A new method for the assessment of patient safety competencies during a medical school clerkship using an objective structured clinical examination

Abstract

INTRODUCTION:Patient safety is seldom assessed using objective evaluations during undergraduate medical education.OBJECTIVE:To evaluate the performance of fifth-year medical students using an objective structured clinical examination focused on patient safety after implementation of an interactive program based on adverse events recognition and disclosure.METHODS:In 2007, a patient safety program was implemented in the internal medicine clerkship of our hospital. The program focused on human error theory, epidemiology of incidents, adverse events, and disclosure. Upon completion of the program, students completed an objective structured clinical examination with five stations and standardized patients. One station focused on patient safety issues, including medical error recognition/disclosure, the patient-physician relationship and humanism issues. A standardized checklist was completed by each standardized patient to assess the performance of each student. The student's global performance at each station and performance in the domains of medical error, the patient-physician relationship and humanism were determined. The correlations between the student performances in these three domains were calculated.RESULTS:A total of 95 students participated in the objective structured clinical examination. The mean global score at the patient safety station was 87.59±1.24 points. Students' performance in the medical error domain was significantly lower than their performance on patient-physician relationship and humanistic issues. Less than 60% of students (n = 54) offered the simulated patient an apology after a medical error occurred. A significant correlation was found between scores obtained in the medical error domains and scores related to both the patient-physician relationship and humanistic domains.CONCLUSIONS:An objective structured clinical examination is a useful tool to evaluate patient safety competencies during the medical student clerkship.

Ensino da segurança do paciente na graduação em saúde: reflexões sobre saberes e fazeres

“…In spite of that, there are already Brazilian initiatives to give patient safety training programs in Medical schools to focus on the adverse effect, how to recognize it and how to communicate with the patient using participative methodologies. Even so, these initiatives are not linked to specific courses yet 10 . This situation calls for an urgency in shifting the attention of the training institutions to reach out to larger audiences of students, also contributing with the effort of programs aimed to foster professional teamwork in health care services 9 .…”

“…This training process should be inserted in the clinical approach and when showcasing best practices, and it should be continuous during the course of the students' itinerary in the different practice settings that are required in their training program 6,9,10 .…”

Brazilian version of the Jefferson Scale of Empathy: psychometric properties and factor analysis

“…Brazilian students are rarely exposed to such skills in their medical training in most of Brazil’s medical schools. This area of competence is usually practiced at isolated moments of the medical curriculum related to the interdisciplinary field of humanities, patient safety [24], and bioethics. This presentation format in the curriculum may erroneously suggest to students that empathy is an exclusively inner characteristic or a natural disposition [25] rather than a multidimensional competence to be taught, trained, and assessed [24,26].…”

Exame Clínico Estruturado Como Ferramenta Educacional Na Área De Saúde: Revisão Integrativa

“…Verificou-se, ainda, que nem sempre há uma equivalência entre os desempenhos observados no ECOE e as condutas adotadas na realidade (23) . (24) .…”

“…Por fim, alguns autores asseveraram que o ECOE é pertinente à avaliação da competência clínica e, por isso, elevar a qualidade do respectivo exame é uma questão primordial na atualidade, tendo em vista que os avanços no ECOE são refletidos na melhoria da qualidade do ensino e formação profissional (15,17,18,(20)(21)(22)(23)(24)26) . A confiabilidade geral do ECOE foi satisfatória quando confrontada com estudos similares (26) .…”