Undergraduate medical students' perceptions and intentions regarding patient safety during clinical clerkship

Morbidity and Mortality Conferences in Internal Medicine Specialty Training in Japan: A Nationwide Cross-sectional Study

Objective This study evaluated the implementation status of morbidity and mortality conferences in internal medicine specialty training programs in Japan. Methods This cross-sectional study surveyed hospitals in Japan with certified internal medicine specialty training programs. Program directors or equivalently responsible physicians managing certified internal medicine training programs were invited to participate in this study (n=619). Materials Data were collected using an online questionnaire that included questions about the number of morbidity and mortality conferences, types of cases covered, collaboration of the patient safety section and other health professions, and whether or not the conferences were conducted by a subspecialty department-led or program-based. Results Responses were received from 123 hospitals (19.8% response rate), of which 59 (48%) had some form of internal medicine morbidity and mortality conference in place. The average number per year was 9.63 (standard deviation: 18.12). Hospitals with morbidity and mortality conferences in subspecialty departments held significantly more conferences. Furthermore, the involvement of the patient safety department tended to be associated with holding more conferences. Autopsy rates were significantly higher in hospitals with program-based internal medicine morbidity and mortality conferences than subspecialty-led. Conclusion Internal medicine specialty training hospitals had more morbidity and mortality conferences than previously reported. Program-based morbidity and mortality conferences in internal medicine are associated with higher autopsy rates and may lead to an organizational reporting culture and lifelong learning attitudes that support patient safety. Collaboration with organizational management sections, such as patient safety, would be effective in implementing these conferences in internal medicine training programs.

Unveiling the hidden struggle of healthcare students as second victims through a systematic review

BACKGROUND

When healthcare students witness, engage in, or are involved in an adverse event, it often leads to a second victim experience, impacting their mental well-being and influencing their future professional practice. This study aimed to describe the efforts, methods, and outcomes of interventions to help students in healthcare disciplines cope with the emotional experience of being involved in or witnessing a mistake causing harm to a patient during their clerkships or training.

METHODS

This systematic review followed the PRISMA guidelines and includes the synthesis of eighteen studies, published in diverse languages from 2011 to 2023, identified from the databases MEDLINE, EMBASE, SCOPUS and APS PsycInfo. PICO method was used for constructing a research question and formulating eligibility criteria. The selection process was conducted through Rayyan. Titles and abstracts of were independently screened by two authors. The critical appraisal tools of the Joanna Briggs Institute was used to assess the risk of bias of the included studies.

RESULTS

A total of 1354 studies were retrieved, 18 met the eligibility criteria. Most studies were conducted in the USA. Various educational interventions along with learning how to prevent mistakes, and resilience training were described. In some cases, this experience contributed to the student personal growth. Psychological support in the aftermath of adverse events was scattered.

CONCLUSION

Ensuring healthcare students' resilience should be a fundamental part of their training. Interventions to train them to address the second victim phenomenon during their clerkships are scarce, scattered, and do not yield conclusive results on identifying what is most effective and what is not.

Medical students' experiences, perceptions, and management of second victim: an interview study

BACKGROUND

The term second victim describes a healthcare professional who has been involved in an adverse event and feels wounded by the event. The effects of this experience differ. It can present as second victim syndrome, describing a wide range and degree of emotional and behavioural responses. Studies show that medical students can also experience second victim. The aim of this study was to elucidate medical students' experiences, perceptions, and management of second victim and second victim syndrome and to describe possible learning needs around these issues.

METHODS

Thirteen medical students and two recent medical graduates participated in semi-structured focus group interviews. The interviews lasted 1.5-2 h and were audiotaped, transcribed, and analysed using Braun and Clarke's six-step approach for thematic analysis.

RESULTS

Four main themes were identified: contributing factors; current coping strategies; perception of own requirements and learning needs; wishes for the future healthcare system. Students' behavioural and emotional response to dilemmas were affected by stakeholders and practices embedded in the healthcare system. Students described patient-injury and unexpected events as triggers for second victim, but also harmful interactions with individuals and feelings of self-blame. Students' coping centred around their network, formal offers, and separation of personal- and work-life. Students sought a clear definition of second victim and a desire for role-models. Students' wished to learn how to handle feeling like a burden to others, managing waiting time after patient complaints, and learning how to help second victims recover. Students emphasized the importance of the healthcare organisation understanding students' needs and providing them relevant support.

