Limits...
Students' perceptions of patient safety during the transition from undergraduate to postgraduate training: an activity theory analysis.

de Feijter JM, de Grave WS, Dornan T, Koopmans RP, Scherpbier AJ - Adv Health Sci Educ Theory Pract (2010)

Bottom Line: Using activity theory as analytical framework, we performed constant comparative thematic analysis of the focus group transcripts to identify important themes.We found eight general themes relating to two activities: learning to be a doctor and delivering safe patient care.Simultaneous occurrence of these two activities can cause contradictions.

View Article: PubMed Central - PubMed

Affiliation: Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands. j.defeijter@maastrichtuniversity.nl

ABSTRACT
Evidence that medical error can cause harm to patients has raised the attention of the health care community towards patient safety and influenced how and what medical students learn about it. Patient safety is best taught when students are participating in clinical practice where they actually encounter patients at risk. This type of learning is referred to as workplace learning, a complex system in which various factors influence what is being learned and how. A theory that can highlight potential difficulties in this complex learning system about patient safety is activity theory. Thirty-four final year undergraduate medical students participated in four focus groups about their experiences concerning patient safety. Using activity theory as analytical framework, we performed constant comparative thematic analysis of the focus group transcripts to identify important themes. We found eight general themes relating to two activities: learning to be a doctor and delivering safe patient care. Simultaneous occurrence of these two activities can cause contradictions. Our results illustrate the complexity of learning about patient safety at the workplace. Students encounter contradictions when learning about patient safety, especially during a transitional phase of their training. These contradictions create potential learning opportunities which should be used in education about patient safety. Insight into the complexities of patient safety is essential to improve education in this important area of medicine.

Show MeSH
Model of the relations between the different themes
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC3139877&req=5

Fig2: Model of the relations between the different themes

Mentions: All discussions were recorded and transcribed verbatim and the transcripts were entered into qualitative data analysis software (Atlas.ti 6.0). JF used constant comparative analysis (Strauss and Corbin 1997) to identify and code the topics that were discussed. After all transcripts were coded, every transcript was analyzed for a second time to ensure that all newly derived codes that came up in later transcripts were also checked in earlier transcripts. After WG had also analysed all the transcripts, the two researchers reached agreement on coding through discussion. The emerging themes were incorporated in a model (Fig. 2), and all the researchers (JF, WG, RK (a professor of Internal Medicine) and AS (a medical doctor and professor of medical education)) discussed the themes and their mutual relations until a consensus was reached. To ensure that the model was an accurate reflection of the focus group discussions, we performed a member check, explaining the model to the participants and inviting their comments. We received responses from eight participants, who stated that the model was an accurate reflection of the discussions. Suggestions by participants led to modification of some of the visual aspects of the model.Fig. 2


Students' perceptions of patient safety during the transition from undergraduate to postgraduate training: an activity theory analysis.

de Feijter JM, de Grave WS, Dornan T, Koopmans RP, Scherpbier AJ - Adv Health Sci Educ Theory Pract (2010)

Model of the relations between the different themes
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3139877&req=5

Fig2: Model of the relations between the different themes
Mentions: All discussions were recorded and transcribed verbatim and the transcripts were entered into qualitative data analysis software (Atlas.ti 6.0). JF used constant comparative analysis (Strauss and Corbin 1997) to identify and code the topics that were discussed. After all transcripts were coded, every transcript was analyzed for a second time to ensure that all newly derived codes that came up in later transcripts were also checked in earlier transcripts. After WG had also analysed all the transcripts, the two researchers reached agreement on coding through discussion. The emerging themes were incorporated in a model (Fig. 2), and all the researchers (JF, WG, RK (a professor of Internal Medicine) and AS (a medical doctor and professor of medical education)) discussed the themes and their mutual relations until a consensus was reached. To ensure that the model was an accurate reflection of the focus group discussions, we performed a member check, explaining the model to the participants and inviting their comments. We received responses from eight participants, who stated that the model was an accurate reflection of the discussions. Suggestions by participants led to modification of some of the visual aspects of the model.Fig. 2

Bottom Line: Using activity theory as analytical framework, we performed constant comparative thematic analysis of the focus group transcripts to identify important themes.We found eight general themes relating to two activities: learning to be a doctor and delivering safe patient care.Simultaneous occurrence of these two activities can cause contradictions.

View Article: PubMed Central - PubMed

Affiliation: Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands. j.defeijter@maastrichtuniversity.nl

ABSTRACT
Evidence that medical error can cause harm to patients has raised the attention of the health care community towards patient safety and influenced how and what medical students learn about it. Patient safety is best taught when students are participating in clinical practice where they actually encounter patients at risk. This type of learning is referred to as workplace learning, a complex system in which various factors influence what is being learned and how. A theory that can highlight potential difficulties in this complex learning system about patient safety is activity theory. Thirty-four final year undergraduate medical students participated in four focus groups about their experiences concerning patient safety. Using activity theory as analytical framework, we performed constant comparative thematic analysis of the focus group transcripts to identify important themes. We found eight general themes relating to two activities: learning to be a doctor and delivering safe patient care. Simultaneous occurrence of these two activities can cause contradictions. Our results illustrate the complexity of learning about patient safety at the workplace. Students encounter contradictions when learning about patient safety, especially during a transitional phase of their training. These contradictions create potential learning opportunities which should be used in education about patient safety. Insight into the complexities of patient safety is essential to improve education in this important area of medicine.

Show MeSH