First, do o harm Ehacig patiet safety teachig i udergraduate medical educatio A joit report by the Geeral Medical Coucil ad the Medical Schools Coucil Geeral Medical Coucil 1
A shared commitmet Medical schools, represeted by the Medical Schools Coucil (MSC), commit to the followig priciple. Udergraduate medical educatio should cotiue to prepare studets to appreciate the role of systems ad processes i esurig patiet safety. Studets eed to uderstad the ratioale for these safety systems ad processes, the importace of complyig with them, ad the risks to safety associated with attempts to circumvet them. The Geeral Medical Coucil (GMC) commits to supportig the developmet of excellece i the teachig of patiet safety. It does this by cotiuig to look for ad to share best practice through its quality assurace process, ad implemetig Promotig excellece 1 a ew set of stadards that will support schools to keep safety at the heart of udergraduate medical educatio. They eed to uderstad the types ad causes of errors i healthcare ad be familiar with key safety-improvemet tools such as root cause aalysis. They also eed to work well i teams, ad to value the cotributio of good team-workig to safer care. Their educatio should provide them with suitable motivatio ad skills to desig, implemet ad improve safety systems ad processes throughout their career. The Medical Schools Coucil The Uiversity of Buckigham ad the Uiversity of Cetral Lacashire, which are ot yet fully accredited by the GMC ad therefore are also ot curretly MSC members, also commit to the priciple.
Cotets Foreword 02 What has prompted the move towards teachig patiet safety? 04 Why have we writte this report? 08 Opportuities ad challeges of teachig patiet safety 10 Curriculum topics ad medical schools examples 20 Medical schools examples of udergraduate patiet safety teachig iitiatives 26 Safety ideas from the GMC 2015 aual coferece 36 What we do 38 Refereces 40 Geeral Medical Coucil 01
Foreword Today s icreasigly complex healthcare systems offer huge beefits to patiets, but also place them at risk the scale of which has oly recetly become apparet. Despite the best efforts of healthcare professioals, estimates suggest as may as 1 i 10 hospital patiets i the UK suffer harm durig the delivery of care. 2 Reducig the burde of this harm is a huge challege for healthcare systems, ad oe i which success will deped to a large part o educatio. As the doctors of tomorrow, today s medical studets will be equipped with the kowledge, skills ad behaviours to practise safely ad to improve the safety of the systems i which they work. A shared commitmet towards patiet safety The GMC ad the MSC recogise that cliical ad o-cliical learig eviromets must do all they ca to promote the value of patiet safety. I the past, those who orgaise ad provide healthcare have bee slow to recogise that this is a safety critical idustry that ot oly requires systems to reduce the likelihood of harm to patiets but also requires a educatio ad traiig system that cultivates a differet approach to care i which safety ad quality are cetral. That is why the safety of patiets is at the core of the GMC s ew stadards for educatio ad traiig; 1 this icludes the expectatio that traiig should take place i a ope ad hoest learig culture. 3 UK medical schools recogise this ad are developig a umber of iitiatives to put the disciplie of patiet safety at the forefrot of the mids of ew medical graduates. The GMC will support them i this edeavour by cotiuig to look for ad share best practice relatig to patiet safety particularly as we implemet the ew stadards for medical educatio ad traiig. We are delighted i this report to uderlie our shared commitmet to make the teachig of patiet safety a key priority. As well as highlightig ad reiforcig the commitmet from medical schools to teach patiet safety, we hope this report will serve as a useful sapshot of curret progress, ad focus attetio o areas where future work could be cocetrated. 02 Geeral Medical Coucil
Takig o ew challeges i a developig area Icorporatig the relatively ew ad still developig disciplie of patiet safety ito established curricula has brought challeges the discussios which iformed this report with medical schools, doctors, medical studets ad other groups show that while there has bee great progress, there is some way still to go. First amog these challeges is the eed to embed a ope ad trasparet safety culture ito the cliical eviromets where studets lear. I this report we have focused o udergraduate patiet safety teachig. The lessos that studets lear i medical school set the toe for the rest of their educatio ad traiig. The work we have doe for this report has show that much of the jourey so far has bee achieved through idividual cotributios, from ethusiasts withi medical schools ad from doctors i traiig ad studets themselves. To highlight some of these cotributios, this report icludes examples of medical school iitiatives, as well as details of patiet safety projects from medical studets ad doctors i traiig. I additio, we have icluded suggestios for reforms to improve safety that were submitted to the GMC 2015 aual coferece. We very much hope this short report recogises the great work that is uderway ad ispires others to move forward with this vital work. However, postgraduate traiig ad cotiuig professioal developmet are also critical i developig the safety leaders of the future. At each stage, progress made by oe group will traslate ito a stroger safety culture i the learig eviromet itself, ad make it easier for future groups to lear. Niall Dickso GMC, Chief Executive Dr Katie Petty-Sapho MSC, Chief Executive Geeral Medical Coucil 03
What has prompted the move towards teachig patiet safety? 04 Geeral Medical Coucil
