American Journal of Medical Quality 2016, Vol. 31(6) 601 © The Author(s) 2016 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1062860616669753 ajmq.sagepub.com Q-Tip In a 2005 review, only 62% of US medical schools reported teaching patient safety and quality. 1 Most studies show that students are aware of errors in health care, but students often incorrectly attribute errors to individual failures. 2,3 Many medical students do not have the atti- tudes or skills necessary to speak up should they experi- ence an error or deviation from best practice. 2,4,5 This study examined the degree to which students may have difficulty perceiving, understanding, communicat- ing, investigating, or improving issues in safety and qual- ity along the 6 dimensions of quality outlined by the Institute of Medicine. This cross-sectional study utilized an original 34-item survey, distributed to third-year (N = 53) and fourth-year (N = 81) medical students at a Midwestern medical school and at other institutions nationwide through an Association of American Medical Colleges listserv (N = 122). Responses (N = 246) were analyzed by frequency. Chi- square testing confirmed that there were no substantial dif- ferences between the various cohorts surveyed, and groups were combined for analysis. This study was approved by the Wright State University institutional review board. Across all groups, a majority of respondents perceived deficits in safety (62%), timeliness (77%), and efficiency (81%). Students also perceived deficits in equitability (34%), evidence-based care (44%), and patient-centered- ness (29%). More than 90% of the students stated that they perceived avoidable adverse events, and 29% of the respondents perceived avoidable adverse events on a monthly basis. Of those who perceived deficits, 51% reported raising these issues to a superior; these students noted evidence of a change in response to their comment 20% of the time. Roughly 50% of students reported feel- ing “usually” or “almost always” comfortable approach- ing their superiors about quality issues. A majority of students (54%) reported that their experience of quality deficits affects their view of the practice of medicine. In substantial proportions, medical students perceived deficits in quality across all six aims for improvement. Students noted that quality deficits did affect their percep- tions of the practice of medicine and students witnessed what they perceived as avoidable events that negatively affected a patient’s health. Many students recognize these issues on a regular basis; however, they are not likely to bring these issues to the attention of other health care pro- fessionals. We hypothesize that the experience of systems issues without the empowerment to enact change them- selves or see change enacted by superiors results in more jaded students. Taken together, these results strongly sup- port the importance of training medical students to act as advocates for systems issues and quality improvement, as similarly reported in other studies. 2,4 References 1. Anderson MB, Kanter SL. Medical education in the United States and Canada, 2010. Acad Med. 2010;85(9 suppl):S2-S18. 2. Wetzel AP, Dow AW, Mazmanian PE. Patient safety atti- tudes and behaviors of graduating medical students. Eval Health Prof. 2012;35:221-238. 3. Leape LL, Brennan TA, Laird N, et al.The nature of adverse events in hospitalized patients: results of the Harvard Medical Practice Study II. N Engl J Med. 1991;324:377- 384. 4. White AA, Gallagher TH, Krauss MJ, et al. The attitudes and experiences of trainees regarding disclosing medical errors to patients. Acad Med. 2008;83:250-256. 5. King A, Holder MG Jr, Ahmed RA. Errors as allies: error management training in health professions education. BMJ Qual Saf. 2013;22:516-519. 669753AJM XX X 10.1177/1062860616669753American Journal of Medical QualitySwamy et al research-article 2016 1 Boonshoft School of Medicine, Wright State University, Dayton, OH Corresponding Author: Lakshmana Swamy, MD, MBA, 72 East Concord Street, Evans 124, Boston, MA 02118. Email: lax.swamy@gmail.com Student Perceptions of Clinical Quality and Safety Lakshmana Swamy, MD, MBA 1 , Colleen Badke, MD, MPH 1 , Arvind Suguness, MD 1 , Jacob McKeegan, MD 1 , Karen Kirkham, MD 1 , and Nicole J. Borges, PhD 1 James F. Pelegano, MD, MS, Kashmira Satish Chawla, BA, MSc, Valerie Pracilio, MPH, CPPS, and Karthik Rao, Section Editors at FUDAN UNIV LIB on December 12, 2016 ajm.sagepub.com Downloaded from