SHM Student And Resident Scholar Grant- Research Summary
Christina Brown, MD, Sanket Aggarwal, MD, Ahad Bootwala, Justin Sapp, Shobha S. Rao, MD
Specific Aims:
Current literature shows that many graduating health-professional students are not adequately trained to identify safety hazards [1]. By implementing early integration of core patient safety measures in medical student education, we hope to reduce the occurrence of adverse events longitudinally throughout a health professional’s career. Data demonstrates that patient safety simulations are an effective method to train medical professional students in identifying patient safety events [3]. These standard simulations, coined “Room of Horrors” by University of Chicago allow a low-stakes environment for participants to identify hazards [2]. Escape Rooms are an entertaining activity for teambuilding, improving communication, and developing memory skills. This project aimed to utilize this format to mimic a high-stakes hospital environment while teaching basic patient safety concepts. Our primary aim was to show this was an effective teaching tool through comparison of a standard patient safety printout module that is generally covered in didactics during the medical school curriculum. The secondary aim was to measure self-reported confidence in identifying and speaking out about patient safety hazards and if it was influenced by the two educational methods.
Study Design:
Students were recruited to participate in a printout module (control) or an Escape Room (experimental). In creating puzzles for the escape room, we focused on three major themes: patient identification, patient advocacy, and physical harm. We highlighted errors that included matching patient information, bringing awareness to gender pronouns, and identifying hazardous conditions within the patient room. The modules were adapted from the standardized training students were required to complete at Rush University. Students were eligible for inclusion if they were enrolled in a medical graduate program at Rush University. Participants were excluded if they were not enrolled at Rush University or were current employees of the Rush University Medical Center. A pretest was administered prior to randomization to assess and establish a baseline knowledge of patient safety, attitudes, and self-reported confidence based on a 5-point Likert scale towards patient safety. Participants were randomly assigned to either the module or Escape Room simulation. The Escape Room attendees also participated in a debrief following their simulation. After completion of either one, they were asked to complete a posttest. In addition, both groups of participants went into a standardized simulation room to complete an assessment involving identifying patient safety concerns as a team. A 3-month and 6-month follow up survey was completed.
Data is currently being analyzed with preliminary data available including unpaired sample t-test and qualitative analysis.
Preliminary Results:
The study consisted of 22 participants divided into the Escape Room (n=13) and the printout module (n=9). A 3-month and 6-month follow up survey were sent out with notable loss to follow up (3 month with n=11, 6-month n=7). On questions that assessed the importance of patient safety teaching such as “learning how to improve patient safety is an appropriate use of my training” and “I would like to receive further education on patient safety and quality improvement” participants averaged a score of 4.41/5.00 and 3.72/5.00, respectively. The initial standardized simulation assessment following either intervention showed each group received the majority of the points out of twelve. There was no statistically significant difference between the two groups identifying the standardized simulation hazards (p=0.06). Individual survey questions rating confidence in speaking up about patient safety were not statistically significant, when comparing pretest and posttest self-reported confidence. Overall, the average rating pretest self-reported confidence was 3.68 with posttest average of 4.08 (p=0.0003). This indicates that either intervention was successful in improving a student’s confidence about speaking to a peer, nursing staff, a resident, or an attending.
Plans for Future Work:
Our preliminary data shows promise that patient safety can and should be talked about more in medical education. Since both groups were able to identify the standardized simulation hazards with no significant difference in accuracy, it may be beneficial to include other measurements such as time required to complete simulation activity. While even something as simple as a module to discuss the topic can prove to be beneficial, students collectively showed interest in an Escape Room learning format; feedback provided in the survey offers reassurance. Comments included “so much fun,” “very interactive,” “fun way to learn about patient safety.” The lack of difference between both groups can also be attributed to the small sample size. We hope to increase our recruitment efforts to continue expanding the data collection and encourage stronger follow up to study long-term retention. If we can prove the efficacy of escape rooms as learning tools, this project has the potential to be implemented into the medical student curriculum and expanded to other various topics within medicine.
References:
- Clay, AS, SM Chudgar, KM Turner, J Vaughn, NW Knudsen, JM Farnan, VM Arora, and MA Molloy. 2017. "How Prepared Are Medical and Nursing Students to Identify Common Hazards in the Intensive Care Unit?" Annals of the American Thoracic Society 14 (4): 543-549. doi:10.1513/AnnalsATS.201610-773OC.
- Farnan, JM, S Gaffney, JT Poston, K Slawinksi, M Cappaert, B Kamin, and VM Arora. 2016. "Patient Safety Room of Horrors: a Novel Method to Assess Medical Students and Entering Residents' Ability to Identify Hazards of Hospitalisation." BMJ Quality and Safety 25 (3): 153-158. doi:10.1136/bmjqs-2015-004621.
- Wiest, K, J Farnan, E Byrne, L Matern, M Cappaert, K Hirsh, and V Arora. 2017. "Use of Simulation to Assess Incoming Interns' Recognition of Opportunities to Choose Wisely." Journal of Hospital Medicine 12 (7): 493-497. doi:10.12788/jhm.2761.
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