Three Ways to Teach Medical Students about Quality and Safety (without Overloading the Curriculum)

By Scott Harris

Safety and quality are popular watchwords these days in health care. Many believe they are powerful allies in the battle to improve care and control costs.

But despite more than a decade on the front burner, medical errors still caused nearly 80,000 deaths among Medicare beneficiaries between 2007 and 2009, according to the 2011 HealthGrades “Patient Safety in American Hospitals” study. During the same time period, one in 10 surgical patients died after contracting one of a handful of “serious but treatable” conditions, the study found. These and other safety- and quality-related lapses accounted for $7.3 billion in unnecessary costs to taxpayers.

Plenty of efforts are underway across the country to improve the quality and safety of care, but what about the leaders of tomorrow? What should students and residents be learning, and when should they be learning it? And how should institutions incorporate these subjects into curricula that are already bursting at the seams?

For their part, medical students seem eager for more. According to the AAMC’s 2011 Medical School Graduation Questionnaire, nearly a third of respondents believed existing instruction around health care quality improvement was “inadequate.”

According to David Nash, MD, MBA, the Dr. Raymond C. and Doris N. Grandon Professor of Health Policy and Medicine at Jefferson Medical College of Thomas Jefferson University in Philadelphia and founding dean of the university’s school of population health, medical schools may not be fully seizing the opportunity to help tomorrow’s doctors deliver higher-quality care.

“Quality and safety just aren’t on the radar,” Nash says. “But we know that these issues are fundamental to health care reform. Realistically, what can schools and students do?”

Nash believes that quality and safety lessons resonate most when they accompany initial exposure to clinical activities.

“About halfway through year three is when the students are ready,” Nash says. “That’s the time when these issues start to make a lot of sense.”

Nash suggests three things a school can do—or that third- and fourth-year students can do on their own—to improve quality and safety knowledge without sacrificing other areas of instruction.

First, a journal club for interested students (and perhaps faculty) is a great place to start, Nash says. This is simply a group that gets together to read and discuss articles about quality and safety from relevant medical journals.

Second, the Institute of Healthcare Improvement’s Open School for Health Professions, and similar programs around the country, offers introductions to core quality and safety concepts, free of charge.

Third, require that one series of rounds each year focus on quality and safety.

“You can infuse all of this into the culture that already exists, rather than creating another graft-on,” Nash observes.

Many medical schools and teaching hospitals now offer special instruction around quality and safety. Others are moving more slowly. In the latter case, Nash said, learners wishing for more quality and safety instruction should make those wishes known.

“Clamor to get this into the curriculum,” Nash says. “Change bubbles up from the bottom.”