CONCLUSION

Students experience second victim as described in the literature. Students' emotional responses were caused by classical second victim triggers, but also other triggers in the educational environment: harmful interactions and self-blame. Although some triggers differ from the second victim definition, these different triggers should be considered equally serious and acknowledged. We must aim to prepare students for future adverse events and emotional responses. The health organisation and healthcare professionals must support students' mental well-being and contribute to ideal conditions for students' professional development and management of second victim as future physicians.

Attitudes of undergraduate medical students toward patients' safety in Jordan: a multi-center cross-sectional study

BACKGROUND

Patient safety practices are crucial in healthcare as they aim to reduce harm, medical errors, and ensure favorable outcomes for patients. Therefore, this study aims to examine the attitudes towards patient safety among undergraduate medical students in Jordanian medical schools.

METHODS

A descriptive cross-sectional study was conducted among undergraduate medical students. Participants completed the Attitudes to Patient Safety Questionnaire- III (APSQ-III), which examines students' attitudes in 26 items distributed in nine domains. Results are represented as mean ± standard deviation for all participants and subgroups.

RESULTS

Our study included 1226 medical students. They reported positive attitudes toward patient safety with a mean score of 4.9 (SD ± 0.65). Participants scored the highest score in "Working hours as error cause" followed by "Team functioning". Gender, academic-year, and first-generation student status had a significant association with certain patient safety domains. Females scored significantly higher than males in four domains, while males scored higher in one domain. First-generation medical students had a significantly lower score for "Professional incompetence as error cause". Interestingly, pre-clinical students recorded more positive attitudes in "Patient safety training received" and "Disclosure responsibility" domains.

CONCLUSION

Undergraduate medical students in Jordan demonstrated positive attitudes towards patient safety concepts. Our study provides baseline data to improve current educational programs and enhance the patient safety culture among medical students. Additional studies are needed to delve into actual attitudes toward patient safety and to assess how educational programs contribute to the cultivation of this culture.

Exploration of students' reaction in medical error events and the impact of personalized training on the speaking-up behavior in medical error events

BACKGROUND

The ability of medical students to speak up before a medical error occurs is a timely and necessary interaction to prevent potential patient harm. As it may be crucial to improve patient safety, we explored how medical students react to a medical error and provided them appropriate training regarding speaking up about medical issues.

METHODS

A quasi-experimental study was conducted in Taiwan involving 153 medical students who participated in a speaking-up simulation course. They were divided into two groups. The first group participated in a non-life-threatening scenario before the intervention, followed by a personalized debriefing session, then a life-threatening scenario after the intervention. The second group participated in a life-threatening scenario before the intervention, followed by a personalized debriefing session, then a non-life-threatening scenario after the intervention. Students also completed patient safety attitude survey.

RESULTS

During the preintervention scenario, the overall medical students' speaking-up rate to medical error was 45.1%. The speaking-up rate of medical students in life-threatening scenario was significantly higher than the rate in non-life-threatening scenario before the intervention (64.6% vs 24.3%, p < 0.001). After personalized debriefing, the speaking-up rate to medical errors was significantly improved both in life-threatening scenarios (95.9%, p < 0.001) and in non-life-threatening scenarios (100%, p < 0.001). Male medical students had significantly higher speaking-up rates than female students in life-threatening scenario (76.2% vs 51.4%, p = 0.02). On post-intervention surveys, students provided several reasons for their likelihood of speaking up or remaining silent during a medical error event.

CONCLUSIONS

Medical students' rate of speaking-up to medical error was higher in a simulated life-threatening scenario than in a simulated non-life-threatening scenario. Faculty-led personalized debriefing can facilitate medical students' adoption of communication strategies to speak up more in medical error events. Educators should also consider gender differences when they design effective assertive communication courses.[Box: see text].

The Relationship between Professional Identity, Performance and Attitude to Medical Errors Self-reporting among Medical Students

INTRODUCTION

Medical errors are a serious problem in providing medical care and ensuring the health of society, and discovering the causes of errors to minimize the possibility of their occurrence is one of the main challenges in the field of treating patients. This study aimed to determine the relationship between professional identity, performance and attitude to self-reported medical errors among medical interns of Ardabil University of Medical Sciences.

