Dataset Information

Improving patient safety by enhancing raising concerns at medical school.

ABSTRACT:

Background

Doctors and medical students have a professional responsibility to raise concerns. Failure to raise concerns may compromise patient safety. It is widely known that medical students frequently encounter unprofessional behaviours in the workplace, but little is known about the barriers to raising concerns amongst medical students. This paper explores these issues and discusses some innovations in the medical undergraduate curriculum, offering a good practice model for other medical and healthcare curricula. We set out to ascertain the attitudes and experiences of medical students in relation to raising concerns. This data was then used to innovate the raising concerns curriculum, and access to the raising concerns system, in order to fundamentally improve patient safety and experience, as well as the student experience.

Methods

The authors conducted a mixed methods quantitative and qualitative research study. Research was based at a UK medical school and involved data collection using an anonymous, voluntary survey emailed to all medical students (n = 363) as well as voluntary attendance focus groups (n = 24) recruited by email. Both tools investigated student attitudes towards raising concerns and explored student ideas for solutions to improving the process. The focus group data was thematically analysed by three researchers.

Results

The authors identified five key themes which described medical student attitudes towards raising concerns. This article discusses these themes and the resulting work to enhance medical education within the medical school curriculum.

Conclusions

More research is needed to further address the barriers that medical students find in raising concerns. However, despite being a single study in one UK medical school, the authors propose some changes which they hope may inspire other educators to build upon their raising concerns curricula to foster more transparent undergraduate cultures and ultimately improve patient experience and safety.

SUBMITTER: Johnson L

PROVIDER: S-EPMC6064143 | biostudies-literature | 2018 Jul

REPOSITORIES: biostudies-literature

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Publications

Improving patient safety by enhancing raising concerns at medical school.

Johnson Luke L Malik Natasha N Gafson Irene I Gostelow Naomi N Kavanagh Jayne J Griffin Ann A Gishen Faye F

BMC medical education 20180728 1

<h4>Background</h4>Doctors and medical students have a professional responsibility to raise concerns. Failure to raise concerns may compromise patient safety. It is widely known that medical students frequently encounter unprofessional behaviours in the workplace, but little is known about the barriers to raising concerns amongst medical students. This paper explores these issues and discusses some innovations in the medical undergraduate curriculum, offering a good practice model for other medi ...[more]

PMID: 30055604

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Project description:Introduction: In 2012 safety strategies were defined in five intervention areas to improve patient safety in Austria. Regarding policy development, patient safety should be mandatory part of education of all healthcare sectors, and measures to improve hygiene standards are to be included in organizational development. The aim of this project was to achieve sustained improvement in routine procedures and anchor patient safety in the undergraduate medical curriculum by making online instructional videos on clinical skills and hygiene procedures permanently available as preparation for the first clinical clerkship. Method: Short films explaining how to insert urinary catheters in women and men were produced and provided online. These videos were shown to medical students shortly before the practical Objective Structured Clinical Examination (OSCE). After viewing the videos, all of the students were surveyed using an online questionnaire with 15 questions regarding quality and acceptance. The effect of the videos on learning success was determined by the assessment outcome through red cards in the practical exam. A red card for behavior endangering the doctor or others meant zero points and discontinuation of the assessment at that particular OSCE station. Results: A total of 647 students viewed one of the two videos on urinary catheters, 623 responded to the online Moodle questionnaire completly. 551 (85.2%) reported being better able to recall individual steps and procedures, 626 students (96.7%) positively rated the fact that instructional videos were available on the Medical University of Vienna's website. More than half of the respondents (56.6%) were better able to remember critical hygiene practices. The comparison of the assessment outcomes on the OSCE for 2016 and 2013, a year in which the instructional videos were not yet available, shows no significant (chi2=3.79; p>0.05) but a trend towards improvement. The chance of getting a red card in 2013 was 3.36 times higher than in 2016. Conclusion: Even if our study was unable to show significant improvements in the OSCE as a result of viewing the videos, it appears that clearly imparting medical skills and hygiene standards-including in visual form-is still important prior to the first clerkship to ensure the highest level of patient safety possible. The combination of teaching and learning formats, such as videos on online platforms with textbooks or lecture notes, is well suited to increase effectiveness and efficiency in learning. There is a need for further studies to investigate and analyze the effects of instructional videos in more detail.

Project description:ObjectiveA recent Institute of Medicine report called for attention to safety issues related to electronic health records (EHRs). We analyzed EHR-related safety concerns reported within a large, integrated healthcare system.MethodsThe Informatics Patient Safety Office of the Veterans Health Administration (VA) maintains a non-punitive, voluntary reporting system to collect and investigate EHR-related safety concerns (ie, adverse events, potential events, and near misses). We analyzed completed investigations using an eight-dimension sociotechnical conceptual model that accounted for both technical and non-technical dimensions of safety. Using the framework analysis approach to qualitative data, we identified emergent and recurring safety concerns common to multiple reports.ResultsWe extracted 100 consecutive, unique, closed investigations between August 2009 and May 2013 from 344 reported incidents. Seventy-four involved unsafe technology and 25 involved unsafe use of technology. A majority (70%) involved two or more model dimensions. Most often, non-technical dimensions such as workflow, policies, and personnel interacted in a complex fashion with technical dimensions such as software/hardware, content, and user interface to produce safety concerns. Most (94%) safety concerns related to either unmet data-display needs in the EHR (ie, displayed information available to the end user failed to reduce uncertainty or led to increased potential for patient harm), software upgrades or modifications, data transmission between components of the EHR, or 'hidden dependencies' within the EHR.DiscussionEHR-related safety concerns involving both unsafe technology and unsafe use of technology persist long after 'go-live' and despite the sophisticated EHR infrastructure represented in our data source. Currently, few healthcare institutions have reporting and analysis capabilities similar to the VA.ConclusionsBecause EHR-related safety concerns have complex sociotechnical origins, institutions with long-standing as well as recent EHR implementations should build a robust infrastructure to monitor and learn from them.

Dataset Information

Improving patient safety by enhancing raising concerns at medical school.

Background

Methods

Results

Conclusions

Publications

Improving patient safety by enhancing raising concerns at medical school.

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