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Shah KP, Goyal S, Ramachandran V, Kohn JR, Go JA, Wiley Z, Moturu A, Namireddy MK, Kumar A, Jacobs RC, Stampfl M, Shah JR, Fu J, Lin WV, Ho B, Wey G, Lin SY, Caruso AC, Gay LJ, Stewart DE, Andrabi S. Efficacy of quality improvement and patient safety workshops for students: a pilot study. BMC MEDICAL EDUCATION 2020; 20:126. [PMID: 32326951 PMCID: PMC7181569 DOI: 10.1186/s12909-020-1982-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 02/24/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND While the Association of American Medical Colleges encourages medical schools to incorporate quality improvement and patient safety (QI/PS) into their curriculum, medical students continue to have limited QI/PS exposure. To prepare medical students for careers that involve QI/PS, the Institute for Healthcare Improvement chapter at an allopathic medical school and school of allied health professions initiated self-directed learning by offering student-led workshops to equip learners with skills to improve the quality and safety of healthcare processes. METHODS In this prospective cohort study, workshops were hosted for medical students between 2015 and 2018 on five QI/PS topics: Process Mapping, Root-Cause Analysis (RCA), Plan-Do-Study-Act (PDSA) Cycles, Evidence Based Medicine (EBM), and Patient Handoffs. Each workshop included a hands-on component to engage learners in practical applications of QI/PS skills in their careers. Change in knowledge, attitudes, and behaviors was assessed via pre- and post-surveys using 5-point Likert scales, and analyzed using either the McNemar test or non-parametric Wilcoxon signed-rank test. Surveys also gathered qualitative feedback regarding strengths, future areas for improvement, and reasons for attending the workshops. RESULTS Data was collected from 88.5% of learners (n = 185/209); 19.5% of learners reported prior formal instruction in these topics. Statistically significant improvements in learners' confidence were observed for each workshop. Additionally, after attending workshops, learners felt comfortable teaching the learned QI/PS skill to colleagues (mean pre/post difference 1.96, p < 0.0001, n = 139) and were more likely to pursue QI/PS projects in their careers (mean pre/post difference 0.45, p < 0.0001, n = 139). Lastly, learners demonstrated a statistically significant increase in knowledge in four out of five skills workshop topics. CONCLUSION Few medical students have formal instruction in QI/PS tools. This pilot study highlights advantages of incorporating an innovative, student-directed modified 'flipped classroom' methodology, with a focus on active experiential learning and minimal didactic instruction.
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Affiliation(s)
- Kevin P. Shah
- Office of Undergraduate Medical Education, Baylor College of Medicine, Houston, TX USA
| | - Shreya Goyal
- Office of Undergraduate Medical Education, Baylor College of Medicine, Houston, TX USA
| | - Vignesh Ramachandran
- Office of Undergraduate Medical Education, Baylor College of Medicine, Houston, TX USA
| | - Jaden R. Kohn
- Office of Undergraduate Medical Education, Baylor College of Medicine, Houston, TX USA
| | - Jonathan A. Go
- Office of Undergraduate Medical Education, Baylor College of Medicine, Houston, TX USA
| | - Zachary Wiley
- Office of Undergraduate Medical Education, Baylor College of Medicine, Houston, TX USA
| | - Anoosha Moturu
- Office of Undergraduate Medical Education, Baylor College of Medicine, Houston, TX USA
| | - Meera K. Namireddy
- Office of Undergraduate Medical Education, Baylor College of Medicine, Houston, TX USA
| | - Anjali Kumar
- Office of Undergraduate Medical Education, Baylor College of Medicine, Houston, TX USA
| | - Ryan C. Jacobs
- Office of Undergraduate Medical Education, Baylor College of Medicine, Houston, TX USA
| | - Matthew Stampfl
- Office of Undergraduate Medical Education, Baylor College of Medicine, Houston, TX USA
| | - Jesal R. Shah
- Office of Undergraduate Medical Education, Baylor College of Medicine, Houston, TX USA
| | - Justin Fu
- Office of Undergraduate Medical Education, Baylor College of Medicine, Houston, TX USA
| | - Weijie V. Lin
- Office of Undergraduate Medical Education, Baylor College of Medicine, Houston, TX USA
| | - Brandon Ho
- Office of Undergraduate Medical Education, Baylor College of Medicine, Houston, TX USA
| | - Grace Wey
- Office of Undergraduate Medical Education, Baylor College of Medicine, Houston, TX USA
| | - Sophie Y. Lin
- Office of Undergraduate Medical Education, Baylor College of Medicine, Houston, TX USA
| | - Andrew C. Caruso
- Department of Medicine, Section of General Internal Medicine, Baylor College of Medicine, Houston, TX USA
| | - Lindsey Jordan Gay
- Department of Medicine, Section of General Internal Medicine, Baylor College of Medicine, Houston, TX USA
| | - Diana E. Stewart
- Department of Medicine, Section of General Internal Medicine, Baylor College of Medicine, Houston, TX USA
- Department of Pediatrics, Section of Pediatric Hospital Medicine, Baylor College of Medicine, Houston, TX USA
| | - Sara Andrabi
- Department of Emergency Medicine, Baylor College of Medicine, Houston, TX USA
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Hayashi R, Fujita S, Iida S, Nagai Y, Shimamori Y, Hasegawa T. Relationship of patient safety culture with factors influencing working environment such as working hours, the number of night shifts, and the number of days off among healthcare workers in Japan: a cross-sectional study. BMC Health Serv Res 2020; 20:310. [PMID: 32293448 PMCID: PMC7158118 DOI: 10.1186/s12913-020-05114-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 03/17/2020] [Indexed: 11/23/2022] Open
Abstract
Background Patient safety culture is defined as a product of individual and group values, attitudes, perceptions, competencies, and patterns of behavior that determine the commitment to, and the style and proficiency of, an organization’s health and safety management. Factors influencing healthcare workers’ working environment such as working hours, the number of night shifts, and the number of days off may be associated with patient safety culture, and the association pattern may differ by profession. This study aimed to examine the relationship between patient safety culture and working environment. Methods Questionnaire surveys were conducted in 2015 and 2016. The first survey was conducted in hospitals in Japan to investigate their patient safety management system and activities and intention to participate in the second survey. The second survey was conducted in 40 hospitals; 100 healthcare workers from each hospital answered a questionnaire that was the Japanese version of the Hospital Survey on Patient Safety Culture for measuring patient safety culture. The relationship of patient safety culture with working hours in a week, the number of night shifts in a month, and the number of days off in a month was analyzed. Results Response rates for the first and second surveys were 22.4% (731/3270) and 94.2% (3768/4000), respectively. Long working hours, numerous night shifts, and few days off were associated with low patient safety culture. Despite adjusting the working hours, the number of event reports increased with an increase in the number of night shifts. Physicians worked longer and had fewer days off than nurses. However, physicians had fewer composites of patient safety culture score related to working hours, the number of night shifts, and the number of days off than nurses. Conclusions This study suggested a possibility of improving the patient safety culture by managing the working environment of healthcare workers. High number of night shifts may lead to high number of event reports. Working hours, the number of night shifts, and the number of days off may differently influence patient safety culture in physicians and nurses.
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Affiliation(s)
| | - Shigeru Fujita
- Department of Social Medicine, Toho University School of Medicine, Tokyo, Japan
| | - Shuhei Iida
- Nerima General Hospital, Tokyo, Japan.,Institute of Healthcare Quality Improvement, Tokyo, Japan
| | - Yoji Nagai
- Hitachinaka General Hospital, Ibaraki, Japan
| | - Yoshiko Shimamori
- Department of Common Fundamental Nursing, Iwate Medical University School of Nursing, Iwate, Japan
| | - Tomonori Hasegawa
- Department of Social Medicine, Toho University School of Medicine, Tokyo, Japan.
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Komasawa N, Terasaki F, Nakano T, Kawata R. Relationships between objective structured clinical examination, computer-based testing, and clinical clerkship performance in Japanese medical students. PLoS One 2020; 15:e0230792. [PMID: 32214357 PMCID: PMC7098585 DOI: 10.1371/journal.pone.0230792] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 03/08/2020] [Indexed: 11/18/2022] Open
Abstract
Background It is unclear how comprehensive evaluations conducted prior to clinical clerkships (CC), such as the objective structured clinical examination (OSCE) and computer-based testing (CBT), reflect the performance of medical students in CC. Here we retrospectively analyzed correlations between OSCE and CBT scores and CC performance. Methods Ethical approval was obtained from our institutional review board. We analyzed correlations between OSCE and CBT scores and CC performance in 94 medical students who took the OSCE and CBT in 2017 when they were 4th year students, and who participated in the basic CC in 2018 when they were 5th year students. Results Total scores for OSCE and CBT were significantly correlated with CC performance (P<0.001, each). More specifically, medical interview and chest examination components of the OSCE were significantly correlated with CC performance (P = 0.001, each), while the remaining five components of the OSCE were not. Conclusion Our findings suggest that the OSCE and CBT play important roles in predicting CC performance in Japanese medical education context. Among OSCE components, medical interview and chest examination were suggested to be important for predicting CC performance.
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Affiliation(s)
- Nobuyasu Komasawa
- Medical Education Center, Osaka Medical College, Takatsuki, Japan
- * E-mail:
| | - Fumio Terasaki
- Medical Education Center, Osaka Medical College, Takatsuki, Japan
| | - Takashi Nakano
- Medical Education Center, Osaka Medical College, Takatsuki, Japan
| | - Ryo Kawata
- Medical Education Center, Osaka Medical College, Takatsuki, Japan
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Abstract
BACKGROUND Nationally, there is an expectation that residents and fellows participate in quality improvement (QI), preferably interprofessionally. Hospitals and educators invest time and resources in projects, but little is known about success rates or what fosters success. PURPOSE To understand what proportion of trainee QI projects were successful and whether there were predictors of success. METHODS We examined resident and fellow QI projects in an integrated healthcare system that supports diverse training programs in multiple hospitals over 2 years. All projects were reviewed to determine whether they represented actual QI. Projects determined as QI were considered completed or successful based on QI project sponsor self-report. Multiple characteristics were compared between successful and unsuccessful projects. RESULTS Trainees submitted 258 proposals, of which 106 (41.1%) represented actual QI. Non-QI projects predominantly represented needs assessments or retrospective data analyses. Seventy-six percent (81/106) of study sponsors completed surveys about their projects. Less than 25% of projects (59/258) represented actual QI and were successful. Project category was predictive of success, specifically those aimed at preventive care or education. CONCLUSION Less than a quarter of trainee QI projects represent successful QI. IMPLICATIONS Hospitals and training programs should identify interventions to improve trainee QI experience.
