title: The influence of the causes and contexts of medical errors on emergency medicine residents' responses to their errors: an exploration.
abstract: OBJECTIVE
  To determine emergency medicine residents' emotional and behavioral responses to their medical errors and examine associations between residents' responses to medical error and perceptions of their training.
  
  
  METHODS
  In 2003, 55 residents at two U.S. residency programs were asked to complete questionnaires about their errors and responses to their errors in three domains: emotional response, learning behavior, and disclosure. The questions were a mixture of free text, yes/no responses, and some were rated using a five-point Likert scale. Based on a conceptual framework, the authors constructed scales to describe the various domains and associations between the residents' responses to medical error and perceptions of their training were examined using Somers' D.
  
  
  RESULTS
  A total of 43 residents returned questionnaires (80%); 40 of these residents described errors. Thirty-three (83%) residents discussed the error with someone; 27 (71%) with the attending and 10 (28%) with the patient/family. Negative emotions were common: 27 (68%) felt remorse, 21 (53%) guilt, 23 (58%) inadequacy, and 22 (55%) frustration. Residents' negative emotional responses were associated with their personal characteristics [26% (95% CI, 5-47%) association with lack of experience] and residents' perceptions of their training environment: 15% association with job overload (95% CI, -8-38%) and 23% association with lack of institutional support (95% CI, 5-41%). While 32 (81%) residents increased attention to detail, only 2 (5%) increased their use of evidence-based medicine.
  
  
  CONCLUSIONS
  Errors committed by emergency medicine residents often resulted in negative emotions, limited constructive system-based improvements, and inadequate disclosure. Negative perceptions of the training environment are associated with negative emotional responses.
authors.affiliation: Department of Emergency Medicine, School of Medicine, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC 27599, USA. hobgood@med.unc.edu
authors.forename: Cherri
authors.initials: C
authors.lastname: Hobgood
authors.forename: Armando
authors.initials: A
authors.lastname: Hevia
authors.forename: Joshua H
authors.initials: JH
authors.lastname: Tamayo-Sarver
authors.forename: Bryan
authors.initials: B
authors.lastname: Weiner
authors.forename: Ralph
authors.initials: R
authors.lastname: Riviello
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D015984:Causality; D003142:Communication; D030881:Disclosure; D004635:Emergency Medicine / Q000193:education*; D004636:Emergency Service, Hospital / Q000592:standards*; D004644:Emotions; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D007858:Learning; D008297:Male; D019300:Medical Errors / Q000517:prevention & control* / Q000523:psychology; D009341:Negativism; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014481:United States; D000078329:Workforce