title: Surgical resident education in patient safety: where can we improve?
abstract: BACKGROUND
  Effective communication and patient safety practices are paramount in health care. Surgical residents play an integral role in the perioperative team, yet their perceptions of patient safety remain unclear. We hypothesized that surgical residents perceive the perioperative environment as more unsafe than their faculty and operating room staff despite completing a required safety curriculum.
  
  
  METHODS
  Surgeons, anesthesiologists, and perioperative nurses in a large academic children's hospital participated in multifaceted, physician-led workshops aimed at enhancing communication and safety culture over a 3-y period. All general surgery residents from the same academic center completed a hospital-based online safety curriculum only. All groups subsequently completed the psychometrically validated safety attitudes questionnaire to evaluate three domains: safety culture, teamwork, and speaking up. Results reflect the percent of respondents who slightly or strongly agreed. Chi-square analysis was performed.
  
  
  RESULTS
  Sixty-three of 84 perioperative personnel (75%) and 48 of 52 surgical residents (92%) completed the safety attitudes questionnaire. A higher percentage of perioperative personnel perceived a safer environment than the surgical residents in all three domains, which was significantly higher for safety culture (68% versus 46%, P = 0.03). When stratified into two groups, junior residents (postgraduate years 1-2) and senior residents (postgraduate years 3-5) had lower scores for all three domains, but the differences were not statistically significant.
  
  
  CONCLUSIONS
  Surgical residents' perceptions of perioperative safety remain suboptimal. With an enhanced safety curriculum, perioperative staff demonstrated higher perceptions of safety compared with residents who participated in an online-only curriculum. Optimal surgical education on patient safety remains unknown but should require a dedicated, systematic approach.
authors.affiliation: Center for Surgical Trials and Evidence-Based Practice, University of Texas Medical School at Houston, Houston, Texas; Department of Pediatric Surgery, University of Texas Medical School at Houston, Houston, Texas; Children's Memorial Hermann Hospital, Houston, Texas.
authors.forename: Luke R
authors.initials: LR
authors.lastname: Putnam
authors.affiliation: Center for Surgical Trials and Evidence-Based Practice, University of Texas Medical School at Houston, Houston, Texas; Department of Pediatric Surgery, University of Texas Medical School at Houston, Houston, Texas.
authors.forename: Shauna M
authors.initials: SM
authors.lastname: Levy
authors.affiliation: Department of Pediatric Surgery, University of Texas Medical School at Houston, Houston, Texas.
authors.forename: Caroline M
authors.initials: CM
authors.lastname: Kellagher
authors.affiliation: Department of Internal Medicine, University of Texas Medical School at Houston, Houston, Texas.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Etchegaray
authors.affiliation: Department of Internal Medicine, University of Texas Medical School at Houston, Houston, Texas.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Thomas
authors.affiliation: Center for Surgical Trials and Evidence-Based Practice, University of Texas Medical School at Houston, Houston, Texas; Department of General Surgery, University of Texas Medical School at Houston, Houston, Texas.
authors.forename: Lillian S
authors.initials: LS
authors.lastname: Kao
authors.affiliation: Center for Surgical Trials and Evidence-Based Practice, University of Texas Medical School at Houston, Houston, Texas; Department of Pediatric Surgery, University of Texas Medical School at Houston, Houston, Texas; Children's Memorial Hermann Hospital, Houston, Texas.
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Lally
authors.affiliation: Center for Surgical Trials and Evidence-Based Practice, University of Texas Medical School at Houston, Houston, Texas; Department of Pediatric Surgery, University of Texas Medical School at Houston, Houston, Texas; Children's Memorial Hermann Hospital, Houston, Texas. Electronic address: kuojen.tsao@uth.tmc.edu.
authors.forename: KuoJen
authors.initials: K
authors.lastname: Tsao
mesh_terms: D001291:Attitude of Health Personnel; D013502:General Surgery / Q000706:statistics & numerical data*; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data*; D061214:Patient Safety
keywords: Patient safety; Patient safety education; Resident education; Resident safety; Safety attitudes questionnaire