Presented by: Kevin Morash1; Heather Grant, MSc.2; Mark Harrison, MD1, 2 1Queen’s School of Medicine, Kingston, ON 2Division of Orthopaedic Surgery, Queen’s University, Kingston, ON

1. Implementation of a Patient Safety Training
Program for New Surgical Residents
Kevin Morash1; Heather Grant, MSc.2; Mark Harrison, MD1, 2
1Queen’s School of Medicine, Kingston, ON
2Division of Orthopaedic Surgery, Queen’s University, Kingston, ON

2. Context
• Safety Attitudes Questionnaire (SAQ)3
– Measures safety culture: attitudes and perceptions of frontline healthcare workers with respect to
patient safety
– 60 questions divided into 6 categories: Safety Climate, Teamwork Climate, Stress Recognition,
Perceptions of Management, Working Conditions and Job Satisfaction
• Validated Test of Patient Safety Knowledge (VTPSK)4
– Measures trainees’ objective knowledge relating to patient safety
– 14 multiple-choice questions
– Used to assess the effectiveness of educational interventions
• Queen’s University Surgical Foundations “Boot Camp”
– Concentrated, hands-on course for PGY1 Surgical Residents
– Instructs basic surgical and emergency skills
– A component of the Queen’s University Surgical Foundations program for all PGY1 and PGY2
Surgical Residents
3. Helmreich, R.L, Neilands, T.B, Rowan, K., Vella, K., Boyden, J., Roberts, P.R., & Thomas, E.J. (2006). The Safety Attitudes Questionnaire: psychometric properties, benchmarking data, and emerging
research. BMC Health Services Research, 6, 44-53.
4. Kerfoot, B.P., Conlin, P.R., Travison, T., & McMahon, G.T. (2007). Patient safety knowledge and its determinants in medical trainees. Journal of General Internal Medicine, 22, 1150-1154.

3. Opportunity
• Pilot SAQ data collected from Surgical Residents at Queen’s University in July 2013
– Highlighted Safety Climate, Teamwork Climate and Stress Recognition as target areas for
intervention
• Objectives:
– Develop, implement and evaluate a patient safety training program for the Surgical Foundations
“Boot Camp”
– Improve safety climate and theoretical patient safety knowledge among PGY1 Surgical Residents
– Identify areas of weakness in current resident safety climate
– Generate suggestions to improve patient safety at Queen’s University-affiliated hospitals

4. Intervention
• Intervention group
– PGY1 Surgical Residents
• Training in General Surgery, OB/GYN, Ophthalmology, Orthopaedics and Urology programs
• Control groups
– PGY1 Anesthesia/Internal Medicine Residents
– PGY2-5 Surgical Residents
• Timeline
– June 2014
• All groups completed SAQ and VTPSK pre-test
– July 2014
• PGY1 Surgical Residents received 4.5 hours of didactic lectures, cases and role plays
– Topics: Safety Culture, Teamwork, Communication, Human Factors Design and Risk
Management
– Supplemented by assigned readings and online modules
• Control groups received no dedicated patient safety training
– August 2014
• All groups repeated the SAQ and VTPSK, 2 weeks after the final didactic session

5. Measurement
• Primary outcome:
– Differences in SAQ scores, specifically in the Safety Climate, Teamwork Climate and Stress
Recognition categories
• Secondary outcomes:
– Changes in mean VTPSK scores
– Changes in mean SAQ scores in the Perceptions of Management, Working Conditions and Job
Satisfaction categories
• Other data collected:
– SAQ communication scale
– Evaluations of teaching methods
– Suggestions to improve patient safety at Queen’s University
• Analysis:
– Overall and categorized SAQ data were analyzed using one-way ANOVA, Tukey’s HSD and
paired t-tests
– VTPSK data were analyzed using chi-squared tests

6. Contribution to Patient Safety: SAQ Results
• There were no significant differences in SAQ scores between groups on the pre-test or post-test
(Figure 1)
• There were no significant changes between pre-test and post-test SAQ scores in any study groups:
- PGY1 surgical residents: n=11, 75.6 ± 6.1 to 74.3 ± 9.2, p=0.78
- PGY1 anesthesia/internal medicine residents: n=7, 74.2 ± 5.4 to 75.4 ± 12.2, p=0.83
- PGY2-5 surgical residents: n=7, 70.4 ± 7.1 to 68.7 ± 24.2, p=0.87
100
90
80
70
60
50
40
30
PGY1 Surgery Pre-Test PGY1 Surgery Post-Test
PGY1 Anesthesia/Internal Pre-Test PGY1 Anesthesia/Internal Post-Test
PGY2-5 Surgery Pre-Test PGY2-5 Surgery Post-Test
Safety Climate Teamwork Climate Stress Recognition Perceptions of
Management
Working
Conditions
Job Satisfaction Overall
Mean Score (%)
SAQ Category
Figure 1. Mean SAQ pre-test and post-test scores (with standard deviations) by category for PGY1 surgical residents, PGY1 anesthesia/internal medicine
residents and PGY2-5 surgical residents.

7. Contribution to Patient Safety: VTPSK Results
• PGY2-5 surgical residents scored significantly higher (p=0.02) on the VTPSK than PGY1 surgical
residents and PGY1 anesthesia/internal medicine residents at baseline (Figure 2)
• There were no differences between groups in post-test VTPSK scores (p=0.62)
90
80
70
60
50
40
30
20
10
0
*
Pre-Test Post-Test
Mean Score (%)
PGY1 Surgery
PGY1 Anesthesia/Internal
PGY2-5 Surgery
Figure 2. Mean VTPSK pre-test and post-test scores (with standard deviations) for PGY1 surgical residents, PGY1 anesthesia/ internal medicine residents and PGY2-5
surgical residents. * = p<0.05.

8. Lessons Learned, Partnerships and Sustainability
• Lessons Learned
– The patient safety training program did not improve SAQ scores
– While VTPSK scores did improve for PGY1 surgical residents relative to the PGY2-5 surgical
residents, this improvement did not exceed the PGY1 anesthesia/internal medicine controls
– This study was limited by its sample size, and could have been influenced by self-selection of
control group participants
• Partnerships
– This project served to instruct new surgical residents on several aspects of safety culture, and
improve their theoretical knowledge relating to patient safety
– Delivered at an early juncture in postgraduate training, this knowledge and awareness should
inform their clinical experiences with patients and families as they proceed through training
• Sustainability
– This study should be repeated with a larger sample size, particularly in control groups
– The patient safety curriculum developed for this study will be continued in future years
– The audience could be expanded to include:
• Medical students and senior residents from Queen’s University
• Learners from other institutions