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Li H, Kong X, Sun L, Zhu Y, Li B. Major educational factors associated with nursing adverse events by nursing students undergoing clinical practice: A descriptive study. NURSE EDUCATION TODAY 2021; 98:104738. [PMID: 33453559 DOI: 10.1016/j.nedt.2020.104738] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 11/27/2020] [Accepted: 12/17/2020] [Indexed: 06/12/2023]
Abstract
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.
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Affiliation(s)
- Hui Li
- Zhengzhou Health Vocational College, Xingyang District, Zhengzhou 450122, Henan Province, China
| | | | - Lulu Sun
- Chinese Nursing Association, China
| | | | - Bo Li
- Henan University School of Nursing and Health, Longting District, Kaifeng 475004, Henan Province, China.
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Peiris-John R, Selak V, Robb G, Kool B, Wells S, Sadler L, Wise MR. The State of Quality Improvement Teaching in Medical Schools: A Systematic Review. JOURNAL OF SURGICAL EDUCATION 2020; 77:889-904. [PMID: 32057742 DOI: 10.1016/j.jsurg.2020.01.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 01/14/2020] [Indexed: 06/10/2023]
Abstract
INTRODUCTION While teaching patient safety and quality improvement (QI) skills to medical students is endorsed as being important, best practice for achieving learner outcomes in QI is particularly unclear. We systematically reviewed QI curricula for medical students to identify approaches to QI training that are associated with positive learner outcomes. METHODS We searched databases (Medline, EMBASE, and Scopus) and article bibliographies for studies published from 2009 to 2018. Studies evaluating QI teaching for medical students in any setting and reporting learner outcomes were included. Educational content, teaching format, achievement of learning outcomes, and methodological features were abstracted. Outcomes assessed were learners' satisfaction, attitudes, knowledge and skills, changes in behavior and clinical processes, and benefits to patients. RESULTS Twenty of 25 curricula targeted medical students exclusively. Most curricula were well accepted by students (11/13 studies), increased their confidence in QI (9/11) and led to knowledge acquisition (17/20). Overall, positive learner outcomes (Kirkpatrick Levels 1 to 4A) were demonstrated across a range of curricular content and teaching modalities. In particular, 2 curricula demonstrated positive changes in learners' behavior (Kirkpatrick Level 3), both incorporating a clinical audit or QI project based in hospitals, and supplemented by didactic lectures. Seven curricula were associated with improvements in processes of care (Kirkpatrick Level 4A) all of which were set in a clinical setting and supplemented by didactic lectures and/or small group sessions. None of the curricula evaluated patient benefits (Kirkpatrick Level 4B). CONCLUSIONS Whilst there is heterogeneity in educational content and teaching methods, most curricula are well accepted and led to learners' knowledge acquisition. Although there is limited evidence for the impact of QI curricula on learner behavior and benefit to patients, and for interprofessional QI curricula, teaching QI in the clinical setting leads to better learner outcomes with location being potentially a surrogate for clinical experience.
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Affiliation(s)
- Roshini Peiris-John
- Section of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
| | - Vanessa Selak
- Section of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Gillian Robb
- Section of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Bridget Kool
- Section of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Susan Wells
- Section of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Lynn Sadler
- Women's Health, Auckland City Hospital, Auckland, New Zealand
| | - Michelle R Wise
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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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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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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Larramendy-Magnin S, Anthoine E, L’Heude B, Leclère B, Moret L. Refining the medical student safety attitudes and professionalism survey (MSSAPS): adaptation and assessment of patient safety perception of French medical residents. BMC MEDICAL EDUCATION 2019; 19:222. [PMID: 31226982 PMCID: PMC6588893 DOI: 10.1186/s12909-019-1667-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 06/12/2019] [Indexed: 05/30/2023]
Abstract
BACKGROUND Implementing a patient safety curriculum for medical students requires to identify their needs and current awareness of the topic. Several tools have been developed to measure patient safety culture, but none of them have been developed in the French context. Our objective was to adapt and refine the psychometric properties of the MSSAPS, developed by Liao et al, to use it among general practice (GP) residents. METHODS 1-We conducted a translation and transcultural adaptation of the MSSAPS questionnaire (28 items, 5 dimensions: safety culture, teamwork culture, experiences with professionalism, error disclosure culture and comfort expressing professional concerns) in accordance with the international recommendations. 2-We studied the new questionnaire' psychometric properties on a sample of GP residency students in 2016. This validation comprised 2 steps: a confirmatory factor analysis (CFA) for each dimension of the MSAPPS to explore the adequacy of the structure of the questionnaire; an exploratory factor analysis to refine the instrument, using a principal component analysis and Cronbach's α-coefficients calculation. A final CFA examined the structure validity of the refined questionnaire. 3-We described the items and the safety cultural scores in our sample of residents. RESULTS Among 391 eligible students, 213 responded (54%). The initial structure was not confirmed by CFAs, showing a poor fit for 3 of the 5 dimensions: safety culture, teamwork culture and professionalism. Exploratory PCA led to 3 dimensions: Safety culture (PVE: 18.5% and 7 of 8 initial items), Experiences with professionalism (PVE: 17.8% and 5 of 7 initial items) and Error disclosure culture (PVE: 13.6% and 3 of 4 original items). Cronbach's α-coefficients were 0.74, 0.78 and 0.76 respectively. The final CFA confirmed the existence of the 3 latent dimensions with a good fit to the and highly significant structural coefficients (P < 0.001). Mean scores were equal to 65.4 [63.6; 67.6] for the safety culture, 66.9 [63.8; 70.1] for the experience with professionalism, and 54.4 [51.6; 57.2] for the error disclosure culture. CONCLUSION This study reports satisfactory psychometrics properties of the French version of the MSAPPS and provides evidence of important training needs for GP residents in the field of patient safety culture.
