[Patient education during outpatient procedures]. / Patientenaufklärung bei ambulanten Eingriffen.

Patient education is a key obligation for doctors under the treatment contract. The expansion of the AOP catalogue (catalogue of operations that can be performed on an outpatient basis in accordance with Section 115b of the Fifth Book of the German Social Code (SGB V)) from January 2023 opens up new outpatient treatment options that tend to involve higher risks. This risk profile must be taken into account when informing patients.In any case, the timing of the information should be chosen so that the patient can give their consent in a well-considered manner. There is no fixed "blocking period" between information and consent, so the patient can consent immediately. In the case of high-risk procedures, the patient should be informed several days in advance. Criteria for determining the right time are the type and severity of the procedure, urgency and individual circumstances of the patient. The information provided should be complete and comprehensible, including the diagnosis, need for treatment, risks and alternatives. Comprehensive documentation of the information provided goes without saying.Telemedical counselling is possible in suitable cases, but the risk of timely and complete counselling remains with the doctor performing the procedure. In view of outpatient procedures that require follow-up care at home, the safety information should be more comprehensive.The expansion of the AOP catalogue opens up new opportunities for outpatient procedures, but harbours legal risks. Adapted risk and safety information is required, whereby telemedicine can optimise practice organisation.

[Patient education during outpatient procedures]. / Patientenaufklärung bei ambulanten Eingriffen.

Patient education is a key obligation for doctors under the treatment contract. The expansion of the AOP catalogue (catalogue of operations that can be performed on an outpatient basis in accordance with Section 115b of the Fifth Book of the German Social Code (SGB V)) from January 2023 opens up new outpatient treatment options that tend to involve higher risks. This risk profile must be taken into account when informing patients.In any case, the timing of the information should be chosen so that the patient can give their consent in a well-considered manner. There is no fixed "blocking period" between information and consent, so the patient can consent immediately. In the case of high-risk procedures, the patient should be informed several days in advance. Criteria for determining the right time are the type and severity of the procedure, urgency and individual circumstances of the patient. The information provided should be complete and comprehensible, including the diagnosis, need for treatment, risks and alternatives. Comprehensive documentation of the information provided goes without saying.Telemedical counselling is possible in suitable cases, but the risk of timely and complete counselling remains with the doctor performing the procedure. In view of outpatient procedures that require follow-up care at home, the safety information should be more comprehensive.The expansion of the AOP catalogue opens up new opportunities for outpatient procedures, but harbours legal risks. Adapted risk and safety information is required, whereby telemedicine can optimise practice organisation.

The effect of refresher training on fact description in medical incident report writing in the Japanese language.

To maintain the effectiveness of the training (1st-Training Session: 1st-TS) to accurate describe facts in the medical incident reports (IRs) in Japanese, a refresher TS was designed and its effectiveness was examined. First, textual analysis showed that IRs' accuracy significantly decreased six months after the 1st-TS. Based on this result, the refresher TS was designed and conducted with 64 residents. To verify the refresher TS' effectiveness, IRs after the 1st-TS, six months later, and after the refresher TS were compared via text analysis. The results showed that the refresher TS restored the description rate of patient's background, safety check procedures, original work procedures, information on equipment used, reporter's actions, and post-incident response. The questionnaire was also administered and showed that the refresher TS contributed to residents' motivation to learn about IRs. In conclusion, the refresher TS contributed to sustaining the effect of the 1st-TS on accurately describing IRs.

Training residents in medical incident report writing to improve incident investigation quality and efficiency enables accurate fact gathering.

We assessed whether training on writing readable and accurate medical incident reports (IRs) improves the quality of fact description. In this training, 124 residents created fictional IRs. We provided tips, including using When, Where, Who, What, Why, How. We compared the fictional IRs with and without tips, and the trainees' and non-trainees' IRs submitted in the first five months after training. Results indicated that the subject words in IRs were more clarified and the readability was improved. The fictional IRs using tips were more accurate, with increased descriptions of the patient's background, reporter's actions, team members' actions and conversations, safety check procedures, result of the error, and post-incident response. The reporter's actions, work procedures, and environment were more clarified in the trainees' IRs than in the non-trainees' IRs. This training may help analysts comprehend the sequence of and underlying factors for reporter's actions based on IRs.

