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Medical error: a discussion of the medical construction of error and suggestions for reforms of medical education to
1Department of Primary Care and General Practice, Medical School, University of Birmingham, Birmingham, UK.
Introduction:
There is a growing public perception that serious medical error is commonplace and largely tolerated by the medical profession. The Government and medical establishment's response to this perceived epidemic of error has included tighter controls over practising doctors and individual stick-and-carrot reforms of medical practice.
Discussion:
This paper critically reviews the literature on medical error, professional socialization and medical student education, and suggests that common themes such as uncertainty, necessary fallibility, exclusivity of professional judgement and extensive use of medical networks find their genesis, in part, in aspects of medical education and socialization into medicine. The nature and comparative failure of recent reforms of medical practice and the tension between the individualistic nature of the reforms and the collegiate nature of the medical profession are discussed.
Conclusion:
A more theoretically informed and longitudinal approach to decreasing medical error might be to address the genesis of medical thinking about error through reforms to the aspects of medical education and professional socialization that help to create and perpetuate the existence of avoidable error, and reinforce medical collusion concerning error. Further changes in the curriculum to emphasize team working, communication skills, evidence-based practice and strategies for managing uncertainty are therefore potentially key components in helping tomorrow's doctors to discuss, cope with and commit fewer medical errors.
Insights
Medical education and socialization contribute to medical errors. Reforms should focus on curriculum changes, emphasizing teamwork and communication to reduce errors and improve patient safety.
Area of Science:
- Medical Education
- Healthcare Professionalism
- Patient Safety
Background:
- Public perception of frequent medical errors.
- Government and medical establishment response includes stricter controls and reforms.
- Critically reviews literature on medical error, socialization, and education.
Purpose of the Study:
- Analyze the origins of medical error within education and socialization.
- Evaluate recent reforms in medical practice.
- Propose theoretically informed approaches to reduce medical error.
Main Methods:
- Literature review on medical error, professional socialization, and medical student education.
- Critical analysis of existing reforms and their impact.
- Discussion of themes like uncertainty, fallibility, and professional judgment.
Main Results:
- Medical education and socialization contribute to themes of uncertainty, fallibility, and collusion regarding medical errors.
- Recent reforms have had limited success due to individualistic vs. collegiate tensions.
- Identifies specific aspects of education and socialization that perpetuate avoidable errors.
Conclusions:
- Addressing the genesis of medical error in education and socialization is crucial for long-term reduction.
- Curriculum reform emphasizing teamwork, communication, evidence-based practice, and uncertainty management is recommended.
- Future doctors need better tools to discuss, manage, and reduce medical errors.