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This systematic review explored the perceptions and experiences of students raising concerns during pre-registration health and/or social care training in England. Speaking up and raising concerns as a pre-registration student is a complex, multi-faceted and non-linear social phenomenon. Experiences and perceptions are impacted by the novice student position alongside individual, interpersonal and organisational factors. Open cultures within teams and organisations, leadership, support and feedback may enable students overcome barriers to raising concerns. Raising concerns may reduce avoidable harm. Pre-registration students offer a ‘fresh pair of eyes’; however, they face barriers related to their student position. Synthesis of speaking-up experiences and perceptions of students in English settings can inform the design of learning environments which equip pre-registration students with the knowledge and skills required to cultivate safety behaviours. These skills contribute positively to safety culture and support learning and improvement in complex systems such as health and social care.- Posted
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In this LinkedIn post, Helen Vosper highlights the new Human Factors for patient safety course at Aberdeen University.- Posted
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On Wednesday 19 March 2025, over 280 healthcare staff in England attended the first ever Patient Safety Specialists event to celebrate completion of the National Patient Safety Syllabus training. Claire Morgan, Patient Safety Specialist, Royal London Hospital, Barts Health NHS Trust, reflects on the day. Over 280 healthcare staff in England attended the first ever Patient Safety Specialists (PSSs) event to celebrate completion of the National Patient Safety Syllabus training. With a further 203 graduates across England, these were the first ever cohort of PSSs to have passed the NHS Patient Safety Syllabus Levels 3 and 4. This historical event was held at Hollywell Park Conference Centre on the impressive campus of Loughborough University in the heart of Leicestershire. The sun shone and, despite the Government’s announcement to dissolve NHS England (NHSE) the week before, many of the delegates saw true reason to celebrate with this first event driving patient safety in England. The Faculty at Loughborough, headed by Professor Mike Fray, celebrated with us our success and a welcome introduction was given by Professor Nick Jennings the Vice Chancellor of Loughborough University. Lessons shared To start the morning, Professor Sue Hignett shared the insights from almost 500 PSSs’ videos that had been submitted as our final coursework. Lessons shared included: Changing the safety approach in terms of Safety II and human factors and ergonomics (HFE) principles. Embedding the Just Restorative Culture. Using safety science tools. Developing and using common language. Engaging with Patient Safety Partners. Promoting the PSSs. Considering IT design and usability. Procuring and designing medical devices and buildings. Applying the 'hierarchy of controls' for actions. Reviewing policies, procedures, guidelines using safety science tools. In addition, pre-event survey results collected from the delegates included an impressive array of ideas on what support they need, including: Future continuing professional development (CPD). Formation of a support network. Governance and advocacy on roles of PSS for organisations. Their ideas for the next steps included: Application of learning in sharing knowledge. PSS role development and recognition. Culture and practice. System level collaboration impact. Reflections on the course Presenting next were six PSSs, chosen from different healthcare sectors, to reflect on the course in terms of take-aways, personal growth and organisational impact, including threats and opportunities. I was asked to present on behalf of an Acute Trust and my organisation the Royal London Hospital, Barts Health Trust. With similarities to the other presenters, I extolled the virtue of the practical nature of the Loughborough course, affording participants the opportunity to the test the tools and methods that we had been introduced to throughout the five courses. Personal growth was often focussed on with the unique PSS network and ‘specialist’ expertise now gained. The impact, including opportunities and challenges on the variety of organisations operating within the varied and complex socioeconomic healthcare system that we work in, became apparent. Professor Thomas Jun then gave the opportunity for section-specific smaller group discussions. Delegates agreed that undertaking the Levels 3 and 4 of the Patient Safety Syllabus was no mean feat for most participants. The course adopted a blended learning approach of 100 hours online and five in-person days delivered conveniently around the country. There were five courses, with a number of modules, and six assignments applied to ‘Wicked’ problems to submit, requiring application of tools and methods introduced. Appointment of at least one PSS is a requirement for NHS organisations in England. Once nominated by our Chief Executive Officers (CEOs), we started the course in November 2023 working towards a deadline of December 2024, with many of us admitting to spending much of our own time working towards the goal. Most of us will never forget the legendary hospitality and encouragement of the Loughborough Faculty and those at the Health Service Safety Investigations Body (HSSIB) on the five in-person days of the course. Looking forward After a welcome lunch at Hollywell House, we were invited to explore future opportunities in PSS training both from Ben Peachey, CEO at the Chartered Institute in Ergonomics and Human Factors, and Professor Mike Fray at Loughborough. Dr Robert Pralat who has been conducting research into the role of Patient Safety Partners and Specialists updated us on the NIHR research led by THIS institute at the University of Cambridge. Finally, a discussion panel facilitated by Thomas was convened between Professor Ramani Moonesinghe (the interim NHSE Patient Safety Director), Dr Helen Vosper (HSSIB education team), Helen Keynes (Head of Quality and Patient Safety at NHSE) and Professor Jay Banerjee (Emergency Physician and Quality Improvement Fellow Leicester). This allowed interesting and thought provoking discussion on the future of patient safety. Professor Mike Fray finished the day with a running display of the 483 PSSs' names to a positive music accompaniment bringing finale to a great day. Personal reflections I personally see PSSs as the golden thread of patient safety throughout England and these 483 PSSs should be encouraged to take this movement forward by whatever replaces NHSE. They must lead, challenge and champion patient safety in their organisations and beyond. The benefit of improving patient safety is supported by science, with patients at the forefront; Martha’s Rule empowers patients, their parents and carers to challenge where concerns are not listened to. The impact of compassionate engagement of the Patient Safety Incident Response Framework (PSIRF) for patients and staff involved in patient safety incidents from personal perspectives must be spearheaded. The value of organisational cultural benefits and reputations, along with the potential financial impact of improving patient safety in healthcare, cannot be underestimated. Finally, thank you Aidan Fowler, the previous Director of Patient Safety at NHSE, and all those at NHSE involved in writing the Patient Safety Strategy in 2019, which introduced the National Patient Safety Syllabus and the concept of a PSS. I also want to thank the authors of the National Patient Safety Syllabus at the Academy of Royal Colleges of Medicine, what was Health Education England, the Loughborough Faculty for delivering, NHSE for sponsoring and, of course, the healthcare organisations and their CEOs for supporting all 483 of us through our journey. Acknowledgement: Thank you Thomas for your input into this blog. -
