Presenter: Osmon N. Sanyar, MD
Institution: University of Utah
Co-Author: Michael P. Silver, MPH
Introduction: The 1999 Institute of Medicine report on error in medicine is changing the landscape of health care in the United States. At every level of the health care system, there is an expectation of increased attention to patient safety and competence in addressing issues identified. Medical education and training must respond to these changes to prepare physicians to work effectively in the health care system of the future. Medical Schools and graduate medical education programs are essential components of the patient safety movement. This report describes a three-year curriculum development project in patient safety in a family practice residency program. This project is currently entering its second year.
Methods: Curriculum development activities are a collaboration between residency program faculty and the state of Utah’s Medicare Quality Improvement Organization. The curriculum introduces principles and practices of error and safety management drawn from within and outside of health care. First-year activities included:
Reducing Medical Error in a Family Practice Residency Program
- three interactive learning sessions incorporated into the program’s training structure introducing themes of learning from error, teamwork and communications, and the multifactorial nature of accidents;
- an introduction to patient safety to residency faculty;
- multidisciplinary teamwork training at the outpatient training clinics;
- an introduction of outpatient safety event reporting;
- applied safety management activities: failure modes and effects analysis, root cause analysis;
- review of the program features and structures; and
- surveys and interviews of residents, faculty, and staff regarding attitudes towards patient safety and the developing curriculum.
Results: Learning session and teamwork training participants (residents, faculty, and clinic staff) rated the activities as generally important and relevant to their work. A majority expressed interest in learning more about the topics and would recommend the sessions to colleagues. Some reservations were expressed about the importance of the topic in primary care and the relevance of experience from outside health care. The program review identified opportunities for expanded learning from errors and safety related events.
Discussion: Residency training is, by its very nature, a core patient safety activity. Through supervised experience, medical knowledge is transformed into medical expertise. This endeavor is fraught with hazard – not only the usual hazards of training and inexperience, but also those stemming from conflicting priorities and goals impacting residents, and program administration. Such hazards are explicitly recognized and defended against by the developers, directors, accreditors, regulators, and faculty of these systems of care and training. Ultimately, the success of efforts to defend against these hazards is determined by working assumptions about the limitations of human performance, maintaining defenses in the face of competing priorities, and obtaining valid feedback about system performance (e.g., error and accidents). The challenge for residency training is both to model and transmit the values and principles of effective safety management.
Discussion: Residency training is, by its very nature, a core patient safety activity. Through supervised experience, medical knowledge is transformed into medical expertise. This endeavor is fraught with hazard – not only the usual hazards of training and inexperience, but also those stemming from conflicting priorities and goals impacting residents, and program administration. Such hazards are explicitly recognized and defended against by the developers, directors, accreditors, regulators, and faculty of these systems of care and training. Ultimately, the success of efforts to defend against these hazards is determined by working assumptions about the limitations of human performance, maintaining defenses in the face of competing priorities, and obtaining valid feedback about system performance (e.g., error and accidents). The challenge for residency training is both to model and transmit the values and principles of effective safety management.
