Attitudes to patient safety amongst medical students and tutors: Developing a reliable and valid measure

Figures & data

Table

Practice points

Patient safety education is increasingly being introduced into medical school curricula and a measure of the effectiveness of different forms of delivery of patient safety education is needed. This study developed an internally reliable patient safety attitude measure that has good face validity, internal reliability, and can distinguish the responses of different groups. This questionnaire could be used as a before and after measure to assess the success of changes in the undergraduate curriculum to incorporate patient safety training. The tool could also be used to measure attitudes within other populations of qualified healthcare professionals or as an outcome measure in patient safety intervention studies.

Table 1.  Reliability coefficients, FL and inter-item correlations of a nine-factor rotated solution

Factor	Items per scale	Factor loading range	Internal consistency (Cronbach's alpha)	Mean inter-item correlation
Importance of patient safety in the curriculum	5	0.57–0.76	0.73	0.37
Error reporting confidence	4	0.71–0.87	0.82	0.53
Workplace changes to reduce errors	4	0.57–0.69	0.67	0.35
Patient safety training received	4	0.75–0.82	0.81	0.51
Professional incompetence as error cause	3	0.67–0.74	0.62	0.36
Disclosure responsibility	3	0.66–0.79	0.64	0.38
Error inevitability	3	0.52–0.69	0.56	0.30
Working hours as error cause	2	0.73–0.77	0.63	0.46
Patient involvement in reducing error	2	0.69–0.71	0.43	0.28

Table 2.  Means (SD: standard deviations), loading ranges, reliability coefficients and mean inter-item correlations of a nine-factor rotated solution

Factor	Items per scale	Means (SD)	Factor loading range	Cronbach's alpha	Mean inter-item correlation
Patient safety training received	3	4.46 (1.15)	0.77–0.82	0.82	0.60
Error reporting confidence	4	3.79 (1.25)	0.55–0.79	0.78	0.46
	3		0.62–0.79	0.77	0.53
Working hours as error cause	3	5.17 (1.11)	0.73–0.83	0.71	0.45
Error inevitability	4	6.27 (0.74)	0.46–0.75	0.64	0.32
	3		0.62–0.75	0.63	0.36
Professional incompetence as error cause	4	4.97 (0.95)	0.67–0.68	0.68	0.35
Disclosure responsibility	4	5.11 (1.07)	0.54–0.79	0.68	0.35
	3		0.66–0.79	0.65	0.38
Team functioning (formerly 'workplace changes’)	2	5.32 (1.15)	0.78–0.80	0.69	0.53
Patient's role in error	2	5.17 (1.11)	0.69–0.74	0.68	0.51
Importance of patient safety in the curriculum	4	5.29 (0.93)	0.39–0.69	0.65	0.33
	3		0.62–0.69	0.66	0.41

Note: Values in bold italics indicate values after removal of items to improve internal consistency of scales.

Table 3.  APSQ-III items and corresponding FL

Factor	Item	Item loading
1. Patient safety training received	My training is preparing me to understand the causes of medical errors.	0.82
	I have a good understanding of patient safety issues as a result of my undergraduate medical training.	0.79
	My training is preparing me to prevent medical errors.	0.77
2. Error reporting confidence	I would feel comfortable reporting any errors I had made, no matter how serious the outcome had been for the patient.	0.79
	I would feel comfortable reporting any errors other people had made, no matter how serious the outcome had been for the patient.	0.77
	I am confident I could talk openly to my supervisor about an error I had made if it had resulted in potential or actual harm to my patient.	0.62
	I feel confident I could report an error I had made without feeling I would be blamed.	0.55
3. Working hours as error cause	Shorter shifts for doctors will reduce medical errors.	0.83
	By not taking regular breaks during shifts doctors are at an increased risk of making errors.	0.74
	The number of hours doctors work increases the likelihood of making medical errors.	0.73
4. Error inevitability	Even the most experienced and competent doctors make errors.	0.75
	A true professional does not make mistakes or errors (R)	0.65
	Human error is inevitable.	0.62
	I don’t think I will make errors once I am a qualified doctor.	0.46
5. Professional incompetence as error cause	Most medical errors result from careless nurses.	0.68
	If people paid more attention at work, medical errors would be avoided (R)	0.68
	Most medical errors result from careless doctors (R)	0.67
	Medical errors are a sign of incompetence (R)	0.67
6. Disclosure responsibility	It is not necessary to report errors which do not result in adverse outcomes for the patient (R)	0.79
	Doctors have a responsibility to disclose errors to patients only if they result in patient harm	0.71
	All medical errors should be reported.	0.66
	It is the responsibility of all health care professionals to formally report all medical errors which occur.	0.54
7. Team functioning	Better multi-disciplinary teamwork will reduce medical errors.	0.80
	Teaching teamwork skills will reduce medical errors.	0.78
8. Patient involvement in reducing error	Patients have an important role in preventing medical errors.	0.74
	Encouraging patients to be more involved in their care can help to reduce the risk of medical errors occurring.	0.69
9. Importance of patient safety in the curriculum	Teaching students about patient safety should be an important priority in medical students training.	0.69
	Patient safety issues cannot be taught and can only be learned by clinical experience when qualified (R)	0.62
	Learning about patient safety issues before I qualify will enable me to become a more effective doctor.	0.65
	Learning about patient safety issues is not as important as learning other more skill-based aspects of being a doctor.	0.39

Note: Shaded items were removed in the final version of the questionnaire to improve internal scale consistency. (R) indicates that the item was reverse scored.