Analysis of performance and predictors of success in the final fellowship examination of the College of Intensive Care Medicine.

OBJECTIVES: To analyse the performance and predictors of success in the final fellowship examination of the College of Intensive Care Medicine (CICM), and to compare the outcomes of international medical graduates (IMGs) attempting the CICM fellowship exam with those of local trainees, defined as those from Australia, New Zealand and Hong Kong (ANZ-HK). To compare the performance of IMGs from countries with comparable health care systems (CHS) with those from other countries (non-CHS). DESIGN, SETTING AND PARTICIPANTS: Analysis of six exam presentations collected prospectively between 2009 and 2011. MAIN OUTCOME MEASURES: Pass rates in the final fellowship exam. RESULTS: Between 2009 and 2011, 233 candidates presented to the exam 334 times, and 73% were IMGs. ANZ-HK trainees performed better at the exam (79% v 46%, P<0.0001). IMG trainees from CHS performed better than trainees from non-CHS (60% v 40%, P<0.01). Any candidate completing an ANZ primary exam performed better than non-ANZ primary candidates (74% v 41%, P<0.0001). IMG candidates successful at a postgraduate exam from a CHS country performed better than candidates from a non-CHS country (56% v 34%, P=0.005). The success rate of IMGs improved to 64% after obtaining an ANZ primary. Candidates taking the exam while working in an intensive care unit had a pass rate of 57% compared with 48% of candidates working in non-ICU posts (P=0.23). This was not statistically significant. CONCLUSIONS: A significant proportion of candidates appearing for the CICM fellowship examination are IMGs. Pass rates for trainees who have graduated from the ANZ- HK systems have a higher success rate in the fellowship examination. IMGs from a CHS country, or those who completed an ANZ primary have a much higher success rate compared with other IMGs.

Uni- and interdisciplinary effects on round and handover content in intensive care units.

OBJECTIVE: The aim of this study was to explore differences in the verbal content of handovers and rounds conducted in uni- and interdisciplinary social contexts. We expected higher proportions of goals to be articulated during interdisciplinary rounds. BACKGROUND: Lack of explanatory connections between round improvement initiatives and outcomes suggest insufficient understanding about health care communications, especially the role of social interaction. METHODS: The recognition-primed abstract decomposition space (RP-ADS) was used to analyze the information content of nurse handovers and morning rounds in a unidisciplinary- (physicians only) and an interdisciplinary-round intensive care unit (ICU). Data were collected using audio recordings of rounds and handovers for five patients for 5 days each in both ICUs. RESULTS: Hierarchical log-linear analyses show strong associations between events (medical rounds vs. nurses' shift handovers), type (uni- vs. interdisciplinary), and focus (levels of the RP-ADS) with highly significant combined two-way and higher-order interactions, LRchi2(df=4) = 30.91, p < .0001. All tests of partial association were also highly significant. Differences among levels of the variables were evaluated using standardized residuals. CONCLUSION: Nurses focused on RP-ADS data and intervention levels, whereas physicians focused on diagnoses and expectations. Clinical goals that integrate these orientations emerged to a greater extent in interdisciplinary rounds. In addition, social context of rounds appears to influence nurse handovers. Unidisciplinary ICU nurse handovers consisted of a series of data- and intervention-related observations, whereas ICU nurse handovers in interdisciplinary ICUs tended to integrate data, interventions and clinical goals. APPLICATION: These results are relevant to the design and implementation of clinical communication improvement initiatives and support tools.