Study characteristics, course structure and content
| Lead author Reference Year Country | Study type | Participant number and specialty | Course structure | Course content |
|---|---|---|---|---|
| Aboumatar41 2012 USA | Before and after study | 120 third-year medical students. Recruited from a single institution | 3-day clinically oriented patient safety intersession using role-play and simulation, skills demonstrations, small-group exercises and case-based learning | Medical error understanding and prevention, teamwork and communication, systems thinking |
| Ahmed20 2014 UK | Before and after study | 1169 junior physicians across a region (16 institutions) | Monthly 60 min sessions led by junior physicians between January and July 2011. Sessions comprised case-based discussion and analysis of patient safety incidents encountered in practice, facilitated by trained faculty | Key patient safety concepts, RCA/systems-based analysis, communication and teamwork, incident reporting |
| Anderson18 2009 UK | Before and after study | 199 students including 58 final year medical students learning in uni-professional groups and 36 learning in interprofessional groups as part of a regional programme | 1-day workshop involving DVD and small-group facilitated discussion to analyse key safety issues using the National Patient Safety Agency RCA tool. Supporting handbook containing additional relevant materials. Nine events held over 2 years | DVD of patient journey to focus on learning themes of situational awareness, communication, leadership and empowerment. RCA |
| Arora21 2012 UK | Before and after study | 27 surgical residents. Recruited from across 19 hospitals | 3 h training programme comprising lectures, video demonstrations and small-group discussions | Patient safety overview, adverse events, human factors, systems-based analysis, communication and teamwork in surgery |
| Cox28 2009 USA | Before and after study | Over 787 interprofessional teams of medical, nursing, health administration and respiratory therapy students. Recruited from across 3 sites | 4-week curriculum comprising lectures, problem-based learning, small-group work, simulation. Participants given cases describing a medical error. Team-based simulation of RCA and use of performance improvement tools. Presentation on completion | Patient safety overview, RCA, QI overview, teamwork |
| Cox31 2011 USA | Prospective cohort study | 12 faculty members and 46 internal medicine residents. Recruited from a single institution | 3 h long faculty development session including videos, role-play and mock facilitation sessions. Plus manual of key safety education topics. Implementation of an alternative reporting system for anonymous narratives of ‘care that did not go as intended’. Monthly ‘Safety Story’ sessions of 4–6 residents with faculty member to discuss contributing factors and propose potential solutions | Faculty training included patient safety overview, RCA and teamwork |
| Dudas34 2011 USA | Retrospective pre–post study | 108 medical students (second-year, third-year and fourth-year students as part of paediatric clerkship). Recruited from a single institution | During course of 9-week clerkship, 25 min online video on systems-based analysis of medical errors. 60 min large-group faculty demonstration of Learning From Defects tool. Subsequent self-directed small-group identification and analysis of medication errors in practice. Group presentation at closing 60 min session | Systems-based analysis |
| Gupta43 2014 USA | Retrospective pre–post study | 26 neonatology fellows. Recruited from a single institution | Workshops, web-based modules, completion of a quality and safety project, presentation at departmental conference, participation in departmental morbidity and mortality conference. Optional selected readings and web-based modules | Core patient safety concepts, QI, human factors, communication and teamwork, error disclosure, incident reporting and systems thinking |
| Hall32 2010 USA | Before and after study and comparison with historical control | 146 third-year medical students undertaking a medicine clerkship. 65 in intervention group, 81 in control group. Recruited from a single institution | 2 mandatory 1 h patient safety ‘booster’ conferences. First conference involved RCA brainstorming exercise of an adverse event. Assignment to identify and summarise an actual patient safety event or concern. During second conference case presentation including proposed system modifications to improve patient safety | RCA including proposed system modifications for improvement |
| Holland42 2010 USA | Before and after study | 26 PGY-3 internal medical residents. Recruited from a single institution | 4-week rotation comprising web-based patient safety and QI curriculum including interactive modules, and self-directed reading and assignments. Completion of QI proposal and presentation at end of rotation | Patient safety overview, QI overview including PDSA, medical error, RCA, human factors engineering, safety interventions |
| Jansma23 2010 The Netherlands | Before and after study with 6-month follow-up | 33 specialty registrars (GP, anaesthesiology, dermatology, internal medicine). Recruited from a single institution | 2-day course comprising plenaries, group discussions and role-play | Patient safety overview, human error, disclosure, medicolegal aspects of critical incidents, RCA, tips and tools to improve safety in practice |
| Jansma24 2010 The Netherlands | Prospective cohort study | 71 residents (surgical and non-surgical). Recruited from 5 hospitals | Multispecialty 2-day patient safety course including plenaries and small-group sessions. At end of course participants asked to formulate 1 action point to improve patient safety | Patient safety overview, human factors, teamwork, contribution to safer care (including RCA), medicolegal aspects |
| Jericho33 2010 USA | Before and after study | Anaesthesiology residents (approximately 51—number not clearly stated). Recruited from a single institution | 90 min interactive case-based lecture coupled with an expectation of adverse event reporting. Supplemented with education manual. Quarterly conferences to discuss reports and near-immediate feedback from Department of Safety and Risk Management | Patient safety definitions, adverse event reporting, investigation/process improvements, communication, and apology and remedy |
