Effects of Patient Narratives

Researchers from Yorkshire [1] report a fascinating study where the effects of patient narratives on attitude towards safety of newly qualified doctors were investigated in a RCT. Two outcomes measures were used: a scale of safety attitude and a scale of emotional affect. The intervention involved facilitated workshops where patients and early career doctors would discuss harrowing safety narratives. I thought this might be an effective educational intervention. However, there was no measured difference between intervention and control doctors on the safety attitude questionnaire. What about emotional effects? This result was interesting since both positive and negative affect increased in the intervention group; a ‘bimodal’ effect.

I have never been impressed with safety attitude/culture/climate questionnaires which cover all sorts of factual questions, such as whether the respondent knows that fatigue can cause error, so the null result on this end-point was not surprising. That said, the sub-scale dealing with the relevance of patient involvement did improve in the intervention group compared to control. The split effect on emotion is more puzzling and I think could be well explored by qualitative research. Maybe the young doctors felt inhibited in discussing some of their feelings because of the dynamic within the groups. I don’t think we should give up on stories about medical failure and the patient voice surely enriches the narrative.

— Richard Lilford, CLAHRC WM Director

Reference:

  1. Jha V, Buckley H, Gabe R, et al. 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. BMJ Qual Saf. [ePub]
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