Increasing Patient Safety by Reducing Medical Errors

To prevent unnecessary morbidity and mortality, health professionals must have both an understanding of systems and a commitment to their improvement, this according to Dr. Abbas Hyderi, Associate Dean for Undergraduate Medical Education at University of Illinois (UIC) College of Medicine and keynote speaker at the 24th Annual Geoffrey Bourne Memorial Lecture.

Dr. Hyderi, who also serves as Associate Professor of Clinical Family Medicine at UIC, gave a lively presentation titled “Implementing the AAMC EPA #13: Identify systems failures and contribute to a culture of safety and improvement” at Bourne Lecture Hall to a group of physicians and health care administrators attending SGU’s annual clinical meetings that week.

“The goal here is to increase both the preparedness of interns from day one, as well as patient safety, by decreasing the ‘July phenomenon’,” said Dr. Hyderi. “Though there is some conflicting data, evidence shows that in the month of July there is an increase in the risk of medical errors that occur in association with this time of year in which US medical school graduates begin their residencies.”

Describing Entrustable Professional Activities (EPAs) as units of professional practice, Dr. Hyderi goes on to define these activities as tasks or responsibilities to be entrusted to the unsupervised execution by a trainee once he or she has attained specific competence.

EPA 13 in particular focuses on the expected behaviors of an entrustable learner, including their ability to recognize and report patient safety concerns in a timely manner using existing system reporting structures; to speak up and find actual and potential errors, even against hierarchy; to identify and reflect on the element of personal responsibility for errors; and to recognize causes of lapses, such as fatigue, and modify behavior or seek help.

“EPA 13 is the most aspirational of all the EPAs and could be the biggest game changer in medical education,” stated Dr. Hyderi. “Our hope is that changing our educational and clinical learning environments and systems to create a ‘speak up’ culture will support students to work on systems and not just in systems. Also, this EPA highlights that the self-regulated learning cycle is analogous to the quality improvement cycle and so students will be able to reflect on both their personal and systems contributions to medical errors and continuously improve.”

In his lecture, Dr. Hyderi also considered some of the opportunities for and barriers to incorporating EPA 13 into a school’s medical curriculum, which include the vulnerability, concerns, and hesitance that interns feel when considering when to “speak up”, and the need for more faculty champions and staff support dedicated to EPA projects. Yet, he firmly believes that EPA 13 can serve as a guide to better train students in order to significantly reduce medical errors from the very start of their internship.

“I believe we do not do enough direct observation of nor provide feedback on clinical skills training of students by the time they graduate medical school,” added Dr. Hyderi. “The goal of the five-year project is to test the feasibility of the framework, develop strategies for instruction and assessment, and vet ‘entrustment’ approaches with students being better prepared to successfully transition to graduate medical education.”

In addition to his roles at UIC, Dr. Hyderi is also actively engaged in educational research and scholarship including being the Co-Chair of the Provost’s Strategic Planning Task Force on Interprofessional Education (IPE), as well as Co-Principal Investigator for the primary care residency expansion grant for the UIC Family Medicine Residency. Currently, he is the Chair of the College-wide Curriculum Transformation Task Force and the Chicago campus lead for the prestigious five-year Association of American Medical Colleges (AAMC) Core Entrustable Professional Activities for Entering Residency (CEPAER) Project and was part of the team that represented the College at Harvard’s Shapiro Institute Millennium Conference focused on post-clerkship curriculum.

Dr. Hyderi joins a distinguished list of Bourne speakers that includes Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases (NIAID), and neurology pioneer Lord Walton of Detchant. The lecture series is named for St. George’s University’s first Vice Chancellor, Dr. Geoffrey H. Bourne, an educator, scientist, writer, and visionary who helped guide the University in its early development.

– Ray-Donna Peters