Patient safety in medical residency training: Balancing bravery and checklists

Abstract

Distributing responsibility for patient safety between individual professionals and organisational systems is a pressing issue in contemporary healthcare. This article draws on Habermas’ distinction between ‘lifeworld’ and ‘system’ to explore patient-safety culture in medical residency training. Sociological accounts of medical training have indicated that applying systemic solutions in patient-safety training and practice may conflict with residents’ needs. Residents would navigate safety systems to get their work done and safeguard learning opportunities, acting ‘in between’ the system and traditional processes of socialisation and learning on the job. Our ethnographic study reveals how residents seek to connect system and professional-based learning, and do them together in situated manners that evolve in the course of medical training. We reveal three themes that closely align with the residents’ developmental process of maturing during training and on the job to become ‘real’ physicians: (1) coming to grips with the job; (2) working around safety procedures; and (3) moving on to independence. A more explicit focus on learning to deal with uncertainty may enable residents to become more skilled in balancing safety systems.

Dimensions of safety culture: a systematic review of quantitative, qualitative and mixed methods for assessing safety culture in hospitals

“…Frameworks or theories were used in 11 studies (35.5%) to guide the collection and analysis of qualitative data, and included grounded theory, 45 a lifeworld versus system distinction, 46 and the SAQ's dimensions. 47 48 The…”

“…56 Finally, two studies (6.5%) used a combination of qualitative methods, including observations, informal conversations, interviews, within an ethnographic study design to examine how team communication affected safety culture in surgery, 57 and the developing patient safety culture of medical residents. 46 More than half of studies using qualitative methods did so in conjunction with surveys to assess safety culture in a mixed methods design (n=19, 61.3%), to elaborate 49 58 or compare 59 with quantitative findings, develop a safety culture survey, 60 or identify factors influencing patient safety culture. 61 Some survey studies also incorporated abbreviated qualitative data by including open response questions.…”

TeamSTEPPS improves patient safety

“…The TeamSTEPPS training model,21 22 which is tailored to China’s national requirements, can be used to combine the country’s current medical resources and environment with the goal of making up for various weaknesses in medical team cooperation while also enhancing patient safety and medical quality. The use of team training in patient safety produces a very high level of medical acceptance, in contrast to traditional educational approaches 23. The environment is immersive, and there are many options for interaction and communication for medical staff.…”

“…The use of team training in patient safety produces a very high level of medical acceptance, in contrast to traditional educational approaches. 23 The environment is immersive, and there are many options for interaction and communication for medical staff. The study’s findings indicate that after using the team training mode, medical and nursing cooperation attitudes scored higher than they did previously across four dimensions: teamwork, safety climate, management perspective and job satisfaction.…”

Aligning work-as-imagined and work-as-done using FRAM on a hospital ward: a roadmap

“…Ward care is no exception because the often unpredictable and busy nature of the work makes it a place where everyday care is difficult to manage or improve 7. While adherence to clinical and nursing guidelines is a necessary starting point, most clinicians and nurses would agree that deviations from standards are equally important to meet the unpredictable course of events inherent in treating unstable ward patients 8–11. This means that the actual performance of work can differ (significantly) from how it was intended.…”