Patient Safety Course Research Articles

Twitter as a tool to enhance student engagement during an interprofessional patient safety course

Twitter and other social media forums are gaining popularity in both the academic and conference arenas as tools to increase participant engagement, attention and interaction. While Twitter has been used successfully to engage college students, it has not been explored for use in an interprofessional curriculum. We sought to explore it as a method to foster student engagement. During a weeklong interprofessional patient safety course we invited students and faculty to participate in a Twitter conversation. It was found that this form of social media successfully captured a “behind the scenes” conversation and the experiences of the students which would have not been otherwise captured. This information is guiding future interprofessional educational programming in both the medical and nursing schools.

Board 249 - Program Innovations Abstract Simulation Olympics as a Platform to Assess Assimilation of Learned Teamwork Dynamics (Submission #360)

Introduction/Background It has been found that interprofessional team training can positively impact patient safety and teamwork knowledge acquisition in healthcare students who take part in such courses early in their careers.1 In addition, courses which provide interactive educational experiences seem to be most impactful.1 Our patient safety course consists of five days of interactive, experiential learning experiences with several lectures throughout the week to anchor learned concepts. This weeklong course concludes with an engaging, onstage competition called Sim Olympics ™ which is used as a platform to promote student engagement, as well as to highlight student teams that have demonstrated excellence during the course. In 2008 Okuda et al2 introduced Sim Wars to the medical simulation community. Sim Wars is an onstage competition for assessing teamwork, communication and patient care.2 Several years ago we adopted this competition as a way to engage students attending a simulation-based patient safety course and named it Sim Olympics™. Rather than volunteering to compete, as done in Sim Wars, our student teams were selected based on their performance during a simulation encounter in the course which was scored with a crisis resource management (CRM) tool developed by our team of patient safety experts. We sought to answer the question of whether Sim Olympics™ could serve as a way to evaluate mastery of teamwork concepts by students in the audience. Other researchers have successfully used the review and scoring of video vignettes to assess acquisition of patient safety competencies such as teamwork, collaboration, leadership and problem solving.2 Thus, we hypothesized that Sim Olympics™ would be similarly successful. Methods Two hundred twenty learners from the school of medicine and school of nursing participated in the first simulation-based interprofessional patient safety course held at the University of Miami. The two highest scoring teams were selected during a simulation encounter using our CRM tool as a scoring instrument. Each team consisted of four medical students and two nursing students. They were given a case that was more challenging than cases earlier in the week. Immediately following each team’s performance, the audience members were asked to evaluate each team using the same CRM tool that was used to select the teams. Finally, the audience was asked to select the winner based either on the numerical scores they gave the team or based on their overall impression of team performance. One hundred ninety students evaluated team one’s encounter and 170 students evaluated team two’s encounter (outliers more than two standard deviations from the mean were discarded). Scores submitted by the audience members were analyzed using a Student’s t-test comparing the differences in the mean scores of each team, showing a statistically significant difference (p<.001). Results: Conclusion Our students were able to assimilate their learning of teamwork dynamics by demonstrating an ability as a group to discern subtle differences in great teamwork and good teamwork. An onstage competition can be used successfully as a platform to assess assimilated learning.

