Article review: How competent do trainees feel?

It is 2 a.m. You, the resident, have just spoken to your staff/attending, who told you to do a task. You have seen one, but don't feel comfortable doing one independently.

• Will you tell your staff/attending about how you feel? 
• What if the patient did poorly after that?

This study examines the perception of EM trainees of their competence and adverse events and how they feel about reporting them.

Methods

• Anonymous web-based survey sent to all trainees from 9 EM programs in Canada outside Quebec. 
• 37.3% trainees responded.

Results

Competence

• 40% trainees felt they had minimal supervision when doing a task that they did not feel safe about. 
• Most 'unsafe' tasks included providing care overnight, admission decision or procedures.
• When feeling incompetent, a third of trainees will not report this to their staff.
• Barriers include worry about loss of trust, automony or respect.

Adverse events

• 64% trainees felt responsible for contributing to adverse events.
• Most relate to procedures - chest tubes, central lines, paracentesis.
• Majority, but not all, reported the most serious events to the staff.
• Barriers include fear of appearing incompetent and humiliation.

How would I change my teaching practice

• Ensure trainees feel safe. Maybe do a dry run of central line insertion/break bad news prior.
• Encourage trainees to voice their discomfort. They are learning, not just working.
• Discuss adverse events and medical errors with trainees.

Reference
Friedman S, Sowerby R, Guo R, Bandiera G. Perceptions of emergency medicine residents and fellows regarding competence, adverse events and reporting to supervisors: a national survey. CJEM: Canadian journal of emergency medical care. 2010, 12(6), 491-9. PMID: 21073775