Sage Journals: Discover world-class research

Abstract

The quest to improve patient safety has become a global movement. In order to improve a culture of patient safety, it is important for medical students who will start the profession, as well as health professionals, to know patient safety before graduation. The study aims to assess the attitudes of medical students to patient safety culture and the notification of medical error. The study has been conducted with a total of 1,278 volunteer students from the Faculties of Medicine in Turkey. A web-based survey was administered to medical students. It was found that the attitudes of medical students to the culture of patient safety are generally moderate (64.06 ± 18.55 and 69.0 [IQR: 59.8–75.9]), and few of the students (32.3%) who witnessed a medical error shared the malpractice with someone. There was almost no education on patient safety during medical school. The students in the fourth grade got higher scores in disclosure responsibility compared to those in the other grades. In the study, age was significantly linearly and negatively correlated with the scores of error reporting confidence, team functioning, patient’s role in error subscales and total score. We concluded that the attitudes of medical students to patient safety culture and the notification of medical errors should be developed and supported by the faculty management. Furthermore, this study creates an awareness in terms of the application of about patient safety at training programme in medicine faculties in Turkey.

Keywords

Patient safety safety culture medical error medicine student medicine education

Introduction

Seeking to raise patient safety has become a worldwide movement (World Health Organization, 2011). It is important for medical students, who will begin their careers as health professionals, to know about patient safety before graduation (Rubin & Franchi-Christopher, 2002). Medical students should identify medical errors and should be educated to report them in case of encountering a medical error (Seiden et al., 2006).

The Association of American Medical Colleges emphasised that students should have the ability to describe the principles of patient safety development prior to graduating from medical faculty (Batalden et al., 2001). Based on the above justifications, significant international institutions have reached a consensus on including subjects on patient safety in medical curricula as early as possible and have issued various reports regarding this in recent years (Batalden et al., 2001; Institute for Healthcare Improvement, 2010). However, the World Health Organization (WHO) published a report for the preparation of a curriculum about patient safety in medical faculties in 2009 (World Health Organization, 2009). In line with these reports, the subject of patient safety was included in curricula of medical faculties in several countries (Bechtold et al., 2007; Patey et al., 2007). In Turkey, only a medical faculty of a university incorporated a lecture called ‘patient safety and interprofessional cooperation’ into its curriculum. As it is seen, the studies regarding this subject were limited to an elective course only at one university in Turkey.

Providing education on patient safety before starting work is important for the health systems of countries to develop a culture of patient safety accordingly and to minimise medical errors. When physicians and other health personnel have a perception towards patient and employee safety before graduation, they can protect themselves, patients/relatives and colleagues from the first time they start working against the risks of illness and occupational accidents. Today, many healthcare personnel are needed during the fight against the COVID-19 outbreak. Most countries have called on newly graduated health workers to meet the staffing needs. These newly recruited healthcare professionals found themselves in this struggle before they even gained a corporate culture. For this reason, it has become an important issue to have healthcare personnel with a patient safety culture before graduation.

Material and Methods

The study was designed as descriptive and cross-sectional using self-report questionnaires on the web.

Study Population and Sample

The study population consisted of 81 units in Turkey that have a medical school with fourth-grade, fifth-grade and sixth-grade classes. The total number of students in the specified classes of these universities was 37,964. A permission letter was sent to the medical faculties of the universities to carry out the study. Thirty-eight universities (n = 17,590) agreed to participate in the study. However, due to the intense working conditions, collaborators of 12 universities withdrew from the study. In total, 16 universities (n = 2,855) participated in the study.

Data Collection Tools

In the study, ‘questionnaire on attitudes to patient safety among medical students’ developed by Carruthers et al. (2009) was used. It was determined by another study conducted between 2000 and 2013 that this questionnaire ideally measures the culture of patient safety among medical students (Chanelière et al., 2016).

