H.F. Ryder is associate professor, Department of Medicine and Medical Education, and professor, The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; ORCID: https://orcid.org/0000-0003-3120-1166. J.T. Huntington is assistant professor, Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. A. West was health scientist, White River Junction VA Medical Center, White River Junction, Vermont, and staff member, Veterans Affairs Office of Rural Health, Eastern Region, until his retirement in 2017. G. Ogrinc is senior associate dean, Medical Education, professor, Department of Medicine, and professor, The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
Acad Med. 2019 Dec;94(12):1910-1915. doi: 10.1097/ACM.0000000000002872.
Identifying and processing medical errors are overlooked components of undergraduate medical education. Organizations and leaders advocate teaching medical students about patient safety and medical error, yet few feasible examples demonstrate how this teaching should occur. To provide students with familiarity in identifying, reporting, and analyzing medical errors, the authors developed the interactive patient safety reporting curriculum (PSRC), requiring clinical students to engage intellectually and emotionally with personally experienced events in which the safety of one of their patients was compromised.
In 2015, the authors incorporated the PSRC into the third-year internal medicine clerkship. Students completed a structured written report, analyzing a patient safety incident they experienced. The report focused on severity of outcome, root cause(s) analysis, system-based prevention, and personal reflection. The report was bookended by 2 interactive, case-based sessions led by faculty with expertise in patient safety, quality improvement, and medical errors.
Students accurately analyzed the severity of the outcome, and their reports directly led to 2 formal root cause analyses and 4 system-based improvements.
The time- and resource-efficient PSRC allows students to apply patient safety knowledge to a medical error they experienced in a way that can directly affect care delivery. This model-interactive learning sessions coupled with engaging in a personally experienced case-can be implemented in various settings. Educators seeking to use student-experienced events for learning should not discount the emotional effects of those events on medical students.
识别和处理医疗差错是本科医学教育中被忽视的环节。组织和领导者提倡向医学生传授患者安全和医疗差错知识，但很少有可行的示例说明应该如何进行教学。为了让学生熟悉识别、报告和分析医疗差错，作者开发了互动式患者安全报告课程（PSRC），要求临床学生在情感上和理智上参与到其患者安全受到损害的个人经历事件中。
2015 年，作者将 PSRC 纳入了第 3 年的内科实习课程。学生完成了一份结构化的书面报告，对他们经历的患者安全事件进行分析。报告侧重于结果的严重程度、根本原因分析、基于系统的预防措施和个人反思。报告由 2 个由具有患者安全、质量改进和医疗错误专业知识的教员领导的基于案例的互动课程进行引导和收尾。
学生准确地分析了结果的严重程度，他们的报告直接导致了 2 次正式的根本原因分析和 4 次基于系统的改进。
时间和资源效率高的 PSRC 允许学生将患者安全知识应用于他们经历过的医疗差错中，从而直接影响医疗服务的提供。这种模型——互动学习课程结合个人经历的案例——可以在各种环境中实施。教育工作者在寻求使用学生经历过的事件进行学习时，不应低估这些事件对医学生的情绪影响。
