PURPOSE: This study investigated the attitudes of Korean medical students about patient safety to determine which perspectives required increased focus in terms of educational development. METHODS: Attitudes were assessed using the Patient Safety Questionnaire, a tool designed to measure attitudes toward patient safety among medical students. Questionnaires were distributed to 580 clinical year students across four medical schools in December 2018. RESULTS: A total of 300 returned questionnaires were used in the final analysis. More than half of all respondents agreed (i.e., gave more than 4 out of 7 points) with most items and thoroughly considered the concept of patient safety. However, many students misperceived several items (e.g., professional incompetence as a cause of errors, disclosure responsibility, the importance of patient safety in the curriculum, and situational awareness). CONCLUSION: Attitudes toward patient safety are highly important due to their substantial impacts on behavioral decisions in the clinical setting. As such, patient safety education should be designed to place greater emphasis on proper attitude. This study's findings should be useful for medical instructors who wish to determine the appropriate areas of curricular focus.
Curriculum ; Disclosure ; Education ; Education, Medical ; Humans ; Patient Safety ; Schools, Medical ; Students, Medical ; Surveys and Questionnaires

Concern for patient safety underlies the need for interprofessional education (IPE). One way to measure the effectiveness of IPE is by measuring attitude change toward other healthcare professionals; however, there are currently no valid Korean tools to measure such a change in attitudes. Therefore, this study aims to develop and test a Korean version of the Interprofessional Attitudes Scale (IPAS). The original IPAS was translated into Korean according to the World Health Organization’s guidelines after obtaining permission from the article’s corresponding author. A total of 414 questionnaires were collected from third- and fourth-year medical and nursing students at four Korean institutions in December 2018. To analyze the validity of the Korean IPAS, exploratory and confirmatory factor analyses were conducted. Cronbach’s α was used to evaluate reliability. Results from the exploratory factor analysis identified four functions: teamwork, community-centeredness, patient-centeredness, and respect for diversity. Significant cross-correlations were found among the four functions (r=0.438–0.631, p<0.001) along with overall reliability (Cronbach’s α=0.929) and reliability of each subfactor (Cronbach’s α=0.804–0.897). This study verified the validity and reliability of the Korean version of the IPAS, so this scale can be used in the future to measure the effectiveness of IPE in Korea.

PURPOSE: This study investigated the attitudes of Korean medical students about patient safety to determine which perspectives required increased focus in terms of educational development. METHODS: Attitudes were assessed using the Patient Safety Questionnaire, a tool designed to measure attitudes toward patient safety among medical students. Questionnaires were distributed to 580 clinical year students across four medical schools in December 2018. RESULTS: A total of 300 returned questionnaires were used in the final analysis. More than half of all respondents agreed (i.e., gave more than 4 out of 7 points) with most items and thoroughly considered the concept of patient safety. However, many students misperceived several items (e.g., professional incompetence as a cause of errors, disclosure responsibility, the importance of patient safety in the curriculum, and situational awareness). CONCLUSION Attitudes toward patient safety are highly important due to their substantial impacts on behavioral decisions in the clinical setting. As such, patient safety education should be designed to place greater emphasis on proper attitude. This study's findings should be useful for medical instructors who wish to determine the appropriate areas of curricular focus.

BACKGROUND: Epidural administration of dilute solution of local anesthetic and lipid-soluble opioid provides the best pain relief during labor and delivery. The purpose of this study was to evaluate the safety, efficacy and patient satisfaction of patient-controlled epidural analgesia compared with continuous infusion epidural analgesia. METHODS: Forty healthy full-term parturients who requested epidural analgesia were assigned randomly to either patient-controlled epidural analgesia (PCEA) group or continuous infusion epidural analgesia (CIEA) group. All parturients received proper dose of 0.25% bupivacaine with 0.0008% fentanyl to block T10 sensory level. PCEA was programmed as followings; no background infusion, a 4 ml bolus dose and 15min lock-out interval using 0.0625% bupivacaine with 0.0002% fentanyl. CIEA was started with the same solution at 12ml/hr constantly. RESULTS: Hourly requirement of 0.0625% bupivacaine (mean+/-SD 7.1+/-5.8 ml/hr, median 7.6 ml/hr in PCEA group and mean+/-SD 13.2+/-2.9 ml/hr, median 12 ml/hr in CIEA group) during labor was significantly reduced in PCEA group (p<0.05). Maternal satisfaction, obstetric and neonatal parameters were shown no statistically significant difference. Incidences of postpartum complications such as gait disturbance, urinary difficulty, pruritus, nausea and vomiting were rare in both groups. CONCLUSIONS: Patient-controlled epidural analgesia is safe and effective and has 37% sparing effect of bupivacaine dosage used per hour compared with continuous infusion epidural analgesia.
Analgesia ; Analgesia, Epidural* ; Anesthetics ; Bupivacaine ; Fentanyl ; Gait ; Incidence ; Nausea ; Patient Satisfaction ; Postpartum Period ; Pruritus ; Vomiting

