Clinical Research and Pharmacovigilance Program

Do House Officers Learn

from their Mistakes? Wu AW, Folkman S, McPhee SJ, Lo B.

Adam Kwan, B.Sc

Amjad Atrash, B.Sc Pharmacy

Lia Alderete, B.Sc MLT

Valentyna Burbelo, B. and M. in Pharmaceutical Sciences

AAPS, Canada

2016

Research Program Director: Peivand Pirouzi

Methods

A cross-sectional survey of physicians was conducted using free text and fixed

response questions to determine why medical mistakes occur

Setting: Three large academic medical centers

Population: House officers in residency training programs in internal medicine

Of all house officers contacted (254), 114 responded (45%)

All respondents reported at least one mistake

Study developed a survey to be mailed out to house officers and mailed back

once completed

Package included pen and a self-addressed postage paid return envelope

Response postcards included section to indicate that either the survey had been

returned or that recipient wished not to be bothered by further contact

Results: Key Findings

Serious adverse outcome in 90% of cases, death in 31%

Also includes physical discomfort, emotional distress, additional therapy, additional procedures and prolonged hospital stay

Serious adverse outcomes resulting from errors in diagnosis (33%), prescribing (29%), evaluation (21%), communication (5%), procedural complications (11%)

54% of respondents had discussed the mistake with a supervising physician

Only 24% had told the patients or families

A number of responses to mistakes by house officers identified:

Remorse

Fear and/or anger

Guilt

Isolation

Feelings of inadequacy

Results: Changes in Practice

Constructive changes were more likely in house officers who accepted

responsibility and discussed it

Most frequently reported changes were paying more attention to detail (82%),

confirming clinical data personally (72%), and seeking advice (62%)

Constructive changes were less likely if they attributed the mistake to job

overload

Defensive changes were more likely if house officer felt the institution was

judgmental

Conclusion: Main Points

Physicians in training frequently experience mistakes that harm patients

Supervising physicians and patients are often not told about mistakes

Overwork and judgmental attitudes by hospitals discourage learning

Educators should encourage house officers to accept responsibility and to discuss

their mistakes

Doctors are encouraged to discuss diagnosis and treatment with patients and

to empower the patient to take part in the decision-making process so

patients are better informed and more likely to question treatment and

outcomes with their doctor

References

Wu AW, Folkman S, McPhee SJ, Lo B. Do house officers learn from their

mistakes? JAMA, 1991, 265:2089-2094.