Assessment of an educational intervention for embryologists to reduce gamete and embryo misidentification in in vitro fertilization laboratories

Interventions to Reduce IVF lab errors

Article information

Korean J Fertil Steril. 2026;.cerm.2026.09642

Publication date (electronic) : 2026 July 7

doi : https://doi.org/10.5653/cerm.2026.09642

Eun Ha Kim ¹^,^*

, Eun Kyung Kim ¹^,^*

, Hye Won Youm ¹, Jung Jae Ko ¹, Kyung-Ah Lee^,²^,³

¹CHA Fertility Program Management Office, Seongnam, Republic of Korea

²Advanced Research Division of Reproductive Medicine, CHA University Global IVF Group, Seongnam, Republic of Korea

³Department of Biomedical Science, College of Life Sciences, CHA University, Pocheon, Republic of Korea

Corresponding author: Kyung-Ah Lee Advanced Research Division of Reproductive Medicine, CHA University Global IVF Group, 335 Pangyo-ro, Bundang-gu, Seongnam 13488, Republic of Korea Tel: +82-31-881-7415 Fax: +82-31-881-7958 E-mail: leeka@cha.ac.kr

*These authors contributed equally to this study.

Received 2026 May 7; Revised 2026 May 22; Accepted 2026 May 23.

Abstract

Objective

This study evaluated the effectiveness of a standardized Simultaneous, Aloud, inFormation, Electronic witnessing, Monitoring, One by one, and DocumEnt (SAFE MODE)-based training program in improving embryologists’ patient safety awareness and procedural performance, aiming to reduce the risk of gamete and embryo misidentification.

Methods

This multicenter, cross-sectional pre–post survey study was conducted across six in vitro fertilization (IVF) centers within the CHA University Global IVF Group in South Korea. Ninety-nine embryologists provided valid responses, and 53.5% had less than 1 year of experience. Participants completed a 14-session online training program (40 min/session) based on the SAFE MODE framework: simultaneous checking, calling aloud together, information double-checking, electronic witnessing, visual monitoring together, one-by-one handling, and document cross-checking. A 17-item, 5-point Likert scale questionnaire was used to assess safety awareness and procedural performance. Analyses included paired and independent t-tests, Pearson correlation analysis, and multiple regression analysis (SPSS ver. 25.0).

Results

Safety awareness scores increased significantly from 3.65 to 3.97 (p<0.05); procedural performance scores increased from 3.82 to 4.17 (p<0.01). Embryologists with less than 1 year of experience showed the greatest improvement, with scores increasing from 3.43 to 4.00 (p<0.05). Completion of all 14 sessions was associated with higher performance scores than mid-term training completion (4.17 vs. 3.85, p<0.01). Post-training safety awareness was positively correlated with post-training performance (r=0.215, p<0.05).

Conclusion

SAFE MODE-based training was associated with significant improvements in safety awareness and procedural performance, particularly among embryologists with less than 1 year of experience. This approach may offer a practical strategy for reducing laboratory error risk and strengthening patient safety in IVF.

Keywords: Embryologist training; Gamete and embryo misidentification; In vitro fertilization laboratory; Patient safety; SAFE MODE (7-CHA Guidelines)

Introduction

Assisted reproductive technology (ART), particularly in vitro fertilization (IVF), depends on the precision of embryologists. Human errors, including gamete or embryo misidentification, can have serious emotional, legal, ethical, and reputational consequences [1-3]. Although stringent protocols and technological interventions, such as double witnessing, radio-frequency identification tagging, and electronic witnessing systems, have been implemented [4-6], near-miss incidents continue to occur because of factors such as stress and communication failures [7,8]. International standards, including International Organization for Standardization (ISO) 15189 and International Federation of Fertility Societies guidelines, emphasize robust patient identification and chain-of-custody protocols; however, embryologist training remains inconsistent worldwide [9].

