Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen University, Rigshospitalet, Ryesgade 53B, DK-2100, Copenhagen, Denmark.
Department of Family Medicine, Health Sciences Education Program, McMaster University, Toronto, Canada.
Adv Health Sci Educ Theory Pract. 2022 Aug;27(3):761-792. doi: 10.1007/s10459-022-10091-0. Epub 2022 Feb 21.
The purpose of this scoping review was to explore how errors are conceptualized in medical education contexts by examining different error perspectives and practices. This review used a scoping methodology with a systematic search strategy to identify relevant studies, written in English, and published before January 2021. Four medical education journals (Medical Education, Advances in Health Science Education, Medical Teacher, and Academic Medicine) and four clinical journals (Journal of the American Medical Association, Journal of General Internal Medicine, Annals of Surgery, and British Medical Journal) were purposively selected. Data extraction was charted according to a data collection form. Of 1505 screened studies, 79 studies were included. Three overarching perspectives were identified: 'understanding errors') (n = 31), 'avoiding errors' (n = 25), 'learning from errors' (n = 23). Studies that aimed at'understanding errors' used qualitative methods (19/31, 61.3%) and took place in the clinical setting (19/31, 61.3%), whereas studies that aimed at 'avoiding errors' and 'learning from errors' used quantitative methods ('avoiding errors': 20/25, 80%, and 'learning from errors': 16/23, 69.6%, p = 0.007) and took place in pre-clinical (14/25, 56%) and simulated settings (10/23, 43.5%), respectively (p < 0.001). The three perspectives differed significantly in terms of inclusion of educational theory: 'Understanding errors' studies 16.1% (5/31),'avoiding errors' studies 48% (12/25), and 'learning from errors' studies 73.9% (17/23), p < 0.001. Errors in medical education and clinical practice are defined differently, which makes comparisons difficult. A uniform understanding is not necessarily a goal but improving transparency and clarity of how errors are currently conceptualized may improve our understanding of when, why, and how to use and learn from errors in the future.
本研究旨在通过考察不同的错误视角和实践，探讨医学教育背景下错误的概念化方式。本研究采用范围综述方法，制定了系统的检索策略，以识别发表于 2021 年 1 月之前的英文医学教育相关研究。选择了 4 本医学教育期刊（《医学教育》《高级健康科学教育进展》《医学教师》和《学术医学》）和 4 本临床期刊（《美国医学会杂志》《普通内科学杂志》《外科学年鉴》和《英国医学杂志》）进行了专门选择。根据数据收集表对数据提取进行图表记录。在 1505 篇筛选出的研究中，有 79 篇研究被纳入。确定了三个总体视角：“理解错误”（n=31）、“避免错误”（n=25）、“从错误中学习”（n=23）。旨在“理解错误”的研究使用了定性方法（31 篇中的 19 篇，61.3%），并在临床环境中进行（31 篇中的 19 篇，61.3%），而旨在“避免错误”和“从错误中学习”的研究则使用了定量方法（“避免错误”：25 篇中的 20 篇，80%；“从错误中学习”：23 篇中的 16 篇，69.6%，p=0.007），并在临床前（25 篇中的 14 篇，56%）和模拟环境中进行（23 篇中的 10 篇，43.5%）（p<0.001）。这三个视角在纳入教育理论方面存在显著差异：“理解错误”的研究为 16.1%（31 篇中的 5 篇），“避免错误”的研究为 48%（25 篇中的 12 篇），“从错误中学习”的研究为 73.9%（23 篇中的 17 篇），p<0.001。医学教育和临床实践中的错误定义不同，这使得比较变得困难。不一定需要达成统一的理解，但提高对当前错误概念化方式的透明度和清晰度，可能有助于我们理解未来何时、为何以及如何利用和从错误中学习。
