Merrilyn Walton

Factors affecting the utility of the multiple mini-interview in selecting candidates for graduate-entry medical school

Context  We wished to determine which factors are important in ensuring interviewers are able to make reliable and valid decisions about the non‐cognitive characteristics of candidates when selecting candidates for entry into a graduate‐entry medical programme using the multiple mini‐interview (MMI).

The WHO patient safety curriculum guide for medical schools

Background The urgent need for patient safety education for healthcare students has been recognised by many accreditation bodies, but to date there has been sporadic attention to undergraduate/graduate medical programmes. Medical students themselves have identified quality and safety of care as an important area of instruction; as future doctors and healthcare leaders, they must be prepared to practise safe healthcare. Medical education has yet to fully embrace patient safety concepts and principles into existing medical curricula. Universities are continuing to produce graduate doctors lacking in the patient safety knowledge, skills and behaviours thought necessary to deliver safe care. A significant challenge is that patient safety is still a relatively new concept and area of study; thus, many medical educators are unfamiliar with the literature and unsure how to integrate patient safety learning into existing curriculum. Design To address this gap and provide a foothold for medical schools all around the world, the WHOs World Alliance for Patient Safety sponsored the development of a patient safety curriculum guide for medical students. The WHO Patient Safety Curriculum Guide for Medical Schools adopts a ‘one-stop-shop’ approach in that it includes a teachers manual providing a step-by-step guide for teachers new to patient safety learning as well as a comprehensive curriculum on the main patient safety areas. This paper establishes the need for patient safety education of medical students, describes the development of the WHO Patient Safety Curriculum Guide for Medical Schools and outlines the content of the Guide.

Developing a national patient safety education framework for Australia

Background: In 2004, The Australian Council for Safety and Quality in Health Care recognised that the lack of a comprehensive framework describing competencies for patient safety was a barrier to achieving a competent and safe health workforce. This article describes the building of a national patient safety education framework that describes the competencies for healthcare workers. Aim: Develop an educational framework that was patient centred and identified the knowledge, skills and behaviours required by healthcare workers irrespective of their profession, position or location. Methods: The content of the framework was developed using a four-staged approach: literature review, development of learning areas and topics, classification into learning domains and, lastly, converting into a performance-sbased format. An extensive consultation and validation process was also undertaken. Results: A national patient safety education framework was endorsed by The Australian Council for Safety and Quality in Health Care in 2005. The framework is already being used to develop curricula and train the trainer programmes in patient safety. Conclusions: The framework, which draws its educational approach from adult learning principles, was extensively researched and built on the experience of healthcare workers. The next challenge is to test different strategies for implementing the framework.

Hierarchies: the Berlin Wall of patient safety

To maximise patient safety considerations the medical hierarchy needs to be balanced in favour of teaching and learning rather than the exercise of power

Experiences of the multiple mini-interview: a qualitative analysis

Context  Multiple mini‐interviews (MMIs) are increasingly used in high‐stakes medical school selection. Yet there is little published research about participants’ experiences and understandings of the process. We report the findings from an international qualitative study on candidate and interviewer experiences of the MMI for entry into a graduate‐entry medical school.

Creating a "no blame" culture: have we got the balance right?

There is a need to clarify where and how professional responsibility fits into the “no blame” culture How the media reports patient harm associated with adverse events continues to cause public concern and disturb health professionals. The need for health professionals to communicate more effectively with the public about medical errors has been identified,1,2 but to date there is little evidence of this happening. Tensions surrounding professional responsibility and accountability (as opposed to institutional accountability) and the quality and safety “no blame” approach within the health system prevent health professionals communicating clearly with the public. How can we give a clear message to the public when we do not have a clear understanding of these issues ourselves? The current focus on improving care by redesigning systems, tasks and workforce3 necessarily emphasises the multiple factors underpinning errors, relies on reporting systems for capturing errors, and advocates a “blame free” environment so that staff will report their mistakes or near misses. This approach examines system factors as causes of errors rather than individuals. Evidence from other industries and disciplines supports this approach. The safety agenda requires us to switch from an individual focus to a system focus but, in making this switch, professional accountability has been cast as the “black sheep” of safety improvement. Undeveloped systems of professional accountability, inadequate support from professional bodies for professional regulation, inadequate understanding of public interest, and …

Patient safety and quality of care in developing countries in Southeast Asia: a systematic literature review