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Affiliation(s)
| | - Emmanuelle Anthoine
- Department of Public Health, Nantes University Hospital, 85 rue Saint Jacques 44093 Nantes Cedex 1, Nantes, France
- UMR 1246 INSERM SPHERE “MethodS in Patients-centered outcomes and HEalth ResEarch”, Universities of Nantes and Tours, Nantes, France
| | | | - Brice Leclère
- Department of Public Health, Nantes University Hospital, Nantes, France
| | - Leïla Moret
- Department of Public Health, Nantes University Hospital, 85 rue Saint Jacques 44093 Nantes Cedex 1, Nantes, France
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Butcher RL, Carluzzo KL, Watts BV, Schifferdecker KE. A Guide to Evaluation of Quality Improvement and Patient Safety Educational Programs: Lessons From the VA Chief Resident in Quality and Safety Program. Am J Med Qual 2018; 34:251-259. [DOI: 10.1177/1062860618798697] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
With the recent proliferation of quality improvement (QI) and patient safety (PS) education programs, guidance is needed on how to assess the effectiveness of these programs. Without a systematic approach, evaluation efforts may end up being disjointed, lead to excess participant burden, or yield unhelpful feedback because of poor fit with program priorities. This article presents a framework for developing a multilevel evaluation infrastructure using examples from the evaluation of the national Department of Veterans Affairs Chief Resident in Quality and Safety program, a 1-year, post-accreditation program to develop leadership and teaching skills in QI and PS. It illustrates how to apply the framework to establish evaluation priorities and methods, and shares sample results and how they are used to guide program improvements and track important outcomes at multiple levels. The framework is particularly relevant to other nonaccredited advanced QI/PS programs, yet offers useful considerations for evaluating any advanced medical education program.
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Affiliation(s)
- Rebecca L. Butcher
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH
| | | | - Bradley V. Watts
- VA National Center for Patient Safety, White River Junction, VT
- Dartmouth College, Hanover, NH
| | - Karen E. Schifferdecker
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH
- Dartmouth College, Hanover, NH
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Ginossar T, Heckman CJ, Cragun D, Quintiliani LM, Proctor EK, Chambers DA, Skolarus T, Brownson RC. Bridging the Chasm: Challenges, Opportunities, and Resources for Integrating a Dissemination and Implementation Science Curriculum into Medical Education. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2018; 5:2382120518761875. [PMID: 29707648 PMCID: PMC5892792 DOI: 10.1177/2382120518761875] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 02/07/2018] [Indexed: 05/31/2023]
Abstract
BACKGROUND Physicians are charged with implementing evidence-based medicine, yet few are trained in the science of Dissemination and Implementation (D&I). In view of the potential of evidence-based training in D&I to help close the gap between research and practice, the goal of this review is to examine the importance of D&I training in medical education, describe challenges to implementing such training, and provide strategies and resources for building D&I capacity. METHODS We conducted (1) a systematic review to identify US-based D&I training efforts and (2) a critical review of additional literature to inform our evaluation of the challenges and opportunities of integrating D&I training in medical education. RESULTS Out of 269 unique articles reviewed, 11 described US-based D&I training. Although vibrant and diverse training opportunities exist, their capacity is limited, and they are not designed to meet physicians' needs. Synthesis of relevant literature using a critical review approach identified challenges inherent to changing medical education, as well as challenges related to D&I science. Finally, selected strategies and resources are available for facilitating incorporation of D&I training into medical education and overcoming existing challenges. CONCLUSIONS Integrating D&I training in the medical education curriculum, and particularly in residency and fellowship training, holds promise for bridging the chasm between scientific discoveries and improved patient care and outcomes. However, unique challenges should be addressed, including the need for greater evidence.
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Affiliation(s)
- Tamar Ginossar
- Department of Communication & Journalism and the Comprehensive Cancer Center, The University of New Mexico, Albuquerque, NM, USA
| | - Carolyn J Heckman
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Deborah Cragun
- Department of Global Health, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Lisa M Quintiliani
- School of Medicine, Section of General Internal Medicine, Boston University, Boston, MA, USA
| | - Enola K Proctor
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - David A Chambers
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Ted Skolarus
- Section Chief, Urology, VA Ann Arbor Healthcare System Associate Professor, Department of Urology, University of Michigan VA Ann Arbor HSR&D Center for Clinical Management Research
| | - Ross C Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, USA
- Division of Public Health Sciences and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
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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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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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