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Journal of General Internal Medicine

, Volume 21, Issue 5, pp 419–423 | Cite as

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

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 

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References

  1. 1.
    Hayward RA, Hofer TP. Estimating hospital deaths due to medical errors: preventability is in the eye of the reviewer. JAMA. 2001;286:415–20.PubMedCrossRefGoogle Scholar
  2. 2.
    Institute of Medicine. To Err Is Human. Washington, DC: National Academy Press; 1999.Google Scholar
  3. 3.
    Vincent C, Neale G, Woloshynowych M. Adverse events in British hospitals: preliminary retrospective record review. BMJ. 2001;322:517–9.PubMedCrossRefGoogle Scholar
  4. 4.
    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.CrossRefGoogle Scholar
  5. 5.
    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.PubMedCrossRefGoogle Scholar
  6. 6.
    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.PubMedCrossRefGoogle Scholar
  7. 7.
    Institute of Medicine. Crossing the Quality Chasm: The IOM Health Care Quality Initiative. Washington, DC; National Academy Press; 2001.Google Scholar
  8. 8.
    Institute of Medicine. Health Professions Education: A Bridge to Quality. Washington, DC: National Academy Press; 2003.Google Scholar
  9. 9.
    Liang BA. A system of medical error disclosure. Qual Safety Health Care. 2002;11:64–8.CrossRefGoogle Scholar
  10. 10.
    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.PubMedGoogle Scholar
  11. 11.
    Mazor KM, Simon SR, Yood RA, et al. Health plan members’ views on forgiving medical errors. Am J Managed Care. 2005;11:49–52.Google Scholar
  12. 12.
    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.PubMedCrossRefGoogle Scholar
  13. 13.
    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.Google Scholar
  14. 14.
    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.Google Scholar
  15. 15.
    Volpp KG, Grande MD. Residents’ suggestions for reducing errors in teaching hospitals. N Engl J Med. 2003;348:851–5.PubMedCrossRefGoogle Scholar
  16. 16.
    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.CrossRefGoogle Scholar
  17. 17.
    ACGME Outcomes Project. www.ACGME.org/Outcomes.Google Scholar
  18. 18.
    Pierluissi E, Fischer MA, Campbell AR, Landefeld CS. Discussion of medical errors in morbidity and mortality conferences. JAMA. 2003;290:2838–42.PubMedCrossRefGoogle Scholar
  19. 19.
    Mizrahi T. “Managing medical mistakes: ideology, insularity and accountability among internists-in-training.” Soc Sci Med. 1984;19:135–46.PubMedCrossRefGoogle Scholar
  20. 20.
    Wu AW, Folkman S, McPhee SJ, Lo B. Do house officers learn from their mistakes? JAMA. 1991;265:2089–94.PubMedCrossRefGoogle Scholar
  21. 21.
    Krueger RA, Casey MA. Focus Groups. 3rd edn. Thousand Oaks, CA: Sage Publications; 2000.Google Scholar
  22. 22.
    Miles M, Huberman AM. Qualitative Data Analysis. 2nd edn. Thousand Oaks, CA: Sage Publications; 1994.Google Scholar
  23. 23.
    Hafferty FW. Beyond curriculum reform: confronting medicine’s hidden curriculum. Acad Med. 1998;73:403–7.PubMedCrossRefGoogle Scholar
  24. 24.
    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.PubMedCrossRefGoogle Scholar
  25. 25.
    Lempp H, Seale C. The hidden curriculum in undergraduate medical education: qualitative study of medical students’ perceptions of teaching. BMJ. 2004;329:770–3.PubMedCrossRefGoogle Scholar
  26. 26.
    Hundert EM, Hafferty F, Christakis D. Characteristics of the informal curriculum and trainees’ ethical choices. Acad Med. 1996;71:624–42.PubMedCrossRefGoogle Scholar
  27. 27.
    Stern D. Practicing what we preach? An analysis of the curriculum of values in medical education. Am J Med. 1998;104:569–75.PubMedCrossRefGoogle Scholar
  28. 28.
    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.PubMedCrossRefGoogle Scholar
  29. 29.
    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.PubMedCrossRefGoogle Scholar
  30. 30.
    McCafferty MH, Polk HC Jr. Addition of “near-miss” cases enhances a quality improvement conference. Arch Surg. 2004;139:216–7.PubMedCrossRefGoogle Scholar

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

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