NATIONAL POSTGRADUATE EMERGENCY MEDICINE TTT (NPEMTTT): SUPERVISOR COURSE 6 Julai2023 Auditorium Hospital Rembau, Negeri Sembilan JAWATANKUASA BERSAMA KEPAKARAN PERUBATAN KECEMASAN
Time Content Method Trainer 0830-0845 Overview of NPEM Curriculum Lecture Khadijah Poh 0845-0900 Overview of assessment Lecture Azhana 0900-0915 WPBA Lecture Aida 0915 -0930 Feedback Lecture Ida Zarina 0930-1000 Break 1000-1200 WPBA stations (30 min each) A: MiniCEX (video) B: CBD (simulated) C: IBA (video) D: FMAT (video) Moderators: A: Iman/ Lim B: Hashim/ Hafyz C: Nadzrul/Aizuddin D: Khadijah P/ Azhana 1200-1215 Clinical supervision Lecture Faizal Amri 1215-1230 Thesis supervi sion Lecture Muhaimin 1230-1300 Poor performance Lecture Hashim 1300-1400 Lunch 1400-1430 Case scenarios on trainees who need help A: Thesis non-progress B: Family/ social C: Physical & mental health D: Bullying/ workplace issues Group discussion Moderators: A: Muhaimin/Emi B: Hafyz/ Aizud/Azhana C: ANS/ Suraina D: Ida/ Lim 1430-1530 Knowledge sharing Group presentation Faizal & moderators 1530-1600 Conclusion and Q&A Azhana End of course TENTATIVE NATIONAL POSTGRADUATE EMERGENCY MEDICINE TtT (NPEMTtT): SUPERVISOR COURSE
NATIONAL POSTGRADUATE EMERGENCY MEDICINE TtT (NPEMTtT): SUPERVISOR COURSE SECRETARIAT DR LIM TECK SENG DR EMI NOORINA MOHD NOOR DR SURAINA SULAIMAN DR MUHAMMAD SAIFUDDIN ARIF DR DAYANG HAZRIEZA AMID AZWAN BIN MUHAMMAD YASIN Jabatan Kecemasan dan Trauma Hospital Tuanku Jaafar Seremban DR MUHAMMAD IKRAM BIN HANAFI DR FIRDAUS FAZREEN BIN FAKHRORAZI Jabatan Kecemasan dan Trauma Hospital Rembau
NATIONAL POSTGRADUATE EMERGENCY MEDICINE TtT (NPEMTtT): SUPERVISOR COURSE SPEAKERS DR. KHADIJAH POH YUEN YOONG Jabatan Perubatan Kecemasan Pusat Perubatan Universiti Malaya DR. AZHANA BINTI HASSAN Jabatan Kecemasan dan Trauma Hospital Tuanku Ja'afar Seremban ASST. PROF DR AIDA NUR SYARINI MOHD SHAH Jabata n Perubatan Kecemasan Kulliyyah of Medicine Sultan Ahmad Shah Medical Centre, IIUM DR. IDA ZARINA BINTI ZAINI Jabatan Perubatan Kecemasan Pusat Perubatan Universiti Kebangsaan Malaysia DR. FAIZALAMRI HAMZAH Jabatan Perubatan Kecemasan Pusat Perubatan Universiti Kebangsaan Malaysia DR. ABDUL MUHAIMIN NOOR AZHAR Jabatan Perubatan Kecemasan Pusat Perubatan Universiti Malaya PROF MADYA DR HASHIM EMBONG Jabatan Perubatan Kecemasan Pusat Perubatan Universiti Kebangsaan Malaysia
NATIONAL POSTGRADUATE EMERGENCY MEDICINE TtT (NPEMTtT): SUPERVISOR COURSE MODERATORS PROF MADYA DR HASHIM EMBONG Jabatan Perubatan Kecemasan Pusat Perubatan Universiti Kebangsaan Malaysia DR. MOHD IMAN SAIFUL SUHARDI Jabatan Perubatan Kecemasan Kulliyyah of Medicine Sultan Ahmad Shah Medical Centre, IIUM DR. MOHD NADZRUL SHAH MOHD JUNIT Jabatan Perubatan Kecemasan Kulliyyah of Medicine Sultan Ahmad Shah Medical Centre, IIUM DR. MOHD HAFYZUDDIN MD YUSUF Jabatan Perubatan Kecemasan Pusat Perubatan Universiti Malaya DR. MOHD AIZUDDIN AZIZAH ARIFAH Jabatan Perubatan Kecemasan Pusat Perubatan Universiti Malaya
