Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, University Hospital Basel, Basel, Switzerland
Education Development and Research, Maastricht University, Maastricht, The Netherlands.
BMJ Qual Saf. 2020 Sep;29(9):727-734. doi: 10.1136/bmjqs-2019-009808. Epub 2019 Nov 8.
Learning is in delicate balance with safety, as faculty supervisors try to foster trainee development while safeguarding patients. This balance is particularly challenging if trainees are allowed to experience the educational benefits of failure, acknowledged as a critical resource for developing competence and resilience. While other educational domains allow failure in service of learning, however, we do not know whether or not this strategy applies to clinical training.
We conducted individual interviews of clinical supervisors, asking them whether they allowed failure for educational purposes in clinical training and eliciting their experiences of this phenomenon. Participants' accounts were descriptively analysed for recurring themes.
Twelve women and seven men reported 48 specific examples of allowing trainee failure based on their judgement that educational value outweighed patient risk. Various kinds of failures were allowed: both during operations and technical procedures, in medication dosing, communication events, diagnostic procedures and patient management. Most participants perceived minimal consequences for patients, and many described their rescue strategies to prevent an allowed failure. Allowing failure under supervision was perceived to be important for supporting trainee development.
Clinical supervisors allow trainees to fail for educational benefit. In doing so, they attempt to balance patient safety and trainee learning. The educational strategy of allowing failure may appear alarming in the zero-error tolerant culture of healthcare with its commitment to patient safety. However, supervisors perceived this strategy to be invaluable. Viewing failure as inevitable, they wanted trainees to experience it in protected situations and to develop effective technical and emotional responses. More empirical research is required to excavate this tacit supervisory practice and support its appropriate use in workplace learning to ensure both learning and safety.
教师在培养学员的同时，需要兼顾安全，这使得学习与安全之间处于微妙的平衡状态，因为他们需要保护患者。如果允许学员从失败中获得教育收益，那么这种平衡就会变得极具挑战性，因为失败被认为是培养能力和韧性的关键资源。然而，虽然其他教育领域允许为了学习而失败，但我们并不知道这一策略是否适用于临床培训。
我们对临床导师进行了个人访谈，询问他们是否允许在临床培训中出于教育目的而允许失败，并引出他们对这种现象的经验。对参与者的描述性分析得出了反复出现的主题。
12 名女性和 7 名男性报告了 48 个具体案例，他们根据教育价值大于患者风险的判断，允许学员失败。允许各种类型的失败发生：包括手术和技术操作过程中、药物剂量、沟通事件、诊断程序和患者管理等方面。大多数参与者认为对患者的影响最小，许多人描述了他们的救援策略，以防止允许的失败。在监督下允许失败被认为对支持学员发展很重要。
临床导师允许学员因教育利益而失败。在这样做的过程中，他们试图平衡患者安全和学员学习。允许失败的教育策略在以患者安全为承诺的零错误容忍文化的医疗保健中可能看起来令人震惊。然而，导师们认为这种策略是非常宝贵的。他们将失败视为不可避免的情况，希望学员在受保护的情况下体验失败，并培养有效的技术和情感反应。需要进行更多的实证研究来挖掘这种隐性的监督实践，并支持其在工作场所学习中的适当使用，以确保学习和安全。