No study has examined the effectiveness of backboards and air deflation for achieving adequate chest compression (CC) depth on air mattresses with the typical configurations seen in intensive care units. To determine this efficacy, we measured mattress compression depth (MCD, mm) on these surfaces using dual accelerometers. Eight cardiopulmonary resuscitation providers performed CCs on manikins lying on 4 different surfaces using a visual feedback system. The surfaces were as follows: A, a bed frame; B, a deflated air mattress placed on top of a foam mattress laid on a bed frame; C, a typical air mattress configuration with an inflated air mattress placed on a foam mattress laid on a bed frame; and D, C with a backboard. Deflation of the air mattress decreased MCD significantly (B; 14.74 +/- 1.36 vs C; 30.16 +/- 3.96, P < 0.001). The use of a backboard also decreased MCD (C; 30.16 +/- 3.96 vs D; 25.46 +/- 2.89, P = 0.002). However, deflation of the air mattress decreased MCD more than use of a backboard (B; 14.74 +/- 1.36 vs D; 25.46 +/- 2.89, P = 0.002). The use of a both a backboard and a deflated air mattress in this configuration reduces MCD and thus helps achieve accurate CC depth during cardiopulmonary resuscitation.
Beds ; Cardiopulmonary Resuscitation/*instrumentation/methods ; *Compressive Strength ; Equipment Design ; Heart Massage/*instrumentation/methods ; Humans ; Intensive Care Units ; Manikins ; Prospective Studies

OBJECTIVE: This study investigated and compared the perspectives on emergency medicine (EM) professionalism competencies of medical students and EM residents. In addition, how they learned their EM professionalism was also investigated to develop the base of an educational program of professionalism in the field of EM. METHODS: Medical students in four medical colleges/schools and EM residents were recruited for the questionnaire. Regarding the importance and educational need for EM professionalism, 23 items for medical students and 59 items for EM residents were asked. The items were rated on a five point Likert scale. The perspectives of the two groups were compared. The learning methods for professionalism were investigated. RESULTS: A total of 198 medical students and 109 EM residents responded to the questionnaire. The residents responded with mean of 3.0 or more on all items, agreeing on the importance and educational need. On the other hand, the mean scale was less than 4.0 in communication and cooperation with society and social accountability. The students responded with a mean scale of 4.0 or more on all items and agreed on the importance and educational need. Of the 23 common items, there were differences between the two groups in 17 items, showing a higher mean value in the students. The most common methods of learning EM professionalism was bedside teaching during the clinical clerkship for students, and patient handover or board round for residents. CONCLUSION: EM residents tended to place more importance on medical care than social communication, cooperation, and ethical items. The most common learning method of EM professionalism was clinical practice-associated activities. The results of this study could help to develop a systematic and realistic educational program of EM professionalism in EM clerkship and resident training.
Clinical Clerkship ; Emergencies ; Emergency Medicine ; Hand ; Humans ; Learning ; Methods ; Patient Handoff ; Professionalism ; Social Responsibility ; Students, Medical

