (0

.28–

1.00

)3.

0±

0.9

2.9

±1.

13.

1±

0.7

0.61

648

Know

the

diag

nose

s an

d tre

atm

ent o

f ora

l infl

amm

ator

y illn

esse

s: a

ngio

edem

a, e

pigl

ottit

is, l

aryn

gitis

, and

par

aton

silla

r ab

sces

s2.

94.

30.

94 (0

.78–

1.00

)3.

5±

0.7

3.6

±0.

53.

4±

0.8

0.64

1

49Kn

ow th

e di

agno

ses

and

treat

men

t of t

he fo

llow

ing

inju

ries:

fore

ign

body

in th

e ey

e, o

cula

r inj

urie

s, c

anal

icul

ar la

cera

tion,

co

rnea

l abr

asio

n, a

nd h

yphe

mia

3.0

3.5

0.71

(0.3

7–1.

00)

2.7

±0.

92.

9±

0.9

2.5

±0.

80.

354

50Kn

ow th

e di

agno

stic

sta

ndar

d of

acu

te g

lauc

oma

2.4

3.0

0.67

(0.3

2–1.

00)

2.9

±0.

83.

0±

0.7

2.8

±0.

90.

605

51Kn

ow th

e tre

atm

ent o

f che

mic

al-in

duce

d ey

e in

jury

3.0

3.3

0.56

(0.2

0–0.

93)

2.8

±0.

82.

9±

0.6

2.7

±0.

90.

616

52Kn

ow th

e tre

atm

ent o

f nas

al h

emor

rhag

e3.

64.

30.

75 (0

.44–

1.00

)3.

5±

0.7

3.6

±0.

73.

4±

0.7

0.64

153

Know

the

diag

nosi

s of

trau

mat

ic p

erfo

ratio

n of

ear

dru

m3.

13.

80.

58 (0

.20–

0.97

)3.

3±

1.1

3.7

±1.

03.

0±

1.1

0.17

754

Can

diag

nose

nas

al b

one

fract

ure

3.6

4.8

0.92

(0.7

2–1.

00)

3.6

±0.

73.

8±

0.4

3.6

±0.

70.

522

13.

Der

mat

olog

ic55

Know

the

diag

nosi

s an

d tre

atm

ent o

f her

pes

zost

er3.

34.

80.

88 (0

.65–

1.00

)4.

2±

0.7

4.2

±0.

74.

1±

0.7

0.71

156

Know

the

diag

nosi

s an

d tre

atm

ent o

f ana

phyla

xis3.

64.

50.

83 (0

.56–

1.00

)4.

1±

0.8

3.9

±0.

84.

3±

0.8

0.28

1*

Know

the

diag

nosi

s an

d tre

atm

ent o

f her

pes

zost

er*

Know

the

char

acte

r and

can

diff

eren

tiate

of f

ollo

win

g de

rmat

olog

ic d

isor

ders

: ery

them

a m

ultif

orm

e, to

xic e

pide

rmal

ne

cros

is, e

xfol

iativ

e de

rmat

itis,

toxic

sho

ck s

yndr

ome,

sta

phylo

cocc

al s

cald

ed s

kin

synd

rom

e, a

nd m

enin

goco

ccem

ia 1

4. T

raum

a57

Can

iden

tify

anat

omic

al lo

catio

n of

inju

ry in

a tr

aum

a pa

tient

3.7

4.3

0.69

(0.3

4–1.

00)

4.2

±0.

54.

1±

0.6

4.3

±0.

50.

458

58Ca

n tri

age

patie

nt w

ith m

ultip

le in

jurie

s2.

93.

30.

58 (0

.20–

0.96

)4.

2±

0.6

4.1

±0.

34.

2±

0.8

0.75

059

Know

flui

d th

erap

y fo

r tra

umat

ic h

ypov

olem

ic s

hock

2.6

4.0

0.88

(0.6

5–1.

00)

4.0

±0.

73.

9±

0.8

4.1

±0.

70.

553

60Ca

n id

entif

y pr

esen

ce o

f inj

ury

usin

g FA

ST2.

14.

