Adkins Sherry, Alta'any Rahaf, Brar Kewaljit, Kauser Humaira, Hughbanks Savannah, Rabah Kelly, Flowers Stacy
Rural Family Medicine Residency, Wright State University, Greenville, OH, USA.
School of Professional Psychology, Wright State University, Dayton, OH, USA.
J Med Educ Curric Dev. 2024 Aug 14;11:23821205241272358. doi: 10.1177/23821205241272358. eCollection 2024 Jan-Dec.
I am a healer, yet sometimes I do more harm than good…David Hilfiker, 1984.
Medical error is common and significantly impacts patients, physicians, learners, and public perception of the medical system; however, residents receive little formal training on this topic. Research on error response in practicing physicians is limited, and even more so on medical education interventions to improve this. This study evaluates a curriculum developed to foster the sharing of faculty medical error stories, practice of constructive coping strategies, and growth in resident confidence in managing error.
Researchers identified factors related to effective physician error management and recovery to develop a targeted intervention for family medicine residents. The intervention consisted of three one hour didactic sessions in a medium-sized midwestern, urban family medicine residency program over the course of 6 months. Instructional methods included guided reflection after mentor storytelling, small group discussion, role play, and self-reflection.
Of the 30 residents, 22 (73%) completed the preintervention survey, and 15 (50%) completed the postintervention survey. While most residents reported having experienced error (55%), fewer than half of the residents reported they knew what to do when faced with medical errors (46%). This increased to 93% after intervention. Personal error stories from mentors were the most desired type of training reported by residents preintervention, but this was surpassed by legal and malpractice concerns in the postintervention survey. Rates of reported error story sharing increased after the intervention. Residents reported self-efficacy (I can be honest about errors) and self-awareness (I acknowledge when I am at increased risk for error) also increased with intervention. However, these changes did not reach statistical significance.
Family medicine residents are receptive to learning from peers and mentors about error management and recovery. A brief intervention can impact the culture around disclosure and support. Future research should focus on the impact of targeted interventions on patient-oriented outcomes related to medical error.
我是一名治疗者，但有时我造成的伤害大于益处……大卫·希尔菲克，1984年。
医疗差错很常见，且对患者、医生、学习者以及公众对医疗系统的认知有重大影响；然而，住院医师在这个主题上接受的正规培训很少。关于执业医生差错应对的研究有限，而关于改善这一情况的医学教育干预的研究更是如此。本研究评估了一个旨在促进教员分享医疗差错故事、实践建设性应对策略以及增强住院医师处理差错信心的课程。
研究人员确定了与有效的医生差错管理和恢复相关的因素，以制定针对家庭医学住院医师的针对性干预措施。该干预包括在中西部一个中等规模城市的家庭医学住院医师培训项目中，在6个月的时间里进行三次一小时的理论课程。教学方法包括在导师讲述故事后进行引导性反思、小组讨论、角色扮演和自我反思。
30名住院医师中，22名（73%）完成了干预前调查，15名（50%）完成了干预后调查。虽然大多数住院医师报告经历过差错（55%），但不到一半的住院医师报告说他们知道面对医疗差错时该怎么做（46%）。干预后这一比例增至93%。干预前，住院医师报告最希望得到的培训类型是导师的个人差错故事，但在干预后调查中，这被法律和医疗事故问题超越。干预后，报告的差错故事分享率有所提高。住院医师报告说，自我效能感（我可以对差错保持诚实）和自我意识（当我处于差错风险增加时我能意识到）也随着干预而增强。然而，这些变化没有达到统计学意义。
家庭医学住院医师愿意向同行和导师学习差错管理和恢复方法。一次简短的干预可以影响围绕披露和支持的文化。未来的研究应关注针对性干预对与医疗差错相关的以患者为导向的结果的影响。
