Teaching Medical Students Health Care Failure Mode and Effect Analysis: A Case Study of Inpatient Pain Management Computerized Decision Support.

There is a pressing need to provide health professional leaners experiential learning opportunities in health systems science and quality improvement. Moreover, there are several published tools to diagnose and treat health system vulnerabilities and hazards. The Health Care Failure Mode and Effect AnalysisTM (HFMEA) is a systems-engineering tool that the military and aerospace industries developed to proactively identify potential errors. While this technique has been used in a range of healthcare settings, there are few reports where health professional educators have used it with learners to teach quality improvement and systems engineering methods. We describe herewith an application of HFMEA in a medical informatics professional student rotation. In this manuscript, we briefly review HFMEA theory and methods, illustrate its application to address a quality improvement initiative, and reflect upon its value - and limitations - when used in an educational context.