NATIONAL POSTGRADUATE EMERGENCY MEDICINE TtT (NPEMTtT): SUPERVISOR COURSE PARTICIPANTS DR MOHD AMIN MOHIDIN DR MUHAMMAD RAMDHAN ABD AZIZ DR MURNIZA MURAD DR FAIRUZ NADIRAH BADRUL HISAN Hospital Sultanah Aminah, Johor Bahru DR MARYAM SUMAIYA AHMAD TERMIZI DR NOOR HAYATI YASMIN NGA TIMIN DR LEE CHEE SIONG Hospital Sultan Ismail, Johar Bahru DR CHE ROS ABDULLAH DR NOR ALIZA ARIFFIN Hospital Sultanah Nora Ismail, Batu Pahat DR ZUL IMRAN MALEK ABDOL HAMID Hospital Pakar Sultanah Fatimah, Muar DR MOHD ZAKARIA MOHD ZAKI CHUAH DR RABIHA MOHD ALIF DR ABDUL RAHMAN ABDUL KADIR DR MOHD HAFIZ MOHAMED SAKAN Hospital Melaka
NATIONAL POSTGRADUATE EMERGENCY MEDICINE TtT (NPEMTtT): SUPERVISOR COURSE PARTICIPANTS DR SUHAIMI MAHMUD DR ZURAIDAH WAHID DR NORHAZIZAH HUSSIN DR AHMAD FADZIL SUJAK DR MUHAMMAD FAIZ BAHERIN DR NURAISYAH MOHAMED HAMSON DR SYARIFAH NAEMAH SYED MANSOR Hospital Tuanku Jaafar, Seremban DR MOHD ADLAN ALI DR MOHD AMIN OMAR Hospital Tuanku Ampuan Najihah, Kuala Pilah DR AMELIA AMIR DR BHASYANI NAGARETNAM Hospital Sungai Buloh DR MUHAMMAD NUR AZMI BAHARUDDIN DR MUHAMMAD ZULHILMI ABU BAKAR Hospital Al-Sultan Abdullah, UiTM Puncak Alam
Dr Mohd Amin Mohidin Dr Maryam Sumaiya Ahmad Termizi Dr Che Ros Abdullah Dr Ahmad Fadzil Sujak Dr Muhammad Faiz Baherin Dr Rabiha Mohd Alif Dr Bhasyani Nagaretnam GROUP 1 Dr Zul Imran Malek Abdol Hamid Dr Mohd Zakaria Mohd Zaki Chuah Dr Syarifah Naemah Syed Mansor Dr Mohd Adlan Ali Dr Amelia Amir Dr Muhammad Nur Azmi Baharuddin Dr Nor Aliza Ariffin GROUP 3 Dr Mohd Amin Omar Dr Suhaimi Mahmud Dr Abdul Rahman Abdul Kadir Dr Murniza Murad Dr Zuraidah Wahid Dr Noor Hayati Yasmin Nga Timin Dr Muhammad Ramdhan Abd Aziz GROUP 2 Dr Mohd Hafiz Mohamed Sakan Dr Nuraisyah Mohamed Hamson Dr Fairuz Nadirah Badrul Hisan Dr Norhazizah Hussin Dr Muhammad Zulhilmi Abu Bakar Dr Lee Chee Siong GROUP 4 NATIONAL POSTGRADUATE EMERGENCY MEDICINE TtT (NPEMTtT): SUPERVISOR COURSE GROUPING &STATIONS STATION A :Auditorium: MINI CEX (Video) STATION B: ED Discussion Room: CBD (Simulated) STATION C: Bilik Seminar 1: IBA (Video) STATION D: Bilik Seminar 2: FMAT (Video)
NATIONAL POSTGRADUATE EMERGENCY MEDICINE TtT (NPEMTtT): SUPERVISOR COURSE WPBA : TRAINER BOOKLET This booklet is a compilation of slides for training on Workplace-based Assessment prepared by: DR AIDAWATI BUSTAM Senior Lecturer in Emergency Medicine, Universiti Malaya National Postgraduate Medical Curriculum (NPMC) Course Director December 2022 Workplace-Based Assessment: Trainer Booklet National Postgraduate Emergency Medicine (NPEM) Curriculum
NATIONAL POSTGRADUATE EMERGENCY MEDICINE TtT (NPEMTtT): SUPERVISOR COURSE WBPA 1 : MINI-CEX WBPA 1 Mini-Clinical Evaluation Exercise(Mini-CEX) TtT objectives: • Understand the purposes of Mini-CEX as a Workplace Based Assessment in EM training. • Able to conduct Mini-CEX with their EM trainees. What is Mini-CEX? • A direct observation of Trainee's interactions with a patient in clinical setting. • Trainee performs with the Trainer observing. • Followed by immediate and constructive feedback from the Trainer. What does it assess? • Trainee's history taking, physical examination and counselling skills that result in demonstration of the trainee's clinical judgement and reasoning in diagnosis and management. • Trainee's attitudes and professional behaviour at the workplace. • What the Trainee actually 'does' in practice rather than what they merely know. Why it matters? • Inadequacies in history taking and physical examinations were factors in