Telluride Interdisciplinary Patient Safety Roundtable
November/December 2011
Telluride Interdisciplinary Patient Safety Roundtable:
Medical Students’ Daily Narrative Reflections
As each new report of medical harm is published, the need to redesign medical education to prepare young physicians capable of approaching patient care in ways that decrease the opportunity for harm reaches a new level of urgency. The human and financial costs related to medical harm and error are now being captured more frequently and in greater detail as reporting capabilities are forced to grow in tandem with more vigorous reporting requirements. It is the same innovative thinking applied to new technologies, new approaches to patient care, and redesign of systems that must also be applied in the education of young physicians in order to improve outcomes at the bedside. The Telluride Patient Safety Educational Roundtable (TPSER) developed by University of Illinois at Chicago anesthesiologists and patient safety thought leaders David Mayer, MD, and Timothy McDonald, MD, JD, is one such educational innovation.
For the last seven years, Mayer and McDonald have assembled interdisciplinary stakeholders from a variety of areas in healthcare for the Roundtable, held in Telluride, Colorado, at the Telluride Science and Research Center. The goal is to use the multidisciplinary expertise to design patient safety centered curriculum for medical students. Medical educators, curriculum development/assessment experts, safety and patient advocacy leaders, administrators, healthcare providers, students, and residents came together for the first time in 2005. As a result of the yearly Roundtables, general curricular principles have been defined, along with 11 specific elements essential for an effective patient safety undergraduate medical education curriculum, as discussed in the 2009 Teaching and Learning in Medicine article by Mayer et al.
Telluride Patient Safety Educational Roundtable Student Summer Camp: Class of 2011
Six years of Roundtable discussions have now led Mayer and McDonald to create the Telluride Patient Safety Student Summer Camp, including both residents and medical students in the discussions. Objectives of the Summer Camp include:
- Identification and development of future leaders and champions in patient safety, risk reduction, and open, honest and professional communication between patients, families, and caregivers.
- Development of a growing number of patient safety student camp alumni who serve as mentors during their residency training to (a) medical students enrolled in future patient safety student camps and (b) medical students and residents at their respective medical centers and health systems.
- Creation of a community through social networking, where summer camp medical students and summer camp alumni can interact with international leaders in patient safety, education, and patient advocacy.
- Creation of a series of annual collaborative patient safety and quality improvement projects between summer camp medical students, faculty, patient advocates, and alumni mentors that are implemented within the student’s medical school and beyond.
The following narrative reports, provided by the medical student attendees and educators, convey the resulting effect participation in the Telluride Patient Safety Summer Camp had on attendees in 2011.
Methods
Students from medical schools across the United States were invited to apply for 20 Telluride Roundtable Patient Safety Summer Camp scholarships funded by The Doctors Company Foundation. Students submitted their CVs, letters of recommendation, and a two-page personal statement describing why they should be considered for a scholarship. Sixty-two applications were received, and students were selected based on academic scholarship, work in the patient safety/quality improvement field, and a history of strong leadership experience.
The four-day program format included plenaries led by international patient safety leaders, stories of patient harm shared by family members, viewing of educational documentary films based on patient stories of medical error (The Story of Lewis Blackman [2009] and The Story of Michael Skolnik [2010]), small break-out and large group discovery, discussion, and consensus and teambuilding exercises. The program format was designed to encourage interactive discovery and creative dialogue among the medical students and patient safety thought leaders in a relaxed, informal setting. Time to network was also built into the program format, providing an opportunity for the development of lasting relationships and resources within the patient safety community.
Students were required to keep a daily reflective journal of their experience throughout the week to be used in a qualitative assessment of the program’s impact on attendees. Students were also encouraged to develop patient safety projects they would spearhead along with Telluride faculty mentors over the course of the coming school year. Results of student reflections are reported here, and a discussion of the experience by program educators follows.
Results
Four major themes were uncovered through qualitative analysis of the medical student attendee reflections. The four recurring themes include: 1) satisfaction with the diversity of backgrounds and experience of the conference presenters, their high level of expertise and knowledge of patient safety topics and quality of interactions with their peers; 2) the existence of a sub-culture of disrespect and humiliation within the culture of medicine and the role this sub-culture plays in undermining patient safety and patient care; 3) the interactions with patient advocate attendees and the educational value of hearing patient stories; and 4) hearing first-hand accounts of successful implementation of practices and/or programs to improve patient safety. Examples of student reflections follow.
The Conference Presenters
• I cannot leave out some recognition of the incredible people all around me—each way I look there is an expert in patient safety, a patient advocate with more courage than most anyone, and wide-eyed students. The experts represent trailblazers. They are the people speaking up for what is right and best for patients. They are great examples.
• I was inspired by meeting my peers and seasoned leaders in the field (Dr. Oates, Dr. Leape, etc.) to take a more active role in effecting change. I think that I had previously thought of myself as relatively powerless… but I was impressed by the passion and commitment my peers showed to starting substantive curricular and organizational changes that would go far beyond what I had previously imagined possible in medical school.
