Medical mistakes: a workshop on personal perspectives

Postoperative complications and their association with post-traumatic stress disorder in academic vascular surgeons

OBJECTIVES

Postoperative complications are an inherent component of surgical practice. This study seeks to address their association with emotional responses of academic vascular surgeons.

METHODS

An anonymous electronic survey was sent to all vascular surgery program directors in North America with a request to disseminate to their faculty. The survey captured data on demographics and practice type and used imbedded validated measures to determine emotional responses to postoperative complications and to assess coping mechanisms. Univariate analysis was performed to determine differences between those who reported at least partial symptoms of post-traumatic stress disorder (PTSD) following their worse major complication over the previous year and those who did not. Multivariable logistic regression analysis was performed for all covariates found significant on univariate analysis, and those deemed clinically relevant.

RESULTS

The survey was distributed to 267 faculty at 128 institutions in the United States and 10 institutions in Canada and completed by 65 participants (response rate, 32%). Twenty of 65 (31%) identified as female, and the total group had a mean age of 47 ± 10.2 years. Most respondents (43/65; 66%) reported a major complication within 3 months of the survey, with the majority of respondents (45/65; 69%) reporting the outcome of patient mortality. Of respondents, 20 of 65 (31%) demonstrated at least partial symptoms of PTSD in response to the worst complication from the previous year, with 12 of 65 (19%) meeting the clinical diagnosis of PTSD. Respondents in the PTSD group were more likely to criticize/blame themselves following the complication (P = .0028); less likely to identify the complication as "expected" (P = .048) or to believe causes of their complications were due to others/external factors; and more likely to identify as a female (55% vs 20%; P = .008). Regarding support following major complications, most respondents (57/65; 88%) desired the ability to discuss details of the case with a respected peer. The most common external pressure influencing their emotional responses to complications was maintaining reputation and a sense of honor (66%). Gender differences persisted on multivariate analysis (P = .016).

CONCLUSIONS

Emotional responses following major postoperative complications in vascular surgery are common and may pose a risk for PTSD. This may occur more commonly following complications that are unexpected or in cases in which the cause of the complication was due to a perceived or actual surgical mistake. The ubiquitous nature and severity of the emotional toll of major complications for vascular surgeons is poorly described and under-recognized. Gender-related differences may exist, and most surgeons desire a support network of respected peers with whom to discuss complications.

The Second Victim Experience and Support Tool: A Cross-Cultural Adaptation and Psychometric Evaluation in Italy (IT-SVEST)

OBJECTIVE

Second victims are defined as healthcare workers involved in an unanticipated adverse patient event, who experienced professional and psychological distress. The Second Victim Experience and Support Tool (SVEST) is a survey developed and validated in the United States, which describes the experience of second victims. This study aims to perform the cross-cultural adaptation of the SVEST and to evaluate its psychometric characteristics in the Italian context.

METHODS

Translation and cross-cultural adaptation process was performed according to the World Health Organization guidelines. Then, 349 healthcare workers, including nurses, doctors, residents, and technicians, involved in direct patient care-a potential second victim-completed the Italian version of SVEST in a validation survey at the Academic Hospital of Udine. The SVEST consists of 29 items, divided into 7 dimensions, 2 outcome variables, and 7 support options. The Italian version was assessed for internal consistency through Cronbach α, for content validity with content validity index for scales and for item and for construct validity with Confirmatory Factor Analysis.

RESULTS

The internal consistency of the instrument was adequate in its overall evaluation with Cronbach α value of 0.88 (95% confidence interval = 0.86). The content validity index for scales was 0.94 and that for item was 0.70. The confirmatory factor analysis results showed a good model fit for the 9-factor structure (χ2 = 676.18, df = 327, P < 0.001). Root mean squared error of approximation, Akaike information criterion, and comparative fix index Tucker-Lewis index values also suggested a good fit to the data.

CONCLUSIONS

The Italian version of the SVEST can be used to evaluate second victim experiences, demonstrating adequate validity, reliability, and good psychometric properties.

