Continuing Medical Education and Patient Safety: An Agenda for Lifelong Learning

Continuing education and improvement of medical practice has long been a tradition in the medical profession. As John Shaw Billings noted over a century ago, “The education of the doctor which goes on after he has his degree is, after all, the most important part of his education.”1 Beyond the extensive array of formal continuing education programs available, physicians have, over the years, developed a variety of informal approaches to improving clinical skills based on review and critique of patient management.2 A key ingredient of this tradition has been a focus on recognizing and learning from medical error. The 13th Century Oath of Maimonides advises physicians: “Today he can discover his errors of yesterday and tomorrow he can obtain a new light on what he thinks himself sure of today.” Continuing this tradition, Sir William Osler advised young physicians, “Begin early to make a three-fold category—clear cases, doubtful cases and mistakes…. It is only by getting your cases grouped in this way that you can make any real progress in your post-collegiate education.”3 Osler himself served as a role model in this regard, as Cushing describes: Once in a ward class there was a man whom he demonstrated as showing all the classical symptoms of croupous pneumonia. The man came to autopsy later. He had no pneumonia, but a chest full of fluid. Dr. Osler seemed delighted, sent especially for all those in his ward class, showed them what a mistake he had made, how it might have been avoided and how careful they should be not to repeat it.4 Recently the profession's interest in recognizing, learning from, and preventing medical error has been reinvigorated, as the papers in this special issue of JAMIA illustrate. In 1998, the President's Advisory Commission on Consumer Protection and Quality …