**5. Instructional methods and implementation of patient safety education**

Patient safety as a subject is new, generic, multidisciplinary and highly contextual course. It should be based on experiences, and learners should have the opportunity to reflect on their practices.

• Integrated with the existing curriculum.

Although patient safety is a new subject, it has many facets in the existing curriculum and links with basic and clinical sciences. Almost all healthcare curricula have restricted space and time for adding new courses. It is a good approach to review the existing curriculum to identify where to integrate patient safety topics. Thus, it could be vertically integrated into the existing curriculum. Topics of patient safety are generic and could be applied to any specialty. In the existing curriculum, we can find generic areas that are suitable to include patient safety principles e.g. communication skills, ethics, professionalism…etc.

Patient safety is related to all healthcare professionals' clinical practice so it should not be studied in isolation. Topics of patient safety curriculum were designed to be easily integrated into the existing medical teaching, for example, anatomy, pediatric, physiology, etc. Incorporation of all topics is essential for the development of safe heath care providers [13]. Spiral approach is recommended while implementing patient safety curriculum. The curriculum should be spread over the undergraduate level program [17].

• Multi-professional/ Multidisciplinary.

The WHO Multi-professional Patient Safety Curriculum Guide (2011) was established responding to the need for providing harmless care. Being a safe healthcare provider requires different competencies that cover specific knowledge, skills, and attitude. Heath care workers should collaborate together to provide safe service, to guarantee that patient safety learning is delivered in an incorporated way which should be single coordinated, system based, in a team dependent approach, and includes different specialties. Patient safety curriculum includes basic, behavioral and clinical sciences. It is a multi-professional subject needs the repeated application to the workplace settings. It has been reported that medical students are positive about learning with other students who participated in clerkships of different specialties

• Experiential/ Provides opportunities for application and reflection

The course may include interactive lectures, e.g. problems with inappropriate supervision by a physician, to highlight the relation between theory and practice. Then the students had to reflect on incidents concerning patient safety based on their own personal experience and to complete an incident report card for each of these incidents. The course may also include presentations arranged by the students, which are followed by a 10-minute discussion for each presentation. Assessment of the students includes content, structure and presentation techniques [10].

Most courses in patient safety were introduced by lecturing and discussion which have short terms positive changes but the transfer of knowledge to the practice is low [9]. Learning patient safety could be enhanced by reflection, feedback, portfolio, and critical incident analysis, case discussions with senior clinicians, simulation environments and workshops. So, patient safety courses based on personal experiences and reflections enable students to transfer knowledge into practice and have a high impact on future career [10]. Some studies reveal that students emphasized active learning and experiential activities to reinforce safety principles [18].

• Contextual.

To ensure patient safety, the future physician must be prepared to know potential sources of errors and to recognize their own susceptibilities to error. An elective course in the open disclosure of the health care providers, which is communicating with the patients the errors and how it happened, can be introduced. This training of disclosure may decrease the harm

The course of patient safety necessities to be more focused. Writing objectives that are specific to the learners, measurable and relevant to their needs, help to focus the content course and essential for planning the appropriate instructional methods of conducting the

Patient safety as a subject is new, generic, multidisciplinary and highly contextual course. It should be based on experiences, and learners should have the opportunity to reflect on their

Although patient safety is a new subject, it has many facets in the existing curriculum and links with basic and clinical sciences. Almost all healthcare curricula have restricted space and time for adding new courses. It is a good approach to review the existing curriculum to identify where to integrate patient safety topics. Thus, it could be vertically integrated into the existing curriculum. Topics of patient safety are generic and could be applied to any specialty. In the existing curriculum, we can find generic areas that are suitable to include patient safety

Patient safety is related to all healthcare professionals' clinical practice so it should not be studied in isolation. Topics of patient safety curriculum were designed to be easily integrated into the existing medical teaching, for example, anatomy, pediatric, physiology, etc. Incorporation of all topics is essential for the development of safe heath care providers [13]. Spiral approach is recommended while implementing patient safety curriculum. The cur-

The WHO Multi-professional Patient Safety Curriculum Guide (2011) was established responding to the need for providing harmless care. Being a safe healthcare provider requires different competencies that cover specific knowledge, skills, and attitude. Heath care workers should collaborate together to provide safe service, to guarantee that patient safety learning is delivered in an incorporated way which should be single coordinated, system based, in a team dependent approach, and includes different specialties. Patient safety curriculum includes basic, behavioral and clinical sciences. It is a multi-professional subject needs the repeated application to the workplace settings. It has been reported that

**5. Instructional methods and implementation of patient safety** 

principles e.g. communication skills, ethics, professionalism…etc.

riculum should be spread over the undergraduate level program [17].

of the future patients [16].

