L. Shepherd is associate professor, Department of Medicine, Division of Emergency Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; ORCID: https://orcid.org/0000-0001-9551-4546. K.A. LaDonna is assistant professor, Departments of Innovation in Medical Education and Medicine, University of Ottawa, Ottawa, Ontario, Canada. S.M. Cristancho is assistant professor, Department of Surgery and Faculty of Education, and scientist, Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada. S. Chahine is assistant professor, Department of Medicine and Faculty of Education, and scientist, Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; ORCID: https://orcid.org/0000-0003-0488-773X.
Acad Med. 2019 Aug;94(8):1157-1163. doi: 10.1097/ACM.0000000000002752.
Error is inevitable in medicine, given its inherent uncertainty and complexity. Errors can teach powerful lessons; however, because of physicians' self-imposed silence and the intricacies of responsibility and blame, learning from medical error has been underexplored. The purpose of this study was to understand how physicians perceived learning from medical errors by exploring the tension between responsibility and blame and factors that affected physicians' learning.
Nineteen physicians participated in semistructured interviews, conducted in 2016-2017 at Western University in Canada, that probed their experiences in learning from medical errors. Data collection and analysis were conducted iteratively, with themes identified through constant comparative analysis.
Participants felt personal responsibility and blame for their errors. Residency produced particularly salient memories of errors. Participants identified interconnecting cultural factors (normalizing error, peer support and mentorship, formal rounds) and individual factors (emotional response, confidence and experience), which either helped or hindered their perceived learning.
Learning from medical error requires navigation through blame and responsibility. The keen responsibility felt by physicians must be acknowledged when enacting a system-based approach to medical error. Adopting a learning culture perspective suggests opportunities to enable and disable features of the learning environment to optimize learning from error as residents learn to become the most responsible physician for all outcomes. A better understanding of the factors that shape learning from error can help make the transition from error to learning more explicit, thereby increasing the opportunity to learn and teach from errors that permeate the practice of medicine.
由于医学固有的不确定性和复杂性，医学中难免会出现错误。错误可以带来深刻的教训；然而，由于医生的自我缄默以及责任和归咎的复杂性，从医疗差错中学习的情况并未得到充分探索。本研究的目的是通过探讨责任和归咎之间的紧张关系以及影响医生学习的因素，了解医生如何看待从医疗差错中学习。
19 名医生参加了 2016 年至 2017 年在加拿大西安大略大学进行的半结构化访谈，探讨他们从医疗差错中学习的经验。通过不断比较分析确定主题，对数据进行了反复收集和分析。
参与者对自己的错误感到个人的责任和归咎。住院医师阶段产生了特别明显的差错记忆。参与者确定了相互关联的文化因素（将错误正常化、同伴支持和指导、正式查房）和个人因素（情绪反应、信心和经验），这些因素或有助于或阻碍他们的感知学习。
从医疗差错中学习需要在归咎和责任之间进行权衡。在实施基于系统的医疗差错处理方法时，必须承认医生所感受到的强烈责任感。采用学习文化的观点表明，有机会启用和禁用学习环境的功能，以优化学习者在成为对所有结果负责的医生过程中从错误中学习的能力。更好地理解影响从错误中学习的因素，可以帮助使从错误中学习的转变更加明确，从而增加从贯穿医学实践的错误中学习和教学的机会。
