Document Detail


Pediatric residents' decision-making around disclosing and reporting adverse events: the importance of social context.
MedLine Citation:
PMID:  20881681     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Maitreya Coffey; Kelly Thomson; Susan Tallett; Anne Matlow
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Academic medicine : journal of the Association of American Medical Colleges     Volume:  85     ISSN:  1938-808X     ISO Abbreviation:  Acad Med     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-30     Completed Date:  2010-10-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8904605     Medline TA:  Acad Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1619-25     Citation Subset:  AIM; IM    
Affiliation:
Division of Paediatric Medicine and Centre for Patient Safety Faculty, University of Toronto, Toronto, Ontario, Canada. trey.coffey@sickkids.ca
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MeSH Terms
Descriptor/Qualifier:
Adult
Decision Making*
Education, Medical, Graduate
Female
Focus Groups
Health Knowledge, Attitudes, Practice*
Humans
Internship and Residency*
Male
Medical Errors*
Pediatrics / education*
Questionnaires
Social Environment*
Social Responsibility
Truth Disclosure*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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