Lewis Jason J, Rosen Carlo L, Grossestreuer Anne V, Ullman Edward A, Dubosh Nicole M
Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
Diagnosis (Berl). 2019 Jun 26;6(2):173-178. doi: 10.1515/dx-2018-0079.
Background Diagnostic errors in emergency medicine (EM) can lead to patient harm as well as potential malpractice claims and quality assurance (QA) reviews. It is therefore essential that these topics are part of the core education of trainees. The methods training programs use to educate residents on these topics are unknown. The goal of this study was to identify the current methods used to teach EM residents about diagnostic errors, QA, and malpractice/risk management and determine the amount of educational teaching time EM programs dedicate to these topics. Methods An 11-item questionnaire pertaining to resident education on diagnostic errors, QA, and malpractice was sent through the Council of Emergency Medicine Residency Directors (CORD) listserv. Differences in the proportions of responses by duration of training program were analyzed using chi-squared or Fisher's exact tests. Results Fifty-four percent (91/168) of the EM programs responded. There was no difference in prevalence of formal education on these topics among 3- and 4-year programs. The majority of programs (59.5%) offer fewer than 4 h per year of additional QA education beyond morbidity and mortality rounds; a minority of the programs (18.8%) offer more than 4 h per year of medical malpractice/risk management education. Conclusions This needs assessment demonstrated that there is a lack of dedicated educational time devoted to these topics. A more formalized and standard curricular approach with increased time allotment may enhance EM resident education about diagnostic errors, QA, and malpractice/risk management.
背景 急诊医学（EM）中的诊断错误可能导致患者受到伤害，以及引发潜在的医疗事故索赔和质量保证（QA）审查。因此，这些主题成为住院医师核心教育的一部分至关重要。培训项目用于教育住院医师这些主题的方法尚不清楚。本研究的目的是确定当前用于向急诊医学住院医师传授诊断错误、质量保证以及医疗事故/风险管理的方法，并确定急诊医学项目在这些主题上投入的教育教学时间量。方法 通过急诊医学住院医师培训主任委员会（CORD）的邮件列表发送了一份关于住院医师诊断错误、质量保证和医疗事故教育的11项问卷。使用卡方检验或费舍尔精确检验分析培训项目时长不同的回复比例差异。结果 54%（91/168）的急诊医学项目做出了回应。在3年制和4年制项目中，这些主题的正规教育普及率没有差异。大多数项目（59.5%）每年在发病率和死亡率讨论之外提供少于4小时的额外质量保证教育；少数项目（18.8%）每年提供超过4小时的医疗事故/风险管理教育。结论 这项需求评估表明，在这些主题上缺乏专门的教育时间。采用更正规、标准的课程方法并增加时间分配，可能会加强急诊医学住院医师对诊断错误、质量保证以及医疗事故/风险管理的教育。
