Safety management for Post-graduate clinical training

采用问卷调查的方式，对日本住院医师的安全管理现状、患者安全教育计划、工作条件进行了调查。223所教学医院（占全部教学医院的23.8%）参与了调查，结果显示：必须建立教育制度，特别是合格教师的数量。2. 教育工具和模块包括标准化的课程内容、通用程序的技能、模拟训练都不发达。医院的防故障和应急系统不发达。即使在那些教学医院中，也没有完全认识到患者安全教育和额外课程的重要性。连续工作超过8小时的工作量往往被低估。为了改善这种状况，特别是建立一个更加公平的教育制度，激励医务人员的策略似乎是必不可少的。为防止住院医师在进行有创手术时发生意外，确保患者安全，对锁骨下静脉穿刺手术进行预测风险分析（PRA），并将风险汇总成电子表格。根据结果，识别出应避免的高风险，并从程序、环境等方面进行分类。编制资讯科技教材，让市民更容易了解电脑的明显及潜在风险。这种信息技术材料在一些教学医院试用并获得了很高的评价。通过对美国一些顶级模拟中心的考察，总结了与模拟培训相关的优点和不足，并从教育的角度总结了可以作为改进医院系统的有力武器的发病率和死亡率会议，认识到这些M&M会议有待于在日本的教学医院普遍举行。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