Leaders: Teaching Students to Speak Up for Safety

Dr. Jennifer S. Myers, an academic hospitalist and the director of quality and safety education for the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, became interested in improving hospital quality almost as soon as she walked through the doors at Penn in 2001. She started with small improvement projects, and within a few years became one of the hospital’s patient safety officers.

But what has really captured her interest over the years has been working with medical students and residents on quality and safety improvement. With that in mind, she launched a regular patient safety conference for residents so they could bring up errors and near misses and work on potential solutions. In 2010, Dr. Myers became the first director of quality and safety education at the medical school. The idea behind creating the position was to better align the quality and safety goals of the hospital with what is happening at the medical school, she said.

In an interview with Hospitalist News, Dr. Myers discussed how quality and safety improvement are handled in training.

Question: What are medical student attitudes about safety and quality improvement? Do they see these as areas worth spending time on during training?

Dr. Myers: I think we have a lot more work to do with the medical schools. I think the students themselves are incredibly energetic, passionate, idealistic, and interested in this area. Just here at Penn, there’s been a lot of interest since we started to open up opportunities for them to become more involved in projects and interest groups. It’s really up to the medical schools now to design curricula that make sense for them and that they can learn from.

Question: How much time do medical students typically spend learning about quality improvement and patient safety?

Dr. Myers: It depends. If you ask 10 medical schools, you’ll get 10 different answers. In the past, students spent hardly any time at all on these areas. The residency focus has been stronger because of the policies of the ACGME (Accreditation Council for Graduate Medical Education). But at the medical school level, there has not been a policy that has been as explicit about the requirements. I think that is coming. The Liaison Committee on Medical Education, which oversees medical schools, is beginning to talk much more about quality and safety. Several thought leaders in the field have written white papers about this that clearly indicate that quality and safety should be taught from the beginning of health professions education – not just to physicians, but also to nurses and pharmacists. We should be doing a lot of this work inter-professionally since that’s how processes are improved in the hospital. At Penn, we are on our journey. We were doing a little. Now we’re doing more. A lot of my job is to make that happen.

Question: On the resident side, are they equally excited about this?

Dr. Myers: The residents are the master problem identifiers and problem solvers in a lot of ways. They are on the front lines. They see what doesn’t work well and what could harm a patient, and they have ideas for how to make it better. One challenge in residency education is having the right culture within the institution that allows and actually incentivizes residents to report problems and participate in their solutions. The second challenge in residency is the time. The training is very condensed, and there are also the strict work-hour restrictions. So you’re taking what was already a very busy curriculum and training program and introducing new content.

Question: There’s been a lot of discussion recently about the need for greater personal accountability by physicians to better balance the "no blame" patient safety culture that has developed in the last 20 years. How do you communicate that idea to students and residents without giving them a mixed message?

Dr. Myers: It’s a very delicate topic to teach. On the one hand, we’re focusing on systems, but on the other hand occasionally we have individual providers who didn’t execute their role or responsibilities correctly or responsibly. Each error has to be considered individually. The most important thing is not to jump to the conclusion that it was someone’s fault. Always look to the system first and see if it was "set up to fail" or failed the clinicians.

Question: What are the areas where you think hospitalists need to be doing more on quality improvement?

Dr. Myers: They definitely need to be leading and innovating in the area of quality and safety education. This is not just for academic hospitalists who teach residents and students, but also for community hospitalists because they are seen as the physician leads on their floors. Educating their group, or other groups, or the interdisciplinary team on their unit, is definitely a role.

The other area of growth and leadership for hospitalists is in the actual "doing" of improvement. It’s a skill, and it’s increasingly a needed skill for physicians. The third area is information technology integration and education. This means not only thinking of how health information systems should be built for hospital providers, but also thinking of how to educate users about why they were created in a certain way, how to use them safety, and what’s available.

Take us to your leader. Nominate a hospitalist whose work inspires you. E-mail suggestions to [email protected].