OBJECTIVE: The aim of this study was to develop professionalism competency for residents and medical students in the field of emergency medicine. METHODS: Twenty emergency medicine specialists working at a university hospital were recruited for the modified Delphi method. Seventy-three items were generated and classified into five domains: 13 items in patient care, 19 in communication and cooperation, nine in social accountability, 24 in professionalism, and eight in education and research. Two-step surveys were conducted. RESULTS: Items with a low content validity ratio (< 0.42) were deleted, or combined when the meanings of the items were similar or duplicated through two-step surveys. Finally, 59 items for residents were used: 12 items in patient care, 11 in communication and cooperation, six in social accountability, 23 in professionalism, and seven in education and research. In addition, 23 items for medical students were settled: six items in patient care, five in communication and cooperation, none in social accountability, 11 in professionalism, and one in education and research. CONCLUSION: The items related to social accountability and communication and cooperation with society were considered less important by the panels. In addition, there was a tendency to clearly distinguish between resident and student levels in professionalism competency. Based on the results of this study, it is important to form a basis for developing educational programs of professionalism of emergency medicine for senior medical students and residents.
Clinical Competence ; Delphi Technique* ; Education ; Emergencies* ; Emergency Medicine* ; Humans ; Methods ; Patient Care ; Professionalism* ; Social Responsibility ; Specialization ; Students, Medical*

Objective: This study was evaluated the behavior intention of emergency medicine residents before and after education using a vignette case about professionalism, particularly in physician impairment. The residents’ reaction to this type of education was evaluated. Methods: Thirty-four residents from five teaching hospitals participated in this education program consisting of lecture and discussion using cases. They wrote their behavioral intention and their opinions before and after education. Their satisfaction and reaction to the education experience were also collected. Results: The frequencies of the common reasons for the action or the basis of the judgment, concerns during decision making, and desired help were similar, but their action decisions changed into more systemic and reasonable ones after the education. They had fewer learning experiences of non-clinical skills and were satisfied with this type of professionalism education. Furthermore, they felt the importance and educational needs of professionalism beyond this topic and would cope with similar problem situations the way they learned in this education. Conclusion In the professionalism education using the case discussion of impairment and self-monitoring, little had changed in the participants’ reasons for the action, concerns when decision making, and desired help, but their behavior intentions changed as they learned. This study provided the opportunity to recognize the importance of professionalism, patient safety, and peer relationship. Small group discussions using the vignette case can be suggested to provide professionalism education for the emergency medicine residents.

Interprofessional education (IPE) can promote high-quality patient care and good medical outcomes through teamwork among health professionals. However, there are no valid measurements to prove the effectiveness of IPE in Korea. This study aimed to develop and test a Korean version of the Self-efficacy for Interprofessional Experimental Learning Scale (SEIEL). The original SEIEL was translated into Korean by two experienced medical professors, and 368 questionnaires were collected from medical and nursing students (third and fourth year). To analyze the validity of the Korean version of the SEIEL, an exploratory and confirmatory factor analysis was conducted. Cronbach's α was used to evaluate reliability. Results from the exploratory factor analysis identified two functions: “interprofessional collaboration” and “interprofessional team evaluation.” A significant cross-correlation was found between the two functions (r=0.690, p<0.001), with a Cronbach's α value of 0.932. The reliability and validity of the Korean version of the SEIEL was identified in this study. This tool can be helpful in measuring the effectiveness of IPE in Korea.

Objective: This study was evaluated the behavior intention of emergency medicine residents before and after education using a vignette case about professionalism, particularly in physician impairment. The residents’ reaction to this type of education was evaluated. Methods: Thirty-four residents from five teaching hospitals participated in this education program consisting of lecture and discussion using cases. They wrote their behavioral intention and their opinions before and after education. Their satisfaction and reaction to the education experience were also collected. Results: The frequencies of the common reasons for the action or the basis of the judgment, concerns during decision making, and desired help were similar, but their action decisions changed into more systemic and reasonable ones after the education. They had fewer learning experiences of non-clinical skills and were satisfied with this type of professionalism education. Furthermore, they felt the importance and educational needs of professionalism beyond this topic and would cope with similar problem situations the way they learned in this education. Conclusion In the professionalism education using the case discussion of impairment and self-monitoring, little had changed in the participants’ reasons for the action, concerns when decision making, and desired help, but their behavior intentions changed as they learned. This study provided the opportunity to recognize the importance of professionalism, patient safety, and peer relationship. Small group discussions using the vignette case can be suggested to provide professionalism education for the emergency medicine residents.