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Objectives: To evaluate and compare the educational impact of the University of Geneva Faculty of Medicine (UGFM) emergency medicine clerkship training with that provided by the Swiss Army medical officer cadets school (ARMY). The assessment was designed to assess students' clinical knowledge and competency in major emergency situations, ACLS (Advanced Cardiac Life Support) and ATLS (Advanced Traumatic Life Support)., Methods: Prospectively, 56 UGFM students were compared with 52 ARMY officer cadets by a multiformat pre- and post-training examination. The exam consisted of a multiple-choice questionnaire (MCQ), a standardised vignette-based oral exam (SOE) and a standardised practical cardio-pulmonary resuscitation (CPR) exercise., Results: Overall, on the pre- and post-training testing, total scores improved significantly for the UGFM by 10% (from 63 to 73%) and for the ARMY by 9% (from 60 to 69%). Knowledge assessed on the MCQ improved for the UGFM by 8% (64 to 72%) but not significantly for the ARMY. Performance on the SOE improved by 10% for UGFM (54 to 64%) and the ARMY (47 to 57%) as well as performance on the CPR, which improved by 15% for UGFM (72 to 87%) and 19% for the ARMY (67 to 86%). Post-training performance indicated that, respectively, UGFM scored significantly higher than the ARMY on the MCQ (72 and 68%) and the SOE (64 and 57%) but not on the CPR. Internal reliability indexes for the MCQ, SOE and CPR were respectively 0.72, 0.86 and 0.92. Correlations between the MCQ, SOE and CPR varied between 0.07 to 0.19., Conclusions: In general, the multimethod assessment seemed to provide a complementary approach to evaluation of the trainees' competency in emergency training. Except for the ARMY MCQ performance, both training programmes seemed to be effective in improving trainees' overall knowledge and clinical performance. The trainees' performances are reviewed and discussed in terms of the specific skills assessed on the SOE, the context of the trainees' expected level of performance, the teaching and evaluation approaches, and implications in establishing the equivalence of the two programmes.

Objective: Early admission to hospital with minimum delay is a prerequisite for successful management of acute stroke. We sought to determine our local pre- and in-hospital factors influencing this delay., Patients and Methods: Time from onset of symptoms to admission (admission time) was prospectively documented during a 6-month period (December 2004 to May 2005) in patients consecutively admitted for an acute focal neurological deficit presented at arrival and of presumed vascular origin. Mode of transportation, patient's knowledge and correct recognition of stroke symptoms were assessed. Physicians contacted by the patients or their relatives were interviewed. The influence of referral patterns on in-hospital delays was further evaluated., Results: Overall, 331 patients were included, 249 had an ischaemic and 37 a haemorrhagic stroke. Forty-five patients had a TIA with neurological symptoms subsiding within the first hours after admission. Median admission time was 3 hours 20 minutes. Transportation by ambulance significantly shortened admission delays in comparison with the patient's own means (HR 2.4, 95% CI 1.6-3.7). The only other factor associated with reduced delays was awareness of stroke (HR 1.9, 95% CI 1.3-2.9). Early in-hospital delays, specifically time to request CT-scan and time to call the neurologist, were shorter when the patient was referred by his family or to a lesser extent by an emergency physician than by the family physician (p < 0.04 and p < 0.01, respectively) and were shorter when he was transported by ambulance than by his own means (p < 0.01)., Conclusions: Transportation by ambulance and referral by the patient or family significantly improved admission delays and early in-hospital management. Correct recognition of stroke symptoms further contributed to significant shortening of admission time. Educational programmes should take these findings into account.