When theory meets reality- a mismatch in communication: a qualitative study of clinical transition from communication skills training to the surgical ward.

BACKGROUND: Communication skills training in patient centered communication is an integral part of the medical undergraduate education and has been shown to improve various components of communication. While the effects of different educational interventions have been investigated, little is known about the transfer from theoretical settings to clinical practice in the context of communication skills courses not integrated in the clinical curriculum. Most studies focus on single factors affecting transfer without considering the comprehensive perspective of the students themselves. The aim of this study is to explore how the students experience the transition to clinical practice and what they perceive as challenges in using patient centered communication. METHODS: Fifteen 4th year medical students were interviewed 3 weeks after the transition from an advanced communication skills course to surgical internship using semi-structured interviews. Qualitative content analysis was used to analyze the interviews. RESULTS: The analysis resulted in a theme 'When theory meets reality- a mismatch in communication'. It was comprised of four categories that encompassed the transfer process, from theoretical education, practical communication training and surgical internship to students' wishes and perceived needs. CONCLUSIONS: We concluded that preparing the students through theoretical and practical training should reflect the reality they will face when entering clinical practice. When educating medical students as a group, their proclivity for perfectionism, high performance environment and achievement-related stress should be taken into consideration. The role of tutors being role models, offering guidance, giving feedback and providing support plays a major part in facilitating transfer of communication skills. To enable transfer to a larger extent, the environment needs to promote patient centeredness and students need more opportunities to practice communication with their patients.

Safety culture development in the construction industry: The case of a safety park in Sweden.

The problem of occupational accidents in the construction industry has necessitated a focus on proactive measures such as safety management programs. An example of this is safety parks, i.e. facilities where employees and managers from different construction companies can participate in site-specific activities and train in safety-related matters in a realistic context. Two specific focus areas are often present within these types of safety management programs: hands-on safety training and safety culture development as being within the purview of management. The purpose of this article is to investigate the developers' intentions with the park in relation to safety culture development. Twenty interviews were conducted with experts in the area of health and safety. Results indicate that the safety park can contribute as a mirror for the companies own operations, with new information and knowledge of how work can be performed with safety being prioritized, to developing communication regarding safety-related matters, and finally the stations at the park may initiate a translation process as to how the lessons learned at the park can be applied to the participants' own workplaces. All in all, the activities at the park can be said to be normative in nature, i.e. the developers seemingly have a desire to steer the safety culture development in a certain direction. There is a need for further research focusing on the concept of safety culture in these types of programs and, more broadly, in relation to its intended industry-wide effects.

Exploring safety culture research in the construction industry.

BACKGROUND: Despite numerous regulatory initiatives to improve health and safety in the construction industry, it still ranks as one of the most accident-prone industries worldwide. A dedicated focus on safety culture has been suggested as a complement to laws, regulations and management systems. OBJECTIVE: This article explores safety culture research conducted in the construction industry, with the aim to provide insight into the specific themes that tend to be in focus as well as what theoretical and methodological approaches that tend to be favored. METHODS: Searches in scientific databases were conducted twice. In a first attempt, searches resulted in 54 hits but only two articles fit the scope of the study. A revision of the search phrase resulted in 124 hits. Ultimately, 17 articles fit the scope of the study and were included. The content of the articles was analyzed and sorted thematically. RESULTS: The results show that four themes are prevalent in the existing literature: 1) unique challenges entail a need for situated applications, 2) models developed to operationalize safety culture, 3) measuring safety culture, and 4) safety management and leadership as key factors. CONCLUSION: Although research focusing on the construction industry has come to favor certain study designs and definitions of safety culture, further research may be enriched by broadening the theoretical and methodological perspectives. Specifically, researchers should conduct more in-depth qualitative studies that take the complexity of the industry into account, including the interpersonal relations between the actors involved.

Occupational accidents in Swedish construction trades.

The purpose of this study is to analyze accidents occurring in the Swedish construction industry, focusing specifically on the situation in the individual trades. The article includes all occupational accidents with at least 1 day of absence from work that were reported to the Swedish Social Insurance Agency for the year 2016. The results, focusing on accident cause, injured body parts as well as accidents per weekday, month and age, show that although the trades share commonalities regarding occupational accidents, a number of trade-specific problem areas stand out. With this in mind, conclusions are drawn regarding the situation in each respective trade and suggestions are made for future studies focusing on accidents in construction industry trades.

The changed relations between the construction industry and occupational health services.

BACKGROUND: From the 1960s until the beginning of the 1990s, the construction industry in Sweden received support for health and safety issues from Bygghälsan, an Occupational Health Service (OHS) that targeted the construction industry. In the 1990s, a reorganization of the OHS changed the relations between the actors involved. OBJECTIVES: This study explores these changed relations between the construction industry and the "old" industry-specific Bygghälsan versus the relations with "new" external OHS. METHODS: Semi-structured interviews were conducted with 22 interviewees from the construction industry and individuals involved in OHS which were transcribed and analyzed. RESULTS: The results suggest that OHS have changed towards a more general character instead of tailor-made services which has had a negative effect on the relations. Further, Bygghälsan was perceived as being a part of the construction industry while contemporary OHS providers were perceived as outsiders which further complicates building trustful relations. CONCLUSIONS: The relation between the construction industry and Bygghälsan was perceived as better compared to the relations with the new companies providing external OHS. The main barrier to building better relations is the perception that contemporary OHS do not have the same knowledge about the construction industry as Bygghälsan.

Occupational safety in the construction industry.

BACKGROUND: The paper is a research review focusing on occupational safety in the construction industry. OBJECTIVE: The purpose is to present research that highlights the areas of occupational safety and risks and to identify areas where research is lacking. METHODS: 146 articles from scientific journals, mainly covering the construction industry in Europe, Canada, USA, Australia and Japan have been studied. The findings are presented under 11 categories: accident statistics; individual factors; legislation and regulations; ethical considerations; risk management; leadership, management, organization; competence; safety design; cost-benefit calculations; programs and models; and technical solutions. RESULTS: The research is dominated by initiatives from researchers and government authorities, while the construction industry only appears as the object for the research. There is a scarcity of research on integrated systems encompassing subcontractors, as well as a lack of research with sociological perspectives on accidents. Furthermore, only a few studies have applied a gender perspective on safety in construction, i.e. there is a need of further research in this particular area. CONCLUSIONS: A range of initiatives have been taken to increase safety in the construction industry and the initiatives are mainly reported to be successful. There are some cultural differences, but basically researchers present similar results regardless of country.