A Scoping Review of Peer-led Education in Patient Safety Training

Building a Trauma-Informed Community: Applying Community Building Circles to an Academic Health Research Setting

PROBLEM

Within health science disciplines, power dynamics exist that can not only perpetuate harm but also foster feelings of powerlessness and disengagement. Although diversity, equity, and inclusion approaches have been prioritized by many institutions to improve student and staff recruitment, few effective structures exist to promote the retention, support, and inclusion of these individuals.

APPROACH

Restorative justice circles facilitate a collaborative and personal exercise that welcomes the input of all members, thus acting as a catalyst toward broader and more deeply rooted culture changes and conflict resolution. Restorative justice circles can be applied to strengthen academic learning environments by building community and creating intentional dialog spaces to promote accountability and belonging. The Phoenix Gender-based Violence Lab is an interdisciplinary health research lab composed of diverse researchers who meet monthly for a restorative justice-inspired community-building circle and discussion. The lab members participated in community-building circles from August 2021 to August 2022 during which circle facilitators aimed to prioritize safety, trustworthiness, and transparency and provide collaboration opportunities.

OUTCOMES

All 10 research team members consented to an anonymous evaluation survey to share their perspectives about incorporating this approach into lab time. Research team members expressed many benefits of circle discussions, including mitigated power dynamics (n = 5), increased lab cohesion (n = 9), improved research processes (n = 6), and enhanced honesty and accountability (n = 4).

NEXT STEPS

Circle practice has shown promising results within the Phoenix Gender-based Violence Lab, indicating that other academic and medical settings should consider its potential to enhance group dynamics, foster accountability, and cultivate deeper collaboration and appreciation among group members. Further investigation of circle practice in diverse medical and academic settings is needed to fully comprehend the range of outcomes resulting from this intervention and whether they align with the fundamental principles of restorative justice.

Educational Outcomes of Diversity Curricula in Graduate Medical Education

Background

Education is an important step toward achieving equity in health care. However, there is little published literature examining the educational outcomes of curricula for resident physicians focused on diversity, equity, and inclusion (DEI).

Objective

Our objective was to review the literature to assess the outcomes of curricula for resident physicians of all specialties focused on DEI in medical education and health care.

Methods

We applied a structured approach to conducting a scoping review of the medical education literature. Studies were included for final analysis if they described a specific curricular intervention and educational outcomes. Outcomes were characterized using the Kirkpatrick Model.

Results

Nineteen studies were included for final analysis. Publication dates ranged from 2000 to 2021. Internal medicine residents were the most studied. The number of learners ranged from 10 to 181. The majority of studies were from a single program. Educational methods ranged from online modules to single workshops to multiyear longitudinal curricula. Eight studies reported Level 1 outcomes, 7 studies reported Level 2 outcomes, 3 studies reported Level 3 outcomes, and only 1 study measured changes in patient perceptions due to the curricular intervention.

Conclusions

We found a small number of studies of curricular interventions for resident physicians that directly address DEI in medical education and health care. These interventions employed a wide array of educational methods, demonstrated feasibility, and were positively received by learners.

Patient Safety Training Programs for Health Care Professionals: A Scoping Review

OBJECTIVE

This study aimed to map the evidence available on patient safety training programs for health professionals.

METHODS

A scoping review was carried out. Several studies published between January 2010 and March 2020 in the following databases were investigated: CINAHL; MEDLINE; Nursing & Allied Health Collection: Comprehensive; Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic Reviews; Cochrane; MedicLatina , via EBSCOhost; World Health Organization; Google Scholar; BVS- Biblioteca Virtual da Saúde ; PubMed; B-On; and RCAAP- Repositórios Científicos de Acesso Aberto de Portugal .

RESULTS

A total of 2841 articles were found, 7 were included. Most studies report that the development of patient safety programs for health care professionals provides them with tools and techniques to recognize adverse incidents induced by the professional system/practice; recognize human factors related to patient safety, such as nontechnical skills or tiredness; understand high-risk clinical processes; develop strategies that influence and enhance patient safety culture; promote communication, teamwork, and organizational culture concerning patient safety; analyze other characteristic and emerging topics in patient safety; and develop project proposals to improve patient safety, allowing health care professionals to consolidate their knowledge, leading initiatives to improve patient safety.

CONCLUSIONS

There are still few studies that test patient safety training programs, which is a concern given the importance of implementing safe practices. The existing evidence proves the efficacy of the training programs in improving patient safety, although there are some gaps.

