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

Lebanese medical students' attitudes towards patient safety and medical error disclosure: A cross-sectional study

OBJECTIVE

To assess Lebanese medical students' attitudes towards patient safety and medical error disclosure.

METHODS

This was a cross-sectional study involving medical students from seven different medical schools in Lebanon. The participants completed the Attitudes to Patient Safety Questionnaire (APSQ-III) online, which consists of 26 items across nine key patient safety domains. Items were scored from 1 (strongly disagree) to 5 (strongly agree). Demographic data were also collected.

RESULTS

Of the 549 students enrolled in the study, 325 (59%) were female and 224 (41%) were male. More than half (287, 52%) were aged between 20 and 22 years and 95% were Lebanese. The overall attitude of students towards patient safety was positive (3.59 ± 0.85) with the most positive attitudes in the domains of 'Team functioning' followed by 'Working hours as an error cause'. More positive attitudes were perceived among male students in the domains of 'Professional incompetence as an error cause' and 'Disclosure responsibility' whereas more positive attitudes were seen in female students in the domain of 'Working hour as an error cause'. Older medical students had more positive attitudes in the domain of 'Team functioning' than younger students.

CONCLUSION

Medical students in Lebanon had an overall positive attitude towards patient safety. These findings may be used to guide improvements in patient safety education and enhance patient-centred care in medical institutions in Lebanon.

Exploring medical and nursing students' perceptions about a patient safety course: a qualitative study

BACKGROUND

Educating health professionals on patient safety can potentially reduce healthcare-associated harm. Patient safety courses have been incorporated into medical and nursing curricula in many high-income countries and their impact has been demonstrated in the literature through objective assessments. This study aimed to explore student perceptions about a patient safety course to assess its influence on aspiring health professionals at a personal level as well as to explore differences in areas of focus between medical and nursing students.

METHODS

A dedicated patient safety course was introduced for year III medical and year II and IV nursing students at the Aga Khan University (2021-2022). As part of a post-course assessment, 577 participating students (184 medical and 393 nursing) wrote reflections on the course, detailing its influence on them. These free-text responses were thematically analyzed using NVivo.

RESULTS

The findings revealed five major themes: acquired skills (clinical, interpersonal), understanding of medical errors (increased awareness, prevention and reduction, responding to errors), personal experiences with patient safety issues, impact of course (changed perceptions, professional integrity, need for similar sessions, importance of the topic) and course feedback (format, preparation for clinical years, suggestions). Students reported a lack of baseline awareness regarding the frequency and consequences of medical errors. After the course, medical students reported a perceptional shift in favor of systems thinking regarding error causality, and nursing students focused on human factors and error prevention. The interactive course format involving scenario-based learning was deemed beneficial in terms of increasing awareness, imparting relevant clinical and interpersonal skills, and changing perspectives on patient safety.

CONCLUSIONS

Student perspectives illustrate the benefits of an early introduction of dedicated courses in imparting patient safety education to aspiring health professionals. Students reported a lack of baseline awareness of essential patient safety concepts, highlighting gaps in the existing curricula. This study can help provide an impetus for incorporating patient safety as a core component in medical and nursing curricula nationally and across the region. Additionally, patient safety courses can be tailored to emphasize areas identified as gaps among each professional group, and interprofessional education can be employed for shared learning. The authors further recommend conducting longitudinal studies to assess the long-term impact of such courses.

Patient Safety in the Surgical Field: A Cross-Sectional Study Among Al-Baha University Medical Students

Background Patient safety and quality of surgical care are crucial in healthcare. Adequate knowledge and attitudes among healthcare providers regarding differentiating malpractice from surgical complications are essential for preventing adverse events. We aimed to assess medical students' knowledge and attitudes toward patient safety in surgical procedures. Methodology A cross-sectional study was conducted among clinical years of medical students and interns at Al-Baha University, Saudi Arabia, from June 15, 2023, to August 1, 2023. Exclusion criteria were students from basic years, pharmacology students, applied medical science, dental students, and students from other universities. A self-administered questionnaire collected data on participants' demographics, knowledge, attitudes, and practices related to patient safety in surgical procedures. Results A total of 271 medical students participated, exceeding the target sample size of 181. Participants' ages ranged from 20 to 28 years, with the majority between 23 and 25 (60.5%). Males accounted for 63.8% of participants. The largest group was fourth-year students (31.7%), followed by interns (23.6%), those in sixth year (23.2%), and those in fifth year (21.4%). Moreover, 82.7% of participants demonstrated good knowledge of patient safety concepts. The highest level of knowledge was noted among fourth-year students (89.5%), and the lowest was among fifth-year medical students (75.9%), but was not statistically significant (p=0.701). Most participants demonstrated appropriate attitudes and practices (83.6%); however, 9.2% refused to perform surgery on a patient with active hepatitis B due to concerns for their own safety. Conclusion The majority of participants exhibited suitable knowledge and attitudes toward patient safety in surgical scenarios, but there was deficient knowledge among fifth- and sixth-year students. Moreover, a negative attitude regarding patient safety was noticed, exemplified by refusing surgeries on patients with active hepatitis B.

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.

