Leung GK, Ang SB, Lau TC, Neo HJ, Patil NG, Ti LK
Correspondence: Dr Gilberto KK Leung, gilberto@hkucc.hku.hk
ABSTRACT
INTRODUCTION Undergraduate education in medical schools plays an important role in promoting patient safety. Medical students from different backgrounds may have different perceptions and attitudes toward issues concerning safety. This study aimed to investigate whether patient safety cultures differed between students from two Asian countries, and if they did, to find out how they differed. This study also aimed to identify the educational needs of these students.
METHODS A voluntary, cross-sectional and self-administered questionnaire survey was conducted on 259 students from two medical schools – one in Hong Kong and the other in Singapore. None of the students had received any formal teaching on patient safety. We used a validated survey instrument, the Attitudes to Patient Safety Questionnaire III (APSQ-III), which was designed specifically for students and covered nine key factors of patient safety culture.
RESULTS Of the 259 students, 81 (31.3%) were from Hong Kong and 178 (68.7%) were from Singapore. The overall response rate was 66.4%. Significant differences between the two groups of students were found for two key factors – ‘patient safety training’, with Hong Kong students being more likely to report having received more of such training (p = 0.007); and ‘error reporting confidence’, which Singapore students reported having less of (p < 0.001). Both groups considered medical errors as inevitable, and that long working hours and professional incompetence were important causes of medical errors. The importance of patient involvement and team functioning were ranked relatively lower by the students.
CONCLUSION Students from different countries with no prior teaching on patient safety may differ in their baseline patient safety cultures and educational needs. Our findings serve as a reference for future longitudinal studies on the effects of different teaching and healthcare development programmes.
Keywords: curriculum, medical error, medical student, patient safety, survey
Singapore Med J 2013; 54(9): 501-505; http://dx.doi.org/10.11622/smedj.2013172
REFERENCES
1. Willeumier D. Advocate health care: a systemwide approach to quality and safety. Jt Comm J Qual Saf 2004; 30:559-66. | ||||
2. Kohn LT, Corrigan JM, Donaldson MS, eds. To err is human. Building a safer health system. Washington DC: National Academies Press, 2000. | ||||
3. Alper E, Rosenberg EI, O'Brien KE, Fischer M, Durning SJ. Patient safety education at U.S. and Canadian medical schools: results from the 2006 Clerkship Directors in Internal Medicine survey. Acad Med 2009; 84:1672-6. http://dx.doi.org/10.1097/ACM.0b013e3181bf98a4 |
||||
4. Leung GK, Patil NG. Patient safety in the undergraduate curriculum: medical students' perception. Hong Kong Med J 2010; 16:101-5. | ||||
5. Moskowitz E, Veloski JJ, Fields SK, Nash DB. Development and evaluation of a 1-day interclerkship program for medical students on medical errors and patient safety. Am J Med Qual 2007; 22:13-7. http://dx.doi.org/10.1177/1062860606296669 |
||||
6. Patey R, Flin R, Cuthbertson BH, et al. Patient safety: helping medical students understand error in healthcare. Qual Saf Health Care 2007; 16:256-9. http://dx.doi.org/10.1136/qshc.2006.021014 |
||||
7. Flanagan B, Nestel D, Joseph M. Making patient safety the focus: crisis resource management in the undergraduate curriculum. Med Educ 2004; 38:56-66. http://dx.doi.org/10.1111/j.1365-2923.2004.01701.x |
||||
8. Barach P. Patient safety curriculum. Acad Med 2000; 75:551-2. http://dx.doi.org/10.1097/00001888-200005000-00082 |
