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REVIEW ARTICLE
Year : 2022  |  Volume : 49  |  Issue : 2  |  Page : 117-120

Integrating patient safety in the existing undergraduate medical curriculum


1 Medical Education Unit Coordinator and Member of the Institute Research Council, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India
2 Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India

Date of Submission20-Jul-2021
Date of Acceptance16-Sep-2021
Date of Web Publication23-Aug-2022

Correspondence Address:
Saurabh RamBihariLal Shrivastava
Professor, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV) – Deemed to be University, Thiruporur - Guduvancherry Main Road, Ammapettai, Nellikuppam, Chengalpet District - 603108, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jss.jss_102_21

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  Abstract 


The field of medicine has made significant advancements owing to multiple scientific innovations, and the outcome is quite evident in terms of improvement in the health outcomes. The aim of the current review is to understand the magnitude of the problem, scope of patient safety in undergraduate medical education, and components of the same. An extensive search of all materials related to the topic was carried out in the PubMed search engine and World Health Organization website. Overall, 20 articles were selected based upon the suitability with the current review objectives and analyzed. Keywords used in the search include patient safety and medical education in the title alone only. If we really aim to minimize the errors on our part and thereby improve the patient safety, the ideal approach will be to train the undergraduate medical students about different aspects of patient safety during their training period. We must understand that mere knowledge about patient safety (Knows level in Miller's Pyramid) will not serve the desired purpose. Rather, the better approach will be to target knows how and even does level in Miller's Pyramid, as ensuring patient safety is predominantly a skill. To conclude, patient safety curriculum is an important component of the medical undergraduate training. The need of the hour is to acknowledge the importance of patient safety, plan for its integration within the existing curriculum, and implement the same with the help of faculty members.

Keywords: Curriculum, patient safety, undergraduate medical education


How to cite this article:
Shrivastava SR, Shrivastava PS. Integrating patient safety in the existing undergraduate medical curriculum. J Sci Soc 2022;49:117-20

How to cite this URL:
Shrivastava SR, Shrivastava PS. Integrating patient safety in the existing undergraduate medical curriculum. J Sci Soc [serial online] 2022 [cited 2022 Sep 27];49:117-20. Available from: https://www.jscisociety.com/text.asp?2022/49/2/117/354256




  Introduction Top


The field of medicine has made significant advancements owing to multiple scientific innovations, and the outcome is quite evident in terms of improvement in the health outcomes.[1] However, at the same time, it is a proven fact that hospitalized patients are at risk for being exposed to medical errors.[1] In fact, the incidence of adverse events due to unsafe care has been ranked as one of top 10 leading causes of death and disability across the globe.[2] The need of the hour is that we have to accept that errors in health care is foreseeable, but it is essential that we learn from our earlier mistakes and not repeat them in the future.[1],[3] The aim of the current review is to understand the magnitude of the problem, scope of patient safety in undergraduate medical education, and components of the same.


  Methods Top


An extensive search of all materials related to the topic was carried out in the PubMed search engine and World Health Organization website. Relevant research articles focusing on patient safety in undergraduate medical education published in the period 2002–2021 were included in the review. A total of 22 studies similar to the current study objectives were identified initially, of which 2 were excluded due to the unavailability of the complete version of the articles. Overall, 20 articles were selected based upon the suitability with the current review objectives and analyzed. Keywords used in the search include patient safety and medical education in the title alone only (viz. patient safety [ti] AND medical education [ti]; patient safety [ti] AND undergraduate medical education [ti]). The articles published only in English language were included for the current review [Figure 1]. The collected information is presented under the following subheadings, namely magnitude of the problem, patient safety and undergraduate medical education, patient safety curriculum: current status in medical education, components of patient safety curriculum, additional considerations, potential barriers and recommendations, and implications for practice.
Figure 1: Selection of studies

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Magnitude of the problem

In low- and middle-income nations, it has been reported that on an annual basis close to 135 million adverse events are reported each year that accounts for more than 2.5 million deaths.[2] On a surprising note, it has been identified that even in developed nations, 10% of the patients receiving hospital care are exposed to adverse events, of which 50% are totally preventable.[2] These trends clearly suggest that a significant proportion of the financial load on patients and family members or work load on health-care workers and hospitals is because of the errors made in hospitals, most of which are preventable.[1],[4] These are quite alarming estimates considering that we have made significant gains in health care and thus calls for an urgent need to take active interventions to improve patient safety and well-being by creating a safer system of care.[2]

Patient safety and undergraduate medical education

If we really aim to minimize the errors on our part and thereby improve the patient safety, the ideal approach will be to train the undergraduate medical students about different aspects of patient safety during their training period.[4],[5] The planned training should not only provide them information about what is patient safety and the magnitude of the same, but also give due exposure about the skills and behavior expected of a medical doctor to minimize the incidence of patient harm.[4],[5],[6] The available evidence suggests that not many undergraduate students get adequate exposure to harm reduction approaches and thus it makes them not competent to ensure patient safety once they land in clinical practice.[3],[6],[7],[8],[9]

