Letters
Health services administration
Volume 193 - Issue 8

Patient safety: time for a transformational change in medical education

Author:  John A H Williamson

Med J Aust 2010; 193 (8): 487-488. || doi: 10.5694/j.1326-5377.2010.tb04017.x
Published online: 18 October 2010
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To the Editor: I read, with encouragement and hope, Runciman’s timely editorial concerning the pressing need for patient safety education to become an integral part of medical undergraduate curricula.1 I also support his plea for patient safety to now be treated as a full-blooded science.

His description of medicine as “islands of excellence in a sea of mediocrity” is both apt and perhaps still somewhat generous.

In many health care ranks (in common with the rest of the human race) there continues to be a reluctance at the personal level to admit the natural and ever-present human tendency to err.2 Consequently, opportunities continue to be lost to learn from analysis of these mistakes by reporting their mechanisms honestly in detail, either anonymously or openly in a trusting work environment.

Sadly, the ongoing barriers of a blame culture (often accompanied by outcome bias), misplaced ego and lack of understanding of such fundamental issues as error cascades and latent errors work against these simple and powerful safety improvement steps. The preoccupation of sections of our medicolegal system with blaming and shaming usually innocent health care individuals for system failures is also a barrier to such reporting.

While Runciman suggests a gradual awakening of appreciation of such system faults, lip service still abounds and basic human error concepts continue to be uncomprehended or overlooked, even by some of the more senior and influential members of our profession. This works against the education of junior doctors. As Runciman urges, the only way to deal with this now is to give the young, fertile medical undergraduate minds the opportunity to grasp these fundamental concepts at the beginning of their clinical lives. It is their patients who will benefit as well as their own peace of mind and, importantly, their own humility, throughout their years ahead.

The repeated objection that undergraduate curricula are already overloaded is not acceptable. The science of patient safety is no longer an optional or minor subject for medicine. It should be woven intimately throughout the undergraduate curriculum.

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