30.

96 (0

.84–

1.00

)2.

3±

1.0

1.9

±0.

92.

6±

1.1

0.14

3 1

5. M

uscu

losk

elet

al61

Can

diag

nose

the

follo

win

g m

uscu

losk

elet

al il

lnes

ses:

cel

lulit

is, a

nd n

ecro

tizin

g fa

sciit

is2.

74.

00.

90 (0

.66–

1.00

)3.

9±

0.7

3.7

±0.

94.

1±

0.6

0.21

062

Know

the

diag

nose

s an

d tre

atm

ent o

f the

follo

win

g sy

mpt

oms

and

illnes

ses:

bac

k pa

in, c

omm

on fr

actu

res

and

disl

oca-

tions

, com

partm

ent s

yndr

omes

, cru

sh s

yndr

ome,

ost

eoar

thro

sis,

rhab

dom

yolys

is, a

nd s

oft t

issu

e tra

uma

3.0

4.3

0.94

(0.7

8–1.

00)

3.6

±0.

73.

2±

0.7

4.0

±0.

70.

021

*Ca

n di

ffere

ntia

te ty

pes

of m

uscu

losk

elet

al in

flam

mat

ory

diso

rder

s: a

rthrit

is, b

ursi

tis, c

ompl

icat

ions

of s

yste

mic

rheu

mat

ic

dise

ases

, ost

eom

yelit

is, a

nd rh

eum

atic

pol

ymya

lgia

(Con

tinue

d to

the

next

pag

e)

Supp

lem

enta

ry T

able

1. C

ontin

ued



Topi

cs a

nd q

uest

ions

Kore

an e

mer

genc

y re

side

nts

Cam

eroo

nian

doc

tors

Juni

or

(n=

7)Se

nior

(n

=5)

AUC

(9

5%CI

)To

tal

(n=

19)

GP

(n=

9)Sp

ecia

list

(n=

10)

P va

lue

16.

Psy

chia

tric

and

beha

vior

63Kn

ow th

e fo

llow

ing

psyc

hiat

ric e

mer

genc

y illn

esse

s: a

nore

xia a

nd b

ulim

ia c

ompl

icat

ions

, anx

iety

and

pan

ic a

ttack

s,

conv

ersi

on d

isor

ders

, del

iber

ate

self-

harm

and

sui

cide

atte

mpt

, dep

ress

ive il

lnes

s, p

erso

nalit

y di

sord

ers,

sub

stan

ce,

drug

and

alc

ohol

abu

se

2.6

3.8

0.88

(0.6

5–1.

00)

2.8

±1.

03.

0±

1.0

2.7

±0.

90.

511

*Kn

ow th

e fo

llow

ing

beha

vior d

isor

ders

: affe

ctive

dis

orde

rs, c

onfu

sion

and

con

scio

usne

ss d

istu

rban

ces,

inte

lligen

ce

dist

urba

nces

, mem

ory

diso

rder

s, p

erce

ptio

n di

sord

ers,

psy

cho-

mot

or d

istu

rban

ces,

and

thin

king

dis

turb

ance

s 1

7. R

esus

cita

tion

64Kn

ow th

e tre

atm

ent c

ours

e of

car

diac

arre

st in

nee

d of

defi

brilla

tion

3.1

4.3

0.94

(0.7

8–1.

00)

3.3

±0.

92.

8±

0.8

3.7

±0.

70.

016

65Kn

ow il

lnes

ses

of p

ulse

less

ele

ctric

act

ivity

and

asy

stol

e: A

cido

sis,

hyp

oxia

, hyp

othe

rmia

, hyp

o-/h

yper

kale

mia

, hyp

ocal

-ca

emia

, hyp

o-/h

yper

glyc

emia

, hyp

ovol

emia

, ten

sion

pne

umot

hora

x, c

ardi

ac ta

mpo

nade

, myo

card

ial i

nfar

ctio

n, p

ulm

o-na

ry e

mbo

lism

, and

poi

soni

ng

2.9

4.3

0.94

(0.7

8–1.

00)

3.4

±0.

73.

1±

0.6

3.6

±0.