Content Article
Safety in surgery series
Patient Safety Learning posted an article in Surgery
Patient Safety Learning asked the Patient Safety Group (PSG) of the Royal College of Surgeons of Edinburgh (RCSEd) to draw up their top tips for patient safety in surgery to share on the hub. They came up with three useful resources for surgeons and surgical trainees: Top 10 priorities for patient safety in surgery Top 10 tips for surgical safety: Think Safety, think SEIPS Top 10 patient safety tips for surgical trainees In this blog, Anna Paisley, Consultant Upper GI Surgeon and RCSEd Council Member and Chair of the PSG, reflects on the process her and the team went through to collate these patient safety resources. We hope you find these resources useful. When asked to do this by Patient Safety Leaning, we were delighted to contribute. However, what seemed initially to be a straightforward task, turned out to be rather challenging. Patient safety covers such a vast area, and it proved very difficult to select only 10 key tips. Each member of the multi-disciplinary surgical team will have a slightly different outlook and perspective; the safety principles most important to their specific practice will inevitably vary. No one size fits all. Each member of the PSG had a slightly different set of tips based on their experience, skill set and discipline. All submissions were of course valid and we thought it would be helpful to include the three main approaches. 1 Top 10 priorities for patient safety in surgery Manoj Kumar, Consultant General and Upper GI Surgeon in Aberdeen, PSG Educational Lead and Convenor of the RCSEd Team Based Quality Review workshop, spearheaded a comprehensive set of patient safety tips for surgery aimed primarily for surgical patient safety leaders. His strong belief is that improving patient safety in surgery requires more than isolated interventions—it demands a sustained cultural and systemic shift. His top 10 priorities are grounded in evidence-based practice and real-world experience, recognising that safer care emerges when we design systems that support people to do the right thing, every time. This approach combines Human Factors principles, team-based quality reviews and learning, psychological safety as well as leadership engagement to drive improvement from the ground up. It moves beyond reactive fixes to proactive action, reduces unwarranted variation and enables learning across all levels of the organisation. By embedding these principles into daily practice, surgical teams can move toward high reliability environments and deliver safer, more effective care for every patient. 2 Top 10 tips for surgical safety: ‘Think Safety, think SEIPS’” When asked to give her top 10 tips for patient safety in surgery, Claire Morgan, Consultant in Restorative Dentistry, PSG Deputy Chair and Member of RCSEd Dental Council, chose to structure her response using Carayon’s Systems Engineering Initiative for Patient Safety (SEIPS). The SEIPS framework allows us to consider any patient safety issue or question using a systems-based approach. This affords a broad view, including application of a Safety 2 thinking; i.e. why do things normally go well. From Claire’s personal perspective, ’Think Safety, Think SEIPS’ ensures a constant recheck of all factors that might contribute to any patient safety incident. SEIPS is a relatively simple tool to use with consideration of six contributory systems to patient safety: tasks tools and technology person organisation internal environment external factors. However, it does not stop there, as it is the interaction between all these systems and then processes that determines outcomes. This approach produced a visual map demonstrating the complexity of the socio-technical systems involved in surgical safety from a human factors perspective. 3 Top 10 patient safety tips for surgical trainees As a consultant Upper Gastro-intestinal surgeon from Edinburgh, RCSEd Council Member and PSG Chair, I compiled a simple list with trainee members of the surgical team in mind. Introducing key patient safety principles early in a training pathway is crucial to helping develop an appropriate patient safety culture in any workplace. I wanted to highlight the principle that patient safety is everyone’s responsibility, and not just that of the quality improvement team. I also wanted to emphasise the crucial point that all members of the team have an important voice and should feel empowered and able to speak up if they feel something is not right. So, the RCSEd PSG have used three separate approaches in defining our top ten tips for patient safety in surgery. I hope that you find them useful and that one will resonate with you from your own individual perspective. Share your resources and top tips What more is needed to support surgeons and trainees? Do you have a tool or policy, a personal reflection, peer-reviewed literature that we could share and highlight on the hub. What other top tips would be useful to surgeons, students and patients? Share your ideas in the comments below (you will need to be a hub member, sign up is free and easy) or contact our editorial team at [email protected].- Posted
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We asked the Patient Safety Group (PSG) of The Royal College of Surgeons of Edinburgh (RCSEd) to draw up their top 10 patient safety tips for surgical trainees. See also: Safety in surgery series Top 10 tips for surgical safety: ‘Think Safety, think SEIPS’ Top 10 priorities for patient safety in surgery Listen to the patient and what matters to them; share decisions with them. Encourage the patient to be in control of their care; they only have to consider their own care and will not be lost to follow up. Trust your instincts; always speak up if you think something is not right. Never be afraid to ask for help if you need it. Look after yourself and your team; there can be no patient safety without team safety. Foster good team working; recognise and respect the value of all team members; take account of everyone’s strengths and weaknesses. Take responsibility for the safety of your patients; patient safety is everyone’s responsibility, not just that of the quality improvement team. Help design systems that make it easier for you to do the right thing. Do not make assumptions. Work as imagined is not the same as work done; make sure you always test any process in practice and confirm that what you think is the case is actually happening. Regularly audit your practice. Celebrate good practice and share your experiences. Take on board feedback and learn from it; be willing to change practice. When outcomes are not as expected, openly discuss and learn, to enable you and your team to reduce the risk of the same thing happening again.- Posted