OBJECTIVE To establish current knowledge of patient safety and quality of care in developing countries in Southeast Asia, current interventions and the knowledge gaps. STUDY DESIGN Systematic review and narrative synthesis. DATA SOURCES Key words, synonyms and subject headings were used to search seven electronic databases in addition to manual searching of relevant journals. DATA SYNTHESIS Titles and abstracts of publications between 1990 and 2014 were screened by two reviewers and checked by a third. Full text articles were screened against the eligibility criteria. Data on design, methods and key findings were extracted and synthesized. RESULTS Four inter-related safety and quality concerns were evident from 33 publications: (i) the risk of patient infection in healthcare delivery, (ii) medications errors/use, (iii) the quality and provision of maternal and perinatal care and (iv) the quality of healthcare provision overall. CONCLUSIONS Large-scale prevalence studies are needed to identify the full range of safety and quality problems in developing countries in Southeast Asia. Sharing lessons learnt from extensive quality and safety work conducted in industrialized nations may contribute to significant improvements. Yet the applicability of interventions utilized in developed countries to the political and social context in this region must be considered. Strategies to facilitate the collection of robust safety and quality data in the context of limited resources and the local context in each country are needed.

Reducing stress and burnout in junior doctors: the impact of debriefing sessions

Background Internship and residency are difficult times with novice practitioners facing new challenges and stressors. Junior doctors may experience burnout, a syndrome that encompasses three dimensions: emotional exhaustion, depersonalisation and reduced personal accomplishment. While there is some existing literature on the prevalence of burnout in junior doctors, there are few studies on interventional strategies. Aims This study aimed to examine the prevalence of burnout in a cohort of junior doctors and whether debriefing sessions reduced levels of burnout. Methods A prospective randomised controlled study of a convenience sample of postgraduate year 1 doctors in a single hospital was undertaken during a rotation term in 2011. All participants completed a questionnaire using a validated tool, the Maslach Burnout Inventory, to determine the prevalence of burnout. They were then randomly assigned to a group who were to receive four debriefing sessions over 2 months, or, to the control group, who had no debriefing sessions. Quantitative and qualitative analyses were conducted. Results Thirty-one postgraduate year 1 doctors participated in the study, with 13 being assigned to the group receiving debriefing sessions and 18 assigned to the control group. At baseline, 21/31 (68%) participants displayed evidence of burnout in at least one domain as measured by the Maslach Burnout Inventory. Burnout was significantly higher in women. There was no significant difference in burnout scores with debriefing. The intervention was well received with 11/18 (61%) suggesting they would recommend the strategy to future junior doctors and 16/18 (89%) found that the sessions were a source of emotional and social support. Conclusions Burnout is prevalent among postgraduate year 1 doctors, and they value the emotional and social support from attending debriefing sessions. A larger study is required to determine if debriefing can reduce the incidence of burnout in junior doctors.

Teaching patient safety to clinicians and medical students

T here is strong consensus about the need to improve quality and safety in health care by improving the health service design and focusing on health care delivery. The agenda, now worldwide, includes educating the health workforce about patient safety. How can clinical educators manage this demand for new knowledge and skills? Clinical teachers need to become acquainted with the literature and integrate patient safety learning into existing educational and training programmes. This paper describes how the Australian National Patient Safety Education Framework (ANPSEF) can be used to develop such programmes for students and clinicians, using a learning topic from the NPSEF. The Framework is freely available from the website.

Psychological morbidity in Australian doctors who have and have not experienced a medico-legal matter: cross-sectional survey.

Objective: To describe the differences in psychological morbidity between Australian general practitioners (GPs) who have experienced a medico-legal matter and those who have not. Methods: A total of 1499 GPs were initially invited to participate in the study. Two hundred and sixty requested not to participate, with 1239 subsequently being sent a survey. There were 566 respondents (45.7% response rate to survey). There were two sources of data. First, a cross-sectional survey sought demographic information, personality traits via the Eysenck Personality Questionnaire (EPQ), history of a medico-legal matter with any medical defence organization, and measures of psychological morbidity, including the General Health Questionnaire (GHQ), Sheehan Disability Scale (SDS), and Alcohol Use Disorders Identification Test. Second, information was extracted from the United Medical Protection database on medico-legal matters. Results: Fifty-nine per cent of respondents to the survey reported ever having a medico-legal matter, with 13% having a current medico-legal matter. Those with a current matter reported increased levels of disability (in work, social or family life) and higher prevalence of psychiatric morbidity (45% vs 27% GHQ ‘case identification’ rates), compared to those with no current matter. Those respondents with a history of past medico-legal matters reported increased levels of disability (SDS) and depression subscores (GHQ). Male respondents drank significantly more alcohol than female respondents, and male respondents with current or past medico-legal matters had significantly higher levels of alcohol use than male respondents with no experience of medico-legal matters. Conclusions: Doctors who have current and past medico-legal matters have a higher level of psychological morbidity. The study design was unable to distinguish cause or effect. A longitudinal study is planned to investigate this. The findings have significant implications for medical training, doctor support systems and medical insurance groups.