Role-modeling and medical error disclosure: a national survey of trainees.
OBJECTIVE
To measure trainees' exposure to negative and positive role-modeling for responding to medical errors and to examine the association between that exposure and trainees' attitudes and behaviors regarding error disclosure.


METHODS
Between May 2011 and June 2012, 435 residents at two large academic medical centers and 1,187 medical students from seven U.S. medical schools received anonymous, electronic questionnaires. The questionnaire asked respondents about (1) experiences with errors, (2) training for responding to errors, (3) behaviors related to error disclosure, (4) exposure to role-modeling for responding to errors, and (5) attitudes regarding disclosure. Using multivariate regression, the authors analyzed whether frequency of exposure to negative and positive role-modeling independently predicted two primary outcomes: (1) attitudes regarding disclosure and (2) nontransparent behavior in response to a harmful error.


RESULTS
The response rate was 55% (884/1,622). Training on how to respond to errors had the largest independent, positive effect on attitudes (standardized effect estimate, 0.32, P < .001); negative role-modeling had the largest independent, negative effect (standardized effect estimate, -0.26, P < .001). Positive role-modeling had a positive effect on attitudes (standardized effect estimate, 0.26, P < .001). Exposure to negative role-modeling was independently associated with an increased likelihood of trainees' nontransparent behavior in response to an error (OR 1.37, 95% CI 1.15-1.64; P < .001).


CONCLUSIONS
Exposure to role-modeling predicts trainees' attitudes and behavior regarding the disclosure of harmful errors. Negative role models may be a significant impediment to disclosure among trainees.
Dr. Martinez is assistant professor of medicine, Vanderbilt University School of Medicine, Nashville, Tennessee. Dr. Hickson is senior vice president for quality, safety, and risk prevention, assistant vice chancellor for health affairs, Joseph C. Ross Chair for Medical Education and Administration, and professor of pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee. Dr. Miller is senior associate dean for health sciences education and professor of medical education and administration, Vanderbilt University School of Medicine, Nashville, Tennessee. Dr. Doukas is William Ray Moore Endowed Chair of Family Medicine and Medical Humanism and professor of family and geriatric medicine, University of Louisville School of Medicine, Louisville, Kentucky. Dr. Buckley is associate professor of clinical medicine and vice chair for quality improvement and patient safety, Indiana University School of Medicine, Indianapolis, Indiana. Dr. Song is director of graduate studies, Center for Bioethics, and associate professor, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota. Dr. Sehgal is associate professor and associate chair for quality and safety, Department of Medicine, University of California at San Francisco, San Francisco, California. Ms. Deitz is managing director of evaluation, Office of Medical Education, Stanford University School of Medicine, Stanford, California. Dr. Braddock is professor of medicine, and vice dean for education, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California. Dr. Lehmann is director, Center for Bioethics, Brigham and Women's Hospital, and associate professor of medicine and medical ethics, Harvard Medical School, Boston, Massachusetts.
William
W
Martinez
Gerald B
GB
Hickson
Bonnie M
BM
Miller
David J
DJ
Doukas
John D
JD
Buckley
John
J
Song
Niraj L
NL
Sehgal
Jennifer
J
Deitz
Clarence H
CH
Braddock
Lisa Soleymani
LS
Lehmann
D001291:Attitude of Health Personnel; D030881:Disclosure; D004501:Education, Medical / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data*; D008297:Male; D019300:Medical Errors; D015999:Multivariate Analysis; D010819:Physician's Role; D012044:Regression Analysis; D013337:Students, Medical / Q000523:psychology*; D011795:Surveys and Questionnaires