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Teaching and Learning in Medicine
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Designing a Patient Safety Undergraduate Medical Curriculum: The
Telluride Interdisciplinary Roundtable Experience
David Mayera
; Debra L. Klamenb
; Anne Gundersonc
; Paul Barachd
a
Institute for Patient Safety Excellence, University of Illinois at Chicago College of Medicine, Chicago,
Illinois, USA b
Office of Education and Curriculum and Department of Medical Education, Southern
Illinois University School of Medicine, Springfield, Illinois, USA c
Undergraduate Medical Education
and Interprofessional Patient Safety Education and Research, University of Illinois at Chicago,
Chicago, Illinois, USA d
Anesthesiology, University of South Florida, Tampa, Florida, USA
To cite this Article Mayer, David , Klamen, Debra L. , Gunderson, Anne and Barach, Paul(2009) 'Designing a Patient
Safety Undergraduate Medical Curriculum: The Telluride Interdisciplinary Roundtable Experience', Teaching and
Learning in Medicine, 21: 1, 52 — 58
To link to this Article: DOI: 10.1080/10401330802574090
URL: http://dx.doi.org/10.1080/10401330802574090
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Teaching and Learning in Medicine, 21(1), 52–58
Copyright © 2009, Taylor & Francis Group, LLC
ISSN: 1040-1334 print / 1532-8015 online
DOI: 10.1080/10401330802574090
SPECIAL ARTICLES
Designing a Patient Safety Undergraduate Medical
Curriculum: The Telluride Interdisciplinary Roundtable
Experience
David Mayer
Institute for Patient Safety Excellence, University of Illinois at Chicago College of Medicine, Chicago,
Illinois, USA
Debra L. Klamen
Office of Education and Curriculum and Department of Medical Education, Southern Illinois University
School of Medicine, Springfield, Illinois, USA
Anne Gunderson
Undergraduate Medical Education and Interprofessional Patient Safety Education and Research,
University of Illinois at Chicago, Chicago, Illinois, USA
Paul Barach
Anesthesiology, University of South Florida, Tampa, Florida, USA
Purpose: Patient safety has emerged as a global concern in
the provision of quality health care, and yet, to date, few medical
schools have created and/or implemented patient safety curricula.
The purpose of this article is to introduce readers to one model of a
patient safety undergraduate medical curriculum, as designed by a
group of experts attending an annual interdisciplinary roundtable
assembled for this purpose. Summary: The Annual Telluride In-
terdisciplinary Roundtable met in 2005 and 2006 to design what
it considered to be a comprehensive patient safety curriculum for
medical students. Invited members included stakeholders from a
variety of fields, including health care providers, senior health
care administration, students, residents, patient advocacy lead-
ers, and curriculum development/assessment experts. The group
developed a list of general curricular principles, followed by 11
specific elements felt to be essential to an effective patient safety
curriculum for undergraduate medical education students. It also
identified a number of challenges to implementing such a curricu-
lum. Conclusions: A patient safety curriculum, developed by a
group of experts for an undergraduate medical education popu-
lation, was successfully developed over a two-year period of time.
Future meetings of the Telluride Roundtable group have centered
on evaluation and refinement of these curricular elements as pilots
Final revision received 20 October 2007.
We acknowledge the efforts and tireless dedication of the Telluride
Roundtable members in both years 2005 and 2006.
Correspondence may be sent to David Mayer, M.D., University of
Illinois Hospital, 1740 W. Taylor M/C 515, Chicago, IL 60612, USA.
E-mail: dmayer1@uic.edu
occur in a number of medical schools, and new curricular ideas
continue to be developed. Continued interprofessional dialogue
and collaborative research will enable the development and im-
plementation of a standardized longitudinal patient safety student
curriculum.
INTRODUCTION
The goal of a medical education curriculum is to prepare stu-
dents to address problems that affect the health of the public.1
Medical errors and patient safety have emerged as global con-
cerns in the provision of quality health care. There has been
considerable discussion in both the public and private sectors
regarding ways to modify the current medical system to ad-
dress the concerns raised by the Institute of Medicine’s (IOM’s)
1999 report, titled “To Err Is Human; Building a Safer Health
System.”2
The IOM’s report estimated that as many as 98,000
patients die every year from preventable medical errors in hos-
pitals. In their follow-up report, “Crossing the Quality Chasm:
A New Health System for the 21st Century,” the IOM called
for change in the education and training of physicians in or-
der to address these problems.3
Dr. Jordan Cohen, then Presi-
dent of the Association of American Medical Colleges, stated
there needed to be a “collaborative effort to ensure that the
next generation of physicians is adequately prepared to rec-
ognize the sources of error in medical practice, to acknowl-
edge their own vulnerability to error, and to engage fully in the
52
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DESIGNING PATIENT SAFETY CURRICULUM 53
process of continuous quality improvement.”4
However, seri-
ous discussions on the design, implementation, assessment, and
faculty development needs of patient safety education in under-
graduate medical education have been sparse. Although patient
safety has been increasingly recognized as a key dimension of
quality care, there are few published reports addressing the de-
sign, implementation, and assessment of undergraduate patient
safety education. These include introductory workshops in pa-
tient safety,5–8
Crisis Resource Management education based
on lessons learned in the aviation industry,9
calls for safe medi-
cation prescribing10–12
continuous quality improvement,13
and
case-based learning opportunities.14
Nursing faculty have begun
to address patient safety education for new nurses through the
Quality and Safety Education for Nurses initiative (http://www.
qsen.org/). However, considerable effort in areas of patient
safety education is still needed to meet the calls for curricu-
lar redesign.
STRUCTURE OF THE ROUNDTABLE MEETING
Identifying and implementing a curriculum that instills the
necessary knowledge, skills, and attitudes related to patient
safety is challenging to undergraduate medical education. Med-
ical educators from the University of Illinois at Chicago
organized an annual invitational roundtable titled “Design-
ing a Patient Safety and Quality Outcomes Health Science
Curriculum” under the auspices of the Telluride Scientific
Research Conference and the Smithsonian Institute (http://www.
telluridescience.org/). The roundtable is supported by educa-
tional grants from the University of Illinois at Chicago Col-
lege of Medicine and Southern Illinois University School of
Medicine. Two roundtables were held in the summers of 2005
and 2006. Members of the roundtables included stakeholders
from the fields of nursing, pharmacy, medicine, public health,
and law, as well as senior health care administration, students,
residents, and patient advocacy leaders. Content experts in-
cluded those in medical education, curriculum innovation, fac-
ulty development, error science, simulator science, quality care,
informatics, risk management, law, and accreditation. (See end
of article for a complete list of attendees, their job titles, and
what year(s) they attended the conference.)
