Using Clinical Scenarios to Teach Patient Safety

Introduction: The Canadian Medical Education Directives for Specialists (CanMEDS) framework defines the competencies that postgraduate medical education programs must cover for resident physicians. The 2015 iteration of the CanMEDS framework emphasizes Quality Improvement and Patient Safety (QIPS), given their role in the provision of high value and cost-effective care. However, the opinion of Emergency Medicine (EM) program directors (PDs) regarding the need for QIPS curricula is unknown, as is the current level of knowledge of EM residents in QIPS principles. We therefore sought to determine the need for a QIPS curriculum for EM residents in a Canadian Royal College EM program. Methods: We developed a national multi-modal needs assessment. This included a survey of all Royal College EM residency PDs across Canada, as well as an evaluative assessment of baseline QIPS knowledge of 30 EM residents at the University of Toronto (UT). The resident evaluation was done using the validated Revised QI Knowledge Application Tool (QIKAT-R), which evaluates an individual’s ability to decipher a systematic quality problem from short clinical scenarios and to propose change initiatives for improvement. Results: Eight of the 13 (62%) PDs responded to the survey, unanimously agreeing that QIPS should be a formal part of residency training. However, challenges identified included the lack of qualified and available faculty to develop and teach QIPS material. 30 of 30 (100%) residents spanning three cohorts completed the QIKAT-R. Median overall score was 11 out of 27 points (IQR 9-14), demonstrating the lack of poor baseline QIPS knowledge amongst residents. Conclusion: QIPS is felt to be a necessary part of residency training, but the lack of available and qualified faculty makes developing and implementing such curriculum challenging. Residents at UT consistently performed poorly on a validated QIPS assessment tool, confirming the need for a formal QIPS curriculum. We are now developing a longitudinal, evidence-based QIPS curriculum that trains both residents and faculty to contribute to QI projects at the institution level.

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Pharmacology for the prehospital professional

Australasian Journal of Paramedicine ◽

10.33151/ajp.7.2.157 ◽

2009 ◽

Vol 7 (2) ◽

Author(s):

Bill Lord

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Patient Safety ◽

Problem Solving ◽

Drug Administration ◽

Legal Aspects ◽

Safety Issues ◽

Clinical Syndromes ◽

Clinical Scenarios ◽

Clinical Problems

“Pharmacology for the prehospital professional” is a US text that claims to use a problem-solving approach to drug administration using clinical scenarios. The book begins with a brief summary of pharmacokinetic and pharmacodynamic principles, discusses legal aspects of drug administration, and describes drug administration procedures and patient safety issues. Following chapters then describe management of clinical problems under specific clinical syndromes such as anaphylaxis and congestive heart failure. Each chapter presents a brief clinical vignette before outlining the pathophysiology of the case. Management of the case follows, and this includes discussion of drugs commonly used to manage the condition.

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The Role and Validity of Surgical Simulation

International Surgery ◽

10.9738/intsurg-d-14-00004.1 ◽

2015 ◽

Vol 100 (2) ◽

pp. 350-357 ◽

Cited By ~ 69

Author(s):

Riaz A. Agha ◽

Alexander J. Fowler

Keyword(s):

Patient Safety ◽

Surgical Simulation ◽

Patient Centered ◽

Training Time ◽

Clinical Scenarios ◽

Key Skills ◽

The Hours ◽

Competency Based ◽

Training Schemes ◽

Laparoscopic Techniques

In the last three decades, simulation has become a key tool in the training of doctors and the maintenance of patient safety. Simulation offers an immersive, realistic way of learning technical skills. Recent changes to the training schemes in many surgical specialities mean that the hours spent working between senior house officer and consultant have been reduced. This, combined with other pressures (such as reduced operating hours), means that surgery has moved away from its traditional apprenticeship model and toward a competency-based one. Simulation can be a standardized and safe method for training and assessing surgeons. Use of simulation for training has become significant alongside the development of laparoscopic techniques, and evidence suggests that skills obtained in simulation are applicable in real clinical scenarios. Simulation allows trainees to make mistakes, to ask the “what if?” questions, and to learn and reflect on such situations without risking patient safety. Virtual reality simulators have been used to allow experts to plan complicated operations and assess perioperative risks. Most recently, fully immersive simulations, such as those with whole theater teams involved, and patient-centered simulations allow development of other key skills aside from purely technical ones. Use of simulation in isolation from traditional teaching methods will furnish the surgeon in training with skills, but the best time and place to use such skills comes only with experience. In this article we examine the role of simulation in surgical training and its impact in the context of reduced training time.