96 Vignettes in Patient Safety - Volume 3

• Integrated with the existing curriculum.

• Multi-professional/ Multidisciplinary.

course.

**education**

practices.

Patient safety is highly contextual, so, students should have adequate professional practices to learn patient safety, in this regard patient safety is best taught once students involved in the health services. However, some behavioral sciences-based subjects could be learned early such as; what is patient safety, what are human factors, and understanding systems modules. Students need to continuously reflect on their practices and apply the learned knowledge and performance to be a safer provider of health care. Using critical cards incidents to help students reflecting on their personal experiences seems to be useful in improving the transfer of knowledge [10].

#### **5.1. Who should teach patient safety?**

Advocates of patient safety are usually from administrative nonacademic staff. To integrate patient safety throughout the curriculum we need a large number of academic teachers who often are not familiar with concepts and principles of patient safety. Some of them may practice patient safety principles without being aware of such knowledge. Academic clinicians, administrators, nurses, engineers, behavioral scientists are all involved in teaching patient safety. They should have capacity building through training workshops and seminars. Some schools trained healthcare administrators to deliver patient safety curriculum for undergraduates' students [9].

#### **5.2. Limitations**

From the point of view of the tutors who were involved in the implementation of the patient safety curriculum, some recommendations emerged. For example, training of the tutors, and the participation of large number staff in implementation, which will reduce the load on one or two tutors, are essential. The local support for implementation is also required for allocating more time and resources. They also recommended full integration of the curriculum in the undergraduate years [19]. Cost issues are limited to the time of the teachers and the students when the materials are available and the curriculum topics are provided as in the WHO guide [20].

Identification of users of these evaluations is an important step in the evaluation plan. Participants in patient safety courses have sake to provide their own views and participate in the assessment process concerning their own performance and the designed curriculum. These evaluations can provide feedback and be a source of motivation for continuous improvement for learners, faculty, and curriculum developers. An Example for this was the evaluation study of the WHO patient safety curriculum guide, its main aim was assessing the effectiveness of using the guide in teaching patient safety for postgraduate and graduate medical students. Concerning the feedback from this evaluation, it was utilized to guide through future versions of the Curriculum Guide and enhance the understanding of the suc-

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The evaluation results should be publicized as this would be interesting to educators from other institutions that are willing to introduce patient safety principles in their curricula.

After identifying users, we should identify uses of the evaluation, which are generic and specific ones. The generic uses refer to whether the evaluation is used to appraise the performance of individuals, the performance of the entire program, or both. The assessment of learners is closely related to whether they have achieved the cognitive, affective, or psychomotor or competency objectives of a curriculum or not. Meanwhile, it refers to whether an evaluation is used for formative purposes, for summative ones or for both purposes as discussed before. One more thing that should be considered is the specific needs of different users (stakeholders) and the specific ways in which they will put the evaluation to use [21]. Specific uses for evaluation results might include the following: feedback on individual learners' performance to assign grades or detect mastery in certain skills. Feedback on and improvement of program performance is also included in specific uses as the evaluation results could be used to identify parts of the curriculum that are effective and parts that are in need of improvement. Evaluation results may also provide suggestions about how parts of the curriculum could be

Identifying resources that will be used, followed by choosing measurement methods, and

Data collection methods that were used to evaluate the patient safety curriculum guide ranged from simple methods as getting students' perception about the course after receiving a patient safety teaching, and complex methods such as having faculty to review the conducted whole curriculum. These complex methods involve a varieties of tools such as surveys, interviews, and focus group with students, faculty or administration, observation and other methods. Reported data collection tools by previous studies either were face to face or telephone interviews with key stakeholders: teaching staff, and executives at the involved medical schools. Students' surveys regarding patient safety topics were collected before and after teaching patient safety curricula. The two methods were used to get different data. The pre-teaching ones to get information about students' perceptions and attitude towards patient safety and to test their knowledge of patient safety facts and actions. Meanwhile, the post teaching collected data measures two domains the effectiveness of the topics and the effectiveness of

cessful methods of introducing patient safety to curricula [21].

constructing instruments were also included in evaluation plan.

