title: The Future of Graduate Medical Education: A Systems-Based Approach to Ensure Patient Safety.
abstract: In the past 15 years, there has been growing recognition that improving patient safety must be more systems based and sophisticated than the traditional approach of simply telling health care providers to "be more careful." Drawing from his own experience, the author discusses barriers to systems-based patient safety initiatives and emphasizes the importance of overcoming those barriers. Physicians may be slow to adopt standardized patient safety initiatives because of a resistance to standardization, but faculty in training institutions have a responsibility to model safe, effective, systems-based approaches to patient care in order to instill these values in the residents they teach. Importantly, graduate medical education (GME) is well positioned to influence not only how future physicians provide care to patients but also how today's physicians and health care systems improve patient safety and care. The necessary systems-based knowledge and skills are rooted in both understanding and proficiently identifying threats to patient safety, their underlying causes, the development and implementation of effective countermeasures, and the measurement of whether the threat has been successfully addressed. This knowledge and its application is notably absent in the operation of most institutions that sponsor GME training programs in terms of didactic instruction and everyday demonstrated proficiency. Most important of all, faculty must model the behavior and competencies that are desirable in future physicians and not fall into the trap of the "do as I say, not as I do" mentality, which can have a corrosive deleterious effect on the next generation of physicians.
authors: J.P. Bagian is director, Center for Healthcare Engineering and Patient Safety, professor, Department of Anesthesiology, College of Medicine, and professor, Industrial and Operations Engineering, College of Engineering, University of Michigan, Ann Arbor, Michigan. He is cochair of the Accreditation Council for Graduate Medical Education Clinical Learning Environment Review Committee.
authors: James P
authors: JP
authors: Bagian
mesh_terms: D000068:Accreditation; D004503:Education, Medical, Graduate / Q000458:organization & administration* / Q000639:trends; D005180:Faculty, Medical; D006801:Humans; D015279:Organizational Culture; D061214:Patient Safety / Q000592:standards*; D058996:Quality Improvement; D013598:Systems Theory; D014481:United States