title: Effects of a case-based interactive e-learning course on knowledge and attitudes about patient safety: a quasi-experimental study with third-year medical students.
abstract: BACKGROUND
  Patient safety (PS) is influenced by a set of factors on various levels of the healthcare system. Therefore, a systems-level approach and systems thinking is required to understand and improve PS. The use of e-learning may help to develop a systems thinking approach in medical students, as case studies featuring audiovisual media can be used to visualize systemic relationships in organizations. The goal of this quasi-experimental study was to determine if an e-learning can be utilized to improve systems thinking, knowledge, and attitudes towards PS.
  
  
  METHODS
  A quasi-experimental, longitudinal within- subjects design was employed. Participants were 321 third-year medical students who received online surveys before and after they participated in an e-learning course on PS. Primary outcome measures where levels of systems thinking and attitudes towards PS. Secondary outcome measures were the improvement of PS specific knowledge through the e-learning course.
  
  
  RESULTS
  Levels of systems thinking showed significant improvement (58.72 vs. 61.27; p < .001) after the e-learning. Student's attitudes towards patient safety improved in several dimensions: After the course, students rated the influence of fatigue on safety higher (6.23 vs. 6.42, p < .01), considered patient empowerment more important (5.16 vs. 5.93, p < .001) and realized more often that human error is inevitable (5.75 vs. 5.97, p < .05). Knowledge on PS improved from 36.27 % correct answers before to 76.45 % after the e-learning (p < .001).
  
  
  CONCLUSIONS
  Our results suggest that e-learning can be used to teach PS. Attitudes towards PS improved on several dimensions. Furthermore, we were able to demonstrate that a specifically designed e-learning program can foster the development of conceptual frameworks such as systems thinking, which facilitates the understanding of complex socio-technical systems within healthcare organisations.
authors.affiliation: Medical Faculty, Medical Psychology and Medical Sociology, Freiburg University, D-79104, Freiburg, Germany. rainer.gaupp@mps.uni-freiburg.de.
authors.forename: Rainer
authors.initials: R
authors.lastname: Gaupp
authors.affiliation: Medical Faculty, Medical Psychology and Medical Sociology, Freiburg University, D-79104, Freiburg, Germany.
authors.forename: Mirjam
authors.initials: M
authors.lastname: Körner
authors.affiliation: Medical Faculty, Medical Psychology and Medical Sociology, Freiburg University, D-79104, Freiburg, Germany.
authors.forename: Götz
authors.initials: G
authors.lastname: Fabry
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000592:standards; D003194:Computer-Assisted Instruction; D004504:Education, Medical, Undergraduate / Q000379:methods* / Q000592:standards; D004521:Educational Measurement; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D019300:Medical Errors / Q000517:prevention & control; D061214:Patient Safety; D018794:Problem-Based Learning; D000066908:Simulation Training; D013337:Students, Medical; D013663:Teaching; D014584:User-Computer Interface
keywords: Attitudes; Medical education; Patient safety; Safety culture