METHODS

This cross-sectional analytical study was conducted on 187 medical interns with census method in five Ardabil educational hospitals in the second semester of 2020-2021. Data collection tool was a questionnaire consisting of 3 parts (demographic, self-reported attitude towards medical errors and professional identity). The validity of the questionnaire was evaluated using Content validity index (CVI) and Content validity ratio (CVR). The reliability of the attitude section was 0.78 and 0.86 for professional identity section. Data analyses were performed using the IBM SPSS Statistics, version 21 by descriptive statistics, such as mean and standard deviation and independent T-test, chi-square and one-way ANOVA. P-values <0.05 were considered statistically significant.

RESULTS

The mean scores of students' attitudes towards self-report and professional identity were 55.6±8.8 and 60.4±9.8. Less than 50% of the students declared the possibility of reporting their medical errors. There were no significant differences in the mean scores of self-reported attitude, medical error and professional identity according to grade point average, type of faculty and students' gender (P>0.05).

CONCLUSION

The attitude and performance of students regarding the self-disclosure of medical errors was not satisfactory, and it seems that the analysis of the educational programs in the education of medical errors and the legal and ethical aspects of errors needs serious attention.

Evaluating medical students' ability to identify and report errors: finding gaps in patient safety education

BACKGROUND

Although there are frequent complaints of medical students' incompetence in reporting errors, few studies have examined their error-reporting abilities in the real world.

OBJECTIVES

Three sub-functions of self-regulation theory were used to evaluate medical students' ability to identify errors (self-monitoring), analyse root causes (self-judgment), and devise improvement plans (self-reactions). In addition, whether students reacted differently to their errors and those of others (three sub-functions) was also examined.

METHODS

A total of 952 patient safety reports were reviewed retrospectively, submitted by third-year medical students between 2016 and 2018. Data were quantitatively and qualitatively analysed to investigate who committed the error, to identify the type of error and its root causes, and to find suggested improvement plans. Chi-square and Fisher's exact tests were used to compare students' responses to error origins.

RESULTS

Students reported other errors more frequently than their own (67.6% vs. 32.4%). They reported common critical medical errors, including errors related to engaging with patients (34.5%), invasive procedures (20.2%), and infection (18.5%). The root causes identified were more precise than the improvement plans by the students (75.5% vs. 18.4%, respectively). The students' improvement plans were not practical, especially at the patient level (25.8%). When students committed errors, they considered human factors such as fatigue, scheduling, and training as the most common root cause, focussing on improvement plans at the individual level.

CONCLUSIONS

The results suggest that students were good at self-judgment, but not at self-monitoring and self-reactions. They reacted differently, based on who committed the error. To enhance self-regulated learning, Educators should encourage students to confront their errors, reflect on their self-reactions towards errors, develop well-being with time management, and think about the meaning of patient-centredness. Finally, active participation in clinical clerkship longitudinally may provide students with opportunities to learn from their errors.

Bad things can happen: are medical students aware of patient centered care and safety?

Objectives

Quality and safety in healthcare are of the utmost importance, but little is known about whether undergraduate students are aware of patient safety concepts. The objectives of our study were to assess the perception of medical students of challenges in patient safety, and collect their perceptions of error management and prevention.

Methods

This study used an exploratory mixed method strategy. The first study phase collected data from semi-structured interviews of 28 students. Based on this, an online survey was constructed and sent to about 80,000 medical students in Germany. 1053 replies were received and analyzed for responses based on gender, curriculum type (problem based [PBC] vs. science based curriculum [SBC]) and years of training.

Results

Most students understand the importance of patient safety, error avoidance, and the challenges of patient safety interventions. Four themes were identified: (a) the culture of patient safety (what is a good doctor? Doctors’ responsibility), (b) the working environment (the inevitability of mistakes, high work load, hierarchy, competition, teamwork), (c) the challenges of risk reduction (error avoidance, management, skills), and (d) materialistic issue (income vs. humanistic values). Female students were more risk aware than male students. Sixteen percent of students expect negative effects (e.g. punishment) when medical errors were disclosed in a team. Regardless, >70% regard teamwork as an effective error avoidance measure. Error disclosure willingness was high (89.7%).