ED medical errors and adverse events (Verghese et al., 2015, Kachalia et al., 2007). • A review of hospital-based surveys reported a mean satisfaction rate with medical communication of 38% (Lloyd et al., 2000). • Most complaints by the public about ED doctors resulted from treatment and communication problem (Taylor et al., 2002). Case resources • Trainees often manage patients in the presence of their specialist during shift work. • They usually present cases to their specialist as part of the training process. • Some of these cases can serve as opportunities for Mini-CEX. • Mini-CEX does not require formal planning, it can occur almost spontaneously and opportunistic in nature.
NATIONAL POSTGRADUATE EMERGENCY MEDICINE TtT (NPEMTtT): SUPERVISOR COURSE WBPA 1 : MINI-CEX Mapping to ExitELAs Mini-CEX Flowchart
NATIONAL POSTGRADUATE EMERGENCY MEDICINE TtT (NPEMTtT): SUPERVISOR COURSE WBPA 1 : MINI-CEX Mini-CEX: Domains and behaviours/tasks assessed • Patient assessment • Patient counselling Mini-CEX: Patient assessment • Five competency domains for Patient Assessment. • Examples of positive and negative/omitted performances are given below as a guide:
NATIONAL POSTGRADUATE EMERGENCY MEDICINE TtT (NPEMTtT): SUPERVISOR COURSE WBPA 1 : MINI-CEX Mini-CEX: Patient counselling • Five competency domains for Patient Counselling. • Examples of positive and negative/omitted performances are given below as a guide:
NATIONAL POSTGRADUATE EMERGENCY MEDICINE TtT (NPEMTtT): SUPERVISOR COURSE WBPA 1 : MINI-CEX Provide immediate and constructive geedback orally to the Trainee Aim at facilitating the Trainee's training Effective feedback can be successful in promoting self-directed learning, improving the Trainee's abilities, and change clinical practice. Include positive feedback and what areas they should aim to improve and how to improve. Balance the good and bad feedback points, be constructive not destructive. Otherwise the Trainee might end up hating these sessions and thus avoidance behaviour or defensiveness. Give feedback as assessment FOR learning, but stick to the rule: assess now, teach later. Conduction teaching too much during the assessment process disrupts the time devoted to assessment. Trainers: giving feedback
NATIONAL POSTGRADUATE EMERGENCY MEDICINE TtT (NPEMTtT): SUPERVISOR COURSE WBPA 1 : MINI-CEX Using a rating scale to reflect the overall impression of the Trainee's performance (Global Summary Level). A qualitative judgement of the Trainee's performance based on supervision level required by the Trainee for future similar cases. Benchmark: all judgements should be based on the standard expected of a Day 1 specialist. Rating of trainee's performance Global summary level Assessor may ask themselves: Can I leave the room? Do I need to return to check? Can the Trainee now manage a similar case in the future or counsel a patient without onsite supervision? Feedback should be provided to the Trainee to help them improve their performance as indicated by decreasing level of supervision required. Assessing trainees based on supervision level helps to assess whether educational objectives have been achieved by linking them to patient care and patient safety objectives (Ten Cate et al., 2015).
