Journal of Educational Innovation Research 2019, Vol. 29, No. 4, pp DOI: * Differences in At

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1 Journal of Educational Innovation Research 2019, Vol. 29, No. 4, pp DOI: * Differences in Attitudes to Patient Safety and Readiness for Interprofessional Learning in Medical Students according by Gender and Grade Purpose: Necessity about interprofessional cooperation keeps on increasing and patient safety is also highlighted in the medical community. However, there is a lack of awareness of patient safety and interprofessional cooperation among medical students. Therefore, this study aims to find out the grade and gender-based difference among medical students through questionnaire, and then examines the relationship between attitude toward patient safety and readiness for interprofessional cooperation. Method: The survey on grade and gender-based differences in attitudes toward patient safety and readiness for interprofessional cooperation was conducted through a questionnaire survey of 500 medical students from two medical school. For perception of patient safety, APSQ-III was used, and RIPLS was used for readiness for interprofessional cooperation. For the study analysis, we used a two-way ANOVA and simple regression analysis Results: There were significant differences in attitudes to patient safety by grade and gender are sub-factors: Patient safety training received to date, Error reporting, Error inevitability, Team functioning, Patient s role in error, Importance of patient safety in the curriculum. Team-work and collaboration, and professional identity, which are sub-factors of Readiness of healthcare students for interprofessional learning, differed significantly by grade and gender. Teamwork and collaboration have been shown to influence on attitudes to patient safety. Conclusion: This study is expected to raise awareness of patient safety and interprofessional cooperation in the medical education curriculum. It may also help to establish the direction of how patient safety awareness education, including interprofessional collaboration in medical education, should be conducted by grade. Key words : patient safety attitudes, readiness for interprofessional learning, medical students, medical education * Corresponding Author: Yune, So-Jung. Pusan National University School of Medicine, Dept. of Medical Education, Busandaehakro 49, Yangsan, Korea,

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6 (Problem Based Learning; PBL)., PBL (Reynolds, 2003)., ,. 619, 541 ( 87.4%) % 22.5% 23.7% 27.5% 26.3% 100.0% % 64.5% 64.1% 66.0% 61.5% 64.0% % 14.4% 15.2% 17.6% 16.8% 64.0% % 22.1% 23.6% 25.1% 29.2% 100.0% % 35.5% 35.9% 34.0% 38.5% 36.0% % 7.9% 8.5% 9.1% 10.5% 36.0% % 22.4% 23.7% 26.6% 27.4% 100.0% % 100.0% 100.0% 100.0% 100.0% 100.0% % 22.4% 23.7% 26.6% 27.4% 100.0%

7 Carruthers, Lawton, Sandars, Howe Perry(2009) (Attitudes to Patient Safety Questionnaire, APSQ-III). Carruthers, Lawton, Sandars, Howe Perry(2009) 9 26, (Cronbach α) , 1, 2, 1, (Cronbach α).858, Del Bigio, Mulhall, Shevchuk & Mansell(2016) (Readiness of healthcare students for interprofessional learning scale, RIPLS). 19, Likert 5 1 ( ) 5 ( ). (team-work and collaboration), (professional identity), (roles and responsibility) 3, Cronbach α , (Cronbach α) Cronbach α

8 . Tukey, Tamhane T2.,. SPSS 23.0 for Windows(SPSS Inc., Chicago, USA).. < IV-1>, < IV-2>.,,,,,., (F=4.66, p=0.003) (F=10.58, p=0.001), (F=3.66, p=0.12). 4 (M=14.19, SD=3.18) (M=12.54, SD=3.47). 1 2, (M=15.22, SD=2.99) 1 (M=13.12, SD=3.23), 2 (M=14.98, SD=3.09) (M=14.44, SD=3.49). 2 (M=14.98, SD=3.09) 2 (M=14.44, SD=3.49), 3 (M=14.31, SD=3.45) 3 (M=14.99, SD=3.55) < IV-1>., (F=4.31,