Stakeholders and content experts began to develop a struc-
tural framework for a patient safety curriculum through con-
versations and communications prior to the roundtable. The
roundtable participants met for 4 days in August 2005 and
again in August 2006 in Telluride, Colorado, to begin a de-
liberative inquiry process into the design of an interdisciplinary
patient safety curriculum. There was considerable overlap in
attendees for 2005 and 2006, though the groups were not iden-
tical. Roundtable activities included discussions of the current
literature, identification of appropriate educational methodolo-
gies, and recommendations on the design of a patient safety
curriculum as outlined in this article.
OUTCOMES OF THE ROUNDTABLE MEETINGS
The roundtable discussions have to date yielded three main
outcomes that need to be addressed in a new undergraduate
curriculum on patient safety.
Seeing Health Care (and Health Care Education) Through
a Different Lens
To be successful, a patient safety curriculum will require
a qualitative culture shift in the way students and educators
think about health care education. Health care education, as
it currently exists, is focused on an individual’s performance
and assessment of that performance. The educational system
is also silo based—for example, very little interprofessional or
team education occurs. Education, like hospital care, is orga-
nized around specific functions; medical students learn to write
prescriptions, pharmacy students learn to issue the medication,
and nursing students learn to deliver it to patients. Not much
attention, however, is paid to the systems needed to link all
these functions, and the health care students, into a coherent,
integrated, and safe system. In addition, the recognition of the
system as a source of error is generally not addressed in the
training of students. Instead, students are trained to individu-
ally meet their patients’ immediate needs while working around
recurrent system problems, ambiguities, and inefficiencies.
An example of an interdisciplinary systems approach to
reducing medical error may be illustrative to highlight the
difference in seeing health care through this different lens, a
necessary shift if a patient safety curriculum is to be successful.
The Center for Disease Control estimates that sepsis arising
from the insertion of a central venous line affects up to 250,000
patients a year in the United States, killing 15% or more.15
In
an individual silo-based approach to this problem, physicians
might receive additional training as to how to insert the line
more safely, using simulators and other advanced technology.
Beyond that, occasional sepsis arising from central venous line
insertion might be considered an unavoidable consequence
of an invasive procedure. If the health care team approached
the problem from a microsystems perspective, however, other
potential solutions might be considered:16
using transparent
dressings to improve the visibility of the wound to caregivers;
asking a nurse to supervise every insertion of a central line,
watching for lapses in sterile technique, and stopping the
procedure if such a lapse is seen; and avoiding femoral lines
if possible because of increased infection risk. These and
other countermeasures have been instituted in a few hospitals
already utilizing systems perspective and root cause analysis
approaches, with resulting decreases in infections by as much
as 87%.15
The point, however, is that if health care professionals
in these hospitals had been looking at this problem from a
silo-based perspective only, these risk reduction countermea-
sures would never have been conceived, let alone implemented.
Medical students need to be aware from the beginning of their
training that health care occurs within a system and that they
are part of that system, to see medicine through a different lens.
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54 D. MAYER ET AL.
General Curricular Principles in a Patient Safety
Curriculum
Interprofessional education. Roundtable participants
emphasized that interprofessional education should be a
cornerstone of curricula for health science students and that
interprofessional education should be introduced early in the
educational process. The participants recognized the growing
body of work focused on interprofessional education at the
student level. Notable efforts include the Institute for Healthcare
Improvement Healthcare Professionals Education Collaborative
(http://www.ihi.org/IHI/Topics/HealthProfessionsEducation/);
the Robert Wood Johnson Foundation Partnership for Quality
Education initiative (http://www.pqe.org/); and the IOM’s
report titled “Health Professions Education: A Bridge to
Quality,”17
which called for education and assessment of
health student competency in interprofessional teamwork.
Effective interprofessional teamwork is known to reduce errors
caused by miscommunication and poor patient care handover.18
Grumback and Bodenheimer concluded that research on patient
care teams suggests that cohesive teams where physicians and
other health care professionals work together are associated
with improved patient outcomes.19
Improved teamwork skills
and greater collaboration between professions have been linked
with safe and effective health care.20
Students need to be aware
of these outcome improvements. In addition, students need to
both understand and experience firsthand the fact that “interpro-
fessional learning consists of more than just sharing the same
learning environment: it involves acquiring an understanding of
the knowledge base, values and ethos of like-minded individuals
and developing respect for each others’ contribution to the learn-
ing process”21
(p. 147). We cannot expect that students educated
in the current silo model of training will be able to effectively
work in interprofessional teams once they have finished their
training.
Longitudinal curricular approach. Roundtable members
believe that longitudinal approaches must be employed in pa-
tient safety education at the undergraduate level. Practicing and
reinforcing safety skills at each level are key elements in effec-
tive learning. The Dreyfus educational model has been used to
describe five longitudinal stages in the development of knowl-
edge and skills of pilots.22
Similar developmental processes
have been seen in chess players, adults learning a second lan-
guage, and adults learning to drive an automobile.Batalden
defined medical education and physician development as a
continuum starting at the beginning of medical school and
continuing throughout a practitioner’s professional career and
argued that the Dreyfus learning model could be applied to med-
ical education.23
The first stage of the Dreyfus model (“novice
stage”) is where basic concepts, skills and values are learned. For
clinical skills, Batalden noted, “this is where the beginning stu-
dent starts learning how to take a medical history through memo-
rization of the chief complaint, history of present illness, review
of systems and family and social history.” In the second stage,
known as the advanced beginner stage, students begin to exper-
iment with limited applications. It is in this second stage that
the third year medical student begins to appreciate common situa-
tions such as those facing hospitalized patients (admissions, rounds,
discharge) that can only be learned through experience.
The remaining three stages continue through residency and mid-
career, where the recognition of patterns and the use of intuition
are the major work drivers.
In similar fashion, a basic understanding of the concepts
and values of patient safety should be introduced early in the
curriculum, preferably in the first 2 years, followed by the super-
vised experimentation and application of these concepts during
clinical clerkships and on into graduate education.
Advanced patient safety educational opportunities for senior
students. Roundtable participants agreed that students seeking
further knowledge in patient safety should have access to more
intensive educational opportunities as electives. Further train-
ing in advanced competencies could help interested students
develop into leaders, researchers, and scholars in the patient
safety field.
Teaching methodologies. There are a number of different
strategies and educational modalities that roundtable partici-
pants thought should be utilized in addressing patient safety
education at the undergraduate level. These include plenaries,
small-group learning sessions, experiential learning, simulation,
standardized patient role-plays, case-based learning, individual
and team-based learning, and supportive audio-visual material.
Deliberate practice, a regimen of effortful activities coupled
with immediate feedback, designed to optimize improvement,
is the key to effective learning and retention of patient safety
information, as well as the requisite skills and attitudes.24
Assessment strategies. Roundtable participants stressed
that health profession students will need to be assessed in their
abilities as team members, not just individually, in a successful
patient safety curriculum. Their abilities to see systems-based
problems and inefficiencies and to offer systemic solutions
through root cause analyses will also need to be assessed.
