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

为了建立一个关于患者安全的医学教育课程，我们研究了当前与患者安全相关的教育项目的时间、内容和方法。我们还开发了一些情景，让医学生可以体验到涉及不良事件的危急情况，作为一种实用的教育工具。学生在有关患者安全和医德的讲座结束后进行的调查显示，他们认为应该开设这些讲座，因为他们以前的课程没有教授这个主题。将需要适合学生知识、案例研究和讲师涵盖与患者安全相关的各种主题的适当内容。(1)1例患者在血管造影术中发生心肺骤停。医护人员无法适当地进行心肺复苏。问题：先进的心血管生命支持，心肺复苏系统的使用，…团队合作的领导力更多的是意想不到的情况，并有记录。(2)一位居民口头要求注射胰岛素。他意识到这是不合适的，于是写了一份书面订单，但忘记了写下剂量的单位。一位经验不足的护士给病人开了过量的药。问题：药物知识和适当的医嘱。(3)在内窥镜检查中，患者的结肠穿孔。患者愤怒的家人指责患者的医生要为这一事件负责，但没有意识到他们的情绪。问题：在发生不良事件时，知情同意以及与患者及其家人的沟通。(4)一名绝症患者从床上摔下来，出现急性硬膜下血肿，很快死于原发病。一名内科医生试图自己写一份死亡证明，但不知道有必要进行尸检。问题：关于非正常死亡和尸检的法律知识。这些情景在医学教育中的有用性应该得到评估。较少

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