An appropriate understanding of Human Factors in healthcare is vital both from the perspective of patient safety and efficiency^1-2. The earlier that the concepts of human factors training are introduced the more likely they are to be adopted into everyday practice and become as familiar as sounding a chest or taking a focused history.

As part of Edinburgh University Medical Schools preparation for practice of final year medical students they carry out a 3 week period of work shadowing which has integrated workshops and simulated ward rounds. These are run in conjunction with workshops which cover a variety of topics (e.g. safe prescribing, escalation of care of septic patient and communication with human factors training).

As there were 259 medical students divided into 28 sessions and 56 ward rounds, not all of them could receive the human factors workshop prior to their simulated ward round experience. This anomaly presented the opportunity to analyse the effectiveness of the human factors training by comparing the performance of those who had attended the workshop prior to the simulated ward round and those who had not.

Feedback was gained from the students regarding how useful they felt the human factors workshop was and observational data was obtained from the simulated ward rounds. The observational data surrounded set interactions and scenarios which consistently occured in every run of the simulated ward round.

Student feedback was overwhelmingly positive for both the Workshop and the Simulated ward round with over 98% scoring it as either good or very good. Over 96% felt the information gained would be useful or very useful (n=259)

The observation data surrounded two main student-consultant interactions during the ward round:

Scenario 1: The consultant would carry out a chest examination on the first patient and then not volunteer his/her findings to the student who has designated to scribe the notes. For this we collected observations from 52 of the 56 ward rounds (92%). 16 (31%)of these had occurred prior to the students attending the workshops and 36 (69%) followed on from the workshops. Of those who had not had the training 6% of them asked regarding the consultants findings whilst 14% of those who had had the workshop did enquire as to what the examination findings were.

Scenario 2: The consultant requested an antibiotic be changed to a more appropriate one for one of the patients conditions. We observed two different things 1. If the students asked the consultant which antibiotic he/she wanted, and how long this took and 2. was the right or any antibiotic prescribed. Again we collected observations on 50 of the 56 ward rounds (89%) 11 of the 50 (22%) hadn't had the workshop first and 39 of the 50 (78%) had had it. 54% of those who hadn't had the workshops asked the consultant regarding the antibiotic whilst 72% of those who had had the workshops asked the consultant. The average time to ask was 23 seconds for those who hadn't had the workshop and 29 seconds for those who had. 36% of those who hadn't had the workshop wrote either the wrong prescription or none at all whilst this was similar to the group that had had the workshop where 34% of them wrote either the wrong prescription or none at all.

The workshop was well received and boosted confidence from the student perspective and doubled the number of people 'flattening the heirarchy'. When the students were confronted with a scenario/context they were more familiar with (i.e. drug prescribing) they were much more comfortable making their views heard with regards to asking the consultants advice after they had attended the workshop.

In conclusion, though a one off workshop was shown to make an immediate difference its magnitude was not as great as we would have liked. A thread of human factors training has to be incorporated throughout medical school in order to ensure that medical students are comfortable, competent and safe at the time for their departure into healthcare provision.

There is a place for Human Factors training within the undergraduate curriculum.

It needs to be interwoven through-out their clinical attachments rather than being dealt with in a single intervention.

All medical professionals need encourage a flattened heirarchy so as to assist in creating a safer environment for our patients.

There were around 50 staff and volunteers who participated in the running for the workshops and simulated ward rounds. Special mention to goes to the clinical skills team at Edinburgh University and also the many foundation doctors and trainee grades of NHS Lothian who gave up their spare time to help.

1. Kohn L.T., Corrigan J.S., Donaldson, M.S., To Err is Human: Building Safer Health System. National Academy Press. Washington D.C. (1999)

2. Carayon P., Wetterneck  T.B., Rivera-Rodriguez A.J., Hundt A.S., Hoonakker P., Hodden R., Gurses A.P. Human factors systems approach to healthcare quality and patient safety. Applied Ergonomics, 45, 14-15, (2014)