Background <p>Patient safety is a global health priority and a fundamental part of healthcare curricula worldwide. While teaching medical students on theoretical components is straightforward, students may fail to prioritise patient safety due to an incomplete understanding and experience of the pressures of front-line care. Using an observational tool for patient safety learning in real clinical environments appears to help students engage with the significance of safe practice. This review seeks to identify learning approaches that use observational safety tools in practice.</p> Methods <p>This scoping review follows the JBI Evidence Synthesis Template. We searched Medline, CINAHL, Scopus, Web of Science, and The Cochrane Library for relevant papers published from 2009 to June 2024. Papers were appraised for quality indicators and pedagogical theory. They were synthesised using Bigg’s 3P theoretical model into presage (teaching setup), process (teaching), and product (evaluation and assessment) factors.</p> Results <p>Of an initial 10,203 articles, only eight met the search criteria. The selected studies were conducted in North America (five) or Europe (three). The studies involved medical and nursing students in mid-to-late training and were for uni or interprofessional learning. Most studies involved a few representative students (range 11–368). They were conducted in acute clinical settings, including wards and theatres. All studies claimed the use of a safety tool to advance students’ learning, and many involved monitoring real-time clinical practice. The authors reported that the students gained new knowledge, identified errors, valued learning in a team and felt better prepared to speak up for errors. The studies failed to fully describe presage factors for setup challenges and issues. They lacked rigour and adequate theoretical explanations about how learning took place (process). As the work was mainly descriptive and atheoretical, assessment outputs were lacking, but evaluations were described.</p> Conclusions <p>Observational patient safety learning tools used in practice benefit students’ understanding of patient safety, advancing their preparation for practice and remain under-studied and under-developed. The studies were often in their pilot development stages and hence involved few students. Further research on the use of patient safety education tools, used in practice, is urgently required to help educators with teaching design, delivery and assessment.</p>