Conclusions

Although not formally part of the curriculum, students had a positive perspective concerning patient safety. The opportunities and challenges for incorporating patient safety content into the training curriculum were identified and presented.

Perfil de denúncias éticas contra médicos em um estado brasileiro, de 2001 a 2016

Nas últimas décadas, a Medicina convive com o aumento de denúncias éticas e processos judiciais. Este artigo avaliou as sindicâncias apreciadas pelo Conselho Regional de Medicina do Piauí, de 2001 a 2016. Foram incluídas 1011 sindicâncias, totalizando 1073 médicos implicados. Houve significativo crescimento da quantidade de médicos denunciados em função do tempo (p<0,001). O principal denunciante foi o próprio paciente ou seu familiar/representante legal (54,15%), com a queixa principal de negligência (31,87%). Os denunciados mais frequentes foram do sexo masculino (77,45%). O artigo discute fatores associados ao crescimento das denúncias, como distanciamento da relação médico-paciente e represálias ao erro médico.

Patient Safety in the Eyes of Aspiring Healthcare Professionals: A Systematic Review of Their Attitudes

A culture of safety is important for the delivery of safe, high-quality care, as well as for healthcare providers' wellbeing. This systematic review aimed to describe and synthesize the literature on patient safety attitudes of the next generation of healthcare workers (health professional students, new graduates, newly registered health professionals, resident trainees) and assess potential differences in this population related to years of study, specialties, and gender. We screened four electronic databases up to 20 February 2020 and additional sources, including weekly e-mailed search alerts up to 18 October 2020. Two independent reviewers conducted the search, study selection, quality rating, data extraction, and formal narrative synthesis, involving a third reviewer in case of dissent. We retrieved 6606 records, assessed 188 full-texts, and included 31 studies. Across articles, healthcare students and young professionals showed overwhelmingly positive patient safety attitudes in some areas (e.g., teamwork climate, error inevitability) but more negative perceptions in other domains (e.g., safety climate, disclosure responsibility). Women tend to report more positive attitudes. To improve safety culture in medical settings, health professions educators and institutions should ensure education and training on patient safety.

[Design and evaluation of a preclinical medical elective titled "Safety culture in healthcare: Every error counts!"]

INTRODUCTION

The World Health Organization has called for more importance to be attached to the subject of patient safety in medical studies. However, teaching staff are unsure when the right time is to include this topic in existing medical school curricula. The aim of this article is to present the learning objectives, design and evaluation of a two-day elective on patient safety offered in the preclinical phase of medical studies at the Faculty of Medicine, University of Frankfurt am Main. To the best of our knowledge, no existing elective on safety culture has been provided at such an early stage of medical studies in Germany.

METHODS

After defining learning objectives and teaching methods, the safety culture elective was offered in the winter term 2019/20. Based on a questionnaire, a quantitative and qualitative evaluation of the students' acceptance of the elective was carried out. We also sought to investigate whether group role-play was considered an effective means of communicating the teaching content. Acceptance and rejection of the elective were evaluated on a six-point Likert scale.

RESULTS

The resulting elective, consisting of topical input via film, an introductory speech, role-play and discussions, is presented. Nineteen students in the preclinical phase of their medical studies took part. Overall, the quantitative and qualitative evaluation delivered positive results (1.2±0.5), and the topic was perceived to very important. The students considered the didactic implementation and the learning objectives to be very good, and they became acquainted with different sources of error.

DISCUSSION

The preclinical elective would appear to be suitable for demonstrating the importance of medical safety to medical students and teaching them how to deal with the topic constructively. It can be viewed as a best-practice example for the development of comparable learning formats at medical faculties.

CONCLUSION

The results show that the preclinical phase is a suitable time to illustrate the importance of the subject of patient safety during medical studies.

Major educational factors associated with nursing adverse events by nursing students undergoing clinical practice: A descriptive study

BACKGROUND

As the main group of healthcare providers in hospitals, nurses have more frequent contacts than any other clinician and thus are in a better position to improve patient safety. With the purpose of cultivating competent nurses, nursing educators have the responsibility to promote patient safety. A better understanding of educational factors affecting nursing adverse events by nursing students undergoing clinical practice can help nursing educators find appropriate ways to fulfil their duty.

