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Junior doctors' reflections on patient safety
  1. Maria Ahmed1,
  2. Sonal Arora1,
  3. Simon Carley2,
  4. Nick Sevdalis1,
  5. Graham Neale1
  1. 1Centre for Patient Safety and Service Quality, Department of Surgery and Cancer, Imperial College London, UK
  2. 2Postgraduate Medical Education Department, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
  1. Correspondence to Dr Maria Ahmed, Clinical Research Fellow in Education and Training for Quality and Safety, Centre for Patient Safety and Service Quality, Room 504, Medical School Building, Imperial College (St Mary's Campus), Norfolk Place, London W2 1PG, UK; maria.ahmed{at}


Aim To determine whether foundation year 1 (FY1) doctors reflect upon patient safety incidents (PSIs) within their portfolios and the potential value of such reflections for quality of care.

Methods A cross-sectional retrospective review of every ‘reflective practice’ portfolio entry made by all FY1 doctors within an Acute Teaching Hospital Trust was conducted in February 2010. Entries were reviewed by two independent blinded researchers to determine whether they related to a PSI that is, any unintended or unexpected incident that could have or did lead to patient harm. For all entries rated positive by both reviewers, a content analysis approach was used to code PSI into incident type, contributing factors and patient outcome according to validated frameworks developed by the National Patient Safety Agency.

Results 139 reflective practice entries were completed by 30 trainees (15 men, 15 women, mean age 24 years). Of the 139 entries, 49% reflected on a PSI. Of these, 22% were due to errors in clinical assessment; 22% were due to delayed access to care; 18% were due to infrastructure/staffing deficiencies; and 16% were due to medication errors. The most common contributing factors were team/social factors (23%), patient factors (22%), communication and task factors (both 17%). The majority of PSIs led to no harm. Six entries described PSIs resulting in patient death, the majority of which were attributable to diagnostic errors.

Conclusions FY1 doctors commonly reflect on PSIs within their professional portfolios. Such critical reflection can encourage learning but may also promote patient safety and the quality of healthcare across all medical specialties.

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  • Funding This study did not receive specific funding. MA, SA, NS and GN are members of the Imperial Centre for Patient Safety and Service Quality, which is funded by the UK's National Institute for Health Research.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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