Background The Dutch healthcare system relies heavily on residents. This group is thought to be especially susceptible because of the system of hierarchy and dependence in which they work. Multiple studies have related overtime, safety climate, and supervisory support to medical errors. The aim of this study was to examine these themes and their correlations. Methods This cross-sectional questionnaire included multiple validated scales, and demographic and employment data. Correlations between themes were calculated using linear regression analysis. Between-group analyses concerning residents’ current position, department, clinical setting, and experience level compared the mean composite scores. The survey was distributed through Dutch physician associations and social media platforms between February and April 2020. 492 medical residents were included. Results Weekly average overtime was 7.8 hours, which was mostly uncompensated. Residents who were not in a training program, surgical residents, and those working in hospitals reported significantly more overtime. Over one in three felt they had fallen short in the quality of care they delivered. One-third of the respondents did not have a designated supervisor, and supervisor support scored mediocre overall. Medical errors were associated with a poorer safety climate, but other associations were not observed. Conclusions Overtime is abundant in residents, especially in surgical specialties. Safety is a priority but has a tendency to crumble under pressure. Strikingly, a substantial part of the residents felt that they had performed medical procedures that they were not properly trained for and that they had fallen short in the quality of care they delivered. Supervisor support was mostly present in the development of competencies and work-related problems, but residents reported poor rewarding behaviors, and a third did not have a designated mentor. Medical training programs should acknowledge the importance of these themes and make tangible efforts to monitor the needs and experiences of residents.

Objective: Medical Crew Resource Management (CRM) training courses are designed to increase patient safety by reducing the effects of human errors. These training courses are most popular in surgery and a wide range of medical CRM training courses for surgical teams is now available. However, the effects of these CRM training courses on patient outcomes are inconclusive. Although surgical teams feel the need to be trained in team collaboration skills, they are often puzzled about what criteria to apply when choosing a medical CRM training course. This study aimed to compare CRM training courses on didactic components and simulation-exercises to explore if these courses are interchangeable. Methods: In this qualitative study, semi-structured interviews were conducted among 10 main CRM training providers of surgical teams in the Netherlands. Results: Although a large variety was found in the content of CRM training courses, the most substantial differences were found in the simulation-exercises. Nine out of 10 trainers stated that standard simulation-exercises would be a step forward to ensure quality in CRM trainings. According to the trainers, the implementation of medical CRM can reduce human errors and as a result, preventable patient complications. They suggested a quality standard for CRM trainers in the medical field to ensure the quality of medical team training as a way to reach this. Conclusions: Medical CRM training courses are diverse and noninterchangeable. Trainers expect that if CRM becomes part of surgical training and is embedded in operating theatre culture, it could be of great value for patients and professionals.

Background: Most interventions to improve patient safety (Patient Safety Practices (PSPs)), are introduced without engaging front-line professionals. Administrative staff, managers and sometimes a few professionals, representing only one or two disciplines, decide what to change and how. Consequently, PSPs are not fully adapted to the professionals' needs or to the local context and as a result, adoption is low. To support adoption, two theoretical concepts, Participatory Design and Experiential Learning were combined in a new model: Adaptive Design. The aim was to explore whether Adaptive Design supports adaptation and adoption of PSPs by engaging all professionals and creating time to (re) design, reflect and learn as a team. The Time Out Procedure (TOP) and Debriefing (plus) for improving patient safety in the operating theatre (OT) was used as PSP. Methods: Qualitative exploratory multi-site study using participatory action research as a research design. The implementation process consisted of four phases: 1) start-up: providing information by presentations and team meetings, 2) pilot: testing the prototype with 100 surgical procedures, 3) small scale implementation: with one or two surgical disciplines, 4) implementation hospital-wide: including all surgical disciplines. In iterations, teams (re) designed, tested, evaluated, and if necessary adapted TOPplus. Gradually all professionals were included. Adaptations in content, process and layout of TOPplus were measured following each iteration. Adoption was monitored until final implementation in every hospital's OT. Results: 10 Dutch hospitals participated. Adaptations varied per hospital, but all hospitals adapted both procedures. Adaptations concerned the content, process and layout of TOPplus. Both procedures were adopted in all OTs, but user participation and time to include all users varied between hospitals. Ultimately all users were actively involved and TOPplus was implemented in all OTs. Conclusions: Engaging all professionals in a structured bottom-up implementation approach with a focus on learning, improves adaptation and adoption of a PSP. As a result, all 10 participating hospitals implemented TOPplus with all surgical disciplines in all OTs. Adaptive Design gives professionals the opportunity to adapt the PSP to their own needs and their specific local context. All hospitals adapted TOPplus, but without compromising the essential features for its effectiveness.