Music to Medical Ears

The last place one might expect to teach future doctors and nurses about patient safety is on a concert stage. 

But last Wednesday an accomplished string quartet from the 

 performed Mozart’s “Eine kleine Nachtmusik’’ for 210 medical and nursing students who spent the week forging teams to address medical crises thrown at them during the second Interprofessional Patient Safety Course run by the University of Miami's 

The concert was not a respite from the rigors of the intense, fast-paced encounters with simulated patients—lifelike mannequins with fading vital signs and human actors with an assortment of maladies and emotions—that are designed to teach situational awareness, tear down hierarchies, and nurture the mutual respect and team-building skills future physicians and nurses will need to prevent errors and improve patient outcomes in the real world.

As Frost Dean Shelton G. “Shelly” Berg conducted, two violinists, a violist, and a cellist played Mozart’s joyous “little serenade” first beautifully and then badly, clearly demonstrating what happens when professionals with different roles work as a team and carry out their mission with focus, enthusiasm, clear communication, and positive, constructive leadership—and what happens when they don’t.

The attentive audience of about 150 third-year medical students at the Miller School and about 60 second-semester students in the School of Nursing and Health Studies’ (SONHS) accelerated Bachelor of Science in Nursing program, rewarded the musicians—Frost School graduates Michelle Godbee, Amanda Diaz and Ari Urban, and student Brent Charran—with rousing applause when the quartet opened their mini-concert in a Cox Science Building auditorium with a mesmerizing rendition of Mozart’s popular work.

But the medical and nursing students were supposed to see a little bit of themselves when, spurred by Berg, Godbee, a violinist with the Florida Grand Opera who happens to be starting the Miller School’s M.D./M.P.H. program on Monday, morphed into an over-achiever, playing the same piece faster than her fellow musicians; or when Diaz, demonstrating feelings of superiority, played her viola louder than the other instruments; or when Urban, nervous and scared, melted into the background after Berg loudly ridiculed her for asking a question; or when all of them played their parts with technical precision, but without a trace of passion or interest.

Under none of those scenarios did Mozart’s masterpiece sound like one, which conveyed Berg’s point better than any lecture or textbook could. “You have to be present in the moment,” he told the students. “You have to be aware of your job, but you have to be aware of other people’s jobs around you, because their jobs interrelate to yours. You have to react to what they’re doing in real time—and you have to put your heart and soul into it.”

Those were, in a nutshell, the over-arching lessons David Birnbach, Miller School professor and the director of the UM-Jackson Memorial Hospital Center for Patient Safety, and Mary McKay, assistant professor of clinical nursing and safety assurance director, hoped to impart when they and their teams joined forces for the first time last year to include nursing students in the weeklong training course Birnbach established for medical students after an Institute of Medicine (IOM) report concluded that most medical mistakes could be avoided with better communication and teamwork.

Last year’s pilot course was a great success and, with the support of SONHS Dean Nilda (Nena) Peragallo Montano and Miller School Dean Pascal J. Goldschmidt, was expanded to include more activities and simulations this year.

“What educators have been doing is educating nurses in a silo and medical students in a silo and then putting them together expecting them to work effectively as a team,” McKay said. “That’s why this course is such an eye-opening experience. They interact with each other in a variety of ways and they learn, ‘Well, this is what a nurse does, and this is what a physician does.’ They learn we have different roles, but the same ultimate goal—to provide safe, quality patient care—and when we work together we can achieve it.”

Birnbach, who is also senior associate dean for quality, safety, and risk at the Miller School and the University’s vice provost for faculty affairs, added new meaning to the collaborative nature of the course by arranging the Frost School’s live concert this year. (Last year, the Mancini Institute Orchestra performed for the course via video, but Birnbach really wanted a performance that would afford the students the opportunity to interact with the musicians.) He was thrilled with the outcome.

“It was an experiment, but as far as I am concerned it was a grand-slam home run,” he said after the applause died down. “The mistakes that physicians and nurses can make are wonderfully illustrated by musicians: From time to time, everyone can be lazy, unfocused, or showing off. That’s how we scripted the musical errors that Dean Berg and these gifted musicians showed our students.”

Also new to the course this year, which included lectures, team-building exercises, and simulated but realistic patient encounters at the SONHS on the Gables campus, and the Gordon Center for Research in Medical Education and the UM-JMH Center for Patient Safety on the medical campus, was a trip to the Lowe Art Museum. There, nursing and medical students jointly participated in the Lowe’s innovative workshop on “The Fine Art of Healthcare,” which uses art to hone visual thinking strategies.

By breaking into small groups and viewing and discussing different works of art, the students learned how to communicate their own impressions and incorporate the perspective of others who viewed the pieces differently—a process critical not only to interpreting art but making proper diagnoses. As Hope Torrents, the Lowe’s school programs coordinator and creator of the program, notes, “Someone else might see what you missed.”

For medical student Nikesh Shah, both exercises were as instructive as they were unexpected.

“I thought it was awesome,” he said. “Not that lectures are bad, but it was much more eye-opening than a lecture. Seeing and hearing is better than someone telling you that being in sync is important.”

After a long week for both the students and more than 40 faculty from the Miller School, SONHS, the Frost School, and the College of Arts and Sciences, the patient safety course concluded Friday with UM President Donna E. Shalala, who chaired the IOM report on the “Future of Nursing,” observing as the two most improved teams of future physicians and nurses competed in a final simulated patient encounter judged by their classmates.

Maya Bell