Lukela Michael P, Parekh Vikas I, Gosbee John W, Purkiss Joel A, Valle John Del, Mangrulkar Rajesh S
J Grad Med Educ. 2011 Sep;3(3):360-6. doi: 10.4300/JGME-D-10-00164.1.
The need to provide efficient, effective, and safe patient care is of paramount importance. However, most physicians receive little or no formal training to prepare them to address patient safety challenges within their clinical practice.
We describe a comprehensive Patient Safety Learning Program (PSLP) for internal medicine and medicine-pediatrics residents. The curriculum is designed to teach residents key concepts of patient safety and provided opportunities to apply these concepts in the "real" world in an effort to positively transform patient care. Residents were assigned to faculty expert-led teams and worked longitudinally to identify and address patient safety conditions and problems. The PSLP was assessed by using multiple methods.
Resident team-based projects resulted in changes in several patient care processes, with the potential to improve clinical outcomes. However, faculty evaluations of residents were lower for the Patient Safety Improvement Project rotation than for other rotations. Comments on "unsatisfactory" evaluations noted lack of teamwork, project participation, and/or responsiveness to faculty communication. Participation in the PSLP did not change resident or faculty attitudes toward patient safety, as measured by a comprehensive survey, although there was a slight increase in comfort with discussing medical errors.
Development of the PSLP was intended to create a supportive environment to enhance resident education and involve residents in patient safety initiatives, but it produced lower faculty evaluations of resident for communication and professionalism and did not have the intended positive effect on resident or faculty attitudes about patient safety. Further research is needed to design or refine interventions that will develop more proactive resident learners and shift the culture to a focus on patient safety.
提供高效、有效且安全的患者护理至关重要。然而，大多数医生几乎没有接受过正式培训，无法让他们在临床实践中应对患者安全挑战。
我们描述了一个针对内科和内科 - 儿科住院医师的全面患者安全学习计划（PSLP）。该课程旨在教授住院医师患者安全的关键概念，并提供在“现实”世界中应用这些概念的机会，以积极改变患者护理。住院医师被分配到由教师专家领导的团队，并长期合作以识别和解决患者安全状况及问题。通过多种方法对PSLP进行评估。
基于住院医师团队的项目导致了几个患者护理流程的改变，有可能改善临床结果。然而，与其他轮转相比，患者安全改进项目轮转的教师对住院医师的评价较低。关于“不满意”评价的意见指出缺乏团队合作、项目参与度和/或对教师沟通的响应性。通过一项综合调查衡量，参与PSLP并未改变住院医师或教师对患者安全的态度，尽管在讨论医疗差错时的舒适度略有增加。
PSLP的开发旨在营造一个支持性环境，以加强住院医师教育并让住院医师参与患者安全倡议，但它导致教师对住院医师在沟通和专业素养方面的评价较低，并且对住院医师或教师对患者安全的态度没有产生预期的积极影响。需要进一步研究来设计或完善干预措施，以培养更积极主动的住院医师学习者，并将文化转变为关注患者安全。
