Patient safety in health care
professional educational curricula:
Examining the learning experience
Some initial findings
Dr Alison Steven
Senior Research Associate
School of Medical Education Development
On behalf of the Patient Safety Education study Group
Copyright [Newcastle University] [8/04/08] All rights reserved.
Background
Education, be it formal or informal, is the 'key’ to
how health care professionals think about, talk
about and write about mishaps, errors and
keeping patients safe.
Pre-qualification education has a
central role in enhancing patient safety
but we need to develop a better
understanding of the formal and
informal learning which takes place.
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The study
NPSA funded
Two and a half years
5 partner institutions exploring undergraduate
education for 4 health care professions :
Medicine, Nursing, Physiotherapy, Pharmacy
Newcastle University
(Revd Dr Pauline Pearson - PI)
(Dr Alison Steven – Lead researcher)
University of East Anglia
(Professor Amanda Howe)
University of Edinburgh
(Professor Aziz Sheikh)
University of Manchester
(Dr Darren Ashcroft)
University of Surrey
(Professor Pam Smith)
Copyright [Newcastle University] [8/04/08] All rights reserved.
The study aim
To study the formal and informal
ways pre-qualification students from
a range of healthcare professions
learn about keeping patients safe
from errors, mishaps and other
adverse events (broadly known as
Patient Safety).
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Theoretical framework
Knowledge contexts
( Stewart 2006 Drawn from Eraut 1994
)
Academic context
Theories and models, views and debate
Experts validate knowledge
Professional
Knowledge
Organisational context
How it is learned
Development and implementation of policy
How it is used
Validated by public debate
Practice context
Action – doing, experience and knowing
Validated by personal judgement
Stewart J. Asking for senior intervention: conceptual insights into the
judgement of risk by doctors . PhD thesis, Newcastle University, Newcastle,
UK, 2006.
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The study design
Phased by context:
•1 Academic context
(Course content as planned and delivered)
• *Part 1 Curriculum analysis and exploration (13 courses)*
• Part 2 focusing down on 8 case study courses
•2a Organisational context
(Influences on courses and practice)
•2b Practice context
(The cultures to which students are exposed)
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Phase 1 : ‘Academic context’ (Course content as planned, delivered and received)
1a) Analyse for ‘intentions’
(Education as planned)
1b) Decide on number of ‘case
studies’ (max.8)
1) Collect course
documents
(approx. 13 courses)
1.1) Interview key informants
(up to approx. 26)
3) Compare (1st time)
3b) Undertake focus groups:
Students,
Patients involved in
education,
Newly Qualified Staff.
3a)
Develop
questions
for focus
groups
5)
Use analyses
to develop
questions
and areas
for
attention in
phase 2b
4a) Compare (2nd time)
2) Undertake observations of
teaching in academic and practice
settings (Education as delivered)
Up to approx . 32 - 4 per course)
2a) Analyse for ‘culture’ and
influences on translation of
intended curriculum.
4) Feed
back into
cultural
analysis
3c) Analyse for views and
opinions of PS education
(Education as received)
‘practice based
case studies’
Phase 2a: ‘Organisational contexts’ (Influences on courses and practice)
6a) Collect organisational documentation from practice settings (guidelines, protocols)
6b) Collect policy documents from professional bodies (policies, recommendations)
6d)
Analyse for
underlying
organisational
ethos
6c) Undertake interviews in relation to organisational and practice contexts. (e.g. Managers,
Risk managers, Audit and quality leads)
Phase 2b: ‘Practice contexts’ (How PS is undertaken in day to day
working: the cultures to which students are exposed)
Outcomes
Detailed understanding of
• a range of PS curricula
• the ways in which curricula are
translated and interpreted in
academic and practice
contexts,
• organisational influences,
• cultural factors influencing
translation and interpretation of
curricula,
Everyday practicesPS practice.
9) Invite
participants at
each collaboration
site to feedback
presentations of
findings. For
respondent
validation and
refinement of
analysis.
7b) Analyse for espoused
notions and perceptions of
PS practice, policy and
education
.
