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Addressing Patient Safety Through Dedicated Simulation-based Training

      To the Editor:
      Guided by the time-honored axiom of “primum non nocere”, protecting patients from medical errors and improving safety of clinical practice have become global health priorities. In an effort to conquer health care practices most detrimental to patient safety while aiming at improving operational safety of patient care in both developed and developing countries, the World Health Organization (WHO) regularly launches campaigns such as “Clean Care is Safer Care” or “Safe Surgery.” However, despite continuous (inter-)national efforts, research shows that unintended patient harm is common, reaching up to 25.1 instances per 100 hospital admissions, and being life-threatening or causing patients' death in 1 of 10 instances, while being potentially preventable in 63%.
      • Landrigan C.P.
      • Parry G.J.
      • Bones C.B.
      • et al.
      Temporal trends in rates of patient harm resulting from medical care.
      Among the strategies through which to reduce incidence of patient harm resulting from medical care, education and training certainly are among the most powerful and sustainable. Simulation-based training is one tool to help achieve the goal of a safer health care system by allowing novice and more experienced medical professionals to learn, practice, and perfect their craft without exposing patients to harm. The impact of simulation-based training stretches even beyond direct educational effects, as simulation can further be utilized to identify safety threats in actual clinical environments.
      • Patterson M.D.
      • Geis G.L.
      • Falcone R.A.
      • et al.
      In situ simulation: detection of safety threats and teamwork training in a high risk emergency department.
      Hence, performing simulation-based training in real clinical settings not only provides interdisciplinary technical and nontechnical skills practice,
      • Schmitt M.H.
      • Gilbert J.H.
      • Brandt B.F.
      • Weinstein R.S.
      The coming of age for interprofessional education and practice.
      but also allows for concurrent system evaluation, and thus, contributes to patient safety improvement in several ways.
      The WHO's World Alliance for Patient Safety recommends implementation of patient safety training during the early part of medical education, including simulation exercises, role plays, and team-building exercises as instructional methods.
      • Walton M.
      • Woodward H.
      • Van Staalduinen S.
      • et al.
      The WHO patient safety curriculum guide for medical schools.
      However, patient safety curricula at the undergraduate level are scarce,
      • Wong B.M.
      • Etchells E.E.
      • Kuper A.
      • et al.
      Teaching quality improvement and patient safety to trainees: a systematic review.
      and formal patient safety education is highly variable, with much of the teaching and learning around medical errors being informal and occurring as students witness mistakes.
      • Fischer M.A.
      • Mazor K.M.
      • Baril J.
      • et al.
      Learning from mistakes. Factors that influence how students and residents learn from medical errors.
      As every health care professional should commit him- or herself to patient safety as the primary objective of patient care, development and incorporation of dedicated simulation-based patient safety programs should become a priority for medical schools.

      References

        • Landrigan C.P.
        • Parry G.J.
        • Bones C.B.
        • et al.
        Temporal trends in rates of patient harm resulting from medical care.
        N Engl J Med. 2010; 363: 2124-2134
        • Patterson M.D.
        • Geis G.L.
        • Falcone R.A.
        • et al.
        In situ simulation: detection of safety threats and teamwork training in a high risk emergency department.
        BMJ Qual Saf. 2013; 22: 468-477
        • Schmitt M.H.
        • Gilbert J.H.
        • Brandt B.F.
        • Weinstein R.S.
        The coming of age for interprofessional education and practice.
        Am J Med. 2013; 126: 284-288
        • Walton M.
        • Woodward H.
        • Van Staalduinen S.
        • et al.
        The WHO patient safety curriculum guide for medical schools.
        Qual Saf Health Care. 2010; 19: 542-546
        • Wong B.M.
        • Etchells E.E.
        • Kuper A.
        • et al.
        Teaching quality improvement and patient safety to trainees: a systematic review.
        Acad Med. 2010; 85: 1425-1439
        • Fischer M.A.
        • Mazor K.M.
        • Baril J.
        • et al.
        Learning from mistakes. Factors that influence how students and residents learn from medical errors.
        J Gen Intern Med. 2006; 21: 419-423

      Linked Article

      • The Coming of Age for Interprofessional Education and Practice
        The American Journal of MedicineVol. 126Issue 4
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          Interprofessional education for collaborative practice is an important innovation globally and in US health professions education. The recent spotlight on interprofessional education in the United States was launched by a series of reports in the US Institute of Medicine's Quality Chasm series. They raised concerns over medical errors and health care quality as significant sources of morbidity and mortality in the United States and proposed health professions' education for patient-centered, team-based care as one means to address these concerns.
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      • The Reply
        The American Journal of MedicineVol. 127Issue 12
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          Interprofessional education and collaborative practice (IPECP) programs have the option of focusing exclusively on quality and safety issues.1 Other clinically relevant IPECP topics, such as the team management of specific diseases, can be set aside. It's noteworthy that IPECP team-based management of specific diseases lends itself to in situ simulation-based training, along the lines described by Mileder in his thoughtful letter.
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