SIDM's priority: Translating ideas into action

Mayer, Thom tmayer at BEST-PRACTICES.COM
Thu Nov 5 12:47:20 UTC 2015


Folks:

In support of Pat's excellent idea-and as symbol of how deep the problem is, I teach a large portion of the American College of Emergency Physicians (ACEP) Emergency Department Directors' Academy course,, which addresses both physician and nurse leadership.  To date, we have had over 1,500 physician and nurse leaders go through the course, part of which highlights the often disparate ways in which physicians and nurses are educated.

100% of the nurse leaders have told me that "critical thinking skills" are the single most important attribute in hiring emergency department nurses.  And yet when I ask the physicians, less than 10 had any idea whatsoever what that term meant, simply because they are not exposed to that specific concept.  A decidedly unscientific sample, to be sure, but one which I fear would hold true in other specialties.

Obviously, I think a Critical Thinking module is an excellent idea.

Best,

Thom

Thom A. Mayer, MD, FACEP, FAAP
Founder and CEO
[BP]



From: Pat Croskerry [mailto:croskerry at EASTLINK.CA]
Sent: Wednesday, November 04, 2015 3:52 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] SIDM's priority: Translating ideas into action


Mark: these all look worthwhile initiatives.

I'd like to add a further one: given that a number of studies now point to a significant proportion of diagnostic failure being due to thinking failures, and given that meta-analytic studies demonstrate conclusively that by far the most effective way of improving reasoning and problem solving skills is through critical thinking interventions, I advocate for the introduction of critical thinking interventions at UGME and PGME. Others have already designated critical thinking as a meta-competency and some programs have embarked on this in separate initiatives. Others in the ethics domain have strongly proposed that this be done as an 'ethical imperative', and, given the unacceptably high estimates of preventable deaths from diagnostic failure it's hard to argue with that.

Rather than each inventing our own wheels, how about developing a generic Critical Thinking Module that would be available off the shelf that medical educators could use? The content could be approved by a consensus committee. This would be an inexpensive project with potentially high returns.

Pat


On 11/04/15 12:43 PM, Mark Graber <mark.graber at IMPROVEDIAGNOSIS.ORG<mailto:mark.graber at IMPROVEDIAGNOSIS.ORG>> wrote:
With the IOM report now officially out on the street, SIDM is now focused on how to change practice to improve diagnosis.  The "Coalition to Improve Diagnosis" will be our first priority; the Coalition steering committee has had several meetings already, and the next steps are for each organization to identify at least one action they can take, and for all the members to agree on a common action. The Coalition will also be growing very soon to include another set of key national organizations.

We are also urging federal agencies to step up to the plate.  Founding Board member David Newman-Toker represented SIDM at a meeting yesterday of the AHRQ National Advisory Committee, and publicly thanked AHRQ for being a key supporter of our efforts through funding of our Diagnostic Error Conferences, the IOM report itself, and through the new R01 and R18 grant funding to study diagnostic error they have recently made available. We asked the NAC to support 3 initiatives deriving from the IOM report:  1) Developing a Common Format for organizations to report diagnostic errors to their Patient Safety Organizations; 2) Working with DOD, HHS, VA and others to develop the national research priorities for diagnosis, and to develop a public-private partnership to promote research; and 3) Providing dedicated funding for AHRQ to support research on diagnostic error in proportion to the harm associated with diagnostic error.

Later this month I'll be addressing a group at the CDC to emphasize the actions we'd like to see them take: 1) Resurrect the clinical pathologist position by providing funding for this type of consultation; 2) Resuscitate autopsies at key designated centers as a way to learn about errors; 3) Help develop and use failsafe procedures for test reporting; and 4) Use second opinions in anatomic pathology.

We'll provide updates on these activities as they come up, and would love to hear about initiatives that the listserv readership might also know about, or be involved with.

  Mark

Mark L Graber MD FACP
President, SIDM  www.improvediagnosis.org<http://www.improvediagnosis.org>
919 990-8497
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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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