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Supreme Court Hears Arguments in Michigan Diversity Case Budget Outlook Mixed for Medical Schools, Hospitals Striking a 'Match': New Graduates Ready for Their Next Step Gastric Bypass Surgery Offers New Hope for the Morbidly Obese Innovations in Medical Education: Medical Scholars in the Making A Word From the President: Setting Global Standards for Medical Education Viewpoint: Guiding the 'IOM Generation' A Day in the Life of a Medical Student
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Viewpoint: Guiding the 'IOM Generation'
This month, AAMC's member institutions will send over 15,000 graduates into the medical world. When these students began their academic journey in the fall of 1999, the Institute of Medicine (IOM) was getting ready to release its landmark report To Err Is Human. In the years since, the issue of medical errors has drawn increased media attention, and there have been many high-profile cases. But is our healthcare system any safer? And equally important, have medical schools truly trained this next generation of doctors - the "IOM Generation" - about patient safety? Do they understand that "errors happen" because systems fail, and that when systems fail, it may be due to something as mundane as a healthcare worker not being in the same room when a key decision was made? Historically, the medical and healthcare communities have looked to the AAMC as the focal point of quality; i.e., a training ground for scientific interventions and groundbreaking ideas in education and leadership. Additionally, the AAMC is seen as a leading advocate for science-based medicine. In keeping with this tradition, the AAMC recently published the monograph Patient Safety and Graduate Medical Education. Written by the Joint Committee of the Group on Resident Affairs and Organization of Resident Representatives, the publication raises the bar for teaching patient safety and affirms the importance of a science-based approach. Additionally, it embraces the IOM report's central tenet by noting the importance of systems research and root-cause analyses in discovering why errors occur and for finding ways to improve patient safety. Then, in groundbreaking fashion, the monograph advocates that institutional and graduate medical cultures provide "emotional counseling and support, as needed, to those individuals touched by error and/or participating in the error disclosure and analyses processes." This is an excellent point, and the monograph is an excellent start, advocating several other important improvements. However, more action is needed. As the world's leading funder of patient-safety research, the Agency for Healthcare Research and Quality (AHRQ) is excited about the opportunities to work with organizations like the AAMC in guiding the IOM Generation. There are many steps association members can take today to realize that goal, and AHRQ stands ready to help. For example: Paperless Prescribing. As the monograph itself notes, computerized physician order entry and other decision support help ensure that all parties involved in administering medication to a patient know exactly which drug a doctor intended for a specific patient, as well as the proper dosage. By eliminating all handwritten prescriptions now, AAMC members can help hasten health care's transition to the ultimate goal of paperless prescribing. Medication Reconciliation Errors. Another immediate action step is for the AAMC to focus on what has been referred to as medication reconciliation errors; i.e., the errors of simple communication that occur when patients transition from hospital to home, nursing home, or to another setting. Often, these seemingly mundane communications turn out to be the most critical ones. "Owning" the Issue. To the extent errors still occur, AAMC must help member institutions "own" the issue. Academic medical centers have a unique opportunity to lead by making patient safety a top priority for medical education from day one. Failure to do so risks further erosion of public trust in academic medicine's essential missions. Faculty Recognition. One of the most critical challenges facing academic medical institutions pertains to faculty recognition for achievements in patient safety. Will faculty who identify and implement cost-effective strategies for reducing avoidable harms be recognized as they would for contributions to the peer-reviewed literature? Or is such work perceived only as "interesting" but non-essential activity? If we expect the IOM Generation to change the way they think about patient safety, then medical institutions must change the way they think about the teaching of patient safety. Explicit recognition through promotion and academic credit reinforces the message that reduction of avoidable harms is essential. The track record to date should inspire humility. AAMC's challenge is to develop these faculty incentives and rewards. Certainly every generation is defined by the events of its time. At the start of the 20th century, the Flexner Report led to fundamental changes in the structure and process of medical education. Today, armed with a vastly improved array of interventions, we have a similar opportunity to redesign medical education and clinical care. AHRQ is ready to join with the AAMC in assuring that the legacy of the IOM Generation is predictably safer health care for all of us. Translating the recently published monograph into action must be a sustained priority for all academic medical centers. |
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