Teaching medical students to recognise and report errors

Abstract

BackgroundMedical student error reporting can potentially be increased through patient safety education, culture change and by teaching students how to report errors. There is scant literature on what kinds of errors students see during clinical rotations. The authors developed an intervention to better understand what kinds of errors students see and to train them to identify and report errors.MethodsA safety curriculum was delivered during the Medicine clerkship for the academic year 2015–2016. Prior to the workshop, students completed a preintervention survey to determine whether they had reported a clinical error. Subsequently, they participated in an educational workshop. Facilitated discussions about conditions contributing to errors, types of errors, prevention of errors and importance of reporting followed. Students were required to submit a simulated error report about an error they personally observed. An end-of-year survey was sent to students who participated in the curriculum to determine clinical error reporting frequency.ResultsStudents submitted 282 reports. Near miss errors were seen in 64% and adverse events in 36%. National Quality Forum serious events were reported in 14%, including one death. Recommendations to prevent similar events were weak (62%). Students correctly categorised 93% near miss, 88% adverse events, 67% diagnostic, 81% treatment and 78% preventative errors. On the preintervention survey, 8.5% stated they submitted an error report to their clinical site. On the end-of-year survey, 18% confirmed submitting a formal error report.ConclusionTraining students to recognise and report errors can be successfully integrated into a clinical clerkship and impact clinical error reporting.

The Association Between Cognitive Medical Errors and Their Contributing Organizational and Individual Factors

“…This transformation can be achieved by promoting trust among healthcare providers, encouraging cooperation among employees, and enhancing awareness regarding the importance of reporting and sharing any information about MEs. 17 , 39 , 47 In summary, blame culture perceives errors as personal failures, and this may be a barrier for healthcare providers in reporting MEs. Meanwhile, safety culture perceives errors as learning opportunities, whereby healthcare providers can report, share, and discuss MEs without fear of punishment or blame and the same errors can therefore be prevented from occurring in the future.…”

Identifying and Analyzing Systems Failures: An Interactive, Experiential Learning Approach to Quality Improvement for Clerkship-Level Medical Students

“…Other opportunities for medical student involvement described in the literature include preclerkship and longitudinal curricula, 13,26,32 simulation-based learning of QI, 11 dedicated clerkships to QI, 24 and involvement in safety event reporting, analysis, and QI project implementation. [11][12][13] Each medical school and institution may vary in the opportunities available to students in their specific setting. We believe instruction in QI and systems-based practice should be introduced early in the medical school curriculum.…”

“…We hypothesize that these changes could increase students' likelihood of reporting future safety events and contributing to institutional QI efforts, while also addressing students' desire to have "[our suggestions] taken seriously" as described in session evaluations. 7,12 While we did not assess students' behavior over time, future research should evaluate the longitudinal impact of such modules on students' involvement in QI and patient safety during medical training and throughout their career. 13,26,32 Conclusion Medical schools are introducing QI and patient safety concepts in preclinical classrooms, yet few provide opportunities to apply these tools in the clinical setting.…”

“… 25 We believe that providing this training to medical students during their clerkship year is critical for successful integration of QI and systems based-practice with developing clinical skills, and overall professional development. Curricula targeting preclerkship students, 26 offered in specific clerkships but not the entire clinical year, 12 or focusing on other topics within QI/patient safety other than identifying and analyzing root causes—such as disclosing errors to patients 7 —have been reported previously. At the time of writing, we found no QI curricula focusing on a systematic approach to root-cause analysis for medical students in the clerkship year that was published and immediately available for use.…”

“… 6 , 9 We wanted to equip them with introductory skills to begin to understand what contributes to errors as well as prepare them to report safety errors and contribute to hospital-wide QI measures in the future. 10 – 12 We also hoped to influence students' attitudes towards QI and patient safety by introducing the concept of just culture and a culture of safety, and helping students shift from blaming individuals for safety incidents to understanding the system factors that may contribute to health care errors and near misses. 13 We report our evaluation of this pilot and next steps for our curriculum development in this publication.…”