Becoming a specialist in emergency medicine

Informal learning from error in hospitals: what do we learn, how do we learn and how can informal learning be enhanced? A narrative review

Learning from error is not just an individual endeavour. Organisations also learn from error. Hospitals provide many learning opportunities, which can be formal or informal. Informal learning from error in hospitals has not been researched in much depth so this narrative review focuses on five learning opportunities: morbidity and mortality conferences, incident reporting systems, patient claims and complaints, chart review and prospective risk analysis. For each of them we describe: (1) what can be learnt, categorised according to the seven CanMEDS competencies; (2) how it is possible to learn from them, analysed against a model of informal and incidental learning; and (3) how this learning can be enhanced. All CanMEDS competencies could be enhanced, but there was a particular focus on the roles of medical expert and manager. Informal learning occurred mostly through reflection and action and was often linked to the learning of others. Most important to enhance informal learning from these learning opportunities was the realisation of a climate of collaboration and trust. Possible new directions for future research on informal learning from error in hospitals might focus on ways to measure informal learning and the balance between formal and informal learning. Finally, 12 recommendations about how hospitals could enhance informal learning within their organisation are given.

Restructuring the Morbidity and Mortality Conference in a Department of Pediatrics to serve as a vehicle for system changes

PURPOSE

Morbidity and Mortality conference (MMC) serves an important role in medical care and education. We restructured our Department of Pediatrics MMC to focus on multidisciplinary participation and improved communication among disciplines, quality improvement, and system changes for safer clinical care and enhanced learning from adverse outcomes.

METHOD

The structure and philosophy of the Department of Pediatrics MMC was changed. We present guiding principles for the restructuring process and evaluation results postrestructuring, which examined achievement of conference goals, including quality improvement.

RESULTS

The MMC led to system changes within the Department of Pediatrics as well as other parts of the hospital. Satisfaction with these changes was high among conference participants, who felt that the conference achieved its goals of including multiple disciplines and creating system changes.

CONCLUSIONS

The successful change in the focus of the pediatric MMC conference resulted in significant hospital-wide system changes, quality improvements, enhanced education, and departmental satisfaction.

Mentoring in emergency medicine: the art and the evidence

A mentor is a person who takes a special interest in the professional development of a junior colleague and provides guidance and support. Mentoring can be beneficial for students, residents, junior colleagues and researchers and can be very rewarding for the physician who provides this guidance. Although mentoring is a well recognized topic in academic medicine, relatively little has been written about mentoring in emergency medicine (EM). Consequently, we conducted a literature review on mentoring in EM and present our findings in this paper. We discuss different models of mentoring, factors that foster the development of strong mentor ship programs, the responsibilities of mentors and mentees, and issues specific to mentorship of female, minority and research physicians. We also present several case scenarios as a basis for recommendations for teachers and learners in EM.

Optimizing resident training: results and recommendations of the 2009 Council of Residency Directors consensus conference

This paper reports the results of a consensus conference of the Council of Emergency Medicine Residency Directors (CORD) to discuss the experiential training component of residency education in the emergency department (ED) and to make recommendations on structuring clinical training. Self-selected emergency medicine (EM) educators discussed experiential training focusing on three topic areas: 1) methods to optimize training in the clinical setting, 2) identification of goals and objectives by training year, and 3) determination of measurable behaviors demonstrating achievement of goals and objectives by residents. Topic areas were organized into the following questions: 1) what is the optimal number and evolution of ED shifts for EM residents during their residency training, 2) what clinical skills are expected of a resident at each level of training, and 3) what objective measures should be used to provide evidence of resident competency? Participants attended a lecture on the goals of the conference, the questions to be answered, and the role and implementation of deliberate practice into experiential training. Attendees were divided into three groups, each discussing one question. Each group had two discussion leaders. All discussions were digitally recorded for accuracy. After discussion all groups reconvened and reported summaries of discussions and recommendations to ensure group agreement. There were 59 participants representing 42 training programs. Educators agree that essential features of designing the ED clinical experience include the need to: 1) structure and tailor the clinical experience to optimize learning, 2) establish expectations for clinical performance based on year of training, and 3) provide feedback that is explicit to year-specific performance expectations.