A Prospective, Longitudinal, Comparative Analysis of the World Health Organization / International Committee of the Red Cross Basic Emergency Care Course on Emergency Medicine Knowledge and Confidence Among Recent Medical School Graduates

A Prospective, Longitudinal, Comparative Analysis of the World Health Organization / International Committee of the Red Cross Basic Emergency Care Course on Emergency Medicine Knowledge and Confidence Among Recent Medical School Graduates | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Prospective, Longitudinal, Comparative Analysis of the World Health Organization / International Committee of the Red Cross Basic Emergency Care Course on Emergency Medicine Knowledge and Confidence Among Recent Medical School Graduates Nichole Michaeli, Andrew Beck, Giovanna De Luca, Mary Gitau, Derek Lubetkin, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5397920/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 08 Jan, 2025 Read the published version in International Journal of Emergency Medicine → Version 1 posted 18 You are reading this latest preprint version Abstract Background The Basic Emergency Care (BEC) course was created by the World Health Organization (WHO) in collaboration with the International Committee of the Red Cross (ICRC) and the International Federation for Emergency Medicine (IFEM) to train frontline providers in low-resource settings. This study evaluates the effectiveness of the course for graduating medical students at the University of Nairobi one year after BEC course completion. Methods This longitudinal, prospective, comparative study was conducted with recent graduates of the University of Nairobi School of Medicine from October 2021 to May 2023. Participants’ retention of emergency medicine knowledge was assessed with a multiple-choice examination 12 to 18 months after completing the BEC course. A survey assessed participants’ confidence in managing patients with emergencies 12–18 months after completing the BEC course using a 4-point Likert scale. These results were compared to a control group of recent University of Nairobi School of Medicine graduates who did not take the BEC course Results The follow-up test scores were lower than the immediate post-course test scores, which suggests some knowledge loss over time. Compared to the control group, the BEC participants had higher test scores during the follow-up period although the difference was not significant. There was no difference between most of the immediate post-course and follow-up survey responses. On follow-up evaluation, BEC participants reported a significant decrease in confidence in understanding emergency drugs and managing an obstructed airway and a patient requiring immobilization. However, compared to the control group, BEC participants had significantly higher self-reported confidence in most areas assessed by the survey. Conclusion This study shows that the WHO BEC course is an effective tool for emergency medicine training for recent graduates from the University of Nairobi. There was an overall increase in confidence among newly practicing physicians who took the BEC. The participants’ decrease in knowledge and confidence 12 to 18 months after the BEC course suggests the need for regular refresher courses. Emergency medicine education Training Emergency Care Figures Figure 1 Background Emergency medical (EM) training is a relatively new, but necessary aspect of medical education worldwide ( 1 ). As formalized emergency medicine education expands across Europe and the United States, it is still in the early stages of development in many low- and middle-income countries (LMICs) ( 1 , 2 , 3 ). EM training is critical as emergency conditions are the leading cause of death and disability worldwide, with a disproportionately high affliction in LMICs ( 4 ). There is a wide range of emergency medicine training in medical schools across the globe. Multiple types of EM courses and clinical rotations have been proposed and implemented with varying success ( 5 , 6 , 7 ). Courses often utilize a multi-modal teaching format, including clinical experience, simulation, procedural skills, and lectures ( 5 , 6 , 7 , 8 ). One pivotal course that has been established is the WHO/ICRC Basic Emergency Care Course (BEC). The BEC course was created by the World Health Organization (WHO) in collaboration with the International Committee of the Red Cross (ICRC) and the International Federation for Emergency Medicine (IFEM) to train frontline providers in low-resource settings. This five-day course focuses on the management of acutely ill and injured patients ( 9 ). The effectiveness of the BEC course has been well documented, and successful courses have been conducted for medical officers, clinical officers, and nurses in many countries ( 10 , 11 , 12 , 13 ). In 2021, we studied the BEC course as a training tool for graduating medical students at the University of Nairobi ( 14 ). Given the perception that medical students in Kenya receive little to no additional formal emergency medical training in medical school ( 15 ), a recommended action by the Kenya Ministry of Health in its Kenya Emergency Care Strategy 2020–2025 report “to “Incorporate emergency medical care training in preservice curricula of all medical training institutions and universities.” Upon completion of medical school, these physicians will work in hospitals throughout the country with a broad range of resources. Often, physicians who completed their intern year at a Kenyan hospital felt that they had received inadequate training on resuscitation and emergency medicine skills ( 15 ). Our prior study was the first of its kind to demonstrate the effectiveness of the BEC course in this unique population. The study showed a significant increase in participants’ confidence and knowledge of managing acutely ill and injured patients immediately following the course ( 14 ). Other BEC studies in Uganda, Tanzania, Zambia, and Nigeria similarly only evaluated participants immediately post- course ( 10 , 12 , 13 ). A study in Sierra Leone surveyed participants six months after the course ( 11 ), but to our knowledge, no studies have evaluated retention of knowledge and confidence beyond six months. This study aims to evaluate long-term retention and maintenance of emergency care knowledge and confidence among University of Nairobi School of Medicine graduates after completing the BEC course. Methods This longitudinal, prospective study was conducted with recent graduates from the University of Nairobi School of Medicine from October 2021 to May 2023. Participants of the initial BEC course in October 2021 were recruited via an advertisement in the University of Nairobi School of Medicine Class of 2021 WhatsApp group ( 16 ). Participants were selected on a continuous, first-come basis, and all students in the 2021 graduating class were eligible to participate. The course was limited to 30 participants according to guidelines from the African Federation for Emergency Medicine (AFEM) ( 17 ). Thirty recent medical graduates participated in a 5-day BEC course in October 2021. The BEC participants’ knowledge was assessed immediately after the course and 12 to 18 months after the course with a 25-question, multiple-choice question (MCQ) examination. A post-course survey assessed participants’ confidence in managing acutely ill and injured patients using a 4-point Likert scale with responses ranging from 1 (strongly disagree) to 4 (strongly agree) and 1 (not confident at all) to 4 (very confident). The post-course confidence survey was also administered immediately after the course and 12 to 18 months after the course. The post-course MCQ exam and survey were the standard versions developed as part of the BEC training package which are available from AFEM ( 18 ). All 30 participants completed the examination and confidence survey immediately after the BEC course in October 2021, while 25 of them completed the follow-up examination and survey between September 2022 to May 2023 (Fig. 1 ). A control group was recruited from graduates of the University of Nairobi School of Medicine Class of 2021 who did not participate in the BEC course offered in October 2021. Participants in the control group were recruited via an email sent to all members of the University of Nairobi School of Medicine Class of 2021 who had not participated in the BEC course. They were recruited from September 2022 to May 2023. Inclusion in the study was based on voluntary responses, and 34 participants were recruited for the control group (Fig. 1 ). All control group participants completed the same post-course examination and confidence survey that was administered to the BEC course participants. De-identified participant data was prospectively collected during the course and managed on a password-protected computer. Quantitative data from the BEC participants' immediate post-course and follow-up examinations and surveys were compared using the paired t-test. Quantitative data from the BEC participants' and control group participants’ examinations and surveys were compared using two-sample t-tests. All analysis was completed using R statistics software ( 19 ). Results Demographics A total of 30 students from the graduating class at the University of Nairobi School of Medicine participated in the BEC course in 2021. Of the 30 participants who took the BEC course, 25 physicians completed a follow-up test and survey between 12 to 18 months after finishing the course. Sixty percent of the follow-up participants were female, while 40% were male. The control group was made up of 34 physicians from the same graduating medical school class as the intervention group, but they had no prior BEC training. Sixty-one percent were male, while 39% were female. The immediate post-course test and survey were completed by all 30 BEC participants, while the follow-up test and survey were completed by 25 BEC participants. All 34 physicians in the control group completed the test and survey. The 5 BEC participants who were lost to follow-up were excluded from the immediate post-course and follow-up pairing and the control group comparison. Test Results The results of the pre-course, immediate post-course, follow-up, and control group tests scores are shown in Table 1 a. The pre-course and immediate post-course data has been published prior( 14 ). The follow-up test scores (87.5, 95% CI: 82.7, 92.4) were significantly lower than the results of the immediate post-course tests (95.4, 95% CI: 94.4, 96.3) (Table 1 b). The follow-up test scores (87.5, 95% CI: 82.7, 92.4) were higher than the pre-course test scores (82.6, 95% CI: 79.2, 85.9), but the results were not statistically significant (Table 1 c). Similarly, the follow-up test scores (87.5, 95% CI: 82.7, 92.4) were higher than the control group test scores (82.6, 95% CI: 79.5, 85.7), but the results were not statistically significant (Table 1 d). Table 1 a Mean score (95% CI) Pre-course test (n = 25) 82.6 (79.2, 