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Do house officers learn from their mistakes?
A W Wu1, S Folkman, S J McPhee
1Department of Veterans Affairs, University of California, San Francisco.
Abstract:
Mistakes are inevitable in medicine. To learn how medical mistakes relate to subsequent changes in practice, we surveyed 254 internal medicine house officers. One hundred fourteen house officers (45%) completed an anonymous questionnaire describing their most significant mistake and their response to it. Mistakes included errors in diagnosis (33%), prescribing (29%), evaluation (21%), and communication (5%) and procedural complications (11%). Patients had serious adverse outcomes in 90% of the cases, including death in 31% of cases. Only 54% of house officers discussed the mistake with their attending physicians, and only 24% told the patients or families. House officers who accepted responsibility for the mistake and discussed it were more likely to report constructive changes in practice. Residents were less likely to make constructive changes if they attributed the mistake to job overload. They were more likely to report defensive changes if they felt the institution was judgmental. Decreasing the work load and closer supervision may help prevent mistakes. To promote learning, faculty should encourage house officers to accept responsibility and to discuss their mistakes.
Insights
Medical errors are common among internal medicine house officers, often leading to serious patient harm. Discussing mistakes and accepting responsibility encourages constructive practice changes, while workload and institutional judgment influence resident responses.
Area of Science:
- Medical Education
- Patient Safety
- Healthcare Quality
Background:
- Medical errors are an unavoidable aspect of healthcare delivery.
- Understanding the link between medical mistakes and practice modification is crucial for improving patient outcomes.
- Internal medicine house officers are a key demographic for studying error reporting and learning.
Purpose of the Study:
- To investigate the relationship between medical mistakes made by internal medicine house officers and subsequent changes in their medical practice.
- To identify factors influencing house officers' responses to errors, including discussion with peers and supervisors, and patient/family communication.
- To explore the impact of perceived workload and institutional culture on error reporting and learning.
Main Methods:
- Anonymous questionnaire survey administered to 254 internal medicine house officers.
- 114 house officers (45%) completed the survey detailing their most significant mistake and their response.
- Data collected on types of mistakes, patient outcomes, and communication patterns.
Main Results:
- Mistakes encompassed diagnosis (33%), prescribing (29%), evaluation (21%), communication (5%), and procedural complications (11%).
- Serious adverse patient outcomes occurred in 90% of cases, including death in 31%.
- Only 54% discussed mistakes with attending physicians; 24% informed patients/families. Accepting responsibility and discussion correlated with constructive practice changes.
Conclusions:
- House officers who accepted responsibility and discussed their errors were more likely to implement constructive practice changes.
- Job overload was associated with fewer constructive changes, while a judgmental institutional environment led to defensive changes.
- Reducing workload, enhancing supervision, and fostering an environment that encourages open discussion of mistakes are vital for medical learning and preventing future errors.
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