Training Residents to Be Error Free

Patient safety is essential to addressing and improving the quality of our health care.  The release of “To Err is Human,” the landmark report by the Institute of Medicine (IOM), highlighted the need for health care professionals to discuss patient safety in relation to medical errors. With a primary focus on systems-based errors, most hospitals and residency programs have designed and implemented structures to address this type of error. However, large gaps in resident education around error remain prevalent. Emily Ruedinger, MD, assistant professor at Seattle’s Children’s Hospital, formerly of the University of Minnesota; and Andrew Olson, MD, an assistant professor at the University of Minnesota, are steadfast in their mission to expand resident training and reduce cognitive error.

“Many medical training programs devote considerable time to systems improvement and knowledge expansion rather than critical examination of cognitive error,” said Ruedinger. “Cognitive error should be considered crucial to reducing overall error, particularly in the cognitive specialties. There are a limited number of resident training programs that include curriculum for and/or discussion of cognitive error. Without such curriculum, a knowledge deficit is created.”

Assessing Medical Errors

As recipients of the 2014 Clinical Care Innovation Challenge (CCIC) Pilot Award, a program sponsored by the Association of American Medical Colleges, Ruedinger and Olson spearheaded the creation and implementation of a novel, longitudinal cognitive error curriculum for pediatric residents at the University of Minnesota. Additionally, an evaluation pre- and post-test tool was piloted with family medicine residents, who served as the control group. The assessment centered on the residents’ knowledge level, attitudes, and opinion of culture in relations to medical errors.

Ruedinger and Olson incorporated active learning techniques that promoted practical application of concepts and skills into the curriculum. Residents developed and expanded their awareness, knowledge, and competencies of cognitive error through interactive approaches such as faculty panel role-modeling, small group discussions, skill-building workshops on peer feedback, written self-reflection, and other structured activities. One facet of the curriculum sought to build residents’ content knowledge surrounding metacognition of medical decision-making, the risks and benefits of different decision-making strategies, types of cognitive error, and development of systems to reduce cognitive error. The incorporation of interactive learning techniques shifted residents’ attitudes toward a culture that supports transparency of thought process and creates an open environment for error disclosure and discussion.

“With academic health centers and teaching hospitals looking to improve care delivery, our curriculum presents an innovative approach to addressing a primary component for improving patient safety,” says Olson. “Through this curriculum, residents could delve deeper into topics and develop applicable skills, which is a vastly different approach from traditional training programs. Moreover, residents were exposed to the perspectives of multiple individuals, like the patient’s family and lawyers.”

Now in their third year of implementation at the University of Minnesota, Ruedinger and Olsen are looking at avenues to bring the curriculum to different audiences and institutions, both locally and nationally. They have received a great deal of interest from colleagues in the medical community, and have been invited to present at a number of meetings and conferences. In her position at Seattle’s Children’s Hospital, Ruedinger is working with colleagues in safety leadership to identify opportunities to integrate the curriculum.

Emily Ruedinger, MD, and Andrew Olson, MD, were recipients of the 2014 Association of American Medical Colleges Clinical Care Innovation Pilot Award. If you are interested in obtaining more information about this project, another CCIC project, or the awards program, please email The  2016 Clinical Care Innovation Challenge Awards application period is currently open and accepting applications.