Holderried Friederike, Heine Daniel, Wagner Robert, Mahling Moritz, Fenik Yelena, Herrmann-Werner Anne, Riessen Reimer, Weyrich Peter, Zipfel Stephan, Celebi Nora
University of Tuebingen, Medical School, Office of the Dean of Student Affairs, Tuebingen, Germany.
University Hospital of Tuebingen, Department for Anaesthesiology, Tuebingen, Germany.
PLoS One. 2014 Feb 20;9(2):e89198. doi: 10.1371/journal.pone.0089198. eCollection 2014.
Patient chart review is the gold standard for detection of potential patient hazards (i.e. medication errors or failure to follow up actionable results) in both routine clinical care and patient safety research. However, advanced medical students' ability to read patient charts and to identify patient hazards is rather poor. We therefore investigated whether it is possible to teach advanced medical students how to identify patient hazards independent of context (i.e. cancer versus cardiac failure) in patient charts.
All fifth-year medical students in one semester (n = 123) were randomized into two groups. One group (IC) received a patient chart review-training first and then a control-intervention and the other group (CI) received the control-intervention first and then the patient chart review-training. Before and after the teaching sessions, students reviewed different scenarios with standardized fictional patient charts containing 12 common patient hazards. Two blinded raters rated the students' notes for any patient hazard addressed in the notes using a checklist. The students were blinded to the study question and design. There was no external funding and no harm for the participating students.
A total of 35 data sets had to be excluded because of missing data. Overall, the students identified 17% (IQR 8-29%) of the patient hazards before the training and 56% (IQR 41-66%) of the patient hazards after the training. At the second assessment students identified more patient hazards than at the first. They identified even more in the third. The effect was most pronounced after the patient chart review training (all p<.01).
Patient chart review exercises and problem-based patient chart review training improve students' abilities to recognize patient hazards independent of context during patient chart review.
在常规临床护理和患者安全研究中，查阅患者病历是检测潜在患者风险（即用药错误或未对可采取行动的结果进行跟进）的金标准。然而，高年级医学生阅读患者病历并识别患者风险的能力相当差。因此，我们调查了是否有可能教授高年级医学生如何在不考虑背景（即癌症与心力衰竭）的情况下识别患者病历中的患者风险。
将一个学期内的所有五年级医学生（n = 123）随机分为两组。一组（IC）先接受患者病历审查培训，然后接受对照干预，另一组（CI）先接受对照干预，然后接受患者病历审查培训。在教学课程前后，学生们使用标准化的虚构患者病历复习不同的场景，这些病历包含12种常见的患者风险。两名盲评者使用清单对学生笔记中提到的任何患者风险进行评分。学生们对研究问题和设计不知情。没有外部资金，且对参与的学生没有危害。
由于数据缺失，共排除35个数据集。总体而言，学生们在培训前识别出17%（四分位距8 - 29%）的患者风险，培训后识别出56%（四分位距41 - 66%）的患者风险。在第二次评估时，学生们识别出的患者风险比第一次更多。他们在第三次评估时识别出的更多。在患者病历审查培训后效果最为显著（所有p <.01）。
患者病历审查练习和基于问题的患者病历审查培训可提高学生在查阅患者病历时独立于背景识别患者风险的能力。
