University of Toronto, Ontario, Canada.
CJEM. 2010 Nov;12(6):491-9. doi: 10.1017/s1481803500012719.
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.
A Web-based survey was distributed to residents and fellows, via their residency directors, in all Canadian EM residency programs outside of Quebec.
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 re-spondents (30.5% [95% confidence interval (CI) 19.9%-41.1%]) agreed with the statement, "I sometimes feel unsafe or un-qualified 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%]).
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.
我们旨在描述急诊医学（EM）住院医师和研究员对其临床和程序能力的看法，以及他们报告这些看法给上级的态度、实践和感知障碍。
通过居住主任，向所有加拿大皇家医师学院和加拿大家庭医师学院的 10 个 EM 项目中的 9 个以及 13 个 EM 项目中的 12 个居住项目中的居民和研究员分发了基于网络的调查。
在联系了 220 名居住和研究员后，有 82 名（37.3%）[95%置信区间（CI）19.9%-41.1%]完成了调查的全部或部分内容。答复率因问题略有不同；25 名答复者（30.5%[95% CI 29.9%-41.1%]）同意这一说法，“有时我在承担无人监督的责任或程序时感到不安全或没有资格，但我没有向上级医生报告这一点”，32 名 81 名（39.5%[95% CI 28.2%-50.8%]）在过去 6 个月内有过这种感觉。此外，34 名 82 名（41.5%[95% CI 30.2%-52.7%]）的研究员报告说，他们的主管缺乏能力的情况一半或更少。受训者报告说，他们担心失去信任、自主权或尊重（38/80，47.5%[95% CI 35.9%-59.1%]）或声誉（32/80，40.0%[95% CI 28.6%-51.4%]）。夜间值班（30/79，38%[95% CI 26.6%-49.3%]）、入院决策（13/79，16.5%[7.6%-25.3%]）和中央线插入（13/79，16.5%[95% CI 7.6%-25.3%]）被报告为尽管感到能力不足，但经常进行。改善报告的建议包括鼓励报告而不受处罚（41/82，50.0%[95% CI 38.6%-61.4%]）和营造一个不那么评判的环境（32/82，39.0%[95% CI 27.9%-50.2%]）。
急诊医学住院医师报告说，他们在没有监督的情况下承担责任时经常感到没有能力。报告这些感觉或报告不良事件的障碍似乎与社会压力和权力梯度有关。鼓励对培训文化进行修改，以提高患者安全性。
