Assessing EM Patient Safety and Quality Improvement Milestones Using a Novel Debate Format

Abstract

Graduate medical education is increasingly focused on patient safety and quality improvement; training programs must adapt their curriculum to address these changes. We propose a novel curriculum for emergency medicine (EM) residency training programs specifically addressing patient safety, systems-based management, and practice-based performance improvement, called “EM Debates.” Following implementation of this educational curriculum, we performed a cross-sectional study to evaluate the curriculum through resident self-assessment. Additionally, a cross-sectional study to determine the ED clinical competency committee’s (CCC) ability to assess residents on specific competencies was performed. Residents were overall very positive towards the implementation of the debates. Of those participating in a debate, 71% felt that it improved their individual performance within a specific topic, and 100% of those that led a debate felt that they could propose an evidence-based approach to a specific topic. The CCC found that it was easier to assess milestones in patient safety, systems-based management, and practice-based performance improvement (sub-competencies 16, 17, and 19) compared to prior to the implementation of the debates. The debates have been a helpful venue to teach EM residents about patient safety concepts, identifying medical errors, and process improvement.

Systematic review of the use of debates in health professions education – does it work?

“…Debates were used for three key purposes, the first being development of key skills within health professions education such as effective communication, critical thinking skills, and higher order cognitive skills [4], [9], [23]. Second, five studies used debates as a tool to introduce and teach important healthcare topics such as patient safety [10], health economics [11], medical informatics to medical students [24], healthcare reform policies [25] and microbiology to nursing students [26]. Third, debates were used to teach evidence-based management using case-based scenarios [27].…”

“…Third, debates were used to teach evidence-based management using case-based scenarios [27]. Debates were conducted in the form of classroom presentations of pre-assigned topics by the faculty [4], with pre-and post-debate assessments using quizzes and surveys [9], [10], [11], [13] or judged by the audience vote [27]. Another study also used online discussions among paired student groups and the topics and the sides were randomly assigned [23].…”

“…This was evaluated by some studies using measures such as a Likert scale [10] or additional focus group discussions [24]. …”

“…Preparation of debate requires participants to consider thoroughly the evidence in order to present and argue persuasively for their case. One of the studies [10] that used a Likert scale to measure the impact of debate reported that 71% of residents agreed or strongly agreed that their individual performance on a specific topic related to patient safety and quality improvement had improved by critically appraising the scientific literature and applying evidence-based medicine. In the same study [10], approximately a third of the residents led a debate.…”

“…For individuals, an internal mental process takes place before a specific decision is made whilst for a group, this often involves active deliberation and argumentation over the facts and differing facets of the issues [5]. Debates as a teaching method has been previously employed in a variety of disciplines, ranging from political science [6], mathematics and statistics [7], argumentative writing [8], to healthcare [9], [10], [11]. Though debates are often conducted in the traditional classroom setting, it can be effective even if an online format is adopted [12].…”