Safety management for Post-graduate clinical training

采用问卷调查法，对日本住院医师期间的安全管理现状、患者安全教育项目、工作条件等进行了调查。有223家教学医院(占全部教学医院的23.8%)进行了调查，结果显示：1.教育体系，特别是认证教师的数量有待建立。2.包括标准化课程内容、通用程序技能、模拟培训在内的教育工具和模块不发达。3.医院故障安全和事故/事故后备系统不发达。4.即使在教学医院中，也没有完全认识到病人安全教育和附加课程的重要性。5.连续工作时间超过8小时的工作量往往被低估。要改善这些情况，特别是要建立ad…在更加平等的教育体系中，激励医务人员的策略似乎是不可或缺的。为预防住院医师实施有创操作时发生的事故，确保患者安全，对锁骨下静脉穿刺术进行了预测性风险分析，并将风险汇总到电子表格中。根据结果，识别了应该避免的高风险，并根据程序、环境对其进行了分类。开发了一种信息技术教材，使居民能够在PC上轻松理解明显和潜在的风险。在参观了美国一些顶级模拟中心后，总结了模拟训练的优缺点，体验了可以作为改善医院系统的有力武器的发病率和死亡率会议，并从教育的角度认识到，这些M&M会议还有待于在日本的教学医院普遍举办。较少

An investigational survey using questionnaires clarifying the current situation of the safety management, the educational program concerning the patient safety, the working conditions during the residency program in Japan was conducted. 223 teaching hospitals (23.8% of all the teaching hospitals) responded to the survey and it was revealed that 1. educational systems, especially the quantities of the certified teachers are to be established. 2. educational tools and modules including the standardized contents of the curriculum, skills for the common procedures, simulation training are underdeveloped 3. the hospital fail-safe and back-up system in case of incidents/accidents are underdeveloped 4. The importance of the education about Patient Safety and additional curriculum are not completely recognized even among those teaching hospitals 5. Work load derived from the consecutive working hours over 8hrs tend to be underestimated. To improve these situations especially to establish an ad … More equate educational system, strategies to motivate the medical stuffs seem to be indispensable. To prevent incidents and assure the patient safety when residents perform invasive procedures, predictive risk analysis (PRA) was conducted for sub-clavian veni-puncture procedure and risks are summarized into spreadsheet. Based on the results, high risks that should be avoided are recognized and are categorized in terms of procedure, environment. An IT teaching material that enables residents to understand the apparent and latent risks easily on PC was developed. This IT material was tried among some teaching hospitals and highly reputated.After visiting some top-level simulation centers in USA, the merits and demerits associated with the simulation training were summarized, and the Morbidity & Mortality conferences which could be a potent weapon to improve the hospital systems are experienced and from the educational standpoint, it was recognized that those M&M conferences wait to be commonly held in the teaching hospitals in Japan. Less