Journal Club

Halbach J, Sullivan L Teaching Medical Students About Medical Errors and Patient Safety: Evaluation of a Required Curriculum, Academic Medicine 80(6): 600-6

Reviewed by Elizabeth Stuart, Stanford University

Halbach and Sullivan report on a required patient safety curriculum at the New York Medical College in Valhalla. 572 students participated over 3 years.

The curriculum was intended to raise students' awareness of medical errors and to provide practice with communicating errors to patients and families. The centerpiece of the program was a videotaped simulation: each student disclosed an error to a standardized patient and received feedback from patient, peers, and faculty.

Students completed a brief questionnaire before and after participating in the curriculum. Questionnaire items assessed students' awareness of the frequency and impact of medical errors, the likelihood of committing errors themselves, and their own strengths and weaknesses in interviewing patients and communicating about errors. Participants also completed a written evaluation of the curriculum itself and a follow-up questionnaire 2-8 months after the end of the program.

There were significant improvements on all items of the pre-post curriculum questionnaire. Students' responses on the program evaluation survey indicated that the majority found the curriculum and the SP exercise helpful. Of those who responded to the follow-up questionnaire, most reported an increased awareness of medical errors weeks to months after the end of the curriculum.

Comments:
This paper deserves a catchier title. Based on my own experiences with patient safety education, I expected to read about a curriculum emphasizing prevention and avoidance of medical errors. This program took a happily surprising approach: acknowledging the reality of errors and preparing students to deal with them on an interpersonal level. A few features are worth highlighting:

During the SP exercise, the task of discussing an error with a patient included four key skills: apologizing for the error, taking responsibility for the error, admitting not knowing something, and making attempts to reestablish trust. These are crucial skills with applications far beyond disclosing errors to patients. (They would work well as specific learning objectives or competencies for broader training in professionalism.)

In their introduction, the authors mention "the hidden curriculum" and the need to address emotional and professional cultural barriers to discussing medical errors. The involvement of faculty role models that were willing to openly reflect on their own errors takes an important step in the right direction.

Overall, I found the content of this curriculum intriguing. The evaluation seemed too limited to capture the full impact of the program and would have been strengthened by the inclusion of a control group, outcome measures other than self-reported attitudes, and a qualitative assessment of students' reactions to the program. Still, the paper offers useful ideas for teaching about patient safety and beyond.

(Medical errors and patient safety are other important and "hot" topic areas. How many of you have had to admit errors with patients? Is this a resident or student level skill? How should learners use these skills on the inpatient team with an attending responsible for the patient or when others on the team have committed the error? - Robin Deterding)