Patient safety educational interventions: A systematic review with recommendations for nurse educators.

AIM: This study identified and evaluated tested patient safety educational interventions. This study also described the content, curricular structures and teaching strategies of the educational interventions and determined the methods used for evaluating patient safety learning outcomes. DESIGN: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines directed this review. METHODS: Searches for articles describing and evaluating patient safety educational interventions were conducted using four scholarly databases. Study quality was assessed using the McMaster Critical Review Form. RESULTS: Seven studies met the inclusion criteria. Educational interventions were either presented as stand-alone courses or as lessons embedded in an existing course. All studies employed a mixture of various teaching modalities and several evaluation methods and outcomes. Mixed results were observed in terms of the effects of educational interventions. Future researchers should continue to develop patient safety curricula and examine their effect on student competencies with stronger methodological rigour.

Practice of Human Factors Training Based on SHEL Model:Patient Safety Education for First Year Medical Students / 医学教育

Introduction: The theory of Human Factors (HF), which designs work and environment according to human characteristics, contributes to patient safety. However, there are not enough reports of systematic educational practices on HF. Our training was designed and practiced using SHEL, an explanatory model of HF.　Methods: Ten training sessions were conducted on the components of SHEL, including Software: manual design, Hardware: user-friendly medical device design, Environment: work environment design, Liveware (self) : human characteristics, and Liveware (others) : teamwork.　Reflection: The HF training using SHEL may lead to acquiring procedural knowledge of patient safety management, and to better understanding of HF by students. In addition, focusing on daily errors is expected to increase students’ learning motivation.

6. Extrinsic Factors for Learning: from a Perspective of Patient Safety Education / 医学教育

The “problems” of the “problem” learner are not only those intrinsic to the learner, but also those extrinsic to the educator and the system. This paper focuses on patient safety education as an example of where these extrinsic problems are manifested. Patient safety management in the last two decades has been mainly a means to improve the system by analyzing failed incidents in a no-blame manner, but there is also an emphasis on balancing the accountability of the person involved, thus the importance of education is increasing. However, there are barriers to motivating individuals to learn from their failures. The “problem” in patient safety education may be overcome by assuring psychological safety, giving consideration to motivation based on self-determination theory, and using the Safety-II paradigm to change the viewpoint of failure.

Massive open online course (MOOC) learning builds capacity and improves competence for patient safety among global learners: A prospective cohort study.

BACKGROUND: Education about patient safety has historically been limited in health professionals curricula and largely inaccessible to the general public. We developed a massive open online course (MOOC), The Science of Safety in Healthcare, to present the foundational patient safety principles to a broad global audience of health professionals, learners, and patients interested in patient safety. OBJECTIVES: To describe the Science of Safety in Healthcare MOOC, its effects on patient safety competence, and the satisfaction of course participants. METHODS: The five-week video-based course was delivered in 2013 and 2014, and was organized in five modules: 1) overview of science of safety and safety culture, 2) enabling and contextual factors that influence patient safety and quality, 3) methods to improve safety and quality, 4) translating evidence intro practice and leading change, and 5) summary and opportunities for capacity building. Each module had three or four segments. Participants were introduced to key concepts, and tools and skills to promote patient safety. Participants completed the Health Professional Education in Patient Safety Survey (H-PEPSS), which measures patient safety competence, and a course satisfaction survey. Pre- and post- course H-PEPSS scores were compared using paired t-tests. Course satisfaction surveys were administered at the completion of the course and six months later. RESULTS: A total of 20,957, and 9679 participants enrolled in the course in 2013 and 2014, respectively. About half of participants were 25-44 years old (57%), and female (54%). Participants joined from over 100 countries. The majority were health professionals (61%) or health professionals in training (7%). Mean H-PEPSS scores improved after course completion, with significant increases on all survey domains in both years (p < 0.01). Mean score differences were: Teamwork 0.68 (95% CI: 0.64, 0.71), Communication 0.70 (95% CI: 0.66, 0.73), Managing Risk 0.79 (95% CI: 0.76, 0.82), Human Environment 0.64 (95% CI: 0.61, 0.68), Recognizing and Responding 0.64 (95% CI: 0.61, 0.68), and Culture 0.72 (95% CI: 0.68, 0.75). About 8% of participants in each cohort earned a certificate of completion. At 6-months post-course, the majority of the participants agreed or agreed strongly that the course content was useful (93%) and that the course positively influenced their clinical practice (69%) and communication (84%). CONCLUSIONS: The MOOC course allowed educators to reach a large, diverse audience. The course was well-received and participants reported a significant increase in patient safety competence. As with most MOOCs, rates of completion were low.

