Patient Safety Now Integrated Into Medicine Curriculum

Left: David Mayer MD, Associate Dean of Curriculum, Co-Executive director of the UIC Institute for Patient Safety Excellence, Director of Cardiothoracic Anesthesiology

What do Legos, seesaws and robots have in common? They all are part of the College of Medicine’s innovative patient safety curriculum, which has become a model for medical schools across the country and throughout the world.

David Mayer ’78, MD ’82, Res ’04, associate dean of curriculum, co-executive director of the UIC Institute for Patient Safety Excellence and director of cardiothoracic anesthesiology, began to integrate patient safety into classes six years ago in response to the Institute of Medicine’s 1999 estimate that as many as 98,000 annual deaths occur due to preventable medical errors.

With the help of a $500,000 grant from the U.S. Department of Education to develop and implement this curriculum, patient safety now has become an integral part of core classes and the focus of a growing number of workshops.

Patient safety is taught along with subjects such as ethics, informatics and professionalism in the first- and second-year Essentials in Clinical Medicine course. A dozen required workshops held in the first two years of school teach safety-related topics including teamwork, communication, leadership, stress management and error disclosure.

Teams learn to work together and communicate effectively through games, simulation exercises and role-playing using actors who play patients or caregivers. Students use Lego blocks to build models of healthcare organizational structures, helping them practice and appreciate effective communication skills.

Another group exercise uses a seesaw to stress the impact group actions have on patient safety. During the exercise, raw eggs representing patients are placed under both ends of a board balanced on a cinder block, which represents a new medical technology. In the role of the patients’ clinical team, groups of a dozen students each are charged with safely “implementing” the medical technology by finding a way for eight students to stand together on the board for 10 seconds without tipping the teeter-totter and breaking the eggs. (The other four students on each team act as coaches.)

“It sounds simple, but the exercise stresses the importance of communication, teamwork and planning to the students,” Mayer observes. “Above all, it makes them aware of how vulnerable patients are in a medical system and the need to act carefully.”

During the 2008–09 academic year, third-year student teams began applying patient safety principles while working with a robotic human simulator mannequin. If the simulator receives the wrong medication, it responds the same way a human would. The exercise is videotaped, results are discussed and improvements are suggested.

“Those are things you really can’t teach from books or in traditional classrooms; you’ve got to practice it,” Mayer says.

Another first for the program is an elective two-week intensive patient safety course, in which seniors can get a much deeper understanding of full disclosure, quality improvement, electronic records management and other methods for ensuring and improving patient safety. Students learn that simple changes can make huge differences.

Kristin Donaldson, MD, MPH, was impressed with a procedure implemented in 2005 at the University of Illinois Medical Center that reduced the chance that surgical instruments would be left in patients during surgery. After surgery, the staff started to X-ray patients at high risk for retained objects, such as emergency abdominal and chest surgery patients, even if the sponge and instrument count made after surgery matched the pre-surgery number.

“We’re all human, so making sure there are processes in place to address those human errors is important,” says Donaldson, who currently is an emergency medicine resident at the University of Illinois Medical Center.

After graduation, newly minted doctors will face significant challenges working with new regulations and reimbursement penalties designed to ensure patient safety. “The culture change we are experiencing right now is fairly significant,” says Viveka Boddipalli ’02, MBA ’04, MD ’09, who has begun his residency in internal medicine at the University of Wisconsin School of Medicine and Public Health. “Starting with this generation of doctors, patient safety will be a central focus of the practice.”

Timothy McDonald, MD, JD, associate chief medical officer for safety and risk management, co-executive director of the UIC Institute for Patient Safety Excellence and professor of anesthesiology and pediatrics, already has seen this change taking place among young doctors at the University of Illinois Medical Center. “Residents in our program who came from our medical school are far more likely, when they see an adverse event, to tell the people who need to know about it,” he says.

In addition, College of Medicine students are spreading the word on safety as they venture forth after graduation. “It’s really exciting to see,” Mayer says, “because many of the students who take the course head into residency or professional practice and become leaders in patient safety themselves.”