NEAR MISSES AND THE ROLE OF HIERARCHY IN EDUCATIONAL AND RESEARCH SETTINGS

Two original papers and two commentaries in this issue of QSHC highlight how system hierarchy inhibits identification of risk in both educational and research settings. A report authored by three medical students reminds the reader that because students and trainees are on the frontlines of patient care, they frequently observe near misses that—if candidly addressed—could serve both to make patient care safer but also to provide valuable learning opportunities. The medical hierarchy complicates the ability of these junior members of the care enterprise to assert their concerns. Addressing the complex issue of assertiveness in these hierarchies by junior colleagues deserves explicit attention by our teaching hospitals …