"You Remember Those Days"-A Qualitative Study of Resident Surgeon Responses to Complications and Deaths

OBJECTIVE

Postoperative complications and deaths are unavoidable aspects of a surgical career, but little is known about the impacts of these unwanted outcomes on resident surgeons. The goal of this study was to characterize the impact of complications and deaths on surgery residents in order to facilitate development of improved support systems.

DESIGN

This qualitative study was designed to explore resident surgeons' experiences with unwanted outcomes, including postoperative complications and death. Semi-structured interviews explored a range of topics related to personal experiences with unwanted outcomes. Analyses of interview transcripts were performed iteratively and informed by thematic analysis.

SETTING

An anthropologist at the University of Michigan conducted interviews with general surgery residents from academic, community, and hybrid training programs across the country.

PARTICIPANTS

Twenty-eight mid-level and senior residents (PGY3 and above) were recruited for participation from 14 different training programs across the United States.

RESULTS

Resident surgeons described an initial period of emotional response, characterized by feelings of sadness, frustration, or grief. Simultaneously or soon afterward, interviewees described a period of intellectual response aimed at understanding how and why an outcome occurred, with the expressed goal of learning from it. Many residents described impacts to their personal lives. Several factors that influenced the duration and intensity of these responses were identified, including a sense of ownership, which was a powerful driver for improvement.

CONCLUSIONS

This qualitative study provides a nuanced description of resident surgeons' responses to unwanted outcomes. While emotional responses were characterized by strong feelings, such as sadness and grief, intellectual responses were focused on learning from the events. These data may help inform the development of structured support systems by residency programs.

STRUCTURED ABSTRACT

Facing post-operative complications and deaths is an unavoidable aspect of surgical training, but the impacts on surgery residents has not been well characterized. Through semi-structured interviews with general surgery residents from programs across the United States, this qualitative study explored the ways that residents respond to unwanted outcomes. Residents described an initial period of emotional response, characterized by strong feelings, often of sadness or grief. There was a subsequent or concomitant period of intellectual response, in which residents examined how and why this outcome occurred, with the goal of learning from it. A feeling of ownership was strengthened by involvement in patient care and length of rotation. In light of this detailed description of resident experiences, residency programs can foster the development of improved support for trainees as they navigate these profoundly impactful events.

Exploring Emotional Responses After Postoperative Complications: A Qualitative Study of Practicing Surgeons

OBJECTIVE

This qualitative study explored the impact of postoperative complications on surgeons and their well-being.

BACKGROUND

Complications are an inherent component of surgical practice. Although there have been extensive efforts to reduce postoperative complications, the impact of complications on surgeons have not been well-studied. Surgeons are often left to process their own emotional responses to these complications, the effects of which are not well characterized.

METHODS

We conducted 46 semi-structured interviews with a diverse range of surgeons practicing across Michigan to explore their responses to postoperative complications and the effect on overall well-being. The data were analyzed iteratively, through steps informed by thematic analysis.

RESULTS

Participants described feelings of sadness, anxiety, frustration, grief, failure, and disappointment after postoperative complications. When asked to elaborate on these responses, participants described internal processes such as feelings of personal responsibility and failure, self-doubt, and failing the patient and family. Participants also described external pressures influencing the responses, which included potential impact to reputation and medicolegal issues. Experience level, type of complication, and the surgeon's individual personality were specific factors that influenced the intensity of these responses.

CONCLUSION

Surgeons' emotional responses after postoperative complications may negatively impact individual well-being, and may represent a threat to the profession altogether if these issues remain inadequately recognized and addressed. Knowledge of the impact of unwanted or unexpected outcomes on surgeons is critical in developing and implementing strategies to cope with the challenges frequently encountered in the surgical profession.