These skills are not easily acquired but are nonetheless critical
to enable optimal performance in a health care environment
focused on patient safety. Assessment strategies that could
be used include the use of multiple choice questions for
patient safety knowledge, team-based assessment of groups
of interprofessional students as they work through a clinical
scenario, standardized patient assessment of full disclosure
skills, and the evaluation of student quality improvement
projects undertaken in the 3rd year of medical school.
Specific Content for a Patient Safety Curriculum
Roundtable participants agreed on 11 specific elements of
curriculum content that they believe are essential for an ef-
fective patient safety curriculum at the undergraduate medical
education level.
History of the medical error crisis. Students learning about
the scope and history of the medical error crisis will create a
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DESIGNING PATIENT SAFETY CURRICULUM 55
need to know and a call to action on the part of these future
health care professionals. The knowledge of the IOM’s 1999
report2
alone with an estimated 98,000 deaths per year due to
medical errors will be an eye-opener to students, who otherwise
are buried in learning basic science, diagnosis, and treatment
and have been unaware of the crisis. A need to know in the
area of patient safety will move this topic up on the students’
overcrowded attention list. Students should be exposed to this
material early in the 1st year of medical school.
Interdisciplinary teamwork skills. As discussed, these
skills are critical to the success of any patient safety initiative
and are very much absent in today’s undergraduate medical ed-
ucation curricula. Issues such as role clarity, conflict resolution,
chain of command, and the rehearsal of teams to provide care
in specific situations (such as acute trauma or codes) all need
to be addressed.25
Students should learn about their and other
health care provider roles in the system early in their 1st year
of medical school. Subsequently, in the 2nd year, once students
are acclimated to medical school and beginning to think about
working in clinical settings, topics such as hierarchy, chain-
of-command, team-based care, and leadership skills can be
introduced.
Time and stress management. The ability to manage one’s
time and stress, recognize when another health care team mem-
ber is stressed and thus less effective, or recognize when an
entire team is dysfunctional because of stress-related compli-
cations is well documented in safety literature as critical to
continued optimal performance.26
These skills (managing one’s
own time and stress) ought to be introduced to students early
in their 1st year and should be repeated on at least a yearly
basis as a refresher. More sophisticated skills such as recog-
nizing when another health care team member, or indeed the
entire team is stressed, should be introduced once students are
routinely working with these health care team members in the
3rd year.
Health care microsystems. Education in this arena is im-
portant to help students see the health care system through a
new lens, no longer a silo-based approach to health care. Un-
derstanding that health care professionals all work in multiple
microsystems and being effective in doing so as part of a larger
whole are key competencies in patient safety.27
This important
topic should be introduced to students in their 1st year of medical
school, and lends itself to introduction during interprofessional
training.
Informatics, electronic medical records, and health care tech-
nology. A working knowledge of these new developments in
health care will allow students to interact with them and under-
stand their importance in the provision of patient care. Students
should be introduced to these concepts in either the 1st or 2nd
year, well before they must actually interact with these systems
in the 3rd year.
Error science, error management, and human factor science.
An overview of how medical errors occur, how humans make
mistakes, environmental factors predisposing medical errors,
and principles of how to eliminate the errors from health care
systems will begin to equip students to deal with these issues in
their professional lives. This material would best be introduced
in the 2nd year of medical school as students learn other behav-
ioral science material, and in preparation for their entrance to
the clerkships in the 3rd year of medical school, where they will
see errors in health care systems in action and must therefore be
prepared to begin to understand them.
Communication skills. Although there is communication
skills training in undergraduate medical education curricula cur-
rently, a particular focus on errors in communication and how
these might be avoided is lacking. Patient safety communica-
tion content needs to focus on written skills such as order and
prescription writing, as well as chart documentation, and oral
skills such as communication between members of the health
care team during tasks such as hand-offs and consults. These
skills are best introduced in the 2nd year of medical school, as
they must be in place by the time students begin their 3rd-year
clerkships.
Full-disclosure applications. Students need to be trained
in the techniques of full disclosure to patients once an error has
occurred. Attitudes need to be formed early in students that the
admission of mistakes and the ability to say “I don’t know”
are valued, as these attitudes will allow the culture of medicine
to shift to one of patient safety and continuous learning from
mistakes.28
Students should be introduced to the concept of full
disclosure in the 2nd year of medical school and allowed to
practice this skill with standardized patients using simulated
clinical scenarios.
Risk management and root cause analysis. Risks and haz-
ards embedded within the structure and process of care have the
potential for causing injury and/or harm to patients. Accurate
identification of the root causes of events must precede identi-
fication and implementation of appropriate interventions. The
use of risk assessment techniques including process mapping
and failure modes and effects analysis can be used to identify
at which point interventions are most appropriate. This infor-
mation is essential to give health care providers the tools to
address problems in patient safety in a systematic, organized,
and methodical manner.29
It is probably sufficient to introduce
students to the concept that there are such tools available late in
their 2nd year as part of their quality improvement training. The
actual use of these tools might be implemented into the quality
improvement projects assigned to students in their 3rd and/or
4th years.
Outcome measures and continuous quality improvement.
Teaching students to monitor outcome measures and to crit-
ically examine failures in the system as soon as they occur
will lead to improved quality of care.30,31
Health care providers
trained in this model will more rapidly address failures in sys-
tems, rather than continuing workarounds that are demonstrat-
ing themselves to be noneffective. Lessons from industry—in
particular, Toyota—can be used in health care and health care
education to this end.32
Students should learn about issues of
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56 D. MAYER ET AL.
continuous quality improvement late in their 2nd year of medi-
cal school, through the use of clinically based examples, which
will allow them to actively practice these kinds of skills. Later,
in the 3rd and 4th years of medical school, students should be
given continuous quality improvement projects, which will al-
low them to put their knowledge to work in real clinical settings.
Medication errors and reconciliation. Students should be
proficient in the recognition and prevention of medication errors
and reconciliation, as errors are frequent, often systems based,
and amenable to effective countermeasures if examined with a
patient safety lens. The clerkship year seems the reasonable time
to introduce this subject, as students are in the clinical setting. As
such, there will be ample opportunity to practice the recognition
of medication errors and to begin to learn techniques for their
reconciliation.