70.

123

II. S

peci

fic a

spec

ts o

f em

erge

ncy

med

icin

e 1

8. D

isas

ter

66Kn

ow th

e fo

llow

ing

conc

epts

of d

isas

ter:

disa

ster

pre

pare

dnes

s, m

ajor

inci

dent

pla

nnin

g/pr

oced

ures

/pra

ctic

e, d

isas

ter

resp

onse

, and

mas

s ga

ther

ings

1.9

3.0

0.77

(0.4

3–1.

00)

2.8

±1.

12.

6±

1.0

3.1

±1.

10.

279

19.

Abu

se a

nd a

ssau

lt67

Know

the

follo

win

g co

ncep

ts o

f abu

se a

nd a

ssau

lt: a

buse

in th

e el

derly

and

impa

ired,

chi

ld a

buse

and

neg

lect

, int

imat

e pa

rtner

vio

lenc

e an

d ab

use,

sex

ual a

ssau

lt, p

atie

nt s

afet

y in

em

erge

ncy

med

icin

e, a

nd v

iole

nce

man

agem

ent a

nd

prev

entio

n in

the

ED

2.6

3.5

0.75

(0.4

4–1.

00)

2.8

±1.

02.

4±

0.9

3.2

±1.

00.

106

20.

Env

ironm

enta

l inj

urie

s68

Know

the

diag

nosi

s an

d tre

atm

ent o

f illn

ess

caus

e by

ele

ctric

ity a

nd li

ghte

ning

2.3

3.3

0.79

(0.4

7–1.

00)

3.3

±0.

73.

0±

0.7

3.5

±0.

50.

096

69Kn

ow th

e di

agno

sis

and

treat

men

t of f

ebril

e illn

esse

s an

d co

ld-r

elat

ed il

lnes

ses

2.3

3.5

0.92

(0.7

4–1.

00)

3.5

±0.

63.

3±

0.7

3.6

±0.

50.

356

70Kn

ow th

e tre

atm

ent o

f wat

er-r

elat

ed in

jurie

s: n

ear-

drow

ning

, dys

baris

m a

nd c

ompl

icat

ions

of d

iving

, and

mar

ine

faun

a2.

63.

50.

79 (0

.50–

1.00

)2.

6±

0.8

2.2

±0.

43.

0±

0.8

0.02

171

Know

the

diag

nosi

s an

d tre

atm

ent o

f CO

pois

onin

g2.

64.

00.

88 (0

.65–

1.00

)3.

0±

1.0

2.7

±0.

73.

3±

1.2

0.17

5 2

1. P

reho

spita

l car

e72

Know

abo

ut e

mer

genc

y m

edic

al s

ervic

e or

gani

zatio

ns (a

dmin

istra

tion,

stru

ctur

e, s

taffi

ng, r

esou

rces

)1.

63.

30.

79 (0

.45–

1.00

)3.

1±

0.6

3.1

±0.

83.

1±

0.3

0.96

473

Is in

form

ed o

f med

ical

tran

spor

t (in

clud

ing

neon

ates

, chi

ldre

n, a

nd a

ir tra

nspo

rt)1.

63.

00.

77 (0

.43–

1.00

)2.

9±

0.9

2.7

±0.

73.

1±

1.1

0.32

874

Know

abo

ut c

once

pts

and

issu

es o

f saf

ety

at th

e sc

ene

1.8

3.0

0.73

(0.3

8–1.

00)

3.2

±0.

93.

0±

0.9

3.3

±0.

90.

483

75Kn

ow a

bout

par

amed

ic tr

aini

ng a

nd fu

nctio

n1.

63.

00.

75 (0

.42–

1.00

)3.

2±

0.6

3.1

±0.

63.

2±

0.6

0.75

876

Know

con

cept

s of

col

labo

ratio

n w

ith o

ther

em

erge

ncy

serv

ices

(e.g

. pol

ice

and

fire

depa

rtmen

t)1.

43.

00.

79 (0

.47–

1.00

)3.

5±

0.8

3.1

±0.

83.

