Introduction A patient safety culture (PSC) is a complex phenomenon, representing an essential part of the organizational culture and refers to the shared values, conceptions and beliefs which contribute to the formation and encouragement of safe behavioural models in a health organization. With this study, the authors wanted to delineate the attitude of hospital staff in Bulgaria regarding PSC and to document to whether attitudes differ between physicians and other healthcare professionals (HCPs). Methods A national cross-sectional survey among 384 HCPs was conducted using an online version of the Bulgarian version of Hospital Survey on Patient Safety Culture (B-HSOPSC). The data was analysed with descriptive statistics, non-parametric Mann-Whitney U and x 2 tests. Results The physicians represented 37.50% (144) of the sample and other HCPs 62.50% (240). Respondents from governmental/municipal hospitals prevailed (53.6%). The dimensions “Staffing” and “Non-punitive response to error” were most problematic, as their percentage of positive response rates (PRRs) were lowest. However, “Handoffs and transitions” and “Supervisor/manager expectations and actions promoting safety“ showed the highest mean values in both physicians and other HCPs. From all participants, 76.0% have never reported an adverse event or error. Conclusion The results of the study show that all respondents demonstrate a positive attitude regarding PSC. A comparison of the mean values and that of PRRs in the dimensions did not show any group differences, according to the type of staff position, i.e. physicians or other HCPs.

The study revealed that there was a statistically significant difference in 95% of the cases between anger, hostility in patients with diabetes, hypertension and musculoskeletal disorders. The highest levels of physical aggression were observed in patients with arterial hypertension, M = 17.32 ± 0.86. The highest average levels of verbal aggression were observed in patients with diabetes, M = 15.24 ± 0.64. The highest levels of anger were observed with patients with hypertension, M = 17.96 ± 0.90, and hostility - in patients with hypertension, M = 19.15 ± 0.86. The comparison between the four Aggression Questionnaire scales showed statistically significant differences between the patients with musculoskeletal disorders and the ones with hypertension and diabetes.

E-learning is seen as a possible solution to the problem of modernization of the university education in response to the changing needs of the society. In undergraduate healthcare training, e-learning is implemented predominantly as blended learning in addition to the traditional classroom teaching. A major factor in the success of e-learning are learners' attitudes, beliefs and concerns. The aim of the present study was to investigate undergraduate healthcare students' attitude to e-learning at Medical University -Plovdiv. In this case, e-learning is considered to be electronic educational resources organized as an interactive e-learning unit or course, provided through a learning content management system. The survey was carried out in 2016 through a self-reported questionnaire among 270 first year students from ten healthcare specialties. Participants were asked to express a degree of agreement with nine statements on a five point Likert scale. The influence of gender, age, specialty and previous e-learning experience on the opinion of students was investigated. The results showed that students' attitudes towards e-learning were positive, but learners were not enthusiastic about it. Genders have different views about elearning implementation -women are more likely to accept it. The experience first year students had did not allow them to judge if e-learning supports better time-management or life-long learning skills. Students agreed that implementation of elearning depends on the subjects and there are disciplines that can be provided as distant courses within the learning management system. UDC Classification: 378; DOI: http://dx

Abstract:The training nursing students in the Republic of Bulgaria confirms with the contemporary European requirements. The training is theoretical and practical, with the practical training accounting for at least 50% of the total number of hours in the specialty. The practical training includes clinical practice and pre-graduation traineeship, which complies with the Ordinance on the Unified state requirements regarding the training of nurses. The clinical practice and the pre-graduation traineeship involve a total duration of 2740 hours for students majoring in Nursing (Ordinance on the Unified state requirements). The level of satisfaction of these nursing students is an important indicator of the quality of the practical training. The study involved a sociological method of direct group survey involving an original set of questions with one developed specifically for this survey and others adapted from the questionnaire on job satisfaction of the Institute of Psychology at the Bulgarian Academy of Sciences. This questionnaire on satisfaction comprises 36 statements with three subscales: 1) work organization or organization of the practical training; 2) social-psychological conditions; and 3) material. The approach uses a Likert-type scale from 1 to 4 (1 = "no", 2 = "to a certain extent", 3= "very much", and 4 = "extremely") to score responses. The opinion of 280 fourth-year nursing students from three universities: the Medical University of Plovdiv, Trakia University of Stara Zagora, and 'Prof. Dr. Asen Zlatarov' University of Burgas, is surveyed. The analysis of the results from the conducted empirical survey shows that in their professional activity the surveyed students are primarily motivated by love and care for people (78.8%) followed by the desire to perform an activity that is beneficial to society (63.3%). Then follows the respect on behalf of patients, the team, and society as a whole (52.5%) and subsequently, the emotional attractiveness of the work reflected in the desire to do work that brings pleasure and joy (job satisfaction; 42.4%). The level of student satisfaction with their practical training depends on the organizational-educational, social-psychological, and material and technical conditions of the hospital environment. The analysis of the survey data confirms the significant role of practical training for the professional qualification of these nursing students. However, certain negative trends are also identified. These trends are connected with the satisfaction of the students concerning the procedures they have the opportunity to perform, their relationships with their mentors and medical teams, and that at times they are required to perform inappropriate activities. This calls for increased control on behalf of the tutors.

According to our analysis, contemporary Global Education Politics (GEP) in Medicine is still dominated by a technocratic cognitive framework and content. For this reason we view it crucial to develop a novel educational framework for graduation in medicine with the Person-Centered Care concept implemented within it, as formulated by Juan E Mezzich and informed by the comprehensive assessment and values-based medical practice, developed by Bill (KWM) Fulford. Some of the outstanding training programs in medicine, dentistry and public health are already designed according to this novel approach. Key elements in the curriculum include:Society's Health and Ethics (Ethics and Public Health, pointers of values-based practice, values, evidence and ethics); Health research with a major focus on epistemology and methodology; Personal Life Psychology (life cycles, relationships, cultural diversity, lifestyle planning, stress management); Adverse life events (breaking of bad news, disability, grief and bereavement, euthanasia, suicide); The doctor-patient relationship (patient-centered consultation, problem solving and critical thinking, dealing with uncertainty and professional mistakes).Global medical education may be characterized by progress from facts-based (evidence) to integrative values-and-factsbased clinical education and management. If this is considered with respect to the Bulgarian medical model, which was designed according to German and Russian philosophies in the previous century, then there is a challenging, but nevertheless advantageous opportunity, for a reassessment of the model. In the context of the international movement for person-centered medicine, Bulgarian public health institutions are facing the demand for a proactive adjustment of the medical curriculum with the requirements of the global strategy for an introduction of this model in medical education and postgraduate training.