NATIONAL POSTGRADUATE EMERGENCY MEDICINE TtT (NPEMTtT): SUPERVISOR COURSE WBPA 2 : CbD WBPA 2 Case-based Discussion (CbD) TtT objectives: • Understand the purposes of CbD as a Workplace Based Assessment in EM training. • Able to conduct CbD with their EM trainees. What is C-bD? • A one-to-one assessment with the Trainer. • Trainee presents and discusses a real patient case that he/she has previously managed. • Allows the Trainer to ask focused/probing questions assessing 2 to 3 competency domains. • Followed by immediate and constructive feedback from the Trainer. What does it assess? • Trainee's clinical decision-making and reasoning by asking questions that explore what was done, and why and how any decision, investigation or intervention was decided upon. • Trainee's professionalism and medical record keeping at the workplace. Why it matters? • Studies on diagnostic errors in emergency medicine have shown rates of 0.6-12.5% (O'Connor et al., 1995, Chellis et al., 2001). • Cognitive factors contributed to 96% of diagnostic errors (Kachalia et al., 2007). • Up to 45% of patients do not receive evidence based care (Scott, 2009). Case resources • Should be the Trainee's own patients in his/her own workplace, and seen recently. • Trainee may prepare for 2 to 3 cases and let the Trainer select one for the discussion. • Alternatively, the Trainer may also select cases if aware of issues that would benefit from discussion.
WBPA 2 : CbD NATIONAL POSTGRADUATE EMERGENCY MEDICINE TtT (NPEMTtT): SUPERVISOR COURSE Trainee should select C-bD cases that contribute towards the following exit ELAs: Mapping to ExitELAs Case selection is very important to success. Tell your Trainee to present you with cases that focus on the competencies/Exit ELAs they have not covered in previous C-bD, or those that have been flagged as needing development. Cases in which there was an element of uncertainty or where a conflict in decision-making are particular good ones to choose. Case selection
NATIONAL POSTGRADUATE EMERGENCY MEDICINE TtT (NPEMTtT): SUPERVISOR COURSE C-bD flowchart WBPA 2 : CbD
NATIONAL POSTGRADUATE EMERGENCY MEDICINE TtT (NPEMTtT): SUPERVISOR COURSE WBPA 2 : CbD Seven competency domains are assessed,plus: Professionalism and medical recordkeeping. Trainer determines the competency domains to focus/probe on for the case (2 to 3 out of the seven domains). The domains and examples of positive and negative/omitted performances are given below as a guide: CbD: Competency domains
NATIONAL POSTGRADUATE EMERGENCY MEDICINE TtT (NPEMTtT): SUPERVISOR COURSE WBPA 2 : CbD What issues did you feel the case raised? What issues did you feel needed resolving? What aspects did you feel challenging or difficult? Conducting CbD using the right probing questions What C-bD is NOT? •NOT a knowledge test. •Must NOT be an exploration of what the trainee might hypothetically do. Focus of discussion •Focus on what is in the patient notes. •Explore the trainee's thinking process behind the decisions or actions in managing the case. Questions to start off the C-bD •Ask the trainee to introduce the case briefly - try not to interrupt (2-3mins). •Useful starting point - ask them 3things: •Set the agenda - state explicitly which competency domains you are looking at today.
NATIONAL POSTGRADUATE EMERGENCY MEDICINE TtT (NPEMTtT): SUPERVISOR COURSE WBPA 2 : CbD Good probing questions and questions to avoid •Questions should be open. •Avoid questions that merely test knowledge. You are trying to explore the trainee's clinical reasoning and insight. •Do not ask hypothetical questions. Avoid 'what if..' questions. The discussion is of what the trainee did, not what they hypothetically might do.