*6.2.2. Step 2: collecting and analyzing data*

improved [21].

#### **6. Evaluation and student assessment methods**

Evaluating the course content and the process of implementation is an opportunity for further improvement and reforming. Evaluation includes evaluation of the program as well as students' assessment.

#### **6.1. Evaluation approaches**

Evaluation of any program is variable and has a direct relationship to the intended learning outcomes (ILOs) of the course. It takes various forms, may be either formative or summative, or even both as conducted in WHO patient safety curriculum guide. In the latter, each school selects the patient safety topics in the Curriculum Guide and has the flexibility to do that with plans on how to incorporate these topics in their existing curricula. Then, formative evaluation is conducted where assess the medical schools' different experiences in using the WHO curriculum guide. The aim of this evaluation was to provide feedback to WHO stakeholders and concerned bodies regarding capacity building, implementation, with suggestions for improvement. This also will help other schools who want to use this guide in the future. On the other hand, in summative evaluation, the scope was to the evaluation of the effectiveness of the curriculum guide to develop patient safety curriculum. Retrospective data emerged form conducted interview while prospective data excluded from pre-and-post surveys of students receiving the courses [4].

Overall, the main aim of the conducted evaluative studies of the Patient Safety Curriculum Guide is to assess its effectiveness for teaching patient safety to both undergraduate and graduate medical students [3]. The results of these evaluative studies will guide others when planning for their curriculum guides and promotes in depth background of successful methods used in introducing patient safety to curricula [10].

#### **6.2. Evaluation steps**

Evaluation of the designed course is a necessity. Evaluation involves three main steps, developing an evaluation plan; collecting and analyzing information; disseminating the findings to appropriate stakeholders action [3].

#### *6.2.1. Step 1: the evaluation plan*

In the evaluation plan, it is the framework for the process. So, you should first identify what's to be evaluated, who are your stakeholders, the purpose of the evaluation which is closely related to the evaluation questions.

Identification of users of these evaluations is an important step in the evaluation plan. Participants in patient safety courses have sake to provide their own views and participate in the assessment process concerning their own performance and the designed curriculum. These evaluations can provide feedback and be a source of motivation for continuous improvement for learners, faculty, and curriculum developers. An Example for this was the evaluation study of the WHO patient safety curriculum guide, its main aim was assessing the effectiveness of using the guide in teaching patient safety for postgraduate and graduate medical students. Concerning the feedback from this evaluation, it was utilized to guide through future versions of the Curriculum Guide and enhance the understanding of the successful methods of introducing patient safety to curricula [21].

The evaluation results should be publicized as this would be interesting to educators from other institutions that are willing to introduce patient safety principles in their curricula.

After identifying users, we should identify uses of the evaluation, which are generic and specific ones. The generic uses refer to whether the evaluation is used to appraise the performance of individuals, the performance of the entire program, or both. The assessment of learners is closely related to whether they have achieved the cognitive, affective, or psychomotor or competency objectives of a curriculum or not. Meanwhile, it refers to whether an evaluation is used for formative purposes, for summative ones or for both purposes as discussed before. One more thing that should be considered is the specific needs of different users (stakeholders) and the specific ways in which they will put the evaluation to use [21]. Specific uses for evaluation results might include the following: feedback on individual learners' performance to assign grades or detect mastery in certain skills. Feedback on and improvement of program performance is also included in specific uses as the evaluation results could be used to identify parts of the curriculum that are effective and parts that are in need of improvement. Evaluation results may also provide suggestions about how parts of the curriculum could be improved [21].

Identifying resources that will be used, followed by choosing measurement methods, and constructing instruments were also included in evaluation plan.

#### *6.2.2. Step 2: collecting and analyzing data*

tutors, are essential. The local support for implementation is also required for allocating more time and resources. They also recommended full integration of the curriculum in the undergraduate years [19]. Cost issues are limited to the time of the teachers and the students when the materials are available and the curriculum topics are provided as in the WHO guide [20].

