title: Learning from mistakes. Factors that influence how students and residents learn from medical errors.
abstract: BACKGROUND
  Trainees are exposed to medical errors throughout medical school and residency. Little is known about what facilitates and limits learning from these experiences.
  
  
  OBJECTIVE
  To identify major factors and areas of tension in trainees' learning from medical errors.
  
  
  METHODS
  Structured telephone interviews with 59 trainees (medical students and residents) from 1 academic medical center. Five authors reviewed transcripts of audiotaped interviews using content analysis.
  
  
  RESULTS
  Trainees were aware that medical errors occur from early in medical school. Many had an intense emotional response to the idea of committing errors in patient care. Students and residents noted variation and conflict in institutional recommendations and individual actions. Many expressed role confusion regarding whether and how to initiate discussion after errors occurred. Some noted the conflict between reporting errors to seniors who were responsible for their evaluation. Learners requested more open discussion of actual errors and faculty disclosure. No students or residents felt that they learned better from near misses than from actual errors, and many believed that they learned the most when harm was caused.
  
  
  CONCLUSIONS
  Trainees are aware of medical errors, but remaining tensions may limit learning. Institutions can immediately address variability in faculty response and local culture by disseminating clear, accessible algorithms to guide behavior when errors occur. Educators should develop longitudinal curricula that integrate actual cases and faculty disclosure. Future multi-institutional work should focus on identified themes such as teaching and learning in emotionally charged situations, learning from errors and near misses and balance between individual and systems responsibility.
authors.affiliation: Department of Internal Medicine, Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA 01655, USA. fischerm@ummhc.org
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Fischer
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Mazor
authors.forename: Joann
authors.initials: J
authors.lastname: Baril
authors.forename: Eric
authors.initials: E
authors.lastname: Alper
authors.forename: Deborah
authors.initials: D
authors.lastname: DeMarco
authors.forename: Michele
authors.initials: M
authors.lastname: Pugnaire
mesh_terms: D001291:Attitude of Health Personnel; D003479:Curriculum; D004504:Education, Medical, Undergraduate / Q000379:methods; D004644:Emotions; D013502:General Surgery / Q000193:education; D006801:Humans; D007388:Internal Medicine / Q000193:education; D007396:Internship and Residency; D007858:Learning; D019300:Medical Errors / Q000523:psychology*; D013337:Students, Medical / Q000523:psychology*; D013663:Teaching