The original questionnaire consists of 9 factors and 26 questions: patient safety training received to date (Factor 1), 3 questions; error reporting confidence (Factor 2), 3 questions; working hours as an error cause (Factor 3), 3 questions; error inevitability (Factor 4), 3 questions; professional incompetence as an error cause (Factor 5), 4 questions; disclosure responsibility (Factor 6), 3 questions; team functioning (Factor 7), 2 questions; patient’s role in error (Factor 8), 2 questions; and importance of patient safety in the curriculum (Factor 9), 3 questions. Eight questions in the questionnaire contain negative statements. Cronbach’s alpha value of the original questionnaire is 0.73, whereas the factor loading of each scale item varies between 0.55 and 0.82. Translation of the questionnaire into Turkish and its validity and reliability study were carried out. It was detected in the validity and reliability analyses that the measurement material generally accorded with the factor structure of the genuine scale. It was decided to exclude two questions from the 26 questions due to very low factor loadings (0.129) and the presence of a negative relationship. As a consequence of DFA conducted with 24 questions, it was identified that the factor loadings obtained were above 0.40 and the RMSEA value was at an acceptable level (between 0.05 and 0.08). Considering the sub-factors which consisted of the questions determined, and internal consistency coefficients obtained for the sum (0.650–0.845), scale result was determined to be quite reliable.

Data Collection

A web-based survey was conducted, consisting of demographic characteristics and the questionnaire via Google Forms, and the survey link was shared with the collaborators working at each medical school. All students were informed before the survey link was sent to their e-mail addresses by the collaborators. The study was conducted between May 2019 and September 2020. During the study, a total of four reminders were set for the students to participate in the study. After waiting two more months following the fourth reminder, the study was terminated, considering that there would be no more volunteers for the study.

Ethical Principles of the Research

Ethics committee approval for the research was obtained from the university (dated February 13, 2019 and No 07). Verbal consent was obtained from the participants. All procedures were applied in accordance with the principles of the Declaration of Helsinki.

Statistical Analysis

The distributions of age, duration of clinical training at the hospital in a week, duration of patient safety (PS) education during medical school, and scores of the Patient Safety Culture Attitude Scale (PSCAS) were examined using normality plots. Age and PSCAS scores were summarised by mean ± standard deviation (SD) and median (interquartile range, IQR 1st–3rd quartile); durations were summarised as median (IQR), and categorical variables were assessed by frequency (%).

The Cronbach’s α coefficient was calculated to determine the internal consistency of the responses to PSCAS items. PSCAS scores were compared by the Mann–Whitney U test regarding gender, receiving PS education, and witnessing any medical malpractice(s) during education at medical school, and by the Kruskal–Wallis test regarding the grade of the students. When necessary, the stepwise multiple comparison procedure introduced by Campbell and Skillings (1985) was performed. The correlation between age, duration of clinical training and PSCAS scores was examined by Spearman correlation coefficient (r_S). The correlation coefficients were interpreted considering the cut-off values proposed by Hinkle et al. (2003): 0.00–0.29, negligible correlation; 0.30–0.49, low correlation; 0.50–0.69, moderate correlation; 0.70–0.89, high correlation; 0.90–1.00, very high correlation. The statistical significance was set as p value < .05.

All statistical analyses were performed via IBM SPSS Statistics 22.0 (IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.). Graphs were drawn by Microsoft Office Excel 2016.

Results

In total, 44.8% (n = 1,278) of the students in 19 universities completed the survey. The mean age was 24.21 ± 1.81 years, and the median age was 24 years (IQR: 23–25) for these students. Out of all students, 52.0% (n = 664) were female, and 99.0% (n = 1,265) were single. 90.7% of the students (n = 1,159) were in the Turkish programme; 45.1% (n = 576) were in the sixth grade, 34.5% (n = 441) were in the fifth grade, and 20.4% (n = 261) were in fourth grade. The median duration of clinical training at the hospital per week was 30 h (IQR: 20–40).

Considering the university where students have attended, 24.57% (n = 314) were from 1_University, 20.89% (n = 267) were from 2_University, and 15.73% (n = 201) were from 3_University (Table 1).

Table 1.

The Distribution of University and the Witnessing Malpractice.

University	n (%)
1_University	314 (24.6)
2_University	267 (20.9)
3_ University	201 (15.7)
4_University	126 (9.9)
5_University	75 (5.9)
6_University	69 (5.4)
7_University	50 (3.9)
8_University	45 (3.5)
9_ University	42 (3.3)
10_University	35 (2.7)
11_University	19 (1.5)
12_ University	17 (1.3)
13_University	14 (1.1)
14_University	2 (0.2)
15_ University	1 (0.1)
16_University	1 (0.1)
Witnessing any medical malpractice(s) during the education at medical school	715 (55.9)
Sharing the malpractice with someone	231 (32.3)
The person whom the malpractice was shared to^a
Doctor	186 (80.5)
Classmate	139 (60.2)
Intern student	114 (49.4)
Family	74 (32.0)
Nurse	58 (25.1)
A friend not from the medical school	56 (24.2)
Patient/patient’s family	23 (10.0)
Medical school managers	10 (4.3)
Pharmacy	2 (0.9)
Witnessing that medical professionals did not perform safe medical practices during the clinical education at medical school	828 (64.8)
Reporting one of medical staff that safe medical practices were not applied
Never	355 (42.9)
Rarely	222 (26.8)
Sometimes	190 (23.0)
Frequently	50 (6.0)
Always	11 (1.3)

