Improving patient safety by enhancing raising concerns at medical school

Abstract

BackgroundDoctors and medical students have a professional responsibility to raise concerns. Failure to raise concerns may compromise patient safety. It is widely known that medical students frequently encounter unprofessional behaviours in the workplace, but little is known about the barriers to raising concerns amongst medical students. This paper explores these issues and discusses some innovations in the medical undergraduate curriculum, offering a good practice model for other medical and healthcare curricula.We set out to ascertain the attitudes and experiences of medical students in relation to raising concerns. This data was then used to innovate the raising concerns curriculum, and access to the raising concerns system, in order to fundamentally improve patient safety and experience, as well as the student experience.MethodsThe authors conducted a mixed methods quantitative and qualitative research study. Research was based at a UK medical school and involved data collection using an anonymous, voluntary survey emailed to all medical students (n = 363) as well as voluntary attendance focus groups (n = 24) recruited by email. Both tools investigated student attitudes towards raising concerns and explored student ideas for solutions to improving the process. The focus group data was thematically analysed by three researchers.ResultsThe authors identified five key themes which described medical student attitudes towards raising concerns. This article discusses these themes and the resulting work to enhance medical education within the medical school curriculum.ConclusionsMore research is needed to further address the barriers that medical students find in raising concerns. However, despite being a single study in one UK medical school, the authors propose some changes which they hope may inspire other educators to build upon their raising concerns curricula to foster more transparent undergraduate cultures and ultimately improve patient experience and safety.Electronic supplementary materialThe online version of this article (10.1186/s12909-018-1281-4) contains supplementary material, which is available to authorized users.

Why is patient safety a challenge? Insights from the Professionalism Opinions of Medical Students’ (PoMS) Research

“…The PoMS survey results validate the effects of occupational culture on opinions for patient safety behaviours 5 8-12 21 28 38 44 45 . The scenario involving possible racist comments shows significant transition effects; the public, junior then senior medical students, and finally doctors demonstrate progressively increasing tolerance for not reporting a junior doctor in these circumstances.…”

“…Social psychologists describe the phenomenon of ‘in-group’ bias to describe the bias of individuals who identify as being part of a group to favour their group 13 . Most studies examining the effects of implicit bias in health care have focused on implicit bias towards patients, but there is a growing literature on the factors which influence speaking up for patient safety and/or whistleblowing 5 8-12 14 15 45 .…”

‘Decolonising the Medical Curriculum‘: Humanising medicine through epistemic pluralism, cultural safety and critical consciousness

“…The open format encouraged active participation and contributions from the varied audience. Some findings supported results from the curriculum mapping exercise, including a presentation of a study revealing that UCL medical students were reticent to raise concerns about discrimination they experienced from medical professionals (Johnson et al, 2018), mirroring the low coverage of 'challenging power hierarchies' in CPP teaching. Other themes that were covered include the awarding gap in medical training, the history of medical and scientific racism, misidentifying clinical signs in darker skin tones, the eugenics inquiry at UCL and the relation of biomedicine to traditional and indigenous healing systems.…”

Organisational failure: rethinking whistleblowing for tomorrow’s doctors

“…10 11 Despite this clear move towards a systems approach, current literature relating to medical school ethics curricula continues to be dominated by a focus on individual action-both in recognising transgressions from good practice and the duty to speak out when this occurs. [12][13][14][15][16] This lack of coordination between patient safety and ethics teaching results in a continued focus on individual action that overshadows the social, cultural and organisational underpinnings of healthcare failures 17 and fuels a perception that threats to patient safety result from the actions of a minority of incompetent practitioners. This perspective neglects the gradual drift in standards which sociological theories have shown to precede organisational failings 18 19 and instead reinforces a culture of blame and defensiveness, in which students may view the raising of concerns as a threat to professional integrity.…”