Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Med Educ. 2012 Jan;46(1):107-19. doi: 10.1111/j.1365-2923.2011.04154.x.
During the last decade, there has been a drive to improve the quality of patient care and prevent the occurrence of avoidable errors. This review describes current efforts to teach or engage trainees in patient safety and quality improvement (QI), summarises progress to date, as well as successes and challenges, and lists our recommendations for the next steps that will shape the future of patient safety and QI in medical education.
Trainees encounter patient safety and QI through three main groups of activity. First are formal curricula that teach concepts or methods intended to facilitate trainees' participation in QI activities. These curricula increase learner knowledge and may improve clinical processes, but demonstrate limited capacity to modify learner behaviours. Second are educational activities that impart specific skills related to safety or quality which are considered to represent core doctor competencies (e.g. effective patient handover). These are frequently taught effectively, but without emphasis on the general safety or quality principles that inform the relevant skills. Third are real-life QI initiatives that involve trainees as active or passive participants. These innovative approaches expose trainees to safety and quality by integrating QI activities into trainees' day-to-day work. However, this integration can be challenging and can sometimes result in tension with broader educational goals.
To prepare the next generation of doctors to make meaningful contributions to the quality mission, we propose the following call to action. Firstly, a major effort to build faculty capacity, especially among teachers of QI, should be instigated. Secondly, accreditation standards and assessment methods, both during training and at end-of-training certification examinations, should explicitly target these competencies. Finally, and perhaps most importantly, we must refocus our attention at all levels of training and instil fundamental, collaborative, open-minded behaviours so that future clinicians are primed to promote a culture of safer, higher-quality care.
在过去十年中，人们一直致力于提高患者护理质量并防止发生可避免的错误。本综述描述了目前教授或吸引学员参与患者安全和质量改进（QI）的努力，总结了迄今为止的进展、成功和挑战，并列出了我们对未来步骤的建议，这些步骤将塑造医学教育中患者安全和 QI 的未来。
学员通过三组主要活动来接触患者安全和 QI。首先是正式课程，教授旨在促进学员参与 QI 活动的概念或方法。这些课程增加了学习者的知识，并且可能改善临床流程，但证明改变学习者行为的能力有限。其次是传授与安全或质量相关的特定技能的教育活动，这些活动被认为是医生的核心能力（例如有效的患者交接）。这些活动通常都能有效地教授，但没有强调指导相关技能的一般安全或质量原则。第三是涉及学员作为主动或被动参与者的真实 QI 举措。这些创新方法通过将 QI 活动整合到学员的日常工作中，使学员接触到安全和质量。然而，这种整合具有挑战性，有时会导致与更广泛的教育目标产生紧张关系。
为了让下一代医生为质量使命做出有意义的贡献，我们提出以下行动呼吁。首先，应该发起一项重大努力来建立教师的能力，尤其是在 QI 教师方面。其次，在培训期间和结束培训认证考试时，认证标准和评估方法都应明确针对这些能力。最后，也许最重要的是，我们必须在各级培训中重新关注并灌输基本的、协作的、开放的思维方式，以便未来的临床医生能够积极促进更安全、更高质量的护理文化。
