Residents, GME Programs Key to Boosting Patient Safety, Say Academic Leaders

There is no single "magic bullet" to prevent medical errors in U.S. hospitals and other clinical settings, according to the authors of a recent article in the journal Health Affairs. There are, however, a handful of factors that can help the nation's medical schools, teaching hospitals and health systems make the transformation from the "old culture of autonomy and independence to the new world of shared accountability, interdependence and teamwork" in which a culture of patient safety can be built.

In particular, these two academic medicine leaders say, resident physicians are in a central position to teach medical students, more junior residents and even faculty to tackle patient safety issues in a new way and help bring about a culture change in medical education to advance patient safety.

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:

Students, for example, learn about the practice of medicine in the classroom and in the lab and through supervised participation in patient care. They also observe clinical work on rotations through clinical settings.

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:

"It has become clear that resident education can be a key driver of culture change, which, in turn, corresponds to improvements in quality and safety," the authors say. "With its long history of advancing the science behind health care, academic medicine is uniquely positioned to advance the culture of patient safety."