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Patient Safety Stories: A Project Utilizing Narratives in Resident Training

Cox, LeeAnn M. MD; Logio, Lia S. MD

Academic Medicine:
doi: 10.1097/ACM.0b013e318230efaa
Quality and Safety

Incident reports have traditionally been the vehicle for identifying, assessing, and responding to quality gaps in hospitals. Yet because of a variety of barriers, residents often fail to participate in this formal process. The authors created a project to engage residents in incident reporting through the use of an online, anonymous narrative format, faculty-facilitated discussion groups, and involvement of patient safety officers in the educational process. During three months, 36 residents submitted a total of 79 stories about patient care that did not “go as intended.” The authors reviewed and scored each story for contributing factors and outcomes. The residents met monthly in small groups with trained faculty facilitators to analyze the stories, which were also shared with the patient safety officers. The stories, narratives of both personal involvement and observed events, ranged from near-misses to sentinel events. Key contributing factors included lapses of professionalism, decision errors, communication/information mishaps, transition mix-ups, and workload difficulties. The narrative format proved a feasible tool for collecting significant, previously unrecognized patient safety issues. Internal medicine residents were willing to discuss gaps in care when given the tools and opportunity for anonymous storytelling and blame-free dialogue.

Author Information

Dr. Cox is assistant professor of clinical medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.

Dr. Logio is professor of medicine, Department of Medicine, Weill Cornell Medical College, New York, New York.

Correspondence should be addressed to Dr. Cox, 1001 West Tenth Street, OPW M200, Indianapolis, IN 46202; telephone: (317) 656-4260; fax: (317) 630-2667; e-mail:

First published online September 26, 2011

© 2011 Association of American Medical Colleges