Department of Anaesthesiology, Klinikum der Universität München, Munich, Germany.
Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, Limburg, The Netherlands.
BMJ Open. 2018 Mar 14;8(3):e019500. doi: 10.1136/bmjopen-2017-019500.
In undergraduate medical education, the topics of errors in medicine and patient safety are under-represented. The aim of this study was to explore undergraduate medical students' behavioural intentions when confronted with an error.
A qualitative case vignette survey was conducted including one of six randomly distributed case scenarios in which a hypothetical but realistic medical error occurred. The six scenarios differed regarding (1) who caused the error, (2) the presence of witnesses and (3) the consequences of the error for the patient. Participants were asked: 'What would you do?". Answers were collected as written free texts and analysed according to qualitative content analysis.
Students from German medical schools participated anonymously through an online questionnaire tool.
Altogether, n=159 students answered a case scenario. Participants were on average 24.6 years old (SD=7.9) and 69% were female. They were undergraduate medical students in their first or second year (n=27), third, fourth or fifth year (n=107) or final year (n=21).
During the inductive coding process, 19 categories emerged from the original data and were clustered into four themes: (1) considering communication; (2) considering reporting; (3) considering consequences; and (4) emotional responsiveness. When the student him/herself caused the error in the scenario, participants did mention communication with colleagues and taking preventive action less frequently than if someone else had caused the error. When a witness was present, participants more frequently mentioned disclosure of the error and taking actions than in the absence of a witness. When the outcome was significant to the patient, participants more often showed an emotional response than if there were no consequences.
The study highlights the importance of coping strategies for healthcare professionals to adequately deal with errors. Educators need to introduce knowledge and skills on how to deal with errors and emotional preparedness for errors into undergraduate medical education.
在本科医学教育中，医学错误和患者安全相关主题的涉及较少。本研究旨在探讨医学生面对错误时的行为意向。
采用定性病例情景调查，包括随机分布的 6 个病例情景中的 1 个，其中发生了一个假设但现实的医疗错误。这 6 个情景在以下方面存在差异：（1）谁导致了错误，（2）是否有目击者，（3）错误对患者的后果。要求参与者回答：“你会怎么做？”。答案作为书面自由文本收集，并根据定性内容分析进行分析。
德国医学院校的学生通过在线问卷工具匿名参与。
共有 159 名学生回答了一个病例情景。参与者平均年龄为 24.6 岁（标准差=7.9），69%为女性。他们是本科医学一年级或二年级学生（n=27）、三年级、四年级或五年级学生（n=107）或五年级学生（n=21）。
在归纳编码过程中，从原始数据中出现了 19 个类别，并被聚类为四个主题：（1）考虑沟通；（2）考虑报告；（3）考虑后果；和（4）情绪反应。当学生本人在情景中导致错误时，与他人导致错误相比，参与者较少提到与同事沟通和采取预防措施。当有目击者在场时，参与者比没有目击者时更频繁地提到披露错误和采取行动。当结果对患者有重大影响时，参与者比没有后果时更经常表现出情绪反应。
本研究强调了应对策略对医疗保健专业人员正确处理错误的重要性。教育者需要在本科医学教育中引入关于如何处理错误和对错误的情绪准备的知识和技能。