A European Society of Human Reproduction and Embryology (ESHRE) survey reported that fewer than half of European countries offer formal licensing or structured training for embryologists, resulting in variable laboratory safety standards [9]. Although standardized education is important for error prevention and for fostering a strong safety culture, evidence regarding the effect of such training on embryologists’ safety awareness remains limited [10].

To address this gap, the CHA University Global IVF Group in the Republic of Korea developed the IVF Laboratory Patient and Sample Identity Verification Training Program, a structured curriculum based on the Simultaneous, Aloud, inFormation, Electronic witnessing, Monitoring, One by one, and DocumEnt (SAFE MODE)/7-CHA Guidelines framework. The program was designed to prevent mismatches involving oocytes, sperm, embryos, and patients by enhancing safety awareness, protocol adherence, and ethical responsibility.

This cross-sectional pre–post survey study evaluated the program’s effectiveness among embryologists with different levels of professional experience. The primary objectives were to assess the impact of SAFE MODE-based training on embryologists’ awareness of patient and sample identity verification, competence in safety protocols, and ethical responsibilities. The study also explored whether the program could support internationally harmonized safety frameworks in IVF laboratories.

Methods

1. Study design and participants

This study used a multicenter cross-sectional survey design with a pre–post educational intervention component to evaluate the effectiveness of a standardized training program for embryologists designed to prevent mismatches among patients, oocytes, sperm, and embryos. The intervention was based on the 7-CHA Guidelines for Patient and Sample Identity Verification, developed by the CHA University Global IVF Group, as summarized in Table 1 and illustrated in Figure 1.

Table 1.

SAFE MODE: 7-CHA Guidelines for patient, gamete, and embryo identification in IVF laboratories

Figure 1.

SAFE MODE: 7-CHA Guidelines. SAFE MODE is an acronym derived from the following seven guideline components: Simultaneous, Aloud, inFormation, Electronic witnessing, Monitoring, One by one, and DocumEnt.

The 7-CHA Guidelines comprise seven key verification principles: (1) simultaneous check, (2) call aloud together, (3) information double-check, (4) electronic witnessing double-check, (5) visual monitoring together, (6) one by one, and (7) document cross-check. The protocol was collectively designated SAFE MODE.

The study was conducted across six CHA University Fertility Center clinics in South Korea and included all embryologists employed between August 2021 and June 2025. Eligible embryologists were routine users of the patient and sample identity verification system and were engaged in IVF laboratory procedures. To ensure comprehensive representation of the eligible embryologist population, no exclusion criteria were applied.

This retrospective study used anonymized survey data and did not involve identifiable human participants; therefore, institutional review board approval was not required.

2. Intervention: patient and sample identity verification training program

The training program comprised 14 lectures, each lasting 40 minutes, delivered remotely via Zoom in two identical sessions to ensure full participation. The curriculum focused on (1) analysis of patient/specimen mix-up incidents and associated risk factors in IVF laboratories and (2) practical application of SAFE MODE across andrology and embryology workflows (Table 1, Figure 1).

Lectures 1–5 covered an overview of patient safety and patient safety procedures in andrology, including patient identification and sperm preparation. Lectures 6–13 addressed patient safety procedures in embryology, including oocyte retrieval, intracytoplasmic sperm injection, embryo culture, embryo transfer, biopsy, and cryopreservation (Table 2). Lecture 14 focused on documentation and record management. Recently hired embryologists underwent training after 8 weeks of employment.

Table 2.

Structure of the 14-lecture SAFE MODE training program for patient and sample identity verification in IVF laboratories

3. Survey administration

Surveys were administered at multiple time points to assess the training effect. A mid-term survey, conducted after lectures 1–5, was administered in August and December 2021 to all embryologists (n=116), of whom 61 responded. A completion survey, conducted after lectures 1–14, was administered in December 2022 to the same cohort, with 60 respondents. Additional completion surveys were administered to recently hired embryologists from January 2023 through March 2024 (n=19; 100% response rate) and from April 2024 through June 2025 (n=20; 100% response rate); all recently hired respondents had less than 1 year of experience. A total of 155 embryologists were invited to participate, yielding 99 valid responses. Respondents in the 2021–2022 surveys were stratified by experience as follows: less than 1, 1–2, 3–5, 6–9, and 10 years or more. The 2023–2025 surveys included only embryologists with less than 1 year of experience (Table 3, Figure 2).

