74 Blood-curdling safe: safety-II FRAM analysis education on anticoagulants

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Background Medication safety, particularly in the management of anticoagulation therapy, remains a persistent challenge in healthcare, with frequent medication errors leading to adverse patient outcomes. Traditional safety approaches (Safety-I) focus on identifying and eliminating errors, whereas the Safety-II perspective emphasizes learning from everyday clinical practice, recognizing how successful outcomes are achieved despite system complexity. This project integrates Safety-II principles into medical education, utilizing the Functional Resonance Analysis Method (FRAM) to align ‘Work-as-Imagined’ (WAI) with ‘Work-as-Done’ (WAD). By embedding this innovative approach in the curriculum, we aim to foster a proactive patient safety mindset among future physicians.Methods A structured educational program was implemented within the medical master’s curriculum at Erasmus MC, consisting of: E-learning Module – Introducing Safety-I and Safety-II principles, with interactive content and quizzes. Case-Based Learning – Students construct FRAM models based on anticoagulation case scenarios, emphasizing variability in clinical practice. Clerkship Observations – During their clerkship, students compare real-world medication management with their initial FRAM models in mind, allowing them to witness the process in practice, identify discrepancies, and recognize resilience strategies Reflective Learning Sessions – Post-clerkship discussions enable students to share insights and refine their understanding of safety concepts.This action research study involved six iterative learning cycles, with continuous refinement based on student feedback.Results Over 500 students participated, generating 64 WAI FRAM models. Learning analytics indicated high student engagement, with improved understanding of medication safety principles. Qualitative feedback highlighted an increased appreciation for resilience in clinical practice, with students demonstrating a shift towards Safety-II thinking. Initial challenges included resistance to abstract concepts, which were addressed by refining case studies to be more clinically relevant.Conclusions Integrating Safety-II and FRAM into medical education enhances students’ ability to critically assess and improve medication safety practices. By shifting focus from error avoidance to system resilience, this approach equips future healthcare professionals with a balanced, proactive perspective on patient safety. The developed educational framework is scalable and adaptable, offering potential for broader implementation across healthcare disciplines. Future research will explore long-term impacts on clinical practice and patient outcomes.

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