Pediatric Residents' Decision-Making Around Disclosing and Reporting Adverse Events: The Importance of Social Context

Coffey, Maitreya MD; Thomson, Kelly PhD; Tallett, Susan MBBS, MEd; Matlow, Anne MD, MSc

doi: 10.1097/ACM.0b013e3181f046a6
Medical Errors

Purpose: Although experts advise disclosing medical errors to patients, individual physicians' different levels of knowledge and comfort suggest a gap between recommendations and practice. This study explored pediatric residents' knowledge and attitudes about disclosure.

Method: In 2006, the authors of this single-center, mixed-methods study surveyed 64 pediatric residents at the University of Toronto and then held three focus groups with a total of 24 of those residents.

Results: Thirty-seven (58%) residents completed questionnaires. Most agreed that medical errors are one of the most serious problems in health care, that errors should be disclosed, and that disclosure would be difficult. When shown a scenario involving a medical error, over 90% correctly identified the error, but only 40% would definitely disclose it. Most would apologize, but far fewer would acknowledge harm if it occurred or use the word “mistake.” Most had witnessed or performed a disclosure, but only 40% reported receiving teaching on disclosure. Most reported experiencing negative effects of errors, including anxiety and reduced confidence. Data from the focus groups emphasized the extent to which residents consider contextual information when making decisions around disclosure. Themes included their or their team's degree of responsibility for the error versus others, quality of team relationships, training level, existence of social boundaries, and their position within a hierarchy.

Conclusions: These findings add to the understanding of facilitators and inhibitors of error disclosure and reporting. The influence of social context warrants further study and should be considered in medical curriculum design and hospital guideline implementation.

Dr. Coffey is assistant professor of pediatrics, Division of Paediatric Medicine and Centre for Patient Safety Faculty, University of Toronto, and staff pediatrician, Hospital for Sick Children, Toronto, Ontario, Canada.

Dr. Thomson is assistant professor, School of Administrative Studies, York University, Toronto, Ontario, Canada.

Dr. Tallett is professor of pediatrics, University of Toronto, and chief of education, SickKids Learning Institute, Hospital for Sick Children, Toronto, Ontario, Canada.

Dr. Matlow is professor of pediatrics, University of Toronto, medical director for patient safety, Hospital for Sick Children, and associate director, University of Toronto Center for Patient Safety, Toronto, Ontario, Canada.

Correspondence should be addressed to Dr. Coffey, Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8; telephone: (416) 813-7938; fax: (416) 813-5663; e-mail:

© 2010 Association of American Medical Colleges