Many people will know the story of Graham Reeves, a patient from Wales who died after surgeons removed the wrong kidney, taking out his healthy kidney and leaving him with one non-functioning organ.1 The only person in that operating theatre to notice the error (by studying the xrays) was a medical student. She spoke up to point out the mistake but was ignored by the surgeon, with tragic results.
The study of medical error and patient safety is big news in today’s NHS and around the world. One of the key principles is that everybody makes errors at some point. Nobody is perfect 100% of the time – that is human nature and we should accept it. What we do need, though, are checks and processes to make sure that errors are prevented, identified when they occur, and stopped from resulting in an adverse outcome. The importance of patient safety has been highlighted by the British Medical Association, General Medical Council and World Health Organisation.
Despite all of this, patient safety has not yet been ingrained in the UK undergraduate medical curriculum.2 This is a shame as I believe medical students are in a strong position to not only understand the principles involved, but to make a positive difference to the safety of health care environments.
Students on clinical placements have the opportunity enjoyed by few senior doctors; to move around different clinical specialties and hospitals. By contrasting modes of working, students have a unique perspective on aspects of care which may be less efficient than elsewhere, or where errors seem to occur more often. They are also unencumbered by tradition, providing a fresh pair of eyes on systems which may have been designed for a bygone era.
Speaking from my own experience, students are acutely aware of the possibility of making mistakes. We are frightened of being the junior doctor who prescribes the wrong dose of medication, or fails to spot the crucial clinical sign. Many of the solutions of patient safety including checklists and failsafe mechanisms which may prevent us from making a serious error are music to our ears.
There is a great deal of scope for medical students to get involved in patient safety projects. These need not simply be audits pointing out deficiencies, but quality improvement exercises where new methods of working are piloted and adapted, with ongoing assessment of changes. Supervision may be needed by a more senior clinician, but students often have the ideas, the time, and the drive to make a real difference. In my own trust, a student-led patient safety group has looked at handover between junior doctors, sepsis identification, and prescribing errors, in some cases making lasting change in clinical systems.
I would really encourage students to set up a patient safety group in their own universities and hospitals, and for this topic to become a much more prominant area of the undergraduate medical curriculum.
- Dyer O. Doctors suspended for removing wrong kidney. BMJ 2004;328:246.2
- Walton M, Woodward H, van Staalduinen S, Lerner C, Greaves F, Noble D, Ellis B, Donaldson L & Barraclough B. The WHO patient safety curriculum guide for medical schools. BMJ Quality and Safety in Health Care 2010;19:542-546
Adrian Hayes is a 4th year student at Warwick Medical School. He previously completed a BSc in Psychology at York University, and a PhD in Forensic Psychiatry at Manchester University. He founded RISC, the patient safety society at Warwick, and is the outgoing Chair.