Barriers to Implementation
Roundtable participants identified a number of challenges
in implementing an undergraduate medical education patient
safety curriculum. First, many physicians and educators serving
as instructors, mentors, and role models have limited knowl-
edge and experience with the competencies required, because
the current medical–legal environment still favors hiding errors
and near-misses instead of learning from them. Indeed, most
physicians believe they provide safe patient care and do not
make mistakes. In a survey given to more than 1,000 doctors,
nurses, and residents in urban teaching and nonteaching hospi-
tals, one third of intensive care staff stated that they have never
made an error.33
However, only one third reported that errors are
handled appropriately, and more than half reported that they find
it difficult to discuss mistakes. It is clear that rather extensive fac-
ulty development will be needed for a successful patient safety
curriculum to be implemented. Second, educational models are
predominantly driven by individual, silo-based performance on
examinations that preferentially reward memorization and recall
of knowledge over application. Kenneth Shine, past-president
of the IOM, concluded that medicine has failed to deliver qual-
ity care to patients, because medicine equates quality with how
much an individual physician knows instead of looking at qual-
ity as how well patients are cared for.34
Changing assessment
strategies to look at interprofessional cooperation and problem
solving will require new methodologies to be developed and im-
plemented, a significant time- and money-consuming endeavor.
Assessment strategies will also need to be modified to reflect the
importance of patient safety education and outcomes. A recent
article by Kachalia et al. reported on the efforts of an expert
panel convened by the American Board of Medical Specialties
to look into the types of patient safety questions that should
be included in medical board certification examinations, which
is encouraging.35
Third, and not inconsequential, will be the
struggle to carve out the time and commitment necessary for
a successful, longitudinal, patient safety curriculum from an
already full curriculum.
SUMMARY AND NEXT STEPS
The goal of a medical education curriculum is to teach stu-
dents to address problems that affect the health of the public, and
patient safety is a concern in the provision of quality health care
that needs to be addressed immediately. Students need to un-
derstand, appreciate, and demonstrate appropriate patient safety
skills early and continuously in their professional educations.
Roundtable participants met for four days each in the summers
of 2005 and 2006 in Telluride, Colorado, to discuss the curric-
ular design of an interdisciplinary patient safety curriculum. If
we are to change the current culture, it is important that students
begin to understand, appreciate, and demonstrate appropriate
skills relative to the prevention of medical error early in their
professional education. Tremendous opportunity exists to pro-
foundly influence the safety of health care delivery by changing
the educational environment, teaching methods, and health pro-
fessional curricula. Although progress has been made, much
more is left to be done. Future meetings of roundtable partici-
pants in Telluride are slated to occur, in which curricular pilots
implemented throughout the year will be discussed; refined;
and, if successful, adopted by others. New curricular opportu-
nities will continue to be discussed and designed. Through this
continued dialogue and ongoing collaborative research, the de-
velopment and implementation of a longitudinal patient safety
curriculum will occur.
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excellence in education (pp. 21–55). Hillsdale, NJ: Erlbaum, 2002.
25. Baker D, Battles J, King H, Salas E, Barach P. The role of teamwork
in the professional education of physicians: Current status and assess-
ment recommendations. Joint Commission Journal on Quality and Safety
2005;31(4):185–202.
26. Sexton JB, Thomas EJ, Helmreich RL. Error, stress and teamwork in
medicine and aviation: Cross-sectional surveys. British Medical Journal
2000;320:745–9.
27. Mohr JJ, Batalden PB, Barach P. Inquiring into the quality and safety of
care in the academic clinical microsystem. In K McLaughlin & A Kaluzny
(Eds.), Continuous quality improvement in health care (3rd ed., pp. 407–
23). Frederick, MD: Aspen, 2005.
28. Cantor M, Barach P, Derse A, Maklan C, Woody G, Fox E. Disclosing
adverse events to patients. Joint Commission Journal on Quality and Safety
2005;31:5–12.
29. Apostolakis G, Barach P. Lessons learned from nuclear power. In M Hatlie
& K Tavill (Eds.), Patient safety, international textbook (pp. 205–25).
Frederick, MD: Aspen, 2003.
30. Vohra P, Daugherty C, Mohr J, Wen M, Barach P. Housestaff and medi-
cal student attitudes towards adverse medical events. JCAHO Journal of
Quality and Safety, 2007, in press.
31. Gould BE, Grey MR, Huntington CG. Improving patient care outcomes
by teaching quality improvement to medical students in community-based
practices. Academic Medicine 2002;77:1011–8.
32. Armstrong EG, Mackey M, Spear SJ. Medical education as a process man-
agement problem. Academic Medicine 2004;79(8):721–8.
33. Sexton JB, Thomas EJ, Helmreich RL. Error, stress and teamwork in
medicine and aviation: Cross-sectional surveys. British Medical Journal
2000;320:745–9.
34. Shine KI. Health care quality and how to achieve it. Academic Medicine
2002;77:91–9.
35. Kachalia A, Johnson J, Miller S, Brennan T. The incorporation of pa-
tient safety into board certifying exams. Academic Medicine 2006;81:317–
25.
LIST OF ROUNDTABLE PARTICIPANTS
Paul Barach, MD, MPH (2005, 2006)
Associate Professor of Anesthesiology
University of South Florida
John Bingham (2005)
Director, Center for Clinical Improvement
Vanderbilt University College of Medicine
Barbara Blakeney, MS, RN (2005)
Past President
American Nursing Association (ANA)
Lydia Cassorla, MD, MBA (2005)
Department of Anesthesiology
University of California at San Francisco Medical Center
Robert M. Galbraith, MD, MBA (2006)
Director for the Center of Innovation.
National Board of Medical Examiners
Anne Gunderson, GNP CRRN-A (2006)
Research Assistant Professor;
Department of Medical Education
University of Illinois Chicago College of Medicine
Pam Hagan, MSN, RN (2006)
Chief Program Officer
American Nursing Association
Helen Haskell (2005, 2006)
Founder and President of Mothers Against Medical Error
(MAME)
Russ Jenkins, MD (2005)
Medical Director
Institute for Safe Medication Practices (ISMP)
Julie K. Johnson (Mohr), M.S.P.H., Ph.D. (2006)
Assistant Professor of Medicine; University of Chicago
Medical Center
Director of Research for the American Board of Medical
Specialties
Debra L. Klamen, M.D., M.H.P.E, F.A. P.A. (2006)
Professor and Chair, Department of Medical Education;
Associate Dean for Education
Southern Illinois University School of Medicine
David Mayer, MD (2005, 2006)
Associate Dean for Curriculum; Co-director Institute for Patient
Safety Excellence
University of Illinois at Chicago College of Medicine
DownloadedBy:[UICUniversityofIllinoisatChicago]At:16:266June2011
58 D. MAYER ET AL.
Tim McDonald, MD JD (2005, 2006)
Associate Chief Medical Officer for Safety, Risk Management
and Quality
Co-director Institute for Patient Safety Excellence
University of Illinois Medical Center at Chicago
Bonnie Miller, MD (2005)
Associate Dean for Undergraduate Medical Education
Vanderbilt University College of Medicine
Lou Oberndorf (2006)
Founder, President and Chief Executive Officer of
Medical Education Technologies, Inc. R
(METI R
)
Ingrid Philibert, MHA, MBA (2006)
Director, Department of Field Activities
Accreditation Council for Graduate Medical Education
(ACGME)
Doris C. Quinn, PhD (2006)
Director of Improvement Education in the Center for Clinical
Improvement
Vanderbilt University
Cary Sennett, MD (2005)
Senior Vice President for Research
American Board of Internal Medicine (ABIM)
Michael Seropian, MD, FRCPC (2006)
Associate Professor; Co-director OHSU Simulation and
Clinical Learning Center.
