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Postgrad Med J. 2017 Nov 9. pii: postgradmedj-2016-134559. doi: 10.1136/postgradmedj-2016-134559. [Epub ahead of print]

Surgical safety checklist training: a national study of undergraduate medical and nursing student teaching, understanding and influencing factors.

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Department of ophthalmology, Western Eye Hospital, London, UK.
Department of anaesthetics and intensive care, Kingston Hospital, London, UK.
Department of Clinical Surgery, University of Edinburgh, Edinburgh, UK.
Clinical advisor, Lifebox Foundation, London, UK.
Department of surgery, Royal Free Hospital NHS Trust, London, UK.



Use of the WHO surgical safety checklist is consistently recognised to reduce harm caused by human error during the perioperative period. Inconsistent engagement is considered to contribute to persistence of surgical Never Events in the National Health Service. Most medical and nursing graduates will join teams responsible for the perioperative care of patients, therefore appropriate undergraduate surgical safety training is needed.


To investigate UK medical and nursing undergraduate experience of the surgical safety checklist training.


An eight-item electronic questionnaire was distributed electronically to 32 medical schools and 72 nursing schools. Analysis was conducted for the two cohorts, and responses from final year students were included.


87/224 (38.8%) of medical students received teaching on the surgical safety checklist, compared with 380/711 (52.0%) of nursing students. 172/224 (76.8%) of medical students and 489/711 (66.9%) of nursing students understood its purpose and 8/224 (3.6%) medical students and 54/711 (7.4%) nursing students reported never being included in the Time Out. After adjusting for confounding factors, provision of formal teaching in checklist use increased understanding significantly (OR 50.39 (14.07 to 325.79, P<0.001)), as did routine student involvement in time outs (OR 5.72 (2.36 to 14.58, P<0.001)).


Knowledge of perioperative patient safety systems and the ability to participate in safety protocols are important skills that should be formally taught at the undergraduate level. Results of this study show that UK undergraduate surgical safety checklist training does not meet the minimum standards set by the WHO.


checklist; medical education; nursing education; patient safety; surgery

Conflict of interest statement

Competing interests: JEFF is Honorary Clinical Advisor the Lifebox Foundation (, an international charity working to make surgery safer in low- and middle-income countries. CLSKf has previously undertaken unpaid design work for the Lifebox Foundation.

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