Department of Plastic and Reconstructive Surgery, University Hospitals Leicester NHS Trust, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, UK.
BMJ Qual Saf. 2013 Jan;22(1):65-71. doi: 10.1136/bmjqs-2012-001009. Epub 2012 Aug 10.
Engagement of junior doctors in patient safety initiatives is high on the national agenda, but there is a lack of studies evaluating patient safety attitudes among junior doctors.
The Junior Doctor-Patient Safety Attitudes and Climate Questionnaire is a multidimensional scale created using items from already-validated scales and inclusion of new items based on further review. It consists of three subscales: 'knowledge and training' (10 items), 'attitudes to patient safety' (15 items) and 'perception of workplace safety climate' (15 items). This was disseminated to foundation trainees, general practice trainees and hospital core and speciality trainees via the Deanery distribution lists and responses were collected anonymously.
A total of 527 complete responses were collected; although self-declared knowledge in patient safety concepts was high, there was less declared understanding of a 'high reliability organisation' (74% no/unsure) and the concept of active failures/latent conditions (60% no/unsure). The greatest agreement was demonstrated for the statement 'Even the most experienced and competent doctors make errors' (p<0.01). However, more senior trainees and surgical trainees (vs medical trainees) demonstrated greater agreement with 'Medical error is a sign of incompetence' (p<0.01). More junior trainees demonstrated greater agreement with 'Management is more interested in meeting performance targets than focusing on patient safety issues' (p<0.01).
This study demonstrates subtle differences in attitudes to patient safety among junior doctors of different grades and specialities. These should be taken into account when designing interventions to improve patient safety education and culture among junior doctors.
初级医生参与患者安全计划在国家议程中占有重要地位，但缺乏评估初级医生患者安全态度的研究。
《初级医生-患者安全态度与气候问卷》是一种多维量表，使用已经验证的量表中的项目创建，并根据进一步的审查纳入新的项目。它由三个分量表组成：“知识和培训”（10 个项目）、“对患者安全的态度”（15 个项目）和“对工作场所安全气候的感知”（15 个项目）。该问卷通过Deanery 分发清单分发给基础培训生、全科培训生和医院核心及专科培训生，回复是匿名收集的。
共收集到 527 份完整回复。尽管自我宣称对患者安全概念的知识很高，但对“高可靠性组织”的理解较少（74%的人表示不知道/不确定），对主动失误/潜在条件的理解也较少（60%的人表示不知道/不确定）。对于“即使是最有经验和最有能力的医生也会犯错”这一说法，达成了最大的共识（p<0.01）。然而，更多的高级培训生和外科培训生（与医学培训生相比）更同意“医疗错误是无能的标志”这一说法（p<0.01）。更年轻的培训生更同意“管理层更关注绩效目标，而不是关注患者安全问题”这一说法（p<0.01）。
这项研究表明，不同级别和专业的初级医生对患者安全的态度存在细微差异。在设计旨在提高初级医生患者安全教育和文化的干预措施时，应考虑到这些差异。
