EDUCATION, TRAINING AND LEARNING Educating physicians prepared to improve care and safety is no accident: it requires a systematic approach

While most newly qualified physicians are well prepared in the science base of medicine and in the skills that enable them to look after individual patients, few have the skills necessary to improve care and patient safety continuously. We apply a systems analysis from the field of human error to identify ways in which medical school education can increase the number of graduates prepared to reflect on and improve professional practice. Doing so requires a systematic approach involving entrance requirements, the curriculum, the organizational culture of training environments, student assessment, and program evaluation. Doctors who graduate from most medicalschools throughout the world are well pre-pared in the science base of medicine and in skills that enable them to look after individual patients. However, few newly qualified physicians have the skills necessary to improve care and patient safety. These include the ability to perceive and work effectively in interdependencies; the ability to understand work as a process; skill in collecting, aggregating, analyzing, and displaying data on processes and outcomes of care; skills in designing healthcare processes; the ability to work in teams and in collaboration with manag-ers and patients; and the willingness to examine honestly and learn from mistakes.1 2 We apply a systems approach from the field of human error to medical school education which shows that the graduation of physicians prepared to improve care is no accident; it requires attention to the educational system as a whole. MODEL OF SYSTEM FAILURE A system model that helps to explain error main-tains that errors are consequences rather than causes—that is, as Reason2 3 argues, they are derived from systemic factors rather than human failings. Humans are fallible and errors are to be expected even in the best organizations.