Department of Health Research Methods, Evidence & Impact, Health Research Methodology PhD Program, McMaster University, Hamilton, Ontario, Canada.
Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.
J Eval Clin Pract. 2021 Apr;27(2):236-245. doi: 10.1111/jep.13531. Epub 2021 Jan 5.
RATIONALE, AIMS, AND OBJECTIVES: The complexity of healthcare systems makes errors unavoidable. To strengthen the dialogue around how physicians experience and share medical errors, the objective of this study was to understand how generalist physicians make meaning of and grow from their medical errors.
This study used a narrative inquiry approach to conduct and analyse in-depth interviews from 26 physicians from the generalist specialties of emergency, internal, and family medicine. We gathered stories via individual interview, analysed them for key components, and rewrote a "meta-story" in a chronological sequence. We conceptualized the findings into a metaphor to draw similarities, learn from, and apply new principles from other fields of practice.
Through analysis we interpreted the story of a physician who is required to make numerous decisions in a short period of time in different clinical environments among the patient's family and whilst abiding by existing rules and regulations. Through sharing stories of success and failure, the clinical supervisor can help optimize the physician's emotional growth and professional development. Similarly, through sharing and learning from stories, colleagues and trainees can also contribute to the growth of the protagonist's character and the development of clinic, hospital, and healthcare system.
We draw parallels between the clinical setting and a generalist physician's experiences of a medical error with the environment and practices within professional sports. Using this comparison, we discuss the potential for meaningful coaching in medical education.
背景、目的和目标：医疗体系的复杂性使得错误难以避免。为了加强关于医生如何体验和分享医疗错误的对话，本研究的目的是了解全科医生如何理解和从他们的医疗错误中成长。
本研究采用叙事探究方法，对来自急诊、内科和家庭医学等普通科专业的 26 名医生进行了深入访谈和分析。我们通过个人访谈收集故事，对关键内容进行分析，并按照时间顺序重新编写“元故事”。我们将研究结果概念化为一个隐喻，以汲取其他实践领域的相似之处、经验和应用新原则。
通过分析，我们解读了一位医生的故事，他需要在不同的临床环境中，在患者的家庭中，在遵守现有规则和规定的情况下，在短时间内做出许多决策。通过分享成功和失败的故事，临床主管可以帮助优化医生的情感成长和专业发展。同样，通过分享和学习故事，同事和学员也可以为主角的性格成长和诊所、医院和医疗保健系统的发展做出贡献。
我们将临床环境与全科医生在医疗错误方面的经验与专业体育环境和实践进行了类比。通过这种比较，我们讨论了在医学教育中进行有意义的辅导的潜力。
