Medical school patient safety initiatives face obstacles

From increasing the use of sepsis bundles to streamlining diagnostic test ordering to improving patient satisfaction with consent procedures, medical students at the Ohio State University College of Medicine develop projects to solve real-world patient safety risks in clinical settings.

This coursework is part of the college’s four-year health system science studies focused on safety, quality and how different healthcare professions and specialties collaborate to improve patient care.

Rather than having health professionals wait to learn certain concepts until later on in their careers, some medical schools are beginning to incorporate patient safety into curricula so graduates enter the workforce more fully prepared.

“Why wait for a physician or a nurse or someone to be in practice for years before allowing them to take a course like this or receive certification?” said Dr. Frank Filipetto, dean of the Texas College of Osteopathic Medicine. ”Let’s not have them develop bad habits.”

However, medical schools must convince students and academic leaders that patient safety is worth prioritizing. Schools looking to implement safety curricula face barriers including student disinterest and uneven internal support for devoting resources to these initiatives.

“The biggest challenge was convincing students that they needed this curriculum and because it’s a change, and they don’t see other medical schools doing this,” Filipetto said. “I’ve had students say, ‘I don’t need to learn this.’” To counter these objections, professors explain how studying safety advantages students by enhancing their skills, in addition to benefiting patients, he said.

The Texas College of Osteopathic Medicine is among the innovators in this area. The school decided a few years ago to emphasize safety so students understand the importance of preventing harm, Filipetto said.

“My vision back then was: We really need to change the way healthcare is being delivered in this country because we have significant issues with medical errors and patient safety issues that result in death,” he said.

With assistance from the Institute for Healthcare Improvement and SaferCare Texas, the college first developed a curriculum and a pilot program to prepare 10 students for an IHI exam to qualify them for a Certified Professional in Patient Safety designation. Nine students passed on their first try, exceeding expectations, Filipetto said.

The Texas College of Osteopathic Medicine refined its safety curriculum and now requires a two-week course and the exam during the third year of medical school. Ninety-eight percent of graduates depart with patient safety certifications, according to the college.

Students learn about the foundations of patient safety, including hospital leadership, a culture of reporting adverse events, and measuring and improving performance. They also study how to identify root causes of safety failures to inform solutions.

More than 5,000 students have earned Certified Professional of Patient Safety designations since the exam debuted in 2012, said IHI Vice President Patricia McGaffigan. Since the Texas College of Osteopathic Medicine began its program, its graduates represent about 10% of those who have passed the test, she said. The IHI is seeking additional academic partners to expand its efforts, she said.

At the Ohio State University College of Medicine, health systems science students take a four-year course completing IHI quality and patient safety modules and engaging in group work to apply the lessons to clinical scenarios, said Dr. Philicia Duncan, program director of the school’s applied health systems science course.

During their final year, students engage in quality improvement projects that identify areas where care could be improved and work with faculty and others on quality and safety initiatives such as a campaign to reduce vaccine hesitancy.

The university ultimately wants safety incorporated into the entire curriculum, Duncan said. “That’s almost looked at as a niche area,” she said. “Once it’s demonstrated that patient safety and quality is more a fabric of medical education and medical practice, then that would help the program’s success.”

The University of Michigan Medical School takes a similar approach that is personalized for students based on their interests and future specialties, said Dr. Jawad Al-Khafaji, director of patient safety and quality improvement. Students also work on projects emphasizing measures to prevent adverse events, he said.

“We’ve had quite a few very impactful projects that ended up changing some of the practices even here at the University of Michigan” and at Veterans Health Administration facilities, said Al-Khafaji, who practices internal medicine at the VA Ann Arbor Healthcare System.

Medical school graduates who are certified in patient safety are attractive to employers because so few physicians have been formally educated on the subject, Filipetto said. Newly minted doctors with this background are prepared to perform duties such as participating in patient safety and quality committees, he said.

Trying to recruit first year medical students to join the patient safety elective over an area like global public health is difficult because most have no idea of what patient safety and quality improvement are or why they are important, Al-Khafaji said.

In addition to persuading students, advocates for patient safety education face skepticism from academic leaders, said Lillee Gelinas, director of patient safety at the Texas College of Osteopathic Medicine.

“The two most common questions we get—not just from medical schools, but other health profession schools—are: ‘How much does it cost and where does it fit in the curriculum?’” Gelinas said. “We can’t answer that. The schools have to look at their own curriculum and where it fits. But the main message is: You can’t just sprinkle the topic of safety and quality into other courses.”

Academic leaders often are reluctant to borrow best practices from other schools or from third parties, and contend they must create safety programs in-house from scratch, said Stephanie Mercado, CEO of the National Association for Healthcare Quality.

“One of the big misconceptions that I’ve experienced working with academic organizations is that they think that there’s a benefit to having a custom program built by their organization,” Mercado said. “They believe it represents a secret sauce, that they are bringing something to the market that no one else has,” she said.

“Programs who are trying to develop this de novo are going to miss the opportunity to have their students meet their peers where they’re at,” Mercado said. “They need to be speaking the same language, the same vocabulary, the same toolkit, and we do that by aligning to a standard.”