Table 3.

Timeline of survey administration, training participation, and distribution of embryologists by professional experience

Figure 2.

Study design and participant flow across training periods, August 2021–June 2025. The 2021 cohort completed mid-term training (Lectures 1–5), whereas the 2022–2024 cohorts completed the full 14-lecture program. Overall, 155 embryologists were eligible, and 99 valid responses were analyzed.

Although all eligible embryologists were invited to participate, response collection was influenced by routine IVF laboratory schedules and clinical workloads.

4. Survey instrument

A 17-item questionnaire was developed to evaluate the effectiveness of the SAFE MODE-based training program. The instrument included items assessing (1) participant characteristics, (2) satisfaction with training logistics, (3) changes in patient safety awareness and procedural performance, based on retrospective pre–post self-assessment, (4) perceived necessity and usefulness of the training, (5) training difficulty, and (6) willingness to provide feedback. All items except the experience question and open-ended feedback items were rated on a 5-point Likert scale, with 1 indicating ‘strongly disagree,’ ‘very low,’ or ‘very little,’ and 5 indicating ‘strongly agree,’ ‘very high,’ or ‘very much.’

The full list of questions was as follows:

1) What is the duration of your work experience as an embryologist, including experience at other hospitals? Response options: less than 1, 1–2, 3–5, 6–9, and 10 years or more.
2) How satisfied are you with your current job duties?
3) Before the training, how familiar were you with each SAFE MODE procedure included in the 7-CHA Guidelines? Separate items: simultaneous check, call aloud together, information double-check, electronic witnessing double-check, visual monitoring together, one by one, and document cross-check.
4) Before the training, how would you rate your level of awareness regarding patient safety verification?
5) Before the training, how would you rate your competence in performing patient safety verification?
6) Before the training, did you consider patient safety verification important and necessary?
7) To what extent did your awareness of patient safety verification improve after the training?
8) To what extent did your competence in performing patient safety verification improve after the training?
9) After the training, do you believe that patient safety verification training is necessary?
10) Since the implementation of the patient safety verification training, do you believe that the training has helped you perform your duties more safely?
11) Did the training help you perform patient identification tasks in andrology (e.g., semen verification)?
12) Did the training help you perform patient identification tasks in embryology (e.g., oocyte identification)?
13) Are you currently performing your duties in accordance with the content of the patient safety verification training?
14) Was the training schedule (date and time) appropriate?
15) How would you rate the difficulty of the training?
16) Are you willing to provide feedback or suggestions to improve the training?
17) Would you be willing to publicly offer recommendations for improving patient safety verification procedures?

The questionnaire was administered anonymously via Google Forms. Participants retrospectively rated both their pre-training and post-training status at the time of each survey.

5. Variables

The primary outcomes were patient safety awareness and procedural performance. Secondary variables included job satisfaction, perceived training difficulty, SAFE MODE knowledge, and willingness to propose improvement plans. Higher scores indicated higher levels of the measured constructs.

6. Statistical analysis

The sample size was calculated using the standard correlation formula in G*Power 3.1 (University of Düsseldorf) [11,12].

n=Zα/2+Zβ21-r2r2

Assuming a medium effect size (r=0.30), α=0.05, and power (1−β)=0.95, a minimum of 111 embryologists was required. After accounting for a 30% non-response rate, the target sample size was set at 155 or more participating embryologists. Data were analyzed using SPSS ver. 25.0 (IBM Corp.). Descriptive statistics were used to summarize embryologist characteristics. The independent t-test was used to compare groups by experience level and survey round, and Pearson correlation analysis and multiple regression analysis were used to evaluate associations among variables and identify factors associated with the outcomes. Statistical significance was set at p<0.05. No data were missing, and all collected data were included in the analyses.