Oregon Health and Science University (OHSU)
Gwen D. Sherwood, PhD, RN, FAAN (2006)
Professor and Associate Dean for Academic Affairs
University of North Carolina at Chapel Hill School of Nursing
Kenichiro Taneda, MD, MPH (2005, 2006)
Senior Researcher of the Department of Policy Sciences
National Institute of Public Health, Japan
Ara Tekian, PhD MHPE (2006)
Director International Affairs; Department of Medical Educa-
tion
University of Illinois at Chicago College of Medicine
Scott Weber (2005)
President
Physicians Practice
Reed Williams, MD (2005, 2006)
Professor and Vice Chairman for Educational Affairs in the
Department of Surgery
Southern Illinois University School of Medicine
DownloadedBy:[UICUniversityofIllinoisatChicago]At:16:266June2011

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Designingpsundergraduatemedicalcurriculum(1)

  • 1. PLEASE SCROLL DOWN FOR ARTICLE This article was downloaded by: [UIC University of Illinois at Chicago] On: 6 June 2011 Access details: Access Details: [subscription number 931141110] Publisher Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37- 41 Mortimer Street, London W1T 3JH, UK Teaching and Learning in Medicine Publication details, including instructions for authors and subscription information: http://www.informaworld.com/smpp/title~content=t775648180 Designing a Patient Safety Undergraduate Medical Curriculum: The Telluride Interdisciplinary Roundtable Experience David Mayera ; Debra L. Klamenb ; Anne Gundersonc ; Paul Barachd a Institute for Patient Safety Excellence, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA b Office of Education and Curriculum and Department of Medical Education, Southern Illinois University School of Medicine, Springfield, Illinois, USA c Undergraduate Medical Education and Interprofessional Patient Safety Education and Research, University of Illinois at Chicago, Chicago, Illinois, USA d Anesthesiology, University of South Florida, Tampa, Florida, USA To cite this Article Mayer, David , Klamen, Debra L. , Gunderson, Anne and Barach, Paul(2009) 'Designing a Patient Safety Undergraduate Medical Curriculum: The Telluride Interdisciplinary Roundtable Experience', Teaching and Learning in Medicine, 21: 1, 52 — 58 To link to this Article: DOI: 10.1080/10401330802574090 URL: http://dx.doi.org/10.1080/10401330802574090 Full terms and conditions of use: http://www.informaworld.com/terms-and-conditions-of-access.pdf This article may be used for research, teaching and private study purposes. Any substantial or systematic reproduction, re-distribution, re-selling, loan or sub-licensing, systematic supply or distribution in any form to anyone is expressly forbidden. The publisher does not give any warranty express or implied or make any representation that the contents will be complete or accurate or up to date. The accuracy of any instructions, formulae and drug doses should be independently verified with primary sources. The publisher shall not be liable for any loss, actions, claims, proceedings, demand or costs or damages whatsoever or howsoever caused arising directly or indirectly in connection with or arising out of the use of this material.
  • 2. Teaching and Learning in Medicine, 21(1), 52–58 Copyright © 2009, Taylor & Francis Group, LLC ISSN: 1040-1334 print / 1532-8015 online DOI: 10.1080/10401330802574090 SPECIAL ARTICLES Designing a Patient Safety Undergraduate Medical Curriculum: The Telluride Interdisciplinary Roundtable Experience David Mayer Institute for Patient Safety Excellence, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA Debra L. Klamen Office of Education and Curriculum and Department of Medical Education, Southern Illinois University School of Medicine, Springfield, Illinois, USA Anne Gunderson Undergraduate Medical Education and Interprofessional Patient Safety Education and Research, University of Illinois at Chicago, Chicago, Illinois, USA Paul Barach Anesthesiology, University of South Florida, Tampa, Florida, USA Purpose: Patient safety has emerged as a global concern in the provision of quality health care, and yet, to date, few medical schools have created and/or implemented patient safety curricula. The purpose of this article is to introduce readers to one model of a patient safety undergraduate medical curriculum, as designed by a group of experts attending an annual interdisciplinary roundtable assembled for this purpose. Summary: The Annual Telluride In- terdisciplinary Roundtable met in 2005 and 2006 to design what it considered to be a comprehensive patient safety curriculum for medical students. Invited members included stakeholders from a variety of fields, including health care providers, senior health care administration, students, residents, patient advocacy lead- ers, and curriculum development/assessment experts. The group developed a list of general curricular principles, followed by 11 specific elements felt to be essential to an effective patient safety curriculum for undergraduate medical education students. It also identified a number of challenges to implementing such a curricu- lum. Conclusions: A patient safety curriculum, developed by a group of experts for an undergraduate medical education popu- lation, was successfully developed over a two-year period of time. Future meetings of the Telluride Roundtable group have centered on evaluation and refinement of these curricular elements as pilots Final revision received 20 October 2007. We acknowledge the efforts and tireless dedication of the Telluride Roundtable members in both years 2005 and 2006. Correspondence may be sent to David Mayer, M.D., University of Illinois Hospital, 1740 W. Taylor M/C 515, Chicago, IL 60612, USA. E-mail: dmayer1@uic.edu occur in a number of medical schools, and new curricular ideas continue to be developed. Continued interprofessional dialogue and collaborative research will enable the development and im- plementation of a standardized longitudinal patient safety student curriculum. INTRODUCTION The goal of a medical education curriculum is to prepare stu- dents to address problems that affect the health of the public.1 Medical errors and patient safety have emerged as global con- cerns in the provision of quality health care. There has been considerable discussion in both the public and private sectors regarding ways to modify the current medical system to ad- dress the concerns raised by the Institute of Medicine’s (IOM’s) 1999 report, titled “To Err Is Human; Building a Safer Health System.”2 The IOM’s report estimated that as many as 98,000 patients die every year from preventable medical errors in hos- pitals. In their follow-up report, “Crossing the Quality Chasm: A New Health System for the 21st Century,” the IOM called for change in the education and training of physicians in or- der to address these problems.3 Dr. Jordan Cohen, then Presi- dent of the Association of American Medical Colleges, stated there needed to be a “collaborative effort to ensure that the next generation of physicians is adequately prepared to rec- ognize the sources of error in medical practice, to acknowl- edge their own vulnerability to error, and to engage fully in the 52 DownloadedBy:[UICUniversityofIllinoisatChicago]At:16:266June2011
  • 3. DESIGNING PATIENT SAFETY CURRICULUM 53 process of continuous quality improvement.”4 However, seri- ous discussions on the design, implementation, assessment, and faculty development needs of patient safety education in under- graduate medical education have been sparse. Although patient safety has been increasingly recognized as a key dimension of quality care, there are few published reports addressing the de- sign, implementation, and assessment of undergraduate patient safety education. These include introductory workshops in pa- tient safety,5–8 Crisis Resource Management education based on lessons learned in the aviation industry,9 calls for safe medi- cation prescribing10–12 continuous quality improvement,13 and case-based learning opportunities.14 Nursing faculty have begun to address patient safety education for new nurses through the Quality and Safety Education for Nurses initiative (http://www. qsen.org/). However, considerable effort in areas of patient safety education is still needed to meet the calls for curricu- lar redesign. STRUCTURE OF THE ROUNDTABLE MEETING Identifying and implementing a curriculum that instills the necessary knowledge, skills, and attitudes related to patient safety is challenging to undergraduate medical education. Med- ical educators from the