Posted: March 20, 2014

Bridging Resident Patient Safety Education with the Institutional Mission: The Patient Safety Rotation


In 1999, the Institute of Medicine released the "To Err is Human" report fueling a heightened focus on patient safety and quality improvement especially highlighting the need for inclusion of these topics in medical education 1,2. More recently, the Accreditation Council for Graduate Medical Education (ACGME) announced the Clinical Learning Environment Review (CLER) program establishing universal requirements focused on six areas relating to the quality and safety of healthcare3. At Indiana University School of Medicine (IUSM), an experiential, patient safety curriculum was developed within the Internal Medicine (IM) residency program that directly addresses four of the six CLER domains, at times touching on all six, and directly integrating into the existing institutional safety efforts. Internal Medicine residents gain patient safety knowledge, skills and attitudes while investigating real time, actual safety concerns identified by peers, nursing, pharmacy, and staff members. With the guidance of a faculty mentor, residents investigate potential safety incident through detailed chart review and inter-professional interviews in an attempt to identify systematic vulnerabilities that may have led to actual or potential patient harm. Direct feedback is provided to the initiator of the investigation in order to foster trust and promote transparency. Additionally, trainees propose potential interventions to address identified gaps and share these and their analyses directly with hospital safety leadership for documentation and action accountability. When appropriate, residents will initiate improvement projects related to their proposed interventions and/or continue work on projects initiated previously. Institutional leadership has embraced and cultivated a culture that supports the safety initiatives developed by the residents as indicated by the full or partial implementation of numerous recommendations to improve care delivery systems. Lastly, at the end of the block, residents lead an inter-professional patient safety conference while highlighting one or more investigations and their efforts for implementing improvements. This conference offers an opportunity to discuss patient safety in an open, blame-free setting and for residents to educate peers regarding patient safety topics fostering an improved culture of safety. The conference is well attended by students, residents, faculty, nursing and physician leaders, as well as hospital administration. Most importantly, this conference has further stimulated hospital leaders to initiate changes in patient care.


Curriculum, Internal Medicine, GME, Quality Improvement, Patient Safety, Rotation


Tyler Lee Davis, MD, Indiana University School of Medicine

Kirsten Fisher, MD, Indiana University School of Medicine

LeeAnn Cox, MD, Indiana University School of Medicine