A shift toward improving patient safety in medical education
David B. Nash, MD, MBA, Founding Dean of the Jefferson School of Population Health
In recent months, I have been witness to a genuine groundswell of interest in improving the methods in which patient safety measures are taught, across the board, in medical education.
In January, there was the release by the Association of American Medical Colleges (AAMC) of “Teaching for Quality,” a report on integrating quality improvement and patient safety across the continuum of medical education. The report articulates a broad vision for health care delivery, offers a strategy to increase faculty capacity, and makes three core recommendations focused on quality improvement and patient safety. I have been on the steering committee at the AAMC since the inception of this program, therefore I can vouch that the report addresses the need to increase the capacity of the academic medical centers, teaching hospitals, and medical schools of the U.S. to meet the challenges of health care in the 21st century. These challenges are numerous and include healthcare redesign, accountable care, cost containment, and the quality of care gap.
On top of “Teaching for Quality,” there was the announcement that the American Medical Association (AMA) will award $10 million in grants over five years to a group of medical schools to engage in a broad range of teaching innovations, including new ways of teaching and assessing core competencies, individualized learning plans, and a greater focus on patient safety, quality improvement and health care financing.
Between eight and 10 medical schools will be awarded the grants for a total of $2 million annually over five years. Medical schools must have filed a brief letter of intent by Feb. 15 and a full proposal by May 15. The winners will be announced no later than July 1, and the grant program will start Sept. 1.
In making the announcement, AMA Executive Vice President and CEO James L. Madara, MD, said “a gap exists between physician training and the day-to-day realities of the evolving and emerging health care system.”
I’ll say. Especially in the area of patient safety. As it currently exists, the curricula and culture of medical education and training allows doctors to enter a lifetime of medical practice with serious competency deficiencies. Medical school graduates learn virtually nothing about quality and safety – how to evaluate it, how to improve it or even that it desperately needs improving.
Medical school graduates themselves tell us that they lack skills that will be vital to medical practice in the coming years. The American Association of Medical Colleges (AAMC) graduating senior questionnaire is an annual survey that every graduating medical student in every medical school fills out. Results of this survey show conclusively that students feel they get inadequate preparation in promoting quality and safety. As many as one-third or more report that they get inadequate instruction in how to interpret and use evidence-based medicine or how to improve the health of their patient populations or how to prevent disease. They also report inadequate training in teamwork and communication with other physicians and health professionals.
Teaching quality and safety improvement is possible. I’m encouraged by the AAMC’s “Teaching for Quality” report, and the AMA’s grant program and believe that both will help medical schools and residency programs continue to expand their commitment to curricular reform and embrace more sophisticated methods of teaching quality and safety. Medical education is retooling slowly but appropriately. I view all of this as a fitting redefinition of medical professionalism.
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