• medical education
• quality improvement
• patient safety

“What gives value to travel is fear. It is the fact that, at a certain moment, when we are so far from our own country . . . we are seized by a vague fear, and an instinctive desire to go back to the protection of old habits.” Albert Camus¹

The doctor-patient relationship has been at the core of medicine for centuries. However, the last decade of the 20th century has seen radical accelerating change in the context in which that relationship is embedded. It is increasingly complex and hurried² and, disturbingly, it is fraught with substantial risk to the patient.³

Similarly, the teacher-learner relationship exists at the core of medical education, which must wrestle with the same accelerating change. While the focus on patient safety gains increasing attention in the clinical setting, it is slow to gain strategic awareness among medical educators. Were it of biological origin, the discovery of an epidemic that results in 44 000–98 000 deaths annually in the US alone³ would quickly find its way to the formal medical curriculum, for changes in biology and technology (particularly of such magnitude) are readily incorporated by medical faculties. Patient safety pushes medical education into unfamiliar territory. Complex systems,⁴ culture,⁵ and teamwork⁶ are not mainstream topics in the traditional curriculum. So, where do we start?

In this issue of QSHC …