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• Engaging junior doctors in patient safety: Don't forget the basics
  Maria Ahmed
  Published on: 13 May 2016

• Published on: 13 May 2016

  Engaging junior doctors in patient safety: Don't forget the basics

  • Maria Ahmed, Clinical Research Fellow
  • Other Contributors:
    • Paul Baker, Jacky Hayden, Charles Vincent

  We read the study by Durani et al (1) and the accompanying editorial (2) with great interest. Aspiring to engage junior doctors in the safety and quality movement is a noble aim but in doing so it is essential to consider the influences of both the formal (explicit) curriculum and the informal ('hidden') curriculum on doctors in training. We feel that whilst Durani et al's questionnaire may be useful to chart temporal tre...

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  We read the study by Durani et al (1) and the accompanying editorial (2) with great interest. Aspiring to engage junior doctors in the safety and quality movement is a noble aim but in doing so it is essential to consider the influences of both the formal (explicit) curriculum and the informal ('hidden') curriculum on doctors in training. We feel that whilst Durani et al's questionnaire may be useful to chart temporal trends in junior doctors' knowledge and attitudes in patient safety, we would caution against using subtle differences uncovered in trainees' responses to inform the subsequent development of educational interventions. To do so risks 'over-engineering' approaches to patient safety education and neglecting the basics.

  Our experience of implementing sustainable patient safety training across a Foundation School ('Lessons Learnt: Building a Safer Foundation')(3) has revealed two core ingredients for engaging junior doctors in safety and quality improvement - training providers as a minimum must ensure i) a safe environment for junior doctors to raise and act on safety concerns and ii) basic instruction and opportunities in patient safety and quality improvement for all junior doctors.

  First and foremost, we argue that in order to engage junior doctors in safety improvement, above all, they need to feel safe in the environment within which they work. Whilst informal discussions of safety and quality issues by junior doctors are commonplace in the 'Doctors' Mess' and at other social gatherings, structured and protected opportunities to do so within teaching programmes are severely lacking.

  Moreover, whilst leadership and quality improvement schemes described by Lemer et al(2) are laudable, they invariably appeal to a self-selected group and are not always accessible to all. In the UK, latest guidance by the General Medical Council emphasises the duty of doctors in raising and acting on concerns about patient safety(4) and that leadership and management is a core role of all doctors,(5) not reserved for the privileged few. To ensure equity of opportunity and to fulfil the regulator's standards we need to ensure the provision of basic training and opportunities for junior doctors across both the domains of patient safety and leadership.

  Through providing basic instruction in patient safety and integrating facilitated case-based discussions of patient safety incidents (PSIs) within the teaching programme, we have successfully created a springboard for Foundation trainees' engagement in safety and quality improvement.(3) Importantly, trainees are not passive recipients of the intervention, rather active collaborators with trainee 'Leads' at each site leading local delivery of the programme and rising to the challenge of peer- leadership. Whilst we do not claim that our programme is a panacea for engaging junior doctors in quality and safety, we do feel it is an important first step in promoting wide-scale clinical engagement in the quality movement.

  Conflict of Interest:

  The authors are part of a team who developed, implemented and evaluated 'Lessons Learnt: Building a Safer Foundation' - a patient safety training programme for Foundation trainees in collaboration with the North Western Deanery and the Imperial Centre for Patient Safety and Service Quality. The programme won the BMJ Excellence in Healthcare Education Award 2012.

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  Conflict of Interest:
  None declared.

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