While first, do o harm is oe of the earliest lessos that ew medical studets lear, this priciple has traditioally bee applied at the level of a idividual doctor s actios. a focus o the culture i which healthcare professioals work, ad the cotributio that opeess ad trasparecy, with patiets ad betwee professioals, makes to safer care The relatively ew field of patiet safety looks more broadly at the way healthcare is delivered. As defied by the World Health Orgaisatio (WHO), the disciplie of patiet safety is the coordiated efforts to prevet harm, caused by the process of health care itself, from occurrig to patiets (see www.who.it/ patietsafety/about). The rise of the patiet safety movemet itself, ad the case for formal traiig for medical studets i patiet safety, are both commoly traced back to the semial Istitute of Medicie report To Err Is Huma (1999). 4 Steps i the developmet of patiet safety sciece ad its adoptio ito maistream healthcare thought have icluded: 5 a realisatio that error is ot ecessarily associated with icompetece, ad that puishmet or blame have ot bee effective i reducig harm a icreasig iterest i the disciplie of huma factors, or ergoomics, as a way to better uderstad the systems i which professioals work ad the way that system factors cotribute to harm a recogitio that healthcare has lessos to lear from other high-risk idustries, which have foud effective ways to reduce harm through buildig a safety culture, workig better i teams ad sharig lessos leart from adverse evets ad ear misses. As the disciplie has evolved, medical educators have worked to defie how patiet safety should be icluded i curricula. A key milestoe i this was the publicatio of the WHO Patiet Safety Curriculum Guide for Medical Schools i 2009, 6 which drew heavily o the Australia Natioal Patiet Safety Educatio Framework. 7, 8 Geeral Medical Coucil 05
The four coutry cotext i the UK The rise of patiet safety as a disciplie is global, ad developmets i patiet safety educatio ad traiig are reflected across the four atios of the UK. A key documet for the Natioal Health Service (NHS) i Eglad was the Berwick review A promise to lear a commitmet to act. 9 Recommedatio 5 of the Berwick review was: Mastery of quality ad patiet safety scieces ad practices should be part of iitial preparatio ad lifelog educatio of all health care professioals, icludig maagers ad executives. Followig the Berwick review, the Natioal Quality Board s Huma Factors i Healthcare cocordat committed to icludig huma factors priciples ad practices ito core educatio ad traiig curricula i the NHS i Eglad. 10 The 2015 Departmet of Health report Culture chage i the NHS put forward a visio of medical studets as the eyes ad ears of the service today ad the safety leaders of the future. 11 Health Educatio Eglad has established a Commissio o Educatio ad Traiig for Patiet Safety. It will make recommedatios to make sure that all healthcare staff ad, i particular those i traiig, are fully aware of all aspects of patiet safety, icludig raisig cocers ad respodig to those cocers. 06 Geeral Medical Coucil
I Scotlad, work is uder way towards a atioal agreemet o the way that quality improvemet ad patiet safety teachig will be delivered. To this ed, the Scottish Govermet, the Scottish Deas Medical Educatio Group ad NHS Educatio for Scotlad are workig with Scottish medical schools ad the Scottish Foudatio School to assess how their curricula deliver patiet safety teachig. Health ad social care professioals i Norther Irelad have formed a task group as part of the Departmet of Health, Social Services ad Public Safety s Quality 2020 iitiative. The task group aims to agree the cotet ad itroductio of a commo curriculum for patiet safety, for udergraduate ad postgraduate teachig ad traiig programmes i health ad social care. * Other schemes that cotribute to patiet safety iclude: Healthcare Improvemet Scotlad s Scottish Patiet Safety Programme NHS Wales 1000 Lives Plus programme Norther Irelad s Quality 2020 iitiative NHS Eglad s Sig up to Safety campaig, Patiet Safety Collaboratives ad the Q iitiative led by the Health Foudatio. * See www.gmc-uk.org/educatio/good_practice.asp Geeral Medical Coucil 07
Why have we writte this report? 08 Geeral Medical Coucil
The GMC ad the MSC agree o the importace of patiet safety teachig for medical studets, ad o the eed to: We also asked medical schools to submit teachig iitiatives to iform this report. Some of these iitiatives are featured i the followig two sectios. set high stadards support medical schools patiet safety iitiatives. This report summarises recet egagemets betwee the GMC, the MSC, medical schools, doctors, medical studets, patiets ad members of the public o the subject of patiet safety teachig. The MSC ad the GMC met medical school educatio leads to discuss patiet safety teachig i a workshop. Subsequetly, the GMC, assisted by four medical schools, held two workshops o udergraduate patiet safety teachig at the 2015 GMC aual coferece see www.gmc-uk.org/about/26044. asp. Notes from these meetigs, attedee feedback cards ad electroic votig o questios to the audiece have all fed ito this report. The GMC believes that sharig examples of practices that work well i oe medical school will help other medical schools to drive up stadards. To this ed, it has begu sharig good practice examples through its Sharig good practice web page see www. gmc-uk.org/educatio/good_practice.asp. The GMC has cosidered the medical schools iitiatives for iclusio as good practice examples. Oce the details are agreed with medical schools, they will be published o the GMC s Sharig good practice web page. The GMC will also ask all medical schools for more iformatio o patiet safety teachig through their 2015 medical schools aual returs. Geeral Medical Coucil 09
Opportuities ad challeges of teachig patiet safety Patiet safety is a relatively ew disciplie for udergraduate medical educatio, ad oe that has brought both opportuities ad challeges for medical schools. To help outlie these challeges, we held a meetig with medical school educatio leads ad the brought medical schools together with doctors, doctors i traiig, medical studets, patiets ad members of the public at the 2015 GMC coferece. We summarise their thoughts o the followig pages. 10 Geeral Medical Coucil
