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

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.

Is tissue an issue? Current practice and opinion in Western Australia for routine histopathology on products of conception.

An anonymous questionnaire-based survey was used to determine current practices and opinions of senior health professionals working in Western Australian (WA) hospitals performing gynaecological procedures, regarding the routine use of histopathology for products of conception (POC) obtained either from the surgical management of miscarriage or termination of pregnancy. Sixty-one senior health professionals completed the survey. Tissue histopathology on POC was routinely requested for miscarriage and termination of pregnancy (TOP) by 87 and 59% of respondents, respectively. Respondents listed the main reasons for requesting routine histopathology as avoidance of misdiagnosis, medico-legal and quality assurance. There were inconsistent practices among WA health professionals regarding sending POC for histopathology; 63% of gynaecology head of departments recommend the introduction of state or national guidelines for the use of histopathology in the surgical management of miscarriages or terminations of pregnancy.

Looking for the second patient: current practice and opinion on pre-operative pregnancy testing in Western Australia.

INTRODUCTION: To determine current hospital practices and the opinions of senior health professionals working in Western Australian (WA) hospitals performing gynaecological procedures regarding pre-operative pregnancy testing. METHODS: Anonymous questionnaire survey sent to all WA public and private hospitals' senior clinical staff (38 units where gynaecological surgery was performed in WA). RESULTS: Sixty-one senior health professionals (heads of department, medical directors, theatre nurse managers), completed the survey (estimated response rate 71%). Thirty-eight (68%) of respondents' units had guidelines for pre-operative pregnancy testing and 55% respondents worked in hospitals which tested all women of reproductive potential. Nineteen (33%) respondents reported cases in which patients had presented for surgery unaware they were pregnant. Forty-one (76%) respondents believed that all women of reproductive potential should have routine pre-operative pregnancy testing. Fifty-four (89%) supported the introduction of national or statewide guidelines. DISCUSSION: There are inconsistent processes of pre-operative assessment of pregnancy status in WA hospitals performing gynaecological surgery potentially resulting in adverse incidents. The majority of senior clinical staff surveyed supported routine pre-operative testing and the need for national or statewide guidelines.

Emergency obstetric simulation training: how do we know where we are going, if we don't know where we have been?

BACKGROUND: Obstetric emergencies contribute significantly to maternal morbidity and mortality. Current training in the management of obstetric emergencies in Australia and internationally focusses on utilising a multidisciplinary simulation-based model. Arguments for and against this type of training exist, using both economic and clinical reasoning. AIMS: To identify the evidence base for the clinical impact of simulation training in obstetric emergencies and to address some of the concerns regarding appropriate delivery of obstetric emergency training in the Australian setting. METHODS: A literature search was performed to identify research undertaken in the area of obstetric emergency training. The initial literature search using broad search terms identified 887 articles which were then reviewed and considered for inclusion if they provided original research with a specific emphasis on the impact of training on clinical outcomes. RESULTS: Ninety-two articles were identified, comprising evidence in the following clinical situations: eclampsia, shoulder dystocia, postpartum haemorrhage, maternal collapse, cord prolapse and teamwork training. Evidence exists for a benefit in knowledge or skills gained from simulation training and for the benefit of training in small units without access to high-fidelity equipment or facilities. CONCLUSIONS: Evidence exists for a positive impact of training in obstetric emergencies, although the majority of the available evidence applies to evaluation at the level of participants' confidence, knowledge or skills rather than at the level of impact on clinical outcomes. The model of simulation-based training is an appropriate one for the Australian setting and should be further utilised in rural and remote settings.

Fitness-to-practise policies in Australian medical schools--are they fit for purpose?

OBJECTIVES: To describe current use and possible effects of Australian medical school fitness-to-practise policies (FTPPs), and to define and benchmark FTPP best practice. DESIGN, SETTING AND PARTICIPANTS: A questionnaire-based study of Australian medical schools was conducted in August 2009. MAIN OUTCOME MEASURES: Use of FTPPs by medical schools; criteria used in FTPPs; remediation processes; numbers of students excluded for professional misconduct, reasons for exclusion, and year of study at time of exclusion. RESULTS: The questionnaire was completed by 15 of 19 medical schools to which it was sent, and 12 schools reported using an FTPP. There was wide variation in the FTPP criteria used by individual schools, and use of an FTPP appeared to be independent of medical student registration with state medical boards and type of course entry. There were no apparent differences in medical student exclusion rates between schools with FTPPs and those without. The most common reason for exclusion was persistent inappropriate attitude or behaviour, including poor attendance, and most exclusions occurred by the third year of study. CONCLUSIONS: Most Australian medical schools use FTPPs, but these policies are variable and lack proven effectiveness. The variations in the numbers of students excluded by the different medical schools for unprofessional behaviour suggest discrepancies in the medical schools' abilities to detect and manage students with problems in this area. Previous calls to develop a nationally consistent approach to the management of poorly behaving students should be addressed.