Undiagnosed Malignancy and Therapeutic Complications in Oncology Patients: A 10-Year Review of Autopsy Cases

CONTEXT.—

Despite technologic and medical advancements, autopsies are essential to uncover clinically unsuspected diagnoses, to advance our understanding of disease processes, and to help reduce medical errors.

OBJECTIVE.—

To investigate the percentage of malignancy clinically diagnosed and undiagnosed in a series of hospital autopsies. Secondarily, to explore the therapeutic complications directly contributing to death in cancer patients.

DESIGN.—

A 10-year retrospective study (2008-2018). All nonforensic autopsies performed at the University of Vermont Medical Center during this period were reviewed by 2 pathologists, and data, including antemortem diagnoses of malignancy, and autopsy findings, including therapeutic complications, were collected.

RESULTS.—

A total of 246 cases documented a diagnosis of malignancy. In 34.5% (85 of 246) of cases a tissue diagnosis of malignancy was first documented following postmortem examination. In 41.2% (35 of 85) of cases there was clinical antemortem suspicion of malignancy, whereas in 58.8% (50 of 85) clinically unsuspected malignancy was first diagnosed after postmortem examination. In 16.0% (8 of 50) of cases the undiagnosed malignancy was the primary cause of death. The overall rate of therapeutic complication related to the treatment of oncologic disease in patients that resulted in death was 21.7% (35 of 161).

CONCLUSIONS.—

Our study shows the percentage of clinically unsuspected malignancies revealed by postmortem examination to be 5% (50 of 1003) of all autopsy cases. In 16% (8 of 50) of cases, the cause of death was due to the clinically undiagnosed malignancy, and hence not an incidental finding. Despite advances in medical therapy in the management of oncologic disease, in up to 21.7% (35 of 161) of cases therapeutic complications directly contributed to death.

Beyond the borders: Lessons from various industries adopted in anesthesiology

Since the first public demonstration of anaesthesia in Boston, USA which happened around 172 years back, the field of anesthesiology has rapidly progressed, with many developments that have improved the quality and safety of anesthesia care. This has enabled tremendous advances in the surgical disciplines and increasing the life expectancy and quality of life of humans. This is a result of learning and constantly evolving. There are several similarities between healthcare and other industries, though there are several distinguishing characteristics that set it apart from other industries. There are a number of safety and quality improvement measures in healthcare which have been influenced by safety practices in other industries. Anaesthesia has been the leader among the medical specialities in adoption of innovative practices from various industries in an effort to advance patient safety, enhance quality of care, reduce waste & inefficiency, and improve customer service and satisfaction. This article emphasises on learnings from other industries in the recent decades, focusing on aviation, high-reliability organizations, car manufacturing, telecommunication, car racing, entertainment, and retail. Learning and implanting the best practices from these industries can bring about a paradigm shift in health care industry. It has a potential to improve efficiency and make anaesthesia safer than ever before in the history of human kind.

The Second Victim Experience and Support Tool: Validation of an Organizational Resource for Assessing Second Victim Effects and the Quality of Support Resources

OBJECTIVES

Medical errors and unanticipated negative patient outcomes can damage the well-being of health care providers. These affected individuals, referred to as "second victims," can experience various psychological and physical symptoms. Support resources provided by health care organizations to prevent and reduce second victim-related harm are often inadequate. In this study, we present the development and psychometric evaluation of the Second Victim Experience and Support Tool (SVEST), a survey instrument that can assist health care organizations to implement and track the performance of second victim support resources.

METHODS

The SVEST (29 items representing 7 dimensions and 2 outcome variables) was completed by 303 health care providers involved in direct patient care. The survey collected responses on second victim-related psychological and physical symptoms and the quality of support resources. Desirability of possible support resources was also measured. The SVEST was assessed for content validity, internal consistency, and construct validity with confirmatory factor analysis.

RESULTS

Confirmatory factor analysis results suggested good model fit for the survey. Cronbach α reliability scores for the survey dimensions ranged from 0.61 to 0.89. The most desired second victim support option was "A respected peer to discuss the details of what happened."

