Linda Headrick, MD, a national leader in integrating quality improvement principles into medical education, teaches students in the University of Missouri School of Medicine clinical simulation center. She led the Retooling for Quality and Safety initiative, which coordinated research on teamwork and quality improvement training at six universities. Their findings, which call for changes in education requirements, appear in the journal Health Affairs.

Interprofessional Quality and Safety Training Could Transform Health Care

Study recommends new requirements to improve education for physicians

More than a decade ago, an Institute of Medicine study revealed that preventable medical errors were a leading cause of death, accounting for more fatalities than breast cancer, traffic accidents or AIDS in the United States. Today, the problem of medical errors remains and might even have escalated.

In the December 2012 issue of the journal Health Affairs, researchers at the University of Missouri and five other universities describe how medical and nursing schools could join forces to prevent potentially deadly errors. Their findings, which call for integrating interprofessional teamwork and quality improvement training into required curricula, are part of the Retooling for Quality and Safety initiative. Spearheaded by the Institute for Healthcare Improvement (IHI), its Open School, and Josiah Macy Jr. Foundation, the initiative conducted a far-reaching study involving nearly 1,400 student encounters.

"Interprofessional teamwork is crucial to developing more cost effective, patient-centered health care systems in the U.S. and around the world. If we expect physicians, nurses and pharmacists to implement new ways of working, we need to find innovative ways for students who'll be entering these professions to train together," said Maureen Bisognano, IHI president and CEO and an Institute of Medicine member. "The six universities who took part in Retooling for Quality and Safety have laid a strong foundation that others can learn from and build on in creating their own programs. Whether it's with grand rounds, simulation or improved communication skills, patient care has become a shared responsibility, and the sooner students experience this, the more prepared they'll be."

Most medical schools train students in quality improvement and patient safety, but most are not doing it with students from other professions. A review of medical schools showed that while 62 percent of them teach quality and safety, only 41 percent provide interprofessional education.

"Education in the health professions must prepare all students for working together toward a safer and better health care system," said Linda Headrick, MD, lead author of the article and senior associate dean for education at the University of Missouri School of Medicine. "The initiative showed us that medical and nursing schools can and should create learning experiences together and integrate that content into existing curricula. Now, we must spread the lessons learned from our research to all medical educators."

Headrick led the Retooling for Quality and Safety initiative. In addition to the University of Missouri, other participants included Johns Hopkins University School of Medicine, Penn State College of Medicine, School of Medicine at the University of Texas San Antonio Health Science Center, University of Colorado Denver School of Medicine, and Case Western Reserve University School of Medicine. Each participant has both a school of nursing and a school of medicine that worked together to develop and implement innovative methods to integrate health care improvement and patient safety content into existing required curricula. They used faculty development sessions, online training, small-group exercises in a classroom, and simulation laboratories.

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Medical and nursing students team up to help prevent a mock patient from falling during a clinical dramatization in the University of Missouri School of Medicine simulation center.

Most sites also developed opportunities for students to apply quality improvement and safety concepts in actual clinical settings. At the University of Missouri, where the importance of quality and safety is emphasized from the time students begin medical school through graduation, educators put a "face" on the issue by having students interact with real patients.

MU students specifically addressed the risk of patient falls, the most common injuries reported in hospitals. Students from different professions reviewed a patient's chart, performed an assessment at the bedside, and created a customized fall prevention plan for each patient and team of care providers. The students also participated in small-group discussions with educators and in a lecture on patient safety. Participating patients were overwhelmingly positive about the experience, reporting that they valued the student encounters and found the personalized fall prevention information useful.

All medical schools participating in Retooling for Quality and Safety are building a continuum of learning experiences in quality and safety across their curricula, as well as sharing what they have learned with other institutions. For example, one common challenge for participating medical schools was overcoming a lack of faculty members who were ready to teach about improving patient care.

"Our findings from this study and others indicate that every academic health system should have a critical mass of physicians who can perform and teach others about how to improve quality and safety," said Headrick, who leads the Association of American Medical Colleges' Teaching for Quality initiative. "Ultimately, our efforts should focus on ensuring that physicians become proficient in quality improvement to advance on their career paths."

The University of Missouri School of Medicine is a national leader in quality, safety and interprofessional education. In 2011, it became the only school to win the CLARION National Interprofessional Team Case Competition three times, and it was awarded the Duncan Neuhauser Award for Curricular Innovation for its interprofessional safety simulation programs.