7. Bias consideration

Selection bias was minimized by inviting all embryologists from the six clinics to participate. Response bias was reduced through anonymous and voluntary survey administration. Information bias was mitigated by using a standardized questionnaire and uniform data collection procedures across all sites. However, residual bias related to retrospective self-assessment cannot be excluded.

Results

1. Characteristics of participating embryologists

Of the 155 eligible embryologists, 99 (63.9%) completed the survey. The mid-term survey was administered to 61 participants after completion of lectures 1–5. The completion survey was administered after lectures 1–14 to the same cohort, with 60 respondents. Two additional cohorts of recently hired embryologists with less than 1 year of experience were also evaluated (n=19 and n=20). Respondents were stratified by years of professional experience as follows: less than 1 year, 53 participants (53.5%); 1–2 years, eight participants (8.1%); 3–5 years, 16 participants (16.2%); 6–9 years, 11 participants (11.1%); and 10 years or more, 11 participants (11.1%) (Table 3).

2. Changes in safety awareness and performance

The paired t-test demonstrated significant post-training improvements in both safety awareness and self-reported performance, with the largest improvements observed among embryologists with less than 1 year of experience. In this subgroup, safety awareness increased from 2.88±0.64 to 4.00±0.53 at mid-term (t=4.97, p=0.002), and performance improved from 3.13±0.64 to 4.00±0.54 (t=2.97, p=0.021). Comparable improvements were observed in the 1–2- and 3–5-year experience groups (Tables 4 and 5). In contrast, senior embryologists with 6 or more years of experience showed no significant changes, most likely because their baseline scores were already high, suggesting a ceiling effect.

Table 4.

Changes in safety awareness scores before and after training by experience level

Table 5.

Changes in performance scores before and after training by experience level

3. Impact of experience level on training gains

The independent-samples t-test confirmed that pre- to post-training improvements were significantly greater among embryologists with less than 1 year of experience than among those with 1 or more years of experience. Embryologists with less than 1 year of experience showed substantial gains in safety awareness (from 2.91±0.66 to 3.28±0.82, p<0.001) and performance (from 4.04±0.62 to 4.40±0.63, p<0.001). Embryologists with 1 or more years of experience demonstrated significant improvement only in performance (from 3.93±0.80 to 4.22±0.66, p=0.036), with no significant change in safety awareness (p=0.195) (Table 6).

Table 6.

Comparison of safety awareness and performance by years of experience

4. Training phase and cohort comparison of outcomes

Participants who completed all 14 lectures (n=60) reported significantly higher post-training performance scores than those who completed only the first five lectures (n=61; 4.17±0.67 vs. 3.84±0.66, p=0.007). Participants who completed the full program also reported greater recognition of the necessity of such training (4.35±0.71 vs. 3.59±0.97, p<0.001) (Table 7).

Table 7.

Comparative analysis of safety awareness, safety performance, and training-related outcomes across training phases and years of experience

5. Correlation analysis

Pearson correlation analysis indicated significant associations among the key variables. Job satisfaction was positively correlated with perceived training difficulty (r=0.236, p<0.05), post-training performance capability (r=0.228, p<0.05), willingness to propose improvement initiatives (r=0.309, p<0.01), and SAFE MODE knowledge (r=0.220, p<0.05) (Table 8).

Table 8.

Pearson correlation coefficients for key variables

Significant positive correlations were also observed between pre- and post-training measures. Pre-training safety awareness was significantly correlated with pre-training performance capability (r=0.363, p<0.001) and post-training safety awareness (r=0.440, p<0.001). Pre-training performance capability was strongly correlated with post-training performance capability (r=0.407, p<0.001). Post-training safety awareness was positively correlated with post-training performance capability (r=0.215, p<0.05). Perceived training difficulty was also positively correlated with post-training performance capability (r=0.389, p<0.001) and SAFE MODE knowledge (r=0.368, p<0.001).

