Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Medical Education and the Institute for Medical Humanities, Inje University College of Medicine, Busan, Korea.
Med Educ Online. 2022 Dec;27(1):2011604. doi: 10.1080/10872981.2021.2011604.
Although there are frequent complaints of medical students' incompetence in reporting errors, few studies have examined their error-reporting abilities in the real world.
Three sub-functions of self-regulation theory were used to evaluate medical students' ability to identify errors (self-monitoring), analyse root causes (self-judgment), and devise improvement plans (self-reactions). In addition, whether students reacted differently to their errors and those of others (three sub-functions) was also examined.
A total of 952 patient safety reports were reviewed retrospectively, submitted by third-year medical students between 2016 and 2018. Data were quantitatively and qualitatively analysed to investigate who committed the error, to identify the type of error and its root causes, and to find suggested improvement plans. Chi-square and Fisher's exact tests were used to compare students' responses to error origins.
Students reported other errors more frequently than their own (67.6% vs. 32.4%). They reported common critical medical errors, including errors related to engaging with patients (34.5%), invasive procedures (20.2%), and infection (18.5%). The root causes identified were more precise than the improvement plans by the students (75.5% vs. 18.4%, respectively). The students' improvement plans were not practical, especially at the patient level (25.8%). When students committed errors, they considered human factors such as fatigue, scheduling, and training as the most common root cause, focussing on improvement plans at the individual level.
The results suggest that students were good at self-judgment, but not at self-monitoring and self-reactions. They reacted differently, based on who committed the error. To enhance self-regulated learning, Educators should encourage students to confront their errors, reflect on their self-reactions towards errors, develop well-being with time management, and think about the meaning of patient-centredness. Finally, active participation in clinical clerkship longitudinally may provide students with opportunities to learn from their errors.
尽管经常有医学生在报告错误方面能力不足的抱怨，但很少有研究检查他们在现实世界中的错误报告能力。
本研究运用自我调节理论的三个子功能来评估医学生识别错误的能力（自我监控）、分析根本原因（自我判断）和制定改进计划（自我反应）。此外，还检查了学生对自己和他人错误的反应是否不同（三个子功能）。
回顾性分析了 2016 年至 2018 年期间三年级医学生提交的 952 份患者安全报告。通过定量和定性分析来调查错误发生的原因，确定错误类型及其根本原因，并找到建议的改进计划。使用卡方检验和 Fisher 确切概率法比较学生对错误来源的反应。
学生报告他人的错误比自己的错误更频繁（67.6%比 32.4%）。他们报告了常见的严重医疗错误，包括与患者互动（34.5%）、有创性操作（20.2%）和感染（18.5%）相关的错误。学生确定的根本原因比他们制定的改进计划更准确（分别为 75.5%和 18.4%）。学生的改进计划不切实际，尤其是在患者层面（25.8%）。当学生犯错时，他们认为疲劳、排班和培训等人为因素是最常见的根本原因，专注于个人层面的改进计划。
结果表明，学生善于自我判断，但不善于自我监控和自我反应。他们根据错误发生的情况做出不同的反应。为了增强自我调节学习，教育者应该鼓励学生面对自己的错误，反思自己对错误的反应，培养与时间管理相关的幸福感，并思考以患者为中心的意义。最后，通过在临床实习中进行积极的参与，为学生提供从错误中学习的机会。
