title: Performance of emergency medicine residents on a novel practice examination using visual stimuli.
abstract: OBJECTIVE
  In 2004, the format of the Royal College of Physicians and Surgeons of Canada certification exam in Emergency Medicine was modified to include an audiovisual session. Residents' performance on such stimuli is unknown. This study aims to determine the performance of Emergency Medicine postgraduate year 5 (PGY-5) on a novel practice examination using visual stimuli, in an effort to guide residents' preparatory study, and to help educators focus the teaching related to visual stimuli.
  
  
  METHODS
  In this prospective observational study, 30 PGY-5 residents from 12 Emergency Medicine programs across Canada participated in a practice examination in which they had to answer 133 questions related to 80 visual stimuli. The stimuli included electrocardiograms, medical imaging and clinical photographs. Three experienced faculty provided "reference standard" answers for the visual stimuli. For analysis purpose, stimuli were classified into 9 clinical domains, outlined in The Model of the Clinical Practice of Emergency Medicine.
  
  
  RESULTS
  Insufficient question numbers in 3 domains prevented reliable inferences. Correct answers were given for 65% of remaining questions, with the following domain distribution: 69% respiratory, 64% trauma, 73% cardiovascular, 62% head-eyes-ears-nose-throat (HEENT), 63% musculoskeletal and 69% cutaneous. Seventy-four percent of ECGs, 64% of imaging, and 62% of photograph-related questions were answered correctly. Incorrect answers were related to a lack of knowledge as well as imprecise or incomplete responses.
  
  
  CONCLUSIONS
  PGY-5 subjects scored lowest in the HEENT and musculoskeletal domains. Medical educators should emphasize these domains in their teaching, and insist on precision and completeness of answers.
authors.affiliation: Department of Emergency Medicine, Queen's University, Kingston, ON.
authors.forename: Danielle
authors.initials: D
authors.lastname: Blouin
authors.forename: Luigi Eugene
authors.initials: LE
authors.lastname: Dagnone
authors.forename: Robert
authors.initials: R
authors.lastname: McGraw
mesh_terms: D001296:Audiovisual Aids; D002170:Canada; D004521:Educational Measurement; D004635:Emergency Medicine / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D011446:Prospective Studies