8±

0.6

0.04

9

Supp

lem

enta

ry T

able

1. C

ontin

ued

(Con

tinue

d to

the

next

pag

e)



Supp

lem

enta

ry T

able

1. C

ontin

ued

Topi

cs a

nd q

uest

ions

Kore

an e

mer

genc

y re

side

nts

Cam

eroo

nian

doc

tors

Juni

or

(n=

7)Se

nior

(n

=5)

AUC

(9

5%CI

)To

tal

(n=

19)

GP

(n=

9)Sp

ecia

list

(n=

10)

P va

lue

III. C

linic

al p

roce

dure

and

ski

ll 2

2. C

PR s

kills

77Kn

ow C

PR p

roce

dure

gui

delin

es fo

r adu

lts a

nd p

edia

trics

3.0

4.3

0.88

(0.6

5–1.

00)

3.6

±0.

93.

2±

0.8

3.9

±0.

90.

103

78Kn

ow a

dvan

ced

CPR

skills

(e.g

. the

rape

utic

hyp

othe

rmia

or o

pen

ches

t CPR

)2.

94.

30.

94 (0

.78–

1.00

)2.

7±

0.9

2.4

±0.

52.

9±

1.1

0.26

379

Know

the

follo

win

g ai

rway

man

agem

ent t

echn

ique

s: in

serti

on o

f oro

phar

ynge

al o

r nas

opha

ryng

eal a

irway

, end

otra

chea

l in

tuba

tion,

alte

rnat

ive a

irway

tech

niqu

es in

the

emer

genc

y se

tting

(e.g

. lar

ynge

al m

ask

inse

rtion

or s

urgi

cal a

irway

)2.

64.

51.

00 (1

.00–

1.00

)2.

9±

1.1

2.3

±0.

93.

5±

1.1

0.02

0

80Kn

ow th

e fo

llow

ing

brea

thin

g an

d ve

ntila

tion

man

agem

ent t

echn

ique

s: o

xyge

n th

erap

y, pu

lse

oxim

etry

and

cap

nogr

aphy

, ba

g-m

ask-

valve

ven

tilat

ion,

thor

acen

tesi

s, c

hest

tube

inse

rtion

, con

nect

ion

to u

nder

-wat

er d

rain

age

and

asse

ssm

ent o

f fu

nctio

ning

, non

-inva

sive

ven

tilat

ion

tech

niqu

es, a

nd in

vasi

ve v

entil

atio

n te

chni

ques

2.3

4.5

1.00

(1.0

0–1.

00)

3.2

±0.

92.

8±

0.8

3.6

±0.

70.

032

81Kn

ow th

e fo

llow

ing

circ

ulat

ory

supp

ort a

nd c

ardi

ac s

kills

and

pro

cedu

res:

mon

itorin

g of

ECG

and

the

circ

ulat

ion,

defi

bril-

latio

n an

d pa

cing

(e.g

. car

diov

ersi

on, t

rans

cuta

neou

s pa

cing

), em

erge

ncy

peric

ardi

ocen

tesi

s, a

nd v

ascu

lar a

cces

s

(per

iphe

ral v

enou

s, a

rteria

l, an

d ce

ntra

l ven

ous

cath

eter

izatio

n, a

nd in

traos

seou

s ac

cess

)

2.4

4.5

1.00

(1.0

0–1.

00)

2.9

±0.

82.

4±

0.9

3.4

±0.

50.

010

82Kn

ow a

bout

diffi

cult

airw

ay m

anag

emen

t alg

orith

m1.

93.

80.

96 (0

.84–

1.00

)2.

8±

1.0

2.2

±0.

73.

4±

1.0

0.00

783

Know

abo

ut th

e dr

ugs

used

in A

CLS

2.1

4.3

1.00

(1.0

0–1.

00)

3.2

±1.

03.

0±

1.1

3.4

±0.

80.

388

84Kn

ow th

e co

ncep

ts a

nd te

chni

ques

of r

apid

seq

uenc

e in

tuba

tion

2.4

4.5

0.96

(0.8

4–1.

00)

2.9

±1.

12.

3±

0.7

3.5

±1.

20.