Discussion

This multicenter study provides robust evidence that a structured training program based on the SAFE MODE framework was associated with significant improvements in embryologists’ safety awareness and self-reported performance related to the prevention of patient-level mismatches involving oocytes, sperm, and embryos in ART laboratories. The greatest improvements were observed among embryologists with less than 1 year of experience, who showed substantial gains in both safety awareness and performance (Tables 4 and 5). These findings build on and extend previous reports showing that formalized training can improve procedural accuracy and risk awareness in high-stakes clinical settings [13,14].

Experience-stratified analyses highlighted differential training benefits across career stages. Embryologists with less than 1 year of experience showed marked improvements in both safety awareness and performance, most likely because they had limited prior exposure to standardized protocols (Table 6). This finding directly addresses the well-documented global variability and inconsistency in embryologist training and competency assessment, which contribute to heterogeneous safety practices across laboratories [9]. By translating abstract safety principles into practical, workflow-integrated procedures for andrology and embryology, the SAFE MODE program may help early-career embryologists mitigate the risk of catastrophic errors, such as gamete or embryo mix-ups [3]. In contrast, senior embryologists with 6 or more years of experience showed only modest gains in performance (from 3.93±0.80 to 4.22±0.66, p=0.036) and no significant change in awareness, consistent with a ceiling effect among experienced practitioners (Table 6). This finding aligns with previous IVF laboratory research suggesting that, for experienced embryologists, educational programs emphasizing sustained vigilance and adherence to standardized safety protocols may be more effective than approaches centered on foundational knowledge acquisition [15]. Accordingly, experience-stratified training programs may be warranted. To prevent complacency and overfamiliarity, embryologists with less than 5 years of experience may benefit from continuous refresher training, whereas those with 6 or more years of experience—who showed limited improvement in safety awareness—may require targeted education using real clinical mix-up cases and reinforcement of professional responsibility to promote meaningful changes in risk perception and vigilance.

Completion of the full 14-module curriculum was associated with significantly higher scores reflecting safety culture and recognition of training necessity (4.35±0.71 vs. 3.59±0.97, p<0.001) (Table 7), underscoring the program’s potential to cultivate collective accountability and stronger safety attitudes. This interpretation is further supported by the finding that perceived training difficulty was positively correlated with post-training performance capability (r=0.389, p<0.001) and SAFE MODE knowledge (r=0.368, p<0.001), suggesting that more challenging content may have been associated with greater knowledge acquisition and improved self-reported performance (Table 8). Given the profound ethical, legal, psychological, and trust-related consequences of identification errors in IVF [16], these improvements are clinically and socially important. By integrating ethical responsibilities—such as safeguarding patient trust, preventing errors, and upholding procedural integrity—into technical training, the SAFE MODE approach is consistent with ISO 15189 accreditation standards, Good Laboratory Practice principles, and evolving frameworks that position patient safety as a fundamental ethical priority in laboratory medicine [17,18].

The positive correlation between post-training safety awareness and performance capability (r=0.215, p<0.05) further suggests that changes in attitudes and perceptions may drive performance improvements, supporting a durable culture of vigilance and shared responsibility (Table 8). In addition, improved leadership skills and emotional intelligence, as emphasized in the contemporary literature [19,20], may reinforce team collaboration, reduce performance gaps across experience levels, and promote a more cohesive laboratory culture.

