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No 'Magic Bullet' to Prevent Medical Errors
Residents, GME Programs Key to Boosting Patient Safety, Say Academic Leaders
By News Staff
Darrell Kirch, M.D., president and CEO of the Association of American Medical Colleges, and Philip Boysen, M.D., executive associate dean of graduate medical education at the University of North Carolina, or UNC, at Chapel Hill School of Medicine, say in the article that residents are the ideal change agents.
Residents "are in a unique position, as learners gaining knowledge from faculty physicians through observation and targeted questioning, and as teachers modeling behaviors and techniques for health professions students," they note.
"As such, residents can bring issues of patient safety to the forefront of care delivery, affecting the practices of their more senior and junior colleagues alike. They can serve as change agents by both mentoring students and 'reverse mentoring' faculty."
The authors say that patient safety training should be part of learning experiences integrated throughout the medical education continuum -- from medical school through residency and into CME -- culminating with the modeling of best practices in the clinical setting. To achieve this, medical schools and clinical practices must collaborate closely.
The authors list five factors that are critical to developing a culture of safety in academic medicine:
- explicit leadership from the top,
- engagement of medical students,
- a focus during residency,
- use of health information technology and
- teamwork among health professionals.
In addition, the majority of graduate medical education, or GME, programs include quality and safety topics in resident orientation, and residents often are assigned to serve on institutional quality and safety committees.
Interprofessional activities are especially important in developing a culture of safety, the article's authors note. These activities empower all health professionals to identify issues that could lead to medical errors, and they facilitate the teamwork that is vital to patient-centered care.
Using the UNC medical school as an example of an institution that has integrated the five factors into its GME program, the authors recount a number of the institution's positive outcomes:
- After the school's leadership made patient safety its highest priority, the medical school has reduced errors and improved care through cultural and curricular changes.
- Residents sit on the patient safety council of UNC hospitals, and resident physicians with faculty mentoring have formed their own patient safety council. Residents also have voting membership on the medical staff executive committee and on the professional liability advisory committee.
- Morbidity and mortality conferences assess human error and performance, fatigue and fitness for duty, and attending physician supervision.
- Residents can take a one-month patient safety elective that covers, for example, how communication relates to safety. They also complete a patient safety project.
- Students complete patient simulation exercises using life-sized, anatomically correct, computerized mannequins. Discussions about care processes with other health professionals are an important component of these exercises.
- Through the school's participation in the Agency for Healthcare Research and Quality's patient safety initiative, Strategies and Tools to Enhance Performance and Patient Safety, residents learn the value of working in multidisciplinary and multiprofessional teams.
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