Exploring students’ perceptions and experiences of raising concerns during pre-registration training in England: A Systematic Review.

Aim: To explore the perceptions and experiences of students raising concerns during pre-registration health and/or social care training in England.

Design: Systematic review.

Data Sources: MEDLINE, CINAHL, ERIC, PsycINFO and Education Research Complete were systematically searched for studies published between September 2015 and August 2024. Grey literature searches were conducted using Google Scholar and ETHOS British Library. Reference lists from included studies were hand searched.

Methods: Joanna Briggs Institute methodological guidance for the conduct of systematic review informed conduct and the convergent integrated approach. Mixed methods appraisal tool was used for quality appraisal.

Findings: Eleven studies were included. Synthesis of findings generated three themes: 1) Conflicting needs of self and others, 2) Navigating the professional workspace, 3) “Choice to voice”.

Conclusion: Speaking up and raising concerns as a pre-registration student is a complex, multi-faceted and non-linear social phenomenon. Experiences and perceptions are impacted by the novice student position alongside individual, interpersonal, and organisational factors. Open cultures within teams and organisations, leadership, support and feedback may enable students overcome barriers to raising concerns.

Impact: Raising concerns may reduce avoidable harm. Pre-registration students offer a “fresh pair of eyes”, however, they face barriers related to their student position. Synthesis of speaking-up experiences and perceptions of students in English settings can inform the design of learning environments which equip pre-registration students with the knowledge and skills required to cultivate safety behaviours. These skills contribute positively to safety culture and support learning and improvement in complex systems such as health and social care.
Reporting Method: The review followed PRISMA reporting guidelines.

Patient or Public Contribution: The conceptualisation of this project was informed by engagement events with higher education staff, students, and Freedom to Speak Up Guardians.

Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.