Individual, cultural, and systems factors affect surgical residents’ experience with medical errors and learning from mistakes

Abstract

Purpose

Medical errors are part of clinical medicine and reflecting on these challenging experiences can contribute to resident learning. The residency training period is a critical time. Residents’ experiences with medical errors may have a significant impact on their future development and learning. The purpose of this study was to determine the experience of surgical residents involved in a medical error or adverse event and factors that may influence learning.

Methods

A transcendental phenomenological research design was used. Semi-structured interviews were performed and were transcribed by an independent professional transcriptionist. Transcripts were analyzed according to the method described by Moustakas. All transcripts were initially coded manually by the lead author and a peer coder, and were organized with qualitative data software (NVivo). Codes were then converted to themes which were supplemented with thick rich description, providing contextual detail.

Results

Twenty surgical residents were interviewed and various themes were noted. Residents described their learning about and reporting of medical errors to be variable and highly dependent on their department. Residents described strong emotional responses to the medical error including feelings of shame and guilt, loss of confidence, and depression. Reactions and interventions by supervising attending and peers had mostly positive impacts on how residents dealt with and learned from the error. Attendings and peers provided support and perspective on the error, allowing the resident involved to feel less isolated. Attendings provided mentorship for the resident so that the experience contributed to transformational learning. The department’s and institution’s handling of the medical error affected the residents’ perception of a culture of safety. Open communication and transparency in discussing errors aided a resident’s growth. Residents who were particularly reflective were more likely to take initiative to develop plans for future learning.

Conclusions

Residents’ experiences with medical errors generate strong responses and are affected both positively and negatively by attendings, peers, the training department, and institution. An appreciation by attendings and the institution in how residents experience medical errors may influence how residents are trained to cope with medical errors and to use these events as learning opportunities.