The multicenter design and experience-stratified analysis strengthen the applicability of these findings across diverse ART settings. Nevertheless, several limitations should be acknowledged. First, although all embryologists across the six centers were invited to participate through standardized survey procedures to minimize selection bias, the survey was voluntary and was conducted during routine IVF laboratory operations. Therefore, the response rate was limited, and response bias cannot be completely excluded. Second, the absence of direct error-rate measurement limited the ability to objectively quantify improvements in safety performance. To address these limitations, future studies should incorporate objective metrics, such as simulation-based competency assessments or longitudinal monitoring of nonconformance rates, to provide more robust evidence of error reduction [21]. Evaluating the effects of individual SAFE MODE components, such as patient identification and cryopreservation protocols, would also provide valuable insights for targeted refinement and optimization.

Future studies should evaluate the long-term effects of the SAFE MODE program on error reduction and patient outcomes through randomized controlled trials or prospective real-world surveillance systems. In addition, scalable, open-access training modules based on the SAFE MODE framework could promote wider international adoption and help reduce the global disparities in embryologist training identified by ESHRE [9]. Artificial intelligence–assisted tools could also complement human training by automating routine verification processes while maintaining essential human supervision [22].

In conclusion, SAFE MODE-based training was associated with marked improvements in safety awareness and self-reported performance in the identification of oocytes, sperm, embryos, and patients, with particularly pronounced benefits among embryologists with less than 1 year of experience. Standardized, experience-tailored training appears to be an important strategy for fostering resilient safety cultures within ART laboratories and promoting patient-centered care in reproductive medicine.

Notes

Conflict of interest

No potential conflict of interest relevant to this article was reported.

Acknowledgments

The authors gratefully acknowledge all participants and research staff for their valuable contributions to this study.

Author contributions

Conceptualization: EHK, EKK. Methodology: EHK, EKK. Formal analysis: EKK, HWY. Data curation: EHK. Project administration: KAL. Investigation: EHK. Supervision: JJK, KAL. Writing-original draft: EHK. Writing-review & editing: EKK, HWY, KAL. Approval of final manuscript: EHK, EKK, HWY, JJK, KAL.

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	Component	Description
S	Simultaneous Check	At every critical stage, at least two embryologists verify that the sample being handled belongs to the correct patient by cross-checking all relevant information, reviewing electronic records, and using the EWS.
A	Call Aloud Together	To ensure that no mix-up occurs, two embryologists read out the patient’s name, personal details, and sample information aloud. Each one checks what the other says, confirming all details verbally together.
F	InFormation Double-Check	Before the procedure starts, two embryologists carefully double-check the patient’s consent forms, personal details, and planned treatment steps. This includes reviewing any recent clinical decisions or changes made in real time.
E	Electronic Witnessing Double-Check	With the introduction of the EWS, two embryologists are required to manually double-check each other at every key electronic identification stage. This extra step applies to processes such as sperm preparation, confirming the right patient-sample match for egg retrieval and embryo transfer, moving samples between dishes, changing culture media, and matching couples/samples for IVF or intrauterine insemination.
M	Visual Monitoring Together	Whenever embryologists are examining oocytes or embryos under the microscope, a second embryologist independently verifies, in real time via a connected external monitor, the number, developmental stage, and quality of the oocytes or embryos to ensure accuracy.
O	One by One	To ensure that no confusion or mix-up between patients occurs, each workstation deals with gametes and embryos from only one patient at a time. All steps and procedures are performed one by one, in sequence.
D, E	DocumEnt Cross-Check	To ensure accuracy, two embryologists independently cross-check the manually completed worksheets against the matching entries in the electronic system.