Patient safety curriculum: Current status in medical education

Based on the available status, currently, it has been reported that either the patient safety topics are not covered at all (as it is still a new topic in many parts of the world) or even if they are covered, they are in bits and pieces.[10],[11] The coverage of topics on an irregular basis defeats the entire purpose and as a result the students fail to understand the importance of the topic. We must understand that if we are looking forward to short-term modifications, a lecture-based program might turn out to be adequate, but if our aim is to ensure inculcation of patient safety related practices in medical students, the teaching–learning and assessment has to happen depending on an explicitly designed formal curriculum.[9],[10],[11]

The proposed curriculum should be gradually and progressively introduced without stretching the overall duration of the training period. It should support the medical colleges in implementing patient safety education and eventually prepare the medical students for safe clinical practice.[1],[4] The process of designing curriculum has to start with the formulation of learning outcomes, and this should be followed-up with curriculum mapping (viz. deciding about which learning objective will be covered when, using which teaching-learning method and how it will be assessed). As far as possible, efforts should be taken to integrate the patient safety material into the existing curriculum.[3],[4],[11]

Components of patient safety curriculum

We must understand that mere knowledge about patient safety (Knows level in Miller's Pyramid) will not serve the desired purpose. Rather, the better approach will be to target knows how and even does level in Miller's Pyramid, as ensuring patient safety is predominantly a skill.[12] Further, we should aim to give hands-on exposure to the medical students and supplement the same with constructive feedback from the teachers and appropriate guidance. The learning areas can range from explaining what is patient safety, its scope, the need, and the after effects that arise because of nonadherence to the harm reduction measures. The next area is to make the students comprehend about the role of human factors in ensuring patient safety and accordingly cover the domains of communication, teamwork, and the work culture in the hospital.[4],[12]

As the undergraduate medical students are quite new to the working pattern of a health-care establishment, it is also ideal to expose them to the complexities of the same and the importance of adopting a system-based approach in ensuring patient safety.[9],[13] In addition, considering the fact that for obtaining positive patient outcomes, it is essential that a medical student not only learn the leader role, but even understand the importance of being an effective team worker and recognize its significance.[14],[15] Further, exposure should be given to realize that human errors are quite possible, but the best approach is to learn from these mistakes and then not repeat them in the future.[10],[11],[12],[13]

Subsequently, students should be oriented about clinical risk management, wherein they are made to understand the presence of those factors which can augment the risk of patient harm and thus how best they can be controlled.[13],[16] Further, students should also be sensitized about quality improvement methods, and the ways in which the doctors should interact with patients and their caregivers, as they all play an important role in ensuring self-care.[11],[12] As nosocomial infections occupy an important place in the healthcare establishments, not exposing the students to infection control measures will make the curriculum incomplete. Finally, the medical students should be oriented about medication safety and the steps that should be taken to ensure patient safety, especially in invasive procedures.[12],[13],[16]

Additional considerations

Patient safety education can be made more meaningful by creating those scenarios which are relevant in the current clinical practice.[1] It is obvious that students learn better in a safe and enabling atmosphere and thus we should encourage experiential learning. The teaching can be carried out using a wide range of methods (such as lectures, small group learning, case-based discussion, and simulation).[10],[11],[17] The assessments can be carried in the form of both formative as well as summative assessments using both theory (viz. multiple-choice questions or logbook documentation) and practical (through a range of work place-based assessment tools or by using objective structured clinical examination) examinations. As always, there has to be a mechanism to evaluate the curriculum on patient safety, so that based on the received feedback, appropriate modifications can be made.[12],[13],[16]

Potential barriers and recommendations

Though patient safety curriculum has been linked with multiple benefits, nevertheless for its successful implementation in all the medical colleges, we have to consider the potential barriers.[16],[17],[18] These barriers include lack of faculty awareness, presence of an informal curriculum, and minimal participation from the teaching staff. The best strategy will be to carry out capacity building session and ensure that the faculty members own the entire curriculum and thus are motivated towards the entire curriculum planning and implementation process.[13],[16],[17]

Implications for practice

The successful implementation of a patient safety curriculum has to start from its planning stage, wherein the learning objectives have to be defined, and here arises the role of the curriculum committee of the institution.[19],[20] It is important to note that special curriculum has been organized for participants to improve the patient safety and quality improvement.[21] Further, as health care delivery essentially requires a team approach, exclusive steps have been taken to incorporate patient safety in the medical education.[22] The Medical Education Unit of the medical college has an important role to play in terms of organization of the faculty development programs, so that all of them are sensitized about their roles, the teaching-learning experiences to be given to students and the mode of assessment. Finally, the medical students have to be also made a part of the entire process to maximize the overall benefits.


