Med students can aid in safety improvement
Report: They can help prevent adverse events
Medical students are often overlooked as valuable participants in ensuring patient safety, assert the authors of a paper published recently in Quality and Safety in Healthcare.1
However, citing four cases from two U.S. academic health centers in which medical students prevented or were in a position to prevent patient harm from occurring, they state, "These cases show that medical students may be an untapped resource for medical error prevention."1
The types of harm prevented included averting non-sterile conditions, missing medications, mitigating exposure to highly contagious patients, and respecting patients' do-not-resuscitate requests.
The authors say that medical students should be trained to recognize errors and to speak up when errors occur. "Those supervising students should welcome and encourage students to actively communicate observed errors and near misses and should work to eliminate all intimidation by medical hierarchy that can prevent students from being safety advocates,"1 according to the authors, who directly participated in each case.
"The rationale for doing this study was the experiences of myself, and other medical students at the time, that medical students could contribute to patient safety and prevent medical errors," says lead author Samuel C. Seiden, MD, now with the University of Chicago Comer Children's Hospital. "My colleagues and I were involved in a series of cases where we either prevented a medical error or were in a position as a medical student to have prevented a medical error but for some reason we didn't."
No formal mechanism
Seiden says there was no formal mechanism in place for students to prevent patient harm. "Students were basically on their own to attempt to do so; communication strategies were ad lib," he recalls. They included talking to residents, faculty members, nurses, and so forth, when they saw something going wrong. "There were also patient safety reporting systems (at least at the University of Chicago) but this is not something that was utilized by the students in the cases being presented," he adds.
Since medical students were involved, would such an approach work only for academic institutions? "Obviously medical students are only in academic institutions, but hierarchies are present in all institutions — i.e., doctors, nurses, technicians, and so forth," Seiden points out. "I think the fundamental point about this paper relates to hierarchy, and that in any instance where there is a hierarchy, there can be an unfortunate tendency for the lower members of the team to feel hesitant to speak up when they see something going wrong. Medical students are particularly susceptible to this kind of hesitancy because they change environments so often (lack of familiarity) and they are being evaluated constantly (fear of repercussions). Nevertheless, I think these lessons are applicable to other hierarchical situations, and the concept of crew resource management (there is a discussion of the Tenerife aviation accident in the paper) is a helpful one."
For readers in academic institutions, he continues, "I humbly think that this paper should be circulated to all faculty, (especially program directors and clerkship directors), chief residents, residents, and medical students. I think the barrier that exists now is an understanding among all these parties that medical students can be involved in this capacity."
Seiden asserts that students need to be empowered to speak up when they think something may be jeopardizing safe patient care, and faculty members and residents need to anticipate and be receptive to students participating in that role.
"I believe the reason people don't speak up when they see something going wrong is rooted in fear of adverse consequences from them doing so," says Seiden. "Promoting more open communication within hierarchical environments requires a multifaceted approach. Students and trainees need to be trained in the importance of communicating vital information in order to keep the interests of the patient paramount. But superiors must also become receptive to trainees asking such questions."
Seiden says his paper holds an important message for quality managers. "There are substantial contributions that medical students, residents, and all members of the health care team can make in enhancing patient safety, but hierarchies present a barrier to realizing those contributions," he warns. "In order to reduce the barriers from these hierarchies, fundamental changes to the culture of medical practice will be needed."
References
- Seiden SC, Galvan C, Lamm R. Role of medical students in preventing patient harm and enhancing patient safety. Qual Saf Health Care 2006;15:272-276.
For more information, contact:
Samuel C. Seiden, MD, University of Chicago, Department of Pediatrics, Comer Children's Hospital, 5721 S. Maryland Ave, MC8016, Chicago, IL 60637 Phone: (773) 255-6284 (office). Phone: (773) 255-6284 (cell). Fax: (773) 665-2786.E-mail: [email protected].
Medical students are often overlooked as valuable participants in ensuring patient safety, assert the authors of a paper published recently in Quality and Safety in Healthcare.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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