Critica a lo que el Magistrado Conoce sobre Norma

A number of initiatives have been launched with the intention of improving patient outcomes and reducing the number of adverse events. A selection of international initiatives includes the following:

• a national consensus conference jointly

sponsored by the American College of Surgeons (ACS) and the Accreditation Council for Graduate Medical Education (ACGME) on the development of a curriculum on patient safety for American residency programs;

• the Institute for Healthcare

Improvement’s (IHI’s) Open School, an online resource for learners, teachers and educators;

• the World Health Organization’s (WHO’s) Patient Safety Curriculum

Guide for Medical Schools; and

• Australia’s National Patient Safety

Education Framework.15

Furthermore, there have also been provincial or local examples of patient safety-focused initiatives within Canada, as follows:

• McGill University’s Faculty of Medicine

and the McGill University Health Centre have provided patient safety teaching to fourth-year students since 2008;

• Memorial University in Newfoundland has

implemented an interprofessional patient safety module for medicine, nursing and pharmacy students; and

• the University of Toronto started a MSc

concentration in quality improvement (QI) and patient safety in 2012.

In 2001, the Royal College of Physicians and Surgeons of Canada hosted a forum on patient safety that generated a national strategy to systematically improve patient safety. Subsequently, a National Steering Committee on Patient Safety was created. The committee identified the need for educational and professional development programs and supported the creation of a national not-for-profit patient safety organization: the Canadian Patient Safety Institute (CPSI). Through collaboration with the Royal College, the CPSI developed The Safety Competencies, the first national effort to identify the knowledge, skills and attitudes required by all graduating health care professionals to ensure the provision of safe patient care. The Safety Competencies framework related to the following six domains of patient safety:

• contribute to a culture of patient safety; • work in teams for patient safety;

• communicate effectively for patient safety; • manage safety risks;

• optimize human and environmental

factors; and

• recognize, respond to and disclose

However, despite the development of The Safety Competencies framework, in addition to the other frameworks that have addressed patient safety through the lens of health professional education, the

implementation of patient safety and quality improvement content in medical education curricula remains inconsistent across Canada and is often limited to pockets of

innovation and excellence.

Current StAtuS

Evidence from across Canada and the United States corroborates a concern that patient safety frameworks and content have not yet been integrated into medical education. For instance, a survey in 2006 of Internal Medicine Clerkship Directors in the United States and Canada indicated that, despite calls from regulatory, medical and educational organizations to increase the patient safety training of medical students, few schools had implemented specific patient safety curricula.16 The IHI recently undertook a research and development project to assist academic medical centres and PGME programs to become aligned and capable in quality and safety programming. As part of this project, a multi-faceted scan was performed. That scan characterized the current state as having

poor institutional QI and patient safety alignment; faculty who do not have the time, motivation, or knowledge to participate in QI and patient safety activities; and residents who travel through their clinical education with little to no exposure to QI and patient safety methods and practice.17

Furthermore, this lack of exposure is echoed in

shortcomings in patient safety knowledge among medical trainees across a broad range of training levels, degrees and specialties, demonstrating a need for effective educational interventions.18 _{Moreover, while some} undergraduate and postgraduate training programs have begun to include the knowledge and skills that represent the scientific aspects of patient safety emphasized in The Safety Competencies framework in their formal curricula, the culture and attitudinal aspects of patient safety are not formally (or informally) addressed. The latter may be the most challenging to address; however, it may be the most critical predictor of resident (and faculty) behaviour.19

exPLorInG PotentIAL

CHALLenGeS to

IMPLeMentAtIon

This paper theorizes that uptake of The Safety Competencies and other frameworks among Canadian PGME programs have been limited for the following reasons:

1. Teaching patient safety has not been an imperative. The Royal College and the College of Family Physicians of Canada (CFPC) do not explicitly require PGME programs to include the teaching and the assessment of the knowledge, skills and attitudes that comprise The Safety

Competencies.

2. The Safety Competencies framework is a high-level, outcomes-based document,20

and it may be challenging for educators to translate the competencies into formal, informal and incidental education for residents. Furthermore, concrete teaching and assessment tools that can be used at

the program level have not been widely developed nor disseminated and, as such, it is challenging for program directors and other educators to convert the high- level framework into practical teaching for learners. Additionally, requirements may be different in different specialties (e.g., medicine versus surgery), making a universal hospital/university approach too non-specific to be applied effectively.

Currently, PGME programs are required to organize their curricula using the CanMEDS framework. Patient safety competencies are embedded in the framework, albeit in a diffused manner. Mapping The Safety Competencies to the CanMEDS framework is often a challenging curricular task; as a result, it may be difficult to incorporate the teaching of The Safety Competencies into existing curriculum. As part of the development of this paper, the authors worked to map the competencies to the CanMEDS Roles. This task was demanding, as each of the six patient safety domains cuts across a number of CanMEDS Roles. Even at the individual competency level, many of the patient safety competencies contained aspects of two or more CanMEDS Roles. An initial classification can be used as a starting point for future debate. An additional document, also mapped to the CanMEDS Roles, provides an assessment tool for program directors.21 _{There is a need for broad} agreement on the linkages between the two frameworks in order for the results of this linking exercise to be a useful tool for program directors.

3. There is not enough expertise at the faculty and program levels to integrate patient safety content into PGME programs. Patient safety and QI are relatively new niche areas of faculty expertise, and there is a paucity of educators with the necessary background/training to develop and

deliver this type of curricula at all levels of training, including faculty development and PGME. In many instances, university support and recognition for teaching — particularly for quality and patient safety — continue to lag behind that for research and clinical care.

4. The culture of medical education — and of many hospitals — is not generally one of patient safety. Although hospitals and programs may mandate safety processes and patient safety curricula, the curricula have not been universally accepted and are often taught without a true commitment to, and understanding of, patient safety. As such, one of the key reasons that uptake has been inconsistent is the existence of the hidden curriculum, which has the potential to undermine initiatives such as The Safety Competencies.

Many tools, including systems thinking and design, teamwork, communication, and situational awareness, are applicable to patient care and are instrumental in delivering the safest care possible. However, to be effected and effective, these sciences and tools must all operate within a supportive environment, which is a culture of patient safety. Until the above are addressed, patient safety will remain on the periphery of medical education and, consequently, will not become explicitly embedded into either the culture or practice of medicine among current and future generations of physicians. In addition, the public cannot ascertain if its physicians are competent in these domains. Medical educators, and the PGME system as a whole, have a responsibility to the public to ensure that the physicians of the future are trained within evolving paradigms of teamwork, communication, systems thinking, and preventing and learning from adverse events, all in a supportive learning environment.

PoSSIBLe SoLutIonS –