title: Factors associated with disclosure of medical errors by housestaff.
abstract: OBJECTIVE
  Attributes of the organisational culture of residency training programmes may impact patient safety. Training environments are complex, composed of clinical teams, residency programmes, and clinical units. We examined the relationship between residents' perceptions of their training environment and disclosure of or apology for their worst error.
  
  
  METHODS
  Anonymous, self-administered surveys were distributed to Medicine and Surgery residents at Boston Medical Center in 2005. Surveys asked residents to describe their worst medical error, and to answer selected questions from validated surveys measuring elements of working environments that promote learning from error. Subscales measured the microenvironments of the clinical team, residency programme, and clinical unit. Univariate and bivariate statistical analyses examined relationships between trainee characteristics, their perceived learning environment(s), and their responses to the error.
  
  
  RESULTS
  Out of 109 surveys distributed to residents, 99 surveys were returned (91% overall response rate), two incomplete surveys were excluded, leaving 97: 61% internal medicine, 39% surgery, 59% male residents. While 31% reported apologising for the situation associated with the error, only 17% reported disclosing the error to patients and/or family. More male residents disclosed the error than female residents (p=0.04). Surgery residents scored higher on the subscales of safety culture pertaining to the residency programme (p=0.02) and managerial commitment to safety (p=0.05). Our Medical Culture Summary score was positively associated with disclosure (p=0.04) and apology (p=0.05).
  
  
  CONCLUSIONS
  Factors in the learning environments of residents are associated with responses to medical errors. Organisational safety culture can be measured, and used to evaluate environmental attributes of clinical training that are associated with disclosure of, and apology for, medical error.
authors.affiliation: Boston University Medical Center, 801 Massachusetts Ave, Suite 470, Boston, MA 02118, USA. andrea.kronman@bmc.org
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Kronman
authors.forename: Michael
authors.initials: M
authors.lastname: Paasche-Orlow
authors.forename: Jay D
authors.initials: JD
authors.lastname: Orlander
mesh_terms: D000046:Academic Medical Centers; D001900:Boston; D002983:Clinical Competence; D030881:Disclosure / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D019300:Medical Errors / Q000523:psychology* / Q000706:statistics & numerical data; D008503:Medical Staff / Q000523:psychology* / Q000706:statistics & numerical data; D008511:Medicine; D015279:Organizational Culture; D061214:Patient Safety; D010817:Physician-Patient Relations; D060891:Root Cause Analysis; D017678:Sex Distribution; D011795:Surveys and Questionnaires