85.9) Immediate Post-course test (n = 25) 95.4 (94.4, 96.3) Follow-up test (n = 25) 87.5 (82.7, 92.4) Control group (n = 34) 82.6 (79.5, 85.7) Table 1 b Mean score (95% CI) P-value (95% CI) Immediate Post-course test(n = 25) 95.4 (94.4, 96.3) 0.0023 (3.1, 12.6) Follow-up test (n = 25) 87.5 (82.7, 92.4) Table 1 c Mean score (95% CI) p-value (95% CI) Pre-course test (n = 25) 82.6 (79.2, 85.9) 0.102 (-11, 1.1) Follow-up test (n = 25) 87.5 (82.7, 92.4) Table 1 d Mean score (95% CI) P-value (95% CI) Follow-up test (n = 25) 87.5 (82.7, 92.4) 0.072 (-0.4, 10.3) Control group (n = 34) 82.6 (79.5, 85.7) Survey Results The results of the immediate post-course, follow-up, and control group survey results are shown in Table 2 a and 2 b. While there was no significant change between most of the immediate post-course and follow-up survey responses, there was a significant decrease in confidence in understanding emergency drugs, managing an obstructed airway, and immobilizing a patient. Participants also report a significant decrease in confidence in other providers’ knowledge and skills to handle emergency care patients and their own level of preparedness to care for all emergency patients on the follow-up survey(Table 2 a). Compared to the control group, the follow-up evaluation of the BEC participants showed significantly higher self-reported confidence across the majority of the survey questions. However, there was no significant difference in confidence between the two groups in “feeling prepared to see emergency care patients in my clinical setting” and “understanding the ABCDEs of basic emergency care”(Table 2 b). Table 2a: Comparison of per question scores between immediate post-course and follow-up surveys Immediate post-course (n=25) One year follow-up (n=25) 1 (strongly disagree) to 4 (strongly agree) Question Mean (95% CI) Mean (95% CI) Paired T-Test I feel comfortable handling any patient requiring emergency care 3.77 (3.61, 3.93) 3.36 (3.07, 3.65) <0.05 I feel nervous about seeing patients with emergencies 1.93 (1.62, 2.24) 1.88 (1.61, 2.15) 0.82 I feel that others in my clinical unit have the knowledge and skills to handle emergency care patients 3.17 (2.91, 3.43) 2.68 (2.4, 2.97) <0.05 I feel that I lack the skills to provide care in most emergencies 1.33 (1.13, 1.54) 1.48 (1.27, 1.69) 0.33 I feel prepared to see emergency care patients in my clinical setting 3.47 (3.28, 3.66) 3.16 (2.77, 3.55) 0.18 I feel confident seeing very ill patients 3.38 (3.19, 3.57) 3.36 (3.13, 3.59) 0.79 I feel uncomfortable using standard emergency protocols 1.4 (1.15, 1.65) 1.52 (1.2, 1.84) 0.70 I feel that I understand the ABCDE’s of basic emergency care 3.83 (3.69, 3.97) 3.60 (3.24, 3.96) 0.37 I feel I have an organized approach that allows me to be prepared for all emergency care patients 3.8 (3.65, 3.95) 3.32 (3.04, 3.61) <0.05 I do not feel confident in my knowledge of emergency care 1.27 (1.1, 1.43) 1.44 (1.23, 1.65) 0.16 Emergency care trainings for generalist healthcare providers are important 4 (n/a) 3.84 (3.58, 4.1 0.21 1 (not confident at all) to 4 (very confident) Emergency management of the acutely ill adult 3.43 (3.25, 3.62) 3.44 (3.2, 3.68) 1 Emergency management of the acutely ill child 3.43 (3.22, 3.65) 3.20 (2.93, 3.47) 0.05 Emergency management of the injured adult 3.6 (3.41, 3.79) 3.44 (3.17, 3.71) 0.26 Emergency management of the injured child 3.47 (3.25, 3.68) 3.20 (2.88, 3.52) 0.07 Emergency management of the patient with Shock 3.63 (3.45, 3.82) 3.52 (3.28, 3.76) 0.27 Emergency management of the patient with altered mental state 3.53 (3.3, 3.77) 3.24 (2.97, 3.51) 0.05 Emergency management of the patient with difficulty in breathing 3.67 (3.49, 3.85) 3.52 (3.28, 3.76) 0.33 Understanding of emergency drugs 3.37 (3.16, 3.57) 2.92 (2.63, 3.21) <0.05 Have skills to manage an obstructed (blocked) airway 3.60 (3.41, 3.79) 2.92 (2.58, 3.26) <0.05 Have skills to manage a patient with difficulty in breathing 3.63 (3.45, 3.82) 3.32 (3.06, 3.58) 0.05 Have skills to manage a patient with bleeding problems 3.6 (3.41, 3.79) 3.32 (3.04, 3.61 0.06 Have skills to immobilize patients 3.77 (3.61, 3.93) 3.32 (3.04, 3.61) <0.05 Table 2b: Comparison of per question scores between the one year follow-up and control group surveys One year follow-up (n=25) Control group (n= 25) 1 (strongly disagree) to 4 (strongly agree) Question Mean (95% CI) Mean (95% CI) Two Sample T-Test I feel comfortable handling any patient requiring emergency care 3.36 (3.07, 3.65) 2.97 (2.75, 3.19) <0.05 I feel nervous about seeing patients with emergencies 1.88 (1.61, 2.15) 2.32 (2.08, 2.56) <0.05 I feel that others in my clinical unit have the knowledge and skills to handle emergency care patients 2.68 (2.4, 2.97) 2.88 (2.64, 3.12) 0.27 I feel that I lack the skills to provide care in most emergencies 1.48 (1.27, 1.69) 1.79 (1.59, 2.00) <0.05 I feel prepared to see emergency care patients in my clinical setting 3.16 (2.77, 3.55) 3.00 (2.81, 3.19) 0.42 I feel confident seeing very ill patients 3.36 (3.13, 3.59) 2.91 (2.66, 3.16) <0.05 I feel uncomfortable using standard emergency protocols 1.52 (1.2, 1.84) 2.03 (1.79, 2.26) <0.05 I feel that I understand the ABCDE’s of basic emergency care 3.60 (3.24, 3.96) 3.15 (2.86, 3.43) 0.77 I feel I have an organized approach that allows me to be prepared for all emergency care patients 3.32 (3.04, 3.61) 2.88 (2.68, 3.09) <0.05 I do not feel confident in my knowledge of emergency care 1.44 (1.23, 1.65) 2.09 (1.83, 2.35) <0.05 Emergency care trainings for generalist healthcare providers are important 3.84 (3.58, 4.1) 3.79 (3.57, 4.02) 0.78 1 (not confident at all) to 4 (very confident) Emergency management of the acutely ill adult 3.44 (3.20, 3.68) 3.00 (2.81, 3.19) <0.05 Emergency management of the acutely ill child 3.20 (2.93, 3.47) 2.85 (2.64, 3.07) <0.05 Emergency management of the injured adult 3.44 (3.17, 3.71) 3.03 (2.81, 3.25) <0.05 Emergency management of the injured child 3.20 (2.88, 3.52) 2.82 (2.59, 3.06) <0.05 Emergency management of the patient with Shock 3.52 (3.28, 3.76) 3.06 (2.83, 3.29) <0.05 Emergency management of the patient with altered mental state 3.24 (2.97, 3.51) 2.91 (2.71, 3.11) <0.05 Emergency management of the patient with difficulty in breathing 3.52 (3.28, 3.76) 2.94 (2.75, 3.13) <0.05 Understanding of emergency drugs 2.92 (2.63, 3.21) 2.53 (2.28, 2.78) <0.05 Have skills to manage an obstructed (blocked) airway 2.92 (2.58, 3.26) 2.44 (2.17, 2.72) <0.05 Have skills to manage a patient with difficulty in breathing 3.32 (3.06, 3.58) 2.79 (2.55, 3.03) <0.05 Have skills to manage a patient with bleeding problems 3.32 (3.04, 3.61) 2.82 (2.59, 3.06) <0.05 Have skills to immobilize patients 3.32 (3.04, 3.61) 2.47 (2.16, 2.78) <0.05 Discussion The BEC course appears to be an effective model for increasing emergency medical knowledge among recent medical school graduates at the University of Nairobi. In our previous study, there was an increase in immediate post-course test scores compared to pre-course test scores, indicating an improvement in knowledge ( 14 ). This study, however, looks at long-term retention of knowledge following the course. Overall, the follow-up test scores were lower than the immediate post-course test scores, which suggests knowledge loss over time. However, the clinical significance of a 4 point decrease on written test scores at 1 year post BEC is debatable. Follow-up test scores were higher than pre-course test scores, although not statistically significant, indicating there is likely some improvement in emergency medicine comprehension even several months after taking the course. Medical knowledge attrition is well documented phenomonen, underscoring the need for regular refresher courses ( 20 , 21 ). Compared to the control group, the BEC participants had higher test scores during the follow-up period, although the difference was not statistically significant. We believe future studies aimed at assessing the long-term effectiveness of the BEC course with a larger sample size may demonstrate statistical significance. When comparing per question scores between the one year follow up and the control group, the BEC cohort had significantly higher confidence scores. BEC course participants were overwhelmingly more comfortable in handling emergency cases when compared with the control group. For example, in response to the question, “I feel comfortable handling any patient requiring emergency care”, compared to their peers who did not take the BEC, they were significantly more comfortable (Table 2 b). Overwhelmingly, clinical confidence was higher among the BEC cohort. These findings are of particular interest, since these both of these groups are now practicing physicians. However, similar to the attrition of knowledge test scores, we saw a loss of confidence in the BEC cohort 12–18 months after the course. Although most BEC studies have only evaluated knowledge and confidence changes immediately post-course, a study in Sierra Leone examined knowledge retention among BEC participants six months after the course ( 11 ). Similar to our study, immediate post-course test scores were significantly higher than the pre-course test scores but demonstrate a decrease in knowledge six months after the BEC. Their findings suggests that there is knowledge loss as soon as six months after completion of the course. The statistically significant loss of confidence in emergency care knowledge underscores importance of re-training of emergency courses as well as the importance of supportive mentorship post-course for effective knowledge, skill retention and clinical confidence. High acuity, low occurrence (HALO) clinical events and procedures, such as those practiced in the BEC, are well defined in the pre-hospital literature ( 22 ). Physicians encounter these HALO scenarios involving acute airways, resuscitations, ob emergencies and rare life-saving procedures. Regular re-trainings, involving simulation based education and deliberate practice, has been demonstrated to maintain HALO event readiness and knowledge retention ( 23 , 24 , 25 ). In Kenya, graduating medical students receive varying degrees of training in emergency care ( 26 ). Physicians taking care of acute or unstable patients, which include junior house officers, need training in emergency care given their high level of autonomy in those roles. Kenya hospitals have varying course requirements for medical officers, such as Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS), and/or Advanced Trauma Life Support (ATLS), but not all medical students have the opportunity to take these training courses. These courses have a more narrow scope, typically require retraining and re-certification every 2–3 years, and can be expensive ( 27 ). The BEC course takes a broad approach to acute emergencies, providing a foundation for stabilizing acutely ill or injured patients. Providing the BEC to new medical school graduates makes it possible to instill these foundational concepts before their internship. The