Journal of General Internal Medicine

, Volume 21, Issue 5, pp 419–423

Learning from mistakes

Factors that influence how students and residents learn from medical errors
  • Melissa A. Fischer
  • Kathleen M. Mazor
  • Joann Baril
  • Eric Alper
  • Deborah DeMarco
  • Michele Pugnaire
Original Articles

DOI: 10.1111/j.1525-1497.2006.00420.x

Cite this article as:
Fischer, M.A., Mazor, K.M., Baril, J. et al. J GEN INTERN MED (2006) 21: 419. doi:10.1111/j.1525-1497.2006.00420.x

Abstract

CONTEXT: Trainees are exposed to medical errors throughout medical school and residency. Little is known about what facilitates and limits learning from these experiences.

OBJECTIVE: To identify major factors and areas of tension in trainees’ learning from medical errors.

DESIGN, SETTING, AND PARTICIPANTS: Structured telephone interviews with 59 trainees (medical students and residents) from 1 academic medical center. Five authors reviewed transcripts of audiotaped interviews using content analysis.

RESULTS: Trainees were aware that medical errors occur from early in medical school. Many had an intense emotional response to the idea of committing errors in patient care. Students and residents noted variation and conflict in institutional recommendations and individual actions. Many expressed role confusion regarding whether and how to initiate discussion after errors occurred. Some noted the conflict between reporting errors to seniors who were responsible for their evaluation. Learners requested more open discussion of actual errors and faculty disclosure. No students or residents felt that they learned better from near misses than from actual errors, and many believed that they learned the most when harm was caused.

CONCLUSIONS: Trainees are aware of medical errors, but remaining tensions may limit learning. Institutions can immediately address variability in faculty response and local culture by disseminating clear, accessible algorithms to guide behavior when errors occur. Educators should develop longitudinal curricula that integrate actual cases and faculty disclosure. Future multi-institutional work should focus on identified themes such as teaching and learning in emotionally charged situations, learning from errors and near misses and balance between individual and systems responsibility.

Key words

medical errors medical education UME GME teaching methods 

Copyright information

© Society of General Internal Medicine 2006

Authors and Affiliations

  • Melissa A. Fischer
    • 1
  • Kathleen M. Mazor
    • 2
  • Joann Baril
    • 3
  • Eric Alper
    • 4
  • Deborah DeMarco
    • 5
  • Michele Pugnaire
    • 6
  1. 1.Department of Internal Medicine and Meyers Primary Care InstituteUniversity of Massachusetts Medical SchoolWorcesterUSA
  2. 2.Meyers Primary Care InstituteUniversity of Massachusetts Medical School Fallon Foundation, and Fallon Community Health PlanWorcesterUSA
  3. 3.Meyers Primary Care InstituteUniversity of Massachusetts Medical School Fallon Foundation, and Fallon Community Health PlanWorcesterUSA
  4. 4.Department of Internal MedicineUniversity of Massachusetts Medical SchoolWorcesterUSA
  5. 5.Department of Internal MedicineUniversity of Massachusetts Medical SchoolWorcesterUSA
  6. 6.Office of Medical Education and Department of Family and Community MedicineUniversity of Massachusetts Medical SchoolWorcesterUSA