The Current State of Patient Safety Education for Future Caregivers…Who Do You Believe?

The Lucian Leape Institute (LLI), named after the physician many consider the “Father of Patient Safety” was formed in 2007. The Institute functions as a think tank and its mission is to provide thought leadership and a strategic vision for improving patient safety. The initial work of the LLI has focused on identifying and framing key transforming concepts that require system-level attention and action. The five transforming concepts identified are:

1) Medical education reform
2) Active consumer engagement in patient care
3) Provision of fully transparent care
4) Integration of care across health care organizations and delivery systems
5) Restoration of pride, meaning and joy in professional work.

The LLI believes success in each of these concepts is critical in moving the national patient safety agenda forward.

The first concept addressed by the LLI was medical education reform and I was delighted to be an invited member of the educational roundtable. We all believe substantial improvements in patient safety will be difficult to achieve without major medical education reform. Medical schools must not only assure that future physicians have the requisite knowledge, skills, behaviors, and attitudes to practice competently, but also are prepared to play active roles in identifying and resolving patient safety problems as well as leading quality improvement initiatives in the future.

The Roundtable published a white paper about two years ago titled, Unmet Needs: Teaching Physicians About Safe Patient Care. The white paper concluded that medical schools today are not doing an adequate job of laying the educational groundwork needed in knowledge and skill development required for the provision of safe, high quality patient care, to wit: systems thinking, problem analysis, human factors concepts, transparency, communication skills, patient-centered care, teaming concepts and skills, and dealing with feelings of doubt, fear, and uncertainty with respect to medical errors.

Conclusions by the Institute caused a lot of push back and rebuttal from many national and local medical education organizations, who believed medical education was doing fine when it came to patient safety and quality improvement curricula for students and residents—and this debate continues. While progress has been made in bringing patient safety into undergraduate and graduate medical education curricula over the past two years, we are still nowhere close to where patient safety education should be  in meeting the needs of the patient. This concern really hit home the past two weeks at our Telluride Patient Safety Summer Camp when resident physicians and medical students shared the following:

On the current state of patient safety education and training in medical school:
Almost all medicals students acknowledged that the four days they spent on patient safety education at the Telluride Summer Camp was more training than they get in their four years of medical school. While all schools have some training in patient safety, it is still infrequent and rarely longitudinal.

On Informed Consent/Shared Decision-making training:
After residents watched the award-winning film The Faces of Medical Error…From Tears to Transparency: The Story of Michael Skolnik and engaged in a two-hour discussion on important differences between informed consent and shared decision-making, Paul Levy asked the residents how much informed consent training they get during their medical school and residency. With a show of hands, every resident acknowledged the three-hour session on informed consent/shared decision making at the Telluride Summer Camp was more training than they received during medical school and residency put together. One resident commented:

I don’t think that I’ve ever thought so much about informed consent as I did today.  A discussion about informed consent to the level of detail that we had today needs to be part of all residency training in the first days of orientation and as refresher training later on in training.  All physicians can, and should, do much better in providing informed consent.

On understanding nursing, and the nurse’s role in team-based patient care:
On day two and three of the Student Summer Camp, Kathy Pischke-Winn, RN and Joe Halbach, MD shared educational strategies and tools for team-based care and effective communication between caregivers. The sessions were powerful – using case-based learning and role-plays, the students gained great insight into communication tools like SBAR (or ISBAR as the Australians attending the summer camp were quick to point out), write-down read-back, CUS and others. At the end of the two-day session, the students shared their complete lack of knowledge (and medical school training) prior to attending the summer camp regarding the important role of the nurse in patient care and other team-based care concepts.

One medical student commented:

Our discussion on the roles of nurses at different institutions was eye-opening in the sense that many of my peer medical students had very little knowledge about other allied health professionals.”

Another fourth-year medical student pointed out this lack of team-based patient care training cuts even deeper:

The discussion about nursing and doctoring reminded me of conversations I had with fellow classmates at school. We were studying for the NBME Behavioral Sciences exam and joking about the ethical dilemma practice questions we were working on. A common theme that we noticed is that any answer involving soliciting a nurse for help or consulting with a nurse would invariably be wrong. We agreed that answers involving nurses can be crossed off and it would be nice to get one on the test because we could narrow down the answers easier. Almost like how there used to rarely be positive depictions of minorities in the cinema, early medical education is nearly void of positive depictions of nurses.

I think we can all agree medical training and educating the young is not near where we need it to be especially in the areas of team-based, patient-centered care.

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