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Factors associated with disclosure of medical errors by housestaff
  1. Andrea C Kronman1,2,
  2. Michael Paasche-Orlow1,
  3. Jay D Orlander1,3
  1. 1Section of General Internal Medicine, Evans Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
  2. 2Women's Health Interdisciplinary Research Center, Boston University School of Medicine, Boston, Massachusetts, USA
  3. 3Medical Service, VA Boston Healthcare System, Boston, Massachusetts, USA
  1. Correspondence to Dr Andrea C Kronman, Boston University Medical Center, 801 Massachusetts Ave, Suite 470, Boston, MA 02118, USA; andrea.kronman{at}


Purpose Attributes of the organisational culture of residency training programmes may impact patient safety. Training environments are complex, composed of clinical teams, residency programmes, and clinical units. We examined the relationship between residents' perceptions of their training environment and disclosure of or apology for their worst error.

Method Anonymous, self-administered surveys were distributed to Medicine and Surgery residents at Boston Medical Center in 2005. Surveys asked residents to describe their worst medical error, and to answer selected questions from validated surveys measuring elements of working environments that promote learning from error. Subscales measured the microenvironments of the clinical team, residency programme, and clinical unit. Univariate and bivariate statistical analyses examined relationships between trainee characteristics, their perceived learning environment(s), and their responses to the error.

Results Out of 109 surveys distributed to residents, 99 surveys were returned (91% overall response rate), two incomplete surveys were excluded, leaving 97: 61% internal medicine, 39% surgery, 59% male residents. While 31% reported apologising for the situation associated with the error, only 17% reported disclosing the error to patients and/or family. More male residents disclosed the error than female residents (p=0.04). Surgery residents scored higher on the subscales of safety culture pertaining to the residency programme (p=0.02) and managerial commitment to safety (p=0.05). Our Medical Culture Summary score was positively associated with disclosure (p=0.04) and apology (p=0.05).

Conclusion Factors in the learning environments of residents are associated with responses to medical errors. Organisational safety culture can be measured, and used to evaluate environmental attributes of clinical training that are associated with disclosure of, and apology for, medical error.

  • Medical error
  • medical education
  • organisational behaviour
  • programme evaluation
  • survey research
  • Women's health
  • Human error

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  • Funding This work was supported by an American Cancer Society Physician Training Award in Preventive Medicine (PT APM 97 185 04, Jane Liebshutz, Principal Investigator) and a Boston University Medical Center Risk Management Grant (Andrea Kronman, Principal Investigator).

  • Competing interests None.

  • Ethics approval Boston University Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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