title: Medical errors; causes, consequences, emotional response and resulting behavioral change.
abstract: OBJECTIVE
  To determine the causes of medical errors, the emotional and behavioral response of pediatric medicine residents to their medical errors and to determine their behavior change affecting their future training.
  
  
  METHODS
  One hundred thirty postgraduate residents were included in the study. Residents were asked to complete questionnaire about their errors and responses to their errors in three domains: emotional response, learning behavior and disclosure of the error. The names of the participants were kept confidential. Data was analyzed using SPSS version 20.
  
  
  RESULTS
  A total of 130 residents were included. Majority 128(98.5%) of these described some form of error. Serious errors that occurred were 24(19%), 63(48%) minor, 24(19%) near misses,2(2%) never encountered an error and 17(12%) did not mention type of error but mentioned causes and consequences. Only 73(57%) residents disclosed medical errors to their senior physician but disclosure to patient's family was negligible 15(11%). Fatigue due to long duty hours 85(65%), inadequate experience 66(52%), inadequate supervision 58(48%) and complex case 58(45%) were common causes of medical errors. Negative emotions were common and were significantly associated with lack of knowledge (p=0.001), missing warning signs (p=<0.001), not seeking advice (p=0.003) and procedural complications (p=0.001). Medical errors had significant impact on resident's behavior; 119(93%) residents became more careful, increased advice seeking from seniors 109(86%) and 109(86%) started paying more attention to details. Intrinsic causes of errors were significantly associated with increased information seeking behavior and vigilance (p=0.003) and (p=0.01) respectively.
  
  
  CONCLUSIONS
  Medical errors committed by residents have inadequate disclosure to senior physicians and result in negative emotions but there was positive change in their behavior, which resulted in improvement in their future training and patient care.
authors.affiliation: Dr. Attia Bari, MBBS, DCH, MCPS, FCPS. Associate Professor of Pediatric Medicine, Department of Pediatric Medicine, The Children's Hospital and The Institute of Child Health, Lahore, Pakistan.
authors.forename: Attia
authors.initials: A
authors.lastname: Bari
authors.affiliation: Rehan Ahmed Khan, MBBS, FCPS, FRCS, JM-HPE, MSc HPE. Associate Professor of Surgery, Islamic International Medical College, Riphah University, Pakistan.
authors.forename: Rehan Ahmed
authors.initials: RA
authors.lastname: Khan
authors.affiliation: Ahsan Waheed Rathore, MBBS, DCH, MRCP, MRCPCH, FRCP. Professor of Pediatric Medicine, Department of Pediatric Medicine, The Children's Hospital and The Institute of Child Health, Lahore, Pakistan.
authors.forename: Ahsan Waheed
authors.initials: AW
authors.lastname: Rathore
keywords: Emotional response; Error disclosure; Medical errors