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Assessing Medical Students’ Perceptions of Patient Safety: The Medical Student Safety Attitudes and Professionalism Survey

Liao, Joshua M. MD; Etchegaray, Jason M. PhD; Williams, S. Tyler; Berger, David H. MD, MHCM; Bell, Sigall K. MD; Thomas, Eric J. MD, MPH

doi: 10.1097/ACM.0000000000000124
Research Reports

Purpose To develop and test the psychometric properties of a survey to measure students’ perceptions about patient safety as observed on clinical rotations.

Method In 2012, the authors surveyed 367 graduating fourth-year medical students at three U.S. MD-granting medical schools. They assessed the survey’s reliability and construct and concurrent validity. They examined correlations between students’ perceptions of organizational cultural factors, organizational patient safety measures, and students’ intended safety behaviors. They also calculated percent positive scores for cultural factors.

Results Two hundred twenty-eight students (62%) responded. Analyses identified five cultural factors (teamwork culture, safety culture, error disclosure culture, experiences with professionalism, and comfort expressing professional concerns) that had construct validity, concurrent validity, and good reliability (Cronbach alphas > 0.70). Across schools, percent positive scores for safety culture ranged from 28% (95% confidence interval [CI], 13%–43%) to 64% (30%–98%), while those for teamwork culture ranged from 47% (32%–62%) to 74% (66%–81%). They were low for error disclosure culture (range: 10% [0%–20%] to 27% [20%–35%]), experiences with professionalism (range: 7% [0%–15%] to 23% [16%–30%]), and comfort expressing professional concerns (range: 17% [5%–29%] to 38% [8%–69%]). Each cultural factor correlated positively with perceptions of overall patient safety as observed in clinical rotations (r = 0.37–0.69, P < .05) and at least one safety behavioral intent item.

Conclusions This study provided initial evidence for the survey’s reliability and validity and illustrated its applicability for determining whether students’ clinical experiences exemplify positive patient safety environments.

Dr. Liao is a resident physician, Department of Internal Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts. At the time of writing, he was a fourth-year medical student, Baylor College of Medicine, Houston, Texas.

Dr. Etchegaray is assistant professor, Department of Internal Medicine, University of Texas Medical School at Houston and UT-Memorial Hermann Center for Healthcare Quality and Safety, Houston, Texas.

Mr. Williams is a fourth-year medical student, University of Texas Health Science Center at Houston, Houston, Texas.

Dr. Berger is professor and vice chair, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, and vice president and chief medical officer, Baylor College of Medicine Medical Center, Houston, Texas.

Dr. Bell is assistant professor of medicine, division of general medicine and primary care, Harvard Medical School, Boston, Massachusetts.

Dr. Thomas is professor of medicine, associate dean for health care quality, and director, UT-Memorial Hermann Center for Healthcare Quality and Safety and at University of Texas Medical School at Houston, Houston, Texas.

Other disclosures: None reported.

Ethical approval: This study was approved by the institutional review board of the University of Texas Health Science Center at Houston.

Correspondence should be addressed to Dr. Etchegaray, 6410 Fannin, UPB 1100, Houston, TX 77030-3006; telephone: (713) 500-6782; e-mail:

© 2014 by the Association of American Medical Colleges