We wholeheartedly agree with Dr. Walsh that simulation— particularly using model scenarios—can be effective in teaching about critical events. However, simulation may not be effective or appropriate for certain kinds of medical errors, such as some failure-to-diagnose cases, operative errors, or system-specific miscommunications. Also, simulation has the relative disadvantages of being relatively costly and time intensive and being difficult to deliver to large numbers of learners simultaneously.
While simulation should clearly have a role in a robust patient-safety training environment, it will not replace directly engaging learners in discussions about malpractice issues and thoughtfully reviewing the most common types of cases. Given the influence of such issues on medical practice, we believe this type of dialogue about malpractice should also be part of the core curriculum for all learners. Further research findings, like those reported by Hochberg et al,1 should help us learn what other methods of patient safety training are most effective, which present the fewest obstacles, and in what combinations they should be used.
Eric J. Alper, MD
Professor of medicine, Department of Medicine, UMassMemorial Medical Center/University of Massachusetts Medical School, Worcester, Massachusetts; [email protected].
Robert M. Wachter, MD
Professor and associate chairman, Department of Medicine, chief, Division of Hospital Medicine, and Marc and Lynne Benioff Endowed Chair, University of California, San Francisco, San Francisco, California.
1 Hochberg MS, Seib CD, Berman RS, Kalet AL, Zabar SR, Pachter HL. Perspective: Malpractice in an academic medical center: A frequently overlooked aspect of professionalism education. Acad Med. 2011;86:365–368. http://journals.lww.com/academicmedicine/Fulltext/2011/03000/Perspective__Malpractice_in_an_Academic_Medical.27.aspx
. Accessed August 10, 2011.