Medical errors during training: how do residents cope?: a descriptive study

Abstract

Abstract Background Physicians’ self-perceived medical errors lead to substantial emotional distress, which has been termed the “second victim phenomenon.” Medical errors during residency are associated with increased burnout and depression. It is important to know how residents cope with self-perceived medical errors and how they gain personal and emotional support in order to develop effective interventions. Objective To assess the impact of self-perceived medical errors on residents’ well-being, the range of coping strategies during training, and the extent of personal and institutional support. Methods An online cross-sectional survey was administered via email in October 2018 to 286 residents across all specialties in a 548-bed single urban academic medical center. The survey covered three domains focusing on residents’ most serious self-perceived medical error: (1) emotional response, (2) coping strategies using the BRIEF COPE Inventory, and (3) personal and institutional support. Results 109/286 residents from various specialties responded. Internal Medicine, Pediatrics and Emergency Medicine constituting 80 % of respondents. Self-perceived medical errors during residency were widespread (95 %). One in five medical errors was classified as moderate to severe. Most residents acknowledged a sense of guilt, remorse and/or inadequacy. Use of maladaptive coping strategies was high. Open-ended responses pointed to fear of retaliation, judgement, shame and retribution. Most residents disclosed their error to a senior resident but did not discuss it with the patient’s family. Only 32 % of residents participated in a debriefing session. Conclusions Most residents were directly involved in medical errors, which affected their emotional well-being. The use of maladaptive coping strategies was high. Residents’ fear of consequences prevented disclosure and discussion of self-perceived medical errors. This information is relevant to implement targeted interventions.

Keywords

• Medical errors
• Patient safety
• Burnout
• Resident wellness
• Coping strategies
• Depression