Provide immediate and constructive feedback orally to the trainee. Aim at facilitating the trainee's training. Effective feedback can be successful in promoting self-directed learning, improving the Trainee's abilities, and change clinical practice. Include positive feedback and what areas they should aim to improve and how to improve. Balance the good and bad feedback points, be constructive, not destructive. Otherwise, the Trainee might end up hating these sessions and thus avoidance behavior or defensiveness. Give feedback as assessment FOR learning, but stick to the rule: assess now, teach later. Conduction teaching too much during the assessment process disrupts the time devoted to assessment. Using a rating scale to reflect the overall impression of the Trainee's performance (Global SummaryLevel). A qualitative judgement of the Trainee's performance based on supervision level required by the Trainee for future similar cases. Benchmark: all judgements should be based on the standard expected of a Day 1 specialist. Trainers: giving feedback Rating of trainee's performance NATIONAL POSTGRADUATE EMERGENCY MEDICINE TtT (NPEMTtT): SUPERVISOR COURSE WBPA 2 : CBD
Global summary level NATIONAL POSTGRADUATE EMERGENCY MEDICINE TtT (NPEMTtT): SUPERVISOR COURSE WBPA 2 : CbD Assessor may ask themselves: Can I leave the room? Do I need to return to check? Can the Trainee now manage a similar case in the future or counsel a patient without onsite supervision? Feedback should be provided to the Trainee to help them improve their performance as indicated by decreasing level of supervision required. Assessing trainees based on supervision level helps to assess whether educational objectives have been achieved by linking them to patient care and patient safety objectives (Ten Cate et al., 2015).
Consent Deliberation(Planning) Preparation Technique Intervention(Troubleshooting) Post intervention management TtT objectives: •Understand the purposes of IBA as a Workplace Based Assessment in EMtraining. •Able to conduct IBA with their EM trainees. What is IBA? •A direct observation of a Trainee performing interventionsin theED. •Trainee performs with the Trainer observing. •Followed by immediate and constructive feedback from the trainer. •More than just a specific clinical procedure. Interventions with diagnostic, therapeutic and resuscitative goals. Covers consent-taking to post intervention management. What does it assess? •Trainee's performance of the intervention in 6 domains: 1. 2. 3. 4. 5. 6. Why it matters? •Knowledge base, clinical reasoning and communication skills, in addition to manual dexterity form the cornerstone of good patient care. •Training of procedural/interventional skills requires a more structured approach, while minimising the burden of assessment but maximising the opportunities for trainee feedback. • • NATIONAL POSTGRADUATE EMERGENCY MEDICINE TtT (NPEMTtT): SUPERVISOR COURSE WBPA 3 : IBA WBPA 3 Intervention Based Assessment (IBA)
NATIONAL POSTGRADUATE EMERGENCY MEDICINE TtT (NPEMTtT): SUPERVISOR COURSE WBPA 3 : IBA Mapping to Exit ELAs The IBAs will contribute towards the following Exit ELAs: Case resources •Trainees often manage patients and perform various interventions in the presence of their specialist during shiftwork. •Some of these interventions can serve as opportunities for IBA. •IBA does not require formal planning, it can occur almost spontaneously and opportunistic in nature Types of IBA
NATIONAL POSTGRADUATE EMERGENCY MEDICINE TtT (NPEMTtT): SUPERVISOR COURSE WBPA 3 : IBA IBA: Domains and behaviours/tasks assessed
NATIONAL POSTGRADUATE EMERGENCY MEDICINE TtT (NPEMTtT): SUPERVISOR COURSE WBPA 3 : IBA
NATIONAL POSTGRADUATE EMERGENCY MEDICINE TtT (NPEMTtT): SUPERVISOR COURSE WBPA 3 : IBA
Trainers: giving feedback •Provide immediate and constructive feedback orally to the trainee. •Aim at facilitating the trainee'straining. •Effective feedback can be successful in promoting self-directed learning, improving the Trainee's abilities, and change clinical practice. •Include positive feedback and what areas they should aim to improve and how to improve. •Balance the good and bad feedback points, be constructive not destructive. Otherwise the Trainee might end up hating these sessions and thus avoidance behaviour or defensiveness. •Give feedback as assessment FOR learning, but stick to the rule: assess now, teach later. Conduction teaching too much during the assessment process disrupts the time devoted to assessment. Rating of trainee's performance •Using a rating scale to reflect the overall impression of the Trainee's performance (Global SummaryLevel). •A qualitative judgement of the Trainee's performance based on supervision level required by the Trainee for future similar cases. •Benchmark: all judgements should be based on the standard expected of a Day 1 specialist. NATIONAL POSTGRADUATE EMERGENCY MEDICINE TtT (NPEMTtT): SUPERVISOR COURSE WBPA 3 : IBA
Global summary level NATIONAL POSTGRADUATE EMERGENCY MEDICINE TtT (NPEMTtT): SUPERVISOR COURSE WBPA 3 : IBA Assessor may ask themselves: Can I leave the room? Do I need to return to check? Can the Trainee now manage a similar case in the future or counsel a patient without onsite supervision? Feedback should be provided to the Trainee to help them improve their performance as indicated by decreasing level of supervision required. Assessing trainees based on supervision level helps to assess whether educational objectives have been achieved by linking them to patient care and patient safety objectives (Ten Cate et al., 2015).
