The concept of emergency medicine (EM) in Japan is different from that in western countries. In the 1960s, a legislation was passed in Japan that implemented the use if emergency medical services, and emergency hospitals were designated by the government. However, there were no EM specialists; therefore, surgeons/physicians without specialist training in EM provided care to emergency patients (1). The Japanese Association for Acute Medicine (JAAM) established a committee to promote the western-type model of EM in 2003. By 2007, more than 150 JAAM-affiliated hospitals had implemented this type of EM. However, because adequate emergency physicians are not available, non-emergency physicians are required to see patients with minor emergent problems in the emergency room. Furthermore, there have not been enough courses aimed at improving the skills of physicians who can treat minor emergent problems. This deficit has led to ambulances not being able to find hospitals with the appropriate resources to treat patients. Furthermore, hospital refusals to accept patients have been a major problem in Japan. One of the most frequent reason given for refusal is “without a specialist,” often in the case of minor emergencies (2).
We developed a Triage & Action (T&A) minor emergency course (http://minoremergency.club/) in Japan and began offering it in 2015 because simulation training can improve clinical knowledge and skills and has been demonstrated to have clinical context validity in a growing number of studies (3− 5). The courses have been held 21 times, and a total of 461 physicians have completed the course as of December 31, 2018. The course aims to improve the clinical knowledge and skills for treating minor emergencies. The training sessions comprises five minor emergencies (Epistaxis, Ear and nose foreign body, Sprain or fracture, Ocular surface foreign bodies, and Burns) as well as lecture- and simulation-based training that is conducted by dedicated multidisciplinary instructors. The simulation-based training uses real-case scenarios, and the participants decide how to treat each training patient with a minor emergency. The instructors describe patients with various disease and injury scenarios. Mannequins are used for “Epistaxis” and “Ear and nose foreign body”. For “Sprain or fracture,” an ankle sprain scenario described by the instructor is used, and the participants treat the patient with a splint. There are pictures of items (e.g., gauze, Vaseline®, and normal saline) in “Burns” and “Ocular surface foreign bodies.” The participants choose which items they will use for treatment and decide if the patients should consult a specialist. The instructors assess the participants’ decisions and skills. This course is a 1-day course (7 h), and two T&A minor emergency instructors supervise five attendants. The instructors for T&A minor emergency are selected by a T&A principal member after taking the course. More than 90% of previous participants have answered “Excellent” or “Good” concerning their level of satisfaction with the course. However, information about the physicians’ clinical practice in treating minor emergencies after taking the course has been limited.
We thought that it was important to improve the physician’s confidence and attitudes in treating minor emergencies. Previously, improvements in clinical skills have been usually evaluated by performing the same simulation task or in a real clinical situation > 3 weeks after the simulation (3, 6). However, T&A minor emergency course trainees from all over Japan have participated in this course, making it difficult to evaluate the change in a particular physician’s skill level. Therefore, we considered that information about a physician’s confidence level and total number of minor emergencies treated could be used in place of real clinical assessments because they could change the physician’s practice and reduce their refusals to treat minor emergencies.
Questionnaires are widely used in medical research to collect information from both patients and health-care professionals (7, 8). Some simulation courses have used questionnaires to evaluate knowledge before and after the simulation course (9 − 11). To ensure that the questionnaire closely matched real-world experience and ability, we thought that the post-course questionnaire should be completed within a few months and should contain information about self-confidence and real clinical practice experience (e.g., the change in the total number of treatments without referrals to a specialist within the specific period). We hypothesized that checking the changes in confidence will provide us information regarding what should be done in T&A minor emergency course in the future.
To the best of our knowledge, no study has reported the use of questionnaires to assess improvement in a physicians’ attitude and self-confidence after participating in a simulation course after a few months. The present study aimed to describe a newly developed questionnaire to evaluate how participants’ attitudes toward clinical practice had changed after completing a T&A minor emergency course and to evaluate the validity and reliability of the new questionnaire.