Learning not to take it seriously: junior doctors’ accounts of error

Abstract

We aimed to investigate experiences of, and responses to, medical error amongst junior doctors and to examine the challenges junior doctors face and the support they receive. We carried out a qualitative study of 38 randomly selected pre-registration house officers (PRHOs) in 10 hospitals. All 38 had graduated in 2000 or 2001 from a single medical school. Errors were common and sometimes serious. In relation to disclosure and learning from error, four main themes emerged: a norm of selective disclosure; the effects of the team; individualised blame and responsibility, and the 'learning moment'. Trainees reported disclosing errors informally, particularly when teams were seen as supportive, but were reluctant to criticize colleagues. Formal reports and disclosure to patients were very rare. Patient care was compromised when juniors did not access senior help, often when working outside their usual team environment. Lack of cooperation between teams and poor continuity of care also contributed to errors. Learning was maximised when errors were formally discussed and constructive feedback offered. However, both blame and the prioritization of reassurance over learning and structured feedback appeared to inhibit reflection on the experience of error. Junior doctors need help to reflect on their experiences and to recognise where they may have made mistakes, particularly in the contexts of shift-work and fragmented teams. Formal reporting systems alone will not facilitate learning from error. Juniors require individual clinical supervision from seniors with appropriate training. Such expertise may benefit the whole team and the training environment.