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BMJ Open Is Committed to Open Peer Review. As Part of This Commitment We Make the Peer Review History of Every Article We Publish Publicly Available BMJ Open: first published as 10.1136/bmjopen-2017-020200 on 12 July 2018. Downloaded from BMJ Open is committed to open peer review. As part of this commitment we make the peer review history of every article we publish publicly available. When an article is published we post the peer reviewers’ comments and the authors’ responses online. We also post the versions of the paper that were used during peer review. These are the versions that the peer review comments apply to. The versions of the paper that follow are the versions that were submitted during the peer review process. They are not the versions of record or the final published versions. They should not be cited or distributed as the published version of this manuscript. BMJ Open is an open access journal and the full, final, typeset and author-corrected version of record of the manuscript is available on our site with no access controls, subscription charges or pay-per-view fees (http://bmjopen.bmj.com). If you have any questions on BMJ Open’s open peer review process please email [email protected] http://bmjopen.bmj.com/ on October 1, 2021 by guest. Protected copyright. BMJ Open BMJ Open: first published as 10.1136/bmjopen-2017-020200 on 12 July 2018. Downloaded from Perceptions of patient safety cultures among medical students: A cross-sectional investigation in Heilongjiang Province, China For peer review only Journal: BMJ Open Manuscript ID bmjopen-2017-020200 Article Type: Research Date Submitted by the Author: 20-Oct-2017 Complete List of Authors: Liu, He; Hebei Medical University, Office of Academic Affairs Li, Ying; Harbin Medical University, Department of Health Policy and Hospital Management Zhao, Siqi; Hebei Medical University, Department of Nursing Psychology and Humanities Jiao, Mingli; Harbin Medical University, Health policy ; Chinese Academy of Social Science, Institute of Quantitative &Technical Economics Lu, Yan; Jiamusi University, School of Public Health Liu, Jinghua; QiQihar Medical University Jiang, Kexin; Harbin Medical University, Department of Health Policy and Hospital Management, School of Public Health Fang, Huiying; Harbin Medical University, Department of Health, Policy and Hospital Management, School of Public Health Sun, Peihang; Harbin Medical University, Department of Health, Policy and http://bmjopen.bmj.com/ Hospital Management, School of Public Health Li, Peng; Harbin Medical University, Department of Health Policy and Hospital Management, School of Public Health Wang, Yameng; Harbin Medical University, Department of Health Policy and Hospital Management Jia, Haonan; Harbin Medical University, Department of Health Policy and Hospital Management, School of Public Health Wu, Yuming; Hebei Medical University, Department of physiology,School of basic medicine on October 1, 2021 by guest. Protected copyright. Liu, Limin; The 2nd Affiliated Hospital of Harbin Medical University, Medical record room Zhao, Yanming; The 2nd Affiliated Hospital of Harbin Medical University, CT room Wu, Qunhong; Harbin Medical University, Department of Social Medicine, School of Public Health <b>Primary Subject Public health Heading</b>: Secondary Subject Heading: Health policy, Medical education and training Keywords: hidden curriculum, medical student, patient safety culture For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 1 of 18 BMJ Open 1 BMJ Open: first published as 10.1136/bmjopen-2017-020200 on 12 July 2018. Downloaded from 2 3 4 5 6 7 8 9 10 11 12 13 14 15 For peer review only 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 http://bmjopen.bmj.com/ 35 36 37 38 39 40 41 42 on October 1, 2021 by guest. Protected copyright. 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 2 of 18 BMJ Open: first published as 10.1136/bmjopen-2017-020200 on 12 July 2018. Downloaded from 1 2 3 Perceptions of patient safety cultures among medical students: A cross-sectional 4 5 investigation in Heilongjiang Province, China 6 7 He Liu1†,Ying Li2†, Siqi Zhao3,Mingli Jiao2,4*, Yan Lu5, Jinghua Liu6, Kexin Jiang2, Huiying 8 Fang2, Peihang Sun2, Peng Li2, Yameng Wang2, Haonan Jia2, Yuming Wu7*, Limin Liu8, 9 9 10* 10 Yanming Zhao , Qunhong Wu 11 12 1 Office of Academic Affairs,Hebei Medical University,361Zhongshan East Road,Chang'an Di 13 strict,Shijiazhuang 050017,China;E-Mail:[email protected] (H.L.) 14 15 2 DepartmentFor of Health peer Policy and Hospitalreview Management, School only of Public Health, Harbin 16 Medical University, 157 Baojian Road, Nangang District, Harbin 150081, China; 17 E-Mails:[email protected](Y.L.);[email protected](S.Z.); 18 19 [email protected](K.J.); [email protected](H.F.);[email protected] (P.S.); 20 [email protected](P.L.); [email