020

85Ca

n pe

rform

inse

rtion

and

repl

acem

ent o

f tra

cheo

stom

y tu

be1.

64.

31.

00 (1

.00–

1.00

)2.

9±

1.0

2.4

±0.

53.

3±

1.3

0.07

1 2

3. P

roce

dure

86Kn

ow th

e fo

llow

ing

gast

roin

test

inal

pro

cedu

res:

inse

rtion

of n

asog

astri

c tu

be, g

astri

c la

vage

, per

itone

al la

vage

, abd

omin

al

hern

ia re

duct

ion,

and

abd

omin

al p

arac

ente

sis

3.1

4.3

0.94

(0.7

8–1.

00)

3.8

±0.

83.

4±

1.0

4.1

±0.

30.

094

87Kn

ow th

e fo

llow

ing

geni

tour

inar

y pr

oced

ures

: ins

ertio

n of

indw

ellin

g ur

ethr

al c

athe

ter,

supr

apub

ic c

ysto

stom

y, te

stic

ular

to

rsio

n re

duct

ion,

and

eva

luat

ion

of p

aten

cy o

f ure

thra

l cat

hete

r2.

43.

80.

83 (0

.52–

1.00

)3.

4±

0.8

3.1

±0.

83.

6±

0.8

0.20

9

88Kn

ow th

e fo

llow

ing

mus

culo

skel

etal

pro

cedu

res:

ase

ptic

join

t asp

iratio

n, fr

actu

re im

mob

ilizat

ion,

redu

ctio

n of

join

t dis

lo-

catio

n, lo

g ro

ll an

d sp

ine

imm

obiliz

atio

n, s

plin

ting

(pla

ster

s, b

race

s, s

lings

, tap

es a

nd o

ther

ban

dage

s), a

nd m

anag

e-m

ent o

f com

partm

ent s

yndr

ome

2.3

3.5

0.83

(0.5

2–1.

00)

3.3

±0.

93.

0±

0.7

3.5

±1.

10.

255

89Kn

ow th

e fo

llow

ing

neur

olog

ical

pro

cedu

res:

eva

luat

ion

of c

onsc

ious

ness

incl

udin

g th

e Gl

asgo

w C

oma

Scal

e, fu

ndus

copi

c ex

am, a

nd lu

mba

r pun

ctur

e2.

93.

80.

71 (0

.34–

1.00

)4.

3±

0.5

4.3

±0.

54.

3±

0.5

0.88

4

90Kn

ow th

e fo

llow

ing

obst

etric

and

gyn

ecol

ogic

al p

roce

dure

s: e

mer

genc

y de

liver

y, va

gina

l exa

min

atio

n us

ing

spec

ulum

, and

as

sess

men

t of t

he s

exua

l ass

ault

victim

1.7

2.0

0.58

(0.2

2–0.

95)

3.8

±0.

83.

8±

0.7

3.9

±0.

90.

739

91Kn

ow th

e fo

llow

ing

tem

pera

ture

con

trol p

roce

dure

s: m

easu

ring

and

mon

itorin

g of

bod

y te

mpe

ratu

re, c

oolin

g te

chni

ques

(e

vapo

rativ

e co

olin

g, ic

e w

ater

or s

lush

imm

ersi

on),

inte

rnal

coo

ling

met

hods

, war

min

g te

chni

ques

, mon

itorin

g he

at

stro

ke p

atie

nts,

and

trea

tmen

t and

pre

vent

ion

of h

yper

- an

d hy

poth

erm

ia

1.6

3.5

1.00

(1.0

0–1.

00)

3.3

±0.

93.

0±

0.7

3.5

±1.

00.

222

92Kn

ow th

e fo

llow

ing

wou

nd m

anag

emen

t pro

cedu

res:

abs

cess

inci

sion

and

dra

inag

e, a

sept

ic te

chni

ques

, tre

atm

ent o

f la

cera

tions

and

sof

t tis

sue

inju

ries,

and

wou

nd ir

rigat

ion

and

wou

nd c

losu

re3.

04.

00.

77 (0

.46–

1.00

)3.