Board 209 - Program Innovations Abstract How Tweet It Is

Introduction/Background Today’s learners known as "Millennials" (individuals born after 1982) are used to nearly instantaneous access to information and constant connectivity.1 They prefer learning environments which are interactive and use technology.1,2 Educators, many of whom are digital immigrants, (those who have not grown up with technology) must be creative in their teaching strategies to meet the demands and keep the attention of the digitally native learner. Twitter is a popular social medium and micro-blogging forum with over 500 million users.3,4 Users are able to post 140 character messages (known at "tweets") online using designated hashtags which identify a conversation (feed). In educational contexts Twitter allows for the extension of in-class conversations to continue5 as well as the ability for participants to offer brief comments about their experiences or opinions.6 Twitter and other social media forums are gaining popularity in educational settings as tools to increase participant engagement, attention and interaction.1,4-6 Twitter has been used successfully to engage students; however, there is scant evidence to support its use as a method to capture qualitative data. We sought to explore its usefulness as a qualitative research data collection method as well as its acceptability as a student engagement tool during an interprofessional simulation-based patient safety course. Methods During a weeklong interprofessional simulation-based patient safety course we invited students and faculty to participate in a Twitter conversation. We archived all Tweets which were tagged using the course hashtag #United4ptsafety. Once per day one faculty member "tweeted" a prompting question which focused on either the course experience or patient safety principles. In addition, it was used to provide reminders and other course specifics throughout the week. All participants were free to use Twitter however they wished, but were given guidelines to follow. All tweets needed to be professionally appropriate and not reveal specifics of simulation encounters. Following completion of the course, the archived tweets were downloaded using a commercially available tool called Hootsuite™. The tweets were then coded using content analysis by three faculty to identify themes. In addition, quantitative data were collected to measure the number of tweets, number of followers and to assess the students’ perception of the tool as a way to engage in the course. The first tweets began coming in three days before the start of the course and consisted mostly of comments around using Twitter for the first time, getting ready for the course and being excited to start the course. A total of 289 tweets were generated throughout the course, with an average daily number of 37 tweets. Themes identified included engagement, collaboration, encouragement, communication, teamwork, reflection, seeking clarification, affirmation of learning and just culture principles. Despite favorable outcomes from the point of view of collecting the shared experience of the course, using Twitter was not rated favorably as a good tool for engagement by the majority the students. Faculty ratings, however, were more favorable despite the fact that the faculty did not tweet as much as the students. Results: Conclusion Our study demonstrates that Twitter is a promising tool to generate and collect qualitative data about the experiences of students as they journey through a course. There were, however, mixed reviews from the point of view of the participants. The unfavorable reviews may have stemmed from confusion around the voluntary nature of participating. It was also noted that a large percentage of the students were first time users of Twitter. Perhaps in the future a more formal way to orient new users and introduce best practice guidelines should enhance effectiveness of Twitter as a tool to promote engagement.

Board 382 - Research Abstract Favorable Shifts in Teamwork Attitudes Following Completion of a Week Long InterProfessional Simulation-Based Patient Safety Course (Submission #359)

Board 382 - Research Abstract Favorable Shifts in Teamwork Attitudes Following Completion of a Week Long InterProfessional Simulation-Based Patient Safety Course (Submission #359)

Three years after the launch of the Helsinki Declaration on patient safety in anaesthesiology

Three years after the launch of the Helsinki Declaration on patient safety in anaesthesiology

A patient safety course for preclinical medical students

We developed a course to introduce incoming third-year medical students to the subject of patient safety, to focus their attention on teamwork and communication, and to create an awareness of patient-safe practices that will positively impact their performance as clinicians. The course, held prior to the start of clinical rotations, consisted of lectures, web-based didactic materials, small group activities and simulation exercises, with an emphasis on experiential learning. First, students inspected a 'room of horrors', which is a simulated clinical environment riddled with errors. Second, we used lenticular puzzles in small groups to elicit teamwork behaviours that parallel real-life interactions in health care. Each team was given 8 minutes to complete a 48-piece puzzle, with five pieces removed at random and given to other teams. The salient teaching point of this exercise is that for a team to complete the task, team members must communicate with members of their own team as well as with other teams. Last, simulation scenarios provided a clinical context to reinforce the skills introduced through the puzzle exercise and lectures. The students were split into groups of six or seven members and challenged with two scenarios. Both scenarios focused on a 56-year-old man in respiratory distress. The teams were debriefed on both clinical management and teamwork. The vast majority of the students (93%) agreed that the course improved their patient safety knowledge and skills. The positive response from students to the introductory course is an important step in fostering a culture of patient safety.

Reflective learning in a patient safety course for final-year medical students

Background: Patient safety has become an important topic over the last decade and has also been increasingly implemented in the undergraduate curriculum. However, the best timing and method of teaching still remains to be decided.Aims: To develop and evaluate a patient safety course for final-year students. The course is based on reflective learning and personal experiences to improve the transfer of theory into practice.Methods: We performed a mixed method evaluation study of the course. An evaluation questionnaire and the number of completed incident report cards were analyzed using descriptive statistics. Focus groups, organized two and four weeks after the course, were analyzed using template analysis; the Theory of Planned Behaviour (TPB) was used to interpret the results.Results: Students found the course overall instructive and reacted positively towards many elements of the course. Focus group analysis showed that an increase in knowledge about patient safety topics resulted in a change of attitudes towards these subjects and in an increase in awareness of patient safety. This influenced students’ behavioral intention and their behavior.Conclusions: A course based on students’ personal experiences enables them to transfer theory on patient safety issues into their own practice and has an effect on their awareness, attitudes and behavior. This could have a large impact on their future role as resident.