Desigig the curriculum Medical school educatio leads ad attedees at the GMC coferece told us that curricula eed to address several key areas, icludig: iterprofessioal workig, icludig with o-cliical maagers the sciece of huma error, ad the system ad huma factors ivolved, icludig a appreciatio of the role a professioal s ow wellbeig plays i errors, ad how professioals ca be supported after havig made a error Much of this material is covered i the WHO *, 12 Multi-professioal Patiet Safety Curriculum Guide, which we have used later i this report as a framework to highlight selected examples from medical schools. Several medical schools have mapped their safety teachig to the WHO curriculum guide, icludig for example, the Uiversities of Ediburgh ad Aberdee ad St George s, Uiversity of Lodo. the processes ivolved i cliical goverace, icludig root cause aalysis ad other tools used to lear from icidets, ad the role of morbidity ad mortality meetigs ad other ways to dissemiate learig the importace of quality improvemet sciece i makig care safer lessos leart from other idustries that have built a strog safety culture, icludig the characteristics displayed by leaders i those idustries the importace of challegig usafe practice ad the ways i which this ca be doe effectively. * The Multi-professioal Patiet Safety Curriculum Guide was released i 2011, buildig o the cotet of the 2009 Patiet Safety Curriculum Guide for Medical Schools. For more iformatio, see www.eemec.med.ed.ac.uk/pages/ patiet-safety ad the 2015 GMC coferece slides at www. gmc-uk.org/promotig_patiet_safety workshop_slides_ AM_60166887.pdf. Geeral Medical Coucil 11
The hidde curriculum We heard from medical school educatio leads ad attedees at the GMC coferece that key elemets of patiet safety sciece were ofte ot taught explicitly, but rather covered as part of geeral traiig i cliical methods. This hidde curriculum might promote the idea of safe practice beig about the maagemet of idividual behaviour, ad the pursuit of persoal perfectio, rather tha the wider focus embraced by patiet safety sciece. Several schools have redesiged their curricula to make their patiet safety curriculum more explicit, or are i the process of doig so. The Uiversity of Aberdee has adopted a spiral desig for its patiet safety curriculum, as a way to develop awareess iitially ad the build o medical studets growig cliical experiece to reiforce key patiet safety learig later o. Imperial College Lodo ad Plymouth Uiversity both use a bled of learig ad teachig strategies across the five years of their programmes to teach patiet safety. They also make use of quality improvemet projects as a additioal aspect of the curriculum to teach the importace of uderstadig the cotributio of systems of care to safety. Brighto ad Sussex medical school highlights the importace of patiet safety through a day-log coferece for its medical studets, featurig experts from medicie ad other idustries. 12 Geeral Medical Coucil
Challeges of teachig patiet safety A strog theme i our discussios at the GMC coferece related to studet egagemet. We heard that medical studets, particularly those at the start of their educatio, foud it difficult to idetify with patiet safety as a disciplie, so they did ot prioritise it. I part this was because those with little cliical experiece foud it hard to relate to patiet safety whe preseted as a abstract academic cocept. The lack of explicit assessmet of patiet safety was also highlighted as a obstacle, as was competitio for studet attetio from other areas of the curriculum, such as basic sciece. Medical studets prioritise learig about patiet safety (%) 22.4 0.9 9.3 Strogly agree Agree Neutral Disagree 29.9 Strogly disagree 37.4 Source: electroic votig report from the 2015 GMC coferece workshop, =107 Geeral Medical Coucil 13
Faculty developmet was also idetified as a barrier. This is ot surprisig give the relatively ew iclusio of patiet safety as a area of the udergraduate curriculum. These cocers reflect areas idetified by earlier work, such as a 2009 report by the Patiet Safety Educatio Study Group. 13 The greatest challege to udergraduate patiet safety teachig is (%) 9.1 Lack of studet egagemet 50.9 12.7 14.5 Lack of studet cliical experiece Lack of time i curriculum Lack of teachig capacity Lack of ope safety culture o cliical placemets 12.7 Source: electroic votig report from the 2015 GMC coferece workshop, =110 14 Geeral Medical Coucil
Positive resposes to teachig patiet safety We heard from medical school educatio leads ad attedees at the GMC coferece, that medical studets respoded positively to several ways of teachig patiet safety. These iclude: learig from patiets, particularly through patiets stories learig from arrative accouts of medical errors ad adverse evets, ad applyig tools such as root cause aalysis to idetify lessos that could be leart from them We eed deeper itegratio of studets ito cliical teams to ecourage them to cosider risks to patiet safety. Respose from a delegate at the GMC 2015 aual coferece whe asked for ideas to improve patiet safety teachig. itegratig safety teachig ito cliical placemets, with a explicit focus o safety applied to studets actual or simulated experieces through expert debriefig ad facilitated critical reflectio. Geeral Medical Coucil 15
Selectig medical studets who will prioritise patiet safety The MSC has produced guidace recommedig that safety-coducive attitudes, such as teamwork ad commuicatio skills, should be idetified at the poit of recruitmet to udergraduate medical educatio. Selectig for Excellece was a idepedet project iitiated by the MSC. The project looked at the selectio of medical studets i detail ad developed guidace o the core values, skills ad attributes eeded to study medicie. The guidace makes it clear that a attitude coducive to patiet safety should be oe of the thigs medical schools assess at selectio. For more iformatio o Selectig for Excellece, visit www. medschools.ac.uk/aboutus/projects/wideig- Participatio/Selectig-for-Excellece/Pages/ Selectig-for-Excellece.aspx. Through the MSC, medical schools are also sharig best practice i the examiatio of patiet safety ad professioalism. Oe example of this is the developmet of a shared bak of examiatio questios by the Medical Schools Coucil Assessmet Alliace. 16 Geeral Medical Coucil