CONCLUSIONS

The SVEST can be used by health care organizations to evaluate second victim experiences of their staff and the quality of existing support resources. It can also provide health care organization leaders with information on second victim-related support resources most preferred by their staff. The SVEST can be administered before and after implementing new second victim resources to measure perceptions of effectiveness.

Wisdom in Medicine: What Helps Physicians After a Medical Error?

PURPOSE

Confronting medical error openly is critical to organizational learning, but less is known about what helps individual clinicians learn and adapt positively after making a harmful mistake. Understanding what factors help doctors gain wisdom can inform educational and peer support programs, and may facilitate the development of specific tools to assist doctors after harmful errors occur.

METHOD

Using "posttraumatic growth" as a model, the authors conducted semistructured interviews (2009-2011) with 61 physicians who had made a serious medical error. Interviews were recorded, professionally transcribed, and coded by two study team members (kappa 0.8) using principles of grounded theory and NVivo software. Coders also scored interviewees as wisdom exemplars or nonexemplars based on Ardelt's three-dimensional wisdom model.

RESULTS

Of the 61 physicians interviewed, 33 (54%) were male, and on average, eight years had elapsed since the error. Wisdom exemplars were more likely to report disclosing the error to the patient/family (69%) than nonexemplars (38%); P < .03. Fewer than 10% of all participants reported receiving disclosure training. Investigators identified eight themes reflecting what helped physician wisdom exemplars cope positively: talking about it, disclosure and apology, forgiveness, a moral context, dealing with imperfection, learning/becoming an expert, preventing recurrences/improving teamwork, and helping others/teaching.

CONCLUSIONS

The path forged by doctors who coped well with medical error highlights specific ways to help clinicians move through this difficult experience so that they avoid devastating professional outcomes and have the best chance of not just recovery but positive growth.

How Surgical Trainees Handle Catastrophic Errors: A Qualitative Study

OBJECTIVE

Surgical trainees are often subject to the negative consequences of medical error, and it is therefore important to determine how trainees cope with error and to find ways of supporting trainees when catastrophic events occur. This article examines how trainees interpret catastrophic surgical outcomes and ways to provide support for trainees who have experienced catastrophic events.

DESIGN

Totally 23 semistructured interviews were conducted with surgical trainees. Interviews were conducted in English and subjected to modified thematic analysis.

SETTING

A tertiary care hospital in Toronto, Canada.

PARTICIPANTS

Interviews were completed with 23 surgery residents. Potential participants were recruited through communications via the Department of Surgery and volunteered to take part in the study.

RESULTS

Totally 5 themes emerged: (1) catastrophic errors usually represent system deficiencies; (2) catastrophic events provide lessons for future practice; (3) many trainees did not feel comfortable speaking with the surgical staff; (4) counseling services should be offered to help a subset of trainees; and (5) the culture of surgery may act as a barrier to trainees seeking help.

CONCLUSIONS

This study demonstrates the importance of providing support for the emotional needs of surgical trainees who have experienced catastrophic surgical errors and the continued need for mentoring by staff surgeons.

Do no harm: is it time to rethink the Hippocratic Oath?

INTRODUCTION

The 1964 revision of the Hippocratic Oath addressed the disconnection in language and context between the classical doctrine and 20th century medicine. Now, 50 years later, we argue that any revision of the Oath must be responsive to the significant social, technical and political changes that have occurred in health care.

THE CONTEXT FOR THE HIPPOCRATIC OATH

This paper examines the ways in which health care and the health professions have changed over the last half-century and describes a range of environmental and contextual features that expose the inadequacies of the 1964 Oath in the worlds of today and the future. We note the constancy of the doctor-patient dyad in contemporary ethical codes and consider from the perspective of patient safety those aspects of care that might fall short of the optimum if the focus on the doctor is retained. We ask whether there is any merit in maintaining a focus on the ethics or professionalism of doctors, or whether more of our attention should be directed towards the ethics of health care itself.

