When Bad Things Happen: Training Medical Students to Anticipate the Aftermath of Medical Errors (original) (raw)
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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.
Teaching medical students to recognise and report errors
BMJ Open Quality
BackgroundMedical student error reporting can potentially be increased through patient safety education, culture change and by teaching students how to report errors. There is scant literature on what kinds of errors students see during clinical rotations. The authors developed an intervention to better understand what kinds of errors students see and to train them to identify and report errors.MethodsA safety curriculum was delivered during the Medicine clerkship for the academic year 2015–2016. Prior to the workshop, students completed a preintervention survey to determine whether they had reported a clinical error. Subsequently, they participated in an educational workshop. Facilitated discussions about conditions contributing to errors, types of errors, prevention of errors and importance of reporting followed. Students were required to submit a simulated error report about an error they personally observed. An end-of-year survey was sent to students who participated in the curr...
Medical Errors; Causes, Consequences, Emotional Response and Resulting Behavioral Change
Pakistan Journal of Medical Sciences, 1969
Objective: To determine the causes of medical errors, the emotional and behavioral response of pediatric medicine residents to their medical errors and to determine their behavior change affecting their future training. Methods: One hundred thirty postgraduate residents were included in the study. Residents were asked to complete questionnaire about their errors and responses to their errors in three domains: emotional response, learning behavior and disclosure of the error. The names of the participants were kept confidential. Data was analyzed using SPSS version 20. Results: A total of 130 residents were included. Majority 128(98.5%) of these described some form of error. Serious errors that occurred were 24(19%), 63(48%) minor, 24(19%) near misses, 2(2%) never encountered an error and 17(12%) did not mention type of error but mentioned causes and consequences. Only 73(57%) residents disclosed medical errors to their senior physician but disclosure to patient's family was negligible 15(11%). Fatigue due to long duty hours 85(65%), inadequate experience 66(52%), inadequate supervision 58(48%) and complex case 58(45%) were common causes of medical errors. Negative emotions were common and were significantly associated with lack of knowledge (p=0.001), missing warning signs (p=<0.001), not seeking advice (p=0.003) and procedural complications (p=0.001). Medical errors had significant impact on resident's behavior; 119(93%) residents became more careful, increased advice seeking from seniors 109(86%) and 109(86%) started paying more attention to details. Intrinsic causes of errors were significantly associated with increased information seeking behavior and vigilance (p=0.003) and (p=0.01) respectively. Conclusion: Medical errors committed by residents have inadequate disclosure to senior physicians and result in negative emotions but there was positive change in their behavior, which resulted in improvement in their future training and patient care.
Attitudes Toward Medical Errors and Adverse Events Health Professions Education
Background: A lack of formal patient safety curricula has contributed to the suboptimal training of medical students and housestaff. Attitudes of physician trainees regarding medical errors and adverse events were surveyed in a pilot study. Methods: Five hundred sixty-three physician trainees were surveyed at an urban teaching hospital. Five domains were evaluated using a factor analysis as they relate to patient safety: knowledge, self-efficacy, awareness of safety culture, barriers/facilitators, and awareness of human factors. Results: One hundred fifty-eight (28%) trainees completed the survey, with 22% (n = 35) describing exposure to at least one adverse medical event. The survey showed good internal validity and reliability. Respondents who reported exposure to adverse events demonstrated a lower awareness of human factor errors (p = .0017) and lower awareness of the hospital's approach to safety (p = .033). Older respondents scored higher on measures of self-efficacy than younger trainees (p = .042). Discussion: The exposure of physician trainees to errors and adverse events can have a negative effect on their attitudes and competencies. Exposure to adverse events and the institution's response may decrease both error reporting and the willingness to adopt safety practices. The results support the need for implementing a sustained patient safety curriculum that promotes learning regarding adverse events.
The emotional impact of medical errors on practicing physicians in the United States and Canada
Joint Commission journal on quality and patient safety / Joint Commission Resources, 2007
Being involved in medical errors can compound the job-related stress many physicians experience. The impact of errors on physicians was examined. A survey completed by 3,171 of the 4,990 eligible physicians in internal medicine, pediatrics, family medicine, and surgery (64% response rate) examined how errors affected five work and life domains. Physicians reported increased anxiety about future errors (61%), loss of confidence (44%), sleeping difficulties (42%), reduced job satisfaction (42%), and harm to their reputation (13%) following errors. Physicians' job-related stress increased when they had been involved with a serious error. However, one third of physicians only involved with near misses also reported increased stress. Physicians were more likely to be distressed after serious errors when they were dissatisfied with error disclosure to patients (odds ratio [OR] = 3.86, confidence interval [CI] = 1.66, 9.00), perceived a greater risk of being sued (OR = .28, CI = 1.50, ...