By Victoria Brazil (@SocraticEM)
Learning from our work is powerful but can be challenging in a busy clinical environment. Capturing video of our individual and team performance may offer opportunities for our educational and QI goals.
Learning from work
One of the unintended consequences of our professional approach to medical education over the last 50 years has been the separation of learning from work. e.g. ‘protected teaching time’ for residents, classroom learning in undergraduate programs, and conferences for CME. This strategy has benefits – structure, planning and efficiency. There is extensive published guidance on the best ways to deliver this structured education – to learn about our work.
However, we risk missing the opportunity to learn more from our work, where tacit, contextual learning powerfully influences clinician behaviour. Role modelling, reflection and feedback have compelling learning impacts. Learning in the workplace also provides the opportunity to learn from and with our teams.
The COVID-19 pandemic has helped us see some of these opportunities more clearly. When rapid changes were required for practice, learning became urgent and high stakes. Team huddles and debriefing tools emerged to support effective and efficient practice-based reflection.
But the constraints on workplace learning and reflection on practice are real – time pressure, variable feedback skills, and a dominant education culture that has diminished respect for apprenticeship approaches.
Maybe video can help?
Simply seeing yourself ‘in action’ can be powerful. Video recordings of performance may mitigate the insight gaps and recall biases that often hamper reflection. Sports coaches and stage performers use video as a tool for performance improvement. Although evidence is mixed, simulation programs often employ video assisted debriefing approaches to aid reflection. Researchers use video reflexive approaches to explore how cognition matches observed behaviours.
Why not real healthcare teams? Two recent articles (both open access ????) help us understand the ‘why’ and ‘how’ of using video to aid reflection on performance.
Douglas and colleagues reviewed the ethical and legal implications of video and audio recording (VAR) in a Canadian emergency department. The paper drew together “experts in clinical, regulatory, legal, quality improvement, patient safety and ethical domains …. to articulate the salient considerations and challenges to implementation of a VAR programme.” The case study described how issues of consent, confidentiality, recording, storage, access and oversight are managed when recordings are made of ‘episodes of interest’ as part of the emergency department’s QI program. Obviously, this is described in the specific context of Ontario, Canada and other legal contexts may differ, but the principles of the approach are clear. What is missing from the paper is any evaluation of the benefits of the VAR program, but the lead author tells me that is in progress…..!
Brogaard & Uldbjerg conducted a systematic review of articles looking at where video review been used by emergency teams, how it has been used (technical solutions, legal and ethical issues), and the evidence that video review improves patient care. Fifty studies were identified as relevant – and included trauma, cardiac arrest, neonatal resuscitation and obstetric emergency teams from Europe, USA, Asia and Australia. The technical aspects of filming were described in most studies – e.g. camera angles, sound, and triggers for commencing recording. Most studies described institutionally approved processes for waiver of consent from staff and patients. Only 5 studies looked at outcome data – the teams’ clinical performance or patient outcomes – and all were favourable, although none were RCTs. The authors then offer a SWOT (strengths, weaknesses, opportunities and threats) analysis and practical guide for those considering the use of VAR. One specific caution was that we have limited guidance as to how to use video to facilitate educational reflection.
My summary of the messages on using VAR to learn from our work?
- Don’t just crack out the iPhone and start recording!
- Be clear on how you are going to use the video before you start.
- The legal and regulatory issues need attention but aren’t insurmountable.
- Technical issues are important e.g. camera angles, automatic triggers to start recording, storage
- Seek out your legal, technical, administrative and healthcare consumer collaborators early.
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