1. 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
2. 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
3. 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
4.
5.
6. 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
7. 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
8. References
Wu AW, Folkman S, McPhee SJ, Lo B. Do house officers learn from their
mistakes? JAMA, 1991, 265:2089-2094.
