New research published in the Canadian Medical Association Journal (CMAJ) Open—which began as research project by a then second-year resident physician with the UBC Department of Emergency Medicine—highlights areas of potential practice improvement in medical education.
The study, which analyzed complaints involving Canadian resident physicians between 2008 to 2017, found that problems with communication skills and professionalism featured prominently.
The NERD Block
The lead researcher, Dr. Charlotte Crosbie, began work on the four-year study when she was a second-year resident in the NERD Block (Novel Education in Research and Design Block) with the UBC Department of Emergency Medicine. Dr. Crosbie is now a Clinical Instructor in UBC Department of Emergency Medicine and Emergency Medicine Physician at Burnaby Hospital.
“It’s a huge accomplishment to complete a research project of this magnitude and submit it for publication while still in residency and preparing for exams—and then have it accepted in their first year as a faculty member. And that’s irrespective of the findings, which are themselves highly noteworthy.”
— Dr. Riyad Abu-Laban
It’s a huge accomplishment to complete a research project of this magnitude and submit it for publication while still in residency and preparing for exams—and then have it accepted in their first year as a faculty member. And that’s irrespective of the findings, which are themselves highly noteworthy,” said Dr. Riyad Abu-Laban, a co-author on the paper, Professor at UBC Department of Emergency Medicine, Emergency Physician at Vancouver General Hospital, and Scientific Director at BC Emergency Medicine Network.
The NERD Block is a one-month research rotation for Royal College of Physicians and Surgeons of Canada – Emergency Medicine residents and Pediatrics Emergency Medicine fellows. It was launched in 2011 and is held annually each fall.
“As a lawyer by training, I wanted to use my previous training and focus on a topic outside of the traditional medical research realm, but something still relevant to physicians. The NERD Block gave me the flexibility to do that.”
— Dr. Charlotte Crosbie
“My life pre-medicine was really the motivator for the study,” said Dr. Crosbie “As a lawyer by training, I wanted to use my previous training and focus on a topic outside of the traditional medical research realm, but something still relevant to physicians. The NERD Block gave me the flexibility to do that.”
The goals of the NERD Block are to increase research knowledge and critical appraisal skills in participants; support participants in developing, workshopping, and refining a research project; and connect participants with a range of academic UBC Department of Emergency Medicine and Pediatric Emergency Medicine faculty members.
“Allowing non-traditional and non-clinical research questions is so important, because not all physicians are interested in clinical research. The support from the NERD course designers, along with the Canadian Medical Protective Association, enabled me to develop this project over time. Even after the course was over, I had continued support and leadership from Dr. Abu-Laban. So, the connections made during the course proved to be very beneficial too,” said Dr. Crosbie
The Study
“College complaints against physicians, including resident physicians, have increased over time,” said Dr. Crosbie. “The perception of problems with clinical care is the most common reason people complain to Colleges about residents and fellows; however, problems with communication and professionalism are more prevalent factors than clinical problems in College decisions. Even though the complaint may be about your medicine, the College will look at the entire file and may find issues with other aspects of your practice. The whole picture—clinical and non-clinical—is important!”
“The perception of problems with clinical care is the most common reason people complain to Colleges about residents and fellows; however, problems with communication and professionalism are more prevalent factors than clinical problems in College decisions.”
— Dr. Charlotte Crosbie
The research team analyzed 142 complaint cases and 163 complaints involving resident doctors closed by the Canadian Medical Protective Association (CMPA) between 2013 and 2017. The CMPA—a legal defence organization representing about 95% of Canadian physicians—maintains a database of complaints involving patient care. To understand the nature of the complaint cases, the team considered the reason for complaint and the outcome of the case as well as whether the complaint involved a procedure and whether the complaint stemmed from a single episode or multiple episodes of care.
The researcher found that problems with communication and professionalism feature prominently in resident college complaints. Analysis of the complaints revealed that 65.0% involved clinical problems, 58.3% involved relationship or communications problems, and 41.1% involved professionalism problems.
The team also noted the potential for mismatch for the perception of care between the patient and physician. Although the most common complaint was poor clinical care, in college decisions, only 22.1% were classified as a clinical problem whereas 40.5% were classified as a patient–physician relationship problem and 38.7% a professionalism problem.
The study also examined how the rates of complaints involving residents have changed over the 10 years from 2008 to 2017 relative to rates for non-trainee physicians. A 10-year trend analysis, showed that—although complaints involving residents increased over time from 0.54 percent in 2008 to 0.79 percent in 2017—the rate of increase was slower for resident physicians than for non-trainee physicians.
The researchers assert that the results underscore the need to address complaints in medical education and provide guidance to programs for improving the quality of clinical practice and mitigating medicolegal risk.
“There is typically not a big focus on medicolegal education in most residency programs, but I think it would be helpful to use this paper to identify areas where practice could be improved, and potentially decrease the chances of a future College complaint or bad outcome from a College decision.”
— Dr. Charlotte Crosbie
“There is typically not a big focus on medicolegal education in most residency programs, but I think it would be helpful to use this paper to identify areas where practice could be improved, and potentially decrease the chances of a future College complaint or bad outcome from a College decision,” said Dr. Crosbie. “Physicians are generally afraid of College complaints and lawsuits, and usually when we understand something better, we are less afraid of it. My other goal with this project was really to foster this better understanding of College complaints and decrease the level of anxiety associated with the legal system, and I hope that’s what people get out of it.”
The study was internally funded by the Canadian Medical Protective Association.