Dr. Jennifer S. Myers, an academic hospitalist and the director of quality and safety education for the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, became interested in improving hospital quality almost as soon as she walked through the doors at Penn in 2001. She started with small improvement projects, and within a few years became one of the hospital’s patient safety officers.

But what has really captured her interest over the years has been working with medical students and residents on quality and safety improvement. With that in mind, she launched a regular patient safety conference for residents so they could bring up errors and near misses and work on potential solutions. In 2010, Dr. Myers became the first director of quality and safety education at the medical school. The idea behind creating the position was to better align the quality and safety goals of the hospital with what is happening at the medical school, she said.

In an interview with Hospitalist News, Dr. Myers discussed how quality and safety improvement are handled in training.

Question: What are medical student attitudes about safety and quality improvement? Do they see these as areas worth spending time on during training?

Dr. Myers: I think we have a lot more work to do with the medical schools. I think the students themselves are incredibly energetic, passionate, idealistic, and interested in this area. Just here at Penn, there’s been a lot of interest since we started to open up opportunities for them to become more involved in projects and interest groups. It’s really up to the medical schools now to design curricula that make sense for them and that they can learn from.

Question: How much time do medical students typically spend learning about quality improvement and patient safety?

Dr. Myers: It depends. If you ask 10 medical schools, you’ll get 10 different answers. In the past, students spent hardly any time at all on these areas. The residency focus has been stronger because of the policies of the ACGME (Accreditation Council for Graduate Medical Education). But at the medical school level, there has not been a policy that has been as explicit about the requirements. I think that is coming. The Liaison Committee on Medical Education, which oversees medical schools, is beginning to talk much more about quality and safety. Several thought leaders in the field have written white papers about this that clearly indicate that quality and safety should be taught from the beginning of health professions education – not just to physicians, but also to nurses and pharmacists. We should be doing a lot of this work inter-professionally since that’s how processes are improved in the hospital. At Penn, we are on our journey. We were doing a little. Now we’re doing more. A lot of my job is to make that happen.

Question: On the resident side, are they equally excited about this?

Dr. Myers: The residents are the master problem identifiers and problem solvers in a lot of ways. They are on the front lines. They see what doesn’t work well and what could harm a patient, and they have ideas for how to make it better. One challenge in residency education is having the right culture within the institution that allows and actually incentivizes residents to report problems and participate in their solutions. The second challenge in residency is the time. The training is very condensed, and there are also the strict work-hour restrictions. So you’re taking what was already a very busy curriculum and training program and introducing new content.

Question: There’s been a lot of discussion recently about the need for greater personal accountability by physicians to better balance the "no blame" patient safety culture that has developed in the last 20 years. How do you communicate that idea to students and residents without giving them a mixed message?

Dr. Myers: It’s a very delicate topic to teach. On the one hand, we’re focusing on systems, but on the other hand occasionally we have individual providers who didn’t execute their role or responsibilities correctly or responsibly. Each error has to be considered individually. The most important thing is not to jump to the conclusion that it was someone’s fault. Always look to the system first and see if it was "set up to fail" or failed the clinicians.

Question: What are the areas where you think hospitalists need to be doing more on quality improvement?

Dr. Myers: They definitely need to be leading and innovating in the area of quality and safety education. This is not just for academic hospitalists who teach residents and students, but also for community hospitalists because they are seen as the physician leads on their floors. Educating their group, or other groups, or the interdisciplinary team on their unit, is definitely a role.

The other area of growth and leadership for hospitalists is in the actual "doing" of improvement. It’s a skill, and it’s increasingly a needed skill for physicians. The third area is information technology integration and education. This means not only thinking of how health information systems should be built for hospital providers, but also thinking of how to educate users about why they were created in a certain way, how to use them safety, and what’s available.

Take us to your leader. Nominate a hospitalist whose work inspires you. E-mail suggestions to [email protected].

