Dear Sir
Patient safety has been receiving increasingly more attention in the last two decades. However, research on patient safety issues during medical school training is scarce. Some patterns of patient hazards (especially diagnostic errors, medication errors, nosocomial infections) constitute a large fraction of patient hazards. Chart review by specially trained physicians is the gold standard for identification of some of these common patient hazards. Thus, a routine screening for common patient hazards during ward rounds might improve patient safety. Since chart review is not commonly taught in most medical schools, we investigated whether advanced medical students acquire the skill to identify patient hazards during chart review en passant (in passing) during clerkships.
A total of 128 fifth-year medical students were asked to review fictional standardized patient charts with 12 common patient hazards. The students’ notes were rated by two blinded raters using a checklist. We asked the students how many weeks they had spent in clerkships in various specialties, particularly internal medicine, surgery and general medicine.
The students reported to have spent 11 ± 4 weeks in clerkships so far. In our study, the students identified only 17%, IQR = 8–30% of the patient hazards. There was no significant correlation between the number of weeks spent in clerkships and identified patient hazards. Only students who reported to have completed at least one chart review previously on their own (n = 13, 10.2% of our study sample) identified more patient hazards than students who had never completed a chart review (29%, IQR = 19–43% versus 17%, IQR = 8–25%, p = 0.02). It is unclear, whether these students improved their recognition of patient hazards during the clerkship or whether the students who perform chart review during clerkships constitute a different sample compared to students who do not perform chart review. We therefore conclude that unstructured clerkships do not contribute significantly to identification of patient hazards by advanced medical students during chart review. A specific training may be warranted.