By Kevin Wang
In 2009, leaders in the field of patient safety wrote about the need for physician leadership in quality and safety. They lamented a limited talent pool, insufficient training, and limited formal roles in medical schools as compared with hospitals. They advocated investment in physician-leaders in quality and safety.
Four years later, there has been visible improvement: the IHI Open School, MOOCs on patient safety, innovative curricula from the medical schools at the University of Missouri and the University of Chicago, and the QI Gateway evidence the strides in educational infrastructure to teach medical students, interns, and residents about the importance of quality and safety.
But there’s a major audience that these efforts have missed: the tens of thousands of pre-medical students in the United States. Just as Pronovost and colleagues noted that there are dozens of MD-PhD programs in basic science versus just a few in quality improvement, I am noting the lack of QI programs for undergraduate pre-medical students.
The importance of culture change to improve safety is well established in the literature. Yet how can quality improve if it isn’t a lens with which to view the field of medicine? Pre-medical students have always been required to learn about biology, organic chemistry, and physics; they publish articles on gene regulation, engineering, or drug development. Few, if any, write papers on health systems or health services research.
It’s not until medical school that students are exposed to safety and quality concepts and learn to view health delivery from a system perspective. Imagine the potential of students who enter medical school with a system perspective on health care and a commitment to quality improvement.
Acquiring knowledge about quality and safety at the undergraduate level is just as essential for future physician leaders as knowledge in biology, chemistry, and physics. What if, while shadowing in the operating room or on the wards, pre-meds were able to analyze problematic situations and prevent medical errors or patient harm? What if they already knew the importance of communication during hand-offs, of the existence of time-outs and debriefings, or were able to see a systems error in infection precautions? Imagine if they were able to leverage those experiences under the supervision of an experienced mentor and apply them later as medical students, hitting the ground running on quality improvement research and initiatives.
Then imagine those students as residents, leading entire CUSP teams with several years of accumulated knowledge and experience. Quality and safety would become an intrinsic part of the medical education process just like biology and anatomy. (Increased clinical experience is also more attractive to premeds than pipetting in a lab all day too, I suspect.)
Involving undergraduates in quality and safety research is low-hanging fruit that could unlock enormous potential, if only the barriers to entry can be reduced. As an undergraduate, I had to search out my own opportunities to learn about patient safety, finally finding them in YouTube videos. I had to beg the registrar to enroll me in graduate-level public health courses on medical errors and quality of care.
Today, I’m glad to see institutions like the IHI Open School and massive open online courses in quality and safety, although they are not yet directed at a pre-medical audience.
Another barrier is a lack of opportunities to conduct patient safety research. Pre-meds can assist researchers in need of increased manpower. Not only do pre-meds seek out relevant clinical experiences, but they are often the most eager and passionate researchers. As a research coordinator on a time andmotion study, I had the honor of working with amazing mentors and peers. I coordinated shifts in which undergraduates willingly stayed on for 10 hours to follow medical interns and track their every move on an iPod Touch.
I’m just one of many undergraduates who have an interest in patient safety. My classmates have convinced schools like Johns Hopkins to award $10,000 fellowships for patient safety and global health initiatives in China, work with the World Health Organization, and measure patient safety culture in Pakistan. A few have even published in high-impact journals as first or co-authors. I know of countless others who are interested but don’t have the resources. Pronovost and others give annual patient safety lectures, but that isn’t ambitious enough.
Investing in delivering quality and safety knowledge to pre-medical students and involving them in research will surely bring positive return on investment in the form of greater patient safety innovation in the future.
—Kevin Wang is an undergraduate public health studies major at Johns Hopkins University. As a research fellow, he’s completed studies on US resident work-hour limitations, interned at the WHO, and implemented quality improvement projects in Chinese hospitals. He is currently applying to medical school. Kevin blogs at wang-kevin.tumblr.com.