INTRODUCTION or talk about adverse events and medical errors



safety is an important element of health care and can be defined as freedom for
a patient from unnecessary harm or potential harm related with health care. Every
year, a number of patients suffer injuries or die because of unsafe and poor
quality health care. Most of these injuries are avoidable.

We Will Write a Custom Essay Specifically
For You For Only $13.90/page!

order now


challenges for patient safety in health care are lack of safety culture and
attitudes that overlook basic safety rules for both the patient as well as the
health-care professional. Health-care professionals are reluctant to report or
talk about adverse events and medical errors for fear of blaming, embarrassment,
punishment. Moreover, there is underreporting of adverse events and medical


The World
Health Organization (WHO) has strategies for safer health care by placing the
patient at the centre through developing guidelines and tools, and building
capacity.  The patient safety education
program was established in 2009 to support the education and training of
medical professionals and students in quality improvements and patient safety.


students are the future medical care providers and they need to understand how
systems affect the quality and safety of healthcare and must prepare themselves
to practice care safely.

The World
Health Organization (WHO) has developed a Patient Safety Curriculum Guide for
medical students to help them meet this future challenge. The medical patient
safety curriculum guide builds patient safety knowledge and capacity to
practice safely1


In Indonesia,
curriculum on patient safety has implemented on 18 medical faculties since 2012
according to the WHO Standard.  Even tough, curriculum on patient safety
for other healthcare professionals has not developed yet. There were also a
guide how to integrate patient safety into medical school curriculum. It will
enable and encourage medical school to include patient safety in their course. However,
very few studies has been investigated of undergraduate medical student
attitude to patient safety. The aim of this study was to assess undergraduate
medical students’ attitudes to patient safety issue and their interest in
education related to patient safety.



cross-sectional survey was conducted at the Faculty of Medicine, Universitas Yarsi,
in 2017. A structured and anonymous self-administered questionnaire was handed
to medical students including preclinical and clinical undergraduate students.
The questionnaire having 15 items related to patient safety issues was adapted
from one used in an earlier study. Those who volunteered were included. No sample
size calculation was done.


The first 4
items in the questionnaire were about students’ perceptions about the causes of
medical errors, the second 6 items were about management of medical error and
the last 4 items addressed their views on inclusion of patient safety education
in medical curriculum. Grading of responses was done using a 5-point ordinal
scale where 1=strongly disagree and 5= strongly agree.


The main
outcome measures were students’ attitudes about patient safety issues and their
attitude to the teaching of patient safety curriculum. Data was analysed using
SPSS 20. Frequency and percentage was used to report categorical data.
Chi-square was used to find out significant difference between the responses of
different groups of students, with p<0.05 being significant.   RESULTS AND DISCUSSION All 519 participants responded. For the purpose of reporting we combined the responses of 'agreed' and 'strongly agreed' to report them as 'agreed', while 'disagreed' and strongly disagreed' were together reported as 'disagreed'. In the following summary our findings, for ease of presentation, the term "majority" was defined as "greater than 50% of respondents".   Items 1 to 4 were aimed at addressing students' knowledge regarding medical errors. Medical error is a complex issue, but error itself is an inevitable part of the patient condition. However, it can be avoided. To achieve this, medical students must learn from past errors, and learn how to prevent future errors (WHO, 2009). Although majority of students were correct in thinking that medical errors are inevitable, about a quarter neutral with this and approximately 13% remained disagree. By giving the teaching of patient safety even in short lecture, the student awareness about inevitable of medical error will improve (Leung, 2010). Half agreed that best care is not always provided to patients (263; 50.67%). The results were similar to the findings of Leung (2010), Shah (2015), and Nabilou (2015). Majority of students thought competent physicians do not make errors (391; 75.34%). For item 4, a significant number of students thought most errors are not related to physicians (249; 47.98%) and this misconception was more among preclinical students (212; 51.08%) than clinical students (37; 35.58%) (p value = 0.006) (Table-2).   The concerns of patient safety are worldwide, and it is widely recognized that medical errors, adverse events, and near miss events are considerably underreported. Items 5 to 8 were related to perceptions about reporting of medical errors (Table 1). It was encouraging that majority of students thought medical errors should be reported (306; 58.96%) and moreover they said there is need to report a near miss event (380; 73.22%) thus will have a chance to learn from those cases. Medical community may not want a doctor especially medical student to speak in view of the risk of litigation, and also to remain quiet and defend other doctors who make mistakes. By learn from error, student will realize that blaming people does not work, and that if people fear being blamed no one will report or learn from the event. Reporting incidents and adverse events is also a systematic way of gathering information about the safety and quality of care.   Almost half number of students disagreed that only physicians can determine the causes of medical error (249; 47.98%). Medical error occur not because patients intentionally hurt by bad people but rather that the system of health care today is so complex that the successful treatment and outcome for each patient depends on many factors, not just the competence of physicians. When so many people and different types of health-care providers (doctors, pharmacists, nurses, laboratory staffs and others) are involved this makes it very difficult to ensure safe care, unless the system of care is designed to facilitate timely and complete information and understanding by all the health professionals.   More than one-third students thought reporting systems will reduce medical errors (205; 39.5%). An incident-reporting system is an important component of an organization's ability to learn from error. Most of health facilities e.g. hospitals will have a reporting system to identify adverse events. It is important that students are aware of these events. Students should seek information on the reporting system used in the hospital where they are practicing or placed. Students should be familiar with the system in place and seek information about how to report an incident.   The vast majority agreed that errors can be prevented by working hard and being more careful (490; 94.41%). In contrary, evidence shows that the traditional "perfectibility" model which assumed that errors can be avoided by being careful enough and working hard can be dangerous as the major contributing factor for adverse events is the human.      Near half said that uncertainty should not be tolerated in patient care and culture of medicine was supportive for dealing with errors (257; 49.52 %). They need to understand the culture of their workplace, and how it impacts upon team functioning. Discussions about medical errors are difficult for doctors in all cultures. Openness to learning from errors will often depend on the personalities of the senior people. In some cultures and hospitals, openness about errors may be new and so it will be very difficult for doctors. In these cases, it may be appropriate for the students to talk about errors in a student teaching session.