title: In-process modification yields improved teaching outcomes for international emergency medicine.
abstract: OBJECTIVE
  To determine if on-going modification of an international teaching course in emergency medicine will improve audience perception and receptivity.
  
  
  METHODS
  Over 4 years, we conducted surveys during emergency medicine symposiums given in Ghana, West Africa. In 2003, 2004 and 2006, symposium interventions of content modification (lecture topics/workshops), audience modification (smaller groups, designing workshops for different levels of providers) and in-process modification (modification of lecture technique in two sequential 2006 symposiums) were done. Survey responses were analyzed to determine what interventions resulted in greater participant satisfaction. When comparing the three groups, a one-way ANOVA test was conducted to determine differences among the 3 years. When comparing two groups, Levene's test for equality of variances was conducted for annual variance, and based on that result, an independent t-test was calculated.
  
  
  RESULTS
  The one-way ANOVA test indicated that there was a statistically significant difference among the three groups (2003, 2004, 2006) of symposium participants in four questions related to the participants' perception of the instructors. The independent t-test comparing the aggregate data of 2003 and 2004 with 2006 (audience modification and in-process modification between two sequential symposiums) showed a statistically significant improvement in the participants' receptivity. The data indicated that modifying the content of international symposiums and modifying the audience to which it is addressed are equally valuable tools to ensure a positive participant receptivity. Moreover, the data indicated that "in-process" modification conducted between the two sequential 2006 symposiums produced a statistically significant increase in positive perception, facilitating knowledge transfer.
  
  
  CONCLUSIONS
  Statistical analysis of surveys coupled with modification and intervention can improve participant satisfaction in international teaching programs.
authors.affiliation: Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ, USA. bradenbr@aol.com
authors.forename: Beau R
authors.initials: BR
authors.lastname: Braden
authors.forename: Kathryn R
authors.initials: KR
authors.lastname: Challoner
authors.forename: Buck A
authors.initials: BA
authors.lastname: Braden
authors.forename: Nicholas
authors.initials: N
authors.lastname: Testa