Hitchner Lily, Yore Mackensie, Burk Charney, Mason Jessica, Sawtelle Vohra Stacy
Department of Emergency Medicine UCSF Fresno Medical Education Program Fresno California USA.
UCLA National Clinician Scholars Program, Department of Emergency Medicine Greater Los Angeles VA Medical Center California Los Angeles USA.
AEM Educ Train. 2023 Apr 1;7(2):e10864. doi: 10.1002/aet2.10864. eCollection 2023 Apr.
Interprofessional feedback and teamwork skills training are important in graduate medical education. Critical event debriefing is a unique interprofessional team training opportunity in the emergency department. While potentially educational, these varied, high-stakes events can threaten psychological safety for learners. This is a qualitative study of emergency medicine resident physicians' experience of interprofessional feedback during critical event debriefing to characterize factors that impact their psychological safety.
The authors conduced semistructured interviews with resident physicians who were the physician team leader during a critical event debriefing. Interviews were coded and themes were generated using a general inductive approach and concepts from social ecological theory.
Eight residents were interviewed. The findings suggest that cultivating a safe learning environment for residents during debriefings involves the following: (1) allowing space for validating statements, (2) supporting strong interprofessional relationships, (3) providing structured opportunities for interprofessional learning, (4) encouraging attendings to model vulnerability, (5) standardizing the process of debriefing, (6) rejecting unprofessional behavior, and (7) creating the time and space for the process in the workplace.
Given the numerous intrapersonal, interpersonal, and institutional factors at play, educators should be sensitive to times when a resident cannot engage due to unaddressed threats to their psychological safety. Educators can address these threats in real time and over the course of a resident's training to enhance psychological safety and the potential educational impact of critical event debriefing.
跨专业反馈和团队合作技能培训在毕业后医学教育中很重要。关键事件汇报是急诊科独特的跨专业团队培训机会。虽然这些多样化的高风险事件可能具有教育意义，但会威胁学习者的心理安全。这是一项关于急诊医学住院医师在关键事件汇报期间跨专业反馈体验的定性研究，旨在确定影响其心理安全的因素。
作者对在关键事件汇报期间担任医师团队负责人的住院医师进行了半结构化访谈。使用一般归纳法和社会生态理论的概念对访谈进行编码并生成主题。
对8名住院医师进行了访谈。研究结果表明，在汇报期间为住院医师营造安全的学习环境包括以下几点：（1）留出空间以确认陈述；（2）支持牢固的跨专业关系；（3）提供跨专业学习的结构化机会；（4）鼓励上级医师表现出易感性；（5）规范汇报流程；（6）抵制不专业行为；（7）在工作场所为该流程创造时间和空间。
鉴于存在众多个人、人际和机构因素，教育工作者应敏锐意识到住院医师因心理安全受到未解决的威胁而无法参与的情况。教育工作者可以在住院医师培训期间实时应对这些威胁，以增强心理安全以及关键事件汇报的潜在教育影响。
