Cited by 565Patient Safety and Medication ErrorsClinical Reasoning and Diagnostic SkillsInnovations in Medical Education

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Do House Officers Learn From Their Mistakes?

Wu, Albert W.·1991·JAMA: The Journal of the American Medical Association

DOI 10.1001/jama.1991.03460160067031

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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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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
DOI: 10.1001/jama.1991.03460160067031
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 › Medicine › Public Health, Environmental and Occupational Health › Patient Safety and Medication Errors
Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
Social Sciences › Education › 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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