The Patient Safety Curriculum for Undergraduate Medical Students as a First Step Toward Improving Patient Safety

Despite the growing emphasis on patient safety and the need for patient safety education, few schools have included this subject in their curriculum. Medical students need to understand and demonstrate appropriate patient safety skills early and continuously in their professional education. Therefore, we introduced a week of patient safety curriculum as a pilot program and attempted to describe and evaluate the effectiveness of a patient safety curriculum for second-year medical students. A 1-week patient safety course was developed and taught to all second-year medical students as part of an existing patient-doctor society course. The curriculum was composed of interactive lecture, discussion, and small-group debriefing facilitated by a tutor dealing with topics about patient safety. Students were asked to complete questionnaires on awareness about patient safety before and after the curriculum. The comparison of questionnaire data obtained before and after the curriculum revealed that the students' awareness about patient safety was significantly increased. Among them, awareness of the frequency of medical errors made by physicians and the awareness of the adverse outcomes due to medical errors were remarkably changed. These findings suggest that a patient safety course could increase the medical students' awareness of patient safety and the reality of medical errors. Continued development and implementation of patient safety curriculum will make medical students, as future doctors and health-care leaders, prepared to better practice and offer safer health care services than ever.

Human factors and online learning

A human factors approach to patient safety offers a means of minimising the incidence and effect of adverse events in the healthcare setting. This article explains how human factors informed the development of an online patient safety course by the Royal College of Nursing. It also describes a novel educational technique called action mapping, which was used to design the online learning course.

How baccalaureate nursing students value an interprofessional patient safety course for professional development.

Nursing students need foundation knowledge and skills to keep patients safe in continuously changing health care environments. A gap exists in our knowledge of the value students place on interprofessional patient safety education. The purpose of this exploratory, mixed methods study was to understand nursing students' attitudes about the value of an interprofessional patient safety course to their professional development and its role in health professions curricula. Qualitative and quantitative data were collected from formative course performance measures, course evaluations, and interviews with six nursing students. The qualitative themes of awareness, ownership, and action emerged and triangulated with the descriptive quantitative results from student performance and course evaluations. Students placed high value on the course and essential nature of interprofessional patient safety content. These findings provide a first step toward integration of interprofessional patient safety education into nursing curricula and in meeting the Institute of Medicine's goals for the nursing profession.

Human Error and Patient Safety: Interdisciplinary Course

Background: The medical community has only recently begun to address how human error affects patient safety. In order to confront human error in medicine, there is a need to teach students who are entering the health professions how potential errors may manifest and train them to prevent or mitigate these problems. Purpose: The objective is to describe a semester-long, interdisciplinary, human error and patient safety course taught at the University of South Florida. Methods: Six interdisciplinary groups, composed of students from five of the university's colleges, were formed. The curriculum consisted of expert lecturers, readings, case studies, and analysis of patient safety problems. Students were evaluated based on their group's work on the final project and peer evaluations. Results: Nursing students scored the highest in each category evaluated. Physicians and medical students had the lowest evaluations in team participation and active engagement. All students rated the course highly and indicated that it enhanced their ability to work in interprofessional settings. Conclusions: The students showed improved knowledge and substantive skill level relative to patient safety and human error concepts. Working in interdisciplinary teams gave the students a better understanding of the role each discipline can have in improving health care systems and health care delivery.

Recognising risk and improving patient safety (R²IPS)

The recognising risk and improving patient safety (R²IPS) course is a one day theoretical course organised by the Countess of Chester NHS Foundation Trust. It aims to teach a strategy that will enable trainees to identify, intervene in, and prevent the components of personal and team behaviours that contribute to increased risk for patients and adverse outcomes. It also helps junior doctors to challenge situations where they believe that a medical error may occur. The course is new but is becoming more and more popular with junior trainees. This course is mainly aimed at newly qualified foundation doctors, as it complements a part of the foundation curriculum, but it is useful for any grade. The day …

Effects on incident reporting after educating residents in patient safety: a controlled study

