Weaving Quality Improvement and Patient Safety Skills Into All Levels of Medical Training

With the launching of the Liaison Committee on Medical Education’s new accreditation Standard ED-19-A in July 2013, a new era in quality improvement/patient safety (QI/PS) has begun. Core curriculum of medical schools must now include multidisciplinary teamwork; that is, inclusion of practitioners and/or students from other health professions. This Standard ED-19-A is harmonious with the earlier Accreditation Council for Graduate Medical Education’s (ACGME) Competency IV.A. 5.c, which calls for QI to be integrated into residents’ training curricula. Residents need to be able to determine their strengths and deficiencies. ACGME requires residents to systematically analyze practice using QI methods; to incorporate formative evaluation feedback into daily practice; to locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems; and to participate in the education of patients and families. ACGME also specifies that residents use information technology to optimize their learning. In a 2009 annotated bibliography, Moskowitz and Nash focused on teaching trainees the tenets of quality and safety. In this 2013 annotated bibliography, Mochan and Nash focus on how teaching these tenets might be implemented successfully. Articles were chosen to reflect various approaches and content areas in medical, nursing, and pharmaceutical education. In addition, the authors also have selected articles that explore efforts to weave QI and PS into beginning levels of the curricula. At all levels, the authors observed recurring useful themes in these articles. These themes include the following: (a) longitudinal mentorship, (b) a culture of safety/ transparency, (c) engagement of patients and their families, (d) safety systems knowledge, (e) teamwork, (f) interorganizational sharing, (g) faculty experts in the field of QI/PS, and (g) evidence-based theory. It became evident in study after study, including those not contained in this bibliography, that longitudinal mentorship was vital to cultivating sustained and meaningful involvement of medical care trainees in QI/PS. Students have many responsibilities and projects competing for their time, so just a few lectures or a single small project will not give them the kind of learning and skill acquisition to develop what Ogrinc et al call eyes to “see” QI/PS issues in every patient encounter. Faculty experts in QI/PS need to meet regularly with students and oversee ongoing projects, with the goal of instilling enthusiasm and competency in QI/PS. The culture of safety/transparency in health care settings, both inpatient and ambulatory, is necessary so that teams of health care givers can learn from their mistakes and prevent them from recurring. It is nonproductive to teach students in the classroom about the value of an open, honest environment and then send them to clinical settings that hide and deny medical errors. With regard to engagement of patients and their families, Sklar points out in a February 2013 article (Acad Med. 2013;88:147-148), titled “Quality and Spaghetti Sauce,” that “one size does not fit all. ” Students need to learn to incorporate into decision making and treatment options the valuable data they should gather from hearing patients and family members speak. In today’s high-tech, often chaotic, and rushed world, knowledge of safety systems and safety science is primary in the health care giver’s arsenal of tools. Too many patients are harmed when caregivers are fatigued or overworked, but outstanding systems can build in protections to “catch” what humans miss and can prevent many mistakes. The old rigid hierarchies of medical care, particularly in hospitals, are now obsolete. Medicine is too complex and far too evolved now for any one individual to have the whole picture. Teamwork and shared expertise lead to better outcomes. As a Japanese proverb says, “None of us is as smart as all of us. ” Similarly, with the fast-paced acquisition of data and knowledge today, interorganizational sharing makes caregivers across the nation more proficient in giving their patients efficient, lower cost, and often quicker solutions to many medical problems. 528568 AJMXXX10.1177/1062860614528568American Journal of Medical QualityMochan and Nash research-article2014