9±

0.9

3.4

±0.

94.

3±

0.8

0.04

3

93Kn

ow d

econ

tam

inat

ion

proc

edur

e fo

r pat

ient

s an

d su

rroun

ding

s2.

33.

30.

73 (0

.41–

1.00

)3.

3±

0.9

2.9

±0.

83.

6±

0.8

0.07

594

Know

pat

ient

tran

sfer

pro

cedu

res:

tele

com

mun

icat

ion

and

tele

med

icin

e pr

oced

ures

, pre

para

tion

of th

e EM

S ve

hicl

e, a

nd

spec

ific

aspe

cts

of m

onito

ring

and

treat

men

t dur

ing

trans

porta

tion

2.3

3.5

0.73

(0.4

0–1.

00)

2.9

±0.

82.

6±

0.7

3.3

±0.

70.

033

*Kn

ow th

e fo

llow

ing

opht

halm

ic p

roce

dure

s: re

mov

al o

f for

eign

bod

y fro

m th

e ey

e, s

lit la

mp

use,

and

late

ral c

anth

otom

y*

Know

the

follo

win

g pr

oced

ures

: mea

sure

men

t of a

bdom

inal

pre

ssur

e, p

roct

osco

py, f

asci

otom

y, an

d es

char

otom

y

Valu

es a

re p

rese

nted

as

mea

n (fo

r Kor

ean

emer

genc

y re

side

nts)

and

mea

n±

SD (f

or C

amer

ooni

an d

octo

rs).

AUC

=ar

ea u

nder

cur

ve, G

P=

gene

ral p

hysi

cian

, ECG

=el

ectro

card

iogr

am, C

OPD

=ch

roni

c ob

stru

ctive

pul

mon

ary

dise

ase,

ABG

A=

arte

rial b

lood

gas

ana

lysis

, GI=

gast

roin

test

inal

, CAP

D=

cont

inuo

us a

mbu

lato

ry p

erito

neal

dia

lysis

, SI

DS=

sudd

en in

fant

dea

th s

yndr

ome,

AID

S=

acqu

ired

imm

une

defic

ienc

y sy

ndro

me,

HBV

=he

patit

is B

viru

s, H

CV=

hepa

titis

C v

irus,

CT

=co

mpu

ted

tom

ogra

phy,

DKA

=di

abet

es k

etoa

cido

sis,

HHS

=hy

perg

lycem

ic h

yper

osm

olar

st

ate,

AKA

=al

coho

lic k

etoa

cido

sis,

VW

D=

Von

Wille

bran

d di

seas

e, F

AST

=fo

cuse

d ab

dom

inal

son

ogra

phy

for t

raum

a, E

D=

emer

genc

y de

partm

ent,

CO=

carb

on m

onox

ide,

CPR

=ca

rdio

pulm

onar

y re

susc

itatio

n, A

CLS

=ad

vanc

ed

card

iac

life

supp

ort,

EMS

=em

erge

ncy

med

ical

ser

vice.

*Nin

etee

n qu

estio

ns w

ere

rem

oved

afte

r exp

ert s

urve

y.



Supplementary Table 2. Scenario-based competency assessment tool of 26 sub-questions developed for 14 questions of the self-survey competency assessment

Scenario Questions and items for the scenario-based competency assessment

1. Septic shock 1 Know the diagnosis and treatment of sepsis and septic shock (self-survey #31)

1) Check onset of fever (1 day ago)2) Check onset of groin pain (3 days ago)3) Check past medical history (diabetes mellitus, hypertension, etc.)4) Can interpret initial vital sign 100/50 mmHg – 106 bpm – 12/min – 99.5°F (37.5°C)5) Can recognize septic shock (vital sign after 5 min) 80/- mmHg – 120 bpm – 28/min – (SpO2 100%)6) Can order appropriate blood lab tests

- CBC, chemistries, coagulation panel, lactate, ABGA (or VBGA), serology, ABO Rh type-Ab screening, etc.7) Can interpret blood lab test results

- Leukocytosis, hyponatremia, ARF or ARF on CRF or CRF, hyperglycemia, elevated lactate level, high anion gap metabolic acidosis8) Know the targets and targeted goal therapy for septic shock patients