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Why is patient safety a challenge? Insights from the Professionalism Opinions of Medical Students (PoMS) Research

10.1101/2021.07.20.21260739 ◽

2021 ◽

Author(s):

paul mcgurgan ◽

katrina Calvert ◽

Kiran Narula ◽

Elizabeth Nathan ◽

Tony Celenza ◽

...

Keyword(s):

Patient Safety ◽

Medical Student ◽

Medical Students ◽

Identity Formation ◽

Medical Doctors ◽

Cross Sectional Survey ◽

Cross Sectional ◽

The Public ◽

Clinical Scenarios ◽

Gender And Age

Introduction Despite increased emphasis on education and training for patient safety in medical schools, there is little known about factors influencing decision making regarding patient safety behaviours. This study examined the nature and magnitude of factors which may influence opinions around patient safety related behaviours as a means of providing insights into how Australian doctors and medical students view these issues relative to members of the public. Methods A national, multicentre, prospective, online cross sectional survey was conducted using responses to hypothetical clinical scenarios. Three cohorts were surveyed Australian enrolled medical students, medical doctors and members of the public. Participant responses were compared for the different contextual variables within the scenarios and the participants demographic characteristics student, doctor, member of the public, gender and age (if public or doctors)/ seniority in the course (if a medical student). Results In total there were 2602 medical student participants, 809 doctors and 503 members of the Australian public. Medical doctors were more likely than other cohorts to have statistically significant differences in how they viewed the acceptability of patient safety related behaviours; doctors were more tolerant of medical students not reporting concerning behaviours. Medical students opinions frequently demonstrated a transition effect, bridging between the doctors and publics attitudes, consistent with professional identity formation. Conclusions Opinions on the acceptability of medical students patient safety related behaviours were influenced by the demographics of the cohort and the contextual complexity of the scenario. Although the survey used hypothetical scenarios, doctors and medical students opinions appear to be influenced by cognitive dissonances, biases and heuristics which may negatively affect patient safety.

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Impact analysis of clinical scenarios on patient safety culture in obstetrical environment: An intervention study in Sousse, Tunisia

Revue d Épidémiologie et de Santé Publique ◽

10.1016/j.respe.2018.05.503 ◽

2018 ◽

Vol 66 ◽

pp. S420-S421

Author(s):

S. Fredj ◽

M. Ben Rejeb ◽

A. Ben Chikh ◽

H. Ghali ◽

S. Khefacha ◽

...

Keyword(s):

Patient Safety ◽

Safety Culture ◽

Impact Analysis ◽

Intervention Study ◽

Patient Safety Culture ◽

Clinical Scenarios

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Letter to the Editor: The Continuing Challenge of Evaluating RSD Impairment and Disability

Guides Newsletter ◽

10.1001/amaguidesnewsletters.1998.sepoct05 ◽

1998 ◽

Vol 3 (5) ◽

pp. 8-10

Author(s):

Robert L. Knobler ◽

Charles N. Brooks ◽

Leon H. Ensalada ◽

James B. Talmage ◽

Christopher R. Brigham

Keyword(s):

Disability Evaluation ◽

Body Part ◽

Loss Of Function ◽

Regulatory Requirements ◽

Major Cardiac Event ◽

Clinical Scenarios ◽

Impairment Score ◽

Occupational Activities ◽

The Difference

Abstract The author of the two-part article about evaluating reflex sympathetic dystrophy (RSD) responds to criticisms that a percentage impairment score may not adequately reflect the disability of an individual with RSD. The author highlights the importance of recognizing the difference between impairment and disability in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides): impairment is the loss, loss of use, or derangement of any body part, system, or function; disability is a decrease in or the loss or absence of the capacity to meet personal, social, or occupational demands or to meet statutory or regulatory requirements because of an impairment. The disparity between impairment and disability can be encountered in diverse clinical scenarios. For example, a person's ability to resume occupational activities following a major cardiac event depends on medical, social, and psychological factors, but nonmedical factors appear to present the greatest impediment and many persons do not resume work despite significant improvements in functional capacity. A key requirement according to the AMA Guides is objective documentation, and the author agrees that when physicians consider the disability evaluation of people, more issues than those relating to the percentage loss of function should be considered. More study of the relationships among impairment, disability, and quality of life in patients with RSD are required.

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