ContextThe electronic health record (EHR) has been identified as a potential site for gathering data about trainees' clinical performance, but these data are not collected or organised for this purpose. Therefore, a careful and rigorous approach is required to explore how EHR data could be meaningfully used for assessment purposes. The purpose of this study was to identify EHR performance metrics that represent both the independent and interdependent clinical performance of emergency medicine (EM) trainees and explore how they might be meaningfully used for assessment and feedback.MethodsUsing constructivist grounded theory, we conducted 21 semi‐structured interviews with EM faculty members and residents. Participants were asked to identify the clinical actions of trainees that would be valuable for assessment and feedback and describe how those activities are represented in the EHR. Data collection and analysis, which consisted of three stages of coding, occurred iteratively.ResultsWhen faculty members and trainees in EM were asked to reflect on the usefulness of using EHR performance metrics for resident assessment and feedback they expressed both widespread support for the idea in principle and hesitation that aspects of clinical performance captured in the data would not be representative of residents’ individual performance, but would rather reflect their interdependence with other team members and the systems in which they work. We highlight three categorisations of system‐level interdependence ‐ medical directives, technological systems and organisational systems ‐ identified by our participants, and discuss strategies participants employed to navigate these forms of interdependence within the health care system.ConclusionsSystem‐level interdependence shapes physicians’ performances, and yet, this impact is rarely corrected for or noted within clinical performance data. Educators have a responsibility to recognise system‐level interdependence when teaching and consider system‐level interdependence when assessing the performance of trainees in order to most effectively and fairly utilise the EHR as a source of assessment data.

Background Point-of-care ultrasound (POCUS) has many applications in emergency medicine, which have been proven to improve patient outcomes. Training programs and well-established guidelines for its use are available, but Canadian adoption rates and attitudes toward this technology have not been recently assessed. Objectives This study aimed to provide a national assessment of the current use of POCUS in Canadian emergency departments (ED) including patterns of use, attitudes towards its role, descriptors of training experience, as well as barriers to increased utilization. Methods An electronic survey was sent to physician members of the Canadian Association of Emergency Physicians. The survey included questions related to demographics, attitudes towards POCUS, POCUS utilization, and barriers to POCUS use. Responses were statistically analyzed to identify significant associations. Results Responses demonstrated a strong association between POCUS training and amount of POCUS usage. Neither hospital type nor community type was associated with the degree of POCUS usage. POCUS was most widely adopted for Canadian Point of Care Ultrasound Society (CPOCUS) core applications and has increased since the last national survey. The most commonly reported barrier to increased POCUS adoption was the lack of training. Most physicians have formal POCUS training in core applications, and approximately one third have advanced training. Conclusions POCUS training and utilization appear to have increased since the last national assessment. This provides a foundation for future POCUS research.

Participants were sensitive to both the best clinical evidence of benefit, as recommended by CPGs, and patient context when determining how care should be managed.