The wider learig eviromet The GMC s ew stadards for educatio ad traiig make clear that both udergraduate ad postgraduate traiig must take place i a appropriate eviromet ad culture where patiet safety is the first cocer. We heard from medical schools ad from GMC coferece delegates about may areas i which the learig eviromet could help or hider patiet safety teachig. These icluded the visibility ad effectiveess of cliical goverace processes, especially the format of icidet reportig, ad the feedback staff receive from this process. Role modellig was idetified as a very powerful driver of learig. Where seior doctors ad other professioals exhibited safety-coscious behaviours, attitudes ad values, medical studets were see to adopt these more easily. Practical examples icluded discussio of errors ad ear misses o ward rouds, ad support for, rather tha complaits about, safety systems such as the WHO surgical safety checklist (available at www.who.it/patietsafety/ safesurgery/ss_checklist). Geeral Medical Coucil 17
Studets curretly receive their medical educatio ad traiig i a ope ad just safety culture that eables them to speak up if they see patiets receivig poor care (%) 0.0 14.0 Strogly agree 29.0 Agree Neutral Disagree 27.0 Strogly disagree 30.0 Source: electroic votig report from the 2015 GMC coferece workshop, =73 18 Geeral Medical Coucil
We heard that idetifyig ad supportig positive role models for patiet safety could promote learig. Facilitatig the expressio of positive behaviours, through structured sessios such as Schwartz rouds, * ad through studet attedace at mortality ad morbidity meetigs, was also felt to be helpful. Effective patiet safety teachig is ultimately depedet upo a suitable learig eviromet, but we heard too that a proactive ad iovative approach to educatio ca also ifluece the eviromet positively. Our studets will ievitably be assessmet drive. We eed to use this appropriately as a tool to drive egagemet i patiet safety topics. Respose from a delegate at the GMC 2015 aual coferece whe asked for ideas to improve patiet safety teachig. * You ca fid more iformatio about Schwartz rouds at www.poitofcarefoudatio.org.uk/ Schwartz-Rouds. Geeral Medical Coucil 19
Curriculum topics ad medical schools examples The WHO Multi-professioal Patiet Safety Curriculum Guide (the WHO curriculum guide) is a blueprit for patiet safety teachig at udergraduate level. It draws o the work of experts from a rage of disciplies ad iteratioal perspectives. May medical schools have used it as a basis for desigig their ow curricula. Patiet safety eeds to be embedded i real cliical experiece so that it does t become a abstract cocept i the classroom. Respose from a delegate at the GMC 2015 aual coferece whe asked for ideas to improve patiet safety teachig. 20 Geeral Medical Coucil
Seekig opportuities for iovatio ad improvemet We asked medical schools to submit examples of patiet safety teachig iitiatives, usig the WHO curriculum guide as a framework. We mapped these examples, ad iformatio submitted separately to the GMC through medical schools aual returs ad from educatio quality visits, agaist the WHO curriculum guide to see which areas had bee best covered ad to highlight topics where there was greatest opportuity for iovatio ad improvemet. Patiet safety is well covered i existig curricula (%) 7.6 3.8 20.0 Strogly agree Agree Neutral 34.4 Disagree Strogly disagree 34.3 Source: electroic votig report from the 2015 GMC coferece workshop, =105 Geeral Medical Coucil 21
The WHO curriculum guide cotais 11 topics, split ito eight theoretical areas ad three that are more practice based. WHO curriculum guide topics 1 What is patiet safety? 2 Why applyig huma factors is importat for patiet safety 3 Uderstadig systems ad the effect of complexity o patiet care 4 Beig a effective team player 5 Learig from errors to prevet harm 6 Uderstadig ad maagig cliical risk 7 Usig quality-improvemet methods to improve care 8 Egagig with patiets ad carers 9 Ifectio prevetio ad cotrol 10 Patiet safety ad ivasive procedures 11 Improvig medicatio safety Of the first eight topics, medical schools voluteered may examples of otable practice related to topics 2, 4, 5, 7 ad 8. For some topics, these examples wet beyod the subject matter covered i the WHO curriculum guide. For istace, several schools gave examples of teachig o learig from errors that ot oly covered the sciece of error ad how to lear lessos from mistakes, but also developed uderstadig of the eablers ad barriers to a effective reportig culture, ad prompted studets themselves to report issues witessed durig cliical placemets. 22 Geeral Medical Coucil
Iexperieced studets fid it harder to egage with patiet safety priciples Medical schools told us that itroducig patiet safety as a key part of the curriculum ca be a challege, particularly to ew studets who have gaied little experiece of cliical practice. This correspoded with what we heard durig our workshops ad what we kow from recet academic work. I which of the followig elemets of patiet safety do graduatig medical studets feel most cofidet? (%) Usig quality improvemet methods for safer care 6.3 Learig from errors ad ear misses 12.6 Egagig with patiets ad carers for safer care 14.7 Effective multidiscipliary teamwork 15.8 Measuremet ad audit 34.7 Uderstadig huma factors 15.8 0 10 20 30 40 Source: electroic votig report from the 2015 GMC coferece workshop, =95 Geeral Medical Coucil 23