Evaluating the course content and the process of implementation is an opportunity for further improvement and reforming. Evaluation includes evaluation of the program as well as

Evaluation of any program is variable and has a direct relationship to the intended learning outcomes (ILOs) of the course. It takes various forms, may be either formative or summative, or even both as conducted in WHO patient safety curriculum guide. In the latter, each school selects the patient safety topics in the Curriculum Guide and has the flexibility to do that with plans on how to incorporate these topics in their existing curricula. Then, formative evaluation is conducted where assess the medical schools' different experiences in using the WHO curriculum guide. The aim of this evaluation was to provide feedback to WHO stakeholders and concerned bodies regarding capacity building, implementation, with suggestions for improvement. This also will help other schools who want to use this guide in the future. On the other hand, in summative evaluation, the scope was to the evaluation of the effectiveness of the curriculum guide to develop patient safety curriculum. Retrospective data emerged form conducted interview while prospective data excluded from pre-and-post surveys of

Overall, the main aim of the conducted evaluative studies of the Patient Safety Curriculum Guide is to assess its effectiveness for teaching patient safety to both undergraduate and graduate medical students [3]. The results of these evaluative studies will guide others when planning for their curriculum guides and promotes in depth background of successful meth-

Evaluation of the designed course is a necessity. Evaluation involves three main steps, developing an evaluation plan; collecting and analyzing information; disseminating the findings to

In the evaluation plan, it is the framework for the process. So, you should first identify what's to be evaluated, who are your stakeholders, the purpose of the evaluation which is closely

**6. Evaluation and student assessment methods**

students' assessment.

98 Vignettes in Patient Safety - Volume 3

**6.1. Evaluation approaches**

students receiving the courses [4].

appropriate stakeholders action [3].

related to the evaluation questions.

*6.2.1. Step 1: the evaluation plan*

**6.2. Evaluation steps**

ods used in introducing patient safety to curricula [10].

Data collection methods that were used to evaluate the patient safety curriculum guide ranged from simple methods as getting students' perception about the course after receiving a patient safety teaching, and complex methods such as having faculty to review the conducted whole curriculum. These complex methods involve a varieties of tools such as surveys, interviews, and focus group with students, faculty or administration, observation and other methods. Reported data collection tools by previous studies either were face to face or telephone interviews with key stakeholders: teaching staff, and executives at the involved medical schools. Students' surveys regarding patient safety topics were collected before and after teaching patient safety curricula. The two methods were used to get different data. The pre-teaching ones to get information about students' perceptions and attitude towards patient safety and to test their knowledge of patient safety facts and actions. Meanwhile, the post teaching collected data measures two domains the effectiveness of the topics and the effectiveness of teaching; through measuring the change of students' perception, knowledge and attitude towards patient safety taught topics after completing the course [4].

In either case, there are three interconnected elements to consider in terms of data analysis [23]:

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• Data reduction; which means simplifying and in other words transforming the raw infor-

• Conclusion drawing; which is closely related to constructing meaning from the data, with

So, by this time, we have developed our evaluation plan, collected our data and analyzed their

This is a crucial step that should not be overlooked. In some cases the conclusions and recommendations of evaluations are not acted upon, and as a consequence this will lead that the reached valuable information is not feed-backed in a meaningful way to all relevant stakeholders. In some instances, the results of evaluation are concerned with the quality of patient safety teaching, so these results (e.g. from student questionnaires, peer observed teaching sessions) must be relayed to and discussed not only with administration, but also with the teachers. The key here in education is to provide an effective constructive feedback. Brinko provided an excellent review of best practice on the process of giving feedback for students or colleagues. It is important that any feedback is received in a way that encourages growth or improvement of learners. Meanwhile, If the evaluation focuses on the effectiveness of the patient safety curriculum, any conclusions and recommendations for improvement must be communicated to all who had a share in implementing the curriculum (e.g. at faculty, teacher

The dissemination step may be in the form of reports or concerned bodies meetings and its format must be meaningful and relevant. Effective communication of evaluation outcomes, findings and recommendations is a key catalyst for improvements in patient safety teaching

One of the reported evaluation models was evaluation of patient safety initiative using the CIPP which stands for (Context, Input, Process, and Product) model. The framework emphasizes multiple stakeholders' interests (e.g. patients, providers, researchers). In this context, many methods fundamental to formative evaluations were used, including use of logic models to frame the evaluation, use of interview and focus group techniques to collect data, triangulation of results from multiple stakeholders, and feedback about the findings to help

In CIPP framework, evaluation emphasizes on documenting what happens in a program including the contextual factors that influenced what occurred. The evaluation shifts its focus according to changes occurring in the program over time, and its intention is to influence

results. Here comes the stage of disseminating these results to the relevant bodies.

