Education for a safety culture

Toby Reynolds is a trainee in anaesthesia from North East London, currently placed at the GMC for a year through the National Medical Director’s Clinical Fellow Scheme.

What medical students learn about safety is crucial for how they behave as doctors. If we are to support the development of the safety culture that the health service needs to encourage, we must understand and share experiences of what works in safety teaching.

The safety of patients has always been the key priority for doctors, going back to the origins of modern medicine and the principle of ‘first do no harm’. This maxim has always been at the forefront of medical education, and has been instilled into successive generations of new doctors. However it is only relatively recently that healthcare has really started to recognise the value of a systems and culture-based approach to providing safe care and avoiding preventable harm, rather than one based on individual practice.

A year and a half ago Don Berwick’s review on patient safety in England’s NHS [PDF] identified education as a prime target for bringing about this culture change, and recommended that all healthcare professionals should be trained in patient safety science and practice.

Safety leaders of the future

Medical students  Professional values in Action

“Students and clinicians in training are the eyes and ears of the service today and the safety leaders of the future.” Image from GMC ‘Medical Students: Professional Values in Action’ microsite

 

Last week the Department of Health published its vision for medical students starting this autumn to be seen as patient safety champions from when they first enrol. “Culture change in the NHS” [PDF] is an update on the last 15 months of work since the department published Hard Truths [PDF], its response to the Mid Staffordshire public inquiry report.

The report sets out the department’s vision for safety in healthcare education:

Students and clinicians in training are the eyes and ears of the service today and the safety leaders of the future. They need to be trained not only in safe care of the patient in front of them – already central to training – but in all the elements crucial to creating safer clinical systems: understanding human factors, measurement and audit, effective multidisciplinary team working, safe handovers of care, learning from error and near misses, and the tools of improvement science.

We know that medical schools have made great strides in meeting this expectation. However, teaching students about safety isn’t as easy as it sounds. For one thing, they are sometimes not as excited about the subject as we would hope they might be. They came to medicine to help people, to diagnose disease and to treat it. Now we are asking them to fill in checklists and to wash their hands?

I can recall sitting at the back of a surgical morbidity and mortality meeting as a student – one of the few I attended at that stage in my career- and finding the interaction between the clinicians more interesting than the learning from the cases. For us, the lessons from these cases were mostly about surgical decision making, something that I had no experience of.

Students need to relate to the subject

Now that I have been in clinical practice for a few years, I find these meetings among the best ways to learn, but when I do see medical students at these meetings, I can still see that they struggle to keep up when they cannot relate to the discussion.

On the other hand I can distinctly remember talking through a critical incident that had occurred at one of one of the hospitals associated with my medical school. A patient had suffered brain damage during emergency attempts to place a device to allow oxygen to be delivered to her lungs. The incident had many causes, at an individual and system level.

Such events are rare, and always tragic. What made this one a powerful lesson in my training was that someone took the time to discuss it with me, even though I had not been directly involved. Through this discussion I was able to relate to both the technical and non-technical factors contributing to the outcome – it wasn’t a formal root cause analysis, but it achieved the same result.
As part of work to share good practice in patient safety teaching, GMC colleagues and I participated in a meeting hosted by the Medical Schools Council last week .

My experiences as a medical student closely reflected what we heard from medical school trainers: Teaching patient safety through lectures alone will not achieve the desired outcome.

Debriefing, case studies and experience

Safety does depend on knowledge, clinical as well as human factors and safety science, but it is also about attitudes and behaviours. To promote these, safety teaching needs to be embedded into other learning activities, such as discussions of clinical scenarios or simulation exercises. We heard that medical students can relate more easily to the experiences of their “near peers”. For example, medical students valued a presentation by recently qualified doctors on what they have learned from near misses and errors in prescribing. For students at the very start of their careers, we heard that introducing the basic ideas about safety in healthcare can actually be achieved more effectively using examples from other areas of life, such as safety on the road.

We are building on these initial discussions on safety teaching in the run up to our conference on March 16, where we will have a workshop on patient safety teaching. We will also be producing a report, with medical schools, to help share what works.

If you have any ideas, we would love to hear them.

Toby Reynolds

 

Toby Reynolds is a trainee in anaesthesia from North East London, currently placed at the GMC for a year through the National Medical Director’s Clinical Fellow Scheme. He is writing this blog in his personal capacity, rather than as a representative of the GMC .

 

3 responses to “Education for a safety culture

  1. Great blog, well done! I agree with your comments about how students learn and how it is not necessarily always through lectures, some of the most unforgettable lessons for me as a medical student and as a doctor in training, have been through discussions on critical incidents, serious untoward events and near misses. Transparency about errors and sharing root cause analysis, or case studies for example in the MPS casebook, are invaluable ways of getting across messages about safety. This requires a culture change, so healthcare workers can learn and share learning from mistakes. Publication of serious incidents on hospital intranets (made anonymous) so that staff are aware of mistakes and incidents that have happened in their work environment and understand the context of their work and decisions may help. Students attached to hospitals could learn from openness around serious incident reporting.

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