BEC course is not a substitute for a multi-year emergency medicine speciality training program; however, the BEC course can increase new medical school graduates’ familiarity with emergency care, prepare them for HALO events and can be more widely implemented than specialized emergency medicine training due to the short-course structure. It may also increase interest in emergency medicine as a medical specialty by exposing new physicians to emergency care. While the target attendees of the BEC course are health care providers in resource-limited settings, this study focused on medical school graduates from a major academic medical center in Nairobi, Kenya. The participants in this study likely had higher baseline knowledge and clinical skills compared to BEC attendees in other settings. By contrast, courses taught in Uganda and Tanzania recruited and trained mixed attendees, including physicians, nurses, nursing officers, allied health professionals, midwives, pharmacists, or technicians ( 13 ). The pre- and post-course test results in these studies were markedly lower than those seen in our study. We suspect this is due to baseline knowledge differences among the groups based on the effect of prior training and job experience. Our results underscore the need for ongoing education and training in acute and emergency care. Ongoing team based acute care training and availability of supportive mentorship has been shown to improve knowledge and skill retention amongst participants ( 28 ). Further studies can be done with implementation of re-training, deliberate practice and post course mentorship to assess the level of retention of knowledge and skills. Limitations This BEC training was offered exclusively to physicians who were new graduates of the University of Nairobi. This limits the comparison to other BEC studies with differing composition of trainees. As such, results of pre-course and post-course scores, knowledge retention, and confidence are not likely comparable to other cohorts due to selection bias among the trainees. Our study compared a first-come, first-served cohort of enrollees against a voluntary control group of first-year intern-level physicians who did not take the course. Since they were not randomized in selection, both the course and control participants may reflect groups of physicians with a special interest in emergency medicine. As such, we may have a false negative conclusion of no difference in overall knowledge during the follow-up period as compared to a general medical graduate. Five physicians in the experimental group were lost to follow-up. While this is not a large percentage, it may also cause incorrect conclusions on the effectiveness of the course, in either a positive or negative direction. The BEC course is generally taught in English, and all Kenyan medical students speak English, in addition to Kiswahili. The same cannot be said for participants from other African countries, where the native or national language may not be English. This may limit comparability across studies as communication differences or limitations may be responsible for score increases or decreases as opposed to actual differences in learning and retention. Conclusions There is minimal formal emergency medicine training for medical students in Kenya. This study shows that the WHO BEC course is an effective tool for emergency medicine training for medical students at the University of Nairobi. The participants’ decrease in knowledge and confidence 12 to 18 months after the BEC course suggests the need for regular refresher courses. However, the overall increase in confidence among newly practicing physicians who took the BEC is encouraging. Implementing this course into the national medical school curriculum could provide a feasible option to improve student’s knowledge of managing and stabilizing critically ill and injured patients, as well as improve clinical confidence after graduation. Abbreviations AFEM: African Federation of Emergency Medicine BEC: Basic Emergency Care: Approach to the acutely ill and injured Course EM: Emergency Medicine HICs: High-income countries ICRC: International Committee of the Red Cross IFEM: International Federation for Emergency Medicine LMICs: Low- and middle-income countries ToT: Training of Trainers WHO: World Health Organization Declarations Ethics approval and consent to participate The authors certify that the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. This study was reviewed and approved by the Kenyatta National Hospital - University of Nairobi Ethics and Research Committee, protocol P703/12/2020 and the Lifespan IRB, protocol 1736842-2. All participants provided written consent to participate in the study. Consent for publication Not applicable Availability of data and materials All datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This research study was supported by funds from the Department of Emergency Medicine, Brown University, the UNC Global Health Scholarship Program and personal professional development funds from UNC faculty. The funding from these sources was used to purchase supplies and equipment for the BEC training and support the researchers’ and course facilitators’ travel expenses. These funding sources did not play a role in the design of the study, the collection, analysis, and interpretation of data, or the writing of the manuscript. Authors’ contributions NM obtained IRB approval, obtained grant funding, coordinated and taught the BEC course, collected data, and wrote the methods section of the manuscript. AB coordinated and taught the BEC course, and wrote the discussion and limitations section of the manuscript. GD coordinated and taught the BEC course, collected data and wrote the discussion and conclusions section of the manuscript. MG coordinated and taught the BEC and provided critical input into the manuscript. DL coordinated and taught the BEC Course and collected data. DO coordinated and taught the BEC Course and provided critical input into the manuscript. GW coordinated and taught the BEC course and provided critical input into the design and execution of the study. JM taught the BEC Course, collected data and provided critical revisions to manuscript. All authors read and approved the final Manuscript. Acknowledgements We would like to thank the University of Nairobi for providing facilities to support this training. A special thanks to Dr. Trufosa Mochache and Dr. Pascal Mugemangango for providing valuable support and guidance to the Nairobi BEC Team. 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(2007), Spaced education improves the retention of clinical knowledge by medical students: a randomised controlled trial. Medical Education, 41: 23-31. https://doi.org/10.1111/j.1365-2929.2006.02644.x Hack KE, Levy MJ, Garfinkel E, Margolis AM. Establishing consensus-based high-acuity low-occurrence skills for EMS physicians: A pilot survey of EMS fellowship faculty. AEM Educ Train. 2022 Dec 20;6(6):e10828. doi: 10.1002/aet2.10828. PMID: 36562031; PMCID: PMC9763967. Hakemi A, Blamoun J, Lundahl A, Armstead T, Hakemi K, Malik M. A Conceptual Framework for Instructional Design of a High Acuity and Low Occurrence Event - Simulation Based Education Training of Residents, Medical Students, and Nurses in Anaphylaxis Utilizing Curated Educational Theories. Adv Med Educ Pract. 2023 Feb 10;14:101-107. doi: 10.2147/AMEP.S398013. PMID: 36798716; PMCID: PMC9926979. Santen SA, Hemphill RR, Pusic M, Cico SJ, Wolff M, Merritt C. Our responsibility to patients: Maintain competency or … stop practicing. AEM Educ Train. 2023 Nov 22;7(6):e10916. doi: 10.1002/aet2.10916. PMID: 37997590; PMCID: PMC10664403. Petrosoniak, A., Sherbino, J., Beardsley, T. et al. Are we talking about practice? A randomized study comparing simulation-based deliberate practice and mastery learning to self-guided practice. Can J Emerg Med 25, 667–675 (2023). https://doi.org/10.1007/s43678-023-00531-0 Lee JA, Wanjiku G, Nduku N, Aluisio AR, Kharel R, Simiyu JT, Wachira BW. The status and future of emergency care in the Republic of Kenya. Afr J Emerg Med. 2022 Mar;12(1):48-52. doi: 10.1016/j.afjem.2021.11.003. Epub 2022 Jan 12. PMID: 35070654; PMCID: PMC8761612. Kenya Council of Emergency Medical Technicians. Trainings. https://kcemt.co.ke/trainings/. Accessed 28 September 2023. Khongo BD, Schmiedeknecht K, Aron MB, Nyangulu PN, Mazengera W, Ndarama E, Tenner AG, Baltzell K, Connolly E. Basic emergency care course and longitudinal mentorship completed in a rural Neno District, Malawi: A feasibility, acceptability, and impact study. PLoS One. 2023 Feb 6;18(2):e0280454. doi: 10.1371/journal.pone.0280454. PMID: 36745667; PMCID: PMC9901771. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5397920","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":380692415,"identity":"91eaac27-da01-4a5c-8606-f66736038640","order_by":0,"name":"Nichole Michaeli","email":"","orcid":"","institution":"University of Vermont Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Nichole","middleName":"","lastName":"Michaeli","suffix":""},{"id":380692416,"identity":"df740b98-8d4f-4c06-8b13-49f2e844028a","order_by":1,"name":"Andrew Beck","email":"","orcid":"","institution":"Warren Alpert Medical School of Brown University","correspondingAuthor":false,"prefix":"","firstName":"Andrew","middleName":"","lastName":"Beck","suffix":""},{"id":380692418,"identity":"609c6847-5a38-4668-ad76-6394ea8d0aa9","order_by":2,"name":"Giovanna De Luca","email":"","orcid":"","institution":"Warren Alpert Medical School of Brown University","correspondingAuthor":false,"prefix":"","firstName":"Giovanna","middleName":"","lastName":"De Luca","suffix":""},{"id":380692420,"identity":"64448e07-8dc5-4f40-8ca5-6a4e6d825763","order_by":3,"name":"Mary Gitau","email":"","orcid":"","institution":"Kenyatta National Hospital","correspondingAuthor":false,"prefix":"","firstName":"Mary","middleName":"","lastName":"Gitau","suffix":""},{"id":380692422,"identity":"6226d8e2-1be3-42cd-a654-b683193643fb","order_by":4,"name":"Derek Lubetkin","email":"","orcid":"","institution":"MaineHealth/Coastal Maine Global Health Fellowship","correspondingAuthor":false,"prefix":"","firstName":"Derek","middleName":"","lastName":"Lubetkin","suffix":""},{"id":380692423,"identity":"a23d803f-cc4b-4645-bda0-493fa9c9b5b3","order_by":5,"name":"Derick Ochieng","email":"","orcid":"","institution":"Nairobi Women’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Derick","middleName":"","lastName":"Ochieng","suffix":""},{"id":380692424,"identity":"9d0a5e19-cef3-4c5c-a4c9-aed19ea30962","order_by":6,"name":"Grace W. Wanjiku","email":"","orcid":"","institution":"Warren Alpert Medical School of Brown University","correspondingAuthor":false,"prefix":"","firstName":"Grace","middleName":"W.","lastName":"Wanjiku","suffix":""},{"id":380692425,"identity":"e5e2b43f-fe66-4981-ab9a-f3907526d36b","order_by":7,"name":"Justin