Note: ^aSeveral options can be selected.

Of the participants, 54.6% (n = 659) reported that they had PS education during medical school. The median duration of this education was 5 h (IQR: 2–12). 96.2% (n = 1,226) of the students stated that they had never attended any education or congress about PS before, while the remaining were determined to have attended such a meeting once or twice a year. 93.8% (n = 1,195) of the students did not have any working experience in health field before they began their education at medical school, 5.3% (n = 68) had worked voluntarily before, 0.5% (n = 6) had been employed for a long-term position and 0.4% (n = 5) had been employed for a short-term position.

Seven hundred and fifteen students (55.9%) have witnessed any medical malpractice(s) during their education at medical school, while 32.3% (n = 231) of them had shared the malpractice with someone. 80.5% (n = 186) of the students who had witnessed any malpractice indicated that they reported it to a doctor; 60.2% (n = 139) had reported it to a nurse, and 49.4% (n = 114) had reported it to an intern student (Table 1).

When the desire of the students’ to report the specified persons that the safe medical practices were not applied was asked, 28.3% (n = 360) stated that they frequently want to report to doctors, 25.1% (n = 321) stated that they never want to report to nurses, 29.7% (n = 379) stated that they sometimes want to report to the faculty members (Figure 1).

Figure 1.

Note: For color usage in this figure, please refer to the web version of the article.

The Cronbach α was .912 for the responses of students to PSCAS items, indicating very high internal consistency. The mean and median total score of PSCAS were 64.06 ± 18.55 and 69.0 (IQR: 59.8–75.9), respectively. The distributions’ subscale scores are given in Table 2.

Table 2.

Comparisons of PSCAS Scores of Students Regarding the Gender.

PSCAS Scores	Total (n = 1,278)	Male (n = 614)	Female (n = 664)	p Value
Patient safety training received	57.91 ± 25.53	58.17 ± 26.71	57.67 ± 24.40	.323
	66.7 (50.0–75.0)	66.7 (50.0–75.0)	66.7 (50.0–75.0)
Error reporting confidence	61.23 ± 25.79	59.15 ± 26.64	63.15 ± 24.85	.007
	66.7 (50.0–75.0)	66.7 (50.0–75.0)	66.7 (50.0–75.0)
Working hours as error cause	76.75 ± 29.16	74.96 ± 30.15	78.41 ± 28.14	.021
	83.3 (75.0–100.0)	83.3 (66.7–100.0)	91.7 (75.0–100.0)
Error inevitability	78.49 ± 22.66	77.54 ± 23.75	79.37 ± 21.59	.565
	83.3 (66.7–100.0)	83.3 (66.7–100.0)	83.3 (75.0–100.0)
Professional incompetence as error cause	52.84 ± 25.50	51.14 ± 25.73	54.41 ± 25.21	.016
	50.0 (33.3–75.0)	50.0 (33.3–75.0)	50.0 (33.3–75.0)
Disclosure responsibility	60.55 ± 19.72	60.06 ± 20.62	61.01 ± 18.86	.381
	58.3 (50.0–75.0)	58.3 (50.0–75.0)	58.3 (50.0–75.0)
Team functioning	79.61 ± 30.27	77.69 ± 31.90	81.38 ± 28.59	.056
	100 (75.0–100.0)	87.5 (75.0–100.0)	100.0 (75.0–100.0)
Patient’s role in error	74.45 ± 29.46	72.33 ± 30.88	76.41 ± 27.97	.023
	75.0 (75.0–100.0)	75.0 (62.5–100.0)	75.0 (75.0–100.0)
Importance of patient safety in the curriculum	73.49 ± 28.88	71.93 ± 29.85	74.94 ± 27.90	.091
	75.0 (62.5–100.0)	75.0 (62.5–100.0)	75.0 (75.0–100.0)
Total	64.06 ± 18.55	62.62 ± 19.38	65.40 ± 17.65	.001
	69.0 (59.8–75.9)	66.7 (58.6–74.7)	70.1 (62.1–75.9)

Notes: Scores are summarized by Mean ± Standard Deviation and median (IQR). PSCAS: Patient Safety Culture Attitude Scale.

