Report recommends med. ed. reform

The U was one of 23 schools named to have already implemented strategies.

Medical students are groomed to be competitive. They learn to score well on tests and look impressive on résumés. What they don’t learn enough of, however, is teamwork — and that very lapse in interpersonal communication training is what’s been disintegrating patient safety in U.S. hospitals, a national report argues. A recent report by the Lucian Leape Institute at the National Patient Safety Foundation details the reform that must happen in medical education in order to address the issue of mistakes in hospitals that result in injuries and deaths. The University of Minnesota Medical School was among 23 U.S. medical schools highlighted in the report as having already incorporated many of the recommended changes. The University’s Academic Health Center allows for a great deal of interdisciplinary education among health-related schools, Lindsey Henson, Medical School vice dean for education, said. Twice a month, leaders from each school meet to discuss opportunities for collaboration or to expand on initiatives that are working well. “In other schools, even if they have nursing, pharmacy or dental schools, those relationships wouldn’t be there,” she said. The report outlines 12 recommendations that could spur the change necessary to promote safe environments, including creating learning cultures that emphasize patient safety, enhance collaborative behavior and encourage transparency. Too often, students are educated in a toxic culture where they’re treated in abusive, demeaning ways by physicians and nurses, said Lucian Leape, chair of the Lucian Leape Institute and adjunct professor at the Harvard School of Public Health. “Our teaching hospitals are very hierarchical,” he said. “We tend to emphasize individual performance instead of teamwork, and yet it’s teamwork we’ve found that is essential to safe practice.” In addition to curriculum reform, truly accepting safety practices will need to be a cultural change for most schools, Henson said. To be accepted into the University’s schools of dentistry, pharmacy and nursing, for example, students are constantly focused on doing better than their peers, she said. “And now you move into a situation where, for a patient to have the best care they can, students have to put their competitiveness and ego to the side and say, ‘How are we going to work together as a team?’ ” she said. “That’s really a culture shift.” As the Medical School continues to undergo its curriculum overhaul, Henson said leaders will expand on the patient safety measures that already exist. To hold weight, the report’s recommendations will need to be adopted by the various accrediting bodies that govern medical school curricula, such as the Liaison Committee on Medical Education, said Dennis O’Leary, a report author and former president of the Joint Commission, a leading accrediting body in the United States. That means setting explicit curricular requirements for patient safety instruction, defining specific competencies for graduating medical students and weaving more safety content into medical textbooks and licensing exams, he said. “There is a need to create a national monitoring mechanism that regularly gathers and publicly reports the progress of the reforms set forth in this paper,” he said. Funding will be necessary to create the sweeping changes the report calls for. Medical schools can make a compelling case to seek Title VII funding under the recently amended Public Health Service Act to inspire curricular reform that includes patient safety, Leape said. Title VII is a provision of the act under which medical schools may receive extra federal funding for the purpose of increasing the number of faculty in health care education and training programs, among other things. “We’re not looking for an infusion of funds,” he said. “We’re looking for a different use of existing funds.” In the end, the changes depend largely on physicians, as students look to them as role models, said David Mayer, associate dean for curriculum at the University of Illinois College of Medicine. “The biggest need is faculty development,” he said. “Many of us who went to school years ago were never trained in these types of skills, this type of knowledge.”