OBJECTIVE

To examine the status quo of nursing adverse events and to discuss the major educational factors concerned in different regions of China.

DESIGN

A descriptive study design was undertaken in 2018.

PARTICIPANTS AND SETTING

A convenience sample of 1173 nursing students undergoing clinical practice was recruited from 22 hospitals in different regions of China.

METHODS

The Chinese version of the Medical Student Safety Attitudes and Professionalism Survey (MSSAPS) was administered to and demographic and professional data were collected from clinical nursing students after obtaining informed consent.

RESULTS

The incidence of nursing adverse events in clinical student nurses was 17.8%. Approximately 87.01% of nursing adverse events were near miss. The positive response rate of safety attitudes and professionalism by clinical nursing students ranged from 57.5% to 96.9%. Logistic analysis indicated that gender, educational level, hospital regions, safety culture and professional behavior experience dimensions were the major factors influencing nursing adverse events.

CONCLUSION

Attention should be paid to the situation in which clinical nursing students are prone to nursing adverse events. Cooperation between nursing colleges and hospitals should be strengthened to promote patient safety in clinical nursing students. We suggest that nursing educators implement patient safety education in both theoretical and practical teaching and use multiple forms, especially simulation-based training, to strengthen safe nursing behavior to reduce the incidence of nursing adverse events.

Undergraduate medical students' attitudes towards medical errors and patient safety: a multi-center cross-sectional study in the Gaza Strip, Palestine

BACKGROUND

In undergraduate medical education, patient safety concepts and understanding of medical errors are under-represented. This problem is more evident in low-income settings. The aim of this study was to explore undergraduate medical students' attitudes towards patient safety in the low-income setting of the Gaza Strip.

METHODS

A cross-sectional, descriptive study included medical students of the two medical schools in the Gaza Strip with 338 medical students completing the Attitudes to Patient Safety Questionnaire-IV (APSQ-IV), which examines patient attitudes in 29 items over 10 domains. Results are represented as means ± standard deviations for each item and domain as well as percentage of positive responses to specific items.

RESULTS

Medical students reported slightly positive patient safety attitudes (4.7 ± 0.5 of 7) with the most positive attitudes in the domains of situational awareness, importance of patient safety in the curriculum, error inevitability and team functioning. While no negative attitudes were reported, neutral attitudes were found in the domains of professional incompetence as a cause of error and error reporting confidence. Study year and gender had no significant association with patient safety attitudes, except for disclosure responsibility, where male students displayed significantly more positive attitudes. The study university was significantly associated with three of the 10 examined domains, all of which involved understanding of medical errors, for which students of University 2 (who had undergone limited patient safety training) held significantly more positive attitudes, compared with students of University 1 (who did not have structured patient safety training).

CONCLUSION

Medical students' patient safety attitudes were very similar among students from both universities, except for understanding of medical error, for which students, who had received structured training in this topic, displayed significantly more positive attitudes. This underlines the power of the 'hidden curriculum', where students adjust to prevalent cultures in local hospitals, while they do their clinical training. Furthermore, it highlights the need for a systematic inclusion of patient safety content in local undergraduate curricula.

Attitudes Toward Patient Safety among Medical Students in Malaysia

The biggest challenge in moving toward a safer healthcare system is patient safety culture—that is, the prevention of harm to patients. Safe medical practices can prevent doing harm to the patients. For this, healthcare professionals must have good attitudes toward patient safety. Medical education plays an important role in promoting patient safety and patient safety attitudes. A study was conducted among medical students in Malaysia to assess their perceptions toward patient safety, using the 26-items Attitudes Toward Patient Safety Questionnaire (APSQ-III). In the analysis, the average percentage of positive responses (APPR) were computed for each domain, and APPR values of ≥75 were used as an indicator of positive perception. Out of the nine domains of APSQ, the students’ attitude was positive in six—Safety Training (85.2%), Error Reporting (76.3%), Working Hours (89.5%), Error Inevitability (86.1%), Team Functioning (94.6%), and Patient Involvement (80.1%). The desired level of positive attitude was not met in Disclosure Responsibility (68.5%), Professional Incompetence (70.0%), and Safety Curriculum (71.1%). APRR for disclosure responsibility was high among the first-year students, but, generally, the effect wore off over the years of study. The results support the need to enhance perception on Disclosure Responsibility, Professional Incompetence, and Safety Curriculum among the medical students in Malaysia.

