Perceptions and Attitudes Toward Patient Safety: Perspectives of Students in the Medical and Health Sciences at the University of Aden, Yemen

Technical Summary: Perceptions and Attitudes Toward Patient Safety Among Health Sciences Students at the University of Aden, Yemen

Problem Statement
Patient safety competencies among health sciences graduates are frequently insufficient, a challenge exacerbated in fragile and conflict-affected settings (FCAS) like Yemen. In these environments, health systems face fragmentation, infrastructure breakdown, and limited regulatory oversight, which severely compromises care quality. While the World Health Organization (WHO) advocates for the integration of patient safety education into undergraduate curricula to foster a safety culture, implementation remains inconsistent globally, particularly in low- and middle-income countries (LMICs). There is a paucity of research comparing composite scores of patient safety perceptions across different healthcare disciplines within such conflict-affected contexts. This study addresses the need to evaluate the understanding and attitudes of undergraduate students toward patient safety to inform curriculum development and faculty training in Yemen's post-conflict academic environment.

Methodology
The study employed a descriptive cross-sectional design conducted in June 2023 at the University of Aden, Yemen. The target population included undergraduate students from the Faculties of Medicine, Dentistry, Pharmacy, and Nursing. A total of 1,233 students participated, representing an 84.4% response rate across the four disciplines.

Data collection utilized a validated, self-administered questionnaire based on the WHO Multi-professional Patient Safety Curriculum Guide. The instrument was content-validated by five experts and piloted with 20 students (Cronbach's α = 0.87). The survey comprised five domains:

1. Error and Patient Safety: Comprehension of human error classifications and reporting systems.
2. Safety of the Healthcare System: Perceptions of systemic protocols and error incidence.
3. Personal Influence on Safety: Confidence in averting, disclosing, and addressing problems.
4. Personal Attitudes Towards Patient Safety: Openness to learning from mistakes.
5. Workplace Safety: Perceptions of institutional support, policies, and non-punitive environments.

Responses were measured on a 5-point Likert scale. Statistical analysis was performed using SPSS version 25.0, employing descriptive statistics and One-Way ANOVA to identify significant differences among the four college groups.

Key Results
The study sample consisted primarily of dentistry (46.7%) and pharmacy (29.0%) students, with medicine (13.6%) and nursing (10.6%) comprising the remainder.

• Knowledge Gaps: General understanding of patient safety was inadequate. Only 32.0% of students acknowledged factors affecting safety, and fewer than 24% were familiar with error reporting protocols or the role of healthcare organizations in reporting.
• Systemic Perceptions: A majority (58.2%) acknowledged that medical errors are prevalent, yet only 11.6% regarded their country's healthcare system as safe. Only 42.0% believed healthcare personnel receive adequate patient safety training.
• Attitudes and Personal Influence: While 63.5% viewed error reporting as beneficial, fewer than half (46.5%) felt consistently capable of ensuring patient safety in practice. Notably, 24.1% of students tended to attribute blame to others rather than addressing underlying issues, indicating a persistent punitive culture.
• Workplace Safety: Perceptions were ambivalent. While 58.8% expected managerial prioritization of safety, only 40.4% believed managers promote error reporting. Fear of criticism remained high, with only ~21% feeling secure from criticism by doctors or nurses when disclosing mistakes.
• Inter-disciplinary Differences: One-way ANOVA revealed statistically significant differences (p < 0.001) across all five domains among the colleges. Nursing students consistently exhibited the highest mean scores in safety perceptions. Pharmacy students also demonstrated superior performance compared to medicine and dentistry students in several categories.

Significance and Claims
The paper claims that while the emerging Yemeni health workforce demonstrates positive attitudes and a willingness to engage with patient safety principles, there is a critical gap between these attitudes and the structural capacity to practice safely. The findings suggest that systemic fragility, rather than knowledge deficits alone, is a primary determinant of safety performance in this context.

The study highlights that current curricula in Yemen, similar to other LMICs, appear oriented toward individual error prevention rather than organizational learning and systems-based thinking. The authors argue that education reforms alone are insufficient without institutional support for a safety culture. They propose that future interventions must be interprofessional, experiential, and non-punitive, aligning with the WHO Global Patient Safety Action Plan (2021–2030). Specifically, the paper suggests that integrating simulation-based learning and standardizing patient safety curricula across all health disciplines could help institutionalize systems-based thinking and improve error reporting processes.

The authors acknowledge limitations, including the cross-sectional design which precludes assessing temporal changes, potential social desirability bias in self-reported data, and the concentration of participants from a single university. However, they assert that the large sample size and multi-disciplinary scope provide robust baseline evidence necessary for guiding curricular and policy reforms in fragile settings.