Part A
Teacher’s
Guide
Patient Safety
Curriculum Guide:
Multi-professional
Edition
1. Background
Why do health-care students need
patient safety education?
Health-care outcomes have significantly improved
with the scientific discoveries of modern medicine.
However, studies from a multitude of countries
show that with these benefits come significant
risks to patient safety. We have learnt that
hospitalized patients are at risk of suffering an
adverse event, and patients on medication have
the risk of medication errors and adverse
reactions. A major consequence of this knowledge
has been the development of patient safety as a
specialized discipline to assist health-care
professionals, managers, health-care
organizations, governments (worldwide) and
consumers who must become familiar with
patient safety concepts and principles. Everyone
is affected. The tasks ahead of health care are
immense and require all those involved in care
to understand the extent of harm to patients
and why health care must move to adopt a safety
culture. Patient safety education and training
is only beginning to occur at all levels. Health-care
students, as future providers of health care and
health-care leaders, must prepare themselves
to practise safe care. Though the curricula of
the different health-care professions are
continually changing to accommodate the latest
discoveries and new knowledge, patient safety
knowledge is different because it applies to all
areas of practice and to all professions.
Health-care students will need to know how
systems impact on the quality and safety of health
care, how poor communication can lead to
adverse events and much more. Students need
to learn how to manage these challenges.
Patient safety is not a traditional stand-alone
discipline; rather, it is one that integrates into all
areas of health care. The World Health
Organization’s (WHO) Patient Safety programme,
and other projects such as this one, aims to
implement patient safety worldwide. Patient
safety is everyone’s business and ranges from
patients to politicians. As health-care students
are among the future leaders in health care,
it is vital that they are knowledgeable and skilful
in their application of patient safety principles
and concepts. The multi-professional edition of
the WHO Patient Safety Curriculum Guide sets
the stage for students, irrespective of their chosen
profession, to begin to understand and practise
patient safety in all their professional activities.
Building students’ patient safety knowledge needs
to occur throughout the entire education and
training of health-care students. Patient safety
skills and behaviours should begin as soon as
a student enters a hospital, clinic or health service.
By getting students to focus on each individual
patient, having them treat each patient as a
unique human being, and using their knowledge
and skills carefully, students themselves can be
role models for others in the health-care system.
Most health-care students have high aspirations
when they enter into their chosen field, but the
reality of health-care systems sometimes deflates
their optimism. We want students to be able
to maintain their optimism and believe that they
can make a difference, both to the individual lives
of patients and the health-care system.
How to use this Curriculum
The Curriculum has been designed for health-care
educational institutions to implement patient
safety learning for students prior to becoming
qualified health-care professionals. Faculties can
introduce all the topics as a whole or they can
start more slowly by introducing one or more
at a time. Each topic has all the underpinning
knowledge required to teach the subject including
suggestions for assessment. We have inserted case
studies to facilitate learning and encourage
teachers and instructors to include them in their
teaching activities. We have also provided
different ideas about how to teach a particular
WHO Patient Safety Curriculum Guide: Multi-professional Edition
22
topic. Many of the topics are best delivered once
the student has experienced their professional
work environment as so much of patient safety
learning requires a team approach and observation
of the health service as a whole, not just the area
where the student happens to be placed.
The topics have been designed so that students
can be responsible for much of their own learning
through reading online material that provides
them with the underpinning knowledge required,
followed by tasks that can be performed to put
the acquired knowledge into practice.
We encourage the different faculties and health
professions to add relevant professional literature
and data to the topics that directly concern their
profession. For example, we would expect that
relevant pharmacy articles and data collections be
included for pharmacy students. Because this
is a Multi-professional Curriculum Guide we were
unable to provide examples for all professions,
but we have included as many as possible where
available and relevant.
What is the Curriculum Guide?
The Curriculum Guide is a comprehensive
programme for the implementation of patient
safety education in health-care educational
institutions worldwide. It comprises two parts.
Part A is a teacher’s guide, which has been
designed to assist teachers to implement the
Curriculum Guide. As we are aware that patient
safety is a new discipline and many health-care
professionals and faculty staff will be unfamiliar
with many of the concepts and principles, this
part lays the foundations for capacity-building
in patient safety education. Part B provides
a comprehensive, ready-to-teach, topic-based
patient safety programme that can be implemented
either as a whole or on a per topic basis.
