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FORUM
Series on Medical Mistakes Targets Preclinical Students
Two of the obstacles to decreasing the occurrence of medical errors, according to experts, are a lack of understanding of why and when they occur and the medical profession's culture of blame. Fears of medical malpractice add to the secrecy surrounding errors and impede efforts to bring the kind of transparency necessary to implement quality-enhancing changes. In an effort to address some of these cultural obstacles, Lucian Leape, a pediatric surgeon turned medical errors guru and adjunct professor of health policy at HSPH, and others have organized a series of lectures for first- and second-year medical students. The series aims at introducing them to the available data and the approaches used for reducing errors and mitigating their impact when they do occur. (See series schedule at below.) Correcting the SystemIn 2000, when the Institute of Medicine released To Err is Human: Building a Safer Health System, the public became aware of the problems facing the quality of American health care, problems that were well known to Leape. The IOM report claiming that up to 98,000 Americans were dying each year in hospitals as a result of medical errors made its way into the national consciousness and gave a needed push to quality-improvement efforts. Leape and colleagues had been working for years to bring attention to these challenges and to develop solutions that focused on changing the medical culture from one of individual blame to systemwide quality improvement. The follow-up report from the IOM's Committee on Quality of Health Care in America, Crossing the Quality Chasm: A New Health System for the 21st Century, while garnering less media and public attention, outlined six aims for the American health care system and approaches for implementing these goals.According to Leape, the allegiance of physicians to the human perfectibility model, compounded by fears of malpractice litigation, highlights the need to teach students about systems approaches to error reduction--that "errors are caused by faulty systems, not by faulty people, and that errors and patient injuries can be prevented by redesign of those systems." The lecture and discussion series set to begin Nov. 14 is the product of the Safety Education Working Group formed in early 2001. Steven Simon, HMS assistant professor of ambulatory care and prevention, took the lead in developing the course, with assistance from Leape and Gordon Harper, HMS associate professor of psychiatry. Through a series of six lectures and discussions in November and December, it is hoped that students will begin to understand the scope and gravity of error and patient injury in health care settings and the reasons why humans make errors. Building on this knowledge, students will be exposed to the use of human-factors principles in the design of systems to make them error-resistant. Importantly, students will understand and become more comfortable with the idea of fallibility and the inevitability of errors. This background should give them an appreciation for why historical approaches to dealing with errors that focused on the individual have failed. The lectures will be followed by six small group workshops for second-year students in January. These will be case-based discussions designed to apply the principles introduced in the lectures. When possible, cases will be selected from those with adverse outcomes discussed in basic science courses. An Error-prevention Priority"Change is difficult," said Leape, who has worked with faculty and administrators to find a place in the HMS curriculum for instruction in safety principles and strategies. "The curriculum is already too full, and many other educators have seemingly valid claims for additional time. The School has the impossible task of prioritizing these requests and continually re-examining the curriculum to ensure that it offers the subjects and experiences that will be most useful for students. Unfortunately, it is a zero-sum game. To put something in, you must take something out. No one wants out."It is not only students who need to be educated about medical errors, according to Leape. Many faculty are unconvinced about the extent of errors and of the value of the systems approach. Although every hospital now has active safety programs, many doctors are skeptical about their value--another major barrier to the integration of error prevention into the curriculum. Leape and others in the patient safety movement are working to educate both practicing physicians and physicians-in-training. Yet their special interest remains reaching out to students. Leape prefers "a balanced approach, in which doctors-in-training learn a strong sense of responsibility to be informed, knowledgeable, careful, and conscientious but also recognize that they will make mistakes and that their mistakes have multiple causes. In other words, an ounce of prevention for students is worth a pound of cure for practicing doctors." --Erica Seiguer, a fourth-year MD-PhD student at HMS Schedule for the Safety Education Lecture Series
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