9 p=0.005). 2(M=10.91, SD=2.00) 3(M=11.06, SD=32.31) 4(M=10.22, SD=2.21). (F=9.505, p=0.000). 1(M=12.21, SD=1.63), 2(M=12.11, SD=1.81), 3(M=11.97, SD=2.16) 4(M=11.08, SD=2.31). (F=3.58, p=0.014), 2(M=11.05, SD=2.16), 3(M=10.96, SD=2.05) 4 (M=10.29, SD=2.39). (F=4.63, p=0.003), 1(M=11.45, SD=1.83), 3(M=11.31, SD=2.05) 4(M=10.62, SD=2.11). (F=6.81, p=0.003) 1(M=11.15, SD=1.64), 2(M=10.88, SD=1.91), 3(M=10.94, SD=1.99) 4(M=10.15, SD=2.09)., (F=6.55, p=0.000), 1(M=108.37, SD=10.32), 2(M=107.55, SD=12.44), 3(M=107.53, SD=13.12) 4(M=102.43, SD=14.21)..,,,,,,, M(SD) M(SD) M(SD) M(SD) M(SD) M(SD) M(SD) M(SD) (2.99) (2.49) (2.91) (1.68) 9.22 (2.19) 9.82 (2.38) (1.97) (3.23) (2.00) (2.79) (1.52) 9.79 (2.01) (1.72) (1.97) (3.49) (2.02) (2.84) (1.96) 9.18 (2.44) 9.91 (2.44) (2.26) (3.09) (1.93) (2.41) (1.52) 8.89 (2.59) 9.80 (2.21) (2.01) (3.55) (2.14) (3.09) (2.08) 8.93 (2.78) 9.68 (2.45) (2.14) (3.45) (2.10) (3.04) (2.29) 9.49 (2.32) 9.57 (2.30) (1.90) (3.18) (2.23) (3.07) (2.08) 9.14 (2.69) 9.64 (2.46) (2.09) (3.47) 9.95 (2.44) (3.63) (2.61) 9.60 (2.36) (2.37) (2.81)

10 ( ) M(SD) M(SD) M(SD) M(SD) M(SD) M(SD) M(SD) M(SD) (1.85) (1.62) (11.11) (1.83) (1.68) (8.69) (2.42) (1.96) (13.27) (2.08) (1.77) (10.85) (2.05) (1.89) (13.68) (2.05) (2.19) (12.06) (1.93) (2.08) (12.55) (2.37) (2.11) (16.54) SS df MS F p post hoc > * > * * > * * * > *

11 ( ) SS df MS F p post hoc ,3> * ,2,3> * ,2,3> * < IV-3>, < IV-4>.

12 M(SD) M(SD) M(SD) M(SD) M(SD) M(SD) M(SD) M(SD) (4.41) (3.18) (6.74) (3.75) (2.84) (5.53) (5.57) (2.95) (7.45) (4.84) (3.76) (7.97) (5.76) (3.95) (8.80) (5.32) (3.85) (8.34) (5.24) (4.02) (8.44) (5.82) (3.43) (7.64) SS df MS F p post hoc >2,3, * >2,3, * >2,3, * ,,., (F=15.74, p=0.000), (F=6.55, p=0.000), (F=14.62, p=0.000),.., 1(M=37.63, SD=4.17) 2(M=34.53, SD=5.33), 3(M=34.68, SD=5.60), 4(M=33.32, SD=5.51), 1(M=35.22, SD=3.08) 2(M=24.00, SD=3.25), 3(M=23.99, SD=3.90), 4(M=23.51, SD=3.85), 1(M=62.85, SD=6.32) 2(M=58.50, SD=7.63), 3(M=58.67, SD=8.62), 4(M=56.84, SD=8.25).

13 , r=-.17 r=.65. (r=.63, p<.001). (r=.55, p<.001), (r=-.17, p<.001). (r=.59, p<.001). r=-.18 r=.54. (r=.54, p<.001)., (r=-.18, p<.001) ** **.38 *** **.39 ***.59 *** ***.25 *** ***.18 ***.21 ***.22 *** ***.35 ***.35 **.37 *** *** ***.42 ***.42 ***.50 ***.11 **.26 ***.63 *** ***.40 ***.33 ***.36 *** ***.55 ***.54 *** ***.29 ***.27 ***.36 *** **.45 ***.46 ***.54 *** ***.18 ***.12 **.16 *** -.18 *** ***.28 ***.38 ***.59 *** - * p<.05, ** p<.01, *** p<.001 < IV-6>. Durbin-Watson 1 3, VIF 10.

