Bump Gregory M, Calabria Jaclyn, Gosman Gabriella, Eckart Catherine, Metro David G, Jasti Harish, McCausland Julie B, Itri Jason N, Patel Rita M, Buchert Andrew
J Grad Med Educ. 2015 Mar;7(1):109-12. doi: 10.4300/JGME-D-14-00280.1.
The Accreditation Council for Graduate Medical Education has begun to evaluate teaching institutions' learning environments with Clinical Learning Environment Review visits, including trainee involvement in institutions' patient safety and quality improvement efforts.
We sought to address the dearth of metrics that assess trainee patient safety perceptions of the clinical environment.
Using the Hospital Survey on Patient Safety Culture (HSOPSC), we measured resident and fellow perceptions of patient safety culture in 50 graduate medical education programs at 10 hospitals within an integrated health system. As institution-specific physician scores were not available, resident and fellow scores on the HSOPSC were compared with national data from 29 162 practicing providers at 543 hospitals.
Of the 1337 residents and fellows surveyed, 955 (71.4%) responded. Compared with national practicing providers, trainees had lower perceptions of patient safety culture in 6 of 12 domains, including teamwork within units, organizational learning, management support for patient safety, overall perceptions of patient safety, feedback and communication about error, and communication openness. Higher perceptions were observed for manager/supervisor actions promoting patient safety and for staffing. Perceptions equaled national norms in 4 domains. Perceptions of patient safety culture did not improve with advancing postgraduate year.
Trainees in a large integrated health system have variable perceptions of patient safety culture, as compared with national norms for some practicing providers. Administration of the HSOPSC was feasible and acceptable to trainees, and may be used to track perceptions over time.
毕业后医学教育认证委员会已开始通过临床学习环境评审访问来评估教学机构的学习环境，包括实习生参与机构的患者安全和质量改进工作。
我们试图解决缺乏评估实习生对临床环境患者安全认知的指标这一问题。
我们使用医院患者安全文化调查（HSOPSC），在一个综合医疗系统内的10家医院的50个毕业后医学教育项目中，测量住院医师和研究员对患者安全文化的认知。由于没有特定机构的医生得分，我们将HSOPSC上住院医师和研究员的得分与来自543家医院的29162名执业医生的全国数据进行了比较。
在接受调查的1337名住院医师和研究员中，955人（71.4%）做出了回应。与全国执业医生相比，实习生在12个领域中的6个领域对患者安全文化的认知较低，包括单位内的团队合作、组织学习、对患者安全的管理支持、对患者安全的总体认知、关于错误的反馈和沟通以及沟通开放性。在促进患者安全的经理/主管行为和人员配备方面，认知较高。在4个领域中，认知与全国规范相当。随着研究生年级的升高，对患者安全文化的认知并没有改善。
与一些执业医生的全国规范相比，一个大型综合医疗系统中的实习生对患者安全文化的认知存在差异。HSOPSC的管理对实习生来说是可行且可接受的，并且可用于长期跟踪认知情况。