• Data display; which refers to organizing information collected in a meaningful way;

mation into a more workable or usable form;

*6.2.3. Step 3: disseminating findings and taking action*

respect to the evaluation question(s).

and student levels).

and curriculum design [24].

**6.3. Used evaluation models**

to strengthen the program.

Concerning the timing of data collection, it is better to start as early as possible. It is better to start form the first week of teaching and end within three weeks up to two months after completion of the course. This depends on the availability of faculty staff and executives to complete the interviews and focus groups [4].

The survey questions were grouped in four domains as reported in many studies: patient safety knowledge; Healthcare system safety; Personal influence over safety; Personal attitude about safety. The WHO staff has developed questions of patient safety knowledge those were reviewed by the developers of the patient safety curriculum guide [3].

The contents of the interview and students' surveys were developed to collect data for answering four research questions defined for evaluation. These questions proposed for WHO curriculum evaluation guide as follow:


One of the reported data collection tools is reflection. Self-reflection has an important role in evaluation and represented a chief activity for a medical or clinical educator. For a reflection to be effective, it may include: experience of teaching or feedback received from others; description of how you felt as a learner and whether you were surprised by those feelings; re-evaluating your experience. Self-reflection will enhance the development of new perspectives in terms of improving the teaching or learning of patient safety approaches and procedures [4].

It is worth mentioning that some studies used a mixed method triangulation design to evaluate their patient safety course. A Course Evaluation Questionnaire (CEQ) completed by participants to assess the overall perceptions and effects of the course and data from incident report cards were used as quantitative measures. Focus groups with participants of the course were used as qualitative tools to get in depth information of the course effect.

During the focus groups, students were asked questions related to their experience with the course, what they believed they had learnt from it, whether they had experienced situations in which patient safety was compromised, if they felt more capable to act safely in their daily practice, and how this feeling was influenced by their environment [10, 22].

Data analysis: data collection may be using any of the previously mentioned tools, may also involve others. They may be just quantitative, qualitative or a combination of both as the case in mixed methods approach.

In either case, there are three interconnected elements to consider in terms of data analysis [23]:


So, by this time, we have developed our evaluation plan, collected our data and analyzed their results. Here comes the stage of disseminating these results to the relevant bodies.

#### *6.2.3. Step 3: disseminating findings and taking action*

teaching; through measuring the change of students' perception, knowledge and attitude

Concerning the timing of data collection, it is better to start as early as possible. It is better to start form the first week of teaching and end within three weeks up to two months after completion of the course. This depends on the availability of faculty staff and executives to

The survey questions were grouped in four domains as reported in many studies: patient safety knowledge; Healthcare system safety; Personal influence over safety; Personal attitude about safety. The WHO staff has developed questions of patient safety knowledge those were

The contents of the interview and students' surveys were developed to collect data for answering four research questions defined for evaluation. These questions proposed for WHO cur-

**1.** Does the curriculum guide contains the necessary as well as sufficient information and topics to allow its effective use in undergraduate training of healthcare professionals? **2.** What is the impact upon students' learning of the inclusion of patient safety teaching in

**3.** In what ways can this curriculum guide be used to support the widespread implementa-

**4.** How could the curriculum guide be modified in the future to best support teaching of

One of the reported data collection tools is reflection. Self-reflection has an important role in evaluation and represented a chief activity for a medical or clinical educator. For a reflection to be effective, it may include: experience of teaching or feedback received from others; description of how you felt as a learner and whether you were surprised by those feelings; re-evaluating your experience. Self-reflection will enhance the development of new perspectives in terms of

It is worth mentioning that some studies used a mixed method triangulation design to evaluate their patient safety course. A Course Evaluation Questionnaire (CEQ) completed by participants to assess the overall perceptions and effects of the course and data from incident report cards were used as quantitative measures. Focus groups with participants of the course

During the focus groups, students were asked questions related to their experience with the course, what they believed they had learnt from it, whether they had experienced situations in which patient safety was compromised, if they felt more capable to act safely in their daily

Data analysis: data collection may be using any of the previously mentioned tools, may also involve others. They may be just quantitative, qualitative or a combination of both as the case

improving the teaching or learning of patient safety approaches and procedures [4].

were used as qualitative tools to get in depth information of the course effect.

practice, and how this feeling was influenced by their environment [10, 22].

towards patient safety taught topics after completing the course [4].

reviewed by the developers of the patient safety curriculum guide [3].

complete the interviews and focus groups [4].

tion of explicit patient safety education globally?

patient safety to students in different environments? [3]

riculum evaluation guide as follow:

the curriculum?

