title: Outcome Feedback within Emergency Medicine Training Programs: An Opportunity to Apply the Theory of Deliberate Practice?
abstract: OBJECTIVE
  Outcome feedback is the process of learning patient outcomes after their care within the emergency department. We conducted a national survey of Canadian Royal College emergency medicine (EM) residents and program directors to determine the extent to which active outcome feedback and follow-up occurred. We also compared the perceived educational value of outcome feedback between residents and program directors.
  
  
  METHODS
  We distributed surveys to all Royal College-accredited adult and pediatric EM training programs using a modified Dillman method. We analyzed the data using student's t-test for continuous variables and Fisher's exact test for categorical variables.
  
  
  RESULTS
  We received 210 completed surveys from 260 eligible residents (80.8%) and 21 of 24 program directors (87.5%) (overall 81.3%). Mandatory active outcome feedback was not present in any EM training program for admitted or discharged patients (0/21). Follow-up was performed electively by 89.4% of residents for patients admitted to the hospital, and by 44.2% of residents for patients discharged home. A majority of residents (76.9%) believed that patient follow-up should be mandatory compared to 42.9% of program directors (p=0.002). The perceived educational value of outcome feedback was 5.8/7 for residents and 5.1/7 for program directors (difference 0.7; p=0.002) based on a seven-point Likert scale (1=not important; 7=very important).
  
  
  CONCLUSIONS
  While Canadian EM training programs do not mandate follow-up, it is performed electively by the majority of residents surveyed. Residents place a significantly greater educational value on outcome feedback than their program directors, and believe that follow-up should be a mandatory component of EM residencies.
authors.affiliation: *Department of Emergency Medicine,University of Ottawa,ON,Canada.
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Dalseg
authors.affiliation: †Clinical Epidemiology Program,Ottawa Hospital Research Institute,ON,Canada.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Calder
authors.affiliation: §School of Medicine & Public Health,University of Newcastle,Callaghan,NSW,Australia.
authors.forename: Curtis
authors.initials: C
authors.lastname: Lee
authors.affiliation: ¶University of Winnipeg,MB,Canada.
authors.forename: Jaymie
authors.initials: J
authors.lastname: Walker
authors.affiliation: *Department of Emergency Medicine,University of Ottawa,ON,Canada.
authors.forename: Jason R
authors.initials: JR
authors.lastname: Frank
mesh_terms: D000328:Adult; D002170:Canada; D002648:Child; D002983:Clinical Competence; D003479:Curriculum; D004635:Emergency Medicine / Q000193:education*; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D008297:Male; D017145:Models, Educational; D011795:Surveys and Questionnaires
keywords: Deliberate practice; Emergency medicine; Feedback; Follow-up; Outcome feedback