When the PSCAS scores were compared regarding the gender of the students, female students were found to have higher scores than male students for the subscales of error reporting confidence, professional incompetence as an error cause, patient’s role in error, and the whole scale (p < .05, Table 2). There were no significant differences between females and males for other subscale scores (p > .05).

The students in the fourth grade got higher scores in disclosure responsibility subscale compared to those in the other grades (p < .05), while there was no significant difference between the same subscale scores of the fifth-grade and sixth-grade students (p > .05, Table 3). The other subscale scores and total score did not differ with respect to the students’ grade (p > .05).

Table 3.

Comparisons of PSCAS Scores of Students Regarding the Grade.

PSCAS Scores	Fourth Grade (n = 261)	Fifth Grade (n = 441)	Sixth Grade (n = 576)	p Value
Patient safety training received	57.6 ± 25.13	56.39 ± 26.71	59.22 ± 24.75	.308
	66.7 (50.0–75.0)	66.7 (41.7–75.0)	66.7 (50.0–75.0)
Error reporting confidence	63.25 ± 25.58	61.73 ± 26.89	59.92 ± 24.99	.053
	66.7 (50.0–75.0)	66.7 (50.0–75.0)	66.7 (50.0–75.0)
Working hours as error cause	76.31 ± 28.91	74.89 ± 30.44	78.39 ± 28.22	.138
	83.3 (66.7–100.0)	83.3 (66.7–100.0)	91.7 (75.0–100.0)
Error inevitability	78.32 ± 23.01	76.91 ± 23.09	79.77 ± 22.13	.154
	83.3 (66.7–100.0)	83.3 (66.7–100.0)	83.3 (75.0–100.0)
Professional incompetence as error cause	50.35 ± 24.02	52.21 ± 25.81	54.44 ± 25.84	.067
	50.0 (33.3–66.7)	50.0 (33.3–75.0)	50.0 (33.3–75)
Disclosure responsibility	64.27 ± 19.82	60.49 ± 20.16	58.91 ± 19.14	.001
	66.7 (50.0–75.0)^a	58.3 (50.0–75.0)	58.3 (50.0–66.7)
Team functioning	79.45 ± 30.36	77.86 ± 32.01	81.01 ± 28.8	.484
	100.0 (75.0–100.0)	100.0 (75.0–100.0)	100.0 (75.0–100.0)
Patient’s role in error	75.29 ± 29.90	72.90 ± 31.13	75.26 ± 27.91	.578
	87.5 (75.0–100.0)	75.0 (75.0–100.0)	75.0 (75.0–100.0)
Importance of patient safety in the curriculum	75.14 ± 29.12	72.34 ± 30.71	73.63 ± 27.3	.235
	87.5 (75.0–100.0)	75.0 (62.5–100.0)	75.0 (62.5–100.0)
Total	64.60 ± 19.10	62.94 ± 19.47	64.68 ± 17.53	.437
	69.0 (62.1–75.9)	67.8 (58.6–75.3)	69.0 (60.9–74.7)

Notes: Scores are summarized by Mean ± Standard Deviation and median (IQR). ^aThe corresponding score is significantly higher compared to those of other grades (p < .05). PSCAS: Patient Safety Culture Attitude Scale.

The students who received PS training during education at medical school had higher scores in the patient safety training received subscale and the total scale, compared with those who had not received any PS training (p < .05, Table 4). There were no significant differences in other subscales’ scores regarding the recipience of the PS training during the education at the medical school (p > .05, Table 4).

Table 4.

Comparisons of PSCAS Scores of Students Regarding the Recipience of PS Training and the Witnessing Any Malpractice(s) During the Education at Medical School.

