Why Is Patient Safety a Challenge? Insights From the Professionalism Opinions of Medical Students’ Research

Abstract

Objectives: Despite increased emphasis on education and training for patient safety in medical schools, there is little known about factors influencing decision making regarding patient safety behaviors. This study examined the nature and magnitude of factors that may influence opinions around patient safety-related behaviors as a means of providing insights into how Australian doctors and medical students view these issues relative to members of the public.Methods: A national, multicenter, prospective, cross-sectional survey was conducted using responses to hypothetical patient safety scenarios involving the following: fabricating results, personal protective equipment, presenteeism, and reporting concerns.Australian enrolled medical students, medical doctors, and members of the public were surveyed.Participant responses were compared for the different contextual variables within the scenarios and the participants' demographic characteristics.Results: In total, 2602 medical student, 809 doctors, and 503 members of the Australian public participated. The 3 demographic groups had significantly differing opinions on many of the patient safety dilemmas. Doctors were more tolerant of medical students not reporting concerning behaviors and attending placements despite recent illness. Medical students' opinions frequently demonstrated a "transition effect," bridging between the doctors and publics' attitudes, consistent with professional identity formation.Conclusions: Opinions on the acceptability of medical students' patient safety-related behaviors were influenced by the demographics of the cohort and the contextual complexity of the scenario. Although the survey used hypothetical scenarios, doctors and medical students' opinions seem to be influenced by cognitive dissonances, biases, and heuristics, which may negatively affect patient safety.

Opinions towards Medical Students’ Self-Care and Substance Use Dilemmas—A Future Concern despite a Positive Generational Effect?

“…The survey findings that doctor cohort respondents’ opinions more often aligned with those of the general public than those of medical students is notable as it is in contrast to the pattern of responses seen in other PoMS data examining opinions towards patient safety dilemmas [ 33 ]. It appears that opinions on self-care related to alcohol or drug use are not influenced by professional identity formation—the students adopting the norms of the behavior of the community they wish to identify with, but instead appear to be ‘generational’ in nature [ 26 ].…”

Hiding in plain sight: Inconvenient facts for patient safety in non‐24/7 theatre on‐site staffed obstetric units

“…As patient safety can be considered a social construct, human factors and organisational group thinking have a key role in what is perceived as ‘safe’ 15,16 . Patients are influenced by how risk is communicated via health professionals, for example, framing absolute risks either positively or negatively 16–18 .…”

“…Studies show that cognitive dissonance may be a factor when HCPs practise in ways that could increase risks to patients. In these circumstances, HCPs tend to under‐estimate the risk of harm, or blame other factors beyond their control 15,19 . It is also possible that HCPs working in smaller obstetric units may become habituated to the fact that care for VBACs needs to be influenced by the resource limitations of their unit, and tolerate some degree of deviance 20 .…”

“…As patient safety can be considered a social construct, human factors and organisational group thinking have a key role in what is perceived as 'safe'. 15,16 Patients are influenced by how risk is communicated via health professionals, for example, framing absolute risks either positively or negatively. [16][17][18] Studies which have sought to ascertain maternal risk tolerance for intra-partum care typically indicate that most patients are relatively risk averse; [16][17][18] a Melbourne-based study by Walker found that the median level of increased risk deemed acceptable to achieve a vaginal birth (compared to caesarean birth) for pregnant women was ten per 10 000 births (95% CI 10-13).…”

“…18 Cognitive dissonance is the mechanism by which people can manage two or more inconsistent beliefs or their behaviour is inconsistent with their beliefs/values. 15,19 Healthcare providers (HCPs) are highly motivated to care for their patients. Studies…”