Evaluation of an international emergency medicine intervention in Tuscany

To measure the effectiveness of a 9-month emergency medicine 'train the trainers' program in Tuscany, Italy.

A total of 81 physicians with emergency department experience completed a training course in Italy. The course included 120 h of didactic lectures, 700 h of clinical rotations and 30 h of practical workshops. The effect of the training course was measured by written multiple-choice and oral case-simulation examinations, and a precourse and postcourse self-assessment instrument using a four-point Likert scale, to describe the ability to care for different types of emergency medicine patients.

Twenty-four physicians completed the course in 2003-2004 and 57 physicians completed the course in 2004-2005. A comparison of an identical examination given as a posttest to the first group and a pretest to the second group demonstrated significant improvement on a 75-question multiple-choice examination (38.7 vs. 46.2 points, P<0.001). Improvement was also seen in oral case examinations, in pediatrics (17.8 vs. 37.3 points, P<0.001) and neurology (24.8 vs. 34.5, P<0.001). In the self-assessment survey, when asked to describe the ability to diagnose and provide initial treatment for several types of patients before and after the course, significant improvement was reported by 13 of 20 participants (65%). When asked to describe the ability to perform a variety of procedures, significant improvement was seen in seven of sixteen (44%).

When measured by written examinations, oral examinations and physician self-assessment, a train the trainers program, designed as part of an international emergency medicine collaboration, was efficacious.