Evaluating the Clinical Learning Environment: Resident and Fellow Perceptions of Patient Safety Culture

Abstract

Background 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. Objective We sought to address the dearth of metrics that assess trainee patient safety perceptions of the clinical environment. Methods 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. Results 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. Conclusions 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.

Patient Safety in the Eyes of Aspiring Healthcare Professionals: A Systematic Review of Their Attitudes

“…Of these, 157 studies were excluded for various reasons, such as mismatch with the inclusion criteria, wrong study design (e.g., validation study, quasi-experimental design), mixed population, wrong focus of the study, or full text not available (see Supplementary File 3 ). Finally, 31 studies meeting the inclusion criteria were included [ 13 , 20 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ] (see Supplementary File 4 ).…”

“…Seventeen studies fulfilled at least four of the five quality appraisal criteria [ 22 , 24 , 25 , 26 , 27 , 28 , 30 , 31 , 33 , 35 , 37 , 38 , 39 , 40 , 43 , 45 , 48 ], and five studies met all criteria [ 28 , 35 , 37 , 39 , 45 ].…”

“…Consequently, mean scores of domains assessed by a 7-point Likert scale reflect a more positive/desired attitude if >4, while mean scores measured by a 5-point Likert scale point to a more positive/desired attitude if >3. For the articles using the HSOPSC, for two of the three studies [ 27 , 28 ] the percentages of respondents answering positively were estimated on the basis of the tables presented, which did not show the exact value of the percentages. …”

“…For the articles using the HSOPSC, for two of the three studies [ 27 , 28 ] the percentages of respondents answering positively were estimated on the basis of the tables presented, which did not show the exact value of the percentages.…”

Healthcare Professional’s Perception of Patient Safety Measured by the Hospital Survey on Patient Safety Culture: A Systematic Review and Meta-Analysis

“…One study surveyed the same institution three times on different years [ 37 ]. Thirty-three studies included a variety of professionals, 22 surveyed nursing staff exclusively and one surveyed only physicians [ 73 ]. Four investigations were multi-center studies [ 31 , 35 , 51 , 66 ] (surveys administered at different hospitals in the same country) and three were international multi-center surveys [ 54 , 63 , 64 ].…”