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What Do I Do When Something Goes Wrong? Teaching Medical Students to Identify, Understand, and Engage in Reporting
Hilary F Ryder1, Jonathan T Huntington, Alan West
1H.F. Ryder is associate professor, Department of Medicine and Medical Education, and professor, The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; ORCID: https://orcid.org/0000-0003-3120-1166. J.T. Huntington is assistant professor, Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. A. West was health scientist, White River Junction VA Medical Center, White River Junction, Vermont, and staff member, Veterans Affairs Office of Rural Health, Eastern Region, until his retirement in 2017. G. Ogrinc is senior associate dean, Medical Education, professor, Department of Medicine, and professor, The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
Problem:
Identifying and processing medical errors are overlooked components of undergraduate medical education. Organizations and leaders advocate teaching medical students about patient safety and medical error, yet few feasible examples demonstrate how this teaching should occur. To provide students with familiarity in identifying, reporting, and analyzing medical errors, the authors developed the interactive patient safety reporting curriculum (PSRC), requiring clinical students to engage intellectually and emotionally with personally experienced events in which the safety of one of their patients was compromised.
Approach:
In 2015, the authors incorporated the PSRC into the third-year internal medicine clerkship. Students completed a structured written report, analyzing a patient safety incident they experienced. The report focused on severity of outcome, root cause(s) analysis, system-based prevention, and personal reflection. The report was bookended by 2 interactive, case-based sessions led by faculty with expertise in patient safety, quality improvement, and medical errors.
Outcomes:
Students accurately analyzed the severity of the outcome, and their reports directly led to 2 formal root cause analyses and 4 system-based improvements.
Next Steps:
The time- and resource-efficient PSRC allows students to apply patient safety knowledge to a medical error they experienced in a way that can directly affect care delivery. This model-interactive learning sessions coupled with engaging in a personally experienced case-can be implemented in various settings. Educators seeking to use student-experienced events for learning should not discount the emotional effects of those events on medical students.
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