[Patient safety 4.0: "Failure of the Week" It's all about role modelling!] / Patient*innen-Sicherheit 4.0: "Fehler der Woche" ­ Um die Vorbildfunktion geht's!

BACKGROUND: The rate of mistakes and near misses in clinical medicine remains staggering. The tendency to cover up mistakes is rampant in "name-blame-shame" cultures. The need for safe forums where mistakes can be openly discussed in the interest of patient safety is evident. Following a comprehensive review of the literature, a semi-structured weekly conference, named "mistake of the week" (MOTW), was introduced, enabling physicians to voluntarily discuss their mistakes and near-misses. The MOTW is intended to encourage cultural change in how physicians approach, process, accept and learn from their own and their peers' mistakes. This study seeks to assess if physicians appreciate, benefit from and are motivated to participate in MOTW. METHODS: Physicians and medical students of the I. and II. Medizinische Klinik at the Academic Teaching Hospital Klinikum Konstanz (Germany) were eligible to participate voluntarily. Four groups of physicians (n=3-6) and one group of medical students (n=5) volunteered to participate in focus group interviews, which were videotaped, transcribed and analyzed. RESULTS: The following success factors are crucial for dealing with and voluntarily disclosing mistakes and near-misses: 1. Exemplification ("follow the boss's lead"), 2. Fixed time slots and a clear forum, 3. Reporting mistakes without fear of penalty or punishment, 4. A trusting working atmosphere. The key effects of the MOTW approach are: 1. People report their mistakes more, 2. Relief, 3. Psychological safety, 4. Lessons learned/errors (potentially) reduced. DISCUSSION: The MOTW conference models an ideal forum to mitigate hierarchy and promote a sustainable organizational dynamic in which mistakes and near misses can be discussed in an environment free from "name-blame-shame", with the ultimate goal of potentially improving patient care and safety.

Usability and preference of electronic vs. paper and pencil OSCE checklists by examiners and influence of checklist type on missed ratings in the Swiss Federal Licensing Exam.

Background: Only a few studies with small sample sizes have compared electronic Objective Structured Clinical Examination (OSCE) rating checklists with traditional paper-based OSCE rating checklists. In this study, the examiner-perceived usability and preference for type of OSCE checklist (electronic vs. paper based) were compared, and the influence of OSCE checklist type on missed ratings was determined, for the Swiss Federal Licensing Examination in clinical skills for human medicine. Methods: All examiners in the Swiss Federal Licensing Examination in clinical skills for human medicine were invited over two subsequent years to evaluate the OSCE checklist type they had worked with during the examination. This was based on a questionnaire with 14 closed questions (i.e., demographic, checklist-type experience, perceived usability, checklist type preference). Furthermore, the numbers of missed ratings for the paper-based checklist were recorded. Results: The data from these examiners (n=377) with experience of both OSCE checklist types were analyzed. The electronic OSCE checklist was rated significantly higher on all usability aspects (i.e., ease of use, candidate rating and error correction, clarity, distraction using the checklist, overall satisfaction), except for the speed of registering comments (no significant difference). The majority of the examiners in both years (2014: 54.5%, n=60, 2015: 89.8%, n=230) reported preference for working with the electronic OSCE checklist in the future. Missed ratings were seen for 14.2% of the paper-based OSCE checklists, which were prevented with the electronic OSCE checklists. Conclusions: Electronic OSCE checklists were rated significantly more user-friendly and were preferred over paper-based OSCE checklists by a broad national sample of examiners, supporting previous results from faculty-level examinations. Furthermore, missed ratings were prevented with the electronic OSCE checklists. Overall, the use of electronic OSCE checklists is therefore advisable.

Elementary school children as standardized patients in a summative OSCE - A mixed-method study according to the Ottawa criteria for good assessment.

BACKGROUND: The goal of the present study was to evaluate whether children as standardized patients (SPs) for a summative OSCE station fulfills the Ottawa criteria for good assessment. METHODS: Data for participating students (n = 124), raters (n = 11), and children (n = 127) were collected using questionnaires (students, raters), focus groups (raters), and interviews (children, raters). The psychometrics (including reproducibility) of this OSCE station were also analyzed according to quality indices. RESULTS: Validity, reproducibility, feasibility, educational effect, and acceptability were attained for this OSCE station. Students and raters accepted the new approach and evaluated it as fair and acceptable, with realism and validity. This OSCE station had a perceived positive educational effect for ∼30% of the students, who expected child SPs. Raters stated it as feasible to involve children. The children enjoyed their participation, which was acceptable and feasible. Statistical measures were in the recommended ranges and showed reproducibility. CONCLUSION: Children as SPs for a summative OSCE station was perceived as fair, acceptable, realistic, and feasible by all stakeholders, and with perceived positive educational impact. This pediatric OSCE station fulfilled five of the seven Ottawa criteria for good assessment. Further studies are needed to investigate different pediatric stations.

Predictive power of high school educational attainment and the medical aptitude test for performance during the Bachelor program in human medicine at the University of Bern: a cohort study.

OBJECTIVE: Prior high school educational attainment and medical aptitude tests are two of the most frequently used selection procedures for admission to medical school. Both of these have been shown to correlate with future performance. However, there is a need for further analysis of the combined impact of these two admissions tools and comparison of their predictive value for future performance. At present, successful completion of high school (Matura) and an aptitude test (Eignungstest Medizinstudium Schweiz, EMS; Swiss Aptitude Test in Medicine) are used for admission to all medical schools in the German-speaking part of Switzerland. The purpose of this study was to explore the predictors that are most decisive for performance in undergraduate medical education. More precisely, we were interested in the contributions of the Matura grade and the EMS score to explanations of performance in the Bachelor program of Medicine at the University of Bern. METHODS: Matura grades, EMS score and performance in the Bachelor program of Medicine were collected for 730 students from four cohorts. Of these, 277 graduated from high school with a biology-chemistry major. Hierarchical regression analysis was conducted for each study year and type of examination to determine which predictors affected performance during undergraduate medical education. RESULTS: These data show that Matura grades are an important predictor for performance in undergraduate medical education. The EMS score had no impact when the Matura grades were part of the analysis. The biology-chemistry major grade was a predictor for performance in the first year of undergraduate study. From the second academic year onwards, past performance in the bachelor’s program was the best predictor for future performance during undergraduate medical education. CONCLUSIONS: Students’ Matura grades predicted their subsequent performance in undergraduate medical education in the bachelor’s program of the University of Bern. In contrast, EMS scores do not explain any additional variance in students’ performance throughout the entire bachelor’s program. These findings suggest a need for rethinking the admission process.