Koo Andrew, Smith Jonathan T
Leeds Teaching Hospitals NHS Trust, St James University Hospital, Beckett Street, Leeds, LS9 7TF, UK.
Insights Imaging. 2019 Jul 17;10(1):68. doi: 10.1186/s13244-019-0751-5.
The Royal College of Radiologists (RCR) and General Medical Council (GMC) encourage learning from mistakes. But negative feedback can be a demoralising process with adverse implications for staff morale, clinical engagement, team working and perhaps even patient outcomes. We first reviewed the literature regarding positive feedback and teamworking. We wanted to see if we could reconcile our guidance to review and learn from mistakes with evidence that positive interactions had a better effect on teamworking and outcomes than negative interactions. We then aimed to review and categorise the over 600 (mainly discrepancy) cases discussed in our educational cases meeting into educational 'themes'. Finally, we explored whether we could use these educational themes to deliver the same teaching points in a more positive way.
The attendance records, programmes and educational cases from 30 consecutive bimonthly meetings between 2011 and 2017 were prospectively collated and retrospectively analysed. Six hundred and thirty-two cases were collated over the study period where 76% of the cases submitted were discrepancies, or perceived errors. Eight percent were 'good spots' where examples of good calls, excellent reporting, exemplary practice or subtle findings that were successfully reported. Eight percent were educational cases in which no mistake had been made. The remaining 7% included procedural complications or system errors.
By analysing the pattern of discrepancies in a department and delivering the teaching in a less negative way, the 'lead' of clinical errors can be turned in to the 'gold' of useful educational tools. Interrogating the whole database periodically can enable a more constructive, wider view of the meeting itself, highlight recurrent deficiencies in practice, and point to where the need for continuing medical training is greatest. Three ways in which our department have utilised this material are outlined: the use of 'good spots', arrangement of targeted teaching and production of specialist educational material. These techniques can all contribute to a more positive learning experience with the emphasis on acknowledging and celebrating excellence (ACE).
英国皇家放射科医师学院（RCR）和英国医学总会（GMC）鼓励从错误中学习。但负面反馈可能是一个令人士气低落的过程，会对员工士气、临床参与度、团队协作甚至患者治疗结果产生不利影响。我们首先回顾了有关正面反馈和团队协作的文献。我们想看看能否将我们关于回顾错误并从中学习的指导意见与如下证据协调一致：正面互动比负面互动对团队协作和结果有更好的影响。然后，我们旨在对我们教育病例会议中讨论的600多个（主要是差异）病例进行回顾和分类，归纳为教育“主题”。最后，我们探讨是否可以利用这些教育主题，以更积极的方式传授相同的教学要点。
对2011年至2017年期间连续30次双月会议的出勤记录、议程和教育病例进行前瞻性整理和回顾性分析。在研究期间整理了632个病例，其中76%提交的病例是差异或被认为是错误。8%是“亮点”，即良好判断、出色报告、模范实践或成功报告的细微发现的例子。8%是未出现错误的教育病例。其余7%包括程序并发症或系统错误。
通过分析科室差异模式并以不那么负面的方式进行教学，临床错误的“铅”可以转化为有用教育工具的“金”。定期审查整个数据库可以对会议本身形成更具建设性、更广泛的看法，突出实践中反复出现的缺陷，并指出继续医学培训需求最大的地方。概述了我们科室利用这些材料的三种方式：使用“亮点”、安排针对性教学和制作专业教育材料。这些技术都有助于营造更积极的学习体验，重点是认可和颂扬卓越（ACE）。