G. Myers","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+klEQVRIiWNgGAWjYBACxgYgkQDjfYAKAAEzPi2MDTAtjDOI0cKAUARUxkOMFuYZ6c8fPNzBEG1wvPfxZ9scG9kGidyDHxgqrBMbcGhhnJFj2JB4hiF3w5njZtK529KMGyTykiUYzqTj08LYkNgG1HIjjY05d9vhxAaJHDMGxrbDeLSkP4Rouf+M+bPltv9QLf/waUkwhNrCxiDNuO0AVEsDHi09bwxngLTMPJPGJtm7Ldm4jeeNsUTCsXRjXFoM29MffPwJ1NJ3/Bjzh5/b7GT72XMMP3yosZbFqQUi8Z9B4QBUhA1EJOBQDgLycAYuQ0fBKBgFo2AUAABE9F2ZnVtTgAAAAABJRU5ErkJggg==","orcid":"","institution":"University of North Carolina at Chapel Hill","correspondingAuthor":true,"prefix":"","firstName":"Justin","middleName":"G.","lastName":"Myers","suffix":""}],"badges":[],"createdAt":"2024-11-05 20:08:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5397920/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5397920/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12245-024-00797-w","type":"published","date":"2025-01-08T15:56:57+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":71625185,"identity":"996e5035-882e-473a-9fda-a9a2198f26c6","added_by":"auto","created_at":"2024-12-17 08:46:01","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":161826,"visible":true,"origin":"","legend":"\u003cp\u003eStudy participant selection\u003c/p\u003e","description":"","filename":"BECPhase2enrollmentFigure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5397920/v1/9a300cb9bde9a5ae23dfae9d.jpg"},{"id":73693879,"identity":"7d3de224-e8bd-485c-87b4-3140c00fcca5","added_by":"auto","created_at":"2025-01-13 16:08:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":966037,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5397920/v1/899c9883-6a1f-4c5c-badb-51eb0cf813e0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A Prospective, Longitudinal, Comparative Analysis of the World Health Organization / International Committee of the Red Cross Basic Emergency Care Course on Emergency Medicine Knowledge and Confidence Among Recent Medical School Graduates","fulltext":[{"header":"Background","content":"\u003cp\u003eEmergency medical (EM) training is a relatively new, but necessary aspect of medical education worldwide (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). As formalized emergency medicine education expands across Europe and the United States, it is still in the early stages of development in many low- and middle-income countries (LMICs) (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). EM training is critical as emergency conditions are the leading cause of death and disability worldwide, with a disproportionately high affliction in LMICs (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThere is a wide range of emergency medicine training in medical schools across the globe.\u003c/p\u003e \u003cp\u003eMultiple types of EM courses and clinical rotations have been proposed and implemented with\u003c/p\u003e \u003cp\u003evarying success (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Courses often utilize a multi-modal teaching format,\u003c/p\u003e \u003cp\u003eincluding clinical experience, simulation, procedural skills, and lectures (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOne pivotal course that has been established is the WHO/ICRC Basic Emergency Care Course (BEC). The BEC course was created by the World Health Organization (WHO) in collaboration with the International Committee of the Red Cross (ICRC) and the International Federation for Emergency Medicine (IFEM) to train frontline providers in low-resource settings. This five-day course focuses on the management of acutely ill and injured patients (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). The effectiveness of the BEC course has been well documented, and successful courses have been conducted for medical officers, clinical officers, and nurses in many countries (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn 2021, we studied the BEC course as a training tool for graduating medical students at the\u003c/p\u003e \u003cp\u003eUniversity of Nairobi (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Given the perception that medical students in Kenya receive little to no additional formal emergency medical training in medical school (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), a recommended action by the Kenya Ministry of Health in its Kenya Emergency Care Strategy 2020\u0026ndash;2025 report \u0026ldquo;to \u0026ldquo;Incorporate emergency medical care training in preservice curricula of all medical training institutions and universities.\u0026rdquo; Upon completion of medical school, these physicians will work in hospitals throughout the country with a broad range of resources. Often, physicians who completed their intern year at a Kenyan hospital felt that they had received inadequate training on resuscitation and emergency medicine skills (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOur prior study was the first of its kind to demonstrate the effectiveness of the BEC course in this unique population. The study showed a significant increase in participants\u0026rsquo; confidence and knowledge of managing acutely ill and injured patients immediately following the course (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Other BEC studies in Uganda, Tanzania, Zambia, and Nigeria similarly only evaluated participants immediately post- course (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). A study in Sierra Leone surveyed participants six months after the course (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), but to our knowledge, no studies have evaluated retention of knowledge and confidence beyond six months.\u003c/p\u003e \u003cp\u003eThis study aims to evaluate long-term retention and maintenance of emergency care knowledge and confidence among University of Nairobi School of Medicine graduates after completing the BEC course.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis longitudinal, prospective study was conducted with recent graduates from the University of Nairobi School of Medicine from October 2021 to May 2023. Participants of the initial BEC course in October 2021 were recruited via an advertisement in the University of Nairobi School of Medicine Class of 2021 WhatsApp group (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Participants were selected on a continuous, first-come basis, and all students in the 2021 graduating class were eligible to participate. The course was limited to 30 participants according to guidelines from the African Federation for Emergency Medicine (AFEM) (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThirty recent medical graduates participated in a 5-day BEC course in October 2021. The BEC participants\u0026rsquo; knowledge was assessed immediately after the course and 12 to 18 months after the course with a 25-question, multiple-choice question (MCQ) examination. A post-course survey assessed participants\u0026rsquo; confidence in managing acutely ill and injured patients using a 4-point Likert scale with responses ranging from 1 (strongly disagree) to 4 (strongly agree) and 1 (not confident at all) to 4 (very confident). The post-course confidence survey was also administered immediately after the course and 12 to 18 months after the course. The post-course MCQ exam and survey were the standard versions developed as part of the BEC training package which are available from AFEM (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). All 30 participants completed the examination and confidence survey immediately after the BEC course in October 2021, while 25 of them completed the follow-up examination and survey between September 2022 to May 2023 (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA control group was recruited from graduates of the University of Nairobi School of Medicine Class of 2021 who did not participate in the BEC course offered in October 2021. Participants in the control group were recruited via an email sent to all members of the University of Nairobi School of Medicine Class of 2021 who had not participated in the BEC course. They were recruited from September 2022 to May 2023. Inclusion in the study was based on voluntary responses, and 34 participants were recruited for the control group (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). All control group participants completed the same post-course examination and confidence survey that was administered to the BEC course participants.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eDe-identified participant data was prospectively collected during the course and managed on a password-protected computer. Quantitative data from the BEC participants' immediate post-course and follow-up examinations and surveys were compared using the paired t-test. Quantitative data from the BEC participants' and control group participants\u0026rsquo; examinations and surveys were compared using two-sample t-tests. All analysis was completed using R statistics software (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eDemographics\u003c/p\u003e\n\u003cp\u003eA total of 30 students from the graduating class at the University of Nairobi School of Medicine participated in the BEC course in 2021. Of the 30 participants who took the BEC course, 25 physicians completed a follow-up test and survey between 12 to 18 months after finishing the course. Sixty percent of the follow-up participants were female, while 40% were male. The control group was made up of 34 physicians from the same graduating medical school class as the intervention group, but they had no prior BEC training. Sixty-one percent were male, while 39% were female.\u003c/p\u003e\n\u003cp\u003eThe immediate post-course test and survey were completed by all 30 BEC participants, while the follow-up test and survey were completed by 25 BEC participants. All 34 physicians in the control group completed the test and survey. The 5 BEC participants who were lost to follow-up were excluded from the immediate post-course and follow-up pairing and the control group comparison.\u003c/p\u003e\n\u003cp\u003eTest Results\u003c/p\u003e\n\u003cp\u003eThe results of the pre-course, immediate post-course, follow-up, and control group tests scores are shown in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003ea. The pre-course and immediate post-course data has been published prior(\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e). The follow-up test scores (87.5, 95% CI: 82.7, 92.4) were significantly lower than the results of the immediate post-course tests (95.4, 95% CI: 94.4, 96.3) (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003eb). The follow-up test scores (87.5, 95% CI: 82.7, 92.4) were higher than the pre-course test scores (82.6, 95% CI: 79.2, 85.9), but the results were not statistically significant (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003ec). Similarly, the follow-up test scores (87.5, 95% CI: 82.7, 92.4) were higher than the control group test scores (82.6, 95% CI: 79.5, 85.7), but the results were not statistically significant (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003ed).