protected](Y.W.); [email protected](H.J.) 21 3 Department of Nursing Psychology and Humanities, Hebei Medical University, Donggang 22 23 Road 48, Yuhua District, Shijiazhuang 050017,China;E-Mail: 24 [email protected](S.Z.) 25 26 4 Institute of Quantitative &Technical Economics,Chinese Academy of Social Science, 27 5 Jian guo men nei Road,Dongcheng District, Beijing100000,China;E-Mail:minglijiao@ 28 126.com(M.J.) 29 30 5 School of Public Health, Jiamusi University, Jiamusi 154007, China; E-Mail: 31 [email protected](Y.L.) 32 6 School of Public Health,QiQihar Medical University,QiQihar 161006,China;E-Mail: 33 34 [email protected](J.L.) http://bmjopen.bmj.com/ 35 7 Department of physiology,School of basic medicine,Hebei Medical University,361Zhongshan 36 Road,Changan District,Shijiazhuang 050017,China;E-Mail: [email protected] 37 38 (Y.W.) 39 8 Medical record room,The 2nd Affiliated Hospital of Harbin Medical University, 40 41 Harbin 150081, China;E-Mail: [email protected] (L.L.) 42 9 CT room,The 2nd Affiliated Hospital of Harbin Medical University,Harbin 150081, on October 1, 2021 by guest. Protected copyright. 43 China;E-Mail: [email protected] (Y.Z.) 44 45 10 Department of Social Medicine, School of Public Health, Harbin Medical University, 157 46 Baojian Road, Nangang District, Harbin 150081, China; 47 E-Mails:[email protected](Q.W.) 48 49 50 †These authors contributed equally to this work. 51 *Correspondence ： [email protected]; [email protected]; 52 53 [email protected] 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 3 of 18 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2017-020200 on 12 July 2018. Downloaded from 1 2 3 Abstract 4 5 Objectives: Medical school education plays an important role in promoting patient safety. The 6 7 present study investigated medical students’ perspectives regarding a general patient safety culture, 8 9 identifying students’ educational needs across different institutions and cohorts. The ultimate goal 10 11 of this assessment was to reveal evidence regarding how to promote patient safety in medical 12 13 school curricula. 14 15 Method: ForA cross-sectional peer study was conducted review within each of theonly four medical universities in 16 17 Heilongjiang province. First through fifth-year medical students completed an anonymous 18 questionnaire—the Attitudes toward Patient Safety Questionnaire III (APSQ-III). Differences in 19 20 responses across the four universities and cohorts were analyzed. 21 22 Results: Overall perceptions of patient safety cultures across the four medical universities were 23 24 positive. The highest positive response rate was for, “I have a good understanding of patient safety 25 26 issues as a result of my undergraduate medical training” (range: 58.4%–99.8%), while the lowest 27 28 positive response rate was for, “medical errors are a sign of incompetence” (14.7%–47.9%). 29 30 Younger cohorts had a better awareness of working hours and teamwork. However, fourth and 31 32 fifth-year students had a better awareness of error inevitability. The lowest positive scores between 33 cohorts included items related to “professional incompetence as an error cause” and “disclosure http://bmjopen.bmj.com/ 34 35 responsibility.” 36 37 Conclusions: Perceptions of a patient safety culture among students from various medical schools 38 39 were positive, suggesting a willingness to learn about this important issue. Policy makers should 40 41 place a greater focus on varied educational needs across schools and cohorts in order to establish 42 on October 1, 2021 by guest. Protected copyright. 43 proper curricula. 44 45 Keywords: hidden curriculum, medical student, patient safety culture 46 47 48 49 Strengths and limitations of this study 50 1. Medical student opinions/evaluations regarding patient safety cultures are rather positive. 51 52 2. Positive perceptions of the patient safety culture tended to decrease from younger to older 53 54 cohorts. 55 56 3. The APSQ-III is a new instrument that has yet to be subjected to re-testing for reliability and 57 58 predictive validity. 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 4 of 18 BMJ Open: first published as 10.1136/bmjopen-2017-020200 on 12 July 2018. Downloaded from 1 2 3 1. Introduction 4 5 Hippocrates, who is considered the "father of medicine," proposed the "Hippocratic Oath." This 6 7 proclamation is made by tens of thousands of medical students worldwide in order to promote a 8 9 rigorous and enthusiastic attitude toward medial education. Here, the maintenance and promotion 10 11 of human safety is of utmost importance. 12 13 However, as noted a decade ago by the Institute of Medicine (IOM), accountability for patient 14 15 safety requiresFor a multilayered peer approach—one review that addresses system only errors as well as human 16 17 ones—to help prevent medical errors [1-3].
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