Patient safety training in preventing human error

Patient safety and risk management training is a vital tool in the educational strategy to minimise the effect of human error on patient safety. However, as pointed out by Fiona Moss and Elisabeth Paice, this has not been a priority in medical education. In their paper published in the book Clinical Risk Management, Moss and Paice regretted that ‘training in risk management is deficient in medical curricula and hampered by lack of openness about errors and mistakes’.

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Rona Patey and colleagues also emphasised the need to improve undergraduate patient safety training. In their paper titled Patient safety: helping medical students understand error in healthcare, they supported their position by citing research which showed that ‘medical students do not have a high understanding of patient safety issues’. Similarly, Simon Peterson-Brown, in his paper titled Improving patient safety through education, advocated for the embedding of human factors training in both undergraduate and postgraduate medical curricula.

Jan Steen – The Severe Teacher. Irina on Flikr. https://www.flickr.com/photos/repolco/9539633229/

In their discussion of the objectives of patient safety training, Moss and Paice highlighted the following important goals:

    • To foster the ‘understanding of the inevitability of human error’
    • To know ‘the factors associated with errors’
    • To learn ‘the way in which systems can pick up and alert the practitioner to potential error
    • To teach the ‘appropriate checking behaviour that will minimise mistakes’
    • To convey ‘the importance of safe handover
    • To learn ‘how to respond effectively to errors and mistakes whether made by themselves or others’
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Mark Graber also explored the learning objectives of safety training as it relates to improving the reliability of medical diagnoses. In his paper titled Educational strategies to reduce diagnostic error: can you teach this stuff?, Graber highlighted the following aims of safety training:

    • To improve clinical expertise
    • To instil reflective thinking skills
    • To improve communication skills
    • To learn to apply checklists in the diagnostic process

Graber argued that these goals all help to establish a feedback loop which augments diagnostic reliability and minimises the risk of harm from diagnostic error. He also maintained that these skills help to reduce the ‘communication breakdowns that contribute to diagnostic error’.

Teacher(?) Statue. SpirosK photography on Flickr. https://www.flickr.com/photos/spirosk/5605471805

David Davis, writing in the book Better Doctors, Better Patients, Better Decisions, also explored the objectives of safety training in terms of the essential safety skills trainees need to acquire. These were:

    • The ability to reflect on their practice
    • The ability to evaluate their competencies
    • The ability to determine their learning needs
    • The ability to search for, critically appraise, and apply learning resources ‘to clinical and other questions
    • The ability to ‘manage large and changing bodies of evidence
    • The ability to practice ‘based on subjective and objective feedback
CC BY 2.5, Link

Robert Trowbridge also explored the critical diagnostic cognitive skills that safety training programmes need to impart to trainees. In his paper titled Twelve tips for teaching avoidance of diagnostic errors, Trowbridge discussed the following diagnostic error-reducing skills:

    • The use of ‘diagnostic timeouts
    • The practice of ‘worst case scenario medicine
    • The use of ‘a systematic approach to common problems’
    • The skill of slowing down
    • The habit of ‘asking why
    • The skill of embracing ‘zebras
    • The habit of asking ‘what can’t we explain?’
    • The ability to find ‘clinical data that doesn’t fit with a provisional diagnosis
    • The practice of acknowledging ‘how the patient makes the clinician feel
    • The habit of admitting mistakes
Eratosthenes Teaching in Alexandria. Mark6mauno on Flickr. https://www.flickr.com/photos/mark6mauno/10832052985

In the next pose, we will look at teamwork training in preventing human error.

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