Teaching but not learning: how medical residency programs handle errors

Abstract

AbstractThis study examines how easily organizations with pluralistic missions enact those missions on an everyday basis. A teaching‐focused organization located in the health care industry is explored for its ability to also pursue a learning‐focused mission with respect to medical errors and patient safety. Extended observations and interviews were conducted of attending and resident physicians working in surgical and medical intensive care unit settings. The results suggest that the everyday work and social organization associated with residency programs fulfilling their core mission of creating competent clinicians leave little room for new or alternative routines, exchanges, and beliefs that would enhance resident learning around safety and error. This supports the idea, in need of further investigation, that multiple missions within an organization may be pursued jointly at the workplace level through a process whereby existing work and social organization effectively meeting one type of mission is used to help meet the goals of additional imperatives. Specifically, the findings highlight the difficulty of establishing new routines, beliefs, and exchanges to heighten organization learning capacity that are not derived from existing forms of behavior within the work environment. Copyright © 2006 John Wiley & Sons, Ltd.