INTRODUCTION or talk about adverse events and medical errors

INTRODUCTION Patientsafety is an important element of health care and can be defined as freedom fora patient from unnecessary harm or potential harm related with health care.

Everyyear, a number of patients suffer injuries or die because of unsafe and poorquality health care. Most of these injuries are avoidable.  Thechallenges for patient safety in health care are lack of safety culture andattitudes that overlook basic safety rules for both the patient as well as thehealth-care professional. Health-care professionals are reluctant to report ortalk about adverse events and medical errors for fear of blaming, embarrassment,punishment. Moreover, there is underreporting of adverse events and medicalerror. The WorldHealth Organization (WHO) has strategies for safer health care by placing thepatient at the centre through developing guidelines and tools, and buildingcapacity.  The patient safety educationprogram was established in 2009 to support the education and training ofmedical professionals and students in quality improvements and patient safety.  Medicalstudents are the future medical care providers and they need to understand howsystems affect the quality and safety of healthcare and must prepare themselvesto practice care safely.

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The WorldHealth Organization (WHO) has developed a Patient Safety Curriculum Guide formedical students to help them meet this future challenge. The medical patientsafety curriculum guide builds patient safety knowledge and capacity topractice safely1 In Indonesia,curriculum on patient safety has implemented on 18 medical faculties since 2012according to the WHO Standard.  Even tough, curriculum on patient safetyfor other healthcare professionals has not developed yet. There were also aguide how to integrate patient safety into medical school curriculum. It willenable and encourage medical school to include patient safety in their course. However,very few studies has been investigated of undergraduate medical studentattitude to patient safety.

The aim of this study was to assess undergraduatemedical students’ attitudes to patient safety issue and their interest ineducation related to patient safety. METHODThecross-sectional survey was conducted at the Faculty of Medicine, Universitas Yarsi,in 2017. A structured and anonymous self-administered questionnaire was handedto medical students including preclinical and clinical undergraduate students.The questionnaire having 15 items related to patient safety issues was adaptedfrom one used in an earlier study. Those who volunteered were included. No samplesize calculation was done. The first 4items in the questionnaire were about students’ perceptions about the causes ofmedical errors, the second 6 items were about management of medical error andthe last 4 items addressed their views on inclusion of patient safety educationin medical curriculum.

Grading of responses was done using a 5-point ordinalscale where 1=strongly disagree and 5= strongly agree. The mainoutcome measures were students’ attitudes about patient safety issues and theirattitude to the teaching of patient safety curriculum. Data was analysed usingSPSS 20. Frequency and percentage was used to report categorical data.Chi-square was used to find out significant difference between the responses ofdifferent groups of students, with p<0.05 being significant. RESULTS AND DISCUSSIONAll 519 participants responded. For the purpose ofreporting we combined the responses of 'agreed' and 'strongly agreed' to reportthem as 'agreed', while 'disagreed' and strongly disagreed' were togetherreported as 'disagreed'.

 In the following summary our findings, for easeof presentation, the term “majority” was defined as “greater than 50% ofrespondents”.  Items 1 to 4 were aimed at addressing students’knowledge regarding medical errors. Medical error is a complex issue, but erroritself is an inevitable part of the patient condition. However, it can beavoided. To achieve this, medical students must learn from past errors, andlearn how to prevent future errors (WHO, 2009).

Although majority of students were correct in thinkingthat medical errors are inevitable, about a quarter neutral with this andapproximately 13% remained disagree. By giving the teaching of patient safetyeven in short lecture, the student awareness about inevitable of medical error willimprove (Leung, 2010). Half agreed that best care is not always provided topatients (263; 50.67%). The results were similar to the findings of Leung(2010), Shah (2015), and Nabilou (2015). Majority of students thought competentphysicians do not make errors (391; 75.34%). For item 4, a significant numberof students thought most errors are not related to physicians (249; 47.

98%) andthis misconception was more among preclinical students (212; 51.08%) than clinicalstudents (37; 35.58%) (p value =0.006) (Table-2).

 The concernsof patient safety are worldwide, and it is widely recognized that medical errors,adverse events, and near miss events are considerably underreported. Items 5 to8 were related to perceptions about reporting of medical errors (Table 1). Itwas encouraging that majority of students thought medical errors should bereported (306; 58.96%) and moreover they said there is need to report a nearmiss event (380; 73.22%) thus will have a chance to learn from those cases. Medicalcommunity may not want a doctor especially medical student to speak in view ofthe risk of litigation, and also to remain quiet and defend other doctors whomake mistakes.

By learn fromerror, student will realize that blaming people does not work, and that ifpeople fear being blamed no one will report or learn from the event. Reportingincidents and adverse events is also a systematic way of gathering informationabout the safety and quality of care. Almost half numberof students disagreed that only physicians can determine the causes of medicalerror (249; 47.98%). Medical error occur not because patients intentionallyhurt by bad people but rather that the system of health care today is socomplex that the successful treatment and outcome for each patient depends on manyfactors, not just the competence of physicians. When so many people and differenttypes of health-care providers (doctors, pharmacists, nurses, laboratory staffsand others) are involved this makes it very difficult to ensure safe care,unless the system of care is designed to facilitate timely and complete informationand understanding by all the health professionals.

 More than one-third students thought reporting systemswill reduce medical errors (205; 39.5%). An incident-reporting system is animportant component of an organization’s ability to learn from error. Most ofhealth facilities e.g. hospitals will have a reporting system to identifyadverse events. It is important that students are aware of these events. Studentsshould seek information on the reporting system used in the hospital where theyare practicing or placed.

Students should be familiar with the system in placeand seek information about how to report an incident.  The vastmajority agreed that errors can be prevented by working hard and being morecareful (490; 94.41%). In contrary, evidence shows that thetraditional “perfectibility” model which assumed that errors can be avoidedby being careful enough and working hard can be dangerous as the major contributingfactor for adverse events is the human.    Near half saidthat uncertainty should not be tolerated in patient care and culture ofmedicine was supportive for dealing with errors (257; 49.52 %). They need tounderstand the culture of their workplace, and how it impacts upon team functioning.Discussions about medical errors are difficult for doctors in all cultures.

Openness to learning from errors will often depend on the personalities of the seniorpeople. In some cultures and hospitals, openness about errors may be new and soit will be very difficult for doctors. In these cases, it may be appropriatefor the students to talk about errors in a student teaching session.