Medical education must include quality improvement and patient safety

Entering medical school is like settling in a new country, you have to learn the language, adapt to the culture and figure out how to succeed. As medical students, we study the pathophysiology, clinical presentation, diagnosis and management of diseases. We learn how to effectively communicate with patients to get their stories and pair these with the physical exam to confidently make a diagnosis. Our goal is to constantly work towards becoming the best physician we can to provide quality care to our future patients.

With this goal in mind, we continue to hear about how the healthcare system fails patients, either through medical error like administering the wrong medication or through gaps in the system where patients are left to navigate on their own.

While these stories hit home, many of us comfort ourselves by vowing that that will never happen to us in our future practice. We will be extra careful to avoid these preventable mistakes. We trust that the medical education imparted to us throughout years of medical school and residency combined with our determination to do our best will prepare us to avoid such outcomes. But is this a realistic expectation or a naive approach? I believe our resolution to avoid these mistakes in and of itself highlights a gap in understanding of how and why these errors occur.

Too often, we assume that poor outcomes result from one individual’s carelessness whereas in reality they likely represent a series of failures embedded in the system itself. So how do we change our thinking to better reflect the reality of the system, a system that we as medical students have modest interaction with in our early stages of medical school? How can we empower ourselves to take steps to change the system and subsequently improve outcomes?

The answer in part, I believe, lies in our medical education. Our medical education is carefully designed to impart the knowledge and skills necessary to provide quality healthcare. But principles for improving healthcare and patient safety are at best minimally covered. Analyzing the system to mitigate potential human and system risks to quality of care and patient safety, responding to adverse events, engaging in professional and inter-professional teamwork, facilitating a culture of safety and patient centeredness, and working with improvement tools and models are skills students, as the next generation of healthcare professionals, need. Just as we develop an internal alarm for diagnostic symptoms suggesting a pulmonary embolism, we need an alarm alerting us of an opportunity to apply principles of quality improvement.

The field of Quality Improvement (QI) and Patient Safety (PS) is emerging as are the avenues for students to engage and learn the principles. The Institute for Healthcare Improvement (IHI) (has created a movement for change and through its Open School provides students the opportunity to take it upon themselves to learn the fundamentals of QI and PS. The IHI Open School Chapters generate a local forum for students to discuss QI and PS and bridge the gap between skills that may not be formally taught and the reality of how these skills can result in more effective and higher quality work. Quality improvement projects connecting students with faculty involved in the field are also starting to surface in medical schools. However, these all represent initiatives students must seek out and opt into rather than being topics infused into the medical curriculum. This then limits the potential for all students coming out of medical school to be equipped with the same toolkit to effectively approach healthcare and the system.

The good news is QI and PS are making their way into formal training through initiatives like Advancing Safety for Patients in Residency Education (ASPIRE). This workshop, from the Canadian Patient Safety Institute and the Royal College of Physicians and Surgeons, prepares medical schools to teach residents QI and PS concepts aligned with the CanMEDS 2015 Framework and Roles. But why wait for higher level training? Why not set the foundation at the very beginning of students’ careers? The old adage you can’t teach an old dog new tricks appropriately reflects the need to start the process of incorporating quality and safety concepts as early as possible in medical education so that they can be built upon throughout training. Higher level regulatory bodies need to assign priority to these topics for students to take notice and appreciate their worth. Assuming that improving care and ensuring the safety of our future patients is something we can learn once we are fully immersed in clinical experiences, I think, is short sighted and a missed opportunity.

Medical school is about learning the science of medicine and clinical training imparts the art of medicine. The time has come to include the science of improvement and safety into medical education so students can confidently resolve to provide the best quality of care for their future patients.