Leape Institute Report

Medical Schools Falling Down on Teaching Patient Safety, Say Education, Safety Experts

April 16, 2010 04:05 pm Barbara Bein

A new report from the Lucian Leape Institute at the National Patient Safety Foundation says that medical schools have to do a better job of teaching future physicians to identify and resolve patient safety problems. Currently, medical schools are not helping students develop the right skills, including communication and teambuilding skills, to enable them to provide safe patient care, says the report, which recommends fundamental changes in the learning culture.

The report, "Unmet Needs: Teaching Physicians to Provide Safe Patient Care," was developed by the Leape Institute's Roundtable on Reforming Medical Education and released last month.

According to the report's executive summary, medical schools focus on providing students with the knowledge and skills for the technical practice of medicine, paying scant attention to instilling the skills, attitudes and behaviors that will permit them to practice safely.

In fact, says the report, medical students "all too often suffer demeaning experiences at the hands of faculty and residents, a phenomenon that appears to reflect serious shortcomings in the medical school and teaching hospital cultures."

Students go on to emulate these behaviors, perpetuating work environments and cultures that are "antithetical to the delivery of safe, patient-centered care," according to the report.

David Nash, M.D., M.B.A, founding dean of the Jefferson School of Population Health in Philadelphia, is a general internist who was one of the 40 expert members of the roundtable that produced the report. He told AAFP News Now that medical schools have made only modest progress in teaching students about patient safety.

Because many medical errors are preventable, medical schools have an obligation to tackle this problem, said Nash, and the first step is training new faculty who are prepared to teach about quality and safety.

An important component of this new "patient safety science" is crew resource management, which trains people to work effectively as a team, he said.

In addition, curriculum committees must push to promote the knowledge and skills that comprise the science of patient safety into the first-year medical school curriculum. In residencies, chief residents should be trained in patient safety so they, in turn, can train those they oversee, Nash said.

"When the senior leadership supports this, then the culture will change. But it will take time to make it work," said Nash, whose school offers a master's of science degree in health care quality and safety.

After deans, faculty and residency directors have been trained, it's important to get questions on patient safety into the medical exams, such as Parts 2 and 3 of the U.S. Medical Licensing Exam, he added.

According to the report, "substantive improvement in patient safety will be difficult to achieve without major medical education reform at the medical school and residency training program levels."

The report made numerous recommendations aimed at beefing up patient safety training, several of which pertain directly to medical schools, teaching hospitals and the accrediting bodies for medical schools and residency programs.

  • Medical school and teaching hospital leaders should place the highest priority on creating learning cultures that emphasize patient safety, model professionalism, enhance collaborative behavior, encourage transparency and value the individual learner.
  • Medical school deans and teaching hospital CEOs should launch a broad effort to emphasize and promote the development of interpersonal skills, leadership, teamwork, and collaboration among faculty and staff.
  • Medical school deans and teaching hospital CEOs should provide incentives to support the enhancement of faculty capabilities for teaching students how to diagnose patient safety problems, improve patient care processes and deliver safe care.
  • The selection process for admission to medical schools should place greater emphasis on attributes that reflect professionalism and orientation to patient care.
  • Medical schools should treat patient safety as a science that encompasses knowledge of error causation and mitigation, human factors concepts, safety improvement science, systems theory and analysis, system design and redesign, working in teams, and error disclosure and apology.

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