Improvement of physician's confidence in handling minor emergencies before/after triage and action minor emergency course.

Dear Editor,

Triage and action (T&A) minor emergency course aimed at improving the clinical knowledge and skills for minor emergencies. However, information on the physicians’ clinical practice for minor emergencies after taking the course was limited. Therefore, this study aimed to evaluate the change in physicians’ confidence, with the hypothesis that the training would significantly improve physicians’ confidence for minor emergency treatment even after 6 months.

This was a Web‐based questionnaire study. Five minor emergencies (epistaxis, ear and nose foreign body, ocular surface foreign body, burn, and sprain or fracture) presented by simulation‐based training were selected, and the clinical experience and confidence (CEC) questionnaire was developed to evaluate changes in confidence for each minor emergency after taking a T&A minor emergency course. The first CEC questionnaire was sent before the course, and the follow‐up CEC questionnaire 6 months thereafter. Nine T&A minor emergency courses held in Japan in 2019 were selected. All participants who answered both the first and follow‐up CEC questionnaires were included. The primary outcome was the change of confidence (0–5; 0, no confidence; 5, full confidence) for each minor emergency. The first and follow‐up CEC questionnaires were compared using the Wilcoxon signed‐rank test with a statistical significance level of P < 0.05.

During the study period, 214 (69.4%) and 115 (37.3%) participants responded to the first and follow‐up CEC questionnaires, respectively; 91 (29.5%) answered both questionnaires. The median period in which both tests were completed was 195 days (interquartile range, 189–200 days). Quantitative analysis of the first and follow‐up CEC questionnaires revealed a significant improvement of confidence in managing all minor emergencies: epistaxis, 2:3 (P < 0.01); ear and nose foreign body, 1:3 (P < 0.01); ocular surface foreign body, 1:3 (P < 0.01); burn, 1:3 (P < 0.01); and sprain or fracture 1:3 (P < 0.01) (Table 1).

Table 1

Characteristics of participants who took the first and follow‐up clinical experience and confidence (CEC) questionnaires following the Triage and Action minor emergency course, and results of the questionnaire

Characteristics of participants (n = 91)	First CEC questionnaire	Follow‐up CEC questionnaire
Age, years	29 (26–45)
Postgraduate year, years	8.0 (5–10)
Male gender	63 (69.2)
Change of hospital during study period, yes		15 (16.9)
Specialty
Resident	41 (45.1)	32 (36.0)
Internal medicine	22 (24.2)	20 (22.5)
Surgery	3 (3.3)	4 (4.5)
General medicine	13 (14.3)	17 (19.1)
Pediatric	1 (1.1)	3 (3.4)
Emergency medicine	5 (5.5)	5 (5.5)
Anesthesiology	1 (1.1)	1 (1.1)
Neurosurgery	1 (1.1)	1 (1.1)
Otolaryngology	1 (1.1)	1 (1.1)
Orthopedic	2 (2.2)	1 (1.1)
Dermatology	1 (3.0)	0 (0.0)
Others	1 (1.1)	2 (2.2)

Data are shown as n (%) or median (interquartile range).

Confidence is said to be important for real practice. Higher confidence level can help with faster decision‐making and handling similar cases. Responses to questions related to confidence have shown that our questionnaire participants’ confidence increased from “median, 1–2” to “median, 3.” Participants who responded to the questionnaire before taking our 1‐day training course were possibly examined while being “not very confident.” In the follow‐up questionnaire, participants responded to the questions about confidence as “a little confident.” These small changes in confidence were considered to have helped physicians in their real practice.

Disclosure

Approval of the research protocol: N/A.

Informed consent: N/A.

Registry and registration no. of the study/trial: N/A.

Animal studies: N/A.

Conflict of interest: None.