Development of a teamwork-oriented educational program for the prevention of adverse medical event

为建立病患安全的医学教育课程，我们研究了当前病患安全教育的时机、内容和方法。我们还开发了一些场景，让医学生体验涉及不良事件的危急情况，作为一种实用的教育工具。讲座结束后的学生调查显示，他们认为应该提供这些讲座，因为他们以前的课程中没有教过这个主题。适当的内容，适合学生的知识，案例研究，讲师涵盖各种主题有关患者安全将是必要的。我们创建了四个场景。(1)患者在血管造影时出现心肺骤停。医护人员无法正确实施心肺复苏。问题：先进的心血管生命支持，心肺复苏系统的使用，在团队合作中的领导……更多的意外情况，和文件。(2)一位居民口头命令给胰岛素。他认识到这是不合适的，然后写了一个书面命令，但忘了写剂量的单位。一个没有经验的护士给病人服了过量的药。问题：药物知识和适当的医嘱。(3)患者在内镜检查时结肠穿孔。病人的家属愤怒地指责医生应该为此负责，但医生没有意识到他们的情绪。问题：在不良事件中与患者及其家属的知情同意和沟通。(4)一名绝症患者从床上摔下，患急性硬膜下血肿，不久因原病死亡。一位医生试图自己写死亡证明，不知道验尸的必要性。问题：关于非正常死亡和尸检的法律知识。应该评估这些场景在医学教育中的有用性。少

To build a curriculum for medical education regarding patient safety, we have studied timing, contents and methodologies of current educational programs relevant to patient safety. We have also developed scenarios in which medical students can experience critical situations involving adverse events as a practical educational tool.The student surveys after the lectures about patient safety and medical ethics revealed that they thought these lectures should be provided because this theme had not been taught in their previous courses. Appropriate content suitable for students' knowledge, case studies, and lecturers covering a variety of topics related to patient safety will be needed.We have created four scenarios. (1)A cardiopulmonary arrest occurred in a patient during an angiography. Medical staff could not appropriately perform the cardiopulmonary resuscitation. Issues : advanced cardiovascular life support, use of a cardiopulmonary resuscitation system, leadership in the teamwork in … More an unexpected situation, and documentation. (2)A resident verbally ordered insulin administration. He recognized that this was not appropriate and then made a written order but forgot to write a unit for the dose. An inexperienced nurse gave an overdose to the patient. Issues : knowledge of drugs and appropriate physician orders. (3)A patient's colon was perforated during an endoscopic examination. The patient's physician was blamed for this event by the patient's angry family members, but failed to acknowledge their emotions. Issues : informed consent and communication with a patient and his family in an adverse event. (4)A terminally ill patient fell down from his bed and suffered from acute subdural hematoma, and soon died of his original illness. A physician tried to write a death certificate by himself, not knowing the necessity of a post-mortern examination. Issues : knowledge of law regarding unusual death and post-mortern examinations. The usefulness of these scenarios in medical education should be evaluated. Less