One of the learning objectives / instructional goals of the Ethics and Professionalism elective course on
“Patient Safety: Better Knowledge for Safer Care” introduced to Kuwait University since 2005 was to
“Enable students to make judgments about the safety of clinical practice through the use of reﬂective
thinking & writing tools to enhance their moral development as future doctors” achieving a higher
category of learning based on the Cognitive Domains of Learning (Blooms’ Taxonomy, Fig 1).
Patient Safety Education For Future Doctors:
A Reﬂective Strategy Eating Unsafe Culture Slowly and Surely
 Department of Community Medicine and Behavioural Sciences, Kuwait University Faculty of Medicine
 Department of Surgery, Kuwait University Faculty of Medicine
 Department of Quality and Accreditation, Mubarak Al-Kabeer Hospital, MOH
Fig 1: Bloom’s Taxonomy (Revised)
Can the student distinguish
between different parts?
Appraise, compare, contrast, criticize,
differentiate, discriminate, distinguish,
examine, experiment, question, test
Define, duplicate, list, memorize,
recall, repeat, state
Can the student recall or
remember the information?
Can the student explain ideas or
Can the student use information
in a new way?
Classify, describe, discuss, explain,
identify, locate, recognize, report,
select, translate, paraphrase
Choose, demonstrate, dramatize,
employ, illustrate, interpret, operate,
schedule, sketch, solve, use, write
Can the student justify a stand
Appraise, argue, defend, select,
support, value, evaluate
Can the student create a new
product or point of view?
Assemble, construct, create, design,
develop, formulate, write
1. Bloom, Benjamin (ed.). Taxonomy of Education al Objectives. Handbook I: Cognitive Domain. David McKay Company, Inc. New York: 1956.
What were the
What will I
What do these results imply?
How did I inﬂuence the
What sense can you make
of the situation?
Fig 2: Gibbs Reﬂective Cycle
What were you thinking
If it arose again, what
would you do?
What else could you have
What was good & bad
about the experience?
Fig 3: Kolb’s Learning Cycle
Adapted by Ivan Mactaggart from Mcleod,2010
“Learning is the process whereby knowledge is created through
the transformation of experience” (David A Kolb, 1984)
A one day informed consent and surgical check lists audit
at a secondary care hospital in Kuwait
Students' Reflection on Current Practice
to Avoid Tubing Misconnection: A Simple Solution,
A Difficult Compliance, A Training Opportunity
Is The Accreditation Program Enough To Ensure Patient Safety?
A Students' Reflection On A Patient Safety Required Area
Exploring students' Feelings Counts in Education:
The Use of Gibbs Reflective Cycle in Teaching Clinical Ethics
The following reﬂective tools were used in an academic context for teaching this elective course:
• Gibbs Reﬂective Cycle (Fig 2).
• The Kolb’s cycle (Fig 3).
• The Burton’s approach (Fig 4).
The use of these tools in a hospital based rotations (Fig 5a) aimed at:
Looking back at an event or having a hands-on experience.
Analyzing the event, ideas or emotions/responses related to the event (thinking in depth and from
different perspectives, trying to explain what happened, for example with reference to the WHO
Nine Patient Safety Solution (Fig 5b).
Thinking carefully about what the event or idea means for them and their on-going development as
future care providers and practicing professionals.
The outcomes of these reﬂective exercises over the years were presented at different conferences and meetings (Fig 5c). The following are some examples:
• The Gibbs Reﬂective Cycle was applied to the students’ experience of reviewing 33 unidentiﬁable medical records for the application of “Performance of Correct Procedure at
Correct Body Site” protocol in the hospital.
• The Kolb’s cycle was applied to the students’ experience of examining 152 patients for hospital adherence to the “Avoiding Catheter and Tubing Misconnections” protocol.
• The Burton’s approach of reﬂection was used during the assessment of 41masked non-identiﬁable consent forms to assess to the pre-intervention patient’s veriﬁcation protocol.
It was evident that the students in this elective course successfully developed
a new realization of the role of human factors in errors and the concept of
system failure suggesting that reﬂective education for patient safety can be
successfully used in patient safety education.
What is most important, interesting, useful,
relevant about the object event or idea?
What have I learned from this?
What does this mean for my future?
We would like to acknowledge the assistance provided by Dr. Susan Jacob;
Department of Community Medicine and Behavioural Sciences, and Quality
Nurses of Mubarak Al-Kabeer Hospital: Abeer G. Dossokey, Amal T. Mohamed,
Asila A. Alrasheedi, Lea Martinez & Rinto Francis.
Fig 4: The Burton’s approach
Fig 5a: The Hospital Based Rotations
(LASA) Medication Names
Single Use of Injection
Performance of Correct
Procedure at Correct
Improved Hand Hygiene to Prevent
Accuracy at Transitions
Avoiding Catheter and
Control of concentrated
Fig 5c: Poster Abstracts