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How Medical Error Shapes Physicians’ Perceptions of Learning

An Exploratory Study

Shepherd, Lisa MD, MHPE; LaDonna, Kori A. PhD; Cristancho, Sayra M. PhD; Chahine, Saad PhD

doi: 10.1097/ACM.0000000000002752
Research Reports
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Purpose Error is inevitable in medicine, given its inherent uncertainty and complexity. Errors can teach powerful lessons; however, because of physicians’ self-imposed silence and the intricacies of responsibility and blame, learning from medical error has been underexplored. The purpose of this study was to understand how physicians perceived learning from medical errors by exploring the tension between responsibility and blame and factors that affected physicians’ learning.

Method Nineteen physicians participated in semistructured interviews, conducted in 2016–2017 at Western University in Canada, that probed their experiences in learning from medical errors. Data collection and analysis were conducted iteratively, with themes identified through constant comparative analysis.

Results Participants felt personal responsibility and blame for their errors. Residency produced particularly salient memories of errors. Participants identified interconnecting cultural factors (normalizing error, peer support and mentorship, formal rounds) and individual factors (emotional response, confidence and experience), which either helped or hindered their perceived learning.

Conclusions Learning from medical error requires navigation through blame and responsibility. The keen responsibility felt by physicians must be acknowledged when enacting a system-based approach to medical error. Adopting a learning culture perspective suggests opportunities to enable and disable features of the learning environment to optimize learning from error as residents learn to become the most responsible physician for all outcomes. A better understanding of the factors that shape learning from error can help make the transition from error to learning more explicit, thereby increasing the opportunity to learn and teach from errors that permeate the practice of medicine.

L. Shepherd is associate professor, Department of Medicine, Division of Emergency Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; ORCID: https://orcid.org/0000-0001-9551-4546.

K.A. LaDonna is assistant professor, Departments of Innovation in Medical Education and Medicine, University of Ottawa, Ottawa, Ontario, Canada.

S.M. Cristancho is assistant professor, Department of Surgery and Faculty of Education, and scientist, Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.

S. Chahine is assistant professor, Department of Medicine and Faculty of Education, and scientist, Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; ORCID: https://orcid.org/0000-0003-0488-773X.

Funding/Support: This work was supported by a Faculty Support for Research in Education grant from the Schulich School of Medicine and Dentistry at Western University, London, Ontario, Canada, and by a grant from the Division of Emergency Medicine, Department of Medicine, Schulich School of Medicine and Dentistry.

Other disclosures: None reported.

Ethical approval: Ethics approval was obtained by the Western University Research Ethics Board, October 1, 2015 (107064).

Previous presentations: An earlier iteration of this manuscript was presented at the Canadian Conference on Medical Education (CCME), April 28–May 1, 2018, Halifax, Nova Scotia, Canada.

Correspondence should be addressed to Lisa Shepherd, Centre for Education Research and Innovation, Health Sciences Addition Room 110, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada, N6A 5C1; email: lshepher@uwo.ca.

© 2019 by the Association of American Medical Colleges