A Case Report on Using a Board Game in Undergraduate Patient Safety Education to Enable Communication Error Experiences / 医学教育

Introduction: It is important to educate undergraduates about communication errors in clinical sites, but it is difficult for clinically inexperienced students to imagine those errors. Therefore, in this study, a board game (BG) was developed and put into practice to encourage students' understanding.　Methods: The BG consists of a board on which the patient's name is written and cards on which drug names are written. Students place cards on the board according to the teacher's instructions. These instructions include multiple traps based on actual incident cases. Through the game, students experienced errors.　Reflection: This BG contains gamification elements that make learning contents simple and fun and simulation elements that reproduce errors with high fidelity. By combining these elements, it is possible for each aspect of the ARCS model to be provided in a well-balanced manner, even in patient safety education for clinically inexperienced students.

Animated stories of medical error as a means of teaching undergraduates patient safety: an evaluation study.

BACKGROUND: Storytelling is a powerful form of communication which can improve attention and lead to lasting behavioural changes. Addressing the need to incorporate patient safety teaching into undergraduate medical curricula, it was hypothesized that medical students could benefit from hearing clinician stories of medical error. The medium of animation was considered to be a potentially engaging means of presenting stories of error to a large audience. METHODS: Three animated videos were developed to accompany audio recordings of junior doctors describing their experiences of a serious incident or near-miss event. The videos were delivered to 200 final-year medical students with a subsequent large-group discussion directed at understanding contributory factors. An evaluative questionnaire exploring learners' reactions and modification of beliefs and perception was distributed. The questionnaire included questions rated on a modified Likert scale and a free-text box. A mixed-methods analysis was conducted with descriptive statistics and qualitative content analysis of the free-text responses. RESULTS: Of the 200 students who attended, 104 completed the questionnaire and 83 completed free-text feedback. Most students responded positively to hearing stories of medical error and felt that the animated videos improved their engagement while the voice recordings helped bring the cases to life. The majority of students agreed the session would impact on their future practice. CONCLUSION: This pilot study confirmed that undergraduate students consider animated, personal stories of medical error an effective, engaging means of learning about patient safety. Longitudinal studies are required to confirm if measurable behaviour change is achieved.

Webquest como recurso tecnológico didático para capacitação de colaboradores em instituição hospitalar / WebQuest as a technological didactic resource for staff training at a hospital

Neste estudo objetivou-se avaliar a utilização da Webquest como recurso tecnológico didático para capacitação quanto às Metas Internacionais de Segurança do Paciente em uma instituição hospitalar. Estudo quantitativo, transversal, realizado em hospital público de ensino, no Sul do Brasil. De 895 colaboradores, participaram da pesquisa 679 (76%), vinculados à diretoria de enfermagem, sendo enfermeiros, técnicos em enfermagem, auxiliares de enfermagem, técnicos administrativose auxiliares operacionais zeladores que foram capacitados quanto as metas de segurança. Foram avaliados 11 itens em cada meta aplicada, dentre eles apenas estrutura física, quantidade de textos, tempo destinado à capacitação, cores e design, aplicação na prática e objetividade dos textos foram referidos como regular ou ruim por um a 3% dos colaboradores. O recurso foi considerado satisfatório como estratégia para educação permanente, possibilitando a identificação de fragilidades do processo, passíveis de melhoria, para aprimoramento da metodologia Webquest em instituição hospitalar.

This study aimed to evaluate the use of WebQuest as a technological didactic training resource at a hospital, in regard to International Patient Safety Goals. It is a quantitative, cross-sectional study, conducted at a public teaching hospital, in Southern Brazil. Of 895 staff members, 679 (76%) connected to the Nursing Directory participated in the study, these beingnurses, nursing technicians, auxiliary nurses, administrative technicians and auxiliary operational custodians that were trained in safety goals. A total of 11 items wereevaluated in each applied goal, among which only physical structure, quantity of texts, time dedicated to training, colors and design, practical application and text objectivity were referred to as regular or bad by 3% of the employees. The resource was considered satisfactory as a strategy for continuing education, enabling identification of process weaknesses, with potential for improvement, in order to refine the WebQuest methodology at a hospital.