BackgroundMedical residents are key figures in delivering health care and an important target group for patient safety education. Reporting incidents is an important patient safety domain, as awareness of vulnerabilities could be a starting point for improvements. This study examined effects of patient safety education for residents on knowledge, skills, attitudes, intentions and behavior concerning incident reporting.MethodsA controlled study with follow-up measurements was conducted. In 2007 and 2008 two patient safety courses for residents were organized. Residents from a comparable hospital acted as external controls. Data were collected in three ways: 1] questionnaires distributed before, immediately after and three months after the course, 2] incident reporting cards filled out by course participants during the course, and 3] residents' reporting data gathered from hospital incident reporting systems.ResultsForty-four residents attended the course and 32 were external controls. Positive changes in knowledge, skills and attitudes were found after the course. Residents' intentions to report incidents were positive at all measurements. Participants filled out 165 incident reporting cards, demonstrating the skills to notice incidents. Residents who had reported incidents before, reported more incidents after the course. However, the number of residents reporting incidents did not increase. An increase in reported incidents was registered by the reporting system of the intervention hospital.ConclusionsPatient safety education can have immediate and long-term positive effects on knowledge, skills and attitudes, and modestly influence the reporting behavior of residents.

A Patient Safety Curriculum for Medical Residents Based on the Perspectives of Residents and Supervisors

To develop a patient safety course for medical residents based on the views of medical residents and their supervisors. In 2007, questionnaires were distributed to investigate residents' and supervisors' perspectives on the current patient safety performance and educational needs of residents. These perspectives were categorized according to the factors that influence daily practice as described in the London Protocol. Selection of course content and corresponding learning goals was made by an expert panel and based on the questionnaires' outcomes. One hundred sixteen (64%) respondents filled out the questionnaire. Residents rated health care as significantly safer than supervisors. Close links were found between described risks and expressed educational needs. Both were found to be predominantly related to team factors, work environmental factors, and individual factors. The principal course themes that were selected are as follows: (1) principles of patient safety, (2) human factors, (3) effective teamwork, (4) contribution to safer care, and (5) medicolegal aspects of patient safety. Residents are not fully aware of all potential risks of their work and of their own role in patient safety. This underlines the need for an explicit focus on patient safety issues during their training. A needs assessment among involved parties engages respondents in the process and can provide valuable input for developing patient safety education for residents.

Residents' intentions and actions after patient safety education.

BackgroundMedical residents are key figures in delivering care and an important target group for patient safety education. The objective of this study was to assess residents' intentions and actions concerning patient safety improvement after patient safety education.MethodsFour multi-specialty 2-day patient safety courses were organized, in which residents from five Dutch hospitals participated. At the end of these courses participants were asked to formulate an action point to improve patient safety. Three months later semi-structured interviews were conducted to reveal actions that were taken, factors that had influenced their behaviour and reactions concerning the education. An inductive theory approach was used to analyze transcriptions.ResultsOut of 71 participants, sixty-nine (97%) residents were interviewed. In total they had formulated 91 action points, which mainly focused on: 'Improving organization of own work/Follow policies' and 'Improving culture/Educating colleagues about patient safety'. Sixty-two (90%) residents declared to have taken action, and 50 (55%) action points were fully carried out. Most actions taken were at the level of the individual professional, rather than at the level of their social or organizational context. Results of actions included adjusting the structure of their own work, organizing patient safety education for colleagues, communicating more efficiently and in a more structured way with colleagues, and reporting incidents. Promoters for action included: 'Awareness of the importance of the action to be taken', 'Supportive attitude of colleagues' and 'Having received patient safety education'. Barriers included: 'Impeding attitude of colleagues', 'High work-pressure', 'Hierarchy' and 'Switching of work stations'.ConclusionsAfter patient safety training, residents reported various intentions to contribute to patient safety improvement. Numerous actions were taken, but there still is a discrepancy between intentions and actual behaviour. To increase residents' participation in patient safety improvement, educational efforts should be supplemented with actions to remove experienced barriers, most of which are related to the residents' social and organizational context.

