Medical students are future doctors. Studies show that learning about patient safety during their training is more effective than learning on the job [13-14]. Medical students’ experiences during their clinical rotations are important influences on their attitudes towards patient safety and their future patient safety behaviours. This study found that medical students’ clinical experiences related to their patient safety grade and patient safety behavioural intentions. The results highlight medical students’ perceptions of patient safety as an important part of clinical practice. Compared to Lee [15], the three highest scores were for ‘We followed standard operating procedures, guidelines, and protocols for the OR’(89.2), ‘The quality of care received by patients was impacted by teamwork’(78.4), and ‘We followed standard operating procedures, guidelines, and protocols for the floor (e.g. checklists to prev’ (73.7). ‘Medical error disclosure to patients and families was an important component of patient safety’ (73.7), and ‘‘I was encouraged by my colleagues to disclose errors to patients/families’(10.3), ‘The culture during my rotations made it easy to disclose medical errors’(13.4), ‘I received education or training on how to disclose medical errors to patients’(18.0) received the lowest overall scores in that previous study [15]. The current study found that ‘We followed standard operating procedures, guidelines, and protocols for the floor (e.g., checklists to prevent central blood stream infections, hand washing)’, ‘I had good collaboration with team members (students, residents, attending, nurses, and other caregivers)’ and ‘I observed excellent patient safety practices’ were almost universally supported (99.5%, 95.4% and 93.7%, respectively). The statements ‘I felt that a patient was discriminated against by a member of my team on the basis of gender, race, sexual orientation, or religion’ (43.1%) and ‘A member of my team was rude and disrespectful to a patient or family member’ (42.8%) were strong barriers to positive student patient safety perceptions.
The results found that ‘If the superior doctor has misconduct, I will not report it’, which was similar to Hoo-Yeon Lee, which found that 41.2% of the sample intended to disclose medical errors committed by team members. The current study’s finding might relate to Chinese students’ flight from responsibility and pressure caused by unhealthy organizational cultures. Students in the medical school culture struggle to manage and protect themselves in the power structure, and, when mistakes or precursors of mistakes happen, they fear that reporting them might bring poor evaluations down upon them that might negatively influence their futures. Many students do not want to admit that they made a mistake or have a weakness, and they might hesitate to report concerns to avoid problems for their teams. Therefore, we should pay attention to the unwillingness of Chinese students to speak up and increase our vigilance to prevent this fear of exposing defects.
This study revealed that some respondents reported that team members were rude, disrespectful or discriminatory. Sometimes, they inadequately answered patients’ questions or ignored them. This is evidence of poor professionalism and professional ethics in healthcare, which previous studies have related to patient safety [16–18]. A culture of professionalism might mitigate errors and procedural violations that primarily arise from cognitive lapses, such as forgetfulness, inattention, low motivation, carelessness or negligence [19–20]. Aside from low levels of personal professionalism, the main reasons for loss of healthcare providers’ sense of responsibility might be work intensity or pressure [21–22]. High work intensity and pressure bring to work against the psychological, work numbness, job burnout, impatience, gradually evolved into do not care about the questions raised by patients because these questions seem to be less valuable when medical workers are busy to deal with works [23]. Hospital administrators should strive to understand decreasing professionalism and propose appropriate measures for improvement.
Based on the variation among the three schools, QMU should focus on improving its teamwork culture, and MMU should target its safety culture, error disclosure culture and comfort expressing professional concerns. Of the schools, JMU’s respondents were most likely to agree with the items, except those about experiences with professionalism, for which they had the lowest agreement. All three schools should aim to improve their curricula in light of their unique weaknesses and continue to improve the cultural factors.
Safety culture was the strongest predictor of the overall patient safety grade, which is consistent with the results of Korean [15] and American [11] studies. A safety culture should be developed to improve the overall extent of patient safety. For example, the extent to which healthcare professionals are comfortable expressing patient safety concerns might influence whether they participate in quality improvement initiatives, report problems, or encourage team members to remember and act on patient safety. We suspect that being comfortable is influenced by the organizational atmosphere because this study’s results found that, despite the culture during respondents’ rotations made it easy to disclose medical errors, 44.2% agreed that disclose errors to patients/families will not be too much encouraged by their colleagues. Influenced by the organizational atmosphere, even if one of their superiors behaved inappropriately, they did not report it.
Patient safety education outside China has entered a state-led popularization stage. Classroom teaching is the traditional way of imparting knowledge. Network teaching uses modern tools for distance learning and academic exchange. Simulation is a popular and successful teaching method. Its greatest advantage regarding patient safety is in its ability to transform knowledge and skills into clinical practice. In China, teaching occurs in the classroom and academic lectures. This study’s three most popular options for learning patient safety were academic lectures, teaching in clinical rounds, and case studies, and the three most popular topics were ‘ways to handle clinical risks’, ‘the causes of medical errors and the principles of risk prevention’, and ‘strengthening infection controls and reducing nosocomial infections’.
Because of time and resource limitations, only three institutions participated in this study, which limits its generalizability to medical students in Heilongjiang Province. Additionally, the data were retrospective and, therefore, the results might suffer from the effects of recall bias. However, this study investigated the needs of medical students regarding the structure and content of patient safety courses, which suggests curricular design revisions. Further, few studies have used MSSAPS in China, making this study a valuable foundation for future research.
This study suggests that medical students need targeted courses on patient safety because they consider patient safety an important part of quality of care [11]. These courses would be most effective when students’ needs are merged with their preferred course arrangements, although few studies have investigated these preferences. This study found that students wanted patient safety education during the intern stage, which might reflect an interest in application during clinical practice.