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Brown ME, Dueñas AN. A Medical Science Educator's Guide to Selecting a Research Paradigm: Building a Basis for Better Research. MEDICAL SCIENCE EDUCATOR 2020; 30:545-553. [PMID: 34457699 PMCID: PMC8368685 DOI: 10.1007/s40670-019-00898-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
A research paradigm, or set of common beliefs about research, should be a key facet of any research project. However, despite its importance, there is a paucity of general understanding in the medical sciences education community regarding what a research paradigm consists of and how to best construct one. With the move within medical sciences education towards greater methodological rigor, it is now more important than ever for all educators to understand simply how to better approach their research via paradigms. In this monograph, a simplified approach to selecting an appropriate research paradigm is outlined. Suggestions are based on broad literature, medical education sources, and the author's own experiences in solidifying and communicating their research paradigms. By assisting in detailing the philosophical underpinnings of individuals research approaches, this guide aims to help all researchers improve the rigor of their projects and improve upon overall understanding in research communication.
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Affiliation(s)
- Megan E.L. Brown
- Health Professions Education Unit, Hull York Medical School, John Hughlings Jackson Building, University Road, Heslington, York, YO10 5DD UK
| | - Angelique N. Dueñas
- Health Professions Education Unit, Hull York Medical School, John Hughlings Jackson Building, University Road, Heslington, York, YO10 5DD UK
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Barnum T, Tatebe LC, Halverson AL, Helenowski IB, Yang AD, Odell DD. Outcomes Associated With Insertion of Indwelling Urinary Catheters by Medical Students in the Operating Room Following Implementation of a Simulation-Based Curriculum. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:435-441. [PMID: 31651436 PMCID: PMC7382914 DOI: 10.1097/acm.0000000000003052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE Catheter-associated urinary tract infection (CAUTI) is a priority quality metric for hospitals. The impact of placement of indwelling urinary catheter (IUC) by medical students on CAUTI rates is not well known. This study examined the impact of a simulation-based medical student education curriculum on CAUTI rates at an academic medical center. METHOD Patient characteristics, procedural data, and outcome data from all operating room IUC insertions from June 2011 through December 2016 at the Northwestern University Feinberg School of Medicine were analyzed using a multivariable model to evaluate associations between CAUTI and inserting provider. Infection data before and after implementation of a simulation-based IUC competency course for medical students were compared. RESULTS A total of 57,328 IUC insertions were recorded during the study period. Medical students inserted 12.6% (7,239) of IUCs. Medical students had the lowest overall rate of CAUTI among all providers during the study period (medical students: 0.05%, resident/fellows: 0.2%, attending physicians: 0.3%, advanced practice clinicians: 0.1%, nurses: 0.2%; P = .003). Further, medical student IUC placement was not associated with increased odds of CAUTI in multivariable analysis (odds ratio, 0.411; 95% confidence interval: 0.122, 1.382; P = .15). Implementation of a simulation-based curriculum for IUC insertion resulted in complete elimination of CAUTI in patients catheterized by medical students (0 in 3,471). CONCLUSIONS IUC insertion can be safely performed by medical students in the operating room. Simulation-based skills curricula for medical students can be effectively implemented and achieve clinically relevant improvements in patient outcomes.
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Affiliation(s)
- Trevor Barnum
- T. Barnum is surgical nurse educator, Department of Surgical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois; ORCID: https://orcid.org/0000-0001-9709-3810. L.C. Tatebe is adjunct assistant professor of surgery, Division of Trauma and Critical Care Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, and trauma, critical care, and general surgeon, Advocate Good Samaritan Hospital, Downers Grove, Illinois; ORCID: https://orcid.org/0000-0003-0401-3813. A.L. Halverson is professor of surgery, Division of Gastrointestinal Surgery, vice chair for education, and faculty, Surgical Outcomes and Quality Improvement Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois; ORCID: https://orcid.org/0000-0003-1040-4183. I.B. Helenowski is statistician, Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. A.D. Yang is associate professor, Division of Surgical Oncology, and faculty, Surgical Outcomes and Quality Improvement Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois. D.D. Odell is associate professor, Division of Thoracic Surgery, and faculty, Surgical Outcomes and Quality Improvement Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Strowd LC, Grant E, Peacock B, Callahan K. Safety in Numbers: Successful Student-Approved Case-Based Interprofessional Safety Workshop Utilizing Simulated Real-Life Safety Cases. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:10874. [PMID: 32175470 PMCID: PMC7065299 DOI: 10.15766/mep_2374-8265.10874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 09/07/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Increasing emphasis on medical trainee competence in patient safety and quality improvement processes has led to development of various safety and quality curricula. METHODS Curriculum surveys indicated our medical school's module-based safety and quality improvement curriculum did not meet student satisfaction benchmarks. We developed a single-day interprofessional patient safety workshop combining students from three different health care training programs (medical doctor, physician assistant, nurse anesthetist). Clinical facilitators from each profession were paired with institutional safety and quality officers. A novel curriculum was created based on a real patient safety case: Students were charged with conducting key interviews of those involved in the event as a root cause analysis (RCA) and developing a process improvement plan based on their RCA findings to present to a panel of institutional executives. Pre- and postevent surveys were completed and analyzed by trainee program. RESULTS This workshop improved students' attitudes regarding interprofessional education and expanded their knowledge of investigating safety events. Overall, assessed knowledge and attitudes improved 53% over the previous safety curriculum. Eighty-one percent of students agreed or strongly agreed that the workshop helped them think about the health care system in a new and different way. One corrective action suggested by a student group during the executive panel was later adopted by our institution and resulted in a permanent change to our health care system. DISCUSSION This case-based interprofessional workshop was well received by students and facilitators and allowed purposeful interactions between students in different arenas of medical training.
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Affiliation(s)
- Lindsay C. Strowd
- Assistant Professor, Department of Dermatology, Wake Forest School of Medicine
| | - Erich Grant
- Assistant Professor, Department of Physician Assistant Studies, Wake Forest School of Medicine
| | - Brian Peacock
- Assistant Professor, Department of Physician Assistant Studies, Wake Forest School of Medicine
| | - Kathryn Callahan
- Associate Professor, Department of Internal Medicine, Section on Gerontology, Wake Forest School of Medicine
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Smith F, Alexandersson P, Bergman B, Vaughn L, Hellström A. Fourteen years of quality improvement education in healthcare: a utilisation-focused evaluation using concept mapping. BMJ Open Qual 2019; 8:e000795. [PMID: 31909214 PMCID: PMC6937017 DOI: 10.1136/bmjoq-2019-000795] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/13/2019] [Accepted: 11/28/2019] [Indexed: 01/07/2023] Open
Abstract
Background The need for training in quality improvement for healthcare staff is well acknowledged, but long-term outcomes of such training are hard to evaluate. Behaviour change, improved organisational performance and results are sought for, but these variables are complex, multifactorial and difficult to assess. Aim The purpose of this article is to explore the personal and organisational outcomes identified by participants over 14 years of university-led QI courses for healthcare professionals. Method Inspired by the Kirkpatrick model for evaluation, we used concept mapping, a structured mixed method that allows for richness of data to be captured and visualised by inviting stakeholders throughout the process. In total, 331 previous course participants were included in the study by responding to two prompts, and 19 stakeholders taking part in the analysis process by doing the sorting. Result Two maps, one for personal outcomes and one for organisational outcomes, show clusters of the responses from previous course participants and how the outcomes relate to each other in meta-clusters. Both maps show possible long-term outcomes described by the previous course participants. Conclusion The results of this study indicate that it is possible that training in quality improvement with a strong experiential pedagogical approach fosters a long-term improvement capability for the course participants and, even more important, a long-term improvement capability (and increased improvement skill) in their respective organisations.
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Affiliation(s)
- Frida Smith
- Technology Management and Economics, Center for Healthcare Improvement, Chalmers University of Technology, Gothenburg, Sweden
- Regional Cancer Centre West, Gothenburg, Sweden
| | - Patrik Alexandersson
- Technology Management and Economics, Center for Healthcare Improvement, Chalmers University of Technology, Gothenburg, Sweden
| | - Bo Bergman
- Technology Management and Economics, Center for Healthcare Improvement, Chalmers University of Technology, Gothenburg, Sweden
| | - Lisa Vaughn
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Andreas Hellström
- Technology Management and Economics, Center for Healthcare Improvement, Chalmers University of Technology, Gothenburg, Sweden
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Seifert LB, Socolan O, Sader R, Rüsseler M, Sterz J. Virtual patients versus small-group teaching in the training of oral and maxillofacial surgery: a randomized controlled trial. BMC MEDICAL EDUCATION 2019; 19:454. [PMID: 31801531 PMCID: PMC6894350 DOI: 10.1186/s12909-019-1887-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 11/25/2019] [Indexed: 05/31/2023]
Abstract
BACKGROUND Computerized virtual patients (VP) have spread into many areas of healthcare delivery and medical education. They provide various advantages like flexibility in pace and space of learning, a high degree of teaching reproducibility and a cost effectiveness. However, the educational benefit of VP as an additive or also as an alternative to traditional teaching formats remains unclear. Moreover, there are no randomized-controlled studies that investigated the use of VP in a dental curriculum. Therefore, this study investigates VP as an alternative to lecturer-led small-group teaching in a curricular, randomized and controlled setting. METHODS Randomized and controlled cohort study. Four VP cases were created according to previously published design principles and compared with lecturer-led small group teaching (SGT) within the Oral and Maxillofacial Surgery clerkship for dental students at the Department for Cranio-, Oral and Maxillofacial Plastic Surgery, Goethe University, Frankfurt, Germany. Clinical competence was measured prior (T0), directly (T1) and 6 weeks (T2) after the intervention using theoretical tests and a self-assessment questionnaire. Furthermore, VP design was evaluated using a validated toolkit. RESULTS Fifty-seven students (VP = 32; SGT = 25) agreed to participate in the study. No competence differences were found at T0 (p = 0.56). The VP group outperformed (p < .0001) the SGT group at T1. At T2 there was no difference between both groups (p = 0.55). Both interventions led to a significant growth in self-assessed competence. The VP group felt better prepared to diagnose and treat real patients and regarded VP cases as a rewarding learning experience. CONCLUSIONS VP cases are an effective alternative to lecture-led SGT in terms of learning efficacy in the short and long-term as well as self-assessed competence growth and student satisfaction. Furthermore, integrating VP cases within a curricular Oral and Maxillofacial Surgery Clerkship is feasible and leads to substantial growth of clinical competence in undergraduate dental students.
