Patient safety education in undergraduate medical education through a global lens: a scoping review

Abstract

Background: Patient safety, an organizing framework to minimize risks and harm to patients in healthcare delivery, is broadly accepted as a crucial component of global undergraduate curricula. The incorporation of Patient Safety Education (PSE) into medical curricula, as suggested by the World Health Organization (WHO) can be challenging and has been partially and inconsistently applied. Factors such as densely packed curricula, gaps in the evidence-base, under-prepared faculty, and low levels of organizational support have influenced implementation. This review highlights teaching and learning evidence relevant for such integration of PSE into undergraduate medical education and considers variations in educational advancement across different regions referred to as WEIRD (Western, Educated, Industrialized, Rich and Democratic) and Non-WEIRD countries.

Methods: We followed the JBI protocol for undertaking scoping reviews to identify evidence-based gaps and recommend further research supporting integration of PSE into undergraduate curricula. Using PubMed, Scopus, ERIC, CINAHL and Cochrane library, 720 papers, from 2013 to 2023, were identified. Screening of titles and abstracts of 61 studies of PSE in undergraduate medical programs, 28 articles met the inclusion criteria. Descriptive statistical and thematic analysis for data extraction about curriculum design, learning and teaching interventions was conducted.

Results: Findings showed 39% of 28 papers reviewed originated in European region, and 36% from the Americas. Over half (57%) of the selected studies used quantitative methods of analysis, 37.4% were mixed methods, and only 3.5% used qualitative approaches. A variety of methods were used including interactive (21.4%), experiential (14.3%) and technology-enhanced (17.8%) pedagogic strategies. The WHO curriculum guides, and the Institute for Healthcare Improvement (IHI) were the common sources shaping the content of the interventions. Four themes were identified, cultural and contextual considerations; curriculum structure/session design; student engagement/ application; leadership support and faculty training.

Conclusions: Most publications and discourses emerged from WEIRD countries. Whilst outlining a range of pedagogical methods and curricular design, few explicitly referenced educational theories or addressed faculty development needs. Greater attention to cultural perspectives, local adaptation, efficacy of implementation strategies is needed globally. Research into longitudinal studies and impact on educational institutions will aid our understanding of how to promote, create and evaluate PSE across diverse countries.

Clinical trial number: Not applicable.

Keywords: Global differences in patient safety education; Medical curriculum integration; Medical students; Medical teaching; Patient safety; Undergraduate medical education.

Fig. 1

PRISMA-ScR diagram of the review process

Fig. 2

a: Study year distribution (2013–2023). b: Geographical distribution of publications. c: Year level of PSE delivery. *No studies originated from African region. Columns color code: Blue: year of study; Green: multiple years, Orange: longitudinal; Pink: not specified

Fig. 3

Teaching methods. *IL: Interactive lectures, CBD: Case-based Discussion, PBL: Problem-based learning, TBL: Team-based Learning, GD: Group Discussion, FC: Flipped class

Fig. 4

Key themes in PSE discourses