Stakeholders\u27 Perceptions of a Hospital Based Emergency Medicine Education & Training Program: A System Change

Background: Emergency Medicine (EM) is a new and developing specialty around the world. In India, one model for capacity building has been the development of partnerships between US academic institutions and private healthcare institutions for implementing post-graduate education and training in EM. Initiated in 2007, programs have grown both in number and scope and have continued to attract new students and partner institutions. This study was undertaken to better understand the impact of EM training programs on hospital systems. Methods: A mixed-methods evaluation was undertaken at 5 program sites across India in the summer of 2016. Two researchers conducted onsite semi-structured interviews with key program stakeholders. Participants included hospital administrators, program directors, hospital consultants, and ancillary staff at each hospital. Interviews were recorded, transcribed and then analyzed using a rapid assessment process. Participants also completed a brief survey. Written surveys were analyzed with univariate analysis. Results: A total of 109 stakeholders were interviewed. Positive impacts were reported among all stakeholders, particularly among administrators, consultants, ancillary staff, and supervising physicians in the ED. 80% of hospital administrators and 90% of direct ED supervisors report improved quality of care particularly among critically ill patients. Some respondents, including 89% of administrators, attributed increased patient volumes at least in part due to the educational program. Of respondents, non-ED consultants were less likely to report improvement in quality during off-service rotations, but 92% reported improved patient care in the hospital related to the program. Positive impacts extended beyond the hospital with many examples of community outreach, layperson education, and improved hospital reputation. Discussion: Evaluation of a changing system of emergency care has proven challenging to study. These data reflect substantial impacts to a hospital and the surrounding system after development of an EM training program, extending beyond the hospital itself to community outreach programs and a wide variety of education and training programs. Further investigation may prove helpful in quantifying the reported improvement in quality and scope of impact