Background:
Adverse events and medical errors have important implications for the physicians involved, who are often “second victims” affected by medical errors. Having committed an error is positively associated with subsequent distress and burnout and high levels of burnout correlate with increased self‐reported errors. The negative feelings associated with adverse events can also lead to reluctance to openly discuss errors, which can have implications for patient safety. However, there is currently little dedicated space in the curriculum for trainees to process the personal effects of adverse events they experience.
Purpose:
We incorporated a small group Adverse Event Reflection Session into a required rotation on quality improvement for internal medicine interns at the University of California San Francisco (UCSF). We anticipated that this intervention would facilitate processing of the emotional impact of medical errors and enhance well‐being for a majority of participating trainees.
Description:
The session consists of a small group facilitated by a faculty member during the intern quality rotation. After providing background information on errors, burnout, and the “second victim” phenomenon, the faculty member shares his or her own experience with a specific adverse event. Interns are then invited to share an adverse event that personally affected them, followed by a facilitated discussion of themes, coping strategies, and resources for further support. From October 2012‐March 2013, four groups of residents (16 total residents) participated in an adverse events reflection session and nearly all residents shared a personal experience during the session. Several common themes emerged, including the challenge of having limited power to make decisions, while feeling ultimately responsible as the physician writing the orders. Residents also felt that relative clinical inexperience led to uncertainty about whether to trust their instincts if differing from senior members of the team. Another theme was resident emphasis on the importance of support from other members of the team for promoting intern resilience and coping. Of 14 residents who returned surveys, nearly all residents rated the relevance of the session and contribution to personal well‐being as excellent to outstanding (7‐9) on 9 point scale, and a majority wished there were more sessions in the curriculum.
Conclusions:
Integration of well‐being innovations into the quality improvement curriculum is well‐received by residents, and was perceived to be a valuable experience by the vast majority of participants, especially in supporting personal well‐being. Common themes emerged that provide opportunities for anticipatory guidance for interns and training of senior residents and faculty, to further support unique challenges to intern well‐being. Further evaluation is needed to determine if such sessions impact resident burnout and well‐being long term