Lecture	Title
1	Patient and sample identity verification overview
	- Ultimate objective: eliminate the risk of sample mix-ups
	- Analysis of mix-up incidents
	- Standard protocol for gamete and embryo mismatch prevention
	- Application of SAFE MODE (7-CHA Guidelines)
	- Advanced solution: E-witness system
2	Andrology reception: Semen sample identification and verification
3	Andrology: Sperm preparation for IUI
4	Andrology: Sperm cryopreservation and thawing
5	Embryology: Sperm preparation for IVF
6	Embryology: OPU
7	Embryology: Fertilization (IVF/ICSI)
8	Embryology: Fertilization assessment
9	Embryology: Embryo culture
10	Embryology: Micromanipulation techniques (ICSI & AH)
11	Embryology: Cryopreservation and thawing
12	Embryology: Embryo transfer and IUI procedures
13	Embryology: PGT biopsy & cell preparation
14	Double-witnessed data verification (OCS/EMR & manual records)

Years	Mid-term completion					Full-term completion
Years	Number	Pre	Post	t	p-value	Number	Pre	Post	t	p-value
<1	8	2.88±0.64	4.00±0.53	4.97	0.002^b)	14	3.43±0.51	4.00±0.68	2.83	0.014^a)
1–2	15	3.33±0.82	4.00±0.53	3.16	0.007^b)	8	3.25±0.46	4.00±0.53	3.00	0.020^a)
3–5	13	3.23±0.60	4.08±0.49	3.81	0.002^b)	16	3.50±0.97	3.88±0.96	1.25	0.232
6–9	8	4.13±0.64	3.75±0.71	–1.00	0.351	11	3.73±0.65	3.91±0.94	0.45	0.659
≥10	17	4.18±0.64	3.88±0.78	–1.32	0.206	11	4.36±0.67	4.09±1.04	−0.64	0.539
Overall	61	3.59±0.82	3.95±0.62	2.77	0.007^b)	60	3.65±0.78	3.97±0.84	2.15	0.036^a)

Years	Mid-term completion					Full-term completion
Years	Number	Pre	Post	t	p-value	Number	Pre	Post	t	p-value
<1	8	3.13±0.64	4.00±0.54	−2.966	0.021^a)	14	3.43±0.51	4.00±0.68	−3.309	0.006^b)
1–2	15	3.20±0.56	3.87±0.52	−3.162	0.007^b)	8	3.38±0.52	3.88±0.35	−2.646	0.033^a)
3–5	13	3.08±0.76	4.08±0.49	−3.950	0.002^b)	16	3.88±0.81	4.12±0.62	−1.074	0.300
6–9	8	4.13±0.64	3.50±0.76	1.667	0.140	11	3.91±0.83	4.18±0.75	−1.000	0.341
≥10	17	4.18±0.64	3.71±0.85	1.817	0.088	11	4.45±0.69	4.64±0.67	−0.559	0.588
Overall	61	3.56±0.81	3.85±0.66	−2.039	0.046^a)	60	3.82±0.77	4.17±0.67	−3.227	0.002^b)

Domain	Group	Number	Pre	Post	t	p-value
Awareness	<1 year	53	2.91±0.66	3.28±0.82	−4.884	<0.001^b)
	≥1 year	46	3.72±0.83	3.96±0.89	−1.316	0.195
	t(p)			−5.317 (0.000)	−3.916 (0.000)
Performance	<1 year	53	4.04±0.62	4.40±0.63	−4.413	<0.001^b)
	≥1 year	46	3.93±0.80	4.22±0.66	−2.163	0.036^a)
	t(p)			0.708 (0.481)	1.373 (0.173)

Survey type	Period	No. of participants	No. of respondents	Years of embryologist experience
Survey type	Period	No. of participants	No. of respondents	<1	1–2	3–5	6–9	≥10
Mid-term	August–December 2021	116	61	8	15	13	8	17
Full-term	December 2022	116	60	14	8	16	11	11
Full-term	January 2023– March 2024	19	19	19	NA	NA	NA	NA
Full-term	April 2024– June 2025	20	20	20	NA	NA	NA	NA
Total	-	155	99	53	8	16	11	11

