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Patient Safety/Medical Errors

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Medical schools and residency programs should provide more training on preventing adverse drug reactions

Adverse drug events, which are injuries resulting from the administration of a drug, and adverse drug reactions, which are unpleasant and undesired effects of drugs, are major complications of drug therapy. These adverse drug events and reactions may cause as many deaths as heart disease and cancer, and many of them could be prevented with proper medical training of doctors. Yet, very little training on medication error prevention has been incorporated into medical school and internal medicine residency programs. The majority of programs provide trainees with limited exposure to pharmacists or computerized systems to help them learn how to predict, avoid, and report adverse drug events and reactions, according to a national survey supported in part by the Agency for Healthcare Research and Quality (HS10385).

Since physician licensing examinations place little emphasis on clinical pharmacology and adverse drug reactions, there is little incentive for educators to dedicate time to these topics, note the researchers who conducted the study. They surveyed medical directors of third-year medical student internal medicine clerkship and residency programs in the spring of 2000 about clinical pharmacology and adverse drug reaction training provided by their programs.

The survey revealed that only 64 percent of internal medicine residencies had formal lectures covering adverse drug reactions, and only 59 percent offered lectures on rational drug prescribing. Also, 29 percent of inpatient and 55 percent of outpatient programs provided residents with little or no opportunity to learn about drug reactions from clinical pharmacologists; 60 percent of residency programs did not have hospital or clinic electronic systems to aid residents in detecting drug interactions. Over half (53 percent) of medical schools did not have clinical rotations that included clinical pharmacology or adverse drug reaction training. Of those that did, only 8 percent of the rotations were mandatory.

More details are in "Centers for Education and Research on Therapeutics report: Survey of medication errors education during undergraduate and graduate medical education in the United States," by Curtis J. Rosebraugh, M.D., M.P.H., Peter K. Honig, M.D., M.P.H., Sally U. Yasuda, M.S., Pharm.D., and others, in the January 2002 Clinical Pharmacology & Therapeutics 71(1), pp. 4-10.

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