Patient safety education among chinese medical undergraduates: An empirical study.

Patient safety education is conducive to medical students' cognition on patient safety and to improvement of medical quality and safety. Developing patient safety education for medical students is more and more widely recognized by World Health Organization and countries all over the world. However, in China, patient safety courses aiming at medical students are relatively few, and there are few reports about the effect of patient safety courses. This paper explored the influence of patient safety curriculum on medical students' attitude to and knowledge of patient safety. The patient safety curriculum was carried out for 2011-grade undergraduates of Tongji Medical College, Huazhong University of Science and Technology. The students participated in the class according to free choice. After the curriculum, the information of gender, major, attended course, attitude toward patient safety, and knowledge of laws and regulations of the 2011-grade undergraduates were collected. After rejecting invalid questionnaires, the number of undergraduates that participated in the survey was 112 (61 students did not take part in the curriculum; 51 took part in). Chi-square test was applied to analyze patient safety education's influence on medical students' attitude to patient safety and their knowledge mastery situation. The influence of patient safety education on the attitude of medical students to patient safety was not significant, but that on their knowledge of patient safety was remarkable. No matter male or female, as compared with medical students who had not accepted patient safety education, they both had a better acquisition of knowledge after having this education (for male students: 95% CI, 4.556-106.238, P<0.001; for female students: 95% CI, 3.183-33.238, P<0.001). Students majoring in Western Medicine had a relatively better mastery of knowledge of patient safety after receiving patient safety education (95% CI, 6.267-76.271, P<0.001). Short-term patient safety education cannot change medical students' stereotyped cognition on matters related to patient safety, but it can effectively enhance their knowledge of laws and regulations of patient safety.

Patient safety education among chinese medical undergraduates: An empirical study / 华中科技大学学报（医学）（英德文版）

Patient safety education is conducive to medical students' cognition on patient safety and to improvement of medical quality and safety. Developing patient safety education for medical students is more and more widely recognized by World Health Organization and countries all over the world. However, in China, patient safety courses aiming at medical students are relatively few, and there are few reports about the effect of patient safety courses. This paper explored the influence of patient safety curriculum on medical students' attitude to and knowledge of patient safety. The patient safety curriculum was carried out for 2011-grade undergraduates of Tongji Medical College, Huazhong University of Science and Technology. The students participated in the class according to free choice. After the curriculum, the information of gender, major, attended course, attitude toward patient safety, and knowledge of laws and regulations of the 2011-grade undergraduates were collected. After rejecting invalid questionnaires, the number of undergraduates that participated in the survey was 112 (61 students did not take part in the curriculum; 51 took part in). Chi-square test was applied to analyze patient safety education's influence on medical students' attitude to patient safety and their knowledge mastery situation. The influence of patient safety education on the attitude of medical students to patient safety was not significant, but that on their knowledge of patient safety was remarkable. No matter male or female, as compared with medical students who had not accepted patient safety education, they both had a better acquisition of knowledge after having this education (for male students: 95% CI, 4.556-106.238, P<0.001; for female students: 95% CI, 3.183-33.238, P<0.001). Students majoring in Western Medicine had a relatively better mastery of knowledge of patient safety after receiving patient safety education (95% CI, 6.267-76.271, P<0.001). Short-term patient safety education cannot change medical students' stereotyped cognition on matters related to patient safety, but it can effectively enhance their knowledge of laws and regulations of patient safety.

Surgical resident education in patient safety: where can we improve?