Variable	Training phase				Years of embryologist experience
Variable	Mid-term (n=61)	Full-term (n=60)	t	p-value	<1 year (n=53)	≥1 year (n=46)	t	p-value
Job satisfaction	3.15±0.83	3.13±0.68	0.103	0.918	3.43±0.72	3.09±0.69	2.431	0.017^a)
Perceived training difficulty	3.82±0.62	3.92±0.67	−0.826	0.410	4.08±0.81	3.96±0.67	0.805	0.429
Pre-training safety awareness level	3.59±0.82	3.65±0.78	−0.411	0.682	2.91±0.66	3.72±0.83	−5.317	<0.001^c)
Pre-training safety performance capability	3.55±0.81	3.82±0.77	−1.846	0.067	4.04±0.62	3.94±0.80	0.708	0.481
Post-training safety awareness level	3.95±0.62	3.97±0.84	−0.118	0.906	3.28±0.82	3.96±0.89	−3.916	<0.001^c)
Post-training safety performance capability	3.84±0.66	4.17±0.67	−2.732	0.007^b)	4.40±0.63	4.22±0.66	1.373	0.173
Post-training perceived need for training	3.59±0.97	4.35±0.71	−4.917	<0.001^c)	4.58±0.56	4.30±0.73	2.161	0.034^a)
Willingness to propose improvement plans	2.49±0.62	2.60±0.94	−0.744	0.459	3.21±0.93	2.54±1.05	3.345	<0.001^b)
SAFE MODE knowledge	4.48±0.62	4.50±0.60	−0.222	0.825	4.55±0.61	4.54±0.59	0.031	0.976
Male-oriented training satisfaction	3.66±0.73	3.93±0.78	−2.027	0.045^a)	-	-	-	-
Embryo-oriented training satisfaction	3.64±0.73	3.95±0.77	−2.278	0.024^a)	-	-	-	-

Comparison		r	df	t	p-value
Job satisfaction	Perceived training difficulty	0.236	97	2.375	<0.05^a)
	Pre-training safety awareness level	−0.110	97	−1.090	0.277
	Pre-training safety performance capability	0.184	97	1.837	0.068
	Post-training safety awareness level	0.060	97	0.594	0.554
	Post-training safety performance capability	0.228	97	2.296	<0.05^a)
	Willingness to propose improvement plans	0.309	97	3.197	<0.01^b)
	SAFE MODE knowledge	0.220	97	2.213	<0.05^a)
Training difficulty	Pre-training safety awareness level	0.023	97	0.228	0.819
	Pre-training safety performance capability	0.234	97	2.355	<0.05^a)
	Post-training safety awareness level	0.148	97	1.472	0.145
	Post-training safety performance capability	0.389	97	4.113	<0.001^c)
	Willingness to propose improvement plans	0.109	97	1.083	0.283
	SAFE MODE knowledge	0.368	97	3.866	<0.001^c)
Pre-training safety awareness level	Pre-training safety performance capability	0.363	97	3.804	<0.001^c)
	Post-training safety awareness level	0.440	97	4.823	<0.001^c)
	Post-training safety performance capability	0.041	97	0.406	0.683
	Willingness to propose improvement plans	−0.084	97	−0.832	0.411
	SAFE MODE knowledge	0.218	97	2.198	<0.05^a)
Pre-training safety performance capability	Post-training safety awareness level	−0.054	97	−0.535	0.597
	Post-training safety performance capability	0.407	97	4.315	<0.001^c)
	Willingness to propose improvement plans	0.180	97	1.797	0.075
	SAFE MODE knowledge	0.256	97	2.600	<0.05^a)
Post-training safety awareness level	Post-training safety performance capability	0.215	97	2.170	<0.05^a)
	Willingness to propose improvement plans	0.086	97	0.852	0.398
	SAFE MODE knowledge	0.109	97	1.083	0.281
Post-training safety performance capability	Willingness to propose improvement plans	0.215	97	2.170	<0.05^a)
Post-training safety performance capability	SAFE MODE knowledge	0.188	97	1.877	0.063
Willingness to propose improvement plans	SAFE MODE knowledge	0.091	97	0.902	0.373