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Affiliation(s)
- Lukas B. Seifert
- Department of Oral, Cranio-Maxillofacial, and Facial Plastic Surgery, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Octavian Socolan
- Department of Oral, Cranio-Maxillofacial, and Facial Plastic Surgery, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Robert Sader
- Department of Oral, Cranio-Maxillofacial, and Facial Plastic Surgery, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Miriam Rüsseler
- Department of Trauma, Reconstructive and Hand Surgery, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Jasmina Sterz
- Department of Trauma, Reconstructive and Hand Surgery, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
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Dumenco L, Monteiro K, George P, Rougas S, Dollase R. Outcomes of a Longitudinal Quality Improvement and Patient Safety Preclerkship Curriculum. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:1980-1987. [PMID: 31348066 DOI: 10.1097/acm.0000000000002898] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE To evaluate whether quality improvement (QI) and patient safety (PS) training in preclerkship medical education resulted in students' development and retention of knowledge, application-based and perceived skills, and attitudes throughout clerkships. METHOD A longitudinal QI/PS curriculum with multimodal curricular components was implemented in the preclerkship curriculum between 2015 and 2017 at the Warren Alpert Medical School of Brown University, Rhode Island. Assessments were administered at baseline (T1), end of year 1 (T2), Clinical Skills Clerkship (T3), and end of clerkships (T4) in the intervention cohort (n = 97). In 2018, T4 data for this cohort were compared with a prior control cohort (n = 97) at T4. RESULTS Results of knowledge-based multiple-choice questions (MCQs) (t[134] = -1.57, P < .001) and application-based skills (t[132] = -8.91, P < .001) demonstrated significant improvement from T1 to T2 (intervention cohort). Assessments of perceived skills showed significant growth from T1 to T2 (t[137] = -23.38, P < .001). Performance on application-based skills significantly improved from T2 to T3 (t[123] = -4.11, P < .001). Compared with the control cohort, the intervention cohort had significantly higher scores on MCQs (t[187.88] = 3.98, P < .001), application-based skills (t[72.69] = 6.40, P < .001), perceived skills (t[106.99] = 5.24, P < .001), and attitudes (t[152] = 5.86, P < .001). CONCLUSIONS Incorporation of preclerkship QI/PS training resulted in improvements in knowledge, application-based and perceived skills, and attitudes that were retained throughout clerkships.
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Affiliation(s)
- Luba Dumenco
- L. Dumenco is assistant dean for medical education, Office of Medical Education and Continuous Quality Improvement, The Warren Alpert Medical School of Brown University, Providence, Rhode Island. K. Monteiro is director, Assessment and Evaluation, Office of Medical Education and Continuous Quality Improvement, The Warren Alpert Medical School of Brown University, Providence, Rhode Island. P. George is associate dean for medical education and director, Clinical Curriculum, Office of Medical Education and Continuous Quality Improvement, The Warren Alpert Medical School of Brown University, Providence, Rhode Island. S. Rougas is director, Doctoring Program, Office of Medical Education and Continuous Quality Improvement, The Warren Alpert Medical School of Brown University, Providence, Rhode Island. R. Dollase is professor emeritus of medical education, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Fujita S, Wu Y, Iida S, Nagai Y, Shimamori Y, Hasegawa T. Patient safety management systems, activities and work environments related to hospital-level patient safety culture: A cross-sectional study. Medicine (Baltimore) 2019; 98:e18352. [PMID: 31852137 PMCID: PMC6922487 DOI: 10.1097/md.0000000000018352] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Improvement in patient safety culture requires constant attention. This study aimed to identify hospital-level elements related to patient safety culture, such as patient safety management systems, activities and work environments.Two questionnaire surveys were administered to hospitals in Japan in 2015 and 2016. The first survey aimed to determine which hospitals would allow their staff to respond to a questionnaire survey. The second survey aimed to measure the patient safety culture in those hospitals. Patient safety culture was assessed using the Hospital Survey on Patient Safety Culture (HSOPS). The relationship of hospital-level patient safety culture with the aforementioned elements in each hospital was analyzed.The response rate to the first survey was 22% (721/3270), and 40 eligible hospitals were selected from the respondents. The second survey was administered to healthcare workers in those 40 hospitals, and the response rate was 94% (3768/4000). The proportion of respondents who had 7 or more days off each month was related to the scores of 7 composites and the Patient Safety Grade of HSOPS. Both the presence of a mission statement describing patient safety and the proportion of respondents who participated in in-house patient safety workshops at least twice annually were related to the scores of 5 composites and the Patient Safety Grade of HSOPS.Our study suggests that the number of days off each month, the presence of a hospital patient safety mission statement, and the participation rate in in-house patient safety workshops might be key factors in creating a good patient safety culture within each hospital.
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Affiliation(s)
- Shigeru Fujita
- Department of Social Medicine, Toho University School of Medicine, Tokyo, Japan
| | - Yinghui Wu
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Shuhei Iida
- Nerima General Hospital
- Institute for Healthcare Quality Improvement, Tokyo
| | | | - Yoshiko Shimamori
- Department of Common Fundamental Nursing, Iwate Medical University School of Nursing, Iwate, Japan
| | - Tomonori Hasegawa
- Department of Social Medicine, Toho University School of Medicine, Tokyo, Japan
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Snelling I, Benson LA, Chambers N. How trainee hospital doctors lead work-based projects. Leadersh Health Serv (Bradf Engl) 2019. [DOI: 10.1108/lhs-12-2018-0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this study is to explore how trainee hospital doctors led work-based projects undertaken on an accredited development programme in England.
Design/methodology/approach
This is a case study of a leadership programme for hospital-based specialty trainees. The programme included participants leading work-based projects which were submitted for academic accreditation. Accounts of 35 work-based projects were thematically analysed to explore how participants led their projects.
Findings
Leadership was often informal and based on a series of individual face-to-face conversations. The establishment of project teams and the use of existing communication processes were often avoided. The reasons for this approach included lack of opportunities to arrange meetings, fear of conflict in meetings and the personal preferences of the participants. The authors discuss these findings with reference to theory and evidence about conversations and informal leadership, highlighting the relevance of complexity theory.
Research limitations/implications
The data are limited and drawn from the best accounts written for a specific educational context. There is therefore limited transferability to the leadership work of hospital-based specialty trainees in general. Future research into medical leadership might explore the micro practices of leadership and change, particularly in informal settings.
Practical implications
Leadership development programmes for trainee hospital doctors might concentrate on developing skills of conversation, particularly where there are or may be perceived power imbalances. Exploring conversations within the theory of complex responsive processes should be considered for inclusion in programmes.
Originality/value
This paper adds some detail to the general understanding of learning leadership in practice.
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Pallari E, Khadjesari Z, Biyani CS, Jain S, Hodgson D, Green JSA, Sevdalis N. Pilot implementation and evaluation of a national quality improvement taught curriculum for urology residents: Lessons from the United Kingdom. Am J Surg 2019; 219:269-277. [PMID: 31812255 DOI: 10.1016/j.amjsurg.2019.11.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/27/2019] [Accepted: 11/09/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND We report the immediate educational impact of a previously developed quality improvement (QI) curriculum for UK urology residents. MATERIALS AND METHODS Prospective pre/post-training evaluation, using the Kirkpatrick framework: residents' QI knowledge, skills and attitudes were assessed via standardized assessments. We report descriptive/inferential statistics and scales psychometric analyses. RESULTS Ninety-eight residents from across the UK provided full datasets. Scale reliability was good (Cronbach-alphas = 0.485-0.924). Residents' subjective knowledge (Mpre = 2.71, SD = 0.787; Mpost = 3.97, SD = 0.546); intentions to initiate QI (Mpre = 3.65, SD = 0.643; Mpost = 4.09, SD = 0.642); attitudes towards doing QI (Mpre = 3.67, SD = 0.646; Mpost = 4.11, SD = 0.591); attitudes towards QI at work (Mpre = 3.80, SD = 0.511; Mpost = 4.00, SD = 0.495); and attitudes towards influencing QI (Mpre = 3.65, SD = 0.482; Mpost = 3.867, SD = 0.473) all improved post-training (all ps < 0.0001). Objective knowledge remained stable (58%-59%, p > 0.05). Residents' satisfaction was high. CONCLUSIONS Our novel QI training is educationally sound and feasible to deliver. Longitudinal evaluation and scalability are planned.
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Affiliation(s)
- Elena Pallari
- Center for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, SE5 8AF, UK; MRC Clinical Trials and Methodology, University College London, London, WC1V 6LJ, UK.
| | - Zarnie Khadjesari
- School of Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK.
| | | | - Sunjay Jain
- Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| | | | - James S A Green
- Bart's NHS Trust, Whipps Cross Hospital, Urological Department, Whipps Cross Road, London, E11 1NR, UK.
| | - Nick Sevdalis
- Center for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, SE5 8AF, UK.