\u0026nbsp;\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003ea\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean score\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e(95% CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePre-course test (n\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e82.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(79.2, 85.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eImmediate Post-course test (n\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e95.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(94.4, 96.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFollow-up test (n\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e87.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(82.7, 92.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eControl group (n\u0026thinsp;=\u0026thinsp;34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e82.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(79.5, 85.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\u0026nbsp;\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eb\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean score (95% CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP-value (95% CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eImmediate Post-course test(n\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e95.4 (94.4, 96.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.0023 (3.1, 12.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFollow-up test (n\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e87.5 (82.7, 92.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\u0026nbsp;\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003ec\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean score (95% CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep-value (95% CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePre-course test (n\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e82.6 (79.2, 85.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.102 (-11, 1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFollow-up test (n\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e87.5 (82.7, 92.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\u0026nbsp;\u0026nbsp;\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003ed\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean score (95% CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP-value (95% CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFollow-up test (n\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e87.5 (82.7, 92.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.072 (-0.4, 10.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eControl group (n\u0026thinsp;=\u0026thinsp;34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e82.6 (79.5, 85.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eSurvey Results\u003c/p\u003e\n\u003cp\u003eThe results of the immediate post-course, follow-up, and control group survey results are shown in Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003ea and \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003eb. While there was no significant change between most of the immediate post-course and follow-up survey responses, there was a significant decrease in confidence in understanding emergency drugs, managing an obstructed airway, and immobilizing a patient. Participants also report a significant decrease in confidence in other providers\u0026rsquo; knowledge and skills to handle emergency care patients and their own level of preparedness to care for all emergency patients on the follow-up survey(Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003ea).\u003c/p\u003e\n\u003cp\u003eCompared to the control group, the follow-up evaluation of the BEC participants showed significantly higher self-reported confidence across the majority of the survey questions. However, there was no significant difference in confidence between the two groups in \u0026ldquo;feeling prepared to see emergency care patients in my clinical setting\u0026rdquo; and \u0026ldquo;understanding the ABCDEs of basic emergency care\u0026rdquo;(Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003eb).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cp\u003eTable 2a: Comparison of per question scores between immediate post-course and follow-up surveys\u0026nbsp;\u003c/p\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eImmediate post-course (n=25)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOne year follow-up (n=25)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"12\" valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1 (strongly disagree) to 4 (strongly agree)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQuestion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePaired T-Test\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eI feel comfortable handling any patient requiring emergency care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3.77 (3.61, 3.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e3.36 (3.07, 3.65)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026lt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eI feel nervous about seeing patients with emergencies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1.93 (1.62, 2.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e1.88 (1.61, 2.15)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eI feel that others in my clinical unit have the knowledge and skills to handle emergency care patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3.17 (2.91, 3.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e2.68 (2.4, 2.97)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026lt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eI feel that I lack the skills to provide care in most emergencies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1.33 (1.13, 1.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e1.48 (1.27, 1.69)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eI feel prepared to see emergency care patients in my clinical setting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3.47 (3.28, 3.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e3.16 (2.77, 3.55)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eI feel confident seeing very ill patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3.38 (3.19, 3.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e3.36 (3.13, 3.59)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eI feel uncomfortable using standard emergency protocols\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1.4 (1.15, 1.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e1.52 (1.2, 1.84)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eI feel that I understand the ABCDE\u0026rsquo;s of basic emergency care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3.83 (3.69, 3.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e3.60 (3.24, 3.96)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eI feel I have an organized approach that allows me to be prepared for all emergency care patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3.8 (3.65, 3.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e3.32 (3.04, 3.61)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026lt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eI do not feel confident in my knowledge of emergency care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1.27 (1.1, 1.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e1.44 (1.23, 1.65)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eEmergency care trainings for generalist healthcare providers are important\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e4 (n/a)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e3.84 (3.58, 4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"12\" valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1 (not confident at all) to 4 (very confident)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eEmergency management of the acutely ill adult\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3.43 (3.25, 3.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e3.44 (3.2, 3.68)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eEmergency management of the acutely ill child\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3.43 (3.22, 3.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e3.20 (2.93, 3.47)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eEmergency management of the injured adult\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3.6 (3.41, 3.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e3.44 (3.17, 3.71)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eEmergency management of the injured child\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3.47 (3.25, 3.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e3.20 (2.88, 3.52)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eEmergency management of the patient with Shock\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3.63 (3.45, 3.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e3.52 (3.28, 3.76)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eEmergency management of the patient with altered mental state\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3.53 (3.3, 3.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e3.24 (2.97, 3.51)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eEmergency management of the patient with difficulty in breathing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3.67 (3.49, 3.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e3.52 (3.28, 3.76)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eUnderstanding of emergency drugs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3.37 (3.16, 3.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e2.92 (2.63, 3.21)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026lt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eHave skills to manage an obstructed (blocked) airway\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3.60 (3.41, 3.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e2.92 (2.58, 3.26)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026lt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eHave skills to manage a patient with difficulty in breathing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3.63 (3.45, 3.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e3.32 (3.06, 3.58)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eHave skills to manage a patient with bleeding problems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3.6 (3.41, 3.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e3.32 (3.04, 3.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eHave skills to immobilize patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3.77 (3.61, 3.