Effectiveness of patient safety training in equipping medical students to recognise safety hazards and propose robust interventions.

OBJECTIVES: In an effort to improve patient safety attitudes and skills among third-year medical students, two patient safety training sessions were added to their curriculum, complementing a previously implemented second-year curriculum on quality improvement, patient safety and teamwork. METHODS: Safety attitudes and skills were assessed before and after students completed the medicine clerkship training and were compared with historical controls. Students identified and reported on observed safety events, with their reports matched to event type and harm score with contemporaneous safety reports from University of Missouri's Patient Safety Network (PSN). Comparisons were assessed by five internal safety experts using criteria for report submission "worthiness", blame tone, target of blame and presence/strength of proposed solutions. RESULTS: Students completing the third-year safety booster conferences expressed statistically higher comfort levels with identifying the cause of an error than did the student control group (p<0.05). Medical students proposed safety interventions that were more robust than those suggested by event reporters regarding similar events within our health system (p<0.0001). The worthiness and blame tone of medical student reports were not statistically different than event reports in PSN. CONCLUSIONS: Completion of two 1-h patient safety booster conferences in the third year of medical school led to increased student comfort in safety event analysis. Students documented stronger resolution robustness scores, suggesting similar training should be offered to PSN reporters. Medical students represent an underutilised resource for identifying and proposing solutions for patient safety issues.

Developing a culture of patient safety at the VA.

Patient safety is a topic that has become prominent in the minds of many, both within and outside the healthcare field over the past several months. But in fact, literature in medical journals describing this topic goes back decades. However, studying these issues is only the first step towards developing useful and practical tools to address errors and does little to change the safety culture that underlies these systems. The VA has taken several steps towards a safety culture and the development and implementation of tools, such as: 1) error reporting mechanisms; 2) tools for root cause and corrective action; and 3) management tools (e.g., safety awards).

A human-centered approach to medical informatics for medical students, residents, and practicing clinicians.

The authors have developed a curriculum in medical informatics that focuses on practical problems in clinical medicine, rather than on the details of informatics technologies. Their development of this human-centered curriculum was guided by the identification of six key clinical challenges that must be addressed by practitioners in the near future and by an examination of the failures of past informatics efforts to make a significant difference in the everyday practice of clinical medicine. Principles of human factors engineering--the body of knowledge about those human abilities, limitations, and characteristics that are relevant to design--are an essential part of this curriculum. Human factors engineering also provides the necessary perspective, as well as the concrete knowledge and methods, that can enable practitioners to properly evaluate their clinical information needs, weight the merits of proposed technology-based solutions, and understand their own inherent performance limitations.

Geographic disorientation: approaching and landing at the wrong airport.

Geographic disorientation in aviation operations results from the failure of an aircrew to recognize and/or maintain the desired position relative to the external ground and airspace environment. Becoming lost during flight, intruding inadvertently into unauthorized airspace, selecting a wrong airway, landing on the wrong runway, and approaching the wrong airport--with or without actual landing--are some examples of inflight geographic disorientation. This is a relatively common phenomenon that can be experienced by any pilot, regardless of experience level and the type of pilot certification. This paper analyzes 75 cases of geographic disorientation that occurred among air carrier pilots plus 16 cases among general aviation pilots between 1982 and 1987. Inflight geographic disorientation can result from a variety of aeromedical and human factors (aircrew, operational, environmental) which, interacting with each other, create the ideal conditions for the occurrence of this phenomenon. The adverse consequences of geographic disorientation for the aircrew, passengers and aircraft are delineated along with specific preventive measures.