“Forgetting” after an exam might not be a bad thing
– Written by: Dr. Claudio Violato –
The assessment of medical and healthcare competence continues to be one of the most challenging aspects of the education, training, licensing and regulation of health care professionals such as doctors, nurses, dentists, optometrists, and other allied health care workers. The report, To Err Is Human: Building a Safer Health System [1], of the Institute of Medicine of the National Academy of Sciences in the United States, made some staggering claims: nearly 100,000 people die annually in American hospitals as the result of medical mistakes. Subsequent commentators have suggested that this is an underestimate and the actual mortality rate is much higher. Some argue that the number of medical mistakes is much higher than is commonly accepted because most of the errors are buried with the patient.
A recent report on adults’ health care experiences in seven countries (New Zealand, the United Kingdom, the United States, Australia, Canada, Germany, and the Netherlands) indicated that 12-20% of adults experienced at least one medical error in the two years of the study [2]. These findings have triggered international discussion, concerns and controversies about patient injuries in health care. The major factors underlying medical errors are thought to be system-based factors (e.g., miscommunication on the ward) as well as person factors resulting in drug overdoses or interactions, misdiagnoses, surgical mistakes, incorrect medications, and simple carelessness. Patient safety, a topic that had been little understood and even less discussed in health care systems, has become a public concern in most Western countries.
Patient safety has now become a mantra of modern medical practice. Despite this, thousands of people are injured or die from medical errors and adverse events (incapacitation, serious injury or death) each year. Worldwide this figure may run into the millions. Leaders in the health care systems have emphasized the need to reduce medical errors as a high priority. Doctors, as main participants, have been called upon to address the underlying systems causes of medical error and harm. Unfortunately, several studies [3] have shown that more than half of hospital doctors surveyed haven’t even heard of the report, To Err Is Human.
While both system-based factors as well as person factors are at the root of medical errors, it is now believed that the impact of some person factors have been underestimated: physician carelessness, lack of knowledge, lack of professionalism, physician exhaustion and sleeplessness, and poor self-assessment, particularly of personal limitations in medical skills [4] [5]. There is concern that the preferred tendency to put the emphasis on systems, but not holding individuals responsible for errors will weaken accountability for physician performance. Failure to identify individual factors may contribute significantly to risk of adverse events and may lead to a focus of patient safety away from the clinician to a systems-based approach. The assessment of the competence of individual health care professionals looms larger than ever.
Assessment is also commonly known as testing. Testing has its roots in antiquity and has undergone rapid advances in the later part of the 20th and the first part of the 21st century. This is because some necessary developments in its emergence – statistical and mathematical theories, advances in test theory, and computer technology and optical readers, online testing, social and political policy – have come only in the last several decades. Currently, the field is undergoing rapid development and change bringing exciting possibilities and challenges. Before describing the current status of testing and its history, however, we must describe and distinguish testing, assessment and evaluation. See the next blog post on: “Assessment, Testing and Evaluation – Aren’t they all the same?”
Sources:
[1] Kohn KT, Corrigan JM, & Donaldson MS (1999) To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press.
[2] Schoen C, Osborn R, Doty M, Bishop M, Peugh J, Murukutia N. (2007). Toward higher performance health systems: Adults’ healthcare experiences in seven countries. Health Affairs 26(6): 717–734.
[3] Brand C, Ibrahim J, Bain C, Jones C & King, B. (2007). Engineering a safe landing: Engaging medical practitioners in a systems approach to patient safety, Internal Medicine Journal, 37, 295-302.
[4] Newman-Toker DE, Pronovost PJ (2009). Diagnostic errors – the next frontier for patient safety. Journal of the American Medical Association, 301, 1060–1062.
[5] Sibinga, EM (2010). Clinician mindfulness and patient safety. Journal of the American Medical Association, 304, 2532-2533.
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