PSCAS Scores	Receiving PS Training			Witnessing Malpractice
PSCAS Scores	No (n = 619)	Yes (n = 659)	p Value	No (n = 563)	Yes (n = 715)	p Value
Patient safety training received	51.80 ± 23.97	63.64 ± 25.63	<.001	58.63 ± 23.89	57.34 ± 26.75	.608
	58.3 (33.3–66.7)	66.7 (58.3–75.0)		66.7 (50.0–75.0)	66.7 (41.7–75.0)
Error reporting confidence	60.26 ± 25.63	62.14 ± 25.92	.122	63.11 ± 25.11	59.74 ± 26.24	.016
	66.7 (50.0–75.0)	66.7 (50.0–75.0)		66.7 (50.0–75.0)	66.7 (50.0–75.0)
Working hours as error cause	77.42 ± 28.48	76.13 ± 29.79	.563	77.07 ± 27.95	76.50 ± 30.10	.351
	83.3 (75.0–100.0)	83.3 (75.0–100.0)		83.3 (75.0–100.0)	91.7 (66.7–100.0)
Error inevitability	79.03 ± 22.16	77.98 ± 23.14	.605	78.82 ± 21.65	78.23 ± 23.44	.735
	83.3 (75.0–100.0)	83.3 (66.7–100.0)		83.3 (66.7–100.0)	83.3 (66.7–100.0)
Professional incompetence as error cause	52.88 ± 25.50	52.79 ± 25.52	.984	53.46 ± 24.37	52.34 ± 26.36	.381
	50.0 (33.3–75.0)	50.0 (33.3–75.0)		50.0 (33.3–75.0)	50.0 (33.3–75.0)
Disclosure responsibility	59.45 ± 19.66	61.58 ± 19.74	.100	60.60 ± 20.04	60.51 ± 19.49	.980
	58.3 (50.0–75.0)	58.3 (50.0–75.0)		58.3 (50.0–75.0)	58.3 (50.0–75.0)
Team functioning	80.25 ± 29.49	79.00 ± 30.99	.581	80.40 ± 29.27	78.99 ± 31.03	.812
	100.0 (75.0–100.0)	100.0 (75.0–100.0)		100.0 (75.0–100.0)	100.0 (75.0–100.0)
Patient’s role in error	74.88 ± 28.73	74.05 ± 30.15	.887	74.62 ± 28.38	74.32 ± 30.31	.478
	75.0 (75.0–100.0)	75.0 (75.0–100.0)		75.0 (75.0–100.0)	75.0 (75.0–100.0)
Importance of patient safety in the curriculum	73.87 ± 28.33	73.14 ± 29.41	.804	73.47 ± 27.61	73.51 ± 29.86	.253
	75.0 (62.5–100.0)	75.0 (62.5–100.0)		75.0 (62.5–100.0)	75.0 (62.5–100.0)
Total	63.24 ± 17.45	64.84 ± 19.50	.001	64.69 ± 17.86	63.57 ± 19.07	.577
	67.8 (59.8–74.7)	70.1 (60.9–77.0)		69.0 (60.9–75.9)	69.0 (59.8–75.9)

Notes: Scores are summarised by Mean ± Standard Deviation and median (IQR). PSCAS: Patient Safety Culture Attitude Scale.

The students who had witnessed any malpractice(s) during education at medical school had significantly lower scores in the error reporting confidence subscale than those who had not witnessed any malpractice(s) (p = .016, Table 4). There was no significant difference in other subscale scores and total score regarding the witnessing any malpractice(s) during the education at medical school (p > .05).

Age was significantly linearly and negatively correlated with the scores of error reporting confidence (r_S = −0.079, p = .005), team functioning (r_S = −0.064, p = .022), patient’s role in error subscales (r_S = −0.086, p = .002) and total score (r_S = −0.068, p = .015). The duration of clinical training at hospital in a week was significantly linearly and positively correlated with the scores of working hours as error cause (r_S = 0.093, p = .001), error inevitability (r_S = 0.095, p = .001), team functioning subscales (r_S = 0.072, p = .011) and total score (r_S = 0.065, p = .021). However, these correlations were negligible.

