LEARNING TO AVOID LEARNING: THE PARADOXES OF RESIDENCY TRAINING AROUND MEDICAL ERRORS.

Abstract

Academy of Management Annual Meeting Proceedings includes abstracts of all papers and symposia presented at the annual conference, plus 6-page abridged versions of the “Best Papers” accepted for inclusion in the program (approximately 10%). Papers published in the Proceedings are abridged because presenting papers at their full length could preclude subsequent journal publication. Please contact the author(s) directly for the full papers. ArticlesLEARNING TO AVOID LEARNING: THE PARADOXES OF RESIDENCY TRAINING AROUND MEDICAL ERRORS.TIMOTHY J. HOFFTIMOTHY J. HOFFPublished Online:13 Dec 2017https://doi.org/10.5465/ambpp.2004.13857704AboutSectionsPDF/EPUB ToolsDownload CitationsAdd to favoritesTrack Citations ShareShare onFacebookTwitterLinkedInRedditEmail AbstractErrors and safety are important issues in organizations. Within the health care industry, current debate around them stresses the need to create "learning cultures" to promote systems-thinking, error reporting, and develop more physician leaders in patient safety. Sociologically, medical residency is seen as the primary training and socialization point for physicians as professionals. Thus, the present study explores the reality and potential of the everyday medical residency work environment to function as a learning culture around mistakes and failure. Extended observations and interviews of attending and resident physicians working in surgical and medical intensive care unit settings revealed over 20 medical errors within each setting, most of which had few learning-oriented attitudes and behaviors associated with them. The study finds inherent paradoxes in the nature of how residents are trained presently that negatively affect the ability of the medical profession and hospitals to foster learning environments with respect medical errors. Through a competing value lens, the paradoxes are viewed as resulting from the need for residency programs to pursue a diverse array of effectiveness goals in order to turn residents into independently practicing physicians, above and beyond the singular focus on minimizing error. The findings highlight the difficulty of attempting to create and maintain "cultures of safety" in organizations which must respond to safety imperatives. They also point to a view of organizational safety management that involves developing reliable ways of simultaneously maintaining divergent cultural practices that allow pursuit of the widest range of effectiveness goals possible.FiguresReferencesRelatedDetails Vol. 2004, No. 1 Permissions Metrics in the past 12 months History Published online 13 December 2017 Published in print 1 August 2004 InformationCopyright of Academy of Management Journal is the property of Academy of Management and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder’s express written permission. However, users may print, download, or email articles for individual use.KeywordsMEDICAL errorsMEDICINE -- PracticeRESIDENTS (Medicine)MEDICAL careSAFETYORGANIZATIONAL learningPHYSICIAN & patientWORK environmentHOSPITALS -- ManagementLEARNINGDownload PDF