“See One, Do One, Teach One” A Medical Education Mantra and Issues of Patient Safety in Teaching Hospitals
From an article “Resident’s Suggestions for Reducing Errors in Teaching Hospitals” in the February 27, 2003 issue of the New England Journal of Medicine by Volpp and Grande:
"I put in a central line today that was complicated by a pneumothorax. I had never done this procedure before, and I am not sure the resident who was supervising me had much more experience than I do."
"See one, do one, teach one" has been a long-standing mantra of medical education.
Well, if it isn’t one, it may be only 3 or 4 or a few more but the person supervising the intern or resident performing the procedure may often be also a resident in training and not a seasoned attending physician who has done 1000 or more and has experienced all the necessary nuances of performing the procedure and has had the opportunity to develop reliable responses to any complications that may occur. Even if the intern or resident has performed a number of procedures, the issue arises as how to establish that the individual has become competent sufficiently to perform the procedure alone and without supervision as may be necessary.
“See one, do one, teach one” is only one example of the concerns regarding patient safety within teaching hospitals. Others involve “handoffs”, the transfer of the care of a patient from a resident physician going off duty to one who is just coming on. When there are many patients to discuss, some details in this relatively brief communication between the two physicians may be missed and the consequences of such “forgotten” information may be critical. Time available to take a thorough history and perform the physical exam may be limited and the time which is available may include distractions for the resident such as interruptions by “urgent” phone calls or paging. In addition, unsatisfactory system practices, also not uncommon to all hospitals, teaching or not, may lead to medication errors or surgical errors as examples. Long work hours, as set by the system, with resident fatigue has been attributed to errors. And errors can lead to patient deaths as publicized in the Institute of Medicine’s 2000 report “To Err is Human” with estimates of as many as 98,000 deaths occurring annually in U.S. hospitals due directly to medical errors. Though the high figure has been debated by some as too high and not an accurate estimate, nevertheless any death due to medical error is of concern.
Teaching hospitals will inform the patient, in print, on admission that they may be examined and treated by staff that are still in training but is this enough information for informed consent by the patient? Admission to a teaching hospital is often unavoidable and always there is the altruistic value to the patients of a contribution to society by permitting the training of physicians on themselves. How else do you think that physicians should be trained to go out into practice with the needed skills for their care of their own patients if not in teaching hospitals? And if teaching hospitals are necessary, what changes would you suggest to make them and all hospitals safer places to be treated? ..Maurice.