Patient Safety Research Center, State University of New York at Buffalo, Buffalo, New York 14215, USA.
J Patient Saf. 2009 Jun;5(2):55-60. doi: 10.1097/PTS.0b013e31819d65c2.
There are international calls for improving education for health care workers around certain core competencies, of which patient safety and quality are integral and transcendent parts. Although relevant teaching programs have been developed, little is known about how best to assess their effectiveness. The objective of this work was to develop and implement an objective structured clinical examination (OSCE) to evaluate the impact of a patient safety curriculum.
The curriculum was implemented in a family medicine residency program with 47 trainees. Two years after commencing the curriculum, a patient safety OSCE was developed and administered at this program and, for comparison purposes, to incoming residents at the same program and to residents at a neighboring residency program.
All 47 residents exposed to the training, all 16 incoming residents, and 10 of 12 residents at the neighboring program participated in the OSCE. In a standardized patient case, error detection and error disclosure skills were better among trained residents. In a chart-based case, trained residents showed better performance in identifying deficiencies in care and described more appropriate means of addressing them. Third year residents exposed to a "Systems Approach" course performed better at system analysis and identifying system-based solutions after the course than before.
Results suggest increased systems thinking and inculcation of a culture of safety among residents exposed to a patient safety curriculum. The main weaknesses of the study are its small size and suboptimal design. Much further investigation is needed into the effectiveness of patient safety curricula.
国际上呼吁提高医疗保健工作者在某些核心能力方面的教育水平，其中患者安全和质量是不可或缺和卓越的部分。尽管已经开发了相关的教学计划，但对于如何最好地评估其效果知之甚少。这项工作的目的是开发和实施客观结构化临床考试（OSCE），以评估患者安全课程的影响。
该课程在一个家庭医学住院医师培训计划中实施，共有 47 名受训者。在开始该课程两年后，在该计划中开发并实施了一项患者安全 OSCE，并为比较目的，在同一计划中的新居民和邻近住院医师计划中的居民进行了评估。
所有接受过培训的 47 名居民、所有 16 名新居民以及邻近计划的 12 名居民中的 10 名参加了 OSCE。在标准化患者病例中，受过培训的居民在检测和披露错误方面的技能更好。在基于图表的病例中，受训居民在识别护理缺陷方面表现更好，并描述了更合适的解决方法。在接触了“系统方法”课程的第三年居民在接触课程后，在系统分析和识别基于系统的解决方案方面的表现优于接触课程之前。
结果表明，接受患者安全课程培训的居民在系统思维和灌输安全文化方面有了提高。该研究的主要弱点是其规模较小和设计欠佳。还需要进一步深入研究患者安全课程的有效性。
