Embedding patient safety into postgraduate medical education
Creators: name: Ahmed, Maria
Publisher: name: Imperial College London
Year: 2013

description: As frontline clinicians, junior doctors (trainees) are being increasingly recognised as powerful agents for change in improving patient safety. However, routine postgraduate medical education (PGME) offers little opportunity for trainees to develop the requisite knowledge and skills to advance safety improvement efforts. This thesis aims to build on the evidence base for patient safety education by developing and evaluating educational interventions informed by users, the existing literature, and educational theory. Section One (Chapters 1 to 3) sets the context for the thesis, providing an introduction to patient safety, relevant educational theory, and the role of education and engagement in improving patient safety. Subsequently, Section Two reports exploratory research to inform the development of a patient safety course for Foundation trainees – junior doctors at the very start of their careers. A systematic review reveals how the UK lags behind international efforts to deliver patient safety education for trainees, and highlights the need to address barriers to its sustainable integration into medical curricula (Chapter 4). An analysis of Foundation trainees’ portfolio entries demonstrates the feasibility of using patient safety incidents (PSIs) experienced by trainees as the basis for learning about patient safety (Chapter 5). Drawing on these findings, Section Three reports the development and evaluation of ‘Lessons Learnt: Building a Safer Foundation’. This is a novel patient safety programme designed to formalise the opportunity for all 1000+ trainees across a Foundation School to learn from PSIs in a structured, facilitated forum. The development and delivery of the programme is first described (Chapter 6), followed by empirical studies to develop senior faculty (Chapter 7), and to evaluate the impact of the programme on trainees’ learning both qualitatively (Chapter 8) and quantitatively (Chapter 9). In Section Four, a different approach is taken to explore non-technical skills (NTS) training for more senior trainees. A tri-continental interview study of 33 surgical team members underlines the need to improve debriefing as a core NTS in Surgery and explores the user perspective on effective debriefing in surgical training (Chapter 10). These findings are used to inform the development of the ‘SHARP 5-Step Feedback Tool for Surgery’ and to evaluate its impact through observation of 100 surgical cases (Chapter 11). A number of conclusions are drawn from the research. Patient safety education is well accepted by trainees and trainers alike, and results in improved safety competencies across knowledge, skill and behavioural domains. It is feasible to embed a large-scale patient safety programme into PGME and to engage senior doctors to support its delivery. Overall, these findings suggest that patient safety education not only improves ‘safety skills’ at an individual level, but may also promote the safety of the wider healthcare system through enhancing medical engagement in patient safety and fostering cultural change. The concluding Section (Chapter 12) summarises the findings in detail. Strengths and limitations of the research are discussed, and recommendations are drawn for accelerating the integration of patient safety education into PGME.