CONCLUSIONS

Patient safety is widely acknowledged as a major health issue. Being open about the interdependency of doctors, the complex socio-political nature of health care, and the inevitability of errors and adverse events need not challenge the authority of the doctor. Rather, openness about both the ways in which medicine has changed and the harms that doctors may (inadvertently) cause might afford medicine the opportunity to build a different relationship with patients (and with society more broadly), that recognises complexity, human fallibility and the uncertainty of medicine.

Disclosing medical mistakes: a communication management plan for physicians

INTRODUCTION

There is a growing consensus that disclosure of medical mistakes is ethically and legally appropriate, but such disclosures are made difficult by medical traditions of concern about medical malpractice suits and by physicians' own emotional reactions. Because the physician may have compelling reasons both to keep the information private and to disclose it to the patient or family, these situations can be conceptualized as privacy dilemmas. These dilemmas may create barriers to effectively addressing the mistake and its consequences. Although a number of interventions exist to address privacy dilemmas that physicians face, current evidence suggests that physicians tend to be slow to adopt the practice of disclosing medical mistakes.

METHODS

This discussion proposes a theoretically based, streamlined, two-step plan that physicians can use as an initial guide for conversations with patients about medical mistakes. The mistake disclosure management plan uses the communication privacy management theory.

RESULTS

The steps are 1) physician preparation, such as talking about the physician's emotions and seeking information about the mistake, and 2) use of mistake disclosure strategies that protect the physician-patient relationship. These include the optimal timing, context of disclosure delivery, content of mistake messages, sequencing, and apology. A case study highlighted the disclosure process.

CONCLUSION

This Mistake Disclosure Management Plan may help physicians in the early stages after mistake discovery to prepare for the initial disclosure of a medical mistakes. The next step is testing implementation of the procedures suggested.

A case of error disclosure: a communication privacy management analysis

To better understand the process of disclosing medical errors to patients, this research offers a case analysis using Petronios’s theoretical frame of Communication Privacy Management (CPM). Given the resistance clinicians often feel about error disclosure, insights into the way choices are made by the clinicians in telling patients about the mistake has the potential to address reasons for resistance. Applying the evidenced-based CPM theory, developed over the last 35 years and dedicated to studying disclosure phenomenon, to disclosing medical mistakes potentially has the ability to reshape thinking about the error disclosure process. Using a composite case representing a surgical mistake, analysis based on CPM theory is offered to gain insights into conversational routines and disclosure management choices of revealing a medical error. The results of this analysis show that an underlying assumption of health information ownership by the patient and family can be at odds with the way the clinician tends to control disclosure about the error. In addition, the case analysis illustrates that there are embedded patterns of disclosure that emerge out of conversations the clinician has with the patient and the patient’s family members. These patterns unfold privacy management decisions on the part of the clinician that impact how the patient is told about the error and the way that patients interpret the meaning of the disclosure. These findings suggest the need for a better understanding of how patients manage their private health information in relationship to their expectations for the way they see the clinician caring for or controlling their health information about errors.

Health care professionals as second victims after adverse events: a systematic review

Adverse events within health care settings can lead to two victims. The first victim is the patient and family and the second victim is the involved health care professional. The latter is the focus of this review. The objectives are to determine definitions of this concept, research the prevalence and the impact of the adverse event on the second victim, and the used coping strategies. Therefore a literature research was performed by using a three-step search procedure. A total of 32 research articles and 9 nonresearch articles were identified. The second victim phenomenon was first described by Wu in 2000. In 2009, Scott et al. introduced a detailed definition of second victims. The prevalence of second victims after an adverse event varied from 10.4% up to 43.3%. Common reactions can be emotional, cognitive, and behavioral. The coping strategies used by second victims have an impact on their patients, colleagues, and themselves. After the adverse event, defensive as well as constructive changes have been reported in practice. The second victim phenomenon has a significant impact on clinicians, colleagues, and subsequent patients. Because of this broad impact it is important to offer support for second victims. When an adverse event occurs, it is critical that support networks are in place to protect both the patient and involved health care providers.