Why was the Curriculum Guide
developed?
Since the Harvard study [1] in 1991 first described
the extent of harm to patients, other countries
have reported similar results, notwithstanding
the differences in their cultures and health
systems. The realization that health care actually
harms patients has increased scrutiny of patient
care in the context of an increasingly complex
health system. This complexity has been
intensified by rapidly changing medical technology
and service demands [2,3]. Doctors, nurses,
midwives, dentists, pharmacists, and other
health-care professionals are expected to manage
this complexity in their daily work, provide
evidence-based health-care services, and maintain
a safe environment for patients. However, unless
23
Part A 1. Background
they are properly educated and trained in patient
safety concepts and principles they will struggle
to do this.
Patient safety education for health-care
professionals in the higher education sector has
not kept up with workforce requirements [3-7]. For
example, incident reporting systems for medication
errors or surgical mistakes have been in use for
many years in several countries, but accounts
of specific curricula related to health-care errors or
patient safety courses embedded in undergraduate
education have started to be described only
recently in the published literature [5,8].
A number of factors have impeded patient safety
education. First, the lack of recognition by
health-care educators that teaching and learning
patient safety should be an essential part of the
undergraduate curricula for health-care students,
and that patient safety skills can be taught [9,10].
Many educators are unfamiliar with the literature
and are unsure how to integrate patient safety
learning into existing curricula [11,12]. Second,
educators need to be open to new areas of
knowledge [3]. One of the difficulties in
introducing new curricula is a reluctance to address
knowledge that originates from outside one’s
profession, such as systems thinking and qualityimprovement methods [10]. It has also been
suggested that the historical emphasis on
treatment of disease rather than prevention of
illness creates a culture that finds it difficult to give
merit to a “non-event”, i.e. a preventable adverse
event [3]. A third factor relates to entrenched
attitudes regarding the traditional teacher-student
relationship - one that may be hierarchical
and competitive [9] and where an “expert”
disseminates information to the student [3,4].
This Curriculum Guide seeks to fill the gap
in patient safety education by providing
a comprehensive curriculum designed to build
foundation knowledge and skills for all health-care
students that will better prepare them for clinical
practice in a range of environments.
References
1. Brennan TA et al. Incidence of adverse events
and negligence in hospitalized patients: results
of the Harvard Medical Practice Study I. New
England Journal of Medicine, 1991, 324:370–376.
2. Runciman B, Merry A, Walton M. Safety and
ethics in healthcare: a guide to getting it right, 1st ed.
Aldershot, UK, Ashgate Publishing Ltd, 2007.
3. Stevens D. Finding safety in medical education.
Quality & Safety in Health Care, 2002,11:109–110.
4. Johnstone MJ, Kanitsake O. Clinical risk
management and patient safety education for
nurses: a critique. Nurse Education Today, 2007,
27:185–191.
5. Patey R et al. Patient safety: helping medical
students understand error in healthcare. Quality
& Safety in Health Care, 2007, 16:256–259.
6. Singh R et al. A comprehensive collaborative
patient safety residency curriculum to address
the ACGME core competencies. Medical
Education, 2005, 39:1195–1204.
7. Holmes JH, Balas EA, Boren SA. A guide
for developing patient safety curricula for
undergraduate medical education. Journal of
the American Medical Informatics Association, 2002,
9 (Suppl. 1):S124–S127.
8. Halbach JL, Sullivan LL. Teaching medical
students about medical errors and patient
safety: evaluation of a required curriculum.
Academic Medicine, 2005, 80:600–606.
9. Sandars J et al. Educating undergraduate
medical students about patient safety: priority
areas for curriculum development. Medical
Teacher, 2007, 29:60–61.
10. Walton MM. Teaching patient safety to
clinicians and medical students. The Clinical
Teacher, 2007, 4:1–8.
11. Walton MM, Elliott SL. Improving safety
and quality: how can education help?
Medical Journal of Australia, 2006,184 (Suppl.
10):S60-S64.
12. Ladden MD et al. Educating interprofessional
learners for quality, safety and systems
improvement. Journal of Interprofessional Care,
2006, 20:497–505.
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