To Improve Patient Safety, Doctors are Learning to Give Instructions on Making Sandwiches

​

“Invariably the student will write, ‘open the bag of bread,’” said Donna Woods, associate professor at the medical school who directs the PhD track that focuses on patient safety and quality of care at the Northwestern University Feinberg School of Medicine.

“And so he rips the bottom rather than doing the little twist-tie thing.”

Reshaping education in patient safety

A year after former president Bill Clinton mentioned a “Patients’ Bill of Rights” in his 2000 State of the Union address, an 18-month-old patient tragically succumbed following a series of medical errors.

Though healthcare quality has been studied since the late 1960s, researchers began to address patient safety more seriously, with hospitals establishing patient safety officers.

“Patient safety became ‘a thing,’” said Dr. Albert Wu, director of the Center for Health Services and Outcomes Research at the Johns Hopkins Bloomberg School of Public Health

Medical education responded in turn, educating young doctors-to-be about patient safety, founded on the grounds of the maxim, primum non nocere which means, “first, do no harm”.

One such institution is Monash University Malaysia’s Jeffrey Cheah School of Medicine and Health Sciences, which implements dynamic learning in patient safety, covering topics about human factors, human errors, medication safety, teamwork and communication.

“Skills like effective communication, teamwork, and leadership are best learned during immersive simulation,” said Dr Rafidah Atan, associate professor at Monash University Malaysia.

“They practice thinking on their feet.”

Patient safety education also for “old-timers”

The focus, of late, has shifted to also re-instill the understanding of patient safety in practicing doctors. The program at Northwestern University is the first PhD track of its kind, primarily targeting clinicians as well as hospital administrators who are interested to become researchers in and improve patient safety.

Launched in 2012, the post-graduate program and implements innovative methods to address medical problems differently, such as communication skills exercises – by means of peanut butter and jelly sandwiches.

To understand the challenges of communicating medical directions, for example, students are made to practice by explaining how a peanut butter and jelly sandwich is constructed - to an instructor role-playing as a “Martian”, an individual who has no basic English skills nor the understanding of simple mechanics of peanut butter jars and bagged bread, said Woods.

This exercise is carried out with the intention to educate students that though they may think their instructions are clear, their directions may not be performed as requested, ultimately leading to confusion and harm.

Woods recounted a similar personal experience, where liver transplant surgeons failed to comply to her instructions of using a different combination of painkiller, despite her thorough directions.

Woods said explained that a surgeon may have wanted to use a different painkiller, but was too focused on the surgical procedure and ultimately did not think of or use it when the painkiller was ordered in the room.

Her solution? To have a nurse verbally remind the surgeon of the drugs ordered, and ensure that they were administered.

Research in patient safety essential for better development

Exercises in the program are coupled with classes on research methodology to help students learn and understand the complexity of the medical system, unlike other programs with optional research components.

“There’s really a paucity of research on what is exactly effective for improving quietly and safety of care,” said Woods.

“How are you going to get that research in order to understand what will be effective and meaningful? You have to develop people who can do research in that area.”

However, the program remains small and will take several years to spread and gain interest, according to Cynthia Barnard, the first individual in the country to receive a PhD in the field, and the sole graduate in 2016, who is now the vice president for quality at Northwestern Memorial Healthcare.

In Barnard’s opinion, despite efforts by the academic community, we still don’t know yet if patients are getting better — which patients think is the job of the doctor in the first place.

Source