• After completing the first day of the roundtable, I feel completely amazed and inspired. The mere fact that healthcare providers of all levels of training and ages can gather in one room and have a productive conversation that is solely based on mutual respect is not commonplace in today’s medical culture.
• Coming to Telluride with no concrete idea of what to expect and a new interest in patient safety, I was blown away by the first day. Having such a wide array of people with very different experiences and backgrounds in one place discussing such complex and important topics was incredibly intense.
• I have been amazed throughout today to learn the varied backgrounds and experiences that everyone in the classroom has that have led them to this meeting. It has been incredibly inspiring to hear all of these stories… how our own perceptions, behaviors, and communication styles impact the care we provide. It has certainly been refreshing to be in a room of medical professionals that accept this automatically—that did not distract us all with a fight about whether this is even true.
The Culture of Medicine
• Dr. Lucian Leape presented a fascinating theory on the root cause of medical errors and dysfunction in the health care system. What is troubling to me is that most aspiring health care professionals enter the system optimistic, with patient-centered focus, but at some point the system corrupts this idealism.
• So convinced am I of the importance of respect for the dignity of patients that I have been actively brainstorming with conference participants (since leaving) and even like-minded members of my own medical school class on ways to address the issue in the coming year.
• Dr. Lucian Leape presented that the problem isn’t that medical students are not taught error science, but that they are being taught disruptive behavior by bad role models. As we broke out into groups, we tackled the question, how can we get CEOs to change the culture of the hospital into making respect the number one priority. This was a powerful conversation, and will be on my mind as I continue throughout the week and as I continue in my career in medicine.
• While positive role models are critical to reforming the culture of medicine, medical students are adults, and can both take steps to improve the clinical environment and patient safety. We can take ownership of promoting respect among each other by validating the concerns and efforts of colleagues and avoiding the jokes that historically served as rites of passage.
• I love the idea of a ‘culture of respect’ and I’m really hopeful that I can bring that idea to my school, not just in my dealings with other people, but also in a more concrete way. I’m going to talk to the head of our IHI chapter as well as the director of our MS1 ethics course.
• Lucian Leape’s call for “joy and meaning in work,” and for respect in healthcare culture, was striking. I think I’d been subconsciously desiring both, and… it really struck a chord in my mind and heart. It’s very clear that cultural change at my institution starts with me… I’m willing to do it, and, let’s face it, clinical teams look to physicians for leadership and that’s part of my responsibility.
Patient Advocates and Their Stories
• I felt that the Lewis Blackman film was a perfect way to start off the conversation. A big take away from the film for me was reconciling team-based care with individual providers feeling a sense of accountability to their patients. Without any individual feeling the duty and ownership of taking care of Lewis, each member of the team allowed things to slip.
• Even after seeing the Lewis Blackman film for the 3rd time, I was still able to pull out new important points that I hope to take back with me to my medical career. The concept that we must not forget ‘what’s the worst it can be’ really stuck out in my mind.
w The patient advocates—I do not even have words for these leaders. I cannot come close to fathoming what is must be like to watch an entire room of people as they watch the story of your own great tragedy. Then not to sit quietly in the back of the room, but to pull yourself to the front to confront your own tragedy head on and answer any question at all in the faith that others can learn from your pain and make positive changes in health care.
• Having people in the room directly impacted by medical mishaps really elevated the conversation and truly made me see that this is not just about QI, this is about saving patients’ lives.
• During our small group discussion, I was challenged by a patient advocate for what she saw as an exclusive perspective prioritizing clinicians’ opinions over others.’ A good dialogue followed and was an excellent reminder…how terrifying the hospital, the ‘system’, can be for patients. I paid significant attention to the patient advocates for the rest of the week, as they provide a really valuable perspective that is rarely vocalized.
• My idea for a project leaving the week at Telluride: Work on Patient Safety App with fellow student, Jeremy, and patient advocates. I am very excited to work with the patient advocates to create an App that will be used to empower patients to know the right questions to ask no matter what time they go into a hospital for care and also know all the components they should understand of informed consent.
• Even more impactful than the input of my peers were the stories shared by the patient advocates. The courage of Helen Haskell and Patty Skolnik to share their tragic stories for the betterment of patients around the world is truly inspirational. It made me nauseous to realize these deaths could have been prevented if one person would have had the courage to speak up against the errors occurring in the hospitals. Those stories impacted me more than any set of data ever could.
• As a medical student in this roundtable, I learned about the importance of personal stories and reforming the medical education to implement change in patient quality. Therefore, I am willing to work with students to implement the videos on personal patient stories in my school’s curriculum and work with other students on writing a paper on health disparities and communication barriers among Latinos.
Successful Patient Safety Programs
• It was moving to learn about a successful, proof-of-concept intervention to tackle communication barriers to patient safety (as presented by Dr. Cliff Hughes, CEO of Australia’s New South Wales [NSW] Clinical Excellence Commission). As a medical student dealing with the rapidly-evolving nature of patient safety in medicine, I am convinced there is a problem but much less cognizant of ways to address shortcomings…seeing a success story in action really gives me a lot more hope that despite the challenges, it is very possible to implement change.