Discussion

In line with the results of the study, it was found that 55.9% of the students had witnessed any medical malpractice(s) during their education at medical school, while 32.3% of them had shared the malpractice with someone. It was seen that the majority (60.2%) of the students who reported medical error(s) notified physicians. However, most (33.4%) of the students who wanted to report those who did not follow safe medical applications had the will to notify their intern friends. Among the students who witnessed that safe medical applications were not performed, the frequency of willing to report to interns was determined to be significantly lower than the frequency of willing to report to other people. Even though several students reported the medical errors they witnessed and those who did not follow safe medical applications to unauthorised people, their act of reporting the errors is important for creating a culture of patient safety (Intepeler & Dursun, 2012). Pursuant to The Joint Commission’s accreditation standards, health organisations are required to ensure the reporting of unexpected results related to the treatment of patients (The Joint Commission, 2015). Evidence collected shows that physicians and students report errors inadequately because of the possible adverse effects on relationships, as well as social habits and rituals (Kaldjian et al., 2008; Madigosky et al., 2006; O’Connor et al., 2010; Seiden et al., 2006; Wetzel et al., 2012). Therefore, the infrastructure required to encourage healthcare professionals and candidates to report medical error(s) should be established and the necessary relevant education should be provided, and communication channels should be kept open (Bell et al., 2010; Gallagher et al., 2006; Karsh et al., 2006).

In this study, it was found that the mean and median total score of PSCAS of students were 64.06 ± 18.55 and 69.0 (IQR: 59.8–75.9), respectively. Patey et al. (2007) revealed in their study that medical students have very little knowledge about patient safety. Levels of the students’ attitudes to culture of patient safety with respect to ‘team functioning’, ‘working hours as error cause’ and ‘error inevitability’ are highest whereas levels of the students’ attitudes to ‘professional incompetence as error cause’ and ‘disclosure responsibility’ were lowest.

The present study showed that female students had higher scores than male students for the subscales of error reporting confidence, professional incompetence as an error cause, patient’s role in error and the whole scale. According to this result, it can be said that female students’ perception of patient safety culture is better.

In the literature, it is stated that education is influential in raising knowledge and awareness about patient safety (Coyle et al., 2005; Gaupp et al., 2016). The students who received PS training during education at medical school had higher scores in the patient safety training received subscale and the total scale, compared with those who had not received any PS training, as determined in this study. Based on this finding, it can be concluded that providing education about the culture of patient safety to medical students is important.

In the study, it was seen that only the students in the fourth grade got higher scores in disclosure responsibility subscale compared to those in the other grades. It was seen that age was significantly linearly and negatively correlated with the scores of error reporting confidence, team functioning, patient’s role in error subscales and total score, as well. Hence, it will be more influential if education on the culture of patient safety is included in the curriculum as early as possible (Bell et al., 2010; Gunderson et al., 2009).

The students who had witnessed any malpractice(s) during education at medical school had significantly lower scores in the error reporting confidence subscale than those who had not witnessed any malpractice(s). On the other hand, it was seen that the duration of clinical training at the hospital per week was significantly, linearly, and positively correlated with the scores of the working hours as an error cause, error inevitability, and team functioning subscales, as well as the total score. The Accreditation Council for Graduate Medical Education has undertaken several reforms related to working hours of health workers to improve patient safety. There are some studies analysing the effect of these reforms on patient safety. It has been concluded, following the studies, that working hours do not have any effect on patient safety, while they have both positive and negative effects (Lee, 2015). The ‘error inevitability’ score of the students who had work experience in the health sector prior to going to medical faculty was observed to be lower. This finding makes us think that errors of the students who had work experience previously can be prevented. A comprehensive event learning system can define many fields that should be improved, and it can be related to the significant and continuous improvements in the culture of patient safety (Kusano et al., 2015). Furthermore, it has been observed in another study that the older healthcare professionals with more working experience and those with a higher education level have more patient safety knowledge (El-Jardali et al., 2014).

Conclusion

It was seen as a result of the study that the attitudes of medical students towards the culture of patient safety are generally at a moderate level, and few of the students who witnessed medical errors shared the malpractice with someone. In order to further develop students’ perception of patient safety culture, management units of the faculties should encourage students to report medical errors that they face and show exemplary attitudes towards them.

Also, it was seen that the students in the fourth grade got higher scores in disclosure responsibility compared to those in the other grades. In the study, age was significantly linearly and negatively correlated with the scores of error reporting confidence, team functioning, patient’s role in error subscales and total score. For this reason, the sooner education is started, the better it will be to create a perception of patient safety culture.

As a result of the study, it was seen that there was almost no education (they had a very short time (median 5 h) or none) on patient safety during medical school. If students who will start their careers soon after medical education receive sufficient education about the culture of patient safety before graduation, they will contribute to health facilities and the health economy by reducing the costs related to medical errors.

