“Near Miss”: A Mixed-Methods Analysis of Medical Student Assignments in Patient Safety

Abstract

The purpose of this study is to inform the curriculum for Entrustable Professional Activity 13 through analysis of fourth year medical student patient safety event assignments. From 2016 to 2021, students were asked to identify a patient safety event and indicate if the event required an incident report. Assignments were reviewed and coded based on Joint Commission incident definitions. Qualitative analysis was performed to evaluate incident report justification. There were 473 student assignments included in the analysis. Assignments reported incidents regarding communication, medical judgment, medication errors, and coordination of care. Students indicated only 18.0% (85/473) would warrant an incident report. Justification for not filing an incident report included lack of harm to the patient or that it was previously reported. Students were able to identify system issues but infrequently felt an incident report was required. Justifications for not filing an incident report suggest a need for a curriculum focused on the value of reporting near misses and hazardous conditions.