Do House Officers Learn From Their Mistakes?
Abstract
Mistakes are inevitable in medicine. To learn how medical mistakes relate to subsequent changes in practice, we surveyed 254 internal medicine house officers. One hundred fourteen house officers (45%) completed an anonymous questionnaire describing their most significant mistake and their response to it. Mistakes included errors in diagnosis (33%), prescribing (29%), evaluation (21%), and communication (5%) and procedural complications (11%). Patients had serious adverse outcomes in 90% of the cases, including death in 31% of cases. Only 54% of house officers discussed the mistake with their attending physicians, and only 24% told the patients or families. House officers who accepted responsibility for the mistake and discussed it were more likely to report constructive changes in practice. Residents were less likely to make constructive changes if they attributed the mistake to job overload. They were more likely to report defensive changes if they felt the institution was judgmental. Decreasing the work load and closer supervision may help prevent mistakes. To promote learning, faculty should encourage house officers to accept responsibility and to discuss their mistakes.
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Diagnostic errors appear to be burdensome in the training environment.
“Such errors also appear to be burdensome in the training environment.4–6”
From Reducing Diagnostic Errors through Effective Communication: Harnessing the Power of Information Technology (2008) · cites this paper as [6]
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Sleep Deprivation, Physician Performance, and Patient Safety
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- Authors
- Wu, A. W.
- Affiliations
- University of California, San Francisco (US)
- Corresponding author
- Wu, Albert W.
- ORCID
- Wu, Albert W.
- Venue
- JAMA: The Journal of the American Medical Association
- Publisher
- American Medical Association (AMA)
- Published
- 1991-04-24
- Volume
- 265
- Issue
- 16
- Pages
- 2089
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2150756606
- Cited by
- 565
- References
- 26
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 3 · 2023: 13 · 2022: 13 · 2021: 12 · 2020: 14 · 2019: 13 · 2018: 14 · 2017: 18 · 2016: 13 · 2015: 9 · 2014: 23 · 2013: 25 · 2012: 32
- FWCI
- 19.64
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (MH 42459, P50MH042459)
- Topics
- Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
- Keywords
- medical errors, learning from mistakes, medical residents, internal medicine residents, error reporting, patient disclosure, acceptance of responsibility, work overload, workload, supervision, adverse clinical outcomes, diagnostic errors, prescribing errors
- MeSH terms
- Analysis of Variance, Clinical Competence, Decision Making, Diagnostic Errors, Hospitals, Teaching, Humans, Internal Medicine, Internship and Residency, Learning, Practice Patterns, Physicians', Drug Prescriptions, Surveys and Questionnaires, Disclosure
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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