- CVP (8–12 mmHg), mean BP (65–90 mmHg), ScvO2 ( ≥ 70%)9) Can provide proper surgical consultation

2 Can diagnose the following musculoskeletal illnesses: cellulitis, necrotizing fasciitis (self-survey #61) 1) Can diagnose the following musculoskeletal illness (with a picture) - necrotizing fasciitis

3 Can interpret ABGA (self-survey #10)1) Can interpret ABGA results with electrolytes ABGA 7.20 – 32 – 95 – 14

- High AG metabolic acidosis, metabolic alkalosis, respiratory acidosis 2. Diabetes ketoacidosis

4 Can evaluate fluid status (dehydration) (self-survey #4)1) Can evaluate fluid status (dehydration): nausea, vomiting, thirsty (polydipsia), polyuria, low BP, tachycardia, tachypnea, dry mucous membrane, clammy and cool

skin, confusion status, dehydrated status 5 Know the diagnosis and treatment of DKA (self-survey #41)

1) Recognition of DKA – high anion gap metabolic acidosis (pH < 7.3), decreased TCO2 ( < 10), hyperglycemia ( > 250), ketonemia2) Initial treatment of DKA – normal saline 2 L/hr for 2hr3) Precautions for insulin administration – confirmation of urine output and K level4) Add 5% dextrose water if BST is approaching 250 mg/dL

6 Can treat electrolyte disorders (self-survey #16)1) Can explain the reason why a patient should have serum potassium level checked frequently

3. STEMI 7 Can differentiate the following illnesses of chest pain: acute coronary syndromes, stable angina, aortic dissection/aneurysm rupture, pulmonary embolism (self-survey #1)

1) Can make a differential diagnosis of chest pain including these diseases: acute coronary syndromes, aortic dissection pulmonary embolism 8 Can interpret ECG (self-survey #3)

1) Can make an interpretation of ECG- 1. Inferior STEMI; 2. Lead II, III, aVF ST segment elevation; 3. Lead I, aVL, V6 (reciprocal) ST segment depression

9 Know the following circulatory support and cardiac skills and procedures: Monitoring of ECG and the circulation, Defibrillation and pacing (self-survey #81)1) Can perform defibrillation and pacing (e.g. cardioversion, transcutaneous pacing)

- 1. Prompt CPR; 2. Defibrillation; 3. Manufacturer recommending dose or biphasic 200J or monophasic 360J4. Multiple trauma

10 Know fluid therapy for traumatic hypovolemic shock (self-survey #59)1) Choice of fluid for initial resuscitation 2) Method of transfusion for hemorrhagic shock patients

11 Know the diagnoses and treatment of traumatic pulmonary disorders: hemothorax, tension pneumothorax, pneumomediastinum (self-survey #8)1) Can explain the diagnosis and the treatment of traumatic pulmonary disorder – hemothorax

5. Anaphylaxis12 Know the diagnoses and treatment of oral inflammatory illnesses: angioedema, epiglottitis, laryngitis, paratonsillar abscess (self-survey #48)

1) Can explain the diagnosis and treatment of angioedema13 Know the diagnosis and treatment of anaphylaxis (self-survey #56)

1) Can explain the diagnosis and treatment of anaphylaxis14 Know about difficult airway management algorithms (self-survey #82)

1) Know about difficult airway management algorithms

CBC = complete blood count, ABGA = arterial blood gas analysis, VBGA = venous blood gas analysis, ARF = acute renal failure, CRF = chronic renal failure, CVP = central ve-nous pressure, BP = blood pressure, ScvO2 = central venous oxygen saturation, AG = anion gap, DKA = diabetes ketoacidosis, TCO2 = total carbon dioxide, STEMI = ST ele-vation myocardial infarction, ECG = electrocardiogram, CPR = cardiopulmonary resuscitation.

Documents

Assessment of Competence in Emergency Medicine among ...€¦ · five life-threatening diseases presenting frequently in emergency rooms of Cameroon. Response rate of the self-survey