Share the experieces of seior teachers ad how they ope up real-life examples. Normally there is a discrepacy betwee teacher s talk/advice ad how they themselves react. Respose from a delegate at the GMC 2015 aual coferece whe asked for ideas to improve patiet safety teachig. We heard that teachig studets the importace of a systems-based approach to uderstadig the cause of healthcare-associated harm, ad the priciples of risk maagemet, was also difficult, particularly where studets were ot equipped with sufficiet experiece to see how these subjects relate to cliical practice. We heard specifically that studets were more egaged whe these topics were taught startig with case examples ad the workig back to theory. Topics 9 11 of the WHO curriculum guide (ifectio prevetio ad cotrol, patiet safety ad ivasive procedures, ad improvig medicatio safety) represet a opportuity to put the more theoretical kowledge of the precedig topics ito practice. The WHO curriculum guide recommeds that they be cosidered together. These areas have represeted core teachig for UK medical schools for some time. We heard that much of what studets lear o these topics is practical, ad that behaviours ad attitudes prevalet i the hospitals ad GP practices where studets have placemets are importat iflueces. 24 Geeral Medical Coucil
I which of the followig elemets of patiet safety do graduatig studets feel least cofidet? (%) Usig quality improvemet methods for safer care 20 Learig from errors ad ear misses 23 Egagig with patiets ad carers for safer care 24 Effective multidiscipliary teamwork 10 Measuremet ad audit 1 Uderstadig huma factors 21 0 10 20 30 Source: electroic votig report from the 2015 GMC coferece workshop, =99 Geeral Medical Coucil 25
Medical schools examples of udergraduate patiet safety teachig iitiatives Medical schools shared with us may examples of iovative or particularly effective iitiatives i patiet safety teachig. We have icluded some of these over the ext few pages, mapped as closely as possible to the topics of the WHO curriculum guide. Some of the material i the WHO guidace is closely related, ad i some cases medical schools iitiatives covered more tha oe of these topics. I these cases we have chose the topic we felt fitted the example best. This was ot a exhaustive survey or audit of medical school curricula, ad there may be other areas of otable practice i udergraduate patiet safety teachig that we did ot hear about. We have ivited all medical schools to share the iitiatives below, ad other projects they feel work well as good practice examples, o the GMC website at www.gmc-uk.org/educatio/good_practice.asp. 26 Geeral Medical Coucil
What is patiet safety? The Uiversity of Exeter medical school uses a public health perspective to itroduce patiet safety to medical studets i their first term. This first sessio, desiged with a hospital chief executive ad led by a public health cosultat, frames the scale of avoidable harm as a major public health issue. It itroduces error as a feature of healthcare provisio that should be expected, ad studied, ad the eed to cosider huma factors to improve systems that are iheretly usafe. Recogisig that pre-cliical studets ofte fid it harder to egage with patiet safety teachig, studets at Warwick medical school desiged a peer-led itroductory patiet safety programme for first ad secod year colleagues. The programme features the stories of some high-profile medical errors ad the lessos leart, ad cotais iteractive workshops i which participats idetify errors i a case study ad discuss the WHO surgical safety checklist i the cotext of surgical patiet ad site idetificatio errors, amogst other topics. The programme orgaisers report that self-reported studet uderstadig of key patiet safety cocepts early doubled after the programme. The Uiversity of Machester medical school ivites a series of promiet healthcare system experts to discuss curret issues facig the NHS, particularly i the cotext of patiet safety ad compassioate care. These evets give studets the chace to meet, hear ad questio opiio leaders ad gai a atioal perspective o patiet safety issues. Brighto ad Sussex medical school highlights the importace of patiet safety through a day-log coferece for its medical studets, featurig experts from medicie ad from other idustries. The programme covers patiet, orgaisatio ad cliical perspectives, as well as sessios o how icidets are ivestigated ad how lessos idetified ca be traslated ito practice. Geeral Medical Coucil 27
Why applyig huma factors is importat for patiet safety The Uiversity of Aberdee medical school builds uderstadig of o-techical skills through practice observatio ad the use of a behavioural ratig scale. Studets are itroduced to huma factors ad o-techical skills through didactic teachig, but the lear to use a locally developed system to rate observed behaviours exhibited by doctors i cliical settigs ad by themselves i simulated exercises. The use of the ratig scale develops a laguage with which studets ca better uderstad ad express key safety-critical behaviours, ad aalyse the performace of colleagues. The patiet safety ad huma factors aspects of doctors metal health ad wellbeig, icludig addictive behaviour, are icorporated i the teachig at St George s, Uiversity of Lodo medical school. Our medical studets will all have experiece of havig bee a patiet themselves, or supportig a patiet relative. We should draw o this more through educatio whe talkig about the patiet perspective. Respose from a delegate at the GMC 2015 aual coferece whe asked for ideas to improve patiet safety teachig. 28 Geeral Medical Coucil