14 . 15% 35%. M SD B β t p R ,..,. 4.,,,, 4.., (Myung et al., 2012).

15 (Carruthers, Lawton, Sandars, Howe, & Perry, 2009). 1 (, 2012),..,,.,, (Roh, 2019;, 2009)..., (Yoo & Park, 2015).,, 3, 4 1, ,,.,, (Ban, 2017). (, 2019), (2015).,.. (,,,,, 2005).,, , 3, 1 2

16 , , 3 4., 2, 3,..,..,.,. 1.,, (Conrad, 1988; Hafferty, 2006). (Lindh Falk, Hammar, & Nyström, 2015),. (Pollard, Miers, & Gilchrist, 2004),, (Tunstall-Pedoe, Rink, & Hilton, 2003). 4,...,,.,. 2, 2,, (Lindh Falk, Hammar, &

17 Nyström, 2015)... (Bar, Leurer, Warshawski, & Itzhaki, 2018),..,,.. 60% (, 2012).. (Ryan & McKenna, 1994). (Zwarenstein & Bryant, 2008).,,. (Kyrkjebø, Brattebø, & Smith-Strøm, 2006).,,, (Kim, Kang, & Kim, 2007).,,..,,.,,,,.,.

18 .512.,.,.,,,, (2005).. (4), ,,,,,, (2012).. (2), ,,,,,,,,,,, (2018).,. (2), (2017).,. (2), , (2014).,. (1), (2019).,..,, (2019). :. (1), (2009).. (3), ,. (2018).. (1), ,, (2017).. (1), , (2015).. (8), (2015).

19 .. Ban, K. A., Chung, J. W., Matulewicz, R. S., Kelz, R. R., Shea, J. A., Dahlke, A. R., Quinn, C. M., Yang, A. D., & Bilimoria, K. Y. (2017). Gender-based differences in surgical residents' perceptions of patient safety, continuity of care, and well-being: an analysis from the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) trial. Journal of the American College of Surgeons, 224(2), Bar, M. A., Leurer, M. K., Warchawski, S., & Itzhaki, M. (2018). The role of personal resilience and personality traits of healthcare students on their attitudes towards interprofessional collaboration. Nurse Education Today, 61, Blendon, R. J., DesRoches, C. M., Brodie, M., Benson, J. M., Rosen, A. B., Schneider, E., Altman, D. E., Zapert, K., Herrmann, M., and Steffenson, A. E. (2002). Views of Practicing Physicians and the Public on Medical Errors. New England Journal of Medicine, 347, Brennan, T. A., Leape, L. L., Laird, N. M., Hebert, L., Localio, A. R., Lawthers, A. G., Newhouse, J. P., Weiler, P. C., & Hiatt, H. H. (1991). Incidence of adverse events and negligence in hospitalized patients: results of the Harvard Medical Practice Study I. New England journal of medicine, 324(6), Carruthers, S., Lawton, R., Sandars, J., Howe, A., & Perry, M. (2009). Attitudes to patient safety amongst medical students and tutors: Developing a reliable and valid measure. Medical Teacher, 31(8), e370-e376. Conrad, P. (1988). Learning to doctor: Reflections on recent accounts of the medical school years. Journal of Health and Social Behavior, 29(4), Curran, V. R., Sharpe, D., Forristall, J., & Flynn, K. (2008). Attitudes of health sciences students towards interprofessional teamwork and education. Learning in Health and Social Care, 7(3), Del Bigio, S., Mulhall, S., Shevchuk, Y., & Mansell, H. (2016). Perceptions of teamwork and interprofessional education in undergraduate pharmacy students. Pharmacy Education, 16(1), Gilbert, J. H. (2005). Interprofessional education for collaborative, patient-centred practice. Nursing leadership, 18(2), Hafferty, F. W. (2006). Professionalism The next wave. N Engl J Med; 355(20), Kyrkjebø, J. M., Brattebø, G., & Smith-Strøm, H. (2006). Improving patient safety by using interprofessional simulation training in health professional education. Journal of Interprofessional Care, 20(5), Kim, E. K., Kang, M. A., & Kim, H. J. (2007). Experience and perception on patient safety culture of employees in hospitals. Journal of Korean Academy of Nursing Administration, 13,