7a) Undertake focus groups in practice
contexts (Staff including where possible
those newly qualified)
Compare
8b) Analyse for Patient Safety
in practice
8a) Undertake observations of practice
context (Maximum 25 days in total)
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Who and where
Nursing
Pharmacy
Sunderland
Northumbria
Medicine
Physiotherapy
Newcastle
Newcastle
Lead
Lead site
site
Nursing
Pharmacy
Medicine
Edinburgh
Edinburgh
Nursing
Patient
Patient Safety
Safety
Study
Study Sites
Sites
University
University of
of
Medicine
East
East
Anglia
Physiotherapy
Anglia
Nursing
Medicine
Pharmacy
Red = Case study sites
Manchester
Manchester
Surrey
Surrey
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Curriculum analysis: Documents collected
Course /
site
Documents
Medicine C
Handbooks years 1-5
Curriculum mapping to
Tomorrows Doctors
IPE
Medicine B
Degree programme
handbook
Personal and professional
development handbooks 1-4
Terminal outcomes grid
Medicine A
Electronic Medical
Curriculum
Medicine D
Validation documents
Student handbook
Paper for GMC
Nursing D
Validation documents
Student handbooks
Concept maps (paper and
electronic)
Nursing E
Validated curriculum
submission document
Student handbook
Module handbooks (9)
Nursing A
Overall programme
handbook
Course handbooks (21) (3 others
not available)
Course overviews
Nursing B
Programme specification
Module handbooks from website
Learning and Teaching
Strategy 2004-7
Pharmacy D
On line prospectus
Unit outlines and learning
outcomes (electronic)
Placements Induction
Handbook (electronic)
Lecture notes
(electronic)
Pharmacy C
Accreditation document
RPSGB
Module handbooks
Programme handbooks
years 1-4
Website outlines
Pharmacy B
Web based course
description
Module descriptors
Physio D
Revalidation submission
2001
Student handbook years 1, 2 and
3
Placement educators’
handbook
Physio B
Programme specification /
course handbook
Module descriptors
Supplementary document
presented at validation
Website outlines
Review of PBL cases
Learning
agreement 2005/6
Website
Web based course
structure and outcomes
Unit documents on
Blackboard
Website: course
description
Programme
specification 2006
Student recruitment and
admissions information
sheet
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Findings
Curriculum analysis : Exploring the micro
Specific words and concepts:
Adverse events,
Critical incidents
Error
Failures
Harm
Mishaps
Mistakes
Near misses
Negligence
Risk (risk assessment)
Safety (safety cycles)
Safe practice
Serious events
Significant events
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Findings
Curriculum analysis : Exploring the micro
Courses
Medicine (/4)
A
C
Nursing (/4)
B
D
Tot
Mean
A
B
2
7
13
3.2
0
0
6
2
19
4.7
2
2
0.5
9
11
2.8
10
10
2
Pharmacy (/3)
E
D
Physiotherapy (/2)
B
D
Tot
Tot.
Tot
Mean
C
B
D
Tot
Mean
Mean
0
0
15
1
4
20
6.9
0
33
1
7
1.8
0
0
0
7
2
1
3
0.7
21
7
0
43
0
0
0
0
0
2
1
1
2
0.5
1
1
0.3
0
14
2.5
0
0
1
1
0.3
0
11
5
1.2
0
0
1
2
0.6
0
7
2
4
1
2
0.5
1
1
0.3
19
63
15
74
18.1
13
31
10
13
Words
Adverse
4
Critical
Incidents
Error
7
10
1
1
Failure
Harm
Mistakes
Near
misses
3
Negligence
1
1
Safe
26
9
9
Serious
Signif.
events
2
Risk
14
5
6
2
8
6
33
27
14
3
4
1
15
3
7
0
13
18
31
199
15
1
1
0.2
0
0
0
0
0
1
1
3
0.7
0
0
0
0
0
3
31
56
14
36
9
14
4.8
3
13
10
10
6
4
4
2
9
11
117
5.5
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Findings
Curriculum analysis : Exploring the meso
Medicine / 4
Nursing / 4
Physiotherapy / 2
Pharmacy / 3
Total
Courses
Topics
Risk assessment
A
C
4
1
Communication
8
Patient handling
1
4
B
2
D
Total Mean A
5
1.25
4
18
4.5
1
2
0.5
Infection control
0
0
Medicines
/prescribing/
dispensing/
administering
11
2
3
8
24
6
Blood
4
2
1
1
8
2
B
E
D
1
3
4
8
16
2
3
1
2
4
5
3
3
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5
2
Total
Mean C
B
D
4
2
1
3
5
1.25
2
12
3
8
1
2
11
16
4
4
4
1
Total
6
9
D
1
5
6
1
0.5
27
4
6
3
20
2
3
1
1
0
0
2
0
43
Mean B
0
1
Total Mean
1
3
33
0.5
9
52
17.3
0
0
92
0
0
0
0
12
Findings
Curriculum analysis : Exploring the meso
Personal and professional development and skills
1. Management of self and others to facilitate safe systems of working
practice
2. Clinical judgement
3. Competence in the safe and effective application of a range of skills
(including communication)
4. Risk assessment, tools and prevention
5. Implementation of safe, effective (evidence based) and efficient treatment
Organisational structures and processes
6. Clinical governance including audit, risk, patient safety, error reporting
7. Compliance with health and safety procedures / legal requirements /
regulations /ethical principles
8. Threats to safety / causes of error
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Findings
Curriculum analysis : Exploring the macro
Overarching dimensions:
Clinical skills
•issues about procedures, use of equipment, interpretation (closely linked
to decision making), communication with patients (incorporating
complaints, explanations, apology, openness and respect) and dealing
with contingencies.
Prescribing
•linked to key words in the vocabulary used in thinking about patient safety
– adverse, effective, safe, error, harm - and also considering both the
behaviour and its function.
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Findings
Curriculum analysis : Exploring the macro
Overarching dimensions:
The individual,
• their actions or omissions and decisions, and their relationship with the
health care system and its assumptions and responses to error or
accident.
Ethics and the law,
• incorporating the balance of benefit and harm, autonomy and risk.
Finally there is a dimension which balances patient and professional, and their
expectations and choices.
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Issues arising from this data set
Limitations of data
Definitions of ‘patient safety’
Curriculum delivery
Professional vocabularies
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Next steps
Part of a much larger study
Some of the issues highlighted are
explored in subsequent data collection
Study ongoing
Due to finish Dec 2008
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Dr Alison Steven
Senior Research Associate
School of Medical Education Development
The Medical School
University of Newcastle
Framlington Place
Newcastle upon Tyne
NE2 4HH
Tel 0191 246 4527
Alison.steven@ncl.ac.uk
http://psafety.ncl.ac.uk
On behalf of the Patient Safety Education study Group