White Andrew A, Gallagher Thomas H, Krauss Melissa J, Garbutt Jane, Waterman Amy D, Dunagan W Claiborne, Fraser Victoria J, Levinson Wendy, Larson Eric B
Department of Medicine, University of Washington School of Medicine, Seattle, Washington 98105-4608, USA.
Acad Med. 2008 Mar;83(3):250-6. doi: 10.1097/ACM.0b013e3181636e96.
To measure trainees' attitudes and experiences regarding medical error and error disclosure.
In 2003, the authors carried out a cross-sectional survey of 629 medical students (320 in their second year, 309 in their fourth year), 226 interns (159 in medicine, 67 in surgery), and 283 residents (211 in medicine, 72 in surgery), a total 1,138 trainees at two U.S. academic health centers.
The response rate was 78% (889/1,138). Most trainees (74%; 652/881) agreed that medical error is among the most serious health care problems. Nearly all (99%; 875/884) agreed serious errors should be disclosed to patients, but 87% (774/889) acknowledged at least one possible barrier, including thinking that the patient would not understand the disclosure (59%; 525/889), the patient would not want to know about the error (42%; 376/889), and the patient might sue (33%; 297/889). Personal involvement with medical errors was common among the fourth-year students (78%; 164/209) and the residents (98%; 182/185). Among residents, 45% (83/185) reported involvement in a serious error, 34% (62/183) reported experience disclosing a serious error, and 63% (115/183) had disclosed a minor error. Whereas only 33% (289/880) of trainees had received training in error disclosure, 92% (808/881) expressed interest in such training, particularly at the time of disclosure.
Although many trainees had disclosed errors to patients, only a minority had been formally prepared to do so. Formal disclosure curricula, coupled with supervised practice, are necessary to prepare trainees to independently disclose errors to patients by the end of their training.
衡量实习生对医疗差错及差错披露的态度和经历。
2003年，作者对美国两家学术医疗中心的1138名实习生进行了横断面调查，其中包括629名医学生（二年级320名，四年级309名）、226名住院医师（内科159名，外科67名）以及283名住院医生（内科211名，外科72名）。
回复率为78%（889/1138）。大多数实习生（74%；652/881）认为医疗差错是最严重的医疗保健问题之一。几乎所有实习生（99%；875/884）都同意应向患者披露严重差错，但87%（774/889）承认至少存在一个可能的障碍，包括认为患者不会理解披露内容（59%；525/889）、患者不想知道差错情况（42%；376/889）以及患者可能会起诉（33%；297/889）。四年级学生（78%；164/209）和住院医生（98%；182/185）中个人经历过医疗差错的情况很常见。在住院医生中，45%（83/185）报告参与过严重差错，34%（62/183）报告有披露严重差错的经历，63%（115/183）曾披露过轻微差错。虽然只有33%（289/880）的实习生接受过差错披露培训，但92%（808/881）表示对这类培训感兴趣，尤其是在披露差错之时。
虽然许多实习生已向患者披露过差错，但只有少数人为此接受过正式培训。正式的披露课程，再加上监督下的实践，对于让实习生在培训结束时能够独立向患者披露差错来说是必要的。
