Racism and implicit biases can threaten the safety of care. The authors in this article outline how implicit bias can affect health professional trainees and impact patient care in obstetrics and gynecology, and outlines strategies to address implicit bias through bias awareness and management curricula, ensuring a supportive learning environment, and faculty development.

The patient safety movement recognizes that most errors occur at the system level, not the individual level, and therefore uses a systems approach toward improving patient safety. A similar systems approach can be used by pharmacy programs to enhance the education of pharmacy students. This article describes the sociotechnical framework of healthcare (structures, processes, outcomes) and parallels with pharmacy programs.

Maternal morbidity and mortality are disproportionately experienced by persons of color in the United States. The authors of this article present a socioecological model for understanding the individual, interpersonal, organizational, community, and societal factors contributing to Black maternal morbidity and mortality. The authors outline several recommendations for improving care, including workforce diversification, incorporating social determinants of health and health disparities into health professional education, and exploring the impact of structural racism on maternal health outcomes.  

Myriad factors contribute to missed nursing care including staffing, team and group norms, and teamwork. Nurses in this study described four themes that contributed to missed nursing care: teamwork in nursing wards; informal teaching and communication; influence of formal and informal leaders; and influencing factors in nurses’ work environment. Developing nurses' clinical leadership skills may improve teamwork and reduce missed care.

Staffing shortages are temporarily alleviated with floating or redeployed staff. This qualitative study of intensive care unit (ICU) critical care nurses and floating non-critical care nurses sought to identify the pros and cons of floating nurses, and strategies to improve patient safety. Floating nurses reported concerns surrounding unfamiliarity with the types of patients or locations of equipment. Critical care nurses reported cognitive overload with doing their routine duties plus orienting floating nurses. One recommendation to improve safety is competency-based nursing curriculum and provide floating nurses occasional training/experience in the ICU.

Simulated hospital rooms have been used in medical education to identify potential safety threats. In this study, pharmacy students participated in a team-based simulation to identify potential latent errors and then completed a system thinking survey. Survey results indicated students had a good understanding of systems thinking, but only identified about half of the potential errors in the simulated room.

In medical education, the “hidden curriculum” refers to the influence of offhand comments, behaviors, and attitudes of senior clinicians on the formation of a student’s professional identity. This scoping review identified five papers examining the hidden curriculum in pharmacy education. The studies identified several approaches to address the hidden curriculum during pharmacy training, such as better integration of formal and informal training activities, encouraging positive mentor:mentee relationships between students and practicing pharmacists, and cultivating professionalism.

Simulation-based training allows learners to learn and practice technical and non-technical skills in a low-risk environment. This review examines the effect of high-fidelity simulation (HFS) on clinical reasoning in nursing students. Results suggest HFS does improve clinical reasoning, but the included studies typically did not directly link improved clinical reasoning to improved patient safety.

Error management training (EMT) encourages learners to make errors during training, and then engage in positive discussions about recognition of those errors. This commentary calls for increased use of EMT for surgical students and residents to promote error recovery.

Learning from mistakes is an essential component of medical and nursing education. This retrospective study examined medical errors and near-misses committed by nursing students at more than 200 prelicensure programs. Of the 1,042 errors and near-misses reported, medication errors were most common (59%). Three primary contributing factors to errors and near-miss events were identified – (1) not checking patient identification, (2) not checking a patient’s allergy status, and (3) not following the “rights” of medication administration.

Medication errors are common, especially among medical trainees. This retrospective cohort study conducted at one medical center in the Netherlands identified a high rate of errors in prescriptions written by medical students (40% of all prescriptions). The most common type of error was inadequate information in the prescription – such as not indicating the dosage form or concentration, or missing usage instructions, or omitting the weight for a pediatric patient. Findings indicate that 29% of errors would not have been intercepted and resolved by an electronic prescribing system or pharmacist.

The Accreditation Council for Graduate Medical Education (ACGME) encourages graduate and undergraduate medical education programs to include the Quality Improvement and Patient Safety (QIPS) curriculum. This review summarizes the status of QIPS programs in the United States. Program length varied widely, from two simulation-based sessions to a two-year QIPS fellowship. Only a quarter of programs used a standardized, validated QIPS evaluation tool, and resident satisfaction and information retention was mixed.

Patient safety improvements must consider the complexities of care delivery to achieve lasting change. This commentary discusses recent evidence examining the effect of duty hour limit adjustments. The authors highlight challenges regarding research design on this medical education policy change and how it affects learner and patient experience. They suggest caution in applying the study conclusions. 

Medical students do not always feel competent when it comes to patient safety concepts. In this study of German medical students, most understood the importance of patient safety, though few could identify concrete patient safety topics, such as near miss events or conditions that contribute to errors. Incorporating patient safety formally into medical education could improve students’ competence in these concepts.

Black patients who experience racism from their providers report receiving lower quality of care. Black public health students were asked about racist behaviors exhibited by their healthcare providers and the impacts the behaviors had on their care. The students recommend education and accountability to reduce providers’ racist attitudes, as well as increasing the number of Black clinicians.  

Racism exacerbates health disparities and threatens patient safety. This article summarizes the relationship between structural racism and health disparities in the United States and highlights how racism impacts health care delivery and health outcomes for patients with sickle cell disease.

Training in patient safety concepts is an important element of health professional education. This article describes learning objectives on patient safety generated by experts on patient safety and medical education. These learning objectives showed high correspondence with the WHO Patient Safety Curriculum Guide’s learning objectives.