University of Illinois at Chicago organized an annual invitational roundtable titled “Design- ing a Patient Safety and Quality Outcomes Health Science Curriculum” under the auspices of the Telluride Scientific Research Conference and the Smithsonian Institute (http://www. telluridescience.org/). The roundtable is supported by educa- tional grants from the University of Illinois at Chicago Col- lege of Medicine and Southern Illinois University School of Medicine. Two roundtables were held in the summers of 2005 and 2006. Members of the roundtables included stakeholders from the fields of nursing, pharmacy, medicine, public health, and law, as well as senior health care administration, students, residents, and patient advocacy leaders. Content experts in- cluded those in medical education, curriculum innovation, fac- ulty development, error science, simulator science, quality care, informatics, risk management, law, and accreditation. (See end of article for a complete list of attendees, their job titles, and what year(s) they attended the conference.) Stakeholders and content experts began to develop a struc- tural framework for a patient safety curriculum through con- versations and communications prior to the roundtable. The roundtable participants met for 4 days in August 2005 and again in August 2006 in Telluride, Colorado, to begin a de- liberative inquiry process into the design of an interdisciplinary patient safety curriculum. There was considerable overlap in attendees for 2005 and 2006, though the groups were not iden- tical. Roundtable activities included discussions of the current literature, identification of appropriate educational methodolo- gies, and recommendations on the design of a patient safety curriculum as outlined in this article. OUTCOMES OF THE ROUNDTABLE MEETINGS The roundtable discussions have to date yielded three main outcomes that need to be addressed in a new undergraduate curriculum on patient safety. Seeing Health Care (and Health Care Education) Through a Different Lens To be successful, a patient safety curriculum will require a qualitative culture shift in the way students and educators think about health care education. Health care education, as it currently exists, is focused on an individual’s performance and assessment of that performance. The educational system is also silo based—for example, very little interprofessional or team education occurs. Education, like hospital care, is orga- nized around specific functions; medical students learn to write prescriptions, pharmacy students learn to issue the medication, and nursing students learn to deliver it to patients. Not much attention, however, is paid to the systems needed to link all these functions, and the health care students, into a coherent, integrated, and safe system. In addition, the recognition of the system as a source of error is generally not addressed in the training of students. Instead, students are trained to individu- ally meet their patients’ immediate needs while working around recurrent system problems, ambiguities, and inefficiencies. An example of an interdisciplinary systems approach to reducing medical error may be illustrative to highlight the difference in seeing health care through this different lens, a necessary shift if a patient safety curriculum is to be successful. The Center for Disease Control estimates that sepsis arising from the insertion of a central venous line affects up to 250,000 patients a year in the United States, killing 15% or more.15 In an individual silo-based approach to this problem, physicians might receive additional training as to how to insert the line more safely, using simulators and other advanced technology. Beyond that, occasional sepsis arising from central venous line insertion might be considered an unavoidable consequence of an invasive procedure. If the health care team approached the problem from a microsystems perspective, however, other potential solutions might be considered:16 using transparent dressings to improve the visibility of the wound to caregivers; asking a nurse to supervise every insertion of a central line, watching for lapses in sterile technique, and stopping the procedure if such a lapse is seen; and avoiding femoral lines if possible because of increased infection risk. These and other countermeasures have been instituted in a few hospitals already utilizing systems perspective and root cause analysis approaches, with resulting decreases in infections by as much as 87%.15 The point, however, is that if health care professionals in these hospitals had been looking at this problem from a silo-based perspective only, these risk reduction countermea- sures would never have been conceived, let alone implemented. Medical students need to be aware from the beginning of their training that health care occurs within a system and that they are part of that system, to see medicine through a different lens. DownloadedBy:[UICUniversityofIllinoisatChicago]At:16:266June2011
  • 4. 54 D. MAYER ET AL. General Curricular Principles in a Patient Safety Curriculum Interprofessional education. Roundtable participants emphasized that interprofessional education should be a cornerstone of curricula for health science students and that interprofessional education should be introduced early in the educational process. The participants recognized the growing body of work focused on interprofessional education at the student level. Notable efforts include the Institute for Healthcare Improvement Healthcare Professionals Education Collaborative (http://www.ihi.org/IHI/Topics/HealthProfessionsEducation/); the Robert Wood Johnson Foundation Partnership for Quality Education initiative (http://www.pqe.org/); and the IOM’s report titled “Health Professions Education: A Bridge to Quality,”17 which called for education and assessment of health student competency in interprofessional teamwork. Effective interprofessional teamwork is known to reduce errors caused by miscommunication and poor patient care handover.18 Grumback and Bodenheimer concluded that research on patient care teams suggests that cohesive teams where physicians and other health care professionals work together are associated with improved patient outcomes.19 Improved teamwork skills and greater collaboration between professions have been linked with safe and effective health care.20 Students need to be aware of these outcome improvements. In addition, students need to both understand and experience firsthand the fact that “interpro- fessional learning consists of more than just sharing the same learning environment: it involves acquiring an understanding of the knowledge base, values and ethos of like-minded individuals and developing respect for each others’ contribution to the learn- ing process”21 (p. 147). We cannot expect that students educated in the current silo model of training will be able to effectively work in interprofessional teams once they have finished their training. Longitudinal curricular approach. Roundtable members believe that longitudinal approaches must be employed in pa- tient safety education at the undergraduate level. Practicing and reinforcing safety skills at each level are key elements in effec- tive learning. The Dreyfus educational model has been used to describe five longitudinal stages in the development of knowl- edge and skills of pilots.22 Similar developmental processes have been seen in chess players, adults learning a second lan- guage, and adults learning to drive an automobile.Batalden defined medical education and physician development as a continuum starting at the beginning of medical school and continuing throughout a practitioner’s professional career and argued that the Dreyfus learning model could be applied to med- ical education.23 The first stage of the Dreyfus model (“novice stage”) is where basic concepts, skills and values are learned. For clinical skills, Batalden noted, “this is where the beginning stu- dent starts learning how to take a medical history through memo- rization of the chief complaint, history of present illness, review of systems and family and social history.” In the second stage, known as the advanced beginner stage, students begin to exper- iment with limited applications. It is in this second stage that the third year medical student begins to appreciate common situa- tions such as those facing hospitalized patients (admissions, rounds, discharge) that can only be learned through experience. The remaining three stages continue