In addition, the causes of medical errors must be carefully analysed, and comprehensive preventive programmes should be implemented due to the financial burden of medical errors on hospitals (David et al., 2013). Health leaders and professionals focus on quality and patient safety as they have never done before, since the economics of quality have changed significantly (Andel et al., 2012).

In a study, learning and continuous improvement, hospital management support, supervisor/manager expectations, error feedback and communication, teamwork and leaving the hospital were found to be important culture determinants of patient safety (Ammouri et al., 2015). Thus, it is important that patient safety and the factors affecting patient safety are taught before graduation from the medical faculty to improve patient safety.

In the study conducted by Kirkman et al. (2015), it has been argued that, although there is an increasing tendency for the development of patient safety training given to medical students, methodological deficiencies continue, and their effect on patient outcomes should be investigated (Kirkman et al., 2015). There is a need for more research to determine whether patient safety training improves patient outcomes (DiCuccio, 2015).

Furthermore, this study is important for evaluating the attitudes of medical students towards the culture of patient safety and developing the curricula of medical faculties with respect to the culture of patient safety.

Similar to envisagement of the WHO, the conclusion of this study supports that an education programme regarding patient safety should be applied at medical faculties. It will be better to utilise the results of other research to determine whether the programme on patient safety that will be included in the curricula of medical faculties should be at a theoretical level or a clinical level.

Footnotes

Acknowledgement

The authors would like to thank the collaborators: Yeliz Kaşko Arici, Gökhan Oturak, Didem Derici, Sara Salcan, İnci Arikan, Meltem Akdemir, Cihan Fidan, Dursun Çadirci, Zerrin Gamsizkan, Ali Ceylan, Adem Doğaner, Pembe Keskinoğlu, Elif Şafak, Melih Gaffar Gözükara, Mustafa N. İlhan and Hüseyin Ali Küçük. They helped conduct surveys for students at the medical school where they worked.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Funding

The authors received no financial support for the research, authorship and/or publication of this article.

ORCID iDs

Nazan Torun

Afra Alkan

Selim Yavuz Sanisoğlu

References

Ammouri

A. Ç

, Tailakh

, Muliira

, Geethakrishnan

, & Al Kindi

(2015). Patient safety culture among nurses. International Nursing Review , 62, 102–110.

Andel

C. Ç.

, Davidow

S. L.

, Hollander

, & Moreno

D. A.

(2012). The economics of health care quality and medical errors. Journal of Health Care Finance , 39, 39.

Batalden

, Berwick

, & Billi

(2001). Report V: Contemporary issues in medicine: Quality of care . Association of American Medical Colleges.

Bechtold

, Scott

, Nelson

, Cox

, Dellsperger

, & Hall

(2007). Educational quality improvement report: Outcomes from a revised morbidity and mortality format that emphasised patient safety. Quality and Safety in Health Care , 16, 422–427.

Bell

S. K.

, Moorman

D. W.

, & Delbanco

(2010). Improving the patient, family, and clinician experience after harmful events: The “when things go wrong” curriculum. Academi Medicine , 85, 1010–1017.

Campbell

, & Skillings

J. H.

(1985). Nonparametric stepwise multiple comparison procedures. Journal of the American Statistical Association , 80, 998–1003.

Carruthers

, Lawton

, Sandars

, Howe

, & Perry

(2009). Attitudes to patient safety amongst medical students and tutors: Developing a reliable and valid measure. Medical Teacher , 31, e370–e376.

Chanelière

M. Ç.

, Jacquet

, Occelli

, Touzet

, Siranyan

, & Colin

(2016). Assessment of patient safety culture: What tools for medical students? BMC Medical Education , 16, 255.

Coyle

Y. M.

, Mercer

S. Q.

, Murphy-Cullen

C. L.

, Schneider

G. W.

, & Hynan

L. S.

(2005). Effectiveness of a graduate medical education program for improving medical event reporting attitude and behavior. Quality Safe Health Care , 14, 383–388.

10.

David

, Gunnarsson

C. L.

, Waters

H. C.

, Horblyuk

, & Kaplan

H. S.

(2013). Economic measurement of medical errors using a hospital claims database. Value in Health , 16, 305–310.

11.

DiCuccio

M. H.

(2015). The relationship between patient safety culture and patient outcomes: A systematic review. Journal of Patient Safety , 11, 135–142.

12.