The attitudes of Korean medical students toward patient safety

PURPOSE

This study investigated the attitudes of Korean medical students about patient safety to determine which perspectives required increased focus in terms of educational development.

METHODS

Attitudes were assessed using the Patient Safety Questionnaire, a tool designed to measure attitudes toward patient safety among medical students. Questionnaires were distributed to 580 clinical year students across four medical schools in December 2018.

RESULTS

A total of 300 returned questionnaires were used in the final analysis. More than half of all respondents agreed (i.e., gave more than 4 out of 7 points) with most items and thoroughly considered the concept of patient safety. However, many students misperceived several items (e.g., professional incompetence as a cause of errors, disclosure responsibility, the importance of patient safety in the curriculum, and situational awareness).

CONCLUSION

Attitudes toward patient safety are highly important due to their substantial impacts on behavioral decisions in the clinical setting. As such, patient safety education should be designed to place greater emphasis on proper attitude. This study's findings should be useful for medical instructors who wish to determine the appropriate areas of curricular focus.

Attitudes of doctors and nurses to patient safety and errors in medical practice in the Gaza-Strip: a cross-sectional study

OBJECTIVES

This study examined the attitudes of nurses and doctors to key patient safety concepts, evaluated differences and similarities between professional groups and assessed positive and negative attitudes to identify target areas for future training.

SETTING

Four major governmental hospitals in the Gaza-Strip.

PARTICIPANTS

A convenience sample of 424 nurses and 150 physicians working for at least 6 months in the study hospitals.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome measures were mean scores with SD as measured for individual items and nine main patient safety domains assessed by the Attitudes to Patient Safety Questionnaire. Secondary outcome measures were the proportions of doctors and nurses, that gave a positive response to each item, represented as percentage of each group.

RESULTS

Nurses and doctors held moderately positive attitudes towards patient safety with five out of nine domain scores >3.5 of 5. Doctors showed slightly more positive attitudes than nurses, despite a smaller proportion of doctors having received patient safety training with 37.5% compared with 41.9% of nurses. Both professions displayed their most positive patient safety attitudes in the same domains ('team functioning' and 'working hours as a cause for error'), as well as their two most negative attitudes ('importance of patient safety in the curriculum' and 'professional incompetence as a cause of error'), demonstrating significant deficits in understanding medical errors. A specific challenge will be the negative attitudes of both professions towards patient safety training for wider dissemination of this content in the postgraduate curriculum.

CONCLUSION

Patient safety attitudes were moderately positive in both professional groups. Target of future patient safety training should be enhancing the understanding of error in medicine. Any training has to be motivating and relevant for clinicians, demonstrating its importance in ongoing professional learning.

Attitudes towards patient safety culture among postgraduate nursing students in China: A cross-sectional study

Patient safety is crucial to healthcare quality. It is important to assess the nursing students' safety attitudes to identify the weaknesses for developing education program and fostering students' engagement in patient safety practices. This study aimed to assess attitudes towards patient safety culture among postgraduate nursing students in China, and explore the factors that affect their safety attitudes and the relationships of safety attitudes and safety-related behaviors. This study used a cross-sectional survey design. A convenience sample of 231 postgraduate nursing students from ten medical universities in China completed the Chinese version of Safety Attitude Questionnaire, including six domains: teamwork climate, safety climate, perceptions of management, job satisfaction, working conditions and stress recognition. The mean scores of the six domains ranged from 65.22 to 70.75 on a 100-point scale. Percentages of positive responses for the six domains were below 55%, with the two lowest percentages for working conditions (35.9%) and safety climate (30.7%). Significantly lower domain scores were found in students with younger age, no work experience, higher workload and received safety education. There were positive correlations between the six domains and safety-related behaviors except for stress recognition. Nursing educators should focus more on the improvement of patient safety education and establishment of supportive work environment to enhance postgraduate nursing students' attitudes towards safety culture.