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Watching Docs Make Medication Errors Is Best Lesson for Students

Medical students should have basic knowledge of common medication errors before they begin seeing patients at the hospital, and researchers from the Johns Hopkins Children’s Center report that allowing them to watch, spot, and analyze errors as they occur can go a long way toward helping prevent potentially fatal mistakes in their future practices.

Analysis of the course, which was piloted in the 2008-2009 academic year and is now taught as part of the Johns Hopkins School of Medicine curriculum, is published in BMJ Quality and Safety in Healthcare.

The observational course was part of a nine-week pediatric rotation at Hopkins Children’s during which 108 medical students shadowed and observed doctors and nurses as they performed daily work on inpatient and outpatient units. The instruction combined personal observation of actual medical errors in the making or near-misses and required students to deconstruct the errors, according to the study.

Students began the course by watching a video of a child receiving the wrong medication. They were then asked to reconstruct the events leading up to the error, answering questions such as “What happened and why?” and “What can be done to prevent future errors?” The students then applied the same watch-spot-analyze approach to their daily rotation in the hospital. Each day’s rotation ended with students discussing any near-misses or errors they witnessed and ways to prevent them from happening. Students were also encouraged to speak up about errors and report them to attending physicians and senior doctors before they reached the patient, as well as log the errors in the hospital’s electronic system that keeps track of such events.

“Beyond providing first-hand observation, a course like this one may give teaching hospitals an untapped and invaluable resource for spotting and preventing medication and other errors—medical students,” said lead investigator Robert Dudas, MD, a pediatrician at Hopkins Children’s, in a press release.

Allowing medical students to spot mistakes while observing clinicians “in the trenches” teaches them how and why medication errors occur and what can be done to prevent them, the Hopkins researchers say. It also fosters an open culture by encouraging them to speak up about and point out mistakes made by others.

“The foundation of patient safety lies in a solid understanding of how and why medication errors happen, combined with a sobering reality check that mistakes do happen,” says co-investigator Marlene Miller, MD, MSc, a pediatric patient safety expert at Hopkins Children’s.

Most of the 108 students (76%) who took the pilot course said they felt so enlightened by the course that it should be made part of the regular curriculum, which it now is. They also reported three times greater willingness to report such errors to colleagues, teachers and hospital officials responsible for patient safety.

The students’ views on medication errors became more realistic after the course. After the course, 89% of students reported a better understanding that in their future practice they will witness colleagues and other hospital staff making errors, compared with 57% before taking it. And after completing the course, 79% of students acknowledged they themselves will likely make mistakes that could harm patients, compared with 64% before the course. Being aware of one’s own fallibility is critical in preventing errors, the investigators said.

“Studies have shown that the majority of medication errors involve junior doctors recently graduating from medical school, so we must instill patient-safety tenets early on during medical school and before these young doctors enter the hospital for hands-on-training,” Dudas said.

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