Pharmacy student attitudes toward an interprofessional patient safety course: an exploratory mixed methods study

Objectives The purpose of this study is to explore attitudes of pharmacy students toward an elective, interprofessional patient safety course. Methods This study used an exploratory mixed methods design. Quantitative data were collected from course evaluations, case study performance, and final examination performance. Qualitative data were collected through interviews with seven first-year pharmacy students. Qualitative themes were triangulated with descriptive results from quantitative analysis of data using a convergence model. Results Students averaged an 88% on the final examination and, through their case studies, demonstrated the ability to apply this content knowledge to practical situations. Data from the course evaluation showed that students placed a high value on receiving patient safety education, and felt that the course should continue to be offered. Five major qualitative themes emerged from student interviews: putting a face on patient safety, reframing my role as a gatekeeper of patient safety, realizing it is just part of the job, everyone in health care needs to be trained about safe systems, and interprofessional learning is needed for safety to work. Comparison of quantitative and qualitative data confirmed the themes that emerged. Conclusions Students found great value in patient safety education. The professional literature has shown that there is a general lack of patient safety education in Doctor of Pharmacy training. Our results demonstrate that early introduction of this type of education has the potential to transform the values-based framework that pharmacists-in-training are forming to include an explicit context of patient safety.

Factors Impacting Hand Hygiene Compliance Among New Interns: Findings From a Mandatory Patient Safety Course

Residency is a critical transition during which individuals acquire lifelong behaviors important for professionalism and optimal patient care. One behavior is proper hand hygiene (HH), yet poor compliance with accepted HH practices remains a critical issue in many settings. This study explored the factors affecting hand hygiene compliance (HHC) in a diverse group of interns at the beginning of graduate training. During a required patient safety course, we observed HH behaviors using a standardized patient encounter. Interns were instructed to perform a focused exam in a simulated inpatient environment with HH products available and clearly visible. Participants were blinded to the HH component of the study. An auditory alert was triggered if participants failed to perform prepatient encounter HH. Compliance rates and the number of alerts were recorded. All encounters were videotaped. The HHC among the 169 participants was 37.9% pre-encounter and was higher among female interns than males, although this difference was not statistically significant (41.6% versus 31.5%, P = .176). International medical graduates had significantly lower HHC compared with US graduates (23.2% versus 45.1%, P = .006). Most initially noncompliant participants performed HH after 1 alert (87.6%). The initial low rate of HHC in our sample is comparable to other studies. Using direct video surveillance and auditory alarms, we improved our success rates for prepatient encounter HHC. Our study identified medical school origin as an important factor for HHC, and the significantly lower compliance for international medical graduates compared with US graduates has not been previously reported. These findings should be considered in designing interventions such as intern orientation and clinical education programs to improve HH behaviors.

Do specialty registrars change their attitudes, intentions and behaviour towards reporting incidents following a patient safety course?

BackgroundReporting incidents can contribute to safer health care, as an awareness of the weaknesses of a system could be considered as a starting point for improvements. It is believed that patient safety education for specialty registrars could improve their attitudes, intentions and behaviour towards incident reporting. The objective of this study was to examine the effect of a two-day patient safety course on the attitudes, intentions and behaviour concerning the voluntary reporting of incidents by specialty registrars.MethodsA patient safety course was designed to increase specialty registrars' knowledge, attitudes and skills in order to recognize and cope with unintended events and unsafe situations at an early stage. Data were collected through an 11-item questionnaire before, immediately after and six months after the course was given.ResultsThe response rate at all three points in time assessed was 100% (n = 33). There were significant changes in incident reporting attitudes and intentions immediately after the course, as well as during follow-up. However, no significant changes were found in incident reporting behaviour.ConclusionsIt is shown that patient safety education can have long-term positive effects on attitudes towards reporting incidents and the intentions of registrars. However, further efforts need to be undertaken to induce a real change in behaviour.

Development and Evaluation of a Required Patient Safety Course

To develop, implement, and assess a required patient safety course for second-year doctor of pharmacy students. A patient safety course was developed that included didactic lectures, case studies, in-class activities, and reading assignments. Written examinations and essays were used to evaluate student learning. In addition, a modified minute paper and a pre- and post-intervention student self-assessment survey were used to assess course outcomes. Results examining the utility of the course teaching format and the relevance of the material in meeting the course outcomes are presented and discussed. The self-assessment course survey indicated major improvements in the students' knowledge and skills, readiness for knowledge application, and commitment to improve patient safety. The course provided pharmacy students with an increased level of understanding of the principles and concepts of patient safety.

Communication and Teamwork

Communication and Teamwork