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Ameryoun A, Pakpour AH, Nikoobakht M, Saffari M, Yaseri M, O'Garo KGN, Koenig HG. Effectiveness of an In-Service Education Program to Improve Patient Safety Directed at Surgical Residents: A Randomized Controlled Trial. JOURNAL OF SURGICAL EDUCATION 2019; 76:1309-1318. [PMID: 30910500 DOI: 10.1016/j.jsurg.2019.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 02/10/2019] [Accepted: 03/05/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Patient safety is a critical issue in healthcare services particularly in surgical units and operation rooms because of the high prevalence and risk of medical errors in such settings. This study was conducted to determine whether a 1-day educational intervention can change the attitude and behavior of surgical residents regarding patient safety. METHODS A total of 90 surgical residents were recruited from 6 university hospitals located in Tehran and Qazvin, Iran, and were randomized to either the intervention or a control group. Those in the intervention group participated in a 1-day workshop on patient safety, whereas the control group received no intervention. Both groups were followed for 3 months after the intervention was completed. The Safety Attitude Questionnaire and Oxford Non-Technical Skills scale were administered at 3 points in time (baseline, 1 month after the intervention, and 3 month later). The data were analyzed using repeated measures analysis of variance. RESULTS Total score on the Safety Attitude Questionnaire improved from 54.5 (SD = 14.4) at baseline to 58.3 (SD = 13.8) 3 months after the intervention in the intervention group; all dimensions, with the exception of working condition, showed significant changes. In addition, the Oxford Non-Technical Skills scale - as assessed by attending surgeons - improved significantly in all domains (p < 0.05). More than 60% of participants in the intervention group scored in the positive range for items assessing safety and teamwork climate. CONCLUSIONS A 1-day interactive educational workshop may be effective in changing the attitude and practice of surgical residents regarding patient safety. Further assessment of this intervention in other healthcare settings involving health professionals from various specialties and use of an objective measure such as number of reported medical errors are needed to corroborate these findings.
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Affiliation(s)
- Ahmad Ameryoun
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Amir H Pakpour
- Social Determinants of Health Research Center (SDH), Qazvin University of Medical Sciences, Qazvin, Iran; Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
| | - Mehdi Nikoobakht
- Department of Neurosurgery, Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Saffari
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran; Health Education Department, Faculty of Health, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| | - Mahdi Yaseri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Keisha-Gaye N O'Garo
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Harold G Koenig
- Duke University Medical Center, Durham, North Carolina; King Abdulaziz University, Jeddah, Saudi Arabia; Ningxia Medical University, Yinchuan, China
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Abstract
Hospitals and healthcare institutions have strong external and internal pressures to improve patient safety and healthcare quality. Quality improvement education has been mandated for resident physicians by the Accreditation Council for Graduate Medical Education. This review describes didactic and experiential curricula for residents in quality improvement interventions as well as factors that create challenges to implementing such a curriculum and those that foster it. Resident attitudes, faculty capacity, institutional resources, and dedicated time are critical elements influencing the success of quality improvement curricula. Faculty interest in quality improvement could be enhanced by academic recognition of their work. Recommendations to facilitate publication of quality improvement efforts are described.
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Ackermann LL, Stewart EA, Riggio JM. Improved Supervision and Safety of Discharges Through Formal Discharge Education. Am J Med Qual 2019; 34:226-233. [DOI: 10.1177/1062860618794283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The goal of this study is to evaluate change in residents’ assessment of supervision and safety of the discharge process after formal discharge instruction education. An educational lecture and workshop addressing high-risk medications, medication reconciliation, follow-up, and handoffs were provided to internal medicine residents. Residents were given a longitudinal survey before and after the discharge education session. Significant improvement in perception was demonstrated in review of discharge instructions ( P < .001), review of new medications/side effects with patients ( P < .001), and review of discharge instructions with and receiving feedback from attending physicians ( P < .001). On review of 40 discharge instructions pre and post intervention, there was an improvement in completion of instructions for high-risk medications ( P < .05 [14 insulin, 26 anticoagulation]). This intervention was viewed positively by residents; more than two thirds of all residents favored a process of formal training over the current model of “training by doing.”
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Cooper K, Hatfield E, Yeomans J. Animated stories of medical error as a means of teaching undergraduates patient safety: an evaluation study. PERSPECTIVES ON MEDICAL EDUCATION 2019; 8:118-122. [PMID: 30767190 PMCID: PMC6468019 DOI: 10.1007/s40037-019-0498-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Storytelling is a powerful form of communication which can improve attention and lead to lasting behavioural changes. Addressing the need to incorporate patient safety teaching into undergraduate medical curricula, it was hypothesized that medical students could benefit from hearing clinician stories of medical error. The medium of animation was considered to be a potentially engaging means of presenting stories of error to a large audience. METHODS Three animated videos were developed to accompany audio recordings of junior doctors describing their experiences of a serious incident or near-miss event. The videos were delivered to 200 final-year medical students with a subsequent large-group discussion directed at understanding contributory factors. An evaluative questionnaire exploring learners' reactions and modification of beliefs and perception was distributed. The questionnaire included questions rated on a modified Likert scale and a free-text box. A mixed-methods analysis was conducted with descriptive statistics and qualitative content analysis of the free-text responses. RESULTS Of the 200 students who attended, 104 completed the questionnaire and 83 completed free-text feedback. Most students responded positively to hearing stories of medical error and felt that the animated videos improved their engagement while the voice recordings helped bring the cases to life. The majority of students agreed the session would impact on their future practice. CONCLUSION This pilot study confirmed that undergraduate students consider animated, personal stories of medical error an effective, engaging means of learning about patient safety. Longitudinal studies are required to confirm if measurable behaviour change is achieved.
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Affiliation(s)
- Kerri Cooper
- Department of Surgery and Cancer, Imperial College London, London, UK.
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Cohen SP. Success of a Resident-Led Safety Council: A Model for Satisfying CLER Pathways to Excellence Patient Safety Goals. J Grad Med Educ 2019; 11:226-230. [PMID: 31024658 PMCID: PMC6476086 DOI: 10.4300/jgme-d-18-00459.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 10/14/2018] [Accepted: 12/10/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The Accreditation Council for Graduate Medical Education (ACGME) Clinical Learning Environment Review (CLER) program focuses on aspects of the graduate medical education learning environment, such as patient safety. Data from CLER site visits reveal that many resident physicians do not receive adequate training on patient safety. OBJECTIVE We evaluated a pediatric resident-led safety council as a method to meet CLER Pathways to Excellence patient safety objectives. METHODS The Duke Pediatric Residency Safety Council (PRSC) created an infrastructure for residents to participate in department safety efforts, review safety events, and act as leaders for safety initiatives. Annual surveys were distributed to graduate medical education trainees through the institution's patient safety center and the PRSC. Survey results of safety attitudes were compared over time within the pediatrics program and between pediatrics and nonpediatrics trainees at the institution. Resident-submitted safety reports were tracked through an institutional safety event repository. RESULTS From 2013 to 2017, the percentage of residents who strongly agreed that they could submit a safety report doubled (from 35% [6 of 17] to 73% [22 of 30], P = .011). The average number of safety reports submitted by a pediatrics resident per year did not significantly change during this period (from 3.0 to 3.8, P = .11). In 2017, 90% of pediatrics residents (27 of 30) agreed or strongly agreed that their concerns would be addressed if they entered a safety report. CONCLUSIONS The council addressed 5 of the 7 CLER Pathways to Excellence in patient safety.
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Backhouse A, Malik M. Escape into patient safety: bringing human factors to life for medical students. BMJ Open Qual 2019; 8:e000548. [PMID: 31206043 PMCID: PMC6542456 DOI: 10.1136/bmjoq-2018-000548] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 02/27/2019] [Accepted: 03/08/2019] [Indexed: 12/14/2022] Open
Abstract
Background Patient safety is at the core of the General Medical Council (GMC) standards for undergraduate medical education. It is recognised that patient safety and human factors' education is necessary for doctors to practice safely. Teaching patient safety to medical students is difficult. Institutions must develop expertise and build curricula while students must also be able to see the subject as relevant to future practice. Consequently graduates may lack confidence in this area. Method We used gamification (the application of game design principles to education) to create a patient safety simulation for medical students using game elements. Gamification builds motivation and engagement, whilst developing teamwork and communication. We designed an escape room-a team-based game where learners solve a series of clinical and communication-based tasks in order to treat a fictional patient while avoiding 'clinician error'. This is followed up with an after action review where students reflect on their experience and identify learning points. Outcome Students praised the session's interactivity and rated it highly for gaining new knowledge and skills and for increasing confidence to apply patient safety concepts to future work. Conclusion Our findings are in line with existing evidence demonstrating the success of experiential learning interventions for teaching patient safety to medical students. Where the escape room has potential to add value is the use of game elements to engage learners with the experience being recreated despite its simplicity as a simulation. More thorough evaluation of larger pilots is recommended to continue exploring the effectiveness of escape rooms as a teaching method.
