Finding safety in medical education

Essential for all who want to improve health care. Expectations of healthcare services are ever increasing and those delivering care no longer hold the monopoly of opinion on what constitutes good or best care. To earn the label “good enough”, care must meet standards expected by consumers as well those of expert providers. Headlines in newspapers, statements in policy documents, and many analyses, surveys and reports repeatedly highlight serious problems in healthcare delivery related to underuse, overuse, or misuse of care.1 Health systems are sometimes unsafe and frequently we harm patients who have trusted us with their care. There is an endemic failure to engage patients with decisions about their care. We know there are problems; we just need to change so that care can be made safer and better. Everyone—authorities, policy makers, and professionals—seems to accept the need for change. New initiatives aiming to cure our ailing systems come in droves. This is an international phenomenon. Many initiatives are linked to programmes that capture a particular approach—for example, evidence based medicine; accreditation and (external) accountability; total quality management; professional development and revalidation; risk management and error prevention; organisational development and leadership enhancement; disease management and managed care; complex adaptive systems; and patient empowerment. They may differ in perspective. Some focus on changing professionals, others on changing organisations or interactions between parts of the system; some emphasise self-regulation, others external control and incentives; some advocate “bottom …