Emergency departments as learning systems: a cultural complement to structural reform

Dear Editor, We read with great interest the article by Cipriano et al., “A decalogue for saving Italian emergency departments”, published in the Emergency Care Journal1. The authors provide a timely and deliberately provocative framework for the rescue of Italian Emergency Departments (EDs), addressing the loss of mission, overcrowding, boarding, workforce depletion, medico-legal vulnerability, weak academic representation, and insufficient emergency medicine-led research. It is important to recognise that the Decalogue already goes beyond purely economic and structural reforms. It proposes reduced working hours, optimised night work, professional diversification across the emergency care network, legal protection, mandatory research during residency, and academic chairs for emergency physicians1. Our purpose, therefore, is not to introduce a cultural dimension as if it were absent, but to develop a complementary operational expression of it: the transformation of the ED into a psychologically safe clinical learning system. [...]