Libro blanco de las ACES Pediátricas 2024

Libro Blanco de las ACES Pediátricas 2024 554 ❚ European Curriculum Recommendations Audit Medical audit refers to the process of a systematic and critical analysis of the quality of medical care. Thus, it is essentially a retrospective analysis involving assessment of key outcomes or processes against some predetermined standard. As such, audit is a quality assurance activity that is patient- or system-focused. Objectives • To develop an understanding of the importance of setting appropriate criteria and standards for clinical care. • To develop an understanding of systems-based practice,realising that good clinical management requires an appropriate framework. • To develop skills in identifying deficiencies within a system. • To develop and to implement strategies to overcome these deficiencies. PRM scenario Trainees are asked to performa clinical audit of patients or patient groups with a specific clinical condition/specific complications/specific problems e.g . care of an infant with bronchiolitis. They may also be asked to audit specific routines/protocols/procedures/guidelines e.g . a local guideline on difficult-to-treat asthma. An audit reviews themanagement of a particular case/a local guideline in comparison to published guidelines and actual study results. The audit should be structured according to key criteria (see assessment of audit). The result of the audit is presented by the trainee to teacher and team, followed by a discussion with the teachers and the team. A good audit may serve as a basis for changing and improving the local diagnostic/care-giving/documentation routine. Method This assessment should follow a criterion-referencedmarking routine which should include five key criteria; these are: • Reason for choice (why was this specific audit done?). • Criteria chosen (howwas the audit done?). • Preparation and planning (whichmethodology was applied?). • Interpretation of data (what was found?). • Proposals for change (what next?). Any properly performed audit should be structured according to these key criteria and should give clear answers to the above questions. Suggested references • Brazil V. Audit as a learning tool in postgraduate emergency medicine training. Emerg Med Australas 2004; 16: 348–352. • Lough JR, McKay J, Murray TS. Audit and summative assessment: a criterion-referencedmarking schedule. Br J Gen Prac 1995; 45: 607–609. Case based discussion (CbD) A structured interview designed to explore professional judgment exercised in clinical cases. Objectives To assess clinical judgement, decision-making and application of medical knowledge in relation to patient care in cases for which the trainee has been directly responsible. It tests: • application of medical knowledge; • application of ethical frameworks; • ability to prioritise, consider implications, justify decisions; • recognition of complexity and uncertainty. Traineemust be assessed against the standard expected of a trainee at the end of their stage of training. PRM scenario The trainee selects between two and four actual cases that they havemanaged, e.g. an infant with bronchiolitis, a child with cystic fibrosis and failure to thrive, a child with empyema and a teenager with difficult-to-treat asthma. Copies are presented to the clinical or educational supervisor and, depend- ing on the time available, one or more cases are selected for discussion. The discussion should be framed around the actual case and should not explore hypothetical events. Questions should be designed to elicit evidence of competence and should not shift into a test of knowledge. Appendix 1. Assessment Toolbox