BACKGROUND: Effective communication and patient safety practices are paramount in health care. Surgical residents play an integral role in the perioperative team, yet their perceptions of patient safety remain unclear. We hypothesized that surgical residents perceive the perioperative environment as more unsafe than their faculty and operating room staff despite completing a required safety curriculum. MATERIALS AND METHODS: Surgeons, anesthesiologists, and perioperative nurses in a large academic children's hospital participated in multifaceted, physician-led workshops aimed at enhancing communication and safety culture over a 3-y period. All general surgery residents from the same academic center completed a hospital-based online safety curriculum only. All groups subsequently completed the psychometrically validated safety attitudes questionnaire to evaluate three domains: safety culture, teamwork, and speaking up. Results reflect the percent of respondents who slightly or strongly agreed. Chi-square analysis was performed. RESULTS: Sixty-three of 84 perioperative personnel (75%) and 48 of 52 surgical residents (92%) completed the safety attitudes questionnaire. A higher percentage of perioperative personnel perceived a safer environment than the surgical residents in all three domains, which was significantly higher for safety culture (68% versus 46%, P = 0.03). When stratified into two groups, junior residents (postgraduate years 1-2) and senior residents (postgraduate years 3-5) had lower scores for all three domains, but the differences were not statistically significant. CONCLUSIONS: Surgical residents' perceptions of perioperative safety remain suboptimal. With an enhanced safety curriculum, perioperative staff demonstrated higher perceptions of safety compared with residents who participated in an online-only curriculum. Optimal surgical education on patient safety remains unknown but should require a dedicated, systematic approach.

Factor analysis of nursing students' perception of patient safety education.

AIM: The aim of this study is to investigate the factor structure of the Health Care Professionals Patient Safety Assessment Curriculum Survey (HPPSACS) when completed by a group of nursing students from one University in the UK. BACKGROUND: The quality, content and delivery of nursing education can have a significant impact on the future students' safety behaviours in clinical settings. The Health Care Professionals Patient Safety Assessment Curriculum Survey HPPSACS has been developed in the US to establish undergraduate nursing students' perceived awareness, skills, and attitudes toward patient safety education. The instrument has not been reported to be used elsewhere; therefore, some psychometric properties remain untested. DESIGN: Pre-registration nursing students (n=272) from three campuses of a university in East of England completed the HPPSACS in 2012. Principal component analysis was conducted to explore the factors emerging from the students' responses. FINDINGS: 222 students (82%) returned the questionnaires. Constraining data to a 4-factor solution explained 52% of the variance. Factors identified were: "Willingness to disclose errors", "Recognition and management of medical errors", "The Perceived interprofessional context of patient safety" and "The perceived support and understanding for improving patient safety". The overall Cronbach's alpha was 0.64, indicating moderate internal consistency of the instrument. LIMITATIONS: Some demographical and descriptive questions on the HPPSACS instrument were modified to accommodate the participants' educational context. However, all items in the HPPSACS which were included in the factor analysis remain identical to the original tool. CONCLUSION: The study offers empirical findings of how patient safety education is contextualised in the undergraduate, pre-registration nursing curriculum. Further research is required to refine and improve the overall reliability of the Health Care Professionals Patient Safety Assessment Curriculum Survey (HPPSACS' instrument).

Educating future leaders in patient safety.

Education of health care professionals has given little attention to patient safety, resulting in limited understanding of the nature of risk in health care and the importance of strengthening systems. The World Health Organization developed the Patient Safety Curriculum Guide: Multiprofessional Edition to accelerate the incorporation of patient safety teaching into higher educational curricula. The World Health Organization Curriculum Guide uses a health system-focused, team-dependent approach, which impacts all health care professionals and students learning in an integrated way about how to operate within a culture of safety. The guide is pertinent in the context of global educational reforms and growing recognition of the need to introduce patient safety into health care professionals' curricula. The guide helps to advance patient safety education worldwide in five ways. First, it addresses the variety of opportunities and contexts in which health care educators teach, and provides practical recommendations to learning. Second, it recommends shared learning by students of different professions, thus enhancing student capacity to work together effectively in multidisciplinary teams. Third, it provides guidance on a range of teaching methods and pedagogical activities to ensure that students understand that patient safety is a practical science teaching them to act in evidence-based ways to reduce patient risk. Fourth, it encourages supportive teaching and learning, emphasizing the need to establishing teaching environments in which students feel comfortable to learn and practice patient safety. Finally, it helps educators incorporate patient safety topics across all areas of clinical practice.

Study of Patient Safety Education for Undergraduates / 医学教育

1) The objective of this study was to investigate patient safety education for undergraduates in Japan.<BR>2) Our survey found that 87.5% of medical schools provided patient safety education for undergraduates.The topics covered were prevention of medical errors, communication, crisis management, and medical ethics.<BR>3) This study found several problems in measurement methods, learning strategies.and human resources of undergraduate medical education.