Report Questions Patient Safety Training, Recommends Improvements

Today's medical students are not learning enough about patient safety, the importance of teamwork and communication, and safety science, according to a new white paper released by the Lucian Leape Institute at the National Patient Safety Foundation on Wednesday.

The report, Unmet Needs: Teaching Physicians to Provide Safe Patient Care, details 12 recommendations for reforming the current medical education curricula to incorporate these vital aspects of providing safe patient care.

"It's apparent to most of us that the major challenge in moving ahead in improving patient safety has been getting physicians up to speed, teaching physicians the science of safety, and the skills they need to make healthcare safe," said Lucian Leape, MD, adjunct professor of health policy at Harvard School of Public Health in Boston, during a press conference Wednesday. "We need to start earlier in medial school, and that's what this is all about."

The report was based on three Roundtable sessions attended by 40 leading experts in medical education, patient safety, healthcare, and healthcare improvement. The report, which is the first in a series on identified priorities, comes 10 years after the release of To Err is Human, the groundbreaking Institute of Medicine report on preventable medical errors.

One main point to come out of the Roundtable discussions was that graduate medical education has focused mostly on clinical knowledge and the science necessary to practice medicine. However, that is not enough for today's complex healthcare system.

"Medical students need to learn the science of safety—why people make mistakes and how to design our systems to prevent them, they need to learn about the practice of safety—how we apply that knowledge in actual practice in our safe systems, and they need to learn about the culture of safety—how we create a work environment that makes that possible," said Leape.

One of the reasons that some graduate medical students leave their residencies unequipped with leadership and communication skills is the toxic atmosphere in which they learn. Many hospitals have struggled to create a culture of safety, an environment that encourages staff members to speak up when they see something going wrong, according to the white paper.

Some of the physicians in charge of teaching the next generation of doctors use intimidating tactics and disruptive behavior in their everyday practice of medicine, which teaches residents a lack of professionalism, the authors added.

"Not only are there the basic science elements of patient safety, but there are also the other skills … teamwork, communication, conflict resolution, leadership—elements that other high reliability organizations train from day one to their environment, trainees, and learners," said David Mayer, MD, associate professor of anesthesiology and associate dean for curriculum at the University of Illinois College of Medicine in Chicago, and a member of the Roundtables, during the press conference.

"Things like mindfulness, calling for help when uncertain—those are signs of a culture of safety outside of healthcare, where in healthcare they are still looked at as signs of weakness that have to be addressed. We need to change the way we teach the next generation of providers," he added.

The report calls on the Liaison Committee on Medical Education (LCME) and the Accreditation Council for Graduate Medical Education (ACGME) to use their leveraging powers to improve patient safety training for medical graduate students. Additionally, the report calls for the creation of new standards by both of these groups, which would take safety science into consideration.

Although John Prescott, MD, chief academic officer at the Association of American Medical Colleges (AAMC), said that educating new doctors about patient safety has been a top priority for American medical schools and teaching hospitals for the last decade, the report asks for more traction from in this area. There are few schools that take a longitudinal, four-year approach to patient safety, said Mayer. The AAMC is taking a comprehensive approach to enhancing quality and patient safety efforts.

The report mentions financial incentives available federally, from Titles VII and VIII of the Public Health Service Act, as well as on a state level. Because preventable medical errors are the eighth leading cause of death in the U.S., a case could be made for using federal funds to bolster graduate medical education requirements.

Another key theme found in the report is the need to launch intensive faculty training programs to ensure that they have the patient safety and communication skills necessary to teach graduate medical students.

"Not only do we need to reform the curriculum, we need to reform the faculty," said Leape. "We have to get them up-to-speed in safety, to learn the science so they can teach it, to learn to be team players, and most of all, to learn to be appropriate role models. Medical students learn the science of medicine in the classrooms and in the labs; they learn the practice of medication by emulating their professors. Therefore, every teacher must be the kind of physician we want our students to become."

To find the full report from the Lucian Leape Institute, including the 12 specific recommendations, visit www.npsf.org/LLI-Unmet-Needs-Report/.