Command economies, graduated responsibility, and Competence-Based Medical Education.

Competence-Based Medical Education (CBME) rightly emphasizes that residents should actively take charge of their own education by ensuring they are progressing towards competence in an array of Entrustable Professional Activities (EPAs). Paradoxically, many CBME curricula then dictate exactly how this is to happen by listing a multitude of variables that must be checked off regarding the specifics of cases encountered. This is burdensome and unrealistic as well as contrary to the spirit of CBME. We want residents to know how to learn so they can problem solve in new situations. This is not achieved by dictating that they see nearly everything during their residency. Command economies with complete and rigid planning from above do not work. This also applies to residency training.

La formation médicale basée sur les compétences (FMBC) souligne à juste titre que les résidents devraient prendre activement en main leur éducation en veillant à développer leurs compétences dans une variété d'activités professionnelles confiables (APC). Paradoxalement, un grand nombre de programmes de FMBC dictent précisément comment cela devrait se passer en dressant la liste d'une multitude de variables qui doivent être cochées selon les particularités des situations cliniques rencontrées. Ceci est fastidieux et peu réaliste de même que contraire à l'esprit de la FMBC. Nous voulons que les résidents sachent comment apprendre de façon à ce qu'ils puissent résoudre les problèmes lorsqu'une nouvelle situation se présente. Il n'est pas possible d'arriver à ce but en exigeant qu'ils soient exposés à presque tout durant leur résidence. Les économies dirigées dont la planification complète et rigide imposée par la direction ne fonctionnent pas. Ceci s'applique aussi aux programmes de résidence.

Improving suicide risk assessment in the emergency department through physician education and a suicide risk assessment prompt.

OBJECTIVE: To determine the efficacy of two interventions on suicide risk assessment within emergency departments (EDs) on improving the documentation of suicide risk factors by emergency medicine and psychiatric physicians during suicide risk assessment. METHOD: An educational intervention on suicide was provided to all emergency medicine and psychiatry physicians and was followed by the placement of a suicide risk assessment prompt within local EDs. The medical charts of all ED patients presenting with suicidal ideation or behaviours were reviewed immediately and six months after the interventions and compared to pre-intervention. Differences in the documentation of 40 biopsychosocial suicide risk factors between specialties and after the interventions were determined. RESULTS: The documentation of 34/40 (p ≤ 0.008) and 33/40 (p ≤ 0.009) suicide risk factors was significantly improved by emergency medicine and psychiatry physicians, respectively, after the interventions and maintained six months later. Immediately and six months after the interventions, the documentation of 8/40 (p ≤ 0.041) and 14/40 (p ≤ 0.048) suicide risk factors, respectively, significantly differed between specialties. CONCLUSION: This suggests that providing a brief educational intervention on suicide to emergency medicine and psychiatry physicians followed by placing a prompt for important, yet commonly undocumented risk factors within the ED is a low-cost and effective intervention for improving documentation of suicide risk assessments within the ED.