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GMC approves 36 courses to teach more than 1,000 NHS physician associates
Patient Safety Learning posted a news article in News
More than 1,000 physician associates (PAs) could begin their careers in the NHS every year after regulators approved dozens of courses to teach them. The General Medical Council (GMC) said it had given 36 courses formal approval to teach PAs and anaesthesia associates (AAs). Overall, these courses had capacity for up to 1,059 PAs and 42 AAs to qualify each year. The GMC said approving training courses would mean that “patients, employers and colleagues can be assured that PAs and AAs have the required knowledge and skills to practise safely once they qualify”. Prof Colin Melville, the GMC’s medical director and director of education and standards, said: “This is an important milestone in the regulation of PAs and AAs and will provide assurance, now and in the future, that those who qualify in these roles have the appropriate skills and knowledge that patients rightly expect and deserve. “As a regulator, patient safety is paramount, and we have a robust quality assurance process for PA and AA courses, as we do for medical schools. We have been engaging with course providers for several years already, and we only grant approval where they meet our high standards.” Read full story Source: The Guardian, 30 April 2025- Posted
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Game-based learning has become increasingly popular in medical education. This study used an originally designed board game to train dental and dental hygiene students in patient safety, investigating the educational value of game-based learning. It found that the board game effectively improved knowledge and awareness of patient safety among dental and dental hygiene students.- Posted
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'The NHS can't tell me where my job will be'
Patient Safety Learning posted a news article in News
Jayne Evans has completed four years at medical school in London - but says she is still being left in the dark about where her first permanent NHS position will be. "I was told that I don't have a job set aside for me," she said. "They've guaranteed we will only be offered jobs other people decline and there's just no sort of timeline that they can give us." Ms Evans has been given a rough idea of where she will be working - the Trent area, which spans almost all of Derbyshire, Nottinghamshire and Lincolnshire - but no further clues. She is one of hundreds of newly-qualified medical students who have not been found a specific job by the NHS yet. Instead they have a so-called "placeholder job", meaning they have only been told the rough part of the country they will be in. Without knowing where they will be living, they say they are not able to start preparations for moving. Ms Evans said it had overshadowed her achievement in qualifying. "I was expecting around this time to feel excited or even nervous, but now mostly I just feel angry and disrespected," she said. "I went into medicine and was told we needed doctors and the NHS needs help but I've been told there is no job for me." Dr Hassan Nassar was one of more than 1,000 medical students in the same position last year. The BMA, the union that represents doctors and medical students in the UK, has accused the government of failing to plan for an increase in resident doctors - formerly known as junior doctors - after increasing the number of medical school places. "The government has increased the number of medical school places - but not the number of foundation jobs," Callum Williams, the union's deputy chair of education, said. "The government needs to increase that funding - and these jobs should go to UK-trained doctors first." Mr Williams said there was a danger students would move abroad. "It's your first job with the NHS, it is supposed to be exciting and instead it leaves a sour taste in your mouth," he said. Read full story Source: BBC News, 7 April 2025- Posted
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An ECG is a test that records the electrical activity of a patient’s heart. It needs to be correctly carried out and accurately interpreted to determine the patient’s condition and potential diagnosis. This Health Services Safety Investigation Body (HSSIB) investigation was prompted by the case of a 29-year-old woman with chest pain. Her ECG was misinterpreted and she later died of a heart attack. The investigation focused on paramedic education, training and competence in ECG practice and the task of carrying out and interpreting an ECG in the context of the patient’s clinical signs and symptoms. The investigation spoke to key stakeholders to understand the safety risks that may be present in this area. The way 12-lead ECGs are undertaken and interpreted was identified as a growing area of concern, with systemic safety risks that can have a significant impact on the outcome for patients. HSSIB identified safety learning for ambulance services to help train qualified paramedics. It has also made a safety recommendation to the Health and Care Professions Council and the College of Paramedics to improve undergraduate teaching for paramedic students, to reduce this safety risk for patients. HSSIB makes the following safety recommendation HSSIB recommends that the Health and Care Professions Council and the College of Paramedics work in collaboration with relevant stakeholders to improve the undergraduate teaching of 12-lead electrocardiograms by reviewing and updating any relevant standards, guidance, and curricula to provide clarification on: the level of education and expected level of competency and assessment required of student paramedics in relation to electrocardiograms any minimum expected standards for electrocardiogram education in higher education institutions, including the time spent on electrocardiogram learning, methods used, and subject matter expertise required of teaching staff how patient protected characteristics, health inequalities and other specific patient factors are taught in relation to electrocardiograms how effective feedback mechanisms can be developed between higher education institutions and ambulance services. This is to help improve consistency in the way paramedic students are educated about electrocardiograms. HSSIB makes the following safety