Barriers to acceptance of medical error: the case for a teaching programme (original) (raw)
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Medical Education, 2001
IntroductionThere is a growing public perception that serious medical error is commonplace and largely tolerated by the medical profession. The Government and medical establishment’s response to this perceived epidemic of error has included tighter controls over practising doctors and individual stick-and-carrot reforms of medical practice.There is a growing public perception that serious medical error is commonplace and largely tolerated by the medical profession. The Government and medical establishment’s response to this perceived epidemic of error has included tighter controls over practising doctors and individual stick-and-carrot reforms of medical practice.DiscussionThis paper critically reviews the literature on medical error, professional socialization and medical student education, and suggests that common themes such as uncertainty, necessary fallibility, exclusivity of professional judgement and extensive use of medical networks find their genesis, in part, in aspects of medical education and socialization into medicine. The nature and comparative failure of recent reforms of medical practice and the tension between the individualistic nature of the reforms and the collegiate nature of the medical profession are discussed.This paper critically reviews the literature on medical error, professional socialization and medical student education, and suggests that common themes such as uncertainty, necessary fallibility, exclusivity of professional judgement and extensive use of medical networks find their genesis, in part, in aspects of medical education and socialization into medicine. The nature and comparative failure of recent reforms of medical practice and the tension between the individualistic nature of the reforms and the collegiate nature of the medical profession are discussed.ConclusionA more theoretically informed and longitudinal approach to decreasing medical error might be to address the genesis of medical thinking about error through reforms to the aspects of medical education and professional socialization that help to create and perpetuate the existence of avoidable error, and reinforce medical collusion concerning error. Further changes in the curriculum to emphasize team working, communication skills, evidence-based practice and strategies for managing uncertainty are therefore potentially key components in helping tomorrow’s doctors to discuss, cope with and commit fewer medical errors.A more theoretically informed and longitudinal approach to decreasing medical error might be to address the genesis of medical thinking about error through reforms to the aspects of medical education and professional socialization that help to create and perpetuate the existence of avoidable error, and reinforce medical collusion concerning error. Further changes in the curriculum to emphasize team working, communication skills, evidence-based practice and strategies for managing uncertainty are therefore potentially key components in helping tomorrow’s doctors to discuss, cope with and commit fewer medical errors.
BMJ Open, 2018
Objectives In undergraduate medical education, the topics of errors in medicine and patient safety are under-represented. The aim of this study was to explore undergraduate medical students’ behavioural intentions when confronted with an error. Design A qualitative case vignette survey was conducted including one of six randomly distributed case scenarios in which a hypothetical but realistic medical error occurred. The six scenarios differed regarding (1) who caused the error, (2) the presence of witnesses and (3) the consequences of the error for the patient. Participants were asked: ‘What would you do?”. Answers were collected as written free texts and analysed according to qualitative content analysis. setting Students from German medical schools participated anonymously through an online questionnaire tool. Participants Altogether, n=159 students answered a case scenario. Participants were on average 24.6 years old (SD=7.9) and 69% were female. They were undergraduate medical students in their first or second year (n=27), third, fourth or fifth year (n=107) or final year (n=21). results During the inductive coding process, 19 categories emerged from the original data and were clustered into four themes: (1) considering communication; (2) considering reporting; (3) considering consequences; and (4) emotional responsiveness. When the student him/herself caused the error in the scenario, participants did mention communication with colleagues and taking preventive action less frequently than if someone else had caused the error. When a witness was present, participants more frequently mentioned disclosure of the error and taking actions than in the absence of a witness. When the outcome was significant to the patient, participants more often showed an emotional response than if there were no consequences. Conclusions The study highlights the importance of coping strategies for healthcare professionals to adequately deal with errors. Educators need to introduce knowledge and skills on how to deal with errors and emotional preparedness for errors into undergraduate medical education.
When Bad Things Happen: Training Medical Students to Anticipate the Aftermath of Medical Errors
Academic Psychiatry
Objective Medical errors affect trainees. Existing curricula emphasize tenets of patient safety but rarely address the impact of medical errors on health care providers, particularly at the undergraduate level. The authors developed an interactive session exploring the professional and personal effects of medical errors for 300 second-year medical students. Methods The session utilized case-based learning, small group discussion, and video vignettes. Physicians in multiple specialties were interviewed, sharing narrative accounts of their experience with medical errors and adverse events. Discussions were facilitated by local physicians, who delivered content and shared personal anecdotes. Surveys using a 5-point Likert scale were conducted before and after the session. Results Pre-and post-test surveys resulted in 91 responses in 2016 and 174 in 2017. In 2016, results showed significant change in student responses by 0.34 units (SD 0.35 units; p < 0.001). Two survey items addressing student awareness and three items addressing confidence were significant. The domains assessing students' attitudes and knowledge regarding medical errors were not significant. In 2017, the overall mean change was 0.33 with a lower standard error, 0.03 (p < 0.001), showing significance in both years the session was delivered. Conclusion A 1-h, small-group session increased medical students' understanding of the impact of medical errors and adverse events on providers and the supportive resources available. Recruitment of local faculty to facilitate discussions and share personal anecdotes enhanced the success of the session. Keywords Undergraduate medical education. Burnout. Medical error. Small group learning. Reflection Medical error and adverse patient outcomes affect trainees. Existing curricula focus primarily on improving the error disclosure process by utilizing educational tools such as standardized patient encounters and structured reflection but rarely address the psychological impact of error on healthcare providers, particularly at the undergraduate level [1]. Considering the prevalence of burnout in physicians and the impact of medical error on physician wellness [2], curricula on this topic to prepare future physicians are needed [3, 4]. According to the National Academy of Medicine (NAM), more than half of healthcare providers in the USA exhibit at least one symptom of burnout [5]. Burnout has been associated with increased medical errors and is linked to increased
Medical Errors and the Trainee: Ethical Concerns
The American Journal of the Medical Sciences, 2004
How medical errors are handled by individual physicians and hospital systems is a topic of considerable interest. In teaching hospitals, medical students and house officers often observe and commit mistakes. Commission of a mistake is associated with serious emotional turmoil and uncertainty among trainees as well as experienced physicians. Although disclosure is the ethical standard, the consequences of disclosure are feared by many. This article focuses on the issues that surround medical errors as they pertain to medical students and residents. It is important that this group of future physicians has appropriate training, mentoring, and support when dealing with errors.