Patient Safety in the Curriculum: The Asian Experience

 

 

 

By ARACELI P. ACOBA, MD

PATIENT SAFETY IS A NEW HEALTHCARE discipline that emphasizes the reporting, analysis, and prevention of medical error that often leads to adverse healthcare events.

The introduction of patient safety in the curriculum is an initiative of the World Health Organization, after several studies worldwide showed staggering figures of annual deaths arising from hospital errors. In August 2004, HealthGrades, a healthcare quality company, reported 200,000 deaths annually from hospital errors. In July 2006, the Institute of Medicine in the US reported that as many as 1.5 million Americans have suffered from medication errors. These are illness, injury or death caused by mistakes made in prescribing, dispensing and taking prescription drugs. The report says medication errors are so common in hospitals that, statistically, a patient will be subjected to a medication error each day of their stay. Several studies in Europe and Australia show the same shocking results. With these numbers, it appears that confinement in a hospital is more risky than riding an airplane! Thus, there is the need to introduce the culture of safety during the early years of medical training.

Over the years, the complexity of the medical practice has increased as diagnosis and treatment of disease has involved complicated technical equipment and highly specialized training. Errors can occur at each state of these processes with constant threat of accidental harm.

Aware of the impact of these errors, the WHO has initiated the incorporation of patient safety as part of the medical curriculum. Traditionally, curricula for doctors have focused on pure clinical skills, diagnosis, treatment and follow-up. Teamwork, quality improvement and risk management have been neglected but is now the primary concern in patient safety.

The 11 aspects of patient safety as recommended by the WHO curriculum are:

1. What is patient safety
2. What is the human factor and why is it important to patient safety
3. Understanding systems and the impact of complexity on patient care
4. Being an effective team player
5. Understanding and learning from errors
6. Understanding and managing clinical risk
7. Introduction to quality improvement methods
8. Engaging with patients and carers
9. Minimizing infections through improved infection control
10. Patient safety and invasive procedures
11. Improving medications safety.

During the APMEC conference in Singapore, reports from the different ASEAN countries showed the incorporation of these topics from first year to fourth year of medical school (see Figure 1). Various strategies were used to ensure that the concepts are taught in varying levels and incorporated into the existing curriculum without adding a new subject to the already heavy load of the current program.

Reports of the different countries on teaching-learning activities for patient safety in the lower years include:

1. Case studies (seminars, PBL)
2. Simulation (e.g., handwashing, patient identification, communication with patient and relatives)
3. Video clips on role play
4. Electronic lectures and online tutorials.

Some teaching-learning activities in the clinics, include:

1. Mortality morbidity conferences taking note of lapses and errors
2. Study modules: Cases of sentinel events discussed
3. Workshops
4. Patient Safety Executive Walkabouts include medical students (Figure 2).

Assessment of knowledge is through patient safety OSCE stations as well as tracking of serious errors during internship. Written exams were also given particularly after video presentation or lectures.

In UERM, the school has started with the incorporation of patient safety in the curriculum from first year to internship. Continued improvement in the curriculum is being done to ensure that students will be aware of this critical aspect of medical care. A strong administrative and faculty commitment, together with patient empowerment, will provide a paradigm shift from traditional approach to a broader multidimensional concept of patient care.

Figure 1. National University of Singapore instrustional design on patient safety.

Figure 2. Example of issues raised during patient safety rounds in the Hospital.