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Affiliation(s)
| | - Myra Malik
- Faculty of Medical Leadership and Management, London, UK
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70
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Myers JS, Wong BM. Measuring outcomes in quality improvement education: success is in the eye of the beholder. BMJ Qual Saf 2019; 28:345-348. [DOI: 10.1136/bmjqs-2018-008305] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2018] [Indexed: 11/03/2022]
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Wu AW, Busch IM. Patient safety: a new basic science for professional education. GMS JOURNAL FOR MEDICAL EDUCATION 2019; 36:Doc21. [PMID: 30993179 PMCID: PMC6446473 DOI: 10.3205/zma001229] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 02/04/2019] [Accepted: 02/04/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Albert W. Wu
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD, United States
| | - Isolde M. Busch
- University of Verona, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Clinical Psychology, Verona, Italy
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González-Formoso C, Clavería A, Fernández-Domínguez MJ, Lago-Deibe FL, Hermida-Rial L, Rial A, Gude-Sampedro F, Pita-Fernández S, Martín-Miguel V. Effectiveness of an educational intervention to improve the safety culture in primary care: a randomized trial. BMC FAMILY PRACTICE 2019; 20:15. [PMID: 30657056 PMCID: PMC6337818 DOI: 10.1186/s12875-018-0901-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 12/28/2018] [Indexed: 11/10/2022]
Abstract
Background Fostering a culture of safety is an essential step in ensuring patient safety and quality in primary care. We aimed to evaluate the effectiveness of an educational intervention to improve the safety culture in the family and community medicine teaching units in an Atlantic European Region. Methods Randomized study conducted in family and community medicine teaching units in Galicia (Spain). Participants were all fourth-year residents and their tutors (N = 138). Those who agreed to participate were randomized into one of two groups (27 tutors/26 residents in the intervention group, 23 tutors/ 23 residents in the control one).All were sent the Survey on Patient Safety Culture. After that, the intervention group received specific training in safety; they also recorded incidents over 15 days, documented them following a structured approach, and had feedback on their performance. The control group did not receive any action. All participants completed the same survey four months later. Outcome measures were the changes in safety culture as quantified by the results variables of the Survey: Patient Safety Grade and Number of events reported. We conducted bivariate and adjusted analyses for the outcome measures. To explore the influence of participants’ demographic characteristics and their evaluation of the 12 dimensions of the safety culture, we fitted a multivariate model for each outcome. Results Trial followed published protocol. There were 19 drop outs. The groups were comparable in outcome and independent variables at start. The experiment did not have any effect on Patient safety grade (− 0.040) in bivariate analysis. The odds of reporting one to two events increased by 1.14 (0.39–3.35), and by 13.75 (2.41–354.37) the odds of reporting 3 or more events. Different dimensions had significant independent effects on each outcome variable. Conclusion A educational intervention in family and community medicine teaching units may improve the incidents reported. The associations observed among organizational dimensions and outcomes evidence the complexity of patient safety culture measurement and, also, show the paths for improvement. In the future, it would be worthwhile to replicate this study in teaching units from different settings and with different health professionals engaged. Trial registration It was retrospectively registered with (ISRCTN41911128, 31/12/2010). Electronic supplementary material The online version of this article (10.1186/s12875-018-0901-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Clara González-Formoso
- Vigo Teaching Unit of Family and Community Medicine and Nursing, EOXI Vigo, Galician Health Service, RedIAPP, Grupo I-Saúde (Instituto de Investigación Sanitaria Galicia Sur), Vigo, Spain
| | - Ana Clavería
- Quality and Research Unit, Primary Care, EOXI Vigo, Galician Health Service, RedIAPP, Grupo I-Saúde (Instituto de Investigación Sanitaria Galicia Sur), Rosalía de Castro 21-23, 36201, Vigo, Spain.
| | - M J Fernández-Domínguez
- Ourense Health Center, EOXI Ourense, Galician Health Service, RedIAPP, Grupo I-Saúde (Instituto de Investigación Sanitaria Galicia Sur), Ourense, Spain
| | - F L Lago-Deibe
- Sárdoma Health Center, EOXI Vigo, Galician Health Service, RedIAPP, Grupo I-Saúde (Instituto de Investigación Sanitaria Galicia Sur), Vigo, Spain
| | - Luis Hermida-Rial
- Fontenla-Maristany Health Center, EOXI Ferrol, Galician Health Service, Ferrol, Spain
| | - Antonio Rial
- Universidad de Santiago de Compostela, Santiago de Compostela, Spain
| | - Francisco Gude-Sampedro
- Epidemiology Department, EOXI Santiago de Compostela, Instituto de Investigación Sanitaria Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Victoria Martín-Miguel
- Vigo Teaching Unit of Family and Community Medicine and Nursing, EOXI Vigo, Galician Health Service, RedIAPP, Grupo I-Saúde (Instituto de Investigación Sanitaria Galicia Sur), Vigo, Spain
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Beekman M, Emani VK, Wolford R, Hanson K, Wickham G, Aiyer M. Patient Safety Morning Report: Innovation in Teaching Core Patient Safety Principles to Third-Year Medical Students. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2019; 6:2382120519842539. [PMID: 31041402 PMCID: PMC6480985 DOI: 10.1177/2382120519842539] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 03/07/2019] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Patient safety (PS) is one of the most important priorities in modern healthcare systems. Unfortunately, PS education is limited in many medical school curricula. Our objective was to implement an innovative curriculum to introduce third-year medical students on their pediatric clerkship to PS concepts and domains, and to provide a safe environment to discuss lapses in PS that they identified while caring for patients. METHODS At the start of the pediatric clerkship, students were introduced to the curriculum, instructed to identify a lapse of PS, and to submit a description and analysis of the lapse using the SAFE framework (S = Safety concern, A = Action taken, F = Failure, linked to safety domains, E = Effects on patient outcome). Two sessions, 90-mins each, were conducted every clerkship during which there was a brief didactic presentation, each student presented their case, and the case discussed by students and faculty. RESULTS Over 19 months, 75 students participated. The most common PS themes identified were Communication (57% of cases), Human factors (39%), and System issues (37%). Anonymous written feedback was obtained; learners reported improved knowledge and ability to identify lapses in PS and to propose potential solutions to prevent similar future events. They expressed a desire for additional PS and quality improvement education. DISCUSSION Our results show that third-year medical students are able to identify lapses in PS and able to propose solutions. This aligns with the Association of American Medical Colleges (AAMC) goals of entrustable professional activities (EPA) 13. We intend to expand the curriculum to other third-year core clerkships.
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Affiliation(s)
- Michele Beekman
- Department of Pediatrics, University of Illinois College of Medicine Peoria, Peoria, IL, USA
| | - Vamsi K Emani
- Department of Internal Medicine, University of Illinois College of Medicine Peoria, Peoria, IL, USA
| | - Robert Wolford
- Department of Emergency Medicine, University of Illinois College of Medicine Peoria, Peoria, IL, USA
| | - Keith Hanson
- Department of Pediatrics, University of Illinois College of Medicine Peoria, Peoria, IL, USA
| | - Gerald Wickham
- Department of Academic Affairs, University of Illinois College of Medicine Peoria, Peoria, IL, USA
- Department of Health Sciences Education, University of Illinois College of Medicine Peoria, Peoria, IL, USA
| | - Meenakshy Aiyer
- Department of Internal Medicine, University of Illinois College of Medicine Peoria, Peoria, IL, USA
- Department of Academic Affairs, University of Illinois College of Medicine Peoria, Peoria, IL, USA
- Department of Health Sciences Education, University of Illinois College of Medicine Peoria, Peoria, IL, USA
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Hoffmann N, Kubitz JC, Goetz AE, Beckers SK. Patient safety in undergraduate medical education: Implementation of the topic in the anaesthesiology core curriculum at the University Medical Center Hamburg-Eppendorf. GMS JOURNAL FOR MEDICAL EDUCATION 2019; 36:Doc12. [PMID: 30993170 PMCID: PMC6446467 DOI: 10.3205/zma001220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 01/07/2019] [Accepted: 01/22/2019] [Indexed: 05/07/2023]
Abstract
Introduction: The focus of public attention and health policy is increasingly being drawn to patient safety. According to studies, more than 30,000 patients die each year as a result of medical errors. To date, learning objectives such as patient safety have not played a role in the core curriculum for medical education in Germany. The National Competence-Based Catalogue of Learning Objectives for Undergraduate Medical Education contains a total of 13 learning objectives relating to this subject. Methods: In a descriptive study, learning content was implemented within the "Operative Medicine" study block offered by the Faculty of Medicine at Universität Hamburg. The definition and occurrence of errors as well as strategies for dealing with and avoiding errors were set as the learning objectives for an interactive lecture, problem-based learning (PBL) case as well as the bedside teaching on anaesthesiology. Students were able to evaluate the lecture directly. During the simulator session on anaesthesia, the safety-relevant information that students requested from patients was compared with the questions asked by a control group in the previous trimester. Results: The topic of patient safety could be integrated into the "Operative Medicine" curriculum through a number of minor changes to classes. The accounts of personal experiences and importance assigned to the subject were considered positive, while content perceived as redundant was criticised. In the simulator, the students appeared to request more comprehensive preoperative safety-relevant information than the control group. Conclusion: The subject's relevance, positive feedback and trend towards a change in behaviour in the simulator lead the authors to deem introduction of the topic of patient safety a success.
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Affiliation(s)
- Nicolas Hoffmann
- University Medical Center Hamburg-Eppendorf, Center for Anaesthesiology and Intensive Care Medicine, Department of Anaesthesiology, Hamburg, Germany
- *To whom correspondence should be addressed: Nicolas Hoffmann, University Medical Center Hamburg-Eppendorf, Center for Anaesthesiology and Intensive Care Medicine, Department of Anaesthesiology, Martinistr. 52, D-20246 Hamburg, Germany, Phone: +49 (0)40/7410-0, Fax: +49 (0)40/7410-54963, E-mail:
| | - Jens C. Kubitz
- University Medical Center Hamburg-Eppendorf, Center for Anaesthesiology and Intensive Care Medicine, Department of Anaesthesiology, Hamburg, Germany
| | - Alwin E. Goetz
- University Medical Center Hamburg-Eppendorf, Center for Anaesthesiology and Intensive Care Medicine, Department of Anaesthesiology, Hamburg, Germany
| | - Stefan K. Beckers
- RWTH Aachen, Faculty of Medicine, University Hospital RWTH Aachen, Anaesthesiology Clinic, Aachen, Germany
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Pallari E, Khadjesari Z, Green JSA, Sevdalis N. Development and implementation of a national quality improvement skills curriculum for urology residents in the United Kingdom: A prospective multi-method, multi-center study. Am J Surg 2018; 217:233-243. [PMID: 30477760 DOI: 10.1016/j.amjsurg.2018.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 09/12/2018] [Accepted: 11/12/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Surgical quality improvement (QI) is a global priority. We report the design and proof-of concept testing of a QI skills curriculum for urology residents. METHODS 'Umbrella review' of QI curricula (Phase-1); development of draft QI curriculum (Phase-2); curriculum review by Steering Committee of urologists (Attendings & Residents), QI and medical education experts and patients (Phase-3); proof-of-concept testing (Phase-4). RESULTS Phase-1: Six systematic reviews were identified of 4332 search hits. Most curricula are developed/evaluated in the USA; use mixed teaching methods (incl. didactic, QI exercises & self-reflection); and introduce core QI techniques (e.g., Plan-Do-Study-Act). Phase-2: curriculum drafted. Phase-3: the curriculum was judged to represent state-of-the-art, relevant QI training. Stronger patient involvement element was incorporated. Phase-4: the curriculum was delivered to 43 urology residents. The delivery was feasible; the curriculum implementable; and a knowledge-skills-attitudes evaluation approach successful. CONCLUSION We have developed a practical QI curriculum, for further evaluation and national implementation.