Uderstadig systems ad the effect of complexity o patiet care As part of a iterprofessioal patiet safety educatio package, the Uiversity of Leicester medical school has developed a video teachig aid that emphasises how complex systems iteract to produce errors. The video recreates a real-life patiet experiece, followig her through the developmet of a acute stroke ad subsequet admissio to hospital. Errors become apparet at each stage of her jourey, ad studets work i small groups to idetify ad reflect o these. The Uiversity of Sheffield medical school offers year 2 studets a patiet safety symposium, delivered by a psychologist ad a emergecy physicia. The symposium addresses the patiet perspective o medical errors through local ad atioal arrative examples. Through these stories the sessio highlights the role of systems ad complexity o patiet care. The Uiversity of Cambridge medical school Year 6 Cliical Course icludes a series of workshops that emphasise the importace of systems iteractios i safe care. Oe workshop covers time maagemet ad icludes a exercise where studets have to prioritise a series of cliical tasks, while ew tasks are costatly beig added. I a secod workshop, studets work through a series of emergecy departmet scearios such as havig to do multiple jobs simultaeously ad maage the expectatios of differet team members. The workshops are facilitated by doctors i traiig as well as seior faculty members. Geeral Medical Coucil 29
Beig a effective team player Plymouth Uiversity Peisula Schools of Medicie ad Detistry puts fial year ursig ad medical studets ito a team-based simulatio programme to prepare them for workig i teams i professioal practice. A key elemet for learig from the programme is debriefig, ad the programme leaders have developed ad evaluated a debriefig model that studets rate highly. Both medical ad ursig studets report better uderstadig of each other s roles ad resposibilities. Year 2 medical studets at the Uiversity of Southampto medical school do six weeked shifts as a healthcare support worker, supported by three tutorials i small groups to reflect o their learig. Key areas of reflectio iclude teamworkig ad what makes a good multidiscipliary team, leadership, professioal behaviour ad uderstadig how these areas cotribute to patiet safety. 30 Geeral Medical Coucil
Uderstadig ad learig from errors Studets at The Uiversity of Sheffield medical school are itroduced to the sciece of huma error i the first two years of their course. I year 3, they discuss local examples of adverse evets with a hospital patiet safety maager, ad the move o to perform a error aalysis, buildig o the material covered i the first two years by workig through real-life examples. Geeral Medical Coucil 31
Uderstadig ad maagig cliical risk Ivestigatio of a critical icidet i hospital has bee a core elemet of the fial year MBBS course at the Uiversity of Dudee medical school sice 2011. All studets receive a tutorial ad complete olie learig o how to review a icidet, after which they are assiged a real icidet to ivestigate. Studets work i teams but write idividual reports, which form part of their fial year portfolio. Year 5 medical studets at the Uiversity of Aberdee medical school cosider the causes of avoidable harm through readig ad critical discussio of major public iquiries. I recet years studets have discussed the Mid Staffordshire public iquiry report ad Health Improvemet Scotlad s report o the Aberdee Royal Ifirmary i small groups, usig a systems approach ad focusig o the features of a safety culture. 32 Geeral Medical Coucil
Usig quality-improvemet methods to improve care All year 3 medical studets at Imperial College Lodo medical school udertake a group project to idetify ad assess safety ad quality deficiecies i the cliical eviromet where they are placed. Studets use audit, surveys or existig orgaisatioal data to idetify safety issues, ad work together to propose effective, efficiet solutios to improvig care. They preset their proposals to the site as part of a competitio. May of the studets proposals have bee take o by cliical teams to improve the local quality of care. Cardiff Uiversity medical school has developed a chagig practice module for year 5 medical studets that icludes a huma factors workshop ru by juior doctors, ad a Ask Oe Questio project based o the Istitute for Healthcare Improvemet (IHI) Ope School iitiative. 14 Studets shadow patiets ad ask them what would improve their experiece, ad the write a report advisig o key areas for improvemet. They must also complete selected courses from the IHI Ope School catalogue. 15 The school plas to exted the Ask Oe Questio project to studets i years 1 ad 2. Geeral Medical Coucil 33
Egagig with patiets ad carers The Uiversity of Leeds medical school rus a sessio o the ivolvemet of patiets i patiet safety. The sessio, facilitated by faculty members ad patiets, icludes reflective discussio o the challeges of patiet safety, ad how to egage with patiets to allow a partership approach to providig safe care. Supportig materials iclude patiet arratives of safety icidets, ad there are plas to iclude patiet examples of excellet care as well. Year 3 studets at Cardiff Uiversity medical school examie patiet joureys by followig a real patiet from admissio to hospital through the course of their stay. They the track their progress i the commuity ad reflect o gaps i systems ad processes. Their reflectios are facilitated i small groups. Medical studets at Quee s Uiversity Belfast lear about adverse evets, systems ad the patiet perspective o patiet safety through followig WHO Patiets for Patiet Safety champio Margaret Murphy tell the story of the evets surroudig the death of her so, Kevi. 16 Kevi s story covers ot oly the factors leadig to errors i the hadlig of his care, but also the respose to these errors, ad the importace of a culture of opeess. You caot teach patiet safety without patiets, that is the simple truth. Respose from a delegate at the GMC 2015 aual coferece whe asked for ideas to improve patiet safety teachig. 34 Geeral Medical Coucil