El-Jardali

, Sheikh

, Garcia

N. A.

, Jamal

, & Abdo

(2014). Patient safety culture in a large teaching hospital in Riyadh: Baseline assessment, comparative analysis and opportunities for improvement. BMC Health Services Research , 14, 122.

13.

Gallagher

T. H.

, Garbutt

J. M.

, Waterman

A. D.

, Flum

D. R.

, Larson

E. B.

, Waterman

B. M.

, Dunagan

W. C.

, Fraser

V. J.

, & Levinson

(2006). Choosing your words carefully: How physicians would disclose harmful medical errors to patients. Archives of Internal Medicine , 166, 1585–1593.

14.

Gaupp

, Korner

, & Fabry

(2016). Effects of a case-based interactive e-learning course on knowledge and attitudes about patient safety: A quasi-experimental study with third-year medical students. BMC Medicine Education , 16, 172.

15.

Gunderson

A. J.

, Smith

K. M.

, Mayer

D. B.

, McDonald

, & Centomani

(2009). Teaching medical students the art of medical error full disclosure: Evaluation of a new curriculum. Teach Learn Medicine , 21, 229–232.

16.

Hinkle

D. E.

, Wiersma

, & Jurs

S. G.

(2003). Applied statistics for the behavioral sciences (5th ed.). Houghton Mifflin.

17.

Institute for Healthcare Improvement. (2010). Unmet needs: Teaching physicians to provide safe patient care . National Patient Safety Foundation. http://www.ihi.org/resources/Pages/Publications/Unmet-Needs-Teaching-Physicians-to-Provide-Safe-Patient-Care.aspx

18.

Intepeler

Ş. S.

, & Dursun

(2012). Tıbbi hatalar ve tıbbi hata bildirim sistemleri. Journal of Anatolia Nursing and Health Sciences , 15.

19.

Kaldjian

L. C.

, Jones

E. W.

, Wu

B. J.

, Forman-Hoffman

V. L.

, Levi

B. H.

, & Rosenthal

G. E.

(2008). Reporting medical errors to improve patient safety: A survey of physicians in teaching hospitals. Archives of Internal Medicine , 168, 40–46.

20.

Karsh

B. T.

, Escoto

K. H.

, Beasley

J. W.

, & Holden

R. J.

(2006). Toward a theoretical approach to medical error reporting system research and design. Applied Ergonomics , 37, 283–295.

21.

Kirkman

M. A.

, Sevdalis

, Arora

, Baker

, Vincent

, & Ahmed

(2015). The outcomes of recent patient safety education interventions for trainee physicians and medical students: A systematic review. BMJ Open , 5, e007705.

22.

Kusano

A. S.

, Nyflot

M. J.

, Zeng

, Sponseller

P. A.

, Ermoian

, Jordan

R. T.

, Carlson

, Novak

, Kane

, & Ford

E. C.

(2015). Measurable improvement in patient safety culture: A departmental experience with incident learning. Practical Radiation Oncology , 5, e229–e237.

23.

Lee

M. J.

(2015). On patient safety: Have the ACGME resident work hour reforms improved patient safety? Clinical Orthopaedics and Related Research , 473, 3364–3367.

24.

Madigosky

W. S.

, Headrick

L. A.

, Nelson

, Cox

K. R.

, & Anderson

(2006). Changing and sustaining medical students’ knowledge, skills, and attitudes about patient safety and medical fallibility. Academic Medicine , 81, 94–101.

25.

O’Connor

, Coates

H. M.

, Yardley

I. E.

, & Wu

A. W.

(2010). Disclosure of patient safety incidents: A comprehensive review. International Journal Quality Health Care , 22, 371–379.

26.

Patey

, Flin

, Cuthbertson

B. H.

, MacDonald

, Mearns

, Cleland

, & Williams

(2007). Patient safety: Helping medical students understand error in healthcare. Quality Safety Health Care , 16, 256–259.

27.

Rubin

, & Franchi-Christopher

(2002). New edition of tomorrow’s doctors. Medical Teacher , 24, 368–369.

28.

Seiden

S. C.

, Galvan

, & Lamm

(2006). Role of medical students in preventing patient harm and enhancing patient safety. Quality Safety Health Care , 15, 272–276.

29.

The Joint Commission. (2015). Patient safety systems chapter for the hospital program . Comprehensive Accreditation Manual for Hospitals.

30.

Wetzel

A. P.

, Dow