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BACKGROUND: Medical errors are frequently encountered by trainees but there is currently no standard curriculum for educating residents about medical errors. Morning report is a case-based peer-facilitated conference in which residents learn concepts in general internal medicine. We used our standard Chief Resident facilitated morning report to enhance resident learning about medical errors. PURPOSE: Evaluate house staff experiences with medical errors and to facilitate resident discussion, understating and reporting of medical errors using a morning report format. DESCRIPTION: Our Quality Chief Resident designed and led a 50-minute morning report by selecting 3 cases of medical errors that had occurred recently on the teaching service: (1) a missed diagnosis that did not result in harm, (2) a delay in initiation of antibiotic therapy due to prolonged administrative approvals, and (3) discovery of a previously unrecognized error by a colleague when the patient was transferred to another service. For each instance, relevant clinical aspects of the case were presented, followed by resident-lead small group discussions about the seriousness of the error, reporting obligations, patient disclosure, and provider emotions. A more formal discussion was then led by the Quality Chief and an attending hospitalist that included the following principles of patient safety and just culture: differentiating adverse events from medical error; harm and near miss; reporting obligations; ethics of disclosure; and the concept of second victim. 17/19 residents and 4/5 faculty attendees completed a voluntary anonymous survey at the end of the session. 88% of residents reported being involved in patient care when an error had occurred and 50% involved in an error with serious patient harm. 75% of residents had experienced emotional distress and 71% reported feelings of guilt related to patient errors. Only 47% reported any previous education about medical errors. Respondents self-reported confidence in reporting errors rose from 31% before the session to 77% reported after the conference. 88% of respondents found the session useful or very useful, and 93% recommended continuing these sessions in the future. CONCLUSIONS: Residents commonly encounter patient care errors which frequently result in feelings of emotional distress and guilt. A peer-led case-based morning report improved resident confidence in error reporting and was felt to be useful to surveyed attendees.'


Presented at Society of Hospital Medicine, 03/30/2015, National Harbor, MD.