Physicians-in-Training Attitudes on Patient Safety: 2003 to 2008

OBJECTIVE:Physician trainees will embody medicine's future culture. We assess whether trainees' patient safety attitudes have evolved over time. METHODS:We anonymously surveyed more than 800 house staff and fourth-year medical students (MS 4) in 2008, at 1 academic institution, with a 19-item questionnaire and compared their responses to the 2003 responses at the same institution on the same questionnaire. RESULTS:A total of 463 trainees (53%) completed the 2008 survey, with a mean overall safety score of 3.54, which significantly improved from the 2003 overall score of 3.41 (P < 0.001). Compared with those from 2003, respondents in 2008 more strongly agree that physician-nurse teamwork (P = 0.001), attending supervision (P = 0.017), 80-hour workweek (P < 0.001), computer order entry (P < 0.001), and improved resident sign-out (P < 0.001) help reduce adverse events. The 2008 trainees feel more prepared to prevent adverse events (P = 0.030) and more acknowledge the ethical responsibility to disclose adverse events to patients (P = 0.002). However, compared with 2003, fewer 2008 respondents felt that reducing nurses' patient load would reduce adverse events (P = 0.015); on 8 questionnaire items, there were no significant attitudinal changes between 2003 and 2008. CONCLUSIONS:Physician trainee safety attitudes at 1 institution improved between 2003 and 2008, and these trainees support many system-based solutions to adverse events. The changes seem incremental and responses do not fully align with all aspects of a safety culture. Cultural change in health care must involve trainees and address their attitudes.