Ifectio prevetio ad cotrol; patiet safety ad ivasive procedures; ad improvig medicatio safety Swasea Uiversity s teachig o prescribig for year 1 ad year 2 medical studets ackowledges the potetial for errors ad covers strategies for reducig risk. Studets are ecouraged to cosider the situatios where mistakes i drug calculatios may arise, ad where commuicatio betwee team members may lead to a drug admiistratio error despite the prescriptio beig correct. Teachig i later years is desiged to cover the drugs with the highest risk of causig harm. Before graduatig, medical studets at Barts ad the Lodo School of Medicie ad Detistry receive lectures o key patiet safety topics, icludig the lessos leart from the Mid Staffordshire iquiry. Oe lecture covers the cocept of a ever evet ad discusses i detail the evets o the NHS Eglad Never Evets list. Brighto ad Sussex medical school delivers a three-week preparatio for practice module at the ed of the curriculum. This multiprofessioal programme looks at safety teachig from the perspective of the doctor i traiig. Durig two practical days the studets udertake a simulated ward roud, practical hadover ad safe prescribig, i additio to participatig i a lessos leart sessio. Usig a variety of iteractive, practical ad simulatio-based sessios the programme builds o existig kowledge ad skills while supportig the trasitio from year 5 medical studet to Foudatio doctor. All Scottish medical schools require studets to complete a Clealiess Champios programme 17 developed by NHS Educatio for Scotlad that stadardises ifectio cotrol teachig, or cover the Clealiess Champios curriculum i their ow programmes. Geeral Medical Coucil 35
Safety ideas from the GMC 2015 aual coferece If you could oly make oe chage At the GMC coferece, delegates were asked What sigle chage would do most to improve patiet safety? We have grouped the aswers ito the followig themes. Better support for whistleblowers, perhaps with a atioal o-medical orgaisatio acceptig aoymous raisig of cocers to build cofidece. Role-modellig of a ope, safety culture by leaders i healthcare, makig it easier for those i the system to raise cocers ad to be ope about mistakes. Better uderstadig, traiig ad implemetatio of discipliary policies ad procedures, to promote opeess ad reduce fear of repercussios or the sese that othig will chage. Stregtheig the coectio betwee the regulator ad the regulated, ad buildig trust i the GMC that has clearer coectios to workig doctors. A visible, idepedet patiet safety advocate ad champio for each departmet, whose accoutability lies outside the departmet. Ecouragig time for teams to meet ad discuss issues i the way they deliver care. Culture chage through educatio. More objective stadards for qualificatio ad revalidatio, icludig the use of examiatios. Developmet of the idea that it is ievitable that doctors will make mistakes, but itolerace of failure to lear from them. 36 Geeral Medical Coucil
Patiet safety poster competitio As part of the GMC coferece, medical studets ad doctors i traiig were asked to desig a poster o a patiet safety project i which they had bee ivolved. The competitio attracted a large umber of etries. After carefully reviewig all the etries, the GMC selected the followig posters to be show o its website. At the coferece, delegates were ivited to vote for their favourite poster ad prizes were awarded for first ad secod place based o the votes received. Dr Arwa Abdel-Aal wo first prize i the competitio for her poster o the dissemiatio of learig poits from serious utoward icidets through aimated videos. Secod prize wet to Dr Siead Millwood for her poster about developig a platform for learig from mistakes. Cogitive aids, care budle implemetatio. Educatio, reportig ad learig. Hadover, teamwork ad commuicatio. Pathway ad process improvemets. You ca see the wiig posters ad read a blog by Dr Abdel-Aal at www.gmc-uk.org/about/26334.asp. Geeral Medical Coucil 37
What we do The role of the GMC We re a idepedet orgaisatio that helps to protect patiets ad improve medical educatio ad practice across the UK. We set the educatioal stadards for all UK doctors through udergraduate ad postgraduate educatio ad traiig. We promote high stadards ad make sure that medical educatio ad traiig reflects the eeds of patiets, medical studets ad doctors i traiig, ad the healthcare systems across the UK. To test whether or ot medical schools meet our stadards for udergraduate educatio, we carry out moitorig ad ispectios, icludig talkig to medical studets about their experieces, ad respodig directly to ay cocers raised. I the UK, medical schools develop their ow curricula to meet outcomes we set. Our stadards for udergraduate medical educatio, Tomorrow's Doctors (2009), stress a umber of patiet safety outcomes for UK medical graduates. 18 For example, outcomes uder the headig The doctor as a professioal cover areas such as uderstadig error ad icidet reportig. The graduate will be able to: 23 (d) Promote, moitor ad maitai health ad safety i the cliical settig, uderstadig how errors ca happe i practice, applyig the priciples of quality assurace, cliical goverace ad risk maagemet to medical practice, ad uderstadig resposibilities withi the curret systems for raisig cocers about safety ad quality. The importace of patiet safety as a disciplie features more promietly i our 2015 revised stadards for medical educatio ad traiig. Where the stadards previously focused o protectig patiets from ay risk posed by medical studets ad doctors i traiig, we will ow make sure that educatio ad traiig take place where patiets are safe, the care ad experiece of patiets are good, ad educatio ad traiig are valued. For example, requiremet 1.3 i the ew stadards states: R1.3 Orgaisatios must demostrate a culture that ivestigates ad lears from mistakes ad reflects o icidets ad ear misses. Learig will be facilitated through effective reportig mechaisms, feedback ad local cliical goverace activities. 38 Geeral Medical Coucil
