Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA.
Indiana University School of Medicine, Indianapolis, IN, USA.
J Gen Intern Med. 2021 May;36(5):1352-1358. doi: 10.1007/s11606-020-06263-6. Epub 2020 Oct 6.
Apologies may play a significant role in medical care, especially in the context of patient safety, medical error disclosure, and malpractice. Studies have shown that when state laws, institutional policies, and individual skills align-including the ability to offer a sincere apology-patients and families benefit. However, little is known about how, and under what conditions, physicians offer apologies in day-to-day care. Even less is known about what medical students learn about apologies from observing their superiors in these settings.
Characterize third-year medical students' experiences of observing and engaging in apologies.
Qualitative descriptive analysis of student professionalism narratives.
Third-year medical students at Indiana University School of Medicine.
A search of 7,384 unique narratives yielded 238 with apologies. A rubric based on four key elements of genuine apologies ((1) acknowledgement, (2) explanation, (3) regret/remorse, and (4) reparation) was used to classify the kind of apology offered. Apology completeness, impact, and timing were also coded.
Seventeen percent of all apologies were complete (i.e., contained all four elements). Over 40% were coded as incomplete or "non-apology" apologies (i.e., those with only the first two elements). A significant relationship between apology completeness and positive student experience was found. Most apologies were offered by the attending physician or resident to patients and family members. Students were generally positive about their experiences, but one in five were coded as negative. Some students were distressed enough to offer apologies on behalf of the faculty. Apology timing did not make a significant difference in terms of student experience.
Few education programs target apologies in the context of routine practice. With little formal instruction, students may rely on adopting what their seniors do. Faculty have an important role to play in modeling the apology process when harms-both great and small-occur.
道歉在医疗保健中可能发挥重要作用，尤其是在患者安全、医疗错误披露和医疗事故的背景下。研究表明，当州法律、机构政策和个人技能一致时——包括提供真诚道歉的能力——患者和家属将受益。然而，人们对医生在日常护理中如何道歉以及在什么条件下道歉知之甚少。对于医学生在这些环境中通过观察上级学习道歉了解多少，知之甚少。
描述三年级医学生观察和参与道歉的经历。
对学生职业道德叙事的定性描述性分析。
印第安纳大学医学院的三年级医学生。
对 7384 条独特叙事进行搜索，得到 238 条包含道歉的叙事。使用真诚道歉的四个关键要素（（1）承认，（2）解释，（3）遗憾/悔恨，和（4）赔偿）的分类准则来对道歉的种类进行分类。还对道歉的完整性、影响和时机进行了编码。
所有道歉中有 17%是完整的（即包含所有四个要素）。超过 40%的道歉被归类为不完整或“非道歉”（即只包含前两个要素）。发现道歉的完整性与积极的学生体验之间存在显著关系。大多数道歉是主治医生或住院医师向患者和家属提出的。学生们普遍对自己的经历持积极态度，但有五分之一的学生表示消极。一些学生感到非常不安，以至于代表教师提出道歉。道歉的时机在学生体验方面没有显著差异。
很少有教育项目针对常规实践中的道歉。由于缺乏正式的指导，学生可能依赖于模仿上级的做法。在发生重大和微小伤害时，教师在道歉过程中发挥着重要作用。