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Affiliation(s)
- Elena Pallari
- Center for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; Department of Cancer Epidemiology and Population Health, Division of Cancer Studies, King's College London, Guy's Hospital, Research Oncology, London, UK
| | - Zarnie Khadjesari
- Center for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; School of Health Sciences, University of East Anglia, Norwich, UK
| | | | - Nick Sevdalis
- Center for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.
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Oates K, Wilson I, Hu W, Walker B, Nagle A, Wiley J. Changing medical student attitudes to patient safety: a multicentre study. BMC MEDICAL EDUCATION 2018; 18:205. [PMID: 30153841 PMCID: PMC6114839 DOI: 10.1186/s12909-018-1313-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 08/16/2018] [Indexed: 05/24/2023]
Abstract
BACKGROUND Although patient safety is becoming widely taught in medical schools, its effect has been less rigorously evaluated. We describe a multicentre study to evaluate student changes in patient safety attitudes using a standardised instrument, the Attitudes to Patient Safety Questionnaire3 (APSQ3). METHODS A patient safety training package designed for medical students was delivered in the first year and second year in four Australian medical schools. It comprises eight face-to-face modules, each of two hours. Seminars start with an interactive introduction using questions, video and role play, followed by small group break-outs to discuss a relevant case study. Groups are led by medical school tutors with no prior training in patient safety. Students and tutors then reassemble to give feedback and reinforce key concepts. Knowledge and attitudes to patient safety were measured using the APSQ3, delivered prior to safety teaching, at the end of the first and second years and 12 months after teaching ceased. RESULTS A significant improvement in attitude over time was demonstrated for four of nine key items measured by the APSQ3: value of patient safety teaching; danger of long working hours, value of team work and the contribution patients can make in reducing error. Informal feedback from students was very positive. CONCLUSION We showed persistent, positive learning from a patient safety education intervention 12 months after teaching finished. Building on the introduction of patient safety teaching into medical schools, pathways for motivated students such as appropriate electives, option terms and team-based research projects would be of value.
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Affiliation(s)
- Kim Oates
- NSW Clinical Excellence Commission Rawson Place, Sydney and University of Sydney, Sydney, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, Australia
| | - Ian Wilson
- Faculty of Science, Medicine and Health, School of Medicine, University of Wollongong, Wollongong, Australia
| | - Wendy Hu
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Ben Walker
- Joint Medical Program, Universities of Newcastle and New England, Newcastle, Australia
| | - Amanda Nagle
- School of Rural Medicine, University of New England, Armidale, Australia
| | - Janice Wiley
- School of Medicine, University of Notre Dame, Sydney, Australia
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Graber ML, Rencic J, Rusz D, Papa F, Croskerry P, Zierler B, Harkless G, Giuliano M, Schoenbaum S, Colford C, Cahill M, Olson AP. Improving diagnosis by improving education: a policy brief on education in healthcare professions. Diagnosis (Berl) 2018; 5:107-118. [DOI: 10.1515/dx-2018-0033] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 07/29/2018] [Indexed: 01/10/2023]
Abstract
Abstract
Diagnostic error is increasingly recognized as a major patient safety concern. Efforts to improve diagnosis have largely focused on safety and quality improvement initiatives that patients, providers, and health care organizations can take to improve the diagnostic process and its outcomes. This educational policy brief presents an alternative strategy for improving diagnosis, centered on future healthcare providers, to improve the education and training of clinicians in every health care profession. The hypothesis is that we can improve diagnosis by improving education. A literature search was first conducted to understand the relationship of education and training to diagnosis and diagnostic error in different health care professions. Based on the findings from this search we present the justification for focusing on education and training, recommendations for specific content that should be incorporated to improve diagnosis, and recommendations on educational approaches that should be used. Using an iterative, consensus-based process, we then developed a driver diagram that categorizes the key content into five areas. Learners should: 1) Acquire and effectively use a relevant knowledge base, 2) Optimize clinical reasoning to reduce cognitive error, 3) Understand system-related aspects of care, 4) Effectively engage patients and the diagnostic team, and 5) Acquire appropriate perspectives and attitudes about diagnosis. These domains echo recommendations in the National Academy of Medicine’s report Improving Diagnosis in Health Care. The National Academy report suggests that true interprofessional education and training, incorporating recent advances in understanding diagnostic error, and improving clinical reasoning and other aspects of education, can ultimately improve diagnosis by improving the knowledge, skills, and attitudes of all health care professionals.
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Affiliation(s)
- Mark L. Graber
- President, Society to Improve Diagnosis in Medicine , New York, NY , USA
- Senior Fellow, RTI International , Raleigh-Durham, NC , USA
| | - Joseph Rencic
- Associate Professor of Medicine , Tufts University School of Medicine , Boston, MA , USA
| | - Diana Rusz
- Research and Program Manager, Society to Improve Diagnosis in Medicine , Chicago, IL , USA
| | - Frank Papa
- Associate Dean, University of North Texas Health Science Center , Fort Worth, TX , USA
| | - Pat Croskerry
- Professor, Department of Emergency Medicine , Dalhousie University Medical School , Halifax, Nova Scotia , Canada
| | - Brenda Zierler
- Adjunct Professor, University of Washington School of Nursing , Seattle, WA , USA
| | - Gene Harkless
- Chair and Associate Professor, University of New Hampshire , Durham, NH , USA
| | - Michael Giuliano
- Assistant Dean for Faculty Resident and Student Development , Seton Hall University , South Orange, NJ , USA
| | - Stephen Schoenbaum
- Special Advisor to the President, Josiah Macy Jr. Foundation , New York, NY , USA
| | - Cristin Colford
- Associate Professor of Medicine, University of North Carolina School of Medicine , Chapel Hill, NC , USA
| | - Maureen Cahill
- National Council State Boards of Nursing , Chicago, IL , USA
| | - Andrew P.J. Olson
- Assistant Professor, Director, Medical Educator Scholarship and Development , University of Minnesota Medical School , Minneapolis, MN , USA
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Dumenco L, Monteiro K, George P, McNicoll L, Warrier S, Dollase R. An Interactive Quality Improvement and Patient Safety Workshop for First-Year Medical Students. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2018; 14:10734. [PMID: 30800934 PMCID: PMC6342418 DOI: 10.15766/mep_2374-8265.10734] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 07/12/2018] [Indexed: 05/30/2023]
Abstract
Introduction There is a call to incorporate quality improvement and patient safety (QI/PS) content into undergraduate medical education, though limited literature exists on optimal teaching strategies. We designed a required, interactive workshop for first-year medical students to introduce principles of QI/PS, specifically focusing on student attitudes, knowledge, and skills. Methods We used active learning principles from existing literature and included the application of QI/PS concepts, engaging in PDSA (plan, do, study, act) cycles, conducting root cause analyses, and creating a fishbone diagram. Evaluation of student knowledge included pre/post assessments with locally designed multiple-choice items and a case scenario from the Quality Improvement Knowledge Application Tool. Additional students' self-assessments included perceived knowledge and problem-solving skills. We also evaluated student satisfaction with the workshop. Results Results on the direct assessment total score (n = 136) indicated significant growth from pretest (65%) to posttest (89%). Indirect assessments (n = 138) targeting perceived ability to define QI/PS principles, identify key components in a QI case scenario, explain the purpose of a fishbone diagram, apply a PDSA cycle, and create a fishbone diagram for a QI case scenario all significantly increased from pre- to postworkshop. The mean overall rating across the 2 years the workshop was administered (ns = 134, 137) was 75% (i.e., good to very good). Discussion First-year medical students' knowledge and perceived skills significantly increased from start to end of the workshop. The workshop was placed in an appropriate stage of the curriculum and contained relevant information for our learners.
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Affiliation(s)
- Luba Dumenco
- Assistant Dean, Office of Medical Education, The Warren Alpert Medical School of Brown University
| | - Kristina Monteiro
- Director of Assessment and Evaluation, Office of Medical Education, The Warren Alpert Medical School of Brown University
| | - Paul George
- Assistant Dean, Office of Medical Education, The Warren Alpert Medical School of Brown University
- Director of Clinical Curriculum, Office of Medical Education, The Warren Alpert Medical School of Brown University
| | - Lynn McNicoll
- Associate Professor, Department of Medicine, The Warren Alpert Medical School of Brown University
| | - Sarita Warrier
- Assistant Dean, Office of Medical Education, The Warren Alpert Medical School of Brown University
| | - Richard Dollase
- Former Director, Office of Medical Education, The Warren Alpert Medical School of Brown University
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Patel E, Muthusamy V, Young JQ. Delivering on the Promise of CLER: A Patient Safety Rotation That Aligns Resident Education With Hospital Processes. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:898-903. [PMID: 29384750 DOI: 10.1097/acm.0000000000002145] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PROBLEM Residency programs must provide training in patient safety. Yet, significant gaps exist among published patient safety curricula. The authors developed a rotation designed to be scalable to an entire residency, built on sound pedagogy, aligned with hospital safety processes, and effective in improving educational outcomes. APPROACH From July 2015 to May 2017, each second-year resident completed the two-week rotation. Residents engaged the foundational science asynchronously via multiple modalities and then practiced applying key concepts during a mock root cause analysis. Next, each resident performed a special review of an actual adverse patient event and presented findings to the hospital's Special Review Committee (SRC). Multiple educational outcomes were assessed, including resident satisfaction and attitudes (postrotation survey), changes in knowledge via pre- and posttest, quality of the residents' written safety analyses and oral presentations (per survey of SRC members), and organizational changes that resulted from the residents' reviews. OUTCOMES Twenty-two residents completed the rotation. Most components were rated favorably; 80% (12/15 respondents) indicated interest in future patient safety work. Knowledge improved by 44.3% (P < .0001; pretest mean 23.7, posttest mean 34.2). Compared to faculty, SRC members rated the quality of residents' written reviews as superior and the quality of the rated oral presentations as either comparable or superior. The reviews identified a variety of safety vulnerabilities and led to multiple corrective actions. NEXT STEPS The authors will evaluate the curriculum in a controlled trial with better measures of change in behavior. Further tests of the curriculum's scalability to other contexts are needed.