| Jha22 2013 UK | Before and after study with control group and follow-up | 263 junior physicians across a region (155 in intervention group, 108 in control group) | 3 h teaching session. Intervention group: patients shared their stories about their experience of safety incidents. Non-intervention group: teaching delivered using “standard methods of teaching”, including presentations and small-group work | Error analysis. Teaching session covered: prescribing, teamwork and communication |
| Leung25 2010 China | Before and after study | 130 third-year medical students. Recruited from a single institution | Two 60 min whole-class lectures using contemporary medical incidents as illustrative cases | Based on WHO curriculum: patient safety overview, human factors, systems thinking, team working, understanding and learning from error, introduction to QI, medication safety |
| Miller27 2014 USA | Before and after study | 110 medical and allied health students. Recruited from a single institution | 1 h introductory lecture discussing general patient safety and QI topics followed by 2 courses (‘Introduction to the Culture of Safety’ and ‘Teamwork and Communication’) including group discussions | Patient safety, QI, teamwork, communication |
| Myung26 2012 Republic of Korea | Before and after study | 156 second-year medical students. Recruited from a single institution | 1-week course composed of interactive lecture, discussion and small-group debriefing | Based on WHO curriculum: patient safety overview, human factors, systems thinking, team working, understanding and learning from error, introduction to QI, medication safety; in addition: RCA |
| Paxton37 2010 USA | Before and after study with control group and follow-up | 51 surgical clerkship students including 46 medical and 5 physician assistant students. Recruited from a single institution | 2 h small-group discussion incorporating slide presentation | Patient safety overview, RCA, epidemiology, error theory, error disclosure and legal considerations |
| Rodrigue30 2013 USA | Before and after study | 42 residents and 36 faculty members. Recruited from a single institution | 5 online modules that residents and faculty members completed together in pairs (duration of each module unreported) | Performance improvement, QI, patient safety, teaching and learning |
| Scott40 2011 USA | Prospective cohort study | 680 residents across medical and surgical specialties. Recruited from a single institution | Economic incentive comprised retirement benefit of 1.5% of residents’ annual salaries. Multifaceted educational campaign including monthly email notifications, audience presentation at major conferences (exact frequency not stated) and one-on-one discussion | Presentation covered mechanics of incident reporting, discussing barriers and dispelling myths |
| Shaw39 2012 USA | Randomised controlled trial | 371 interns across medical and surgical specialties. Recruited from across 2 hospitals | 2 interventions compared: Online Spaced Education programme consisting of cases and questions that reinforce over time, and SQ programme comprising online slide-show followed by quiz | Covered all 9 2009 NPSGs including handover, patient identification, hand hygiene and medication safety |
| Slater19 2012 UK | Before and after study | 11 multiprofessional teams comprising 55 health professionals (including 16 junior physicians and 12 senior physicians). Recruited from across 5 sites | 20-week ‘TAPS’ programme. 2 h online learning module; multiprofessional workshops to conduct QI project, executive-group discussion for organisational learning | Human error, QI tools (process mapping, fishbone diagrams and measurement for improvement) |
| Smith35 2012 USA | Prospective cohort study | 280 internal medicine residents over 2 years. Recruited from a single institution | Monthly noontime QIC. RCA of selected real-life safety events (selected by seniors, analysed by residents not associated with the case). Limited RCA with online resources and mentorship. Presentation to fellow residents and seniors. Intervention proposed and followed through where possible | RCA and QI |
| Stahl38 2011 USA | Before and after study with control group | 110 third-year medical students on surgical clerkship (67 in intervention group, 43 in control group). Recruited from a single institution | Two-part patient safety curriculum: all students attended 1-day lecture on introductory theories, video and small-group discussion (first year). Intervention group attended additional 1.5–2 h clinically oriented classroom discussion, videos, simulation and role-play (third year) | Patient safety principles, crew resource management, team skills, task management and situational awareness |
| Tess44 2009 USA | Retrospective pre–post study | 74 internal medicine residents. Recruited from a single institution | Educational intervention coupled with reorganisation of clinical services to integrate patient safety and QI into daily clinical practice. The educational intervention incorporated an online module in year 1, and a 3-week rotation in QI in year 2. Faculty-led workshops on RCA, performance improvement and the institutional approach to QI | Patient safety overview, QI and RCA |
| Wilson29 2012 USA | Prospective cohort study | 23 graduate level students (including 7 medical students). Recruited from a single institution | Weekly 3 h sessions held over a 15-week period. Each session comprised a presentation by a visiting expert, discussion on assigned reading material and small-group patient safety project work | Patient safety overview, human factors analysis, systems approach to error analysis, crew resource management, law, and policy, and team building |
GP, general practitioner; NPSGs, National Patient Safety Goals; PDSA, plan, do, study, act; PGY, postgraduate year; QI, quality improvement; QIC, QI conference; RCA, root cause analysis; SQ, safety questionnaire; TAPS, Training and Action for Patient Safety.