榜样示范和医疗差错披露：一项针对受训者的全国性调查。

Role-modeling and medical error disclosure: a national survey of trainees.

机构信息

Dr. Martinez is assistant professor of medicine, Vanderbilt University School of Medicine, Nashville, Tennessee. Dr. Hickson is senior vice president for quality, safety, and risk prevention, assistant vice chancellor for health affairs, Joseph C. Ross Chair for Medical Education and Administration, and professor of pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee. Dr. Miller is senior associate dean for health sciences education and professor of medical education and administration, Vanderbilt University School of Medicine, Nashville, Tennessee. Dr. Doukas is William Ray Moore Endowed Chair of Family Medicine and Medical Humanism and professor of family and geriatric medicine, University of Louisville School of Medicine, Louisville, Kentucky. Dr. Buckley is associate professor of clinical medicine and vice chair for quality improvement and patient safety, Indiana University School of Medicine, Indianapolis, Indiana. Dr. Song is director of graduate studies, Center for Bioethics, and associate professor, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota. Dr. Sehgal is associate professor and associate chair for quality and safety, Department of Medicine, University of California at San Francisco, San Francisco, California. Ms. Deitz is managing director of evaluation, Office of Medical Education, Stanford University School of Medicine, Stanford, California. Dr. Braddock is professor of medicine, and vice dean for education, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California. Dr. Lehmann is director, Center for Bioethics, Brigham and Women's Hospital, and associate professor of medicine and medical ethics, Harvard Medical School, Boston, Massachusetts.

出版信息

Acad Med. 2014 Mar;89(3):482-9. doi: 10.1097/ACM.0000000000000156.

DOI:10.1097/ACM.0000000000000156

PMID:24448052

Abstract

PURPOSE

To measure trainees' exposure to negative and positive role-modeling for responding to medical errors and to examine the association between that exposure and trainees' attitudes and behaviors regarding error disclosure.

METHOD

Between May 2011 and June 2012, 435 residents at two large academic medical centers and 1,187 medical students from seven U.S. medical schools received anonymous, electronic questionnaires. The questionnaire asked respondents about (1) experiences with errors, (2) training for responding to errors, (3) behaviors related to error disclosure, (4) exposure to role-modeling for responding to errors, and (5) attitudes regarding disclosure. Using multivariate regression, the authors analyzed whether frequency of exposure to negative and positive role-modeling independently predicted two primary outcomes: (1) attitudes regarding disclosure and (2) nontransparent behavior in response to a harmful error.

RESULTS

The response rate was 55% (884/1,622). Training on how to respond to errors had the largest independent, positive effect on attitudes (standardized effect estimate, 0.32, P < .001); negative role-modeling had the largest independent, negative effect (standardized effect estimate, -0.26, P < .001). Positive role-modeling had a positive effect on attitudes (standardized effect estimate, 0.26, P < .001). Exposure to negative role-modeling was independently associated with an increased likelihood of trainees' nontransparent behavior in response to an error (OR 1.37, 95% CI 1.15-1.64; P < .001).

CONCLUSIONS

Exposure to role-modeling predicts trainees' attitudes and behavior regarding the disclosure of harmful errors. Negative role models may be a significant impediment to disclosure among trainees.

摘要

目的

衡量受训者在应对医疗失误方面的负面和正面榜样的接触程度，并研究这种接触与受训者在错误披露方面的态度和行为之间的关联。

方法

2011 年 5 月至 2012 年 6 月，来自两家大型学术医疗中心的 435 名住院医师和来自美国七所医学院的 1187 名医学生收到了匿名电子问卷。问卷询问了受访者有关以下方面的问题：（1）失误经历，（2）应对失误的培训，（3）与错误披露相关的行为，（4）应对失误的榜样暴露情况，以及（5）披露态度。作者使用多元回归分析方法，分析了负面和正面榜样的暴露频率是否独立预测两个主要结果：（1）披露态度，以及（2）对有害错误的非透明行为。

结果

回应率为 55%（884/1622）。关于如何应对错误的培训对态度有最大的独立正向影响（标准化效应估计值，0.32，P<.001）；负面榜样的影响最大（标准化效应估计值，-0.26，P<.001）。正面榜样对态度有正向影响（标准化效应估计值，0.26，P<.001）。接触负面榜样与受训者在错误回应中更有可能采取非透明行为有关（OR 1.37，95%CI 1.15-1.64；P<.001）。