Medical Training and Errors: Competence, Culture, Caring, and Character

Medical trainees will inevitably make errors as they learn. Errors should be minimized by a stronger focus on competence through better supervision and increased opportunities for simulation, as well as by reinforcing a culture that supports open identification of errors, disclosing errors to patients and families, and that focuses on prevention through quality improvement. Yet, errors are also opportunities for education and remediation. Medicine's duty of care includes care for those harmed through errors and should also include care for those who have made the error. Errors that cause harm to patients challenge trainees to engage the character traits of honesty, humility, trustworthiness, and compassion and to strengthen the practical wisdom to know when and how to exercise these character traits. The moral core of medicine-care of the patient in circumstances that may be uncertain and imperfect-as well as the duties of honesty, disclosure, repair, and redress may make equanimity (the calmness, composure, and evenness of temper needed in difficult and challenging situations) one of the most important character traits medical educators should identify, nurture, and encourage in trainees.