Letters to the Editor
To the Editor:
We urge medical educators to make instruction on patient safety and quality improvement (QI) a priority in medical school curricula. The teaching of these topics to medical students has become critically important, in part because of the ongoing debate on the cost of health care centering on physician practices.
Studies of QI curricula for physicians have shown improvements in the physicians' confidence to undertake QI initiatives.1 However, teaching QI and patient safety to medical students rather than physicians is complicated by at least two factors. Preclinical students often lack the clinical experience necessary to apply improvement solutions to the complex health care environment. And because of competing demands placed on medical curricula, QI and patient safety remain recognized but secondary educational objectives at most medical schools.
For medical schools looking to develop their QI and patient safety curricula, student-led efforts may provide creative ideas. Students are joining extracurricular efforts such as the Institute for Healthcare Improvement's Open School for Health Professions, which offers interactive online modules on patient safety theory, or ImproveHealthCare.org, where a curriculum of online cases puts students at the center of systems-level decisions affecting the quality of their patients' care. Student efforts to improve patient safety are also crossing geographical and professional boundaries. In October 2009, medical and other health professions students from over a dozen countries launched the “Check a Box, Save a Life” campaign: the First Global Student Sprint to Improve Healthcare, a grassroots advocacy effort aimed at encouraging the adoption of the World Health Organization's Safe Surgery Checklist.2
The WHO patient safety curriculum guide,3 currently under pilot-testing, offers an additional comprehensive resource from which schools can build successful courses. Student-led initiatives such as the Global Student Sprint speak to the enthusiasm of students for health reform, but health reform must start with education. Instead of being passive assimilators of change, students can and should play a role in shaping the discourse around improving medical education to ensure that physicians will provide truly quality-conscious and cost-effective health care.
The authors would like to acknowledge John Rose and Andrew Carson-Stevens for their comments on the draft.
Thomas C. Tsai, MPH
Medical student, Stanford University School of Medicine, Stanford, California; firstname.lastname@example.org.
Jordan D. Bohnen
MD/MBA student, Harvard Medical School and Harvard Business School, Boston, Massachusetts.
Shabnam Hafiz, MPH
Medical student, University of California, Davis, School of Medicine, Sacramento, California.
1 Boonyasai RT, Windish DM, Chakraborti C, Feldman LS, Rubin HR, Bass EB. Effectiveness of teaching quality improvement to clinicians: A systematic review. JAMA. 2007;298:1023–1037.
2 Haynes AB, Weiser TG, Berry WR, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009;360:491–499.
3 Ellis O. Putting safety on the curriculum. BMJ. 2009;339:b3725.