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e3.32 (3.04, 3.61)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026lt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003eTable 2b: Comparison of per question scores between the one year follow-up and control group surveys\u0026nbsp;\u003c/p\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOne year follow-up (n=25)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl group (n= 25)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"12\" valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1 (strongly disagree) to 4 (strongly agree)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQuestion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTwo Sample T-Test\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eI feel comfortable handling any patient requiring emergency care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3.36 (3.07, 3.65)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003e2.97 (2.75, 3.19)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026lt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eI feel nervous about seeing patients with emergencies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1.88 (1.61, 2.15)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003e2.32 (2.08, 2.56)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026lt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eI feel that others in my clinical unit have the knowledge and skills to handle emergency care patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e2.68 (2.4, 2.97)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003e2.88 (2.64, 3.12)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eI feel that I lack the skills to provide care in most emergencies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1.48 (1.27, 1.69)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003e1.79 (1.59, 2.00)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026lt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eI feel prepared to see emergency care patients in my clinical setting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3.16 (2.77, 3.55)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003e3.00 (2.81, 3.19)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eI feel confident seeing very ill patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3.36 (3.13, 3.59)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003e2.91 (2.66, 3.16)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026lt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eI feel uncomfortable using standard emergency protocols\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1.52 (1.2, 1.84)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003e2.03 (1.79, 2.26)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026lt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eI feel that I understand the ABCDE\u0026rsquo;s of basic emergency care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3.60 (3.24, 3.96)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003e3.15 (2.86, 3.43)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eI feel I have an organized approach that allows me to be prepared for all emergency care patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3.32 (3.04, 3.61)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003e2.88 (2.68, 3.09)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026lt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eI do not feel confident in my knowledge of emergency care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1.44 (1.23, 1.65)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003e2.09 (1.83, 2.35)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026lt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eEmergency care trainings for generalist healthcare providers are important\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3.84 (3.58, 4.1)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003e3.79 (3.57, 4.02)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"12\" valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1 (not confident at all) to 4 (very confident)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eEmergency management of the acutely ill adult\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3.44 (3.20, 3.68)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003e3.00 (2.81, 3.19)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026lt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eEmergency management of the acutely ill child\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3.20 (2.93, 3.47)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003e2.85 (2.64, 3.07)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026lt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eEmergency management of the injured adult\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3.44 (3.17, 3.71)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003e3.03 (2.81, 3.25)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026lt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eEmergency management of the injured child\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3.20 (2.88, 3.52)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003e2.82 (2.59, 3.06)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026lt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eEmergency management of the patient with Shock\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3.52 (3.28, 3.76)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003e3.06 (2.83, 3.29)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026lt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eEmergency management of the patient with altered mental state\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3.24 (2.97, 3.51)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003e2.91 (2.71, 3.11)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026lt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eEmergency management of the patient with difficulty in breathing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3.52 (3.28, 3.76)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003e2.94 (2.75, 3.13)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026lt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eUnderstanding of emergency drugs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e2.92 (2.63, 3.21)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003e2.53 (2.28, 2.78)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026lt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eHave skills to manage an obstructed (blocked) airway\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e2.92 (2.58, 3.26)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003e2.44 (2.17, 2.72)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026lt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eHave skills to manage a patient with difficulty in breathing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3.32 (3.06, 3.58)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003e2.79 (2.55, 3.03)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026lt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eHave skills to manage a patient with bleeding problems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3.32 (3.04, 3.61)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003e2.82 (2.59, 3.06)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026lt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eHave skills to immobilize patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3.32 (3.04, 3.61)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003e2.47 (2.16, 2.78)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026lt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe BEC course appears to be an effective model for increasing emergency medical knowledge among recent medical school graduates at the University of Nairobi. In our previous study, there was an increase in immediate post-course test scores compared to pre-course test scores, indicating an improvement in knowledge (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). This study, however, looks at long-term retention of knowledge following the course. Overall, the follow-up test scores were lower than the immediate post-course test scores, which suggests knowledge loss over time. However, the clinical significance of a 4 point decrease on written test scores at 1 year post BEC is debatable.\u003c/p\u003e \u003cp\u003eFollow-up test scores were higher than pre-course test scores, although not statistically significant, indicating there is likely some improvement in emergency medicine comprehension even several months after taking the course. Medical knowledge attrition is well documented phenomonen, underscoring the need for regular refresher courses (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCompared to the control group, the BEC participants had higher test scores during the follow-up period, although the difference was not statistically significant. We believe future studies aimed at assessing the long-term effectiveness of the BEC course with a larger sample size may demonstrate statistical significance.\u003c/p\u003e \u003cp\u003eWhen comparing per question scores between the one year follow up and the control group, the BEC cohort had significantly higher confidence scores. BEC course participants were overwhelmingly more comfortable in handling emergency cases when compared with the control group. For example, in response to the question, \u0026ldquo;I feel comfortable handling any patient requiring emergency care\u0026rdquo;, compared to their peers who did not take the BEC, they were significantly more comfortable (Table \u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e2\u003c/span\u003eb). Overwhelmingly, clinical confidence was higher among the BEC cohort. These findings are of particular interest, since these both of these groups are now practicing physicians.\u003c/p\u003e \u003cp\u003eHowever, similar to the attrition of knowledge test scores, we saw a loss of confidence in the BEC cohort 12\u0026ndash;18 months after the course. Although most BEC studies have only evaluated knowledge and confidence changes immediately post-course, a study in Sierra Leone examined knowledge retention among BEC participants six months after the course (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Similar to our study, immediate post-course test scores were significantly higher than the pre-course test scores but demonstrate a decrease in knowledge six months after the BEC. Their findings suggests that there is knowledge loss as soon as six months after completion of the course.\u003c/p\u003e \u003cp\u003eThe statistically significant loss of confidence in emergency care knowledge underscores importance of re-training of emergency courses as well as the importance of supportive mentorship post-course for effective knowledge, skill retention and clinical confidence. High acuity, low occurrence (HALO) clinical events and procedures, such as those practiced in the BEC, are well defined in the pre-hospital literature (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Physicians encounter these HALO scenarios involving acute airways, resuscitations, ob emergencies and rare life-saving procedures. Regular re-trainings, involving simulation based education and deliberate practice, has been demonstrated to maintain HALO event readiness and knowledge retention (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn Kenya, graduating medical students receive varying degrees of training in emergency care (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Physicians taking care of acute or unstable patients, which include junior house officers, need training in emergency care given their high level of autonomy in those roles. Kenya hospitals have varying course requirements for medical officers, such as Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS), and/or Advanced Trauma Life Support (ATLS), but not all medical students have the opportunity to take these training courses. These courses have a more narrow scope, typically require retraining and re-certification every 2\u0026ndash;3 years, and can be expensive (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe BEC course takes a broad approach to acute emergencies, providing a foundation for stabilizing acutely ill or injured patients. Providing the BEC to new medical school graduates makes it possible to instill these foundational concepts before their internship. The BEC course is not a substitute for a multi-year emergency medicine speciality training program; however, the BEC course can increase new medical school graduates\u0026rsquo; familiarity with emergency care, prepare them for HALO events and can be more widely implemented than specialized emergency medicine training due to the short-course structure. It may also increase interest in emergency medicine as a medical specialty by exposing new physicians to emergency care.\u003c/p\u003e \u003cp\u003e While the target attendees of the BEC course are health care providers in resource-limited settings, this study focused on medical school graduates from a major academic medical center in Nairobi, Kenya. The participants in this study likely had higher baseline knowledge and clinical skills compared to BEC attendees in other settings. By contrast, courses taught in Uganda and Tanzania recruited and trained mixed attendees, including physicians, nurses, nursing officers, allied health professionals, midwives, pharmacists, or technicians (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). The pre- and post-course test results in these studies were markedly lower than those seen in our study. We suspect this is due to baseline knowledge differences among the groups based on the effect of prior training and job experience.\u003c/p\u003e \u003cp\u003eOur results underscore the need for ongoing education and training in acute and emergency care. Ongoing team based acute care training and availability of supportive mentorship has been shown to improve knowledge and skill retention amongst participants (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Further studies can be done with implementation of re-training, deliberate practice and post course mentorship to assess the level of retention of knowledge and skills.\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eThis BEC training was offered exclusively to physicians who were new graduates of the University of Nairobi. This limits the comparison to other BEC studies with differing composition of trainees. As such, results of pre-course and post-course scores, knowledge retention, and confidence are not likely comparable to other cohorts due to selection bias among the trainees. Our study compared a first-come, first-served cohort of enrollees against a voluntary control group of first-year intern-level physicians who did not take the course. Since they were not randomized in selection, both the course and control participants may reflect groups of physicians with a special interest in emergency medicine. As such, we may have a false negative conclusion of no difference in overall knowledge during the follow-up period as compared to a general medical graduate. Five physicians in the experimental group were lost to follow-up. While this is not a large percentage, it may also cause incorrect conclusions on the effectiveness of the course, in either a positive or negative direction.\u003c/p\u003e \u003cp\u003eThe BEC course is generally taught in English, and all Kenyan medical students speak English, in addition to Kiswahili. The same cannot be said for participants from other African countries, where the native or national language may not be English. This may limit comparability across studies as communication differences or limitations may be responsible for score increases or decreases as opposed to actual differences in learning and retention.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThere is minimal formal emergency medicine training for medical students in Kenya. This study shows that the WHO BEC course is an effective tool for emergency medicine training for medical students at the University of Nairobi. The participants\u0026rsquo; decrease in knowledge and confidence 12 to 18 months after the BEC course suggests the need for regular refresher courses. However, the overall increase in confidence among newly practicing physicians who took the BEC is encouraging. Implementing this course into the national medical school curriculum could provide a feasible option to improve student\u0026rsquo;s knowledge of managing and stabilizing critically ill and injured patients, as well as improve clinical confidence after graduation.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAFEM: African Federation of Emergency Medicine\u003c/p\u003e\n\u003cp\u003eBEC: Basic Emergency Care: Approach to the acutely ill and injured Course\u003c/p\u003e\n\u003cp\u003eEM: Emergency Medicine\u003c/p\u003e\n\u003cp\u003eHICs: High-income countries\u003c/p\u003e\n\u003cp\u003eICRC: International Committee of the Red Cross\u003c/p\u003e\n\u003cp\u003eIFEM: International Federation for Emergency Medicine\u003c/p\u003e\n\u003cp\u003eLMICs: Low- and middle-income countries\u003c/p\u003e\n\u003cp\u003eToT: Training of Trainers\u003c/p\u003e\n\u003cp\u003eWHO: World Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors certify that the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. This study was reviewed and approved by the Kenyatta National Hospital - University of Nairobi Ethics and Research Committee, protocol P703/12/2020 and the Lifespan IRB, protocol 1736842-2. All participants provided written consent to participate in the study.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAll datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis research study was supported by funds from the Department of Emergency Medicine, Brown University, the UNC Global Health Scholarship Program and personal professional development funds from UNC faculty. The funding from these sources was used to purchase supplies and equipment for the BEC training and support the researchers\u0026rsquo; and course facilitators\u0026rsquo; travel expenses. \u0026nbsp;These funding sources did not play a role in the design of the study, the collection, analysis, and interpretation of data, or the writing of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cem\u003eAuthors\u0026rsquo; contributions\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNM obtained IRB approval, obtained grant funding, coordinated and taught the BEC course, collected data, and wrote the methods section of the manuscript. AB coordinated and taught the BEC course, and wrote the discussion and limitations section of the manuscript. GD coordinated and taught the BEC course, collected data and wrote the discussion and conclusions section of the manuscript. MG coordinated and taught the BEC and provided critical input into the manuscript. DL coordinated and taught the BEC Course and collected data. DO coordinated and taught the BEC Course and provided critical input into the manuscript. GW coordinated and taught the BEC course and provided critical input into the design and execution of the study. JM taught the BEC Course, collected data and provided critical revisions to manuscript. All authors read and approved the final Manuscript.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank the University of Nairobi for providing facilities to support this training. A special thanks to Dr. Trufosa Mochache and Dr. Pascal Mugemangango for providing valuable support and guidance to the Nairobi BEC Team. We also thank Julianne Cyr, MPH, CPH, for her contribution to the literature review for the discussion of this manuscript. \u003cstrong\u003e\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eA Brief History of Emergency Medicine Residency Training [press release]. 2005.\u003c/li\u003e\n\u003cli\u003eNowacki AK, Landes M, Azazh A, Puchalski Ritchie LM. A review of published literature on emergency medicine training programs in low- and middle-income countries. Int J Emerg Med. 2013;6(1):26.\u003c/li\u003e\n\u003cli\u003eRybarczyk MM, Ludmer N, Broccoli MC, Kivlehan SM, Niescierenko M, Bisanzo M, et al. Emergency Medicine Training Programs in Low- and Middle-Income Countries: A Systematic Review. Ann Glob Health. 2020;86(1):60.\u003c/li\u003e\n\u003cli\u003eChang CY, Abujaber S, Reynolds TA, Camargo CA, Jr., Obermeyer Z. Burden of emergency conditions and emergency care usage: new estimates from 40 countries. Emerg Med J. 2016;33(11):794-800.\u003c/li\u003e\n\u003cli\u003eCelenza A, Jelinek GA, Jacobs I, Kruk C, Graydon R, Murray L. Implementation and evaluation of an undergraduate emergency medicine curriculum. Emerg Med (Fremantle). 2001;13(1):98-103.\u003c/li\u003e\n\u003cli\u003eWald DA, Lin M, Manthey DE, Rogers RL, Zun LS, Christopher T. Emergency medicine in the medical school curriculum. Acad Emerg Med. 2010;17 Suppl 2:S26-30.\u003c/li\u003e\n\u003cli\u003eMacFarlane C, Green-Thompson L. Medical student education in emergency medicine: new model from South Africa. Emerg Med Australas. 2006;18(3):276-81.\u003c/li\u003e\n\u003cli\u003eJaneway H, Modi P, Wanjiku G, Millan R, Kato D, Foggle J, et al. Training the trainers in emergency medicine: an advanced trauma training course in Rwanda\u0026apos;s medical simulation center. Pan Afr Med J. 2015;20:242.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. Basic Emergency Care: approach to the acutely ill and injured. World Health Organization; 2018 Dec 17. https://www.who.int/publications/i/item/basic-emergency-care-approach-to-the-acutely-ill-and-injured. Accessed 28 August 2023.\u003c/li\u003e\n\u003cli\u003eTenner AG, Sawe HR, Amato S, Kalanzi J, Kafwamfwa M, Geduld H, et al. Results from a World Health Organization pilot of the Basic Emergency Care Course in Sub Saharan Africa. PLoS One. 2019;14(11):e0224257.\u003c/li\u003e\n\u003cli\u003eSonenthal PD, Kachimanga C, Komba D, Bangura M, Ludmer N, Lado M, et al. Applying the WHO-ICRC BEC course to train emergency and inpatient healthcare workers in Sierra Leone early in the COVID-19 outbreak. BMC Health Serv Res. 2022;22(1):197.\u003c/li\u003e\n\u003cli\u003eOlufadeji A, Usoro A, Akubueze CE, Aiwonodagbon BO, Strong J, Kivlehan SM, et al. Results from the implementation of the World Health Organization Basic Emergency Care Course in Lagos, Nigeria. Afr J Emerg Med. 2021;11(2):231-6.\u003c/li\u003e\n\u003cli\u003eKivlehan SM, Dixon J, Kalanzi J\u003cem\u003e, et al. \u003c/em\u003eStrengthening emergency care knowledge and skills in Uganda and Tanzania with the WHO-ICRC Basic Emergency Care Course. \u003cem\u003eEmergency Medicine Journal \u003c/em\u003e2021;\u003cstrong\u003e38:\u003c/strong\u003e636-642.\u003c/li\u003e\n\u003cli\u003eMichaeli N, De Luca G, Gitau M, Myers J, Ojuka D, Ouma D, et al. Evaluation of the World Health Organization-International Committee of the Red Cross Basic Emergency Care course for senior medical students. Int J Emerg Med. 2023;16(1):29.\u003c/li\u003e\n\u003cli\u003eMuthaura PN, Khamis T, Ahmed M, Hussain SR. Perceptions of the preparedness of medical graduates for internship responsibilities in district hospitals in Kenya: a qualitative study. BMC Med Educ. 2015;15:178.\u003c/li\u003e\n\u003cli\u003eWhatsApp Inc. (Facebook, Inc.). WhatsApp [Internet]. 2020. Available from: https://whatsapp.com.\u003c/li\u003e\n\u003cli\u003eAfrican Federation of Emergency Medicine. Terms of Reference: Basic Emergency Care Course Facilitator. AFEM; Not-dated. https://afem.africa/project/bec-accreditation/. Accessed 24 September 2023.\u003c/li\u003e\n\u003cli\u003eAfrican Federation of Emergency Medicine. BEC Course Accreditation. https://afem.africa/project/bec-accreditation/. Accessed 24 September 2023.\u003c/li\u003e\n\u003cli\u003eR Core Team. R: A Language and Environment for Statistical Computing [Internet]. Vienna, Austria; 2020. Available from: https://www.R-project.org/.\u003c/li\u003e\n\u003cli\u003eCusters, E.J.F.M. Long-term retention of basic science knowledge: a review study. Adv in Health Sci Educ 15, 109\u0026ndash;128 (2010). https://doi.org/10.1007/s10459-008-9101-y\u003c/li\u003e\n\u003cli\u003eKerfoot, B.P., DeWolf, W.C., Masser, B.A., Church, P.A. and Federman, D.D. (2007), Spaced education improves the retention of clinical knowledge by medical students: a randomised controlled trial. Medical Education, 41: 23-31. https://doi.org/10.1111/j.1365-2929.2006.02644.x\u003c/li\u003e\n\u003cli\u003eHack KE, Levy MJ, Garfinkel E, Margolis AM. Establishing consensus-based high-acuity low-occurrence skills for EMS physicians: A pilot survey of EMS fellowship faculty. AEM Educ Train. 2022 Dec 20;6(6):e10828. doi: 10.1002/aet2.10828. PMID: 36562031; PMCID: PMC9763967.\u003c/li\u003e\n\u003cli\u003eHakemi A, Blamoun J, Lundahl A, Armstead T, Hakemi K, Malik M. A Conceptual Framework for Instructional Design of a High Acuity and Low Occurrence Event - Simulation Based Education Training of Residents, Medical Students, and Nurses in Anaphylaxis Utilizing Curated Educational Theories. Adv Med Educ Pract. 2023 Feb 10;14:101-107. doi: 10.2147/AMEP.S398013. PMID: 36798716; PMCID: PMC9926979.\u003c/li\u003e\n\u003cli\u003eSanten SA, Hemphill RR, Pusic M, Cico SJ, Wolff M, Merritt C. Our responsibility to patients: Maintain competency or \u0026hellip; stop practicing. AEM Educ Train. 2023 Nov 22;7(6):e10916. doi: 10.1002/aet2.10916. PMID: 37997590; PMCID: PMC10664403.\u003c/li\u003e\n\u003cli\u003ePetrosoniak, A., Sherbino, J., Beardsley, T. et al. Are we talking about practice? A randomized study comparing simulation-based deliberate practice and mastery learning to self-guided practice. Can J Emerg Med 25, 667\u0026ndash;675 (2023). https://doi.org/10.1007/s43678-023-00531-0\u003c/li\u003e\n\u003cli\u003eLee JA, Wanjiku G, Nduku N, Aluisio AR, Kharel R, Simiyu JT, Wachira BW. The status and future of emergency care in the Republic of Kenya. Afr J Emerg Med. 2022 Mar;12(1):48-52. doi: 10.1016/j.afjem.2021.11.003. Epub 2022 Jan 12. PMID: 35070654; PMCID: PMC8761612.\u003c/li\u003e\n\u003cli\u003eKenya Council of Emergency Medical Technicians. Trainings. https://kcemt.co.ke/trainings/. Accessed 28 September 2023. \u003c/li\u003e\n\u003cli\u003eKhongo BD, Schmiedeknecht K, Aron MB, Nyangulu PN, Mazengera W, Ndarama E, Tenner AG, Baltzell K, Connolly E. Basic emergency care course and longitudinal mentorship completed in a rural Neno District, Malawi: A feasibility, acceptability, and impact study. PLoS One. 2023 Feb 6;18(2):e0280454. doi: 10.1371/journal.pone.0280454. PMID: 36745667; PMCID: PMC9901771.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijem","sideBox":"Learn more about [International Journal of Emergency Medicine](https://intjem.biomedcentral.com/)","snPcode":"12245","submissionUrl":"https://submission.nature.com/new-submission/12245/3","title":"International Journal of Emergency Medicine","twitterHandle":"@IntJEmergMed","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Emergency medicine education, Training, Emergency Care","lastPublishedDoi":"10.21203/rs.3.rs-5397920/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5397920/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe Basic Emergency Care (BEC) course was created by the World Health Organization (WHO) in collaboration with the International Committee of the Red Cross (ICRC) and the International Federation for Emergency Medicine (IFEM) to train frontline providers in low-resource settings. This study evaluates the effectiveness of the course for graduating medical students at the University of Nairobi one year after BEC course completion.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis longitudinal, prospective, comparative study was conducted with recent graduates of the University of Nairobi School of Medicine from October 2021 to May 2023. Participants\u0026rsquo; retention of emergency medicine knowledge was assessed with a multiple-choice examination 12 to 18 months after completing the BEC course. A survey assessed participants\u0026rsquo; confidence in managing patients with emergencies 12\u0026ndash;18 months after completing the BEC course using a 4-point Likert scale. These results were compared to a control group of recent University of Nairobi School of Medicine graduates who did not take the BEC course\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe follow-up test scores were lower than the immediate post-course test scores, which suggests some knowledge loss over time. Compared to the control group, the BEC participants had higher test scores during the follow-up period although the difference was not significant. There was no difference between most of the immediate post-course and follow-up survey responses. On follow-up evaluation, BEC participants reported a significant decrease in confidence in understanding emergency drugs and managing an obstructed airway and a patient requiring immobilization. However, compared to the control group, BEC participants had significantly higher self-reported confidence in most areas assessed by the survey.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis study shows that the WHO BEC course is an effective tool for emergency medicine training for recent graduates from the University of Nairobi. There was an overall increase in confidence among newly practicing physicians who took the BEC. The participants\u0026rsquo; decrease in knowledge and confidence 12 to 18 months after the BEC course suggests the need for regular refresher courses.\u003c/p\u003e","manuscriptTitle":"A Prospective, Longitudinal, Comparative Analysis of the World Health Organization / International Committee of the Red Cross Basic Emergency Care Course on Emergency Medicine Knowledge and Confidence Among Recent Medical School Graduates","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-17 08:37:56","doi":"10.21203/rs.3.rs-5397920/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-21T02:31:34+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-19T18:22:53+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-18T18:10:05+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-15T01:54:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"128568724624495710258667742361887701291","date":"2024-11-14T07:41:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"198220098457366029448284932758475785844","date":"2024-11-13T16:35:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"228314769685939187748094106848556289111","date":"2024-11-13T14:21:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"97088646666451174635214200100161739009","date":"2024-11-13T13:38:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"73592909936818366103824621391008824426","date":"2024-11-13T13:21:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"198848682380226554098922947887270409171","date":"2024-11-13T11:51:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"258051443849929050046361845963381705067","date":"2024-11-13T04:57:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"93124875530585440024666383404988222035","date":"2024-11-11T20:18:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"174551352478295663256082751082589273950","date":"2024-11-11T16:22:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"258878278851962609468501739120500388180","date":"2024-11-11T14:34:09+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-11-11T13:14:26+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-11-11T01:49:45+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-11-11T01:49:20+00:00","index":"","fulltext":""},{"type":"submitted","content":"International Journal of Emergency Medicine","date":"2024-11-05T20:04:18+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijem","sideBox":"Learn more about [International Journal of Emergency Medicine](https://intjem.biomedcentral.com/)","snPcode":"12245","submissionUrl":"https://submission.nature.com/new-submission/12245/3","title":"International Journal of Emergency Medicine","twitterHandle":"@IntJEmergMed","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cc3b99ff-2736-4dcf-84db-520088ce6a40","owner":[],"postedDate":"December 17th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-01-13T16:00:49+00:00","versionOfRecord":{"articleIdentity":"rs-5397920","link":"https://doi.org/10.1186/s12245-024-00797-w","journal":{"identity":"international-journal-of-emergency-medicine","isVorOnly":false,"title":"International Journal of Emergency Medicine"},"publishedOn":"2025-01-08 15:56:57","publishedOnDateReadable":"January 8th, 2025"},"versionCreatedAt":"2024-12-17 08:37:56","video":"","vorDoi":"10.1186/s12245-024-00797-w","vorDoiUrl":"https://doi.org/10.1186/s12245-024-00797-w","workflowStages":[]},"version":"v1","identity":"rs-5397920","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5397920","identity":"rs-5397920","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}