1. Knowledge	Consideration of appropriate sequence of learning	5	“Students may find it easier to develop recurrence prevention strategies after first learning basic preventive measures.”
	Variation in prior knowledge	1	“It’s unclear how well students can analyse and plan countermeasures for the cases.”
2.  Attitude	Unfamiliarity with group learning	5	“My students lack experience with peer assessment, raising concerns aboutfree-riding and cheating.”
	Variation in learner readiness	2	“I’m unsure whether learners are ready to perform root cause analysis onreal-world issues.”
3. Student	Concerns about psychological safety	2	“Students may hesitate to disclose their own mistakes.” “It may be necessary to practise pair work with guidance to avoid blaming oneanother for failures.”
4. Teacher	Insufficient competence in patient safety education	15	“Instructors themselves must be familiar with these methods.” “Educators are unfamiliar with syllabus development.”
	Disconnection between daily duties and academic insight	10	“As a patient safety expert, I struggle to see connections with everyday work.” “I perceive conflict management as separate from patient safety.”
	Context-specific adjustments	7	“I'm concerned that the progression may vary depending on faculty availability.” “It may be acceptable to deliver the lecture and the role-play in separate sessions.”
5. System	Shortage of teachers	11	“It may be difficult to secure enough facilitators.” “Securing time, space, and responsible staff for instruction is challenging.”
	Misalignment with formal assessment requirements	4	“There are too many points to assess; I question whether proper evaluation ispossible.” “If only parts of the activity are implemented, I need confirmation that it still meets the curricular grading requirements.”
	Effort management challenges	3	“Educational duties are not usually included in the job description of full-timepatient safety officers.”
	Need to engage external lecturers	2	“In universities without affiliated hospitals, it may be necessary to invite external professionals from safety offices.”
	Difficulty securing curricular slots	2	“It’s unclear whether time can be allocated within the curriculum.”

Note: No responses were classified under skills

Int J Med Educ. 2026; 17:42-60; doi: 10.5116/ijme.69f0.78c6