Errors in healthcare delivery are a significant and widely acknowledged problem, both in New Zealand and worldwide.1,2 At Capital and Coast District Health Board we investigate critical incidents and serious adverse events so that organisational learning can take place to prevent recurrence. During one such investigation, a fixation error was identified as being contributory. By this we mean a pattern of error, characterised by the persistent pursuit of an initial and incorrect diagnosis, despite subsequent disconfirming evidence. This pattern of error is not uncommon and arises when the practitioners are biased by some feature of the initial clinical context.3

In their report, the reviewing clinicians recommended a series of system-based improvements to improve the detection and prevention of future errors. The recommendations were supported by the office of the Health and Disability Commissioner, and specifically included a commitment to encourage Medical and Nursing Schools in New Zealand to include error-related education in their undergraduate curricula.

Our first step in this process was to survey the Medical and Nursing Schools to enquire about their level of error-related education, and to offer to help with the coordination and development of an undergraduate curriculum to address error and potential countermeasures. We sent questionnaires to 20 nursing and medical schools in New Zealand, and received 14 replies (70%).

One institution reported that they did not provide any error-related education, and the remaining thirteen described some form of error-related or quality assurance education. This included at least a one-hour lecture and a range of opportunistic educational experiences across the clinical curriculum. Seven of the responding institutions expressed an interest and willingness to collaborate in the development of a shared curriculum. The Faculty of Medical and Health Sciences, University of Auckland provided us with a copy of the program for their two-day inter-professional “Quality and Safety” learning module. This formal and structured approach to human factors in healthcare, with focussed error education, is mandatory for their third year students from medicine, nursing and pharmacy. We think that their approach is exemplary, not only because of the importance of error and its consequences, but also because an interdisciplinary approach provides implicit training for clinical teamwork.4

The primary purpose of the recently launched “National Policy For The Management Of Healthcare Incidents” is to “learn from experience and improve systems and processes in healthcare”.5 This Policy includes significant emphasis on education, but with a focus upon the Health and Disability Services. Although an educational focus at the Health and Disability Services level will add to what has already been achieved in specialties such as anaesthesia6 and surgery,7 it will not address undergraduate education.

The need for effective undergraduate education regarding human factors and medical error has been recognized for a number of years,8 and several authors have described curricula that provide effective undergraduate education regarding the ubiquitous nature of error in healthcare, the need for effective error reporting, and for systems to trap and then deal with the consequences of error in healthcare, including disclosure to the patient and their families.4,9,10

We believe that undergraduate education in human factors and error should be mandatory, and the Auckland approach could form the basis for a mandatory national curriculum, similar to the New Zealand Medical Council requirement of Advanced Cardiac Life Support certification, for provisional registration. Such an undertaking would require significant collaboration and cooperation amongst a large number of tertiary education providers and our survey suggests that there is willingness for cooperation of this sort to take place.