The effect of peer education based on Pender's health promotion model on quality of life, stress management and self-efficacy of patients with multiple sclerosis: a randomized controlled clinical trial

Background

As a chronic, disabling disease, multiple sclerosis (MS) has challenged healthcare systems in many ways. MS adversely affects patients’ quality of life and self-efficacy and results in psychological stress. The present study was conducted to investigate the effect of peer education based on Pender’s health promotion model on the quality of life, stress management, and self-efficacy of patients with MS in the south of Iran.

Methods

The present study was a randomized controlled clinical trial. A total of 90 patients were divided into group A intervention group 45 patients) and group B (control group 45 patients). The intervention was peer education based on Pender’s health promotion model. Data were collected using the MS Quality of Life Scale, the Self-efficacy Scale, and the Stress Management Scale. Data analyses were conducted using SPSS version 22. To analyze the data, we used descriptive statistics. Thus, inferential statistics applied included Chi-square, independent-samples t-test, and Repeated measures (ANOVA). The significance level was considered p < 0.05.

Results

The quality of life, self-efficacy, and stress management mean scores of the intervention group as measured immediately and 3 months after intervention were significant (p < 0.05). As for the control group, however, the difference was not significant.

Conclusion

Peer education based on Pender’s health promotion model improves patients’ quality of life, stress management, and self-efficacy with multiple sclerosis. Nursing managers and health system policymakers can use this educational approach for patients with other chronic diseases to enhance their quality of life and self-efficacy.

Trial registration

Iranian Registry of Clinical Trials: IRCT registration number: IRCT20190917044802N3.

Exploring physical therapy students' experience of peer learning in a student-run clinic

BACKGROUND

Participation in a student-run pro bono clinic (SRPBC) provides opportunities for students to develop professional skills, engage with the community, and provide an often-underserved population with needed care.

MATERIALS AND METHODS

This paper describes the results of a mixed-method analysis of student experiences in an SRPBC. A survey with both Likert-type and write-in elements was administered to three cohorts of students enrolled in a doctoral program of physical therapy. Students were prompted to provide their perspective on the value of the clinic experience with respect to professional development, academic relevancy, and personal growth.

RESULTS

The analysis discovered that perspective value of the clinic in the areas of personal growth and academic relevancy differed by cohort. Specifically, 1^st-year students reported that they benefitted immensely by learning from their peers, especially in the use of outcome measures. Second-year students did not report the same benefits.

CONCLUSION

The findings suggest that even though students from different cohorts work together in the same clinic, they may experience the clinic very differently. This observation provided the basis for changes to the SRPBC to enhance leadership and conflict management skills of the 2^nd-year students.

Effects of peer-led study sessions on first-year student pharmacist performance in pharmacy math

INTRODUCTION

To evaluate effects of peer-led study sessions on performance in a traditionally challenging course, Pharmacy Math, among first-year student pharmacists (P1s).

METHODS

Peer-led study sessions were conducted throughout fall 2019 for P1s. Sessions were led by two second-year student pharmacists and focused on study skills and course-related strategies, principles, and content. P1s who attended the majority (at least five) of study sessions were compared to those who attended fewer sessions on student demographics, undergraduate science grade point average, and course outcome (pass/did not pass) using chi-square and independent samples t-tests. Relative risk (RR) was calculated. A sub-analysis of students considered at risk of failing was also conducted.

RESULTS

There were 200 P1 participants. Twenty-four students (12%) attended the majority of the sessions and 176 students (88%) attended fewer sessions. Of the 24 students who attended ≥ five study sessions, all passed Pharmacy Math, while 12 of the 176 students who attended fewer sessions failed Pharmacy Math. Students who attended ≥ five sessions had a 6.8% reduction in risk of failing compared to students who attended fewer sessions (RR = 0.93, 95% CI = 0.895, 0.97). More striking, at-risk students who attended ≥ five study sessions had a 17.1% reduction in risk of failing.

CONCLUSIONS

Peer-led study sessions contribute to reduced risk of failing Pharmacy Math among students who attend a majority of study sessions. Improvements for the future were identified, including mandatory attendance, group structure, and creative ways to cover concepts.

The effect of the COVID-19 pandemic on the patient safety attitude of medical students

PURPOSE

This study aimed to examine the differences in scores of the Attitude to Patient Safety Questionnaire (APSQ) by medical students before and after the outbreak of COVID-19.

