One of the learning objectives / instructional goals of the Ethics and Professionalism elective course on “Patient Safety: Better Knowledge for Safer Care” introduced to Kuwait University since 2005 was to “Enable students to make judgments about the safety of clinical practice through the use of reflective thinking & writing tools to enhance their moral development as future doctors” achieving a highercategory of learning based on the Cognitive Domains of Learning (Blooms’ Taxonomy, Fig 1).

INTRODUCTION:

Patient Safety Education For Future Doctors:A Reflective Strategy Eating Unsafe Culture Slowly and Surely

Manal Bouhaimed,[1,2] Hossam Elamir[3]

[1] Department of Community Medicine and Behavioural Sciences, Kuwait University Faculty of Medicine[2] Department of Surgery, Kuwait University Faculty of Medicine

[3] Department of Quality and Accreditation, Mubarak Al-Kabeer Hospital, MOH

Fig 1: Bloom’s Taxonomy (Revised)

Remembering

Understanding

Applying

Analyzing

Evaluating

Creating

Can the student distinguishbetween di�erent parts?

Appraise, compare, contrast, criticize,di�erentiate, discriminate, distinguish,

examine, experiment, question, test

De�ne, duplicate, list, memorize,recall, repeat, state

Can the student recall orremember the information?

Can the student explain ideas orconcepts?

Can the student use informationin a new way?

Classify, describe, discuss, explain,identify, locate, recognize, report,

select, translate, paraphrase

Choose, demonstrate, dramatize,employ, illustrate, interpret, operate,

schedule, sketch, solve, use, write

Can the student justify a standor decision?

Appraise, argue, defend, select,support, value, evaluate

Can the student create a newproduct or point of view?

Assemble, construct, create, design,develop, formulate, write

1. Bloom, Benjamin (ed.). Taxonomy of Education al Objectives. Handbook I: Cognitive Domain. David McKay Company, Inc. New York: 1956.http://pcs2ndgrade.pbworks.com/w/page/46897760/Revised%20Bloom's%20Taxonomy

DO IT.

What?What happened?

What were theresults?

Now What?What will I

do differentlynext time?

So What?What do these results imply?

How did I influence theoutcome?

DescriptionWhat happened?

DescriptionWhat sense can you make

of the situation?

Fig 2: Gibbs Reflective Cycle

FeelingsWhat were you thinking

and feeling?

Action PlanIf it arose again, what

would you do?

ConclusionWhat else could you have

done?

EvaluationWhat was good & badabout the experience?

ConcreteExperience(Feeling)

Fig 3: Kolb’s Learning Cycle

AbstractConceptualisation

(Thinking)

Adapted by Ivan Mactaggart from Mcleod,2010

“Learning is the process whereby knowledge is created throughthe transformation of experience” (David A Kolb, 1984)

http://www.simplypsychology.org/learning-kolb.html#sthash.DOwEfaZC.q20UZ5MW.dpbs

ReflectiveObservation(Watching)

ActiveExperimentation

(Doing)

A one day informed consent and surgical check lists auditat a secondary care hospital in Kuwait

Students' Reflection on Current Practiceto Avoid Tubing Misconnection: A Simple Solution,

A Difficult Compliance, A Training Opportunity

Is The Accreditation Program Enough To Ensure Patient Safety?A Students' Reflection On A Patient Safety Required Area

Exploring students' Feelings Counts in Education:The Use of Gibbs Reflective Cycle in Teaching Clinical Ethics

Inpatient Wards

TPN Unit

Laboratory

Treatment Rooms

Pharmacy

Medical Records

Operating Theatre

The following reflective tools were used in an academic context for teaching this elective course: • Gibbs Reflective Cycle (Fig 2).• The Kolb’s cycle (Fig 3).• The Burton’s approach (Fig 4).

The use of these tools in a hospital based rotations (Fig 5a) aimed at: Looking back at an event or having a hands-on experience. Analyzing the event, ideas or emotions/responses related to the event (thinking in depth and from different perspectives, trying to explain what happened, for example with reference to the WHO Nine Patient Safety Solution (Fig 5b). Thinking carefully about what the event or idea means for them and their on-going development as future care providers and practicing professionals.

METHODS:

The outcomes of these reflective exercises over the years were presented at different conferences and meetings (Fig 5c). The following are some examples:• The Gibbs Reflective Cycle was applied to the students’ experience of reviewing 33 unidentifiable medical records for the application of “Performance of Correct Procedure at Correct Body Site” protocol in the hospital.• The Kolb’s cycle was applied to the students’ experience of examining 152 patients for hospital adherence to the “Avoiding Catheter and Tubing Misconnections” protocol.• The Burton’s approach of reflection was used during the assessment of 41masked non-identifiable consent forms to assess to the pre-intervention patient’s verification protocol.

Results:

It was evident that the students in this elective course successfully developeda new realization of the role of human factors in errors and the concept ofsystem failure suggesting that reflective education for patient safety can besuccessfully used in patient safety education.

Conclusion:

What is most important, interesting, useful,relevant about the object event or idea?

Interpretation:What happened?

Description:What have I learned from this? What does this mean for my future?

Outcome:

Acknowledgement:We would like to acknowledge the assistance provided by Dr. Susan Jacob;Department of Community Medicine and Behavioural Sciences, and QualityNurses of Mubarak Al-Kabeer Hospital: Abeer G. Dossokey, Amal T. Mohamed,Asila A. Alrasheedi, Lea Martinez & Rinto Francis.

Fig 4: The Burton’s approach

Fig 5a: The Hospital Based Rotations

Patient safetySolutions

Look-alike,Sound-Alike(LASA) Medication Names

Patient Identification

Single Use of InjectionDevices

Performance of CorrectProcedure at CorrectBody Site

Improved Hand Hygiene to PreventHealthcare-Associated Infection

Assuring MedicationAccuracy at Transitionsin Care

Avoiding Catheter andTubing Misconnection

Control of concentratedelectrolyte solutions

Communication DuringPatient Handovers

Fig 5b:

Fig 5c: Poster Abstracts