through residency and mid- career, where the recognition of patterns and the use of intuition are the major work drivers. In similar fashion, a basic understanding of the concepts and values of patient safety should be introduced early in the curriculum, preferably in the first 2 years, followed by the super- vised experimentation and application of these concepts during clinical clerkships and on into graduate education. Advanced patient safety educational opportunities for senior students. Roundtable participants agreed that students seeking further knowledge in patient safety should have access to more intensive educational opportunities as electives. Further train- ing in advanced competencies could help interested students develop into leaders, researchers, and scholars in the patient safety field. Teaching methodologies. There are a number of different strategies and educational modalities that roundtable partici- pants thought should be utilized in addressing patient safety education at the undergraduate level. These include plenaries, small-group learning sessions, experiential learning, simulation, standardized patient role-plays, case-based learning, individual and team-based learning, and supportive audio-visual material. Deliberate practice, a regimen of effortful activities coupled with immediate feedback, designed to optimize improvement, is the key to effective learning and retention of patient safety information, as well as the requisite skills and attitudes.24 Assessment strategies. Roundtable participants stressed that health profession students will need to be assessed in their abilities as team members, not just individually, in a successful patient safety curriculum. Their abilities to see systems-based problems and inefficiencies and to offer systemic solutions through root cause analyses will also need to be assessed. These skills are not easily acquired but are nonetheless critical to enable optimal performance in a health care environment focused on patient safety. Assessment strategies that could be used include the use of multiple choice questions for patient safety knowledge, team-based assessment of groups of interprofessional students as they work through a clinical scenario, standardized patient assessment of full disclosure skills, and the evaluation of student quality improvement projects undertaken in the 3rd year of medical school. Specific Content for a Patient Safety Curriculum Roundtable participants agreed on 11 specific elements of curriculum content that they believe are essential for an ef- fective patient safety curriculum at the undergraduate medical education level. History of the medical error crisis. Students learning about the scope and history of the medical error crisis will create a DownloadedBy:[UICUniversityofIllinoisatChicago]At:16:266June2011
  • 5. DESIGNING PATIENT SAFETY CURRICULUM 55 need to know and a call to action on the part of these future health care professionals. The knowledge of the IOM’s 1999 report2 alone with an estimated 98,000 deaths per year due to medical errors will be an eye-opener to students, who otherwise are buried in learning basic science, diagnosis, and treatment and have been unaware of the crisis. A need to know in the area of patient safety will move this topic up on the students’ overcrowded attention list. Students should be exposed to this material early in the 1st year of medical school. Interdisciplinary teamwork skills. As discussed, these skills are critical to the success of any patient safety initiative and are very much absent in today’s undergraduate medical ed- ucation curricula. Issues such as role clarity, conflict resolution, chain of command, and the rehearsal of teams to provide care in specific situations (such as acute trauma or codes) all need to be addressed.25 Students should learn about their and other health care provider roles in the system early in their 1st year of medical school. Subsequently, in the 2nd year, once students are acclimated to medical school and beginning to think about working in clinical settings, topics such as hierarchy, chain- of-command, team-based care, and leadership skills can be introduced. Time and stress management. The ability to manage one’s time and stress, recognize when another health care team mem- ber is stressed and thus less effective, or recognize when an entire team is dysfunctional because of stress-related compli- cations is well documented in safety literature as critical to continued optimal performance.26 These skills (managing one’s own time and stress) ought to be introduced to students early in their 1st year and should be repeated on at least a yearly basis as a refresher. More sophisticated skills such as recog- nizing when another health care team member, or indeed the entire team is stressed, should be introduced once students are routinely working with these health care team members in the 3rd year. Health care microsystems. Education in this arena is im- portant to help students see the health care system through a new lens, no longer a silo-based approach to health care. Un- derstanding that health care professionals all work in multiple microsystems and being effective in doing so as part of a larger whole are key competencies in patient safety.27 This important topic should be introduced to students in their 1st year of medical school, and lends itself to introduction during interprofessional training. Informatics, electronic medical records, and health care tech- nology. A working knowledge of these new developments in health care will allow students to interact with them and under- stand their importance in the provision of patient care. Students should be introduced to these concepts in either the 1st or 2nd year, well before they must actually interact with these systems in the 3rd year. Error science, error management, and human factor science. An overview of how medical errors occur, how humans make mistakes, environmental factors predisposing medical errors, and principles of how to eliminate the errors from health care systems will begin to equip students to deal with these issues in their professional lives. This material would best be introduced in the 2nd year of medical school as students learn other behav- ioral science material, and in preparation for their entrance to the clerkships in the 3rd year of medical school, where they will see errors in health care systems in action and must therefore be prepared to begin to understand them. Communication skills. Although there is communication skills training in undergraduate medical education curricula cur- rently, a particular focus on errors in communication and how these might be avoided is lacking. Patient safety communica- tion content needs to focus on written skills such as order and prescription writing, as well as chart documentation, and oral skills such as communication between members of the health care team during tasks such as hand-offs and consults. These skills are best introduced in the 2nd year of medical school, as they must be in place by the time students begin their 3rd-year clerkships. Full-disclosure applications. Students need to be trained in the techniques of full disclosure to patients once an error has occurred. Attitudes need to be formed early in students that the admission of mistakes and the ability to say “I don’t know” are valued, as these attitudes will allow the culture of medicine to shift to one of patient safety and continuous learning from mistakes.28 Students should be introduced to the concept of full disclosure in the 2nd year of medical school and allowed to practice this skill with standardized patients using simulated clinical scenarios. Risk management and root cause analysis. Risks and haz- ards embedded within the structure and process of care have the potential for causing injury and/or harm to patients. Accurate identification of the root causes of events must precede identi- fication and implementation of appropriate interventions. The use of risk assessment techniques including process mapping and failure modes and effects analysis can be used to identify at which point interventions are most appropriate. This infor- mation is essential to give health care providers the tools to address problems in patient safety in a systematic, organized, and methodical manner.29 It is probably sufficient to introduce students to the concept that there are such tools available late in their 2nd year as part of their quality improvement training. The actual use of these tools might be implemented into the quality improvement projects assigned to students in their 3rd and/or 4th years. Outcome measures and continuous quality improvement. Teaching students to monitor outcome measures and to crit- ically examine failures in the system as soon as they occur will lead to improved quality of care.30,31 Health care providers trained in this model will more rapidly address failures in sys- tems, rather than continuing workarounds that are demonstrat- ing themselves to be noneffective. Lessons from industry—in particular, Toyota—can be used in health care and health care education to this end.32 Students should learn about issues of DownloadedBy:[UICUniversityofIllinoisatChicago]At:16:266June2011
