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Teaching patient safety in global health: lessons from the Duke Global Health Patient Safety Fellowship
  1. Bria E Johnston1,
  2. Randall Lou-Meda2,
  3. Sindy Mendez2,
  4. Karen Frush3,
  5. Judy Milne4,
  6. Tamara Fitzgerald5,
  7. J Bryan Sexton6,
  8. Henry Rice1
  1. 1 Surgery and Global Health, Duke University Medical Center, Durham, North Carolina, USA
  2. 2 Pediatric Nephrology Unit, Hospital Roosevelt de Guatemala, Guatemala, Guatemala
  3. 3 Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
  4. 4 Patient Safety Office, Duke University Medical Center, Durham, North Carolina, USA
  5. 5 Pediatric Surgery, Duke University Hospital, Durham, North Carolina, USA
  6. 6 Patient Safety Center, Duke University Medical Center, Durham, North Carolina, USA
  1. Correspondence to Dr Henry Rice; henry.rice{at}


Health systems in low-income and middle-income countries (LMICs) have a high burden of medical errors and complications, and the training of local experts in patient safety is critical to improve the quality of global healthcare. This analysis explores our experience with the Duke Global Health Patient Safety Fellowship, which is designed to train clinicians from LMICs in patient safety, quality improvement and infection control. This intensive fellowship of 3–4 weeks includes (1) didactic training in patient safety and quality improvement, (2) experiential training in patient safety operations, and (3) mentorship of fellows in their home institution as they lead local safety programmes. We have learnt several lessons from this programme, including the need to contextualise training to local needs and resources, and to focus training on building interdisciplinary patient safety teams. Implementation challenges include a lack of resources and data collection systems, and limited recognition of the role of safety in global health contexts. This report can serve as an operational guide for intensive training in patient safety that is contextualised to global health challenges.

  • health systems
  • health education and promotion

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  • Handling editor Soumitra Bhuyan

  • Contributors BEJ: study design, data collection, data analysis, data interpretation, manuscript writing, manuscript revision. RL-M: study design, data interpretation, manuscript revision. SM: data collection, manuscript writing, manuscript revision. KF: data analysis, manuscript revision. JM: study design, manuscript revision. TF: study design, manuscript revision. JBS: study design, manuscript revision. HR: study design, data collection, data analysis, manuscript revision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval According to the policy activities that constitute research at Duke University this work met criteria for operational improvement activities, and was considered exempt from review by the Duke University Medical CenterCentre Institutional Review Board (Pro00076984).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No primary data were used in the development of the paper.

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