CJEM Articles: reporting
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Perceptions of emergency medicine residents and fellows regarding competence, adverse events and reporting to supervisors: a national surveyNovember 2010 12 6Glen Bandiera, Ray Guo, Robert J. Sowerby, Steven Marc Friedman
Objective: We sought to characterize the perceptions of emergency medicine (EM) residents and fellows of their clinical and procedural competence, as well as their attitudes, practices and perceived barriers to reporting these perceptions to their supervisors.
Methods: A Web-based survey was distributed to residents and fellows, via their residency directors, in all Canadian EM residency programs outside of Quebec.
Results: Of 220 residents and fellows contacted in 9 of 10 EM programs of the Royal College of Physicians and Surgeons of Canada and 12 of 13 EM programs of The College of Family Physicians of Canada, 82 (37.3%) completed all or part of the survey. Response rates varied slightly by question; 25 of 82 respondents (30.5% [95% confidence interval (CI) 19.9%–41.1%]) agreed with the statement, “I sometimes feel unsafe or unqualified with undertaking unsupervised responsibilities or procedures, but I do not report this to my senior physician” and 32 of 81 (39.5% [95% CI 28.2%–50.8%]) had felt this within the past 6 months. Moreover, 34 of 82 (41.5% [95% CI 30.2%–52.7%]) reported their lack of competence to a supervisor half the time or less. Trainees reported worry about loss of trust, autonomy or respect (38/80, 47.5% [95% CI 35.9%–59.1%]) or reputation (32/80, 40.0% [95% CI 28.6%–51.4%]). Nights on-call (30/79, 38% [95% CI 26.6%–49.3%]), admission decisions (13/79, 16.5% [7.6%–25.3%]) and central line insertion (13/79, 16.5% [95% CI 7.6%–25.3%]) were reported to be frequently undertaken despite not feeling competent. Suggestions to improve reporting included encouragement to report without penalty (41/82, 50.0% [95% CI 38.6%–61.4%]) and a less judgmental environment (32/82, 39.0% [95% CI 27.9%–50.2%]).
Conclusion: Emergency medicine trainees report that they frequently do not feel competent when undertaking responsibilities without supervision. Barriers to reporting these feelings or reporting adverse events appear to relate to social pressures and authority gradients. Modifications to the training culture are encouraged to improve patient safety.
Bjug Borgundvaag, Hannah Park, Howard Ovens
Objective: With the proclamation of Bill 110 in September 2005, Ontario became the first jurisdiction in Canada to mandate that gunshot wounds (GSWs) be reported to authorities. We sought to evaluate the impact of Bill 110, including the awareness of, experience with and opinions about the new law among Ontario emergency physicians (EPs), the public and the police.
Methods: An online survey was distributed to all members of the Section on Emergency Medicine at the Ontario Medical Association. The public survey consisted of 3 closed questions and was performed by the polling firm Ipsos-Reid by telephone. Police opinion was requested through the Ministry of Community Safety and Correctional Services of the Ontario government.
Results: The physician response rate was 25%. The great majority of respondents were aware of the law (93%) and willing to comply (88%), but only half were sure of their obligations and the penalties. Since the law had been proclaimed, the majority (51%) had seen at least 1 GSW victim. Seventy-nine percent reported no problems with either the police or the bill, and 86% perceived no change in relations with patients. Six incidents of patients delaying care were reported. Of the public surveyed, two-thirds were aware of the law. After being informed of the law, almost all (95%) expressed support, and the majority (80%) felt it would not change their relationship with their treating physician. All 47 members of the Ontario Provincial Police who were surveyed agreed that Bill 110 is helpful for shooting investigations, 8 reported that they had personally been involved in cases initiated by a report and 6 had been involved in cases where charges were laid or weapons confiscated. Data on actual reports and results of investigations were not available.
Conclusion: Bill 110 seems to have been broadly accepted by the emergency community and endorsed by the public.