Division of General Medicine, Division of Medical Ethics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
J Am Coll Surg. 2013 Dec;217(6):1145-50. doi: 10.1016/j.jamcollsurg.2013.07.391. Epub 2013 Sep 5.
The "hidden curriculum" and role models for responding to medical errors might play a central role in influencing residents' attitudes about disclosure. We sought to compare surgical and nonsurgical residents' exposure to role modeling for responding to medical errors and their attitudes about error disclosure.
We conducted a cross-sectional, electronic survey of surgical and nonsurgical residents at 2 large academic medical centers. The questionnaire asked respondents about personal experience with medical errors; training for responding to errors; frequency of exposure to role modeling related to disclosure; and attitudes about disclosure. Descriptive statistics were used to describe frequencies. Chi-square and Fisher's exact test were used to compare proportions between surgical and nonsurgical trainees.
The response rate was 58% (253 of 435). Surgical residents reported more frequently observing a colleague be treated harshly (eg, humiliated or verbally abused) for an error than nonsurgical residents (sometimes or often, 39% [26 of 66] vs 20% [37 of 187]; p = 0.002). Surgical residents were more likely than nonsurgical residents to believe they would be treated harshly by others if they acknowledged making a medical error (35% [23 of 66] vs 12% [23 of 187]; p < 0.001) and believe they have to compromise their own values when dealing with medical errors at their institution (11% [7 of 66] vs 2% [4 of 187]; p = 0.008). Surgical residents were less likely than nonsurgical residents to feel free to express concerns to other members of the team about medical errors in patient care (70% [46 of 66] vs 83% [115 of 187]; p = 0.02).
The punitive response to error by senior members of the health care team might be an impediment to the transparent disclosure of errors among residents that might disproportionally affect surgical training programs.
“隐性课程”和应对医疗差错的榜样可能在影响住院医师对披露的态度方面发挥核心作用。我们旨在比较外科和非外科住院医师接触应对医疗差错的榜样以及他们对差错披露的态度。
我们在 2 家大型学术医疗中心对外科和非外科住院医师进行了横断面电子调查。调查问卷询问了受访者有关医疗差错的个人经历；应对差错的培训；接触与披露相关的榜样的频率；以及对披露的态度。使用描述性统计数据来描述频率。使用卡方检验和 Fisher 确切检验比较外科和非外科住院医师之间的比例。
应答率为 58%（253/435）。与非外科住院医师相比，外科住院医师更频繁地观察到同事因错误而受到严厉对待（例如，受到羞辱或口头辱骂）（有时或经常，39%[66 例中的 26 例] vs 20%[187 例中的 37 例]；p=0.002）。与非外科住院医师相比，外科住院医师更有可能认为如果承认犯了医疗错误，他们将受到他人的严厉对待（35%[66 例中的 23 例] vs 12%[187 例中的 23 例]；p<0.001），并且认为在自己的机构处理医疗错误时必须妥协自己的价值观（11%[66 例中的 7 例] vs 2%[187 例中的 4 例]；p=0.008）。与非外科住院医师相比，外科住院医师更不可能自由地向团队的其他成员表达对患者护理中医疗错误的担忧（70%[66 例中的 46 例] vs 83%[187 例中的 115 例]；p=0.02）。
医疗保健团队的资深成员对错误的惩罚性反应可能会阻碍住院医师对错误的透明披露，这可能会不成比例地影响外科培训计划。
