Medical Error: Using Storytelling and Reflection to Impact Error Response Factors in Family Medicine Residents

Overview

Journal J Med Educ Curric Dev

Publisher Sage Publications

Specialty Medical Education

Date 2024 Aug 16

PMID 39149530

Authors

Sherry Adkins

Rahaf Altaany

Kewaljit Brar

Humaira Kauser

Savannah Hughbanks

Kelly Rabah

Stacy Flowers

Affiliations

Soon will be listed here.

Abstract

Objectives: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

References

Penson R, Svendsen S, Chabner B, Lynch Jr T, Levinson W . Medical mistakes: a workshop on personal perspectives. Oncologist. 2001; 6(1):92-9. DOI: 10.1634/theoncologist.6-1-92. View

Lewis J, Rosen C, Grossestreuer A, Ullman E, Dubosh N . Diagnostic error, quality assurance, and medical malpractice/risk management education in emergency medicine residency training programs. Diagnosis (Berl). 2019; 6(2):173-178. DOI: 10.1515/dx-2018-0079. View

Sukalich S, Elliott J, Ruffner G . Teaching medical error disclosure to residents using patient-centered simulation training. Acad Med. 2013; 89(1):136-43. DOI: 10.1097/ACM.0000000000000046. View

White A, Gallagher T, Krauss M, Garbutt J, Waterman A, Dunagan W . The attitudes and experiences of trainees regarding disclosing medical errors to patients. Acad Med. 2008; 83(3):250-6. DOI: 10.1097/ACM.0b013e3181636e96. View

Goldberg R, Kuhn G, Andrew L, Thomas Jr H . Coping with medical mistakes and errors in judgment. Ann Emerg Med. 2002; 39(3):287-92. DOI: 10.1067/mem.2002.121995. View

Perez B, Knych S, Weaver S, Liberman A, Abel E, Oetjen D . Understanding the barriers to physician error reporting and disclosure: a systemic approach to a systemic problem. J Patient Saf. 2014; 10(1):45-51. DOI: 10.1097/PTS.0b013e31829e4b68. View

Bell S, Moorman D, Delbanco T . Improving the patient, family, and clinician experience after harmful events: the "when things go wrong" curriculum. Acad Med. 2010; 85(6):1010-7. DOI: 10.1097/ACM.0b013e3181dbedd7. View

Christmas C, Ziegelstein R . The seventh competency. Teach Learn Med. 2009; 21(2):159-62. DOI: 10.1080/10401330902791362. View

Gallagher T, Waterman A, Ebers A, Fraser V, Levinson W . Patients' and physicians' attitudes regarding the disclosure of medical errors. JAMA. 2003; 289(8):1001-7. DOI: 10.1001/jama.289.8.1001. View

10.

Harrison R, Johnson J, McMullan R, Pervaz-Iqbal M, Chitkara U, Mears S . Toward Constructive Change After Making a Medical Error: Recovery From Situations of Error Theory as a Psychosocial Model for Clinician Recovery. J Patient Saf. 2022; 18(6):587-604. PMC: 9422758. DOI: 10.1097/PTS.0000000000001038. View

11.

Kim C, Park K, Eo E . Education program on medical error disclosure for emergency medicine residents using standardized patients. Korean J Med Educ. 2022; 34(1):1-16. PMC: 8906923. DOI: 10.3946/kjme.2022.215. View

12.

Ream M, Albert D, Lash T, Verbeck N, Weisleder P . Improving Child Neurology Residents' Communication Skills Through Objective Structured Clinical Exams. MedEdPORTAL. 2021; 17:11120. PMC: 7970633. DOI: 10.15766/mep_2374-8265.11120. View

13.

Rabow M, Remen R, Parmelee D, Inui T . Professional formation: extending medicine's lineage of service into the next century. Acad Med. 2010; 85(2):310-7. DOI: 10.1097/ACM.0b013e3181c887f7. View

14.

Makary M, Daniel M . Medical error-the third leading cause of death in the US. BMJ. 2016; 353:i2139. DOI: 10.1136/bmj.i2139. View

15.

Engel K, Rosenthal M, Sutcliffe K . Residents' responses to medical error: coping, learning, and change. Acad Med. 2005; 81(1):86-93. DOI: 10.1097/00001888-200601000-00021. View

16.

Kaldjian L, Jones E, Rosenthal G, Tripp-Reimer T, Hillis S . An empirically derived taxonomy of factors affecting physicians' willingness to disclose medical errors. J Gen Intern Med. 2006; 21(9):942-8. PMC: 1831592. DOI: 10.1111/j.1525-1497.2006.00489.x. View

17.

Ottosen M, Sedlock E, Aigbe A, Bell S, Gallagher T, Thomas E . Long-Term Impacts Faced by Patients and Families After Harmful Healthcare Events. J Patient Saf. 2018; 17(8):e1145-e1151. PMC: 6050155. DOI: 10.1097/PTS.0000000000000451. View

18.

Kusnoor A, Gill A, Hatfield C, Ordonez N, Stritto R, Landrum P . An Interprofessional Standardized Patient Case for Improving Collaboration, Shared Accountability, and Respect in Team-Based Family Discussions. MedEdPORTAL. 2019; 15:10791. PMC: 6354797. DOI: 10.15766/mep_2374-8265.10791. View

19.

Langlois M, Hallam J . Integrating multiple health behavior theories into program planning: the PER worksheet. Health Promot Pract. 2008; 11(2):282-8. DOI: 10.1177/1524839908317668. View

20.

Aaron M, Webb A, Luhanga U . A Narrative Review of Strategies to Increase Patient Safety Event Reporting by Residents. J Grad Med Educ. 2020; 12(4):415-424. PMC: 7450743. DOI: 10.4300/JGME-D-19-00649.1. View