• What a great presentation by Drs. Hughes and Oates. It is great to see the focus on patient safety in other countries and learn their thoughts and methods. It is inspiring to see the ways they have effectively changed the environment in NSW and were able to present a method that has inspired all members of the hospital team.
• Today made me decide that if I ever leave the U.S., I would like to go to Australia and be in the hospitals where Dr. Cliff Hughes and Dr. Kim Oates have been a driving force behind some impressive changes. What Kim has done in medical education and Cliff has done with the Between the Flags programs give me hope that yes, improvement can be made.
• The clinical observation sheets and rapid response escalation implemented in NSW is a tremendous accomplishment, on par, in my opinion, with the Keystone initiative. Australia has had much more consistently beneficial results from its Rapid Response teams than the US…I’d like to see investigation of effects of clinical culture differences and clinical observation protocols on rapid response success and/or prevention in the U.S.
• Listening to Cliff Hughes speak of what he has done in his hospitals in New South Wales was inspiring. It left me empowered that something so seemingly small, like the color-coded medical records, can make such a difference.
Educator Comments
• Despite the slow progress in patient safety, if the students who came to Telluride this year are any indication, the future is bright indeed. These energetic, committed leaders stimulated the faculty and patient advocates, and clearly took inspiration from them in return. We will watch their impact with pleasure and gratitude.
— Lucian L. Leape, MD, Harvard School of Public Health
• When you see their passion—palpable, excited, idealistic—it’s easy to overlook the fact that these students are in positions right now to make a real and lasting difference among their colleagues, among their instructors, among all the other healthcare providers with whom they will work. It takes, sometimes, only one to stand tall and inspire everyone around. Courage shown in the least of them can inspire the most. Once out of school, they’ll assume leadership roles quickly and that ripple of change will spread. What a great investment!
— Richard C. Boothman, JD, chief risk officer, University of Michigan Health System
• What a joy to be with such a talented, enthusiastic group of students. Those who bemoan the future of medical care should meet these future leaders and be reassured. Our main job now is to continue to encourage and nurture them. I gave a little, but received far more.
— Kim Oates, MD, DSC, MHP, FRACP, University of Sydney, Australia
• To impact patient safety it takes a community. When students, residents, patient advocates, and thought leaders in the field gather and share their visions, ideas, and concerns through honest conversations, we move one step closer to keeping patients safe. We break down the walls of hierarchy, becoming one team with one mission—providing safe patient care.
— Carole Hemmelgarn, MPSL, patient advocate
• Telluride 2011 was an experience that reached across the generations. It was little short of inspiring to see the leaders of tomorrow spend nearly a week interacting with and learning from the patient safety leaders of today. That is the magic of Telluride. Where else would they be able to have those conversations?
— Helen Haskell, patient advocate, founder of Mothers Against Medical Error
• Reflecting on discussions with medical students and residents in Telluride I found they did take away an understanding of the great responsibility that comes with their career path. These bright young people are our hope that patient safety becomes paramount in their lives, and in the lives of those they touch.
— Patty Skolnik, patient advocate, founder and director of Citizens for Patient Safety
Rick Boothman, chief risk officer at University of Michigan Health System, leads a breakout session discussion.
Conclusion
The Telluride Patient Safety Educational Roundtable has continued to evolve over the past seven years, tackling critical issues related to the design and assessment of patient safety curricula. The past two years have seen the TPSER incorporate a Patient Safety Student Summer Camp into this work, allowing 20 student scholars in 2010 and 2011 to participate alongside international leaders and patient advocates in safety and transparency in these fruitful and important discussions.
Student and educator narratives highlight both the tangible and intangible powerful outcomes resulting from program participation. Narratives convey the increased awareness of the challenges inherent in the current culture of medicine, the inspiration gleaned from the leaders who shared their stories and experience, as well as a feeling of empowerment necessary to create a culture of safety and respect at their own institutions.
The TPSER has already resulted in the redesign of medical education principles. Discussions throughout the week in Telluride 2011 have resulted in concrete actions by student attendees, and we await the ripple effect this year’s program will have on the medical communities and schools in which they work. Based on the success of including students over the last two years of the program, the number of student and resident scholarships for the Patient Safety Summer Camp will be increased to 60 in 2012. It is our hope that this annual, internationally recognized Telluride Patient Safety Student Summer Camp will continue to send student leaders back into their home environments prepared to create a culture of respect among caregivers, as well as infect others with the importance of patient safety, risk reduction, transparency, and quality improvement strategies that allow for better patient outcomes.
David Mayer is co-executive director of the University of Illinois at Chicago (UIC) Institute for Patient Safety Excellence, associate professor of anesthesiology and founder of the Telluride Patient Safety Roundtable and Student Summer Camps. Mayer may be contacted at dmayer@transparent-health.com.
Tim McDonald is co-executive director of the UIC Institute for Patient Safety Excellence and chief safety and risk officer at the University of Illinois Medical Center.
Susan Doyle is a senior research associate with the Chicago GEAR UP Alliance and serves as the external evaluator for three federally funded patient safety education projects at UIC.
Tracy Granzyk Wetzel is a freelance healthcare writer and educational documentary filmmaker living in Chicago.