My first experience with patient safety came during my junior year of college when I was interning in a gastroenterology practice. I had spent three years learning about the problems facing the healthcare system from professors who were passionate about fixing it. I had read, for example, about the role of checklists in reforming the aviation industry and their promising application in healthcare. I was excited when on my first day, I watched as one physician started each and every procedure with a timeout, diligently going through each step of the checklist before beginning. Afterword, he eagerly told me about the strong evidence supporting checklists’ use and how he felt that they had improved his own practice since he started using them. Over the next few days, I was surprised to see that some physicians only occasionally completed the time outs while some signed the form without doing anything at all. When I spoke to the practice administrator about what I had seen, she laughed and said, “Oh yes, everyone knows how much Dr. L loves his checklists.” I was dismayed to find that this physician had become a sort of joke with his colleagues and realized how much the culture of medicine would have to change before better safety outcomes could be achieved.
This experience made me wonder when these attitudes are learned. At what point do naïve medical students becomes jaded physicians? It is there a critical period after which changing attitudes becomes exponentially more difficult? It seems that more and more, medical schools are beginning to include patient safety and quality improvement in their pre-clinical curriculums. What I am most curious about and have not yet gotten to experience, however, is the hidden curriculum during the clinical years. Once they are out of the classroom, what are medical students learning from observing and participating in actual care teams? What needs to change in medical education in order to create a new generation of physicians with a drastically different view of patient safety? I am hopeful that the Telluride Experience can help me answer these questions and can alter the trajectory of my own education.
Changing the culture of medicine one person, team, or unit at a time is arduous. I believe that one of the most effective ways to change attitudes towards patient safety is to target clinicians during their education before they become set in their ways. I hope to be part of this change and am eager to implement the lessons that I learn at the Telluride Experience.