observations Ambulance services can improve patient safety by including patient protected characteristics, health inequalities and other specific patient factors that can impact on the task of carrying out and interpreting a 12-lead ECG, when developing refresher training. Ambulance services and national organisations can improve patient safety by providing and supporting protected time and resources for paramedic training and continuous professional development, while understanding the potential impact on operational performance. Ambulance services can improve patient safety by providing additional support to paramedic students and paramedics through exposure to a range of clinical scenarios that help develop and maintain 12-lead ECG competency on a regular basis. Acute hospitals and ambulance services can improve patient safety by developing local mechanisms to share information about patient outcomes where paramedics have undertaken a 12-lead ECG. This can help to support learning for paramedics and provide feedback on where their practice may be improved. -
Content Article
Navigating the healthcare system as a university student: My personal experience
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Moving away from home and starting university has been a transformative experience. As an 18-year-old studying law and international relations, I’ve enjoyed the new found independence and academic challenges. However, persistent health issues have complicated my transition, leading to a frustrating journey through the healthcare system. My health struggles Since starting university, I’ve dealt with multiple colds and flu-like symptoms, some may call it ‘freshers flu’. A productive cough that lingered for over a month concerned me, but the situation took a serious turn when I started feeling dizzy and breathless with minimal exertion. Realising the severity of my condition, I knew I needed medical help. Seeking help: a series of missteps 1. Pharmacy visit My first stop was the local pharmacy. After describing my symptoms, the pharmacist suspected iron deficiency and recommended iron tablets. While this seemed plausible, my condition continued to worsen, prompting a call to my parents. 2. Exploring options: walk-in GP and NHS 111 My parents suggested visiting a walk-in GP, but I discovered none were available in my area. I then called NHS 111, hoping for guidance. They advised going to Accident and Emergency (A&E) but also mentioned they would request a GP call-back. Given the NHS’s known pressures, I was hesitant to visit A&E for what I didn’t consider an emergency. 3. Urgent treatment centre attempt My mum then suggested my local hospital’s urgent treatment centre. I mustered my energy to go there, only to be informed that I needed a GP appointment. They again suggested A&E. 4. Finally, A&E Feeling increasingly unwell, I headed to A&E. Although it felt like I was going in circles, this decision was crucial. At A&E, I was redirected to the urgent treatment centre where I finally saw an excellent doctor. I was seen quickly, diagnosed and given medication that soon began to help. A few days later, I received a message from NHS 111 stating that my request for a GP call-back had dropped off the system due to the delay. This entire experience has been eye-opening and frustrating. As a young and intelligent individual, I found navigating the healthcare system challenging. I can only imagine how overwhelming it must be for older adults, those with additional needs or those less familiar with the process. Lessons learned Navigating healthcare while dealing with a serious condition can be daunting. Here are some key takeaways from my experience that may help other university students or young adults who have moved away from home for the first time: Register with a local GP early As soon as you arrive at university, register with a local GP. It’s crucial to have access to medical care, especially when living away from home for the first time. Understand your options Familiarise yourself with the local healthcare facilities, including urgent treatment centres, walk-in clinics and A&E. Knowing where to go in different situations can save valuable time and stress. Persist and advocate for yourself Don’t be afraid to seek second opinions or alternative solutions if your initial attempts to get help are unsuccessful. Be persistent in advocating for your health needs. Stay informed about healthcare systems Understanding how the healthcare system works, including the pressures it faces, can help you make informed decisions about when and where to seek care. Moving forward Despite the hurdles, my health is now improving thanks to the excellent care I eventually received. This experience has taught me the importance of being proactive about my health and understanding the healthcare system. As I continue my university journey, I’ll be better prepared to navigate any future health challenges. If you’re a student facing similar issues, remember that you’re not alone. Reach out to university health services, friends and family for support. And most importantly, take your health seriously—it’s the foundation upon which all other successes are built. Reflections from my mother My mother, who is a healthcare professional working in the NHS, has had her own set of frustrations and concerns for me throughout this ordeal. She shares her own reflections on my experience: Frustration and helplessness Despite my extensive knowledge of the healthcare system, I felt powerless to help my child navigate the healthcare system from miles away. It was frustrating to be unable to fix the situation quickly and efficiently. Worry and concern Being far from home, I was naturally worried about my son’s health. The distance amplified my anxiety, knowing that they were dealing with worsening symptoms without immediate access to care. Concern for others I am also deeply concerned for other students and individuals who might be in similar situations but are not as vocal or persistent. How do they cope and navigate the system, especially those without a strong support network? Emotional impact This experience left me feeling upset and distressed. As a healthcare professional, I am acutely aware of the pressures on the NHS and the potential for patients to fall through the cracks. Seeing my own son’s struggle highlighted these issues in a very personal way. Are you a student or a young adult who has moved away from home for the first time? How easy have you found it accessing healthcare. We would love to hear your stories. Please comment below (you will need to register with the hub, it's free and easy to sign up), share your story in our community forum, or email us at [email protected]. Related reading The challenges of navigating the healthcare system: David's story The challenges of navigating the healthcare system: Margaret's story The challenges of navigating the healthcare system: Sue's story Lost in the system? NHS referrals "I love the NHS, BUT..." Preventing needless harms caused by poor communication in the NHS (DEMOS, November 2023) Robust collaborative practice must become the bedrock of modern healthcare Robbie: A homeless patient’s struggles with the system Digital-only prescription requests: An elderly woman sent round the houses Lost in the system: the need for better admin Digital-only prescription requests: An elderly woman sent round the houses- Posted