Perspectives on developing moral courage in pre-licensure education: A qualitative study

BACKGROUND

Error reporting and speaking up are mechanisms to reduce the incidence of healthcare errors. However, organizational policies don't always align with individuals' perceptions and beliefs to promote these mechanisms. When this misalignment produces fear, moral courage, which is taking action regardless of personal consequences, becomes necessary. Teaching moral courage in pre-licensure education may set a foundation for individuals to speak up in post-licensure careers.

AIM

To explore health professionals' perceptions of healthcare reporting and organizational culture to inform pre-licensure education on how to promote moral courage.

METHODS

Thematic analysis of four semi-structured focus groups with fourteen health professions educators followed by in-depth, semi-structured individual interviews.

FINDINGS

Organizational factors, characteristics that an individual must possess to enact moral courage and priority methods to guide moral courage were identified.

CONCLUSIONS

This study outlines the need for leadership education in moral courage and offers educational interventions to promote reporting and aid in developing moral courage academic guidelines to improve healthcare error reporting and speaking up behaviors.

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.

Individual Characteristics That Promote or Prevent Psychological Safety and Error Reporting in Healthcare: A Systematic Review

Background

Healthcare errors continue to be a safety issue and an economic burden that causes death, increased length of stays, and emotional trauma to families and the person who commits the error.  Speaking up and error reporting within a safety culture can reduce the incidence of error; however, this is complex and multifaceted.

Aim

This systematic review investigates individual characteristics that support or prevent speaking up behaviors when adverse events occur.  This study further explores how organizational interventions designed to promote error reporting correlate to individual characteristics and perceptions of psychological safety.  .

Methods

A systematic review of peer-reviewed articles in healthcare that contain characteristics of an individual that promote or prevent error reporting was conducted. The search yielded 1233 articles published from 2015 to 2021. From this set, 81 full-text articles were assessed for eligibility and ultimately extracted data from 28 articles evaluated for quality using Joanna Briggs Institute critical appraisal tools©.

Principal Findings

The primary themes for individual character traits, values, and beliefs that influence a person's decision to speak up/report an error include self-confidence and positive perceptions of self, the organization, and leadership. Education, experience and knowledge are sub themes that relate to confidence. The primary individual characteristics that serve as barriers are 1) self-preservation associated with fear and 2) negative perceptions of self, the organization, and leadership.

Conclusion

The results show that an individual's perception of their environment, whether or not it is psychologically safe, may be impacted by personal perceptions that stem from deep-seated personal values. This exposes a crucial need to explore cultural and diversity aspects of healthcare error reporting and how to individualize interventions to reduce fear and promote error reporting.

Patient safety in medical education: Tunisian students’ attitudes

Health care delivery continues to be unsafe despite major patient safety (PS) improvement efforts over the past decade. Medical school education plays an important role in promoting this culture during initial training. To determine undergraduate medical students’ attitudes toward PS at a Tunisian medical school. We carried out a cross-sectional study among undergraduate medical students at Ibn Al Jazzar Medical School in Sousse, Tunisia, using a self-administered questionnaire inspired from the valid tool: Attitudes to Patient Safety Questionnaire (APSQ III). A total of 178 medical students responded to the questionnaire. Medical students tend to have an overall positive perceptions of PS culture with a global mean score 5.33 ± 0.5. Among the individual domains ‘Working hours as a cause of error’ earned the highest score (6.38 ± 1.0) followed in order by ‘Team functioning’ (6.24 ± 0.8), ‘Error inevitability’ (5.91 ± 1.0) and ‘Patient involvement in reducing error’ (5.50 ± 1.0). The lowest score was for ‘Professional incompetence as a cause of error’ (4.01 ± 1.0). A PS domain’s mean scores comparison based on socio-demographic variables: gender, age, academic year and on PS training revealed a statistically significant difference (p < 0.05) for five PS key dimensions: ‘ Error reporting confidence ’, ‘ Working hours as a cause of error ’, ‘ Professional incompetence as a cause of error ’, ‘ Team functioning ’ and ‘PS training received’. Tunisian medical students showed positive attitude towards PS. Nevermore, intensive in terms of frequency and duration sessions, based on various teaching methods may be needed to fulfill students’ educational needs.

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.

Knowledge and Attitudes towards Patient Safety among Students in Physical Therapy in Spain: A Longitudinal Study

(1) Background: Patient safety is a discipline of health care management aiming to prevent and reduce errors and harm to patients. The assessment of knowledge and attitudes on patient safety among students in physical therapy is still scarce; no studies have yet explored the changes that internship periods may produce. Objectives: 1. to determine the attitudes and knowledge of students in physical therapy with respect to patient safety in a Spanish University; and 2. to explore changes following a practical internship period. (2) Methods: Longitudinal study. Data from the Attitudes to Patient Safety Questionnaire III (APSQ-III) before and after the internship period were obtained from an initial sample of 125 students and average positive response rates were compared. (3) Results: "Team functioning", "Importance of patient safety in the curriculum", and "Error inevitability" displayed the highest scores, in accordance with the current literature. After the internship period, the dimensions "Patient safety training received" (p = 0.001), "Error reporting confidence" (p = 0.044), and "Professional incompetence as an error cause" (p = 0.027) showed significant changes. (4) Conclusions: The current study, highlighting areas of strengths and weaknesses in the knowledge and attitudes of students in physical therapy towards patient safety, may be a foundation to adopt tailored programs to enhance students' competencies in patient safety.