Students' perceptions of patient safety during the transition from undergraduate to postgraduate training: an activity theory analysis

Abstract

Evidence that medical error can cause harm to patients has raised the attention of the health care community towards patient safety and influenced how and what medical students learn about it. Patient safety is best taught when students are participating in clinical practice where they actually encounter patients at risk. This type of learning is referred to as workplace learning, a complex system in which various factors influence what is being learned and how. A theory that can highlight potential difficulties in this complex learning system about patient safety is activity theory. Thirty-four final year undergraduate medical students participated in four focus groups about their experiences concerning patient safety. Using activity theory as analytical framework, we performed constant comparative thematic analysis of the focus group transcripts to identify important themes. We found eight general themes relating to two activities: learning to be a doctor and delivering safe patient care. Simultaneous occurrence of these two activities can cause contradictions. Our results illustrate the complexity of learning about patient safety at the workplace. Students encounter contradictions when learning about patient safety, especially during a transitional phase of their training. These contradictions create potential learning opportunities which should be used in education about patient safety. Insight into the complexities of patient safety is essential to improve education in this important area of medicine.

Fig. 1

Second generation activity system (Engeström et al. 1999). The subject tries to change something (object) in order to achieve a goal (outcome). This is mediated by tools (artefacts), the rules that apply in that activity, the community that is involved in the activity and the division of labour between members of the community

Fig. 2

Model of the relations between the different themes

Fig. 3

Third generation activity system adapted from Engeström (2001). Triangle on the left activity system of learning to be a doctor. Triangle on the right activity system of safe patient care. The themes we identified are in italics