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Two of England’s leading doctors are to oversee a significant review into postgraduate training for newly qualified medics. National Medical Director Professor Sir Stephen Powis and Chief Medical Officer Professor Sir Chris Whitty will lead the review as part of work to address concerns raised by resident doctors (previously known as junior doctors). The review will be based on feedback from current resident doctors and students, locally employed doctors and medical educators, with a series of engagement events around the country starting from this month. The review will cover placement options, the flexibility of training, difficulties with rotas, control and autonomy in training, and the balance between developing specialist knowledge and gaining a broad range of skills. The national listening events in February and March will be followed by a call for evidence in the spring to ensure the widest possible range of views, experiences and ideas are captured. A report on the review’s findings is due to be published in the summer. Read full story Source: NHS England, 19 February 2025 -
Content Article
Patient safety and high-quality care is the foundation of healthcare delivery, aimed at minimising risks, errors and harm to patients. It is important for students in their pre-registration education to understand that the principles of patient safety, and delivering safe and high-quality care, is not merely an academic requirement but a professional and ethical duty. By embedding patient safety into the core of pre-registration learning, educational establishments can ensure that the healthcare professionals of the future are equipped with the knowledge, skills and attitudes necessary to deliver high-quality, safe and effective care. The guiding principles of effective patient safety encompasses a wide range of practices, including the prevention of medical errors, learning from those errors, effective communication among healthcare teams and fostering a culture that has the patient’s wellbeing at its heart. Medical errors, which often range from diagnostic inaccuracies to medication mistakes, with equal deviations of harm, are a leading cause of preventable harm worldwide. Teaching students early in their careers to recognise and mitigate these risks is essential for building a resilient healthcare system with deep-rooted patient safety practices at its heart. Learning ‘on the shop floor’ should never be underestimated for its importance in pre-registration learning. Classroom and simulation-based learning both provide a safe environment for students to practice procedures and decision-making without risking patient safety. Life-like mannequins and virtual reality tools imitate the real-world scenarios, enabling pre-registration students to gain confidence and competence in handling complex situations. The importance of collaborative learning experiences between all healthcare professional students fosters teamwork and communication. Patient safety often hinges on effective partnerships, as errors can occur when information is not adequately shared among team members. By ensuring patient safety is an integral part of any pre-registration programme enables the students to develop a mutual respect and understanding of other healthcare professionals’ roles and the impact they have in the delivery of safe and effective patient care. Pre-registration education highlights the development of critical thinking skills. Encouraging students to explore case studies, reflect on errors and propose solutions nurtures a proactive approach to patient safety. The educational programme must provide opportunities to explore the ethical principles and legal responsibilities underpinning patient care, ensuring students understand the gravity of their actions and that accountability and transparency are integral to a culture of safety. Educators and patient safety specialists play a pivotal role in cultivating an environment where patient safety is a shared priority. Open and supportive discussions about errors, near misses and system failures help normalise the learning process and reduce stigma. Encouraging students to report, reflect and learn from near-misses and mistakes fosters a mindset focused on continuous improvement rather than blame. Despite its obvious importance, integrating patient safety into pre-registration learning can be challenging. Factors such as limited resources, time constraints and varying levels of expertise may hinder comprehensive training. However, advancements in technology and the growing recognition of patient safety’s importance provide opportunities for innovative approaches. Online modules, augmented reality, and mentorship and working placements within the local governance/quality teams can supplement traditional teaching methods. It is important that influential bodies such as the Nursing and Midwifery Council (NMC), General Medical Council (GMC), Health and Care Professions Council (HPCP) and other accreditation bodies ensure that patient safety within pre-registration education is an integral part and meets rigorous standards. In mandating specific competencies and assessments related to patient safety, these entities hold institutions accountable for producing competent healthcare providers. The integration of patient safety into pre-registration education is vital for preparing future healthcare professionals to navigate the complexities of modern healthcare. By prioritising safety at the earliest stages of education, institutions not only protect patients but also empower students to become confident, ethical and effective practitioners. In an era where the stakes are higher than ever, investing in patient safety education is an investment in the future of healthcare itself.- Posted
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Interprofessional communication and teamwork is critical to patient safety. First-year medical and nursing residents participated in team engagement sessions focused on collaboration and safety behaviours through socialisation, team communication, and engagement skills. Sessions consisted of a pre-recorded scenario of a safety event resulting in a patient's death followed by a facilitated debrief. Escalation of care, SBAR (situation, background, assessment, recommendation), and “ask a question, make a request, voice a concern” were identified as the top 3 safety/communication techniques that could have changed the outcome of the simulated scenario. Approximately two-thirds of participants perceived lack of confidence and fear of giving the wrong information as barriers to safety/communication techniques. -
Content Article