  Conclusion Top


Patient safety curriculum is an important component of the medical undergraduate training. The need of the hour is to acknowledge the importance of patient safety, plan for its integration within the existing curriculum and implement the same with the help of faculty members.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Suleiman AM, Amarasinghe D, Kathuria P, Vandel J, Holloway J, Elkin K, et al. Incorporating patient safety into early undergraduate medical education: Teaching medical students to perform surgical time outs during anatomy. BMJ Open Qual 2021;10:e001229.  Back to cited text no. 1
    
2.
World Health Organization. Patient Safety – Key Facts; 2019. Available from: https://www.who.int/news-room/fact-sheets/detail/patient-safety. [Last accessed on 2021 Apr 20].  Back to cited text no. 2
    
3.
Jain CC, Aiyer MK, Murphy E, Alper EA, Durning S, Aldag J, et al. A national assessment on patient safety curricula in undergraduate medical education: Results from the 2012 clerkship directors in internal medicine survey. J Patient Saf 2020;16:14-8.  Back to cited text no. 3
    
4.
Kiesewetter J, Gutmann J, Drossard S, Gurrea Salas D, Prodinger W, Mc Dermott F, et al. The learning objective catalogue for patient safety in undergraduate medical education--a position statement of the committee for patient safety and error management of the German Association for Medical Education. GMS J Med Educ 2016;33:Doc10.  Back to cited text no. 4
    
5.
Sequeira RP. Patient safety in medical education: Medication safety perspectives. Indian J Pharmacol 2015;47:135-6.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Kirch DG, Boysen PG. Changing the culture in medical education to teach patient safety. Health Aff (Millwood) 2010;29:1600-4.  Back to cited text no. 6
    
7.
Runciman WB. Patient safety: Time for a transformational change in medical education. Med J Aust 2010;193:3-4.  Back to cited text no. 7
    
8.
Bagian JP. The future of graduate medical education: A systems-based approach to ensure patient safety. Acad Med 2015;90:1199-202.  Back to cited text no. 8
    
9.
Myung SJ, Shin JS, Kim JH, Roh H, Kim Y, Kim J, et al. The patient safety curriculum for undergraduate medical students as a first step toward improving patient safety. J Surg Educ 2012;69:659-64.  Back to cited text no. 9
    
10.
Hoffmann N, Kubitz JC, Goetz AE, Beckers SK. Patient safety in undergraduate medical education: Implementation of the topic in the anaesthesiology core curriculum at the University Medical Center Hamburg-Eppendorf. GMS J Med Educ 2019;36:Doc12.  Back to cited text no. 10
    
11.
Bohomol E, Cunha IC. Teaching patient safety in the medical undergraduate program at the Universidade Federal de São Paulo. Einstein (Sao Paulo) 2015;13:7-13.  Back to cited text no. 11
    
12.
World Health Organization. World Alliance for Patient Safety – WHO Patient Safety Curriculum Guide for Medical Schools. Geneva: WHO Press; 2009. p. 1-8.  Back to cited text no. 12
    
13.
Leung GK, Patil NG, Ip MS. Introducing patient safety to undergraduate medical students--a pilot program delivered by health care administrators. Med Teach 2010;32:e547-51.  Back to cited text no. 13
    
14.
Lee YM. Patient safety curriculum in medical education. Korean J Med Educ 2009;21:217-28.  Back to cited text no. 14
    
15.
Nabilou B, Feizi A, Seyedin H. Patient safety in medical education: Students' perceptions, knowledge and attitudes. PLoS One 2015;10:e0135610.  Back to cited text no. 15
    
16.
Nie Y, Li L, Duan Y, Chen P, Barraclough BH, Zhang M, et al. Patient safety education for undergraduate medical students: A systematic review. BMC Med Educ 2011;11:33.  Back to cited text no. 16
    
17.
Holmes JH, Balas EA, Boren SA. A guide for developing patient safety curricula for undergraduate medical education. J Am Med Inform Assoc 2002;9:S124-7.  Back to cited text no. 17
    
18.
Misbah S, Mahboob U. Strengths, weaknesses, opportunities, and threats analysis of integrating the World Health Organization patient safety curriculum into undergraduate medical education in Pakistan: A qualitative case study. J Educ Eval Health Prof 2017;14:35.  Back to cited text no. 18
    
19.
Richter A, Chaberny IF, Surikow A, Schock B. Hygiene in medical education – Increasing patient safety through the implementation of practical training in infection prevention. GMS J Med Educ 2019;36:Doc15.  Back to cited text no. 19
    
20.
Thompson DA, Cowan J, Holzmueller C, Wu AW, Bass E, Pronovost P. Planning and implementing a systems-based patient safety curriculum in medical education. Am J Med Qual 2008;23:271-8.  Back to cited text no. 20
    
21.
Neumeier A, Levy AE, Gottenborg E, Anstett T, Pierce RG, Tad-Y D. Expanding training in quality improvement and patient safety through a multispecialty graduate medical education curriculum designed for fellows. MedEdPORTAL 2020;16:11064.  Back to cited text no. 21
    
22.
Kutaimy R, Zhang L, Blok D, Kelly R, Kovacevic N, Levoska M, et al. Integrating patient safety education into early medical education utilizing cadaver, sponges, and an inter-professional team. BMC Med Educ 2018;18:215.  Back to cited text no. 22
    


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