The End of the Beginning Lessons Learned from the Patient结束的开始从病人的经验教训.pptVIP

What Went Wrong? The personnel The attending surgeon The resident The 3rd year medical student The nurse The anesthesiologist The system The team in the OR Students and residents are often in the best position to recognize and prevent errors Punitive systems mitigate against disclosure Disempowerment mitigates against action Institute of Medicine, November 1999 Medical errors are a serious problem The cause is bad systems We need to redesign our systems We must change the way we train our future clinicians We need to make safety a national priority Develop a safety curriculum Simulation and team training are key Six Dimensions of Care Quality Safe: Avoids Injuries to Patients Timely: Minimizes Waits and Delays for All Effective: Based on Scientific Evidence Efficient: Avoids Waste of Equipment, Supplies Equitable: Not Discriminatory Patient Centered: Responsive to Patient’s Needs Event Rates in US Hospitals Florida Annual Accidental Deaths, 2003 How many ways can it be said? IOM Chasm Report Aims Chasm Report Rules AAMC Report IHI’s framework Recent Reports on AHCs Some things to remember as we get into education… Aristotle The first aim of education is the development of virtue in the citizen Virtue is both intellectual and moral, reason and habit Seeks truth and goodness Harmony Citizenship The Research on learning.. 60’s Learning principles (Gagne, 1962) 70’s Dormant: little empirical work Theoretical, dull irrelevant and faddist (Campbell, 1971) 80’s Goldstein, Wexley (1984) Method based Cognitive psychology and expertise Tannenbaum (1992) Dreyfuss--expertise Theoretical Advancements Organizational frameworks (Tanenbaum, 1993) Climate to transfer (Thayer, 1995) Training motivation (Colquit et al, 2000) Pre training context (Quiones, 1995) Individual/situational characterizes (Mathieu, 1997) Participation and development (Noe, 1992) Post Training Conditions Training evaluation Expanded (Kraiger, 1993) Transfer of Training (Thayer) Transfer “climate”