Spotlight on UNAM: Cultivating Patient Safety

CPR training is one of the first activities for new students at the National Autonomous University of Mexico’s (UNAM) medical school. This training, common even among laypeople, is an eye-opener for many students who hope someday to become practicing physicians. As they struggle to learn proper resuscitation techniques, students realize that performing even this simple medical procedure can lead to injury, or worse, if performed incorrectly.

“Students first have to become aware that they are dealing with human beings. It could be family, it could be children,” said Dr. Irene Durante, general secretary of the medical school at UNAM.  “It has to be something close to them. Otherwise, it is something abstract, not real, not affecting them. It has to be something they can feel.”

UNAM is one of the oldest medical schools in the Americas, dating back to the 1500s. It is also one of the largest, graduating almost 1,000 students from its Mexico City campus every year. Today, UNAM has made a commitment to creating a culture in Mexico’s medical profession that prioritizes patient safety training to reduce errors. They are doing this by making patient safety training an integral part of the medical school curriculum and providing ongoing training for those doctors who have completed their studies.

Around the year 2000, forward-looking faculty at UNAM decided to more formally incorporate training for future doctors in patient safety techniques. Faculty realized that this training was critical because students are in direct contact with patients as early as their third year of school, even before serving as interns. By 2011, patient safety training was officially part of the curriculum, relying on the Patient Safety Movement Foundation Actionable Patient Safety Solutions (APSS) #17: Patient Safety Curriculum. Of the domains in this APPSs, UNAM incorporates: Technology, Teamwork & Communication, Leadership & Leading Change, and Culture of Safety. The materials and coursework help students attain the knowledge, skills, attitude and behaviors necessary to improve patient safety and eliminate preventable medical error.

The medical school at UNAM trains 1,500 students through simulations every week. A critical component of the training is simulations. This training includes actors who serve as “patients” during the training as well as “high fidelity” technology. As part of their studies, students are tested on their patient safety techniques, in addition to clinical abilities and skills.

Simulations are used to prepare students for clinical practice and are applied at several levels. For undergraduate students, these simulations prepare students for their clinical internships. For postgraduate students, simulations are used on an as-needed basis in clinical and surgical training under continuous supervision.

“Students are the easiest ones to get on board,” explained Durante. “They do the training and ask for more. Students like simulation so much that they ask for extra (patient safety) activities. They will even go in on Saturday if it needs to be on Saturday.”

Durante observed that students today are different. “You have to get their attention and keep their attention,” said Durante. “Which means that you have to devise strategies where they can learn the theory; but it has to go beyond theory and that’s where the simulations come in.”

While UNAM is seeding the future generations of Mexican doctors with a culture that values and emphasizes patient safety training, reaching currently practicing doctors and professors is more challenging.  Schedules are tight and making time for additional training is challenging. There’s a more delicate issue as well: doctors who train in the simulation center are sensitive because they are being observed.

But once they get on board, practicing doctors and professors immediately realize the value of the training and they enjoy learning something new, said Durante. There’s another plus for the professors: Those who are trained in APSS techniques make ideal candidates for recruitment by other medical schools to work in their simulation centers.

Faculty at UNAM are also tackling the challenge of continuing education for resident doctors who have left the school and are practicing in hospitals. Thanks to a recent $1.2M donation, the school recently revamped its postgraduate training center, expanding the number of procedures its supports and increasing the number of simulations.

“At UNAM we have a big responsibility in our country, to society,” said Durante. “We cannot rest on our laurels; we have to keep moving forward. The only way to lead is to invest in the future and our investment in patient safety training is part of that.”