"Learning" from other industries: lessons and challenges for health care organizations

Although it is true that health care has several distinguishing characteristics that set it apart, analysts both within and outside the industry point to several similarities with other fields and suggest opportunities for health care to learn from other industries. Applications from other industries have been described in the literature, but the transfer of learning at health care industry level has not been examined. This article investigates health care learning from other industries in the recent decade, focusing on aviation, high-reliability organizations, car manufacturing, telecommunication, car racing, entertainment, and retail; evidence suggests that most innovative practices originate with these fields. The diffusion of innovations from other industries appears to start with a few early adopter organizations (hospitals and health systems) and influential other organizations (The Joint Commission, Institute of Medicine, Agency for Healthcare Research and Quality, or Institute for Healthcare Improvement) pushing for the innovations. Once the trend becomes accepted, consultants and copying behavior seem to contribute to its spread across the industry. An important question to explore is whether the applications in the early adopter organizations are different (in terms of their effectiveness) from those in the rest of the industry. Another intriguing issue is to examine whether other industries learn from health care organizations.

Onclogists' difficulties in facing and disclosing medical errors: suggestions for the clinic

Along with improved safety measures and changes in the culture of medicine, communication is key to reducing the effect of medical errors and to easing the medical, psychologic, and existential burdens they impose on all parties. Disclosure demonstrates respect for patients' autonomy and promotes patient's involvement in informed decision making about ways to correct or alleviate the effects of the error. It also enhances oncologists' integrity and helps restore trust in the patient-doctor relationship. Because of the complexity of cancer treatments and the uncertainty regarding outcomes in oncology, oncologists may rationalize nondisclosure as a way to avoid adding to the physical and existential suffering of their patients. Although there is broad agreement among professional and regulatory bodies, as well as medical ethicists, that physicians should disclose errors to patients-and physicians largely support disclosure of error to patients-studies show discrepancy between physicians' responses to hypothetical clinical scenarios of truth telling about medical errors and actual practices of withholding or tempering the truth. Among common reasons for avoiding disclosure are risk of malpractice lawsuits, fear of being exposed as incompetent, and feeling shame before patients and colleagues. Proper disclosure, however, including a sincere apology, should be part of the management of errors and of their long-term aftermaths. In disclosing medical errors, it is essential for oncologists to pay equal attention to the medical and the emotional aspects of the information they are giving and the reaction that it elicits in patients and families. Specific communication skills regarding disclosure of medical errors can be learned.

Managing the aftermath of critical incidents: meeting the needs of health-care providers and patients

Critical incidents may have serious psychological and health-related impact on patients, their families and the health-care providers involved. Exploring the needs of health-care providers and patients and their families in the aftermath of a critical incident, this article highlights a disconnect between the widely acknowledged ethical obligation for open disclosure and current practice, reviews the available evidence on effective disclosure and barriers to open disclosure and provides an overview of what health-care organisations can do to alleviate the impact of critical incidents on staff, patients and their families. The most critical elements are: (1) effective support systems for clinicians, (2) guidelines on critical incident management including immediate measures, disclosure standards and subsequent incident analysis and (3) educational interventions informing staff about disclosure standards and support systems and training critical disclosure skills. Significant leadership commitment is required to successfully implement such comprehensive incident management systems.

What happens when things go wrong?

When a patient is injured or dies during anesthesia care, both the family of the patient and the health care providers suffer. The family needs to know what happened. The family can benefit from personal contact with the involved physicians. Apology to the injured is very important. The health care providers must report adverse events. Systematic review of adverse events can provide improved patient safety. Mechanisms exist to support the health care providers recovering from these potentially devastating experiences, but useful support is often not immediately available.

