Learning from mistakes
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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.
- Hayward RA, Hofer TP. Estimating hospital deaths due to medical errors: preventability is in the eye of the reviewer. JAMA. 2001;286:415–20. CrossRef
- Institute of Medicine. To Err Is Human. Washington, DC: National Academy Press; 1999.
- Vincent C, Neale G, Woloshynowych M. Adverse events in British hospitals: preliminary retrospective record review. BMJ. 2001;322:517–9. CrossRef
- Braithwaite RS, DeVita MA, Mahidhara R, Simmons RL, Stuart S, Foraida M. Medical Emergency Response Improvement Team (MERIT). Use of medical emergency team (MET) responses to detect medical errors. Qual Safety Health Care. 2004;13:255–9. CrossRef
- Classen DC, Kilbridge PM. The roles and responsibility of physicians to improve patient safety within health care delivery systems. Acad Med. 2002;77:963–72. CrossRef
- Ziegelstein RC, Fiebach NH. “The mirror” and “the village”: a new method for teaching practice-based learning and improvement and systems-based Practice. Acad Med. 2004;79:83–8. CrossRef
- Institute of Medicine. Crossing the Quality Chasm: The IOM Health Care Quality Initiative. Washington, DC; National Academy Press; 2001.
- Institute of Medicine. Health Professions Education: A Bridge to Quality. Washington, DC: National Academy Press; 2003.
- Liang BA. A system of medical error disclosure. Qual Safety Health Care. 2002;11:64–8. CrossRef
- Mazor KM, Simon SR, Yood RA, et al. Health plan members’ views about disclosure of medical errors. Ann Intern Med. 2004 Mar 16;140:409–18.
- Mazor KM, Simon SR, Yood RA, et al. Health plan members’ views on forgiving medical errors. Am J Managed Care. 2005;11:49–52.
- Gallagher TH, Waterman AD, Ebers AG, Fraser VJ, Levinson W. Patients’ and physicians’ attitudes regarding the disclosure of medical errors. JAMA. 2003;289:1001–7. CrossRef
- Mazor KM, Fischer MA, Haley H-L, Hatem D, Quirk ME. Teaching and learning around medical errors: primary care preceptors’ views. Med Educ. 39:982–90.
- Patient Safety and Graduate Medical Education. AAMC Report from the Joint Committee of the Group on Resident Affairs and Organization of Resident Representatives. February 2003.
- Volpp KG, Grande MD. Residents’ suggestions for reducing errors in teaching hospitals. N Engl J Med. 2003;348:851–5. CrossRef
- Schenkel S, Khare R, Rosenthal M, Sutcliffe K, Lewton E. Resident perceptions of medical errors in the emergency department. Acad Emerg Med. 2003;10:1218–324. CrossRef
- ACGME Outcomes Project. www.ACGME.org/Outcomes.
- Pierluissi E, Fischer MA, Campbell AR, Landefeld CS. Discussion of medical errors in morbidity and mortality conferences. JAMA. 2003;290:2838–42. CrossRef
- Mizrahi T. “Managing medical mistakes: ideology, insularity and accountability among internists-in-training.” Soc Sci Med. 1984;19:135–46. CrossRef
- Wu AW, Folkman S, McPhee SJ, Lo B. Do house officers learn from their mistakes? JAMA. 1991;265:2089–94. CrossRef
- Krueger RA, Casey MA. Focus Groups. 3rd edn. Thousand Oaks, CA: Sage Publications; 2000.
- Miles M, Huberman AM. Qualitative Data Analysis. 2nd edn. Thousand Oaks, CA: Sage Publications; 1994.
- Hafferty FW. Beyond curriculum reform: confronting medicine’s hidden curriculum. Acad Med. 1998;73:403–7. CrossRef
- Thiedke C, Blue AV, Chessman AW, Keller AH, Mallin R. Student observations and ratings of preceptor’s interactions with patients: the hidden curriculum. Teach Learn Med. 2004;16:312–6. CrossRef
- Lempp H, Seale C. The hidden curriculum in undergraduate medical education: qualitative study of medical students’ perceptions of teaching. BMJ. 2004;329:770–3. CrossRef
- Hundert EM, Hafferty F, Christakis D. Characteristics of the informal curriculum and trainees’ ethical choices. Acad Med. 1996;71:624–42. CrossRef
- Stern D. Practicing what we preach? An analysis of the curriculum of values in medical education. Am J Med. 1998;104:569–75. CrossRef
- Burack JH, Irby DM, Carline JD, Root RK, Larson EB. Teaching compassion and respect. Attending physicians’ responses to problematic behaviors. J Gen Intern Med. 1999;14:49–55. CrossRef
- Ende J, Pomerantz A, Erickson F. Preceptors’ strategies for correcting residents in an ambulatory care medicine setting: a qualitative analysis. Acad Med. 1995;70:224–9. CrossRef
- McCafferty MH, Polk HC Jr. Addition of “near-miss” cases enhances a quality improvement conference. Arch Surg. 2004;139:216–7. CrossRef
- Learning from mistakes
Journal of General Internal Medicine
Volume 21, Issue 5 , pp 419-423
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- medical errors
- medical education
- teaching methods
- Industry Sectors
- Author Affiliations
- 1. Department of Internal Medicine and Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, USA
- 2. Meyers Primary Care Institute, University of Massachusetts Medical School Fallon Foundation, and Fallon Community Health Plan, Worcester, MA, USA
- 3. Meyers Primary Care Institute, University of Massachusetts Medical School Fallon Foundation, and Fallon Community Health Plan, Worcester, MA, USA
- 4. Department of Internal Medicine, University of Massachusetts Medical School, Worcester, MA, USA
- 5. Department of Internal Medicine, University of Massachusetts Medical School, Worcester, MA, USA
- 6. Office of Medical Education and Department of Family and Community Medicine, University of Massachusetts Medical School, Worcester, MA, USA