Table 2

Summary characteristics of the reviewed studies

Investigator(s)	Date	Location	Theoretical underpinning	Main focus	Sample and setting	Design	Outcomes	Type of error
Aasland and Forde, R.	2005	Europe (Norway)	None explicitly stated. Based on ‘defensive’ and ‘authoritarian’ medical culture influencing openness about medical errors.	How many and what kinds of doctors have experienced medical errors leading to serious patient injury? How does this influence their life and how do they feel about accepting criticism?	1318 doctors Various specialities	Quantitative Cross-sectional Postal questionnaires	Self-report Immediate impact	Adverse events leading to serious patient injury
Arndt	1994	Europe (Germany, England and Scotland)	Methodological framework of interpretative research design using discourse analysis.	How do nurses feel when they make, discover or are involved in an error? What decisions do they have to make and how does this influence their life?	32 ward sisters or senior nurses (samples of 6-12 for each data source) Hospital	Qualitative Cross-sectional Unstructured interviews, focus groups, written reports and case proceedings.	Self-report Immediate impact.	All medication errors.
Christensen et al	1992	USA (Oregon)	None explicitly stated. Based on prior literature suggesting that mistakes may affect the physician particularly in those associated with serious patient harm.	To explore recollections and feelings about physicians' mistakes	11 general internists and medical subspecialists Hospital	Qualitative interview Cross-sectional Semistructured interviews	Self-report Immediate impact	All perceived medical mistakes
Crigger and Meek	2007	USA	Methodological framework—grounded theory approach	To explore the psychosocial process when nurses perceive they have made a mistake and reconciliation of self-esteem and professional image after this	10 nurses Hospital	Qualitative Cross-sectional Semistructured interviews and free text responses to statements	Self-report Immediate impact	All mistakes in hospital-based practice
Cunningham	2004	New Zealand	None explicitly stated. Based on proposition that increasing levels of complaints will impact practice	To assess the impact of receiving a medical complaint on doctors	221 doctors General practice and hospitals	Quantitative Cross-sectional Questionnaire	Self-report Immediate impact	Medical error where a patient complaint was received.
Engel et al	2006	USA	None explicitly stated. Based on prior findings to suggest that making an error can have a significant impact on health professionals.	To explore the emotional challenges faced by resident physicians in the event of medical mishaps.	26 resident physicians Hospital	Qualitative interview Cross-sectional Semistructured interviews.	Self-report Immediate impact.	All near misses and adverse events.
Fischer et al	2006		None explicitly stated. Based on recommendations by oversight organisations such as the Joint Committee of the Group on Resident Affairs and Organisation of Residents Representatives that addressing medical error should be incorporated in medical training.	To identify factors and tensions in trainees learning from medical errors	59 trainee medical students and residents Hospital	Qualitative interview Cross-sectional Semistructured telephone interviews	Self-report Immediate impact	All medical errors
Fisseni et al	2007	Europe (Germany)	None explicitly stated. Based on growing research around the development of an open culture regarding treatment errors	To gain an insight into the most serious errors GP's can recall and the factors that influence their recollection	32 General Practitioners General practice	Quantitative Cross-sectional Semistructured questionnaire	Self-report Immediate impact	Most serious medical errors recalled
Gallagher	2003	USA (St Louis)	None explicitly stated. Based on inevitability of medical errors and the need to understand how best to disclose	To determine patients and physicians view about disclosure of errors	52 patients and 46 physicians Various specialities	Qualitative Cross-sectional Focus group discussions	Self-report Immediate impact	All medical errors
Hobgood et al	2005	USA	Conceptual framework –context, personal beliefs, characteristics, experiences, culture and attributions influence responses and can lead to constructive or defensive behaviour change	To determine how emergency residents respond emotionally and behaviourally to errors and how this is linked to their training experiences	43 emergency medicine residents Hospital	Quantitative Cross-sectional Questionnaire	Self-report Immediate impact	All medical errors
Kaldijiann et al	2008	USA	None explicitly stated. Based on the need for training programmes to provide opportunities to discuss errors	To explore physician's attitudes and practices around discussion of error with colleagues	338 faculty and resident physicians Hospital	Quantitative Cross-sectional Questionnaire	Self-report Immediate impact	All medical errors
Kroll et al	2008	(Europe) UK	None explicitly stated. Based on the lack of literature currently available exploring the experiences of junior doctors	To investigate experiences of, and responses to, medical error among junior doctors, and the challenges and support they receive	38 preregistration house officers Hospital	Qualitative interview Cross-sectional Semistructured interviews	Self-report Immediate impact	All medical errors
Lander et al	2006	USA	None explicitly stated. Based on the increasing likelihood of error due to increased complexity of medical care and need to learn how this affects health professionals.	To describe oto-laryngologists' responses to errors and how they implement changes as a result	210 oto-laryngologists Hospital	Quantitative Cross-sectional Questionnaire (based on classification system developed by Shah et al, 2004)	Self-report Immediate impact	All medical errors
Martinez and Lo	2008	USA	None explicitly stated. Based on lack of information relating to student's experiences of error.	To examine student's experiences with medical errors.	147 medical students in 4th year Hospital	Qualitative Cross-sectional Written essays.	Self-report Immediate impact.	All medical errors.
Meurier et al	1998	Europe (UK)	Attribution theory—whether an internal or external attribution is made influences the subsequent response to an error.	To explore causal attributions made by nurses about errors and how this differs dependent on severity of the error	60 NHS nurses Various specialities	Quantitative Cross-sectional Questionnaire	Self-report Immediate impact	All medical errors
Mizrahi	1984	USA	None explicitly stated. Based on lack of literature regarding physician ideology and behaviour toward error.	To explore how internists in training acquire perceptions of mistakes and how they define and defend these mistakes	290 internal medicine house officers Hospital	3-year longitudinal Cross-sectional elements Observation, semistructured interviews and questionnaire	Observation and self-report Immediate and longer-term impact	All medical errors
Muller and Ornstein	2007	USA	None explicitly stated. Based on previous findings relating to the impact of error on doctors.	To understand how trainees define errors and what factors influence their perception of these