20 Reynolds, F. (2003). Initial experiences of interprofessional problem-based learning: a comparison of male and female students' views. Journal of Interprofessional Care, 17(1), Roh, H. (2019). Patient Safety Education for Medical Students: Global Trends and Korea's Status. Korean Med Educ Rev, 21(1), 1. Roh, H., Park, S. J., & Kim, T. (2015). Patient safety education to change medical students' attitudes and sense of responsibility. Medical Teacher, 37(10), Roh, H., Lee, K. U., Lee, Y. S., Kim, O. J., Kim, S. W., & Choi, J. W. (2010). Effect of patient safety education in surgical clerkship to develop competencies for managing and preventing medical errors. Korean Journal of Medical Education, 22(4), Ryan, A. A., & McKenna, H. P. (1994). A comparative study of the attitudes of nursing and medical students to aspects of patient care and the nurse's role in organizing that care. Journal of Advanced Nursing, 19(1), Hiatt, H. (1991). The nature of adverse events in hospitalized patients: results of the Harvard Medical Practice Study II. New England Journal of Medicine, 324(6), Lee, H. Y., & Lee, S. G. (2018). Medical Students Perceptions and Intentions Regarding Patient Safety. Quality Improvement in Health Care, 24(1), Lindh Falk, A., Hammar, M., & Nyström, S. (2015). Does gender matter? Differences between students at an interprofessional training ward. Journal of Interprofessional Care, 29(6), Mayer, D., Klamen, D. L., Gunderson, A., & Barach, P. (2009). Designing a patient safety undergraduate medical curriculum: the Telluride Interdisciplinary Roundtable experience. Teaching and Learning in Medicine, 21(1), Myung, S. J., Shin, J. S., Kim, J. H., Roh, H., Kim, Y., Kim, J., Kim, G. J., Lee, S. I, Lee J., & Kim, S. W. (2012). The patient safety curriculum for undergraduate medical students as a first step toward improving patient safety. Journal of Surgical Education, 69(5), Oandasan, I., & Reeves, S. (2005). Key elements for interprofessional education. Part 1: The learner, the educator and the learning context. Journal of Interprofessional Care, 19(sup1), Parsell, G., & Bligh, J. (1998). Interprofessional learning. Postgraduate Medical Journal, 74(868), Pollard, K. C., Miers, M. E., & Gilchrist, M. (2004). Collaborative learning for collaborative working? Initial findings from a longitudinal study of health and social care students. Health & Social Care in the Community, 12(4), Tunstall-Pedoe, S., Rink, E., & Hilton, S. (2003). Student attitudes to undergraduate interprofessional education. Journal of Interprofessional Care, 17(2), Walton, M., Woodward, H., Van Staalduinen, S., Lemer, C., Greaves, F., Noble, D., Ellis, B., Donaldson,

21 L., & Barraclough, B. (2010). The WHO patient safety curriculum guide for medical schools. BMJ Quality & Safety, 19(6), Walton, M., & Kerridge, I. (2014). Do no harm: is it time to rethink the Hippocratic O ath?. Medical Education, 48(1), Wilhelmsson, M., Ponzer, S., Dahlgren, L. O., Timpka, T., & Faresjö, T. (2011). Are female students in general and nursing students more ready for teamwork and interprofessional collaboration in healthcare?. BMC Medical Education, 11(1), 15. Wong, B. M., Levinson, W., Shojania, K. G. (2012). Quality improvement in medical education: current state and future directions. Medical Education, 46(1), World Health Organization. (1988). Learning together to work together for health: report of a WHO Study Group on Multiprofessional Education of Health Personnel: the Team Approach [meeting held in Geneva from 12 to 16 October 1987]. Yoo, H. H., & Park, K. H. (2015). The differences in self-efficacy in clinical performance between medical students and residents. Korean Journal of Medical Education, 27(3), Zwarenstein, M., & Bryant, W. (2008). Intervenciones para promover la colaboración entre enfermeras y médicos (Revisión Cochrane traducida). La Biblioteca Cochrane Plus, 3. : / : / :

22 :..,,. : APSQ-III, RIPLS.. :,,,,,.,., 15.0% 35.0%. :..

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