Dr. Jennifer S. Myers, an academic hospitalist and the director of quality and safety education for the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, became interested in improving hospital quality almost as soon as she walked through the doors at Penn in 2001. She started with small improvement projects, and within a few years became one of the hospital’s patient safety officers.

But what has really captured her interest over the years has been working with medical students and residents on quality and safety improvement. With that in mind, she launched a regular patient safety conference for residents so they could bring up errors and near misses and work on potential solutions. In 2010, Dr. Myers became the first director of quality and safety education at the medical school. The idea behind creating the position was to better align the quality and safety goals of the hospital with what is happening at the medical school, she said.

In an interview with Hospitalist News, Dr. Myers discussed how quality and safety improvement are handled in training.

Question: What are medical student attitudes about safety and quality improvement? Do they see these as areas worth spending time on during training?

Dr. Myers: I think we have a lot more work to do with the medical schools. I think the students themselves are incredibly energetic, passionate, idealistic, and interested in this area. Just here at Penn, there’s been a lot of interest since we started to open up opportunities for them to become more involved in projects and interest groups. It’s really up to the medical schools now to design curricula that make sense for them and that they can learn from.

Question: How much time do medical students typically spend learning about quality improvement and patient safety?

Dr. Myers: It depends. If you ask 10 medical schools, you’ll get 10 different answers. In the past, students spent hardly any time at all on these areas. The residency focus has been stronger because of the policies of the ACGME (Accreditation Council for Graduate Medical Education). But at the medical school level, there has not been a policy that has been as explicit about the requirements. I think that is coming. The Liaison Committee on Medical Education, which oversees medical schools, is beginning to talk much more about quality and safety. Several thought leaders in the field have written white papers about this that clearly indicate that quality and safety should be taught from the beginning of health professions education – not just to physicians, but also to nurses and pharmacists. We should be doing a lot of this work inter-professionally since that’s how processes are improved in the hospital. At Penn, we are on our journey. We were doing a little. Now we’re doing more. A lot of my job is to make that happen.

Question: On the resident side, are they equally excited about this?

Dr. Myers: The residents are the master problem identifiers and problem solvers in a lot of ways. They are on the front lines. They see what doesn’t work well and what could harm a patient, and they have ideas for how to make it better. One challenge in residency education is having the right culture within the institution that allows and actually incentivizes residents to report problems and participate in their solutions. The second challenge in residency is the time. The training is very condensed, and there are also the strict work-hour restrictions. So you’re taking what was already a very busy curriculum and training program and introducing new content.

Question: There’s been a lot of discussion recently about the need for greater personal accountability by physicians to better balance the "no blame" patient safety culture that has developed in the last 20 years. How do you communicate that idea to students and residents without giving them a mixed message?

Dr. Myers: It’s a very delicate topic to teach. On the one hand, we’re focusing on systems, but on the other hand occasionally we have individual providers who didn’t execute their role or responsibilities correctly or responsibly. Each error has to be considered individually. The most important thing is not to jump to the conclusion that it was someone’s fault. Always look to the system first and see if it was "set up to fail" or failed the clinicians.

Question: What are the areas where you think hospitalists need to be doing more on quality improvement?

Dr. Myers: They definitely need to be leading and innovating in the area of quality and safety education. This is not just for academic hospitalists who teach residents and students, but also for community hospitalists because they are seen as the physician leads on their floors. Educating their group, or other groups, or the interdisciplinary team on their unit, is definitely a role.

The other area of growth and leadership for hospitalists is in the actual "doing" of improvement. It’s a skill, and it’s increasingly a needed skill for physicians. The third area is information technology integration and education. This means not only thinking of how health information systems should be built for hospital providers, but also thinking of how to educate users about why they were created in a certain way, how to use them safety, and what’s available.

Take us to your leader. Nominate a hospitalist whose work inspires you. E-mail suggestions to [email protected].