Giving inexperienced clinicians a quick coaching session with an expert just before they carry out a procedure boosts their success rate and could improve patient safety, finds a study in the BMJ. Athletes and musicians often rehearse, warm up, or practice just before they are about to perform. Yet in medicine, where performing a procedure can have life-altering consequences, warm-up, or “just-in-time” training is rare to non-existent. To fill this knowledge gap, a team of US researchers conducted a randomised clinical trial to assess whether coaching inexperienced clinicians just before intubating an infant (inserting a breathing tube through the mouth and into the windpipe) could improve the quality of care. The trial took place at Boston Children’s Hospital and involved 153 anaesthesiology trainees (residents, fellows, or student resident nurses) from 10 regional training programs who completed a questionnaire about their knowledge and previous experience of intubating infants. Participants were then randomly assigned to either a 10 minute training session on an infant manikin with an expert airway coach (treatment group) or usual on-the-job training (control group) within one hour of intubating an infant. Just-in-time training was associated with significant improvements in quality of care, including less time to intubation, improved views of the airway while intubating, fewer manoeuvres by the trainee in trying to place the breathing tube in the airway, and fewer technical difficulties. Just-in-time training was also associated with significantly lower cognitive load scores and improved competency. A concern by hospital systems may be that just-in-time training could slow workflow. However, the researchers found brief warm-up sessions feasible and non-disruptive to workflow without becoming a burden to the coaching team. -
News Article
When Sally Mumford enrolled in a training course to become a psychotherapist in 2020, she was excited to start a new career. She hoped to help people understand how their feelings and behaviour were shaped by their pasts. But she quickly realised that the course might not be what she had expected. “I arrived like a lamb to the slaughter,” she said. “There was a real nastiness that percolated down from the top.” Mumford said her tutors at the training centre in London let bullying between students go unchecked. “It was all part of making you into a therapist. The whole ethos was to break you down and build you back up how they wanted you to be.” Mumford is one of more than a dozen people who have studied for psychotherapy qualifications at UK institutions who told the Observer that some courses cross the line from challenging to toxic, with tutors bullying students. Some said their tutors made humiliating remarks to them in public, and left them feeling too scared to speak up or leave the course. But the industry is largely unregulated; “psychotherapist” is not a protected profession, so anyone can set up a practice with that title. Psychotherapist training is also unregulated, and there is a wide range of qualifications across the UK. Amanda Williamson, a psychotherapist who has been campaigning for regulation in the industry for more than a decade, is concerned about “toxic” training courses. “I’ve heard negative feedback about all manner of courses at prominent universities, including appalling tales of bullying and badly-run ‘group process’,” Williamson said. Since psychotherapy training requires students to be vulnerable, she argues, regulations must be more rigorous than in other industries. Therapists and training institutions should be bound by a consistent code of ethics, and regulated by the same body, she said. “Regulation, or at least an inquiry to shine a light on these toxic hotspots that are allowed to fester … is very much overdue.” Read full story Source: The Guardian, 17 November 2024 -
News Article
‘Culture of bullying and undermining’ uncovered in trust’s maternity service
Patient Safety Learning posted a news article in News
Trainee midwives at a struggling trust have raised serious concerns about bullying and feeling afraid to speak up, an NHS England report has revealed. Experiences of pre-registration midwifery trainees at Birmingham Heartlands Hospital and Good Hope Hospital, part of University Hospitals Birmingham Foundation Trust, are detailed in a recent NHS England workforce, education and training report following a visit in January. The report said learners at BHH reported a “concerning culture of bullying and undermining”, with some midwives displaying hostility and rudeness, and one student constantly feeling like they were in “fight or flight mode”. At GHH, students were aware how to raise concerns but described it as a “waste of time”, telling NHSE qualified midwives had informed them they frequently raised concerns about staffing levels without these being resolved. Meanwhile, at BHH trainees said lack of action taken when they tried to raise concerns had created an environment where learners were reluctant to voice fears about patients or seek guidance on patient care. The NHSE report said students provided multiple instances of trying to raise concerns which were either not acted on or they experienced repercussions for having attempted to speak up. One person expressed concerns about a woman who had experienced severe bleeding following birth but their supervising midwife dismissed their concern. They then escalated the matter to another staff member and was taken more seriously, but as a result, the student said their supervising midwife “made my life hell” for the rest of the shift. NHSE said it heard examples where midwives made derogatory comments about students in public, including about one person’s weight, which caused them to leave the building in tears. Read full story (paywalled) Source: HSJ, 24 May 2024 -
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This event gives trainees at all levels the opportunity to attend, present and gain feedback on their Audit and QI work. Further lectures will include the McKeown Medal Lecture, a keynote on patient safety and discussion from a Trainee Committee member. Trainees are invited to submit their abstracts for consideration for presentation at this event. Topics for submission: General Surgery, Trauma & Orthopaedic Surgery, Specialties & Common Interest and Patient Safety. Register -
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One in three medical students plan to quit the NHS within two years of graduating, either to practise abroad or abandon medicine altogether, according to a survey published in BMJ Open. Poor pay, work-life balance and working conditions of doctors in the UK were the main factors cited by those intending to emigrate to continue their medical career. The same reasons were also given by those planning to quit medicine altogether, with nearly 82% of them also listing burnout as an important or very important reason. The findings from the study of 10,486 students at the UK’s 44 medical schools triggered calls for action to prevent an exodus of medical students from the NHS. -