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Affiliation(s)
- Ekta Patel
- E. Patel is chief resident, Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, New York, New York. V. Muthusamy is chief resident, Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, New York, New York. J.Q. Young is professor and vice chair for education, Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, New York, New York
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Tully V, Murphy D, Fioratou E, Chaudhuri A, Shaw J, Davey P. Learning from errors: assessing final year medical students' reflection on safety improvement, five year cohort study. BMC MEDICAL EDUCATION 2018; 18:57. [PMID: 29606098 PMCID: PMC5879916 DOI: 10.1186/s12909-018-1173-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 03/20/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Investigation of real incidents has been consistently identified by expert reviews and student surveys as a potentially valuable teaching resource for medical students. The aim of this study was to adapt a published method to measure resident doctors' reflection on quality improvement and evaluate this as an assessment tool for medical students. METHODS The design is a cohort study. Medical students were prepared with a tutorial in team based learning format and an online Managing Incident Review course. The reliability of the modified Mayo Evaluation of Reflection on Improvement tool (mMERIT) was analysed with Generalizability G-theory. Long term sustainability of assessment of incident review with mMERIT was tested over five consecutive years. RESULTS A total of 824 students have completed an incident review using 167 incidents from NHS Tayside's online reporting system. In order to address the academic practice gap students were supervised by Senior Charge Nurses or Consultants on the wards where the incidents had been reported. Inter-rater reliability was considered sufficiently high to have one assessor for each student report. There was no evidence of a gradient in student marks across the academic year. Marks were significantly higher for students who used Section Questions to structure their reports compared with those who did not. In Year 1 of the study 21 (14%) of 153 mMERIT reports were graded as concern. All 21 of these students achieved the required standard on resubmission. Rates of resubmission were lower (3% to 7%) in subsequent years. CONCLUSIONS We have shown that mMERIT has high reliability with one rater. mMERIT can be used by students as part of a suite of feedback to help supplement their self-assessment on their learning needs and develop insightful practice to drive their development of quality, safety and person centred professional practice. Incident review addresses the need for workplace based learning and use of real life examples of mistakes, which has been identified by previous studies of education about patient safety in medical schools.
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Affiliation(s)
- Vicki Tully
- Medical School, University of Dundee, Dundee, Scotland
- NHS Tayside, Dundee, Scotland
| | | | | | | | | | - Peter Davey
- Medical School, University of Dundee, Dundee, Scotland
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Kilduff CLS, Leith TO, Drake TM, Fitzgerald JEF. Surgical safety checklist training: a national study of undergraduate medical and nursing student teaching, understanding and influencing factors. Postgrad Med J 2017; 94:143-150. [PMID: 29122928 DOI: 10.1136/postgradmedj-2016-134559] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 09/22/2017] [Accepted: 10/21/2017] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Use of the WHO surgical safety checklist is consistently recognised to reduce harm caused by human error during the perioperative period. Inconsistent engagement is considered to contribute to persistence of surgical Never Events in the National Health Service. Most medical and nursing graduates will join teams responsible for the perioperative care of patients, therefore appropriate undergraduate surgical safety training is needed. AIMS To investigate UK medical and nursing undergraduate experience of the surgical safety checklist training. METHODS An eight-item electronic questionnaire was distributed electronically to 32 medical schools and 72 nursing schools. Analysis was conducted for the two cohorts, and responses from final year students were included. RESULTS 87/224 (38.8%) of medical students received teaching on the surgical safety checklist, compared with 380/711 (52.0%) of nursing students. 172/224 (76.8%) of medical students and 489/711 (66.9%) of nursing students understood its purpose and 8/224 (3.6%) medical students and 54/711 (7.4%) nursing students reported never being included in the Time Out. After adjusting for confounding factors, provision of formal teaching in checklist use increased understanding significantly (OR 50.39 (14.07 to 325.79, P<0.001)), as did routine student involvement in time outs (OR 5.72 (2.36 to 14.58, P<0.001)). DISCUSSION Knowledge of perioperative patient safety systems and the ability to participate in safety protocols are important skills that should be formally taught at the undergraduate level. Results of this study show that UK undergraduate surgical safety checklist training does not meet the minimum standards set by the WHO.
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Affiliation(s)
| | - Thomas Oliver Leith
- Department of Anaesthetics and Intensive Care, Kingston Hospital, London, UK
| | - Thomas M Drake
- Department of Clinical Surgery, University of Edinburgh, Edinburgh, UK
| | - J Edward F Fitzgerald
- Clinical Advisor, Lifebox Foundation, London, UK.,Department of Surgery, Royal Free Hospital NHS Trust, London, UK
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Klemenc-Ketis Z, Deilkås ET, Hofoss D, Bondevik GT. Variations in patient safety climate and perceived quality of collaboration between professions in out-of-hours care. J Multidiscip Healthc 2017; 10:417-423. [PMID: 29184416 PMCID: PMC5687361 DOI: 10.2147/jmdh.s149011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To get an overview of health care workers perceptions of patient safety climates and the quality of collaboration in Slovenian out-of-hours health care (OOHC) between professional groups. Materials and methods This was a cross-sectional study carried out in all (60) Slovenian OOHC clinics; 37 (61.7%) agreed to participate with 438 employees. The questionnaire consisted of the Slovenian version of the Safety Attitudes Questionnaire – Ambulatory Version (SAQ-AV). Results The study sample consisted of 175 (70.0%) physicians, nurse practitioners, and practice nurses. Practice nurses reported the highest patient safety climate scores in all dimensions. Total mean (standard deviation) SAQ-AV score was 60.9±15.2. Scores for quality of collaboration between different professional groups were high. The highest mean scores were reported by nurse practitioners on collaboration with practice nurses (4.4±0.6). The lowest mean scores were reported by practice nurses on collaboration with nurse practitioners (3.8±0.9). Conclusion Due to large variations in Slovenian OOHC clinics with regard to how health care workers from different professional backgrounds perceive safety culture, more attention should be devoted to improving the team collaboration in OOHC. A clearer description of professional team roles should be provided.
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Affiliation(s)
- Zalika Klemenc-Ketis
- Department of Family Medicine, Faculty of Medicine, University of Maribor, Maribor.,Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana.,Community Health Centre Ljubljana, Ljubljana, Slovenia
| | | | - Dag Hofoss
- Institute of Health and Society, University of Oslo, Oslo
| | - Gunnar Tschudi Bondevik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen.,National Centre for Emergency Primary Health Care, Uni Research Health, Bergen, Norway
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Mondoux S, Chan TM, Ankel F, Sklar DP. Teaching Quality Improvement in Emergency Medicine Training Programs: A Review of Best Practices. AEM EDUCATION AND TRAINING 2017; 1:301-309. [PMID: 30051048 PMCID: PMC6001504 DOI: 10.1002/aet2.10052] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 07/11/2017] [Accepted: 07/17/2017] [Indexed: 06/01/2023]
Abstract
International graduate medical accreditation bodies are placing increasing emphasis on resident education and competency in the principles of quality improvement and patient safety (QIPS). Current QIPS educational curricula are heterogeneous and variably attain stated objectives. We have conducted a review of QIPS curricular best practices and barriers to implementation of successful QIPS curricula and provide clear solutions aimed at overcoming these barriers. Emergency medicine programs provide fertile ground for QIPS initiatives and can become world leaders in QIPS curricular development and education.
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Affiliation(s)
- Shawn Mondoux
- Division of Emergency MedicineMcMaster UniversityHamiltonONCanada
| | - Teresa M. Chan
- Division of Emergency MedicineMcMaster UniversityHamiltonONCanada
| | - Felix Ankel
- Department of Emergency MedicineHealthPartners InstituteMinneapolisMN
| | - David P. Sklar
- Department of Emergency MedicineUniversity of New MexicoAlbuquerqueNM
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Wray CM, Fahrenbach J, Bassi N, Bhattacharjee P, Modes M, Howell MD, Arora VM. Improving Value by Reducing Unnecessary Telemetry and Urinary Catheter Utilization in Hospitalized Patients. Am J Med 2017; 130:1037-1041. [PMID: 28532986 DOI: 10.1016/j.amjmed.2017.04.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 04/16/2017] [Accepted: 04/18/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Charlie M Wray
- Division of Hospital Medicine, San Francisco Veterans Affairs Medical Center, Calif; Department of Medicine, University of California, San Francisco.
