Department of Postgraduate General Practice Education, NHS Education for Scotland, 2 Central Quay, Glasgow, UK, G3 8BW.
BMC Fam Pract. 2012 Jun 21;13:62. doi: 10.1186/1471-2296-13-62.
Making health care safer is a key policy priority worldwide. In specialty training, medical educators may unintentionally impact on patient safety e.g. through failures of supervision; providing limited feedback on performance; and letting poorly developed behaviours continue unchecked. Doctors-in-training are also known to be susceptible to medical error. Ensuring that all essential educational issues are addressed during training is problematic given the scale of the tasks to be undertaken. Human error and the reliability of local systems may increase the risk of safety-critical topics being inadequately covered. However adherence to a checklist reminder may improve the reliability of task delivery and maximise harm reduction. We aimed to prioritise the most safety-critical issues to be addressed in the first 12-weeks of specialty training in the general practice environment and validate a related checklist reminder.
We used mixed methods with different groups of GP educators (n=127) and specialty trainees (n=9) in two Scottish regions to prioritise, develop and validate checklist content. Generation and refinement of checklist themes and items were undertaken on an iterative basis using a range of methods including small group work in dedicated workshops; a modified-Delphi process; and telephone interviews. The relevance of potential checklist items was rated using a 4-point scale content validity index to inform final inclusion.
14 themes (e.g. prescribing safely; dealing with medical emergency; implications of poor record keeping; and effective & safe communication) and 47 related items (e.g. how to safety-net face-to-face or over the telephone; knowledge of practice systems for results handling; recognition of harm in children) were judged to be essential safety-critical educational issues to be covered. The mean content validity index ratio was 0.98.
A checklist was developed and validated for educational supervisors to assist in the reliable delivery of safety-critical educational issues in the opening 12-week period of training, and aligned with national curriculum competencies. The tool can also be adapted for use as a self-assessment instrument by trainees to guide patient safety-related learning needs. Dissemination and implementation of the checklist and self-rating scale are proceeding on a national, voluntary basis with plans to evaluate its feasibility and educational impact.
保障医疗安全是全球范围内的一项重要政策重点。在专科培训中，医学教育者可能会无意间影响患者安全，例如监督不力、对绩效提供的反馈有限，以及放任不良行为继续存在而不加检查。受训医生也容易发生医疗差错。考虑到要完成的任务规模，确保在培训期间解决所有基本教育问题是有问题的。人为错误和当地系统的可靠性可能会增加安全关键主题覆盖不足的风险。然而，坚持使用清单提醒可能会提高任务交付的可靠性，并最大限度地减少减少伤害。我们的目的是确定在普通科医学培训的头 12 周内需要解决的最关键的安全问题，并验证相关的清单提醒。
我们使用混合方法，在苏格兰的两个地区，使用不同的普通科医生教育者（n=127）和专科受训者（n=9）群体，对清单内容进行优先级排序、开发和验证。通过一系列方法（包括在专门研讨会上进行小组工作、修改后的德尔菲法和电话访谈），对清单主题和项目进行迭代生成和改进。使用 4 分制内容有效性指数对潜在清单项目的相关性进行评分，以确定最终纳入内容。
确定了 14 个主题（例如安全用药、处理医疗紧急情况、记录保存不佳的影响以及有效和安全的沟通）和 47 个相关项目（例如如何通过电话或面对面进行安全网诊、了解实践系统处理结果的方法、识别儿童伤害），这些都是在培训的头 12 周内需要涵盖的关键安全教育问题。内容有效性指数的平均值为 0.98。
开发并验证了一份清单，供教育主管使用，以协助在培训的头 12 周内可靠地交付关键安全教育问题，该清单与国家课程能力相一致。该工具还可以改编为受训者使用的自我评估工具，以指导与患者安全相关的学习需求。正在全国范围内自愿传播和实施该清单和自我评估量表，并计划评估其可行性和教育影响。
