Patient Safety Education for Medical Students: Report of 3 Years of a Curriculum at New York Medical College

Presenters: Joseph L. Halbach, M.D., M.P.H.

Institution: Department of Family Medicine; New York Medical College, Valhalla, New York

Co-Author: Laurie Sullivan, Ph.D., C.S.W.

Introduction: As part of the movement to improve patient safety, education of physicians beginning in medical school has been increasingly advocated. In July 2000, the Department of Family Medicine at New York Medical College integrated into its required third-year clerkship a four-hour curriculum that addresses medical errors. The goals of the curriculum are to introduce students to avenues for communication about medical errors, to expose them to the prevalence and origins of errors, and to increase awareness of the physician’s responsibility for patient safety. Standard methods of evaluation were incorporated from the start. The observations and experiences of the faculty in teaching this course are also assessed.

Methods: The curriculum includes three parts: an introductory lecture-discussion, brief required readings, and a videotaped simulation with a standardized patient followed by a small group feedback session. In the simulations, each student discloses and discusses an outpatient error made with this patient. Since its inception, 572 students have completed the curriculum.

Evaluation is carried out in two ways: student awareness of their strengths and weaknesses regarding communicating a medical error to a patient (pre- and post- matched data collected), and the students’ evaluation of the curriculum. In addition, responses to the single "medication error" question added to the Annual AAMC Graduation Questionnaire in 2001 have been tracked to compare NYMC students to national norms.

Results: The response rates to the pre- and post- evaluation forms were over 99%. Across all three years, an average of 89% of the students reported an increase in their awareness of strengths about discussing a medical error. Ninety-three percent of the students agreed or strongly agreed that the standardized patient/ feedback session was a useful learning experience. An anonymous six-month follow-up questionnaire, (with a response rate of 41% for participants in the first two years) further supported these findings, with many comments reporting that the videotape simulation was the most powerful part of the curriculum.

Compared to responses by the 2001 medical school graduates to the AAMC question on discussing a prescription error with a patient, the NYMC class of 2002, the first to receive this curriculum, showed a significant improvement in the school’s average score. The national average did not change.

Discussion: We have shown that a brief curriculum on safety can be introduced and sustained in a medical school curriculum, that medical student response is extremely positive, and that it appears to improve student awareness and possibly their confidence in disclosing error. Anticipated resistance from the medical school community did not develop. Based on their experiences in developing and teaching this curriculum, the authors have compiled "A Curriculum Guide for Teaching Medical Students and Family Practice Residents" to assist other institutions. The role of medical student education in changing the culture of medicine and in preparing physicians for safer practice needs to be further explored.