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By Michelle Lin
Medical Doctor
Specialty: Emergency Medicine
Blog: http://academiclifeinem.blogspot.com
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Michelle Lin's Twitter Updates

@precordialthump I totally forgot about the EKG library! Awesome stuff. Keep up the great work (when do you sleep?!) 257 days ago
@emeducation Perfect, thanks for the suggestions! Turns out one is co-authored by Jeff Tabas. He already gave them all books. 257 days ago
Recommendations for an EKG resource to review bread & butter cases for senior residents? Pre-graduation panic setting in for our residents. 258 days ago
@danipedia Good point. I use the studies to convince the trauma consults NOT to get c-spine imaging on EVERYONE (citing distracting injury)! 263 days ago
@doctorflash Hi there. Just wanted to drop a note to thank you for all the extra traffic you're sending to blog. Much appreciated!! 273 days ago
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Article review: How competent do trainees feel?

Posted Feb 07 2011 12:00am
It is 2 a.m. You, the resident, have just spoken to your staff/attending, who told you to do a task. You have seen one, but don't feel comfortable doing one independently.
  • Will you tell your staff/attending about how you feel? 
  • What if the patient did poorly after that?
This study examines the perception of EM trainees of their competence and adverse events and how they feel about reporting them.

Methods
  • Anonymous web-based survey sent to all trainees from 9 EM programs in Canada outside Quebec. 
  • 37.3% trainees responded.
Results
Competence
  • 40% trainees felt they had minimal supervision when doing a task that they did not feel safe about. 
  • Most 'unsafe' tasks included providing care overnight, admission decision or procedures.
  • When feeling incompetent, a third of trainees will not report this to their staff.
  • Barriers include worry about loss of trust, automony or respect.
Adverse events
  • 64% trainees felt responsible for contributing to adverse events.
  • Most relate to procedures - chest tubes, central lines, paracentesis.
  • Majority, but not all, reported the most serious events to the staff.
  • Barriers include fear of appearing incompetent and humiliation.


How would I change my teaching practice
  • Ensure trainees feel safe. Maybe do a dry run of central line insertion/break bad news prior.
  • Encourage trainees to voice their discomfort. They are learning, not just working.
  • Discuss adverse events and medical errors with trainees.

Reference
Friedman S, Sowerby R, Guo R, Bandiera G. Perceptions of emergency medicine residents and fellows regarding competence, adverse events and reporting to supervisors: a national survey. CJEM: Canadian journal of emergency medical care. 2010, 12(6), 491-9. PMID: 21073775
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