||||
9. Scobie SD, Lawson M, Cavell G, et al. Meeting the challenge of prescribing and administering medicines safely: structured teaching and assessment for final year medical students. Med Educ 2003; 37:434-7. http://dx.doi.org/10.1046/j.1365-2923.2003.01492.x |
||||
10.Wong BM, Etchells EE, Kuper A, Levinson W, Shojania KG. Teaching quality improvement and patient safety to trainees: a systematic review. Acad Med 2010; 85:1425-39. http://dx.doi.org/10.1097/ACM.0b013e3181e2d0c6 |
||||
11. Walton M, Woodward H, Van Staalduinen S, et al. The WHO patient safety curriculum guide for medical schools. Qual Saf Health Care 2010; 19:542-6. http://dx.doi.org/10.1136/qshc.2009.036970 |
||||
12. Singer SJ, Gaba DM, Falwell A, et al. Patient safety climate in 92 US hospitals: differences by work area and discipline. Med Care 2009; 47:23-31. http://dx.doi.org/10.1097/MLR.0b013e31817e189d |
||||
13. Muller D, Ornstein K. Perceptions of and attitudes towards medical errors among medical trainees. Med Educ 2007; 41:645-52. http://dx.doi.org/10.1111/j.1365-2923.2007.02784.x |
||||
14. Nieva VF, Sorra J. Safety culture assessment: a tool for improving patient safety in healthcare organizations. Qual Saf Health Care 2003; 12 Suppl 2:ii17-23. http://dx.doi.org/10.1136/qhc.12.suppl_2.ii17 |
||||
15. Carruthers S, Lawton R, Sandars J, Howe A, Perry M. Attitudes to patient safety amongst medical students and tutors: Developing a reliable and valid measure. Med Teach 2009; 31:e370-6. http://dx.doi.org/10.1080/01421590802650142 |
||||
16. Leung GK, Patil NG, Ip MS. Introducing patient safety to undergraduate medical students-a pilot program delivered by health care administrators. Med Teach 2010; 32:e547-51. http://dx.doi.org/10.3109/0142159X.2010.528810 |
||||
17. Nie Y, Li L, Duan Y, et al. Patient safety education for undergraduate medical students: a systematic review. BMC Med Educ 2011; 11:33. http://dx.doi.org/10.1186/1472-6920-11-33 |
||||
18. Lim MK. Quest for quality care and patient safety: the case of Singapore. Qual Saf Health Care 2004; 13:71-5. http://dx.doi.org/10.1136/qshc.2002.004994 |
||||
19. Lau DH. Improve patient safety and reduce medical errors. Hong Kong Med J 2002; 8:65-7. | ||||
20.Mack P. Patient safety and medical errors--a Singapore perspective. Singapore Med J 2002; 43:263-4. | ||||
21. Hospital Authority. HA risk Alert [online]. Available at: www.ha.org.hk/visitor/ha_visitor_text_index.asp?Content_ID = 697&Lang=ENG&Dimension = 100. Accessed September 25, 2012. | ||||
22. Loh YH. Public disclosure of healthcare performance information and its application to the Singapore context. Ann Acad Med Singapore 2003; 32:676-84. | ||||
23. Lim J. Open disclosure of medical errors - necessity meeting virtue. In: Singapore Medical Association News [online]. Available at: news.sma.org.sg/4106/In_Sight.pdf. Accessed January 31, 2013. | ||||
24. Madigosky WS, Headrick LA, Nelson K, Cox KR, Anderson T. Changing and sustaining medical students' knowledge, skills, and attitudes about patient safety and medical fallibility. Acad Med 2006; 81:94-101. http://dx.doi.org/10.1097/00001888-200601000-00022 |
||||
25. Fischer MA, Mazor KM, Baril J, et al. Learning from mistakes. Factors that influence how students and residents learn from medical errors. J Gen Intern Med. 2006; 21:419-23. http://dx.doi.org/10.1111/j.1525-1497.2006.00420.x |
||||
26. Pearson P, Steven A, Howe A, et al. Learning about patient safety: organizational context and culture in the education of health care professionals. J Health Serv Res Policy 2010; 15 Suppl 1:4-10. http://dx.doi.org/10.1258/jhsrp.2009.009052 |