METHODS

In total, 97 and 118 medical students completed patient safety courses at Yonsei University Wonju College of Medicine in 2019 and 2020, respectively. In 2019, the course was conducted using traditional learning in the classroom, whereas, in 2020, most of the classes were conducted using non-face-to-face learning methods.

RESULTS

In 2019 and 2020, 49 and 53 students responded to the APSQ. Only one item "Patients are not really aware of how safe their care is" had a lower score in 2020 than in 2019.

CONCLUSION

Although the total APSQ score did not differ between 2019 and 2020, the students in 2020 might have a poor understanding of the role of patients in medical errors.

Evaluating the implementation of a chronic obstructive pulmonary disease management program using the Consolidated Framework for Implementation Research: a case study

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a prevalent chronic disease that requires comprehensive approaches to manage; it accounts for a significant portion of Canada's annual healthcare spending. Interprofessional teams are effective at providing chronic disease management that meets the needs of patients. As part of an ongoing initiative, a COPD management program, the Best Care COPD program was implemented in a primary care setting. The objectives of this research were to determine site-specific factors facilitating or impeding the implementation of a COPD program in a new setting, while evaluating the implementation strategy used.

METHODS

A qualitative case study was conducted using interviews, focus groups, document analysis, and site visits. Data were deductively analyzed using the Consolidated Framework for Implementation Research (CFIR) to assess the impact of each of its constructs on Best Care COPD program implementation at this site.

RESULTS

Eleven CFIR constructs were determined to meaningfully affect implementation. Five were identified as the most influential in the implementation process. Cosmopolitanism (partnerships with other organizations), networks and communication (amongst program providers), engaging (key individuals to participate in program implementation), design quality and packaging (of the program), and reflecting and evaluating (throughout the implementation process). A peer-to-peer implementation strategy included training of registered respiratory therapists (RRT) as certified respiratory educators and the establishment of a communication network among RRTs to discuss experiences, collectively solve problems, and connect with the program lead.

CONCLUSIONS

This study provides a practical example of the various factors that facilitated the implementation of the Best Care COPD program. It also demonstrates the potential of using a peer-to-peer implementation strategy. Focusing on these factors will be useful for informing the continued spread and success of the Best Care COPD program and future implementation of other chronic care programs.

Assessment and analysis of patient safety competency of Chinese nurses with associate degrees: A cross-sectional study

Aim

To analyse the patient safety competency (PSC) of Chinese nurses with associate degrees (ADNs) and explore factors.

Design

A cross-sectional study.

Methods

A convenience sample of 451 ADNs working in 18 hospitals located in Chongqing city of China was investigated using the Patient Safety Competency Nurse Evaluation Scale (PSCNES). Descriptive and inferential statistics were used to analyse the data.

Results

ADNs had a moderate level of PSC. In terms of the six dimensions of PSC, ADNs performed well in clinical practice and safety risk management, while they performed poorly in patient-centred care and patient safety culture. Statistically significant differences were reported in two items. Firstly, ADNs who have participated in patient safety training had a higher level in all dimensions of PSC than those who have not participated in related training. Secondly, ADNs without professional titles had a higher level of patient safety culture than those with professional titles.

Peer-Led Education Expedites Deprescribing Proton Pump Inhibitors for Appropriate Veterans

Costly proton pump inhibitors have been widely prescribed since the 1990s for prevention and treatment of ulcers and gastroesophageal reflux disease. Evidence published since 2012 demonstrates risks associated with taking proton pump inhibitors for longer than 8 weeks. Primary care providers mostly deprescribe proton pump inhibitors for persons not meeting criteria for long-term use. Many patients resist discontinuation.A 3-month evidence-based practice education project was conducted by a nurse practitioner to improve primary care provider peer deprescribing successes with appropriate patients in an outpatient California-based veteran primary care clinic. Fifteen primary care providers were pretested about usual care practices between 2 comparable clinics. Five primary care providers at the smaller clinic location were educated about long-term proton pump inhibitor use risks and introduced to 3 evidence-based practice guidelines using tapering techniques with follow-up care.A Canadian 2017 evidence-based practice proton pump inhibitor deprescribing guideline was proposed for translation into practice. Primary care providers voted to pilot this guideline, dependent upon nursing support. Primary care providers denied frustration with usual care practices, even as all were willing to try an evidence-based practice change between pre- and post-test surveys. Support for peer-led evidence-based practice on-site coaching increased from 87% to 100%. Tapering behavior increased from 67% to 100%, expediting improved long-term medication cessation.