Patients as teachers: a randomised controlled trial on the use of personal stories of harm to raise awareness of patient safety for doctors in training

Abstract

BackgroundPatient safety training often provides learners with a health professional's perspective rather than the patient's. Personal narratives of health-related harm allow patients to share their stories with health professionals to influence clinical behaviour by rousing emotions and improving attitudes to safety.AimThis study measured the impact of patient narratives used to train junior doctors in patient safety.MethodsAn open, multi-centre, two-arm, parallel design randomised controlled trial was conducted in the North Yorkshire East Coast Foundation School (NYECFS). The intervention consisted of 1-h-long patient narratives followed by discussion. The control arm received conventional faculty-delivered teaching. The Attitude to Patient Safety Questionnaire (APSQ) and the Positive and Negative Affect Schedule (PANAS) were used to measure the impact of the intervention.Results142 trainees received the intervention; 141 the control teaching. There was no evidence of a difference in post-intervention APSQ scores between the groups. There was a statistically significant difference in the underlying distribution of both post PA (positive affect) and post NA (negative affect) scores between the groups on the PANAS (p<0.001) with indications of both higher PA and NA scores in the intervention group.ConclusionsInvolving patients with experiences of safety incidents in training has an ideological appeal and seems an obvious choice in designing safety interventions. On the basis of our primary outcome measure, we were unable to demonstrate effectiveness of the intervention in changing general attitudes to safety compared to control. While the intervention may impact on emotional engagement and learning about communication, we remain uncertain whether this will translate into improved behaviours in the clinical context or indeed if there are any negative effects.Trial registration numberGrant reference no. RP-PG-0108-10049.

At a crossroads? Key challenges and future opportunities for patient involvement in patient safety

“…A variety of methods are now available internationally for capturing patients' experience of services, levels of satisfaction, and increasingly, their perspective on the clinical outcomes of treatment. Patients are also now routinely invited to present their experiences of healthcare to board-level executives and within education 3 6. Additionally, patients are increasingly finding their own outlets for providing feedback online via dedicated patient websites or social media 7 8.…”

Patients and families as teachers: a mixed methods assessment of a collaborative learning model for medical error disclosure and prevention

“…We chose to develop didactic workshop cases and share them with P/F before the session in the event that any of the scenarios were too close to their own experience and too emotionally jarring. While the additional safeguards for P/F are important since they enter the sessions in a traditionally more vulnerable role, our findings and others suggest that clinicians may struggle with emotions,45 47 55 and may also benefit from advanced preparation and support.…”

“…In a prior controlled intervention study, use of patient narratives to train doctors in patient safety55 did not demonstrate clear benefit in terms of patient safety attitudes, and generated both positive and negative reactions from doctors. Although data on P/F are limited, prior studies of Standardized Patients (SP) also indicate some potential concerns and stressors for SPs.…”

Medical Ethics Education for Neurology Residents: Where Do We Go from Here?

“…PFACs might improve resident education through direct resident involvement in PFACs, by evaluating and prioritizing ethics and communications training initiatives, or by serving as a conduit by which patients and families might become involved as volunteers, guest speakers, and even teachers in such curricula. 54…”