key: cord-0767595-zd55m458
authors: Lee, Jisoo; Park, Kyung Hye
title: The effect of the COVID-19 pandemic on the patient safety attitude of medical students
date: 2021-08-27
journal: Korean J Med Educ
DOI: 10.3946/kjme.2021.202
sha: 0df5790b6745f9894c6bf57d4a9dfc57f71836bc
doc_id: 767595
cord_uid: zd55m458

PURPOSE: This study aimed to examine the differences in scores of the Attitude to Patient Safety Questionnaire (APSQ) by medical students before and after the outbreak of COVID-19. METHODS: In total, 97 and 118 medical students completed patient safety courses at Yonsei University Wonju College of Medicine in 2019 and 2020, respectively. In 2019, the course was conducted using traditional learning in the classroom, whereas, in 2020, most of the classes were conducted using non-face-to-face learning methods. RESULTS: In 2019 and 2020, 49 and 53 students responded to the APSQ. Only one item “Patients are not really aware of how safe their care is” had a lower score in 2020 than in 2019. CONCLUSION: Although the total APSQ score did not differ between 2019 and 2020, the students in 2020 might have a poor understanding of the role of patients in medical errors.

Coronavirus disease 2019 (COVID-19) and social distancing have affected clinical clerkship, with fewer patients visiting university hospitals and parents of pediatric patients tending to avoid medical students [1, 2] .

Since medical students had limited chances to participate in clinical practice, they also had fewer chances of communicating with patients and meeting with clinical professors for feedback [1] . In addition, clinical practice has either been replaced by simulation or the time spent in hospitals has been limited for medical students in clinical clerkship when clinical practice is conducted [3, 4] . 

In total, 49 students (50.5%) responded in 2019 and 53 students (44.9%) responded in 2020. There were no differences in total scores between the two groups (170.15±20.15 versus 163.57±16.79, p=0.08). The item with the lowest score was "If people paid more attention at work, medical errors would be avoided" in both groups Table 2 ).

We investigated the differences in patient safety attitudes after the completion of the patient safety course by third-year medical students. The total APSQ score was approximately 7 points lower on average among respondents in 2020, but there was no statistical difference. The lack of a significant difference between the total APSQ scores and the same highest and lowest The only item with a difference in the APSQ was "Patients are not really aware of how safe their care is" from the category "Patient's role in error," and the scores of students in 2020 were exceptionally lower compared to other items. This item score was 5.10±1.23 in a study of Park et al. [9] in which the survey of APSQ was conducted in 2018. Although this score is similar to the score in 2019, the score in 2020 was significantly low. In

Mexico, the effect of the patient safety course among

fourth-year medical students was investigated during the COVID-19 pandemic. No survey items were found to be directly related to patient's role in error. Mexican medical students disapproved of just culture [10] . Thus, the patient's role in error could be considered a part of the patient safety culture. Our findings may be attributed to the fact that students had reduced chances of meeting patients during COVID-19, and they underestimated the role of patients. In our medical school, six to seven students were assigned to one clinical department, but the number of students who could gather at a time was limited and the opportunities to meet patients were reduced. For example, only one student was allowed to observe the surgery; in some clinical departments, they did not participate in ward rounds. During clinical clerkship, students acquire knowledge, skills, and attitudes by forming relationships with patients [11] , and peer learning takes place [12] . However, due to the COVID-19-restrictions, their opportunities to observe actual doctors' practice and share in clinical and professional experience were not enough, making it difficult to learn about physical examinations and communicate with patients [4] . For patient safety, experiential learning through clinical practice is important, but there seems to be a limit to this. Medical students felt that they had detracted from authentic communication with patients during clinical clerkship [13] . Senior medical students in the United Kingdom reported that the cancellation or postponement of objective structured clinical examination, assistantship, and electives due to COVID-19 affected their preparation for the first year of training [14] .

Flipped learning in the classroom changed to online lectures. Student-centered methods such as flipped learning had a better effect on learning, regardless of achievements such as grades [12] . On the other hand, non-face-to-face classes were preferred because students could attend from any place and re-learning was convenient when there was a video lecture [5] . and learned while maintaining student satisfaction through non-face-to-face instruction but, in essence, the attitudes that must be learned through experiential learning in interactions with patients, professors, and peer-students must be maintained to a similar, pre-COVID-19 degree.

Jisoo Lee: https://orcid.org/0000-0002-4304-9977;

Kyung Hye Park: http://orcid.org/0000-0002-5901-6088

Acknowledgements: None.

Funding: No financial support was received for this study.

No potential conflict of interest relevant to this article was reported. 

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World Health Organization. WHO patient safety curriculum guide for medical schools

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