100 Vignettes in Patient Safety - Volume 3

in mixed methods approach.

This is a crucial step that should not be overlooked. In some cases the conclusions and recommendations of evaluations are not acted upon, and as a consequence this will lead that the reached valuable information is not feed-backed in a meaningful way to all relevant stakeholders. In some instances, the results of evaluation are concerned with the quality of patient safety teaching, so these results (e.g. from student questionnaires, peer observed teaching sessions) must be relayed to and discussed not only with administration, but also with the teachers. The key here in education is to provide an effective constructive feedback. Brinko provided an excellent review of best practice on the process of giving feedback for students or colleagues. It is important that any feedback is received in a way that encourages growth or improvement of learners. Meanwhile, If the evaluation focuses on the effectiveness of the patient safety curriculum, any conclusions and recommendations for improvement must be communicated to all who had a share in implementing the curriculum (e.g. at faculty, teacher and student levels).

The dissemination step may be in the form of reports or concerned bodies meetings and its format must be meaningful and relevant. Effective communication of evaluation outcomes, findings and recommendations is a key catalyst for improvements in patient safety teaching and curriculum design [24].

#### **6.3. Used evaluation models**

One of the reported evaluation models was evaluation of patient safety initiative using the CIPP which stands for (Context, Input, Process, and Product) model. The framework emphasizes multiple stakeholders' interests (e.g. patients, providers, researchers). In this context, many methods fundamental to formative evaluations were used, including use of logic models to frame the evaluation, use of interview and focus group techniques to collect data, triangulation of results from multiple stakeholders, and feedback about the findings to help to strengthen the program.

In CIPP framework, evaluation emphasizes on documenting what happens in a program including the contextual factors that influenced what occurred. The evaluation shifts its focus according to changes occurring in the program over time, and its intention is to influence

**Figure 1.** Diagram of the steps of the curriculum guide evaluation.

these changes. In this model, evaluation takes several steps, in the first evaluation year, the context and input aspects of the CIPP model are the main focus as well as early experiences in implementing the initiative. The context and input portions of the evaluation were used to examine the strategic aspects of the initiative, which are the circumstances leading to the development of the patient safety initiative (context) and, the strategies followed to carry out the initiative (input). Thereafter, in later evaluation years, the focus is directed towards the process evaluation addressing the operational aspects of carrying out the activities involved, taking into consideration how these activities contributed or may be contributing to the main goal of improving patient safety curricula. Meanwhile, there is a regular update on the information on context and input to assess how changes in the strategic aspects of the initiative had effect. Finally, the last step is the product evaluation, this is performed by measuring the effects of the patient safety initiative on various stakeholder groups [25].

The topics are selected according to the recourses available and it is better integrated into the whole undergraduate curriculum. The objectives are well-defined, competency-based and directly related to the selected content. The instruction should be practice-based and studentcentered. Following this systematic approach maximize the role of the evaluation of students and curriculum in judging the merits of the implemented curriculum. These steps are illus-

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In brief, patient safety is now of international interest and healthcare providers need to learn its principles. Meanwhile, educational strategies involve learning by doing and reflections are essential to bridge the gap between theory and practice. Therefore, patient safety curriculum should be integrated with all levels and years of education. It should be also multidisciplinary and multi-professional. Students should be involved in the health services and have the opportunity to apply the learnt knowledge and performance and reflect on their practices. The outcomes and impact of the implemented curriculum should be continuously evaluated to ensure that skills of the health professionals regarding keeping a safe environment, for both them and the patients, are acquired and such skills are recognized as other clinical and professional skills. All this will increase the effectiveness of health care system and decrease

trated in the conceptual framework (**Figure 2**).

**Figure 2.** The conceptual framework for patient safety curriculum development.

**8. Conclusion**

The steps of the evaluation process for WHO curriculum guide are summarized in the below diagram. Three steps of evaluation are represented: first, evaluation plan which is followed by the second step which is collecting and analyzing data, then the third step of disseminating findings and taking actions (**Figure 1**).