| | - John Fahrenbach
- Center for Healthcare Delivery Science and Innovation, University of Chicago Medical Center, Ill
| | - Nikhil Bassi
- Department of Medicine, University of Chicago, Ill
| | | | - Matthew Modes
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle
| | - Michael D Howell
- Center for Healthcare Delivery Science and Innovation, University of Chicago Medical Center, Ill; Section of Pulmonary and Critical Care Medicine, University of Chicago, Ill
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Kool B, Wise MR, Peiris-John R, Sadler L, Mahony F, Wells S. Is the delivery of a quality improvement education programme in obstetrics and gynaecology for final year medical students feasible and still effective in a shortened time frame? BMC MEDICAL EDUCATION 2017; 17:91. [PMID: 28549464 PMCID: PMC5446706 DOI: 10.1186/s12909-017-0927-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 05/10/2017] [Indexed: 06/01/2023]
Abstract
BACKGROUND Teaching clinical audit skills to nascent health professionals is one strategy to improve frontline care. The undergraduate medical curriculum at the University of Auckland provides improvement science theory and skills in Year 5 teaching, and the opportunity to put this into practice during an Obstetrics and Gynaecology (O&G) clinical attachment in Year 6. In 2015, a revised medical school curriculum at the university resulted in a planned reduction of the O&G attachment from five weeks to four, necessitating revision of the Year 6 Quality Improvement (QI) project. The aim of this study was to evaluate if the revised programme provided an important experiential learning opportunity for medical students without imposing an unsustainable burden on clinical services. METHODS Based on a CIPP (Context/Input/Process/Product) evaluation model, the study was conducted in several stages to get a sense of the context as the new programme was being planned (Context evaluation), the feasibility of an alternative approach to meet the educational need (Input evaluation), the implementation of the revised programme (Process evaluation) and finally, the programme outcomes (Product evaluation). We used multiple data sources (supervisors, students, academic administrators, and hospital staff) and data collection methods (questionnaires, focus groups, individual interviews, consultative workshops, student reports and oral presentations). RESULTS The context evaluation revealed the Year 6 QI programme to be valuable and contributed to O&G service improvements, however, the following concerns were identified: time to complete the project, timely topic selection and access to data, recognition of student achievement, and staff workload. The evaluation of the revised QI project indicated improvement in student perceptions of their QI knowledge and skills, and most areas previously identified as challenging, despite the concurrent reduction in the duration of the O&G attachment. CONCLUSIONS Applying the CIPP model for evaluation to our revised QI programme enabled streamlining of procedures to achieve greater efficiency without compromising the quality of the learning experience, or increasing pressure on staff. A four week clinical rotation is adequate for medical educators to consider opportunities for including QI projects as part of student experiential learning.
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Affiliation(s)
- Bridget Kool
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Michelle R. Wise
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Roshini Peiris-John
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Lynn Sadler
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Faith Mahony
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Susan Wells
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
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Brasaitė I, Kaunonen M, Martinkėnas A, Mockienė V, Suominen T. Health care professionals' skills regarding patient safety. MEDICINA-LITHUANIA 2016; 52:250-256. [PMID: 27697239 DOI: 10.1016/j.medici.2016.05.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 03/17/2016] [Accepted: 05/26/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE The importance of patient safety is growing worldwide, and every day, health care professionals face various challenges in how to provide safe care for their patients. Patient safety skills are one of the main tools to ensure safe practice. This study looks to describe health care professionals' skills regarding patient safety. MATERIALS AND METHODS Data were collected using the skill scale of the Patient Safety Attitudes, Skills and Knowledge (PS-ASK) instrument from different health care professionals (n=1082: physicians, head nurses, nurses and nurse assistants) working in hospitals for adult patients in three regional multi-profile hospitals in the western part of Lithuania. RESULTS Overall, the results of this study show that based on their own evaluations, health care professionals were competent regarding their safety skills. In particular, they were competent in the sub-scale areas of error analysis (mean=3.09) and in avoiding threats to patient safety (mean=3.31), but only somewhat competent in using decision support technology (mean=2.00). Demographic and other work related background factors were only slightly associated with these patient safety skills areas. Especially, it was noted that nurse assistants may need more support from managers and colleagues in developing their patient safety skills competence. CONCLUSIONS This study has served to investigate the general skills of health care professionals in regard to patient safety. It provides new knowledge about the topic in the context of the Baltic countries and can thus be used in the future development of health care services.
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Affiliation(s)
- Indrė Brasaitė
- School of Health Sciences, University of Tampere, Tampere, Finland; Faculty of Health Sciences, Klaipėda University, Klaipėda, Lithuania.
| | - Marja Kaunonen
- School of Health Sciences, University of Tampere, Tampere, Finland; Pirkanmaa Hospital District, Tampere, Finland
| | | | - Vida Mockienė
- Faculty of Health Sciences, Klaipėda University, Klaipėda, Lithuania
| | - Tarja Suominen
- School of Health Sciences, University of Tampere, Tampere, Finland
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Gundle KR, Mickelson DT, Hanel DP. Reflections in a time of transition: orthopaedic faculty and resident understanding of accreditation schemes and opinions on surgical skills feedback. MEDICAL EDUCATION ONLINE 2016; 21:30584. [PMID: 27079887 PMCID: PMC4832217 DOI: 10.3402/meo.v21.30584] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 02/28/2016] [Accepted: 03/16/2016] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Orthopaedic surgery is one of the first seven specialties that began collecting Milestone data as part of the Accreditation Council for Graduate Medical Education's Next Accreditation System (NAS) rollout. This transition from process-based advancement to outcome-based education is an opportunity to assess resident and faculty understanding of changing paradigms, and opinions about technical skill evaluation. METHODS In a large academic orthopaedic surgery residency program, residents and faculty were anonymously surveyed. A total of 31/32 (97%) residents and 29/53 (55%) faculty responded to Likert scale assessments and provided open-ended responses. An internal end-of-rotation audit was conducted to assess timeliness of evaluations. A mixed-method analysis was utilized, with nonparametric statistical testing and a constant-comparative qualitative method. RESULTS There was greater familiarity with the six core competencies than with Milestones or the NAS (p<0.05). A majority of faculty and residents felt that end-of-rotation evaluations were not adequate for surgical skills feedback. Fifty-eight per cent of residents reported that end-of-rotation evaluations were rarely or never filled out in a timely fashion. An internal audit demonstrated that more than 30% of evaluations were completed over a month after rotation end. Qualitative analysis included themes of resident desire for more face-to-face feedback on technical skills after operative cases, and several barriers to more frequent feedback. DISCUSSION The NAS and outcome-based education have arrived. Residents and faculty need to be educated on this changing paradigm. This transition period is also a window of opportunity to address methods of evaluation and feedback. In our orthopaedic residency, trainees were significantly less satisfied than faculty with the amount of technical and surgical skills feedback being provided to trainees. The quantitative and qualitative analyses converge on one theme: a desire for frequent, explicit, timely feedback after operative cases. To overcome the time-limited clinical environment, feedback tools need to be easily integrated and efficient. Creative solutions may be needed to truly achieve outcome-based graduate medical education.
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Affiliation(s)
- Kenneth R Gundle
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Ontario, Canada;
| | - Dayne T Mickelson
- Department of Orthopaedics & Sports Medicine, University of Washington, Seattle, WA, USA
- Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Doug P Hanel
- Department of Orthopaedics & Sports Medicine, University of Washington, Seattle, WA, USA
- Harborview Medical Center, University of Washington, Seattle, WA, USA
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Abstract
The role of resident and fellow trainees in patient-centered improvement processes is critical to a health care system's success. There is a growing impetus to incorporate patient safety and quality improvement into the educational framework of physicians in training. As part of the Next Accreditation System, practice-based learning and improvement and systems-based practice domains mandate that residents and fellows be assessed on their ability to enhance the quality of care and advocate for patient safety. Best practices for incorporating quality improvement and patient safety into the curriculum of residents and fellows remains an area of interest for educators.
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Affiliation(s)
- Emily Mathias
- Pediatric Emergency Medicine, Carman and Ann Adams Department of Pediatrics, Wayne State University, 3901 Beaubien Boulevard, Detroit, MI 48201, USA
| | - Usha Sethuraman
- Pediatric Emergency Medicine, Carman and Ann Adams Department of Pediatrics, Wayne State University, 3901 Beaubien Boulevard, Detroit, MI 48201, USA.
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Moczko TR, Bugaj TJ, Herzog W, Nikendei C. Perceived stress at transition to workplace: a qualitative interview study exploring final-year medical students' needs. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2016; 7:15-27. [PMID: 26834503 PMCID: PMC4716753 DOI: 10.2147/amep.s94105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
OBJECTIVES This study was designed to explore final-year medical students' stressors and coping strategies at the transition to the clinical workplace. METHODS In this qualitative study, semi-standardized interviews with eight final-year medical students (five male, three female; aged 25.9±1.4 years) were conducted during their internal medicine rotation. After verbatim transcription, a qualitative content analysis of students' impressions of stress provoking and easing factors during final-year education was performed. RESULTS Students' statements regarding burdens and dealing with stress were classified into four main categories: A) perceived stressors and provoking factors, B) stress-induced consequences, C) personal and external resources for preventing and dealing with stress, and D) final-year students' suggestions for workplace improvement. CONCLUSION Final-year medical students perceived different types of stress during their transition to medical wards, and reported both negative consequences and coping resources concerning perceived stress. As supervision, feedback, and coping strategies played an important role in the students' perception of stress, final-year medical education curricula development should focus on these specifically.
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Affiliation(s)
- Tobias R Moczko
- Department for General Internal and Psychosomatic Medicine, University Hospital of Heidelberg, Heidelberg, Germany
- School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Till J Bugaj
- Department for General Internal and Psychosomatic Medicine, University Hospital of Heidelberg, Heidelberg, Germany
| | - Wolfgang Herzog
- Department for General Internal and Psychosomatic Medicine, University Hospital of Heidelberg, Heidelberg, Germany
| | - Christoph Nikendei
- Department for General Internal and Psychosomatic Medicine, University Hospital of Heidelberg, Heidelberg, Germany
- Correspondence: Christoph Nikendei, Department for General Internal and Psychosomatic Medicine, University Hospital of Heidelberg, Thibautstraße 2, 69115 Heidelberg, Germany, Tel +49 6221 563 8663, Fax +49 6221 56 5749, Email
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Wong BM. Reporting on Patient Safety and Quality Improvement Education: Designing Projects for Optimal Dissemination. J Grad Med Educ 2015; 7:513-6. [PMID: 26692958 PMCID: PMC4675402 DOI: 10.4300/jgme-d-15-00402.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Brian M. Wong
- Corresponding author: Brian M. Wong, MD, FRCPC, University of Toronto, Sunnybrook Health Sciences Centre, Room H466, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada,
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