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The Prescribing Safety Assessment (PSA) is a 60-question exam required as part of UK medical training to progress from FY1 to FY2. This independent review into the PSA was commissioned by the Medical Schools Council (MSC) together with the British Pharmacological Society (BPS) in the summer of 2022. It suggests a strategic future direction for the PSA and addresses how the PSA has impacted prescribing assessment and practice for medical students and Foundation Year 1 (FY1) doctors. It is intended to support national decision making about the future of UK prescribing assessment in the context of the imminent introduction of the Medical Licensing Assessment (MLA). Recommendations Appropriate and mandatory assessment of prescribing should remain as a condition of practice for doctors in the UK: evidence of prescribing competence is highly desirable for new UK doctors, and those entering the UK from overseas. The addition of the PSA to the MLA should be considered as a pragmatic suggestion to form a Medical and Prescribing Licensing Assessment (MPLA): this could comprise an additional and separate paper under the umbrella of the MLA. The examination regulations need standardising and publishing: both the PSA and the MLA, when launched (or the MPLA) should publish examination regulations. This will standardise examination delivery between administering institutions and clarify the management of irregularities or appeals. The governance of the PSA should be reviewed to ensure that any examination irregularities are identified and addressed prior to confirming results to candidates. The PSA or combined MPLA should be considered as a requirement for medical practice in the UK: this could be a summative assessment as an exit from medical school or an entry requirement for FY1, and should be required for international medical graduates licensing (IMGs) via the PLAB route for entry at FY1 and FY2. The GMC should have regulatory oversight: the PSA (or MPLA) should be a national requirement for medical practice. As such, it should be subject to regulatory oversight from the GMC. If implemented, the proposed MPLA should be funded in the same way as the MLA: the MPLA should be funded in the same way as the MLA will be funded (by universities). In the case of IMGs, funding would follow the model of the PLAB test (self-funded). -
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The UK government’s long-awaited NHS workforce plan for England outlines a vision to increase the number of nursing staff in England over the next 15 years, with a promise of 170,000 more nurses by 2036/37. This article from the Royal College of Nursing (RCN) outlines how the detail of the plan will affect nurses. It argues that the plan fails to acknowledge the financial investment needed if its objectives are to be fulfilled, and expresses the RCN's concern that it does not address financial support for student nurses. Key proposals affecting nursing staff More training places will be offered through degree apprenticeships so staff can “earn while they learn”. Nursing students could take up jobs as soon as they graduate, rather than waiting until September. The plan asks the NMC to consider greater use of simulated learning in order to reduce clinical placement hours for nursing degree students. Investment in occupational health and wellbeing services for staff. Flexible working options will be considered for every job. An intention to reduce reliance on international recruitment from nearly a quarter of staff to about 10% of the workforce. Reform the NHS pension from this year to make it easier to partially retire or return to work. A potential ban on substantive staff working agency shifts.- Posted
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The state of medical education and practice in the UK 2023 is published at a time when the UK health systems face extensive challenges. This report from the General Medical Council (GMC) shares concerning data about the experiences of doctors and the challenges to providing adequate care to patients. In this context, careful and constructive exploration of the practical, evidence-based steps that can be taken to improve the situation is critical – to protect both patients and the doctors who care for them. -
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The UK’s healthcare systems are experiencing a prolonged period of high pressure, with industrial action, backlogs in elective care persisting, and a shortage of doctors that ongoing high vacancy rates evidence. This report by the GMC analyses trends in the medical workforce across the UK. It uses a variety of sources to provide insights for policymakers and workforce planners, as well as offering deeper analysis on specific themes. Conclusions and key insights for workforce planning The number of licensed doctors continues to grow rapidly, with those joining outnumbering those leaving by more than two to one since 2019. However, there are still high vacancy rates and workforce pressure. Over half (52%) of new joiners in 2022 were international medical graduates (IMGs). Even if the ongoing and planned increases to UK medical school places are complemented by a replication of NHS England’s NHS Long Term Workforce Plan (LTWP) in all UK countries—and if those future UK graduates were to replace future IMG joiners—the UK’s healthcare systems would still need large numbers of doctors to continue joining from abroad. Welcoming, integrating, and retaining all doctors who join from abroad will be crucial to meeting the UK’s future healthcare needs. The proportion of doctors leaving the workforce has only returned to the pre-pandemic level of just under 4%. But there are worrying signs. A growing proportion of doctors plan to leave the profession as a result of high levels of dissatisfaction and high risk of burnout. We may be in a limited window of opportunity to address current issues before they manifest into larger proportions of doctors leaving the profession. The growth in the specialty and associate specialist (SAS) and locally employed (LE) doctors group appears to be mainly driven by those taking up LE roles as opposed to SAS roles. In 2021, there were more than double the number of LE doctors (22,576), compared with SAS doctors (10,349), working in England and Wales. The LE doctors cohort has grown because of both IMG joiners and the increasing proportion of doctors who are taking longer periods of time away from formal postgraduate training after their second foundation year (F2). As well as taking time away from training after F2, there are training stages within programmes that many doctors take longer to complete than the minimum possible time. Our data show that undertaking research and gaining experience in a different post partly explain why some training levels take longer than others. The UK’s healthcare systems must evolve to take advantage of the upsides in the broader range of experiences that doctors are building. Adding flexibility to the evidential requirements for joining the Specialist Register or GP Register will be important and legislative changes mean that is now in progress.- Posted
