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      The outcomes of recent patient safety education interventions for trainee physicians and medical students: a systematic review

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          To systematically review the latest evidence for patient safety education for physicians in training and medical students, updating, extending and improving on a previous systematic review on this topic.


          A systematic review.

          Data sources

          Embase, Ovid Medline and PsycINFO databases.

          Study selection

          Studies including an evaluation of patient safety training interventions delivered to trainees/residents and medical students published between January 2009 and May 2014.

          Data extraction

          The review was performed using a structured data capture tool. Thematic analysis also identified factors influencing successful implementation of interventions.


          We identified 26 studies reporting patient safety interventions: 11 involving students and 15 involving trainees/residents. Common educational content included a general overview of patient safety, root cause/systems-based analysis, communication and teamwork skills, and quality improvement principles and methodologies. The majority of courses were well received by learners, and improved patient safety knowledge, skills and attitudes. Moreover, some interventions were shown to result in positive behaviours, notably subsequent engagement in quality improvement projects. No studies demonstrated patient benefit. Availability of expert faculty, competing curricular/service demands and institutional culture were important factors affecting implementation.


          There is an increasing trend for developing educational interventions in patient safety delivered to trainees/residents and medical students. However, significant methodological shortcomings remain and additional evidence of impact on patient outcomes is needed. While there is some evidence of enhanced efforts to promote sustainability of such interventions, further work is needed to encourage their wider adoption and spread.

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          Most cited references 39

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          Teaching quality improvement and patient safety to trainees: a systematic review.

          To systematically review published quality improvement (QI) and patient safety (PS) curricula for medical students and/or residents to (1) determine educational content and teaching methods, (2) assess learning outcomes achieved, and (3) identify factors promoting or hindering curricular implementation. Data sources included Medline (to January 2009), EMBASE, HealthSTAR, and article bibliographies. Studies selected reported curricula outlining specific educational content and teaching format. For articles with an evaluative component, the authors abstracted methodological features, such as study design. For all articles, they conducted a thematic analysis to identify factors influencing successful implementation of the included curricula. Of 41 curricula that met the authors' criteria, 14 targeted medical students, 24 targeted residents, and 3 targeted both. Common educational content included continuous QI, root cause analysis, and systems thinking. Among 27 reports that included an evaluation, curricula were generally well accepted. Most curricula demonstrated improved knowledge. Thirteen studies (32%) successfully implemented local changes in care delivery, and seven (17%) significantly improved target processes of care. Factors that affected the successful curricular implementation included having sufficient numbers of faculty familiar with QI and PS content, addressing competing educational demands, and ensuring learners' buy-in and enthusiasm. Participants in some curricula also commented on discrepancies between curricular material and local institutional practice or culture. QI and PS curricula that target trainees usually improve learners' knowledge and frequently result in changes in clinical processes. However, successfully implementing such curricula requires attention to a number of learner, faculty, and organizational factors.
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            Introducing competency-based postgraduate medical education in the Netherlands.

            Medical boards around the world face the challenge of creating competency-based postgraduate training programs. Recent legislation requires that all postgraduate medical training programmes in The Netherlands be reformed. In this article the Dutch Advisory Board for Postgraduate Curriculum Development shares some of their experiences with guiding the design of specialist training programs, based on the Canadian Medical Educational Directives for Specialists (CanMEDS). All twenty-seven Dutch Medical Specialty Societies take three steps in designing a curriculum. First they divide the entire content of a specialty into logical units, so-called 'themes'. The second step is discussing, for each theme, for which tasks trainees have to be instructed, guided, and assessed. Finally, for each task an assessment method is chosen to focus on a limited number of CanMEDS roles. This leads to a three step training cycle: (i) based on their in-training assessment and practices, trainees will gather evidence on their development in a portfolio; (ii) this evidence stimulates the trainee and the supervisor to regularly reflect on a trainee's global development regarding the CanMEDS roles as well as on the performance in specific tasks; (iii) a personal development plan structures future learning goals and strategies. The experiences in the Netherlands are in line with international developments in postgraduate medical education and with the literature on workplace-based teaching and learning.
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              Quality improvement in medical education: current state and future directions.

              During the last decade, there has been a drive to improve the quality of patient care and prevent the occurrence of avoidable errors. This review describes current efforts to teach or engage trainees in patient safety and quality improvement (QI), summarises progress to date, as well as successes and challenges, and lists our recommendations for the next steps that will shape the future of patient safety and QI in medical education. Trainees encounter patient safety and QI through three main groups of activity. First are formal curricula that teach concepts or methods intended to facilitate trainees' participation in QI activities. These curricula increase learner knowledge and may improve clinical processes, but demonstrate limited capacity to modify learner behaviours. Second are educational activities that impart specific skills related to safety or quality which are considered to represent core doctor competencies (e.g. effective patient handover). These are frequently taught effectively, but without emphasis on the general safety or quality principles that inform the relevant skills. Third are real-life QI initiatives that involve trainees as active or passive participants. These innovative approaches expose trainees to safety and quality by integrating QI activities into trainees' day-to-day work. However, this integration can be challenging and can sometimes result in tension with broader educational goals. To prepare the next generation of doctors to make meaningful contributions to the quality mission, we propose the following call to action. Firstly, a major effort to build faculty capacity, especially among teachers of QI, should be instigated. Secondly, accreditation standards and assessment methods, both during training and at end-of-training certification examinations, should explicitly target these competencies. Finally, and perhaps most importantly, we must refocus our attention at all levels of training and instil fundamental, collaborative, open-minded behaviours so that future clinicians are primed to promote a culture of safer, higher-quality care. © Blackwell Publishing Ltd 2012.

                Author and article information

                BMJ Open
                BMJ Open
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                20 May 2015
                : 5
                : 5
                [1 ]Department of Neurosurgery, Imperial College Healthcare NHS Trust , London, UK
                [2 ]Health Service and Population Research Department, Centre for Implementation Science, King's College London , London, UK
                [3 ]Department of Surgery and Cancer, Imperial College London , London, UK
                [4 ]Health Education North West , Manchester, UK
                [5 ]Department of Experimental Psychology, University of Oxford , Oxford, UK
                [6 ]Centre for Primary Care, NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
                Author notes
                [Correspondence to ] Dr Maria Ahmed; maria.k.ahmed@
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

                Medical Education and Training


                education, medical students, patient safety, residents, physician trainees


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