With great diagnostic power, comes great responsibility for patient safety. But the goal of continuous improvement to the quality of care can be challenging. To meet it requires highly trained laboratory medicine professionals, at all levels, who are equipped to encounter and mitigate problems within the “real-life” clinical setting.
So, how can we best structure training to prepare future practitioners in the pathology field for the realities of patient care? The answer may be to introduce problem-based learning (PBL).
Here, I introduce the PBL approach and examine how it links to patient safety and quality improvement (PSQI).
What is PBL?
PBL is an educational approach where students tackle real-world problems in teams, working through complex cases to find solutions. Students engage in active learning as a team, with a designated chairperson, timekeeper, and scribe. A faculty member initially sits in as a facilitator to guide the team and hold them accountable for their roles.
The team’s goal is to critically analyze a clinical situation and compile a set of questions based on their knowledge gaps, which are then answered as a group after literature review. At the end of these sessions, the team reflects on its learning, the process of PBL, and how to improve team functioning.
Within the context of pathology, this could mean a team of students analyzing a case where a patient presents with a mass and accompanying symptoms, or all events or comorbidities leading to an untimely death. Instead of memorizing facts about a disease, students would actively investigate the pathophysiology related to the presented disease, review anatomy and histology, and discuss diagnostic guidelines.
PBL can be encountered during “unknown” surgical pathology or autopsy case conferences during residency or fellowship. The learning platform could also benefit a wider range of pathology learners earlier in their educational journeys. In fact, many medical schools have already incorporated this learning format in their programs.
How does it link to patient safety?
PBL encourages a more collaborative and comprehensive approach to problem solving, which mimics PSQI efforts. Through PBL, students are trained to approach a problem with continuous questioning, investigation into the unknown, and learning from collected information. As a result, they are learning how to look at the big picture – to find the causes, analyze data critically, consider solutions, and make informed decisions.
These are skills that are crucial when it comes to reducing errors and improving patient outcomes as part of a PSQI team. It’s not just about identifying diseases – it’s about identifying systemic challenges and improving medical practice.
Thinking like a high-reliability organization (HRO)
HROs are those that operate in high-risk environments like aviation and nuclear power but manage to minimize errors over time with a mindful strategy following five principles:
a preoccupation with failure,
a reluctance to simplify,
a sensitivity to operations,
a commitment to resilience, and
a deference to expertise.
Since 2009, the Joint Commission has required the leadership of all health care organizations that it accredits to “create and maintain a culture of safety” and to apply the lessons of high reliability science to improve quality and safety. HRO principles drive the methodology behind PSQI teams. Similarly, PBL and HROs are aligned in how they approach complexity, uncertainty, and continuous learning.
Both cultures emphasize the importance of critical thinking, adaptability, and attentiveness to “blips on the radar” or cues for impending failure. In a “just culture” practiced by systems moving toward HRO status, mistakes are treated not as setbacks but as opportunities to reflect, learn, and refine understanding to help mitigate future error. This mindset helps cultivate a culture of vigilance and continual improvement.
The reluctance to simplify principle reflects an HRO’s recognition of complexity and resistance to the status quo. PBL mirrors this by challenging students to explore open-ended problems that may lack straightforward solutions. In a medical school PBL team, those students could represent a multifaceted healthcare team of radiologists, oncologists, pathologists, or internists offering diverse solutions. This encourages deeper, more critical thinking at a macroscopic level.
HROs also emphasize sensitivity to operations or paying attention to the operational process within the frontlines to reduce error with immediate action. Likewise, PBL fosters critical thinking related to not only the events surrounding a process but to the problem at hand, in real time, accessing immediate resources to solve the problem, learn, and reflect.
A commitment to resilience is another hallmark of HROs. They recognize that failure cannot always be avoided, so they train to respond quickly, adapt effectively, and recover smoothly. In comparison, PBL fosters these very capabilities by encouraging learners to navigate ambiguity, iterate on solutions, and build confidence in the face of uncertainty. Over time, students develop a flexible problem-solving mindset that mirrors the adaptive thinking seen in resilient organizations.
Finally, HROs practice a deference to expertise, meaning they include in decision-making those individuals with the most relevant knowledge, regardless of rank. PBL supports this principle through its collaborative structure, where learners contribute based on what they know or find in literature, and where leadership can shift fluidly within the group. This cultivates respect for expertise and recognition that a healthcare team is multifaceted with varying talents and problem-solving abilities to contribute.
Improving patient outcomes
If we combine PBL, HRO principles, and PSQI in pathology education, we may create a new paradigm for training the future pathology workforce to contribute to the safety culture. The field of pathology is evolving and, by using PBL as a foundation, pathology education becomes more dynamic, interactive, and reflective of real-world healthcare scenarios. The focus is no longer just on individual knowledge, but on cultivating teamwork, problem-solving, and systems thinking – essential skills for reducing errors and improving patient outcomes in pathology.
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