Resident Training and the Medical

Emergency Team

Book Reading : Medical Emergency Teams “Implementation and Outcome Measurement”,

Michael A. DeVita, M.D, 2006
INTRODUCTION
• Medical Emergency Teams (METs) have
emerged at the same time as resident work-
hour restrictions have come into effect,
public awareness of medical error has
increased, and new models of residency
program accreditation have been proposed.
(1,2)
Origins of the MET: A Solution to a Real Problem

• The impetus to create Medical Emergency Teams

comes from studies exam?ining the quality of care
and clinical decision making in patients who
expe?rienced cardiopulmonary arrest, or who had
unplanned admission to an intensive care unit (ICU).
General Overview of a Medical Emergency Team

• Ideally, the MET works best with some constancy in

leadership and team membership.
• To provide one example, we are currently proposing a team
with the following composition:
• Intensive care attending or senior critical care fellow as a leader
• Crisis nurse
• Anesthesiology resident or attending
• Internal medicine or surgery resident
• The overall goals are :
1. perform a quick analysis of vital signs, ventilatory, and oxygen
delivery status to assess the severity of acute and chronic
conditions,
2. make timely decisions about triage, goals of care, or need for the
involvement of other services (surgery, cardiac catheterization
laboratories, etc.), and
3. rapidly stabilize respiratory and cardiovascular status prior to ICU
transfer if needed.
Concerns Over Implementing a Medical
Emergency Team
• In approaching department heads about instituting a MET, concerns
that one should anticipate are:
1. Whether the MET will move decision making authority away from the
physician or the service with primary responsibility for a patient, and
2. Whether the team’s activity will deprive trainees of valuable patient care
experience.
Procedures
• Depending on design, a MET may differ from the current mode of
ward care by having attending physicians or fellows involved early on
in an evaluation and resuscitation.
• Personal experience as a triage attending suggests that the opposite
is true: when working with medical or surgical house staff to evaluate
and stabilize patients in their care, the primary teams are typically
pushed toward doing more whether it is obtaining arterial blood gas
studies, placing arterial or central venous catheters, or making
changes in ventilatory or fluid therapy.
• Residents are actually encouraged to look deeper into the patient’s
problems and to understand more.
A Win-Win Situation
• ACGME (Accreditation Council for Graduate Medical Education)
residency review committees have required accredited programs to
develop competencies in 6 key areas: (2)

• Patient care
• Medical knowledge
• Practice-based learning and improvement
• Interpersonal and communication skills
• Professionalism
• System-based practice
How a Medical Emergency Team Can Teach
Residents about Patient Safety
• Some direct learning objectives can and should be built into
MET operation, but a trainee will also benefit from the
collective unconscious of an institution that encourages:
• Doing things the right way—placing a premium on patient safety
over training
• Understanding the connection between events and errors, how
sources of errors are analyzed, and how change results from this
• Understanding how safety underlies patient-system, doctor-
patient, and doctor-system relationships and how institutional,
cultural, and individual change has come from this focus
• Appreciating multidisciplinary teams and teamwork
Sumber : Medical Emergency Teams “Implementation and Outcome Measurement”, Michael A. DeVita,
M.D, 2006, Hal.227
Sumber : Medical Emergency Teams “Implementation and Outcome
Measurement”, Michael A. DeVita, M.D, 2006, Hal.228
Promoting Performance Standards: A Role for
Human Patient Simulation
• As opposed to a cardiac arrest team, the MET is charged with
managing a wide array of conditions with greater diagnostic and
therapeutic uncertainty.
• These different types of emergencies require different tasks and
priorities, and the role of personnel will vary according to the
situation.
Summary
• The contributors to this text believe that the imple_x0002_mentation
of Medical Emergency Teams will offset some of these short comings
in care and improve the public accountability of medical education.
• The MET can also offer opportunities for the development of
competencies in patient care for both trainees and established
physicians.
• The MET can provide an educational structure from which house
staff can learn a great deal more about interdisciplinary teamwork,
patient safety, and the responsiveness of health care to patient
needs.