Introduction

In 1999 the Institute of Medicine published To Err is Human: Building a Safer Health System, a report on human error and patient safety in the USA. In this report the authors estimate that between 44,000 and 98,000 Americans die each year as a result of medical errors. Although this figure has been highly debated, it is based on extrapolation of the data contained in published studies out of Colorado, Utah, and New York. This figure is the equivalent of a large commercial airliner falling out of the sky every day. If the airline industry experienced that degree of failure, all flights would be voluntarily grounded until a thorough investigation revealed the causes and solutions were put into place. Yet medicine has yet to examine adequately the complex relationship among medical training, human performance, and medical errors.

While many factors influence the incidence of medical error in the USA today, this chapter will focus on training and education. Similarly, while medical errors occur across every medical specialty and affect all patients, this chapter will center on the newborn in the first minutes of life in the delivery room. First, the history of medical training will be reviewed. Next, new methodologies designed to improve the performance of professionals working in dynamic environments will be reviewed. Finally, the impediments to future enhancements of medical training and potential solutions to these will be discussed.