Division of Medical Education, Drexel University College of Medicine, Philadelphia, PA, USA.
Med Educ. 2012 Jul;46(7):668-77. doi: 10.1111/j.1365-2923.2012.04269.x.
The 2000 Institute of Medicine report, 'To Err is Human: Building a Safer Health System', focused the medical community on medical error. This focus led to educational initiatives and legislation designed to minimise errors and increase their disclosure.
This study aimed to investigate whether increased general awareness about medical error has affected interns' attitudes toward medical error and disclosure by comparing responses to surveys of interns carried out at either end of the last decade.
Two cohorts of interns for the academic years 1999, 2000 and 2001 (n = 304) and 2008 and 2009 (n = 206) at a university hospital were presented with two hypothetical scenarios involving errors that resulted in, respectively, no permanent harm and an adverse outcome. The interns were questioned regarding their likely responses to error and disclosure.
We collected 510 surveys (100% response rate). For both scenarios, the percentage of interns who would be willing to fully disclose their mistakes increased substantially from 1999-2001 to 2008-2009 ('no permanent harm': 38% and 71%, respectively [p < 0.001]; 'adverse outcome': 29% and 55%, respectively [p < 0.001]). About two thirds of fully disclosing interns in both scenarios believed 'the patient's right to full information' to be the primary reason for their disclosure. Fear of litigation in response to error disclosure decreased (70% and 52%, respectively), the percentage of interns who felt that 'medical mistakes are preventable if doctors know enough' decreased (49% and 31%, respectively), belief that competent doctors keep emotions and uncertainties to themselves decreased (51% and 14%, respectively), and agreement with leaving medicine if one (as an intern) caused harm or death decreased (50% and 3%, respectively). Prior training about medical mistakes increased more than four-fold between the cohorts.
This comparison of intern responses to a survey administered at either end of the last decade reveals that there may have been some important changes in interns' intended disclosure practices and attitudes toward medical error.
2000 年美国医学研究所的报告《人都会犯错：建立更安全的医疗体系》将医疗界的注意力集中到医疗差错上。这种关注导致了旨在减少差错和增加差错披露的教育举措和立法。
本研究旨在通过对比过去十年末期进行的两次实习医生调查结果，调查对医疗差错的普遍认识提高是否影响了实习医生对医疗差错和披露的态度。
在一所大学医院，我们对参加 1999、2000 和 2001 学年（n = 304）以及 2008 和 2009 学年（n = 206）的两组实习医生分别呈现两个涉及分别导致无永久性伤害和不良后果的差错的假设场景。询问实习医生对差错和披露的可能反应。
我们共收集了 510 份调查问卷（应答率 100%）。对于两个场景，愿意全面披露错误的实习医生比例从 1999-2001 年到 2008-2009 年大幅增加（“无永久性伤害”：分别为 38%和 71%[p < 0.001]；“不良后果”：分别为 29%和 55%[p < 0.001]）。两个场景中约有三分之二的完全披露错误的实习医生认为“患者享有充分信息的权利”是他们披露的主要原因。对差错披露的诉讼恐惧减少（分别为 70%和 52%），认为“如果医生了解足够的信息，医疗差错是可以预防的”的实习医生比例减少（分别为 49%和 31%），相信有能力的医生会将自己的情绪和不确定性隐藏起来的实习医生比例减少（分别为 51%和 14%），如果自己（作为实习医生）造成伤害或死亡而离开医学领域的实习医生比例减少（分别为 50%和 3%）。过去十年末期的实习医生对医疗差错的培训增加了四倍多。
对过去十年末期进行的一次调查中实习医生的反应进行对比，结果显示实习医生在披露做法和对医疗差错的态度方面可能发生了一些重要变化。
