title: Patients as teachers: a randomised controlled trial on the use of personal stories of harm to raise awareness of patient safety for doctors in training.
abstract: BACKGROUND
  Patient safety training often provides learners with a health professional's perspective rather than the patient's. Personal narratives of health-related harm allow patients to share their stories with health professionals to influence clinical behaviour by rousing emotions and improving attitudes to safety.
  
  
  OBJECTIVE
  This study measured the impact of patient narratives used to train junior doctors in patient safety.
  
  
  METHODS
  An open, multi-centre, two-arm, parallel design randomised controlled trial was conducted in the North Yorkshire East Coast Foundation School (NYECFS). The intervention consisted of 1-h-long patient narratives followed by discussion. The control arm received conventional faculty-delivered teaching. The Attitude to Patient Safety Questionnaire (APSQ) and the Positive and Negative Affect Schedule (PANAS) were used to measure the impact of the intervention.
  
  
  RESULTS
  142 trainees received the intervention; 141 the control teaching. There was no evidence of a difference in post-intervention APSQ scores between the groups. There was a statistically significant difference in the underlying distribution of both post PA (positive affect) and post NA (negative affect) scores between the groups on the PANAS (p<0.001) with indications of both higher PA and NA scores in the intervention group.
  
  
  CONCLUSIONS
  Involving patients with experiences of safety incidents in training has an ideological appeal and seems an obvious choice in designing safety interventions. On the basis of our primary outcome measure, we were unable to demonstrate effectiveness of the intervention in changing general attitudes to safety compared to control. While the intervention may impact on emotional engagement and learning about communication, we remain uncertain whether this will translate into improved behaviours in the clinical context or indeed if there are any negative effects.
  
  
  BACKGROUND
  Grant reference no. RP-PG-0108-10049.
authors.affiliation: Medical Education and Undergraduate School of Medicine, University of Liverpool, Liverpool, UK.
authors.forename: Vikram
authors.initials: V
authors.lastname: Jha
authors.affiliation: Department of Health Sciences, University of York, York, UK.
authors.forename: Hannah
authors.initials: H
authors.lastname: Buckley
authors.affiliation: Department of Health Sciences, University of York, York, UK.
authors.forename: Rhian
authors.initials: R
authors.lastname: Gabe
authors.affiliation: Department of Health Sciences, University of York, York, UK.
authors.forename: Mona
authors.initials: M
authors.lastname: Kanaan
authors.affiliation: Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Lawton
authors.affiliation: Warwick Medical School, University of Warwick, Warwick, UK.
authors.forename: Colin
authors.initials: C
authors.lastname: Melville
authors.affiliation: Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.
authors.forename: Naomi
authors.initials: N
authors.lastname: Quinton
authors.affiliation: Leeds Institute of Medical Education, University of Leeds, Leeds, UK.
authors.forename: Jools
authors.initials: J
authors.lastname: Symons
authors.affiliation: Leeds Metropolitan University, Leeds, UK.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Thompson
authors.affiliation: Department of Health Sciences, University of York, York, UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Watt
authors.affiliation: Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.
authors.forename: John
authors.initials: J
authors.lastname: Wright
mesh_terms: D001291:Attitude of Health Personnel; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D007858:Learning; D033262:Narration; D015279:Organizational Culture; D061214:Patient Safety; D010361:Patients; D013663:Teaching / Q000379:methods*
keywords: Health professions education; Medical education; Patient safety