  • 6. 56 D. MAYER ET AL. continuous quality improvement late in their 2nd year of medi- cal school, through the use of clinically based examples, which will allow them to actively practice these kinds of skills. Later, in the 3rd and 4th years of medical school, students should be given continuous quality improvement projects, which will al- low them to put their knowledge to work in real clinical settings. Medication errors and reconciliation. Students should be proficient in the recognition and prevention of medication errors and reconciliation, as errors are frequent, often systems based, and amenable to effective countermeasures if examined with a patient safety lens. The clerkship year seems the reasonable time to introduce this subject, as students are in the clinical setting. As such, there will be ample opportunity to practice the recognition of medication errors and to begin to learn techniques for their reconciliation. Barriers to Implementation Roundtable participants identified a number of challenges in implementing an undergraduate medical education patient safety curriculum. First, many physicians and educators serving as instructors, mentors, and role models have limited knowl- edge and experience with the competencies required, because the current medical–legal environment still favors hiding errors and near-misses instead of learning from them. Indeed, most physicians believe they provide safe patient care and do not make mistakes. In a survey given to more than 1,000 doctors, nurses, and residents in urban teaching and nonteaching hospi- tals, one third of intensive care staff stated that they have never made an error.33 However, only one third reported that errors are handled appropriately, and more than half reported that they find it difficult to discuss mistakes. It is clear that rather extensive fac- ulty development will be needed for a successful patient safety curriculum to be implemented. Second, educational models are predominantly driven by individual, silo-based performance on examinations that preferentially reward memorization and recall of knowledge over application. Kenneth Shine, past-president of the IOM, concluded that medicine has failed to deliver qual- ity care to patients, because medicine equates quality with how much an individual physician knows instead of looking at qual- ity as how well patients are cared for.34 Changing assessment strategies to look at interprofessional cooperation and problem solving will require new methodologies to be developed and im- plemented, a significant time- and money-consuming endeavor. Assessment strategies will also need to be modified to reflect the importance of patient safety education and outcomes. A recent article by Kachalia et al. reported on the efforts of an expert panel convened by the American Board of Medical Specialties to look into the types of patient safety questions that should be included in medical board certification examinations, which is encouraging.35 Third, and not inconsequential, will be the struggle to carve out the time and commitment necessary for a successful, longitudinal, patient safety curriculum from an already full curriculum. SUMMARY AND NEXT STEPS The goal of a medical education curriculum is to teach stu- dents to address problems that affect the health of the public, and patient safety is a concern in the provision of quality health care that needs to be addressed immediately. Students need to un- derstand, appreciate, and demonstrate appropriate patient safety skills early and continuously in their professional educations. Roundtable participants met for four days each in the summers of 2005 and 2006 in Telluride, Colorado, to discuss the curric- ular design of an interdisciplinary patient safety curriculum. If we are to change the current culture, it is important that students begin to understand, appreciate, and demonstrate appropriate skills relative to the prevention of medical error early in their professional education. Tremendous opportunity exists to pro- foundly influence the safety of health care delivery by changing the educational environment, teaching methods, and health pro- fessional curricula. Although progress has been made, much more is left to be done. Future meetings of roundtable partici- pants in Telluride are slated to occur, in which curricular pilots implemented throughout the year will be discussed; refined; and, if successful, adopted by others. New curricular opportu- nities will continue to be discussed and designed. 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LIST OF ROUNDTABLE PARTICIPANTS Paul Barach, MD, MPH (2005, 2006) Associate Professor of Anesthesiology University of South Florida John Bingham (2005) Director, Center for Clinical Improvement Vanderbilt University College of Medicine Barbara Blakeney, MS, RN (2005) Past President American Nursing Association (ANA) Lydia Cassorla, MD, MBA (2005) Department of Anesthesiology University of California at San Francisco Medical Center Robert M. Galbraith, MD, MBA (2006) Director for the Center of Innovation. National Board of Medical Examiners Anne Gunderson, GNP CRRN-A (2006) Research Assistant Professor; Department of Medical Education University of Illinois Chicago College of Medicine Pam Hagan, MSN, RN (2006) Chief Program Officer American Nursing Association Helen Haskell (2005, 2006) Founder and President of Mothers Against Medical Error (MAME) Russ Jenkins, MD (2005) Medical Director Institute for Safe Medication Practices (ISMP) Julie K. Johnson (Mohr), M.S.P.H., Ph.D. (2006) Assistant Professor of Medicine; University of Chicago Medical Center Director of Research for the American Board of Medical Specialties Debra L. Klamen, M.D., M.H.P.E, F.A. P.A. (2006) Professor and Chair, Department of Medical Education; Associate Dean for Education Southern Illinois University School of Medicine David Mayer, MD (2005, 2006) Associate Dean for Curriculum; Co-director Institute for Patient Safety Excellence University of Illinois at Chicago College of Medicine DownloadedBy:[UICUniversityofIllinoisatChicago]At:16:266June2011
  • 8. 58 D. MAYER ET AL. Tim McDonald, MD JD (2005, 2006) Associate Chief Medical Officer for Safety, Risk Management and Quality Co-director Institute for Patient Safety Excellence University of Illinois Medical Center at Chicago Bonnie Miller, MD (2005) Associate Dean for Undergraduate Medical Education Vanderbilt University College of Medicine Lou Oberndorf (2006) Founder, President and Chief Executive Officer of Medical Education Technologies, Inc. R (METI R ) Ingrid Philibert, MHA, MBA (2006) Director, Department of Field Activities Accreditation Council for Graduate Medical Education (ACGME) Doris C. Quinn, PhD (2006) Director of Improvement Education in the Center for Clinical Improvement Vanderbilt University Cary Sennett, MD (2005) Senior Vice President for Research American Board of Internal Medicine (ABIM) Michael Seropian, MD, FRCPC (2006) Associate Professor; Co-director OHSU Simulation and Clinical Learning Center. Oregon Health and Science University (OHSU) Gwen D. Sherwood, PhD, RN, FAAN (2006) Professor and Associate Dean for Academic Affairs University of North Carolina at Chapel Hill School of Nursing Kenichiro Taneda, MD, MPH (2005, 2006) Senior Researcher of the Department of Policy Sciences National Institute of Public Health, Japan Ara Tekian, PhD MHPE (2006) Director International Affairs; Department of Medical Educa- tion University of Illinois at Chicago College of Medicine Scott Weber (2005) President Physicians Practice Reed Williams, MD (2005, 2006) Professor and Vice Chairman for Educational Affairs in the Department of Surgery Southern Illinois University School of Medicine DownloadedBy:[UICUniversityofIllinoisatChicago]At:16:266June2011