Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
Adv Health Sci Educ Theory Pract. 2011 Aug;16(3):347-58. doi: 10.1007/s10459-010-9266-z. Epub 2010 Dec 4.
Evidence that medical error can cause harm to patients has raised the attention of the health care community towards patient safety and influenced how and what medical students learn about it. Patient safety is best taught when students are participating in clinical practice where they actually encounter patients at risk. This type of learning is referred to as workplace learning, a complex system in which various factors influence what is being learned and how. A theory that can highlight potential difficulties in this complex learning system about patient safety is activity theory. Thirty-four final year undergraduate medical students participated in four focus groups about their experiences concerning patient safety. Using activity theory as analytical framework, we performed constant comparative thematic analysis of the focus group transcripts to identify important themes. We found eight general themes relating to two activities: learning to be a doctor and delivering safe patient care. Simultaneous occurrence of these two activities can cause contradictions. Our results illustrate the complexity of learning about patient safety at the workplace. Students encounter contradictions when learning about patient safety, especially during a transitional phase of their training. These contradictions create potential learning opportunities which should be used in education about patient safety. Insight into the complexities of patient safety is essential to improve education in this important area of medicine.
证据表明，医疗差错可能会对患者造成伤害，这引起了医疗保健界对患者安全的关注，并影响了医学生学习相关知识的方式和内容。当学生参与临床实践，实际接触到有风险的患者时，患者安全的教学效果最佳。这种学习方式被称为工作场所学习，它是一个复杂的系统，其中各种因素会影响所学内容和学习方式。活动理论是一种可以突出患者安全这一复杂学习系统中潜在困难的理论。34 名即将毕业的本科医学生参加了四个焦点小组，讨论他们在患者安全方面的经验。我们使用活动理论作为分析框架，对焦点小组的记录进行了持续的比较主题分析，以确定重要的主题。我们发现了与两项活动相关的 8 个一般主题：学习成为一名医生和提供安全的患者护理。这两项活动的同时发生可能会导致矛盾。我们的研究结果说明了在工作场所学习患者安全的复杂性。学生在学习患者安全知识时会遇到矛盾，尤其是在培训的过渡阶段。这些矛盾创造了潜在的学习机会，应该在患者安全教育中加以利用。深入了解患者安全的复杂性对于改进这一重要医学领域的教育至关重要。