Negotiating medical virtues: toward the development of a physician mistake disclosure model

Statistics show that nearly 98,000 patients die each year because of preventable medical mistakes. Despite legal obligations, a majority of physicians either fail to disclose a mistake or disclose it in an incompetent manner, causing detrimental outcomes. This article is the first to synthesize existing research on medical mistakes into an integrative physician mistake disclosure model. The proposed model theorizes that physicians conduct a cost-benefit analysis prior to deciding whether or not to disclose a medical mistake. In the event of disclosure, informational and relational disclosure competence is hypothesized to mediate the inherent detrimental effects of physician defensiveness on immediate and long-term outcomes. The article provides detailed directions for future research and discusses practical implications of the physician mistake disclosure model for physicians and health-care institutions. Most important, the model implies that a supportive organizational climate is needed to curb destructive physician defensiveness, optimize disclosure competence, and minimize detrimental outcomes. Physicians and health-care institutions are advised to collaborate in their attempts to enhance long-term error management and reduce the current number of fatal medical mistakes. The physician mistake disclosure model adds to our current understanding of medical mistake disclosure, and represents a heuristic research and training tool that has the potential to save lives.

Otolaryngologists' responses to errors and adverse events

OBJECTIVES

The objectives of this study were to describe otolaryngologists' emotional reactions to errors and adverse events, their efforts to take responsibility, and their attempts to implement improvements.

STUDY DESIGN AND METHODS

A retrospective, anonymous survey of 2,500 U.S. otolaryngologists who were members of the American Academy of Otolaryngology-Head and Neck Surgery about errors in their practice was conducted. Respondents were asked whether an error had occurred in their practice in the past 6 months and, if so, to describe the error, its consequences, and any corrective actions taken. Two aspects of these reports stood out, which were beyond the scope of the original study: the respondents' emotional responses and their corrective actions.

RESULTS

The response rate was 18.6%. Two hundred ten (45%) respondents reported a total of 212 analyzable error reports and 230 corrective actions. Corrective actions included disclosure to the patient (20 [9%]), ameliorating the consequences of the event to the patient (107 [50%]), personal practice changes (14 [7%]), improvements in the respondent's practice or department (60 [28%]), and hospitalwide or broader corrective actions (19 [9%]). Emotional reactions to errors and adverse events were reported by 22 (10%) otolaryngologists, including regret, embarrassment, guilt, anxiety, loss of temper, and irritation. Legal action was mentioned by five physicians (2%).

CONCLUSIONS

Otolaryngologists took actions not only to treat their patients, but also to improve patient care in their practice, department, hospital, or community. Emotional reactions to errors and adverse events are common and need to be addressed in medical training and practice.

Teaching medical students about medical errors and patient safety: evaluation of a required curriculum

PURPOSE

To assess the effectiveness of a brief curriculum about patient safety and medical errors with third-year medical students.

METHOD

From 2000-03, third-year medical students at New York Medical College, Valhalla, New York, were required to participate in a new curriculum on patient safety and medical errors during their family medicine clerkships. Five hundred seventy-two students participated in a four-hour curriculum that included interactive discussion, readings, a videotape session with a standardized patient, and a small-group debriefing facilitated by a family physician. Before and after participating in the curriculum, students were asked to complete questionnaires on self-awareness about patient communication and safety. Curriculum evaluations and follow-up surveys were also distributed. Responses to each statement on the before and after questionnaires were compared using the Wilcoxon signed-rank test for matched data.

RESULTS

Five hundred eleven (89%) students reported that the opportunity to present an error to a patient increased their confidence about discussing this issue with patients, and 537 (94%) students reported that they strongly agreed or agreed that the standardized patient and feedback exercise was a useful learning experience. A total of 535 before and after questionnaires were used in the analysis. A comparison of before and after questionnaire data revealed statistically significant increases in the self-reported awareness of students' strengths and weaknesses in communicating medical errors to patients (p <or= .01).

CONCLUSION

These findings suggest that awareness about patient safety and medical error can be increased and sustained through the use of an experiential curriculum, and the students rated this as a valuable experience.