1. One of the learning objectives / instructional goals of the Ethics and Professionalism elective course on
“Patient Safety: Better Knowledge for Safer Care” introduced to Kuwait University since 2005 was to
“Enable students to make judgments about the safety of clinical practice through the use of reflective
thinking & writing tools to enhance their moral development as future doctors” achieving a higher
category of learning based on the Cognitive Domains of Learning (Blooms’ Taxonomy, Fig 1).
INTRODUCTION:
Patient Safety Education For Future Doctors:
A Reflective Strategy Eating Unsafe Culture Slowly and Surely
Manal Bouhaimed,[1,2]
Hossam Elamir[3]
[1] Department of Community Medicine and Behavioural Sciences, Kuwait University Faculty of Medicine
[2] Department of Surgery, Kuwait University Faculty of Medicine
[3] Department of Quality and Accreditation, Mubarak Al-Kabeer Hospital, MOH
Fig 1: Bloom’s Taxonomy (Revised)
Remembering
Understanding
Applying
Analyzing
Evaluating
Creating
Can the student distinguish
between different parts?
Appraise, compare, contrast, criticize,
differentiate, discriminate, distinguish,
examine, experiment, question, test
Define, duplicate, list, memorize,
recall, repeat, state
Can the student recall or
remember the information?
Can the student explain ideas or
concepts?
Can the student use information
in a new way?
Classify, describe, discuss, explain,
identify, locate, recognize, report,
select, translate, paraphrase
Choose, demonstrate, dramatize,
employ, illustrate, interpret, operate,
schedule, sketch, solve, use, write
Can the student justify a stand
or decision?
Appraise, argue, defend, select,
support, value, evaluate
Can the student create a new
product or point of view?
Assemble, construct, create, design,
develop, formulate, write
1. Bloom, Benjamin (ed.). Taxonomy of Education al Objectives. Handbook I: Cognitive Domain. David McKay Company, Inc. New York: 1956.
http://pcs2ndgrade.pbworks.com/w/page/46897760/Revised%20Bloom's%20Taxonomy
DO IT.
What?
What happened?
What were the
results?
Now What?
What will I
do differently
next time?
So What?
What do these results imply?
How did I influence the
outcome?
Description
What happened?
Description
What sense can you make
of the situation?
Fig 2: Gibbs Reflective Cycle
Feelings
What were you thinking
and feeling?
Action Plan
If it arose again, what
would you do?
Conclusion
What else could you have
done?
Evaluation
What was good & bad
about the experience?
Concrete
Experience
(Feeling)
Fig 3: Kolb’s Learning Cycle
Abstract
Conceptualisation
(Thinking)
Adapted by Ivan Mactaggart from Mcleod,2010
“Learning is the process whereby knowledge is created through
the transformation of experience” (David A Kolb, 1984)
http://www.simplypsychology.org/learning-kolb.html
#sthash.DOwEfaZC.q20UZ5MW.dpbs
Reflective
Observation
(Watching)
Active
Experimentation
(Doing)
A one day informed consent and surgical check lists audit
at a secondary care hospital in Kuwait
Students' Reflection on Current Practice
to Avoid Tubing Misconnection: A Simple Solution,
A Difficult Compliance, A Training Opportunity
Is The Accreditation Program Enough To Ensure Patient Safety?
A Students' Reflection On A Patient Safety Required Area
Exploring students' Feelings Counts in Education:
The Use of Gibbs Reflective Cycle in Teaching Clinical Ethics
Inpatient Wards
TPN Unit
Laboratory
Treatment Rooms
Pharmacy
Medical Records
Operating Theatre
The following reflective tools were used in an academic context for teaching this elective course:
• Gibbs Reflective Cycle (Fig 2).
• The Kolb’s cycle (Fig 3).
• The Burton’s approach (Fig 4).
The use of these tools in a hospital based rotations (Fig 5a) aimed at:
Looking back at an event or having a hands-on experience.
Analyzing the event, ideas or emotions/responses related to the event (thinking in depth and from
different perspectives, trying to explain what happened, for example with reference to the WHO
Nine Patient Safety Solution (Fig 5b).
Thinking carefully about what the event or idea means for them and their on-going development as
future care providers and practicing professionals.
METHODS:
The outcomes of these reflective exercises over the years were presented at different conferences and meetings (Fig 5c). The following are some examples:
• The Gibbs Reflective Cycle was applied to the students’ experience of reviewing 33 unidentifiable medical records for the application of “Performance of Correct Procedure at
Correct Body Site” protocol in the hospital.
• The Kolb’s cycle was applied to the students’ experience of examining 152 patients for hospital adherence to the “Avoiding Catheter and Tubing Misconnections” protocol.
• The Burton’s approach of reflection was used during the assessment of 41masked non-identifiable consent forms to assess to the pre-intervention patient’s verification protocol.
Results:
It was evident that the students in this elective course successfully developed
a new realization of the role of human factors in errors and the concept of
system failure suggesting that reflective education for patient safety can be
successfully used in patient safety education.
Conclusion:
What is most important, interesting, useful,
relevant about the object event or idea?
Interpretation:
What happened?
Description:
What have I learned from this?
What does this mean for my future?
Outcome:
Acknowledgement:
We would like to acknowledge the assistance provided by Dr. Susan Jacob;
Department of Community Medicine and Behavioural Sciences, and Quality
Nurses of Mubarak Al-Kabeer Hospital: Abeer G. Dossokey, Amal T. Mohamed,
Asila A. Alrasheedi, Lea Martinez & Rinto Francis.
Fig 4: The Burton’s approach
Fig 5a: The Hospital Based Rotations
Patient safety
Solutions
Look-alike,Sound-Alike
(LASA) Medication Names
Patient Identification
Single Use of Injection
Devices
Performance of Correct
Procedure at Correct
Body Site
Improved Hand Hygiene to Prevent
Healthcare-Associated Infection
Assuring Medication
Accuracy at Transitions
in Care
Avoiding Catheter and
Tubing Misconnection
Control of concentrated
electrolyte solutions
Communication During
Patient Handovers
Fig 5b:
Fig 5c: Poster Abstracts