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Incivility in the workplace, school and political system in the United States has permeated mass and social media in recent years and has also been recognized as a detrimental factor in medical education. This scoping review in BMC Medical Education identified research on incivility involving medical students, residents, fellows and faculty in North America to describe multiple aspects of incivility in medical education settings published since 2000. The results of the review highlight that incivility is likely to be under-reported across the continuum of medical education and also confirmed incidences of incivility involving nursing personnel and patients that haven't been emphasised in previous reviews. -
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In this blog, Professor of Medical Education Kate Owen explains how her team has embedded a session on patient safety in the final year curriculum at Warwick Medical School. Using a real-life story posted on the Care Opinion website, the session gives medical students an opportunity to use investigation tools, understand NHS reporting systems and consider the importance of compassionate communication with harmed patients and their families. Patient safety is a fundamental part of a large proportion of teaching in a medical degree. We found, however, that students were reaching the end of their studies and telling us that they had not been “taught patient safety”. We also realised that students had not had any opportunity to rehearse clinical reporting systems and discuss with their peers some of the challenges around reporting errors and near misses. So we decided to develop a workshop for final year students in their assistantship block, to pull together their learning and discuss how this would apply to their FY1 posts. This has now run for two years and is embedded in our curriculum. I am a patient as well as an educator and am aware that discussing one’s own traumatic experiences can have negative impacts on mental health and wellbeing. I believed it was vitally important to centre the session on patient stories, but without causing additional burden, which is why I decided to work with Care Opinion. I read very many Care Opinion stories before deciding to use this one about an elderly woman who went through a series of near misses because of an initial poor clinical decision. I felt it was important to focus on skills and active learning in preparation for becoming a junior doctor so the session has a series of small group activities. During the session, we split the students into groups and give each group a different tool with which to 'investigate' the episode—Fishbone, Root Cause Analysis, Human Factors, the Patient Safety Incident Response Framework and a SEIPS worksheet. We then come back together and discuss the findings, which are usually very similar between groups. We then discuss saying sorry (using this excellent patient video) and get the students to write a letter to the woman's daughter. Next, we look at reporting including using the Yellow Card system and Datix—we get the students to actually complete a form for the patient we have just investigated so that they have done it once before they may need to do it for real. We finish the session by discussing student concerns about patient safety when they start work, and this has resulted in many useful conversations. Students have fed back that the session really highlighted relevant issues: “I think the patient safety session was interesting to put so close to F1, as it highlighted a lot of the system issues with the NHS and how tough it will be.” Related reading Patient Safety Spotlight interview with James Munro, Chief Executive of Care Opinion -
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This report by the Nuffield Trust looks at workforce training issues in England, arguing that the domestic training pipeline for clinical careers has been unfit for purpose for many years. It presents research that highlights leaks across the training pathway, from students dropping out of university, to graduates pursuing careers outside the profession they trained in and outside public services. Alongside high numbers of doctors, nurses and other clinicians leaving the NHS early in their careers, this is contributing to publicly funded health and social care services being understaffed and under strain. It is also failing to deliver value for money for the huge taxpayer investment in education and training. Key facts More than 83,000 students accepted a place to study an undergraduate or postgraduate clinical degree (including medicine, nursing, midwifery and the allied health professions) across the UK in 2022. £2.6 billion was spent on undergraduate education and training in 2022/23 in England, with a further £2.5 billion spent on postgraduate medicine and dentistry. Only half of nurses, midwives and nursing associates (52%) and two in five doctors (39%) joining the UK professional registers were trained domestically in the latest year of data. Around one in eight nursing (13%) and radiography (13%) students did not gain their intended degree between 2014 and 2020, compared with 5% for physiotherapy. Attrition was on the rise for nursing, physiotherapy and radiography in the two years before the Covid-19 pandemic – for radiotherapy it was up to one in six (17%) in 2018/19 compared with 13% in 2016/17. Only one in 14 nursing graduates (7%) do not begin their career as a nurse after graduating. However, around one in nine midwifery graduates (11%) and one in seven occupational therapy graduates (15%) do not immediately join their respective profession. 6,325 fewer new nurses with a UK nationality joined NHS hospital and community services in the year to March 2022 compared with the two years before that (a fall of 32%). Around one in five radiographers (17%), nurses (18%), occupational therapists (21%) and physiotherapists (21%) have left NHS hospital and community settings within two years… this is broadly twice the level seen for midwives (10%), although some professions have more alternative employment opportunities than others, both inside the public sector (for example, general practice) and outside (for example, private practice and social care). The annual leaving rate from NHS hospital and community services flattens out after five years (leaver rates in the subsequent three years vary from 1 percentage point for nurses to 5 percentage points for occupational therapists). Most medical students successfully graduate and start their first foundation year (which they must complete to become fully registered) but only 30% of those completing foundation training in 2021/22 continued straight into GP or consultant training posts. Fewer than three in five doctors (56%) in ‘core training’ remained (even in a different role) in NHS hospital and community services in England eight years later, with half (24%) of this attrition seen in the first two years.- Posted
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