First Joint Patient Safety Course Brings Medical and Nursing Students Together

Already a national model for teaching patient safety to medical students, the Miller School, in collaboration with the School of Nursing and Health Studies, launched what likely will be another trend last week, bringing nursing and medical students together for the University’s first joint patient safety course.

The weeklong Interprofessional Patient Safety Course uses realistic but simulated patient encounters with mannequins and actors to improve “situational awareness” and nurture the mutual respect and communication and team-building skills the future doctors and nurses will need to prevent errors and improve patient outcomes in the real world.

“You are explorers of uncharted territory,” David J. Birnbach, M.D., M.P.H., Senior Associate Dean for Quality, Safety and Risk and Director of the University of Miami/Jackson Memorial Hospital Center for Patient Safety, said in welcoming the students to the inaugural cross-disciplinary course, which he later described succinctly: “The whole idea of this course is to break down the silos, forget about the hierarchy and start learning how to work together as a team. Even if each individual has tunnel vision, when you all work together you have wider vision and see the whole picture.”

For five intense days beginning June 17, 68 nursing students in the Accelerated Bachelor of Science program and 150 third-year medical students attended lectures, participated in team-building exercises and “rounded” on computer-driven, high-fidelity mannequins so lifelike that one who said his name was Greenberg complained of having trouble breathing after knee surgery. Soon after the students, who were divided into 36 teams composed of four medical and two nursing students, gathered at his bedside, Mr. Greenberg rapidly destabilized, putting the students’ leadership, communication, teamwork and situational awareness to the test.

Before visiting Mr. Greenberg in the Center for Patient Safety, the students visited the Room of Horrors, which to the untrained eye didn’t seem as scary as it sounded. But hidden in plain view were 20 errors, many of them potentially life-threatening, that the students had six minutes to identify. Over the week, they also spent time at the Gordon Center for Research in Medical Education on the medical campus and the state-of-the art simulation labs at the School of Nursing and Health Studies on the Gables campus, participating in increasingly tense and difficult patient scenarios.

“We teach them in silos so it’s really nice to bring them together and teach them together,’’ said instructor Susana Barroso, RN, BSN, a nurse specialist who supervised the Room of Horrors. “After all, medicine is a team effort.”

Birnbach, who is also Miller Professor of Anesthesiology and Public Health Sciences and Vice Provost for Faculty Affairs, and Mary McKay, DNP, MSN, BSN, assistant professor of clinical nursing and Safety Assurance Director at the School of Nursing, introduced patient safety to half the students with a sobering overview of why the now-vital discipline began evolving in the 1990s. Ivette Motola, M.D., M.P.H., assistant professor of clinical medicine and director of the Gordon Center’s Division of Prehospital and Emergency Healthcare, and Jill Sanko, MSN, ARNP, research and simulation education specialist, led a similar and simultaneous orientation for the other half.

As they noted, a 1999 report by the Institute of Medicine (IOM) found more people die annually from medical errors, principally errors in medications or mistakes in surgery and surgery complications, than from breast cancer, AIDS and car accidents. The IOM report and subsequent papers looking at medical errors rocked the world of medicine, prompting the Miller School and its partners at Jackson to establish one of the first patient safety centers in the nation. The Miller School soon became one of the first medical schools to require students to pass a week-long patient safety course.

Now the Miller School, in partnership with the nursing school, is among the first to jointly train future nurses and doctors in patient safety, laying the foundation for a future where communication, teamwork and mutual respect will come naturally to physicians and nurses who are often on different wavelengths.

“A key mandate of the IOM Future of Nursing Report was inter-professional collaboration,” said Nilda (Nena) Peragallo Montano, DrPh, RN, Dean and Professor of the School of Nursing. “I am thrilled that our nursing and medical faculty and staff are partnering to establish the framework for those dialogues at the student level.”

Last week, the confidence to have those dialogues was clearly developing. Leaving Mr. Greenberg’s room, Hayley Ennis, a member of the Miller School’s Class of 2015, felt compelled to apologize for what she assumed was her team’s poor showing. “Mr. Greenberg, I’m sorry we did not do very well,” she said.

But in a debriefing the next day, Birnbach showed the team videotapes of that and other sessions and, with constructive criticism, humor, flattery and old-fashioned coaching, congratulated Ennis and the rest of her team, which was led by fellow medical student Christie Thomas, for heeding the lessons taught earlier and greatly improving their communication and teamwork.

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