WBPA 4 Floor Management Assessment Tool (FMAT) TtT objectives: •Understand the purposes of FMAT as a Workplace Based Assessment in EM training. •Able to conduct FMAT with their EM trainees. What is FMAT? •A tool to facilitate a Trainee in their final year undertaking the role of an ED registrar. •Trainer (usually the EP on floor duty/on-call) observes the Trainee and can discuss with the Trainee to gain insight on their decision-making and actions. •Trainer provides immediate feedback to facilitate the Trainee's learning and performance. What does it assess? •Ability of the Trainee to oversee the management of the ED floor in terms of resources, efficiency of patient flow and space utilisation, troubleshooting and providing support to the ED team, and managing challenging situations(curveballs). •Four domains are assessed: situational awareness, decision-making, communication and leadership. NATIONAL POSTGRADUATE EMERGENCY MEDICINE TtT (NPEMTtT): SUPERVISOR COURSE WBPA 4 : FMAT
Why it matters? •Prepares the Trainee with the competency domains deemed important to perform the functions of a specialist managing the ED floor. FMAT sessions •FMAT is best conducted over a period of time e.g. 1-2 hours or over more than one setting e.g. 2-3 registrar calls, to allow as many domains and behaviours/tasks to be observed. Mapping to Exit ELAs •FMAT will contribute towards the following exit ELAs: NATIONAL POSTGRADUATE EMERGENCY MEDICINE TtT (NPEMTtT): SUPERVISOR COURSE WBPA 4 : FMAT
FMAT flowchart NATIONAL POSTGRADUATE EMERGENCY MEDICINE TtT (NPEMTtT): SUPERVISOR COURSE WBPA 4 : FMAT
To assess the competency domains in FMAT, each domain has a list of behaviours/tasks that can be observed during the trainee's registrar duty. The 4 domains (situational awareness, decision making, communication and leadership) can be assessed all together in one Trainee's registrar on-call duty, or separately over multiple settings of the trainee's registrar duty. FMAT: Domains and behaviours/tasks assessed Situational awareness NATIONAL POSTGRADUATE EMERGENCY MEDICINE TtT (NPEMTtT): SUPERVISOR COURSE WBPA 4 : FMAT Decision making
Communication NATIONAL POSTGRADUATE EMERGENCY MEDICINE TtT (NPEMTtT): SUPERVISOR COURSE WBPA 4 : FMAT Leadership
Trainers: giving feedback •Provide immediate and constructive feedback orally to the trainee. •Aim at facilitating the trainee'straining. •Effective feedback can be successful in promoting self-directed learning, improving the Trainee's abilities, and change clinical practice. •Include positive feedback and what areas they should aim to improve and how to improve. •Balance the good and bad feedback points, be constructive not destructive. Otherwise the Trainee might end up hating these sessions and thus avoidance behaviour or defensiveness. •Give feedback as assessment FOR learning, but stick to the rule: assess now, teach later. Conduction teaching too much during the assessment process disrupts the time devoted to assessment. Rating of trainee's performance •Using a rating scale to reflect the overall impression of the Trainee's performance (Global SummaryLevel). •A qualitative judgement of the Trainee's performance based on supervision level required by the Trainee for future similar cases. •Benchmark: all judgements should be based on the standard expected of a Day 1 specialist. Global summary level NATIONAL POSTGRADUATE EMERGENCY MEDICINE TtT (NPEMTtT): SUPERVISOR COURSE WBPA 4 : FMAT
•Assessor may ask themselves: Can I leave the room? Do I need to return to check? Can the Trainee now manage a similar case in the future or counsel apatient without onsite supervision? •Feedback should be provided to the Trainee to help them improve their performance as indicated by decreasing level of supervision required. •Assessing trainees based on supervision level helps to assess whether educational objectives have been achieved by linking them to patient care and patient safety objectives (Ten Cate et al.,2015). NATIONAL POSTGRADUATE EMERGENCY MEDICINE TtT (NPEMTtT): SUPERVISOR COURSE WBPA 4 : FMAT