Patiet safety is also a key feature of the Geeric Professioal Capabilities framework that the GMC is developig for all postgraduate medical traiig curricula. * Work from this project will be take ito accout as we develop learig outcomes ad stadards. Lots of cliicias kow what could improve patiet safety but do ot have the resources, support ad time to do it. Respose from a delegate at the GMC 2015 aual coferece whe asked for ideas to improve patiet safety teachig. The role of the MSC The Medical Schools Coucil represets the iterests ad ambitios of 33 UK medical schools as they relate to the geeratio of atioal health, wealth ad kowledge through biomedical research ad the professio of medicie. The MSC works with medical schools to develop a cosesus as to what costitutes excellet practice i all domais of a medical school s work, icludig educatio. As the represetative body for UK medical schools, the MSC does ot quality assure or moitor medical schools. Istead it provides medical schools with iformatio ad udertakes policy work o their behalf. This eables the schools to develop uique solutios to the issues that all medical schools ecouter i a way that reflects their idividual circumstaces as autoomous istitutios committed to providig excellece i educatio. * The Geeric Professioal Capabilities framework is uder cosultatio. Geeral Medical Coucil 39
Refereces 1 Geeral Medical Coucil, Promotig excellece: stadards for medical educatio ad traiig, 2015. Available at www.gmc-uk. org/educatio/stadards.asp (accessed 18 August 2015). 2 Departmet of Health, A orgaisatio with a memory, 2000. Available at www.aagbi.org/sites/default/files/a%20 orgaisatio%20with%20a%20memory.pdf (accessed 18 August 2015). 3 Geeral Medical Coucil, Promotig excellece: stadards for medical educatio ad traiig, 2015. Theme 1: Learig eviromet ad culture R1.4. Available at www.gmc-uk.org/ educatio/27390.asp (accessed 18 August 2015). 4 Natioal Research Coucil, To Err Is Huma: Buildig a Safer Health System, Washigto, DC: The Natioal Academies Press, 2000. Available at www.ap.edu/catalog/9728/to-err-is-humabuildig-a-safer-health-system (accessed 18 August 2015). 5 Emmauel L, Berwick D, Combes J, et al. What Exactly Is Patiet Safety? 2008. Available at www.ahrq.gov/professioals/qualitypatiet-safety/patiet-safety-resources/resources/advacesi-patiet-safety-2/vol1/advaces-emauel-berwick_110.pdf (accessed 18 August 2015). 6 World Health Orgaisatio, Patiet Safety Curriculum Guide for Medical Schools, 2009. Available at www.who.it/patietsafety/ educatio/curriculum/en_psp_educatio_medical_ Curriculum/e/ (accessed 18 August 2015). 7 Australia Coucil for Safety ad Quality i Health Care, Natioal Patiet Safety Educatio Framework, Caberra: Commowealth of Australia, 2005. Available at www.safetyadquality.gov. au/wp-cotet/uploads/2012/06/natioal-patiet-safety- Educatio-Framework-2005.pdf (accessed 18 August 2015). 8 Walto M, Shaw T, et al. Developig a atioal patiet safety educatio framework for Australia. BMJ Quality & Safety 2006; 15:437 442. 9 Natioal Advisory Group o the Safety of Patiets i Eglad, A promise to lear a commitmet to act, Lodo: Departmet of Health, August 2013. Available at www.gov.uk/govermet/ publicatios/berwick-review-ito-patiet-safety (accessed 18 August 2015). 10 Natioal Quality Board, Huma Factors i Healthcare, 2013. Available at www.eglad.hs.uk/wp-cotet/ uploads/2013/11/qb-hum-fact-cocord.pdf (accessed 18 August 2015). 11 Departmet of Health, Culture chage i the NHS, Lodo: The Statioery Office, February 2015. Available at www.gov.uk/ govermet/publicatios/culture-chage-i-the-hs (accessed 18 August 2015). 12 World Health Orgaisatio, Multi-professioal Patiet Safety Curriculum Guide, Geeva: WHO, 2011. Available at www.who. it/patietsafety/educatio/curriculum/tools-dowload/e/ (accessed 18 August 2015). 13 Patiet Safety Educatio Study Group, Patiet safety i health care professioal educatioal curricula: examiig the learig experiece, 2009. Available at www.birmigham. ac.uk/documets/college-mds/haps/projects/cfhep/psrp/ fialreports/ps030psrpreportfinal0609.pdf (accessed 18 August 2015). 14 Istitute for Healthcare Improvemet, Ask Oe Questio Challege. Available at www.ihi.org/educatio/ihiopeschool/ chapters/pages/askoequestio.aspx (accessed 18 August 2015). 15 Istitute for Healthcare Improvemet, Ope School. Available at www.ihi.org/educatio/ihiopeschool/pages/default.aspx (accessed 18 August 2015). 16 World Health Orgaisatio, A story by a champio of the Patiets for Patiet Safety from Irelad. Available at www.who.it/ patietsafety/patiets_for_patiet/videos/e/ (accessed 18 August 2015). 17 NHS Educatio for Scotlad, Clealiess Champios. Available at www.es.scot.hs.uk/educatio-ad-traiig/by-themeiitiative/healthcare-associated-ifectios/educatioalprogrammes/clealiess-champios.aspx (accessed 18 August 2015). 18 Geeral Medical Coucil, Tomorrow's Doctors: Outcomes 3 The doctor as a professioal. Available at www.gmc-uk. org/educatio/udergraduate/tomorrows_doctors_2009_ outcomes3.asp (accessed 18 August 2015). 40 Geeral Medical Coucil
Email: gmc@gmc-uk.org Website: www.gmc-uk.org Telephoe: 0161 923 6602 Email: admi@medschools.ac.uk Website: www.medschools.ac.uk Telephoe: 020 7419 5430 Textphoe: please dial the prefix 18001 the 0161 923 6602 to use the Text Relay service Geeral Medical Coucil 3 Hardma Street, Machester M3 3AW Joi the coversatio @gmcuk facebook.com/gmcuk likd.i/gmcuk youtube.com/gmcuktv Medical Schools Coucil Wobur House, 20 Tavistock Square, Lodo WC1H 9HD @ukmedschools The GMC is a charity registered i Eglad ad Wales (1089278) ad Scotlad (SC037750). Medical Schools Coucil: Compay limited by guaratee ad registered i Eglad ad Wales umber 8817383. Registered charity umber 1155370. To ask for this publicatio i Welsh, or i aother format or laguage, please call us o 0161 923 6602 or email us at publicatios@gmc-uk.org. Published September 2015 2015 Geeral Medical Coucil Medical Schools Coucil The text of this documet may be reproduced free of charge i ay format or medium providig it is reproduced accurately ad ot i a misleadig cotext. The material must be ackowledged as GMC ad MSC copyright ad the documet title specified. Code: GMC/FDNH/0915