Summary
- Kaiser Permanente School of Medicine shows what it looks like to integrate the Certified Professional in Patient Safety (CPPS)™ into undergraduate medical education in a way that is practical, challenging, and closely connected to clinical work.
From its founding, Kaiser Permanente Bernard J. Tyson School of Medicine® set out to train physicians who understand not only clinical medicine, but also how health care systems work and how they can be improved. Patient safety has been central to that vision.
In 2023, the medical school launched a Patient Safety Selective for third- and fourth-year medical students. The course, called “First, Do No Harm: Physician Leadership in Safety,” is anchored in the Certified Professional in Patient Safety (CPPS)TM review course curriculum. The four-week elective course is optional, but interest has grown steadily. Enrollment increased from seven students in its first year to 20 students in 2025.
Faculty say the growth reflects students’ desire for structured, practical preparation to understand and improve safety in real clinical environments.
Designing Safety Education from the Start
Michael Kanter, MD, CPPS, a founding faculty member at the medical school and early champion of the effort, has long believed that patient safety and quality improvement should be introduced earlier in medical training.
“When you create a new medical school, you get to ask, ‘How should we teach doctors differently?’” Dr. Kanter said. “Safety felt like an essential place to start.”
Dr. Kanter earned his own CPPS credential in 2013 and began exploring whether it could be adapted for medical students. Conversations with the certification team at IHI helped clarify that clinical experience gained during medical school could meet eligibility requirements.
As the idea took shape, the school’s faculty evaluated existing examples of patient safety education in medical schools. In particular, the team drew inspiration from the longstanding work at UNT Health’s Texas College of Osteopathic Medicine (TCOM), which has integrated CPPS into its curriculum and demonstrated the value of introducing patient safety concepts early in medical training. Faculty members described TCOM’s approach as both practical and influential in shaping how they structured their own elective.
Craig Robbins, MD, MPH, CPPS, who serves as course director and splits his time between clinical work, The Permanente Federation, and the medical school’s Department of Health Systems Science, helped translate the content into a structured course. “What we hear consistently from students is that this is where they really get to dive deep and see how patient safety works in the real world,” Dr. Robbins said.
Like at TCOM, the course builds on foundational health systems science taught in the first two years of medical school and gives students dedicated time to focus on patient safety in depth.
Training for System Health Care Needs
Scott Young, MD, senior medical director for Quality and Safety at The Permanente Federation and co-lead instructor, brings experience from both health care and aviation, including service as a naval officer in aerospace medicine.
“Aviation educates people about safety from day one,” Dr. Young said. “Health care has not traditionally done that.”
Dr. Young and faculty were clear from the start that the course needed to go beyond teaching safety concepts in the abstract. Students are expected to practice the tools, language, and decision-making skills they will need to function in highly reliable systems.
Faculty acknowledge that this training helps students anticipate what they may or may not encounter in current clinical practice, particularly when it comes to event analysis, psychological safety, and speaking up across hierarchies. The intent is to prepare students for the health care system of the future, and to be leaders of necessary change.
“We are skating to where the puck needs to be,” Dr. Young said. “If we built the course only for the current state of health care, it would be much less aspirational.”
Learning Through Mentorship and Practice
A defining feature of the elective is its mentorship model. Students are paired with practicing physicians who lead safety and quality work across Kaiser Permanente’s integrated system.
Jason Cheng, DO, CPHFH, medical director for Safety at The Permanente Federation and co-lead instructor, describes the relationships as intentionally bidirectional.
“Students learn how safety work actually happens,” Dr. Cheng said. “At the same time, mentors find real meaning in supporting a new generation that is engaged in this work.”
Students complete a team-based project analyzing a real, de-identified safety event using an analytic approach such as root cause analysis or failure mode and effects analysis. They present their findings and recommendations at the end of the course.
“Some of their analyses align well with what we see in-house,” Dr. Young reflected. “These are complex problems, and they rise to the occasion.”
The Accreditation Council for Graduate Medical Education’s Clinical Learning Environment Review Program (CLER) has identified event analysis as a common weakness in residency training. Students at the medical school are now entering clinical environments with skills that many residents and practicing physicians have not yet learned.
What Students Are Saying
What has surprised faculty most is how quickly students have become advocates for the course. Early participants expressed that they wished they had encountered this material sooner in their training and are able to notice gaps and opportunities across the clinical learning environment.
“They acknowledge the unique knowledge and skills they are exposed to that the vast majority of their respected predecessors, even from the most prestigious institutions, did not have the benefit of receiving,” Dr. Cheng shared.
Looking Ahead
The school’s Patient Safety Selective shows what it looks like to integrate CPPS into undergraduate medical education in a way that is practical, challenging, and closely connected to clinical work. It builds on efforts already underway at other institutions and adds another example of how patient safety education can be embedded early in training.
For the faculty, the work feels ongoing and inspiring.
“It would be wonderful to have a community of medical educators helping each other do this,” Dr. Kanter said.
That community is already forming in the work of IHI’s certification team, and will continue to evolve as more educators and institutions bring their own approaches to incorporating patient safety into medical education. For more information about integrating any of IHI’s certifications into academic programs, please visit ihi.org/certifications.
Patricia McGaffigan, MS, RN, CPPS, is the IHI Senior Advisor for Safety and President, Certification Board for Professionals in Patient Safety.
Sarah Blossom, ICE-CCP, is the Director of Certification at IHI.
Photo by iStock