Caring moments within an interprofessional healthcare team: Children and adolescent perspectives

Patients are now recognized as key partners to improve healthcare outcomes. Some organisations such as the WHO or the Canadian Interprofessional Health Collaborative (CIHC) encourage considering patients as partners in the interprofessional healthcare team. However, limited knowledge exists on patients’ perspective of interprofessional collaboration (IPC) and of their role in the collaborative process, particularly in pediatric settings. The experiences and perspectives of patients regarding IPC have to be considered in order to fully understand the concept of IPC and integrate it into practice. This qualitative study aimed at gaining a better understanding of the perspective of children of IPC, how it affects their experiences of care and how they perceive their own role within the interprofessional team. Semi-structured interviews were used in the pediatric service of a Swiss university hospital, with ten children and adolescents aged between 11-17 years. The participants described the interactions they observed between nurses and physicians and provided insights into how they perceived the quality of that relationship. A respectful relationship between nurses and physicians may have improved the experience of a caring environment. The participants did not perceive their role to be pivotal into the interprofessional relationship. The findings of this study indicate that the interactions between healthcare professionals have an influence on the perspectives and experiences of the participants of their hospitalisation and of IPC. However, integrating children and adolescents into collaborative process will need a change of paradigm and beliefs regarding IPC

Aspects cognitifs de l'erreur en médecine

• En médecine ambulatoire, il a été estimé que 1 patient sur 20 est victime d’une erreur diagnostique et que environ 30% des plaintes légales sont attribuées à des erreurs diagnostiques. • Les médecins sont souvent appelés à prendre des décisions rapidement. La prise de décision est alors facilitée par des stratégies cognitives appelées heuristiques, qui permettent des «raccourcis de la pensée» vers une décision rapide. Elles sont la plupart du temps très performantes mais parfois elles peuvent nous mener à l’erreur • Certaines situations nous exposent à un risque accru de biais cognitifs: c’est le cas des transmissions de patients, les contraintes de temps ainsi que certains facteurs liés au médecin (stress, fatigue) ou au patient (complexité clinique ou relationnelle) • La reconnaissance de ces situations permet d’appliquer des «habitudes» de raisonnement clinique plus explicites, capables de réduire le risque d’erreur cognitif

A multi-method approach to drafting candidate entrustable professional activities for a general internal medicine residency programme

INTRODUCTION: Entrustable professional activities (EPAs) are units of concrete daily clinical tasks that trainee physicians should be able to handle with increasing autonomy during their postgraduate training. EPAs are gaining international recognition as an essential component of competency-based medical training programmes. The process of developing EPAs for a nationwide training programme is complex and requires an in-depth understanding of EPAs as a concept and good knowledge of appropriate development processes. This article provides a detailed description of the methodology and results of a multi-step approach for developing a list of candidate EPAs for Switzerland’s postgraduate training programme in general internal medicine (GIM). METHODS: We took a multi-step approach including a systematic review of international literature, four national focus groups, a national consensus process using a RAND appropriateness method, and a quality check of the selected candidate EPAs using EQual criteria. RESULTS: These steps generated a final list of 247 candidate EPAs in general internal medicine that were submitted for the national consensus process. After two rounds of rating, experts agreed on the appropriateness for general internal medicine postgraduate training of 225 candidate EPAs. Twenty-two were deemed inappropriate, and disagreement persisted only for two EPAs. DISCUSSION: This multi-step programme is one of the few describing in detail the process of developing a list of EPAs and providing evidence of validity at each step. The clinical breadth of our candidate EPAs, together with the detailed description of our methodology, could serve as a useful starting point from which medical education specialists or clinicians could develop or revise applicable lists of EPAs, particularly for postgraduate training programmes in either general internal medicine or family medicine