Implementation of a Web-Based Tool With Text Message Prompts to Improve End-of-Shift Assessments for Emergency Medicine Residents

Abstract

Background: End-of-shift assessments (ESA) can provide representative data on medical trainee performance but do not occur routinely and are not documented systematically. Objective: To evaluate the implementation of a web-based tool with text message prompts to assist mobile ESA (mESA) in an emergency medicine (EM) residency program. Methods: mESA used timed text messages to prompt faculty/trainees to expect in-person qualitative ESA in a milestone content area and for the faculty to record descriptive performance data through a web-based platform. We assessed implementation between January 2018 and November 2019 using the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance). Results: Reach: 96 faculty and 79 trainees participated in the mESA program. Effectiveness: From surveys, approximately 72% of faculty and 58% of trainees reported increases in providing and receiving ESA feedback after program implementation. From ESA submissions, trainees reported receiving in-person feedback on 90% of shifts. Residency leadership confirmed perceived utility of the mESA program. Adoption: mESA prompts were sent on 7792 unique shifts across 4 EDs, all days of week, and different times of day. Faculty electronically submitted ESA feedback on 45% of shifts. Implementation quality: No technological errors occurred. Maintenance: Completion of in-person ESA feedback and electronic submission of feedback by faculty was stable over time. Conclusions: We found mixed evidence in support of using a web-based tool with text message prompts for mESA for EM trainees.