Background: Patient safety education is an increasingly important component of the medical school curricula. Aims: This study reports on the development of a valid and reliable patient safety attitude measure targeted at medical students, which could be used to compare the effectiveness of different forms of patient safety education delivery. Methods: The Attitudes to Patient Safety Questionnaire (APSQ) was developed as a 45-item measure of attitudes towards five patient safety themes. In Study 1, factor analysis conducted on the responses of 420 medical students and tutors, revealed nine interpretable factors. The revised 37-item APSQ-II was then administered to 301 students and their tutors at two further medical schools. Results: Good stability of factor structure was revealed with reliability coefficients ranging from 0.64 to 0.82 for the nine factors. The questionnaire also demonstrated good criterion validity, being able to distinguish between tutors and students across a range of domains. Conclusions: This article reports on the first attempt to develop a valid and reliable measure of patient safety attitudes which can distinguish responses between different groups. The predictive validity of the measure is yet to be assessed. The APSQ could be used to measure patient safety attitudes in other healthcare contexts in addition to evaluating changes in undergraduate curricula.

Objectives. The primary aim of this article was to identify the latent failures that are perceived to underpin medication errors. Study Setting. The study was conducted within three medical wards in a hospital in the United Kingdom. Study Design. The study employed a cross-sectional qualitative design. Data Collection Methods. Interviews were conducted with 12 nurses and eight managers. Interviews were transcribed and subject to thematic content analysis. A two-step inter-rater comparison tested the reliability of the themes. Principal Findings. Ten latent failures were identified based on the analysis of the interviews. These were ward climate, local working environment, workload, human resources, team communication, routine procedures, bed management, written policies and procedures, supervision and leadership, and training. The discussion focuses on ward climate, the most prevalent theme, which is conceptualized here as interacting with failures in the nine other organizational structures and processes. Conclusions. This study is the first of its kind to identify the latent failures perceived to underpin medication errors in a systematic way. The findings can be used as a platform for researchers to test the impact of organization-level patient safety interventions and to design proactive error management tools and incident reporting systems in hospitals. Key Words. Psychology, latent failures, medication errors, patient safety, ward climateSince the early 1990s high-risk organizations have adopted a "systems" approach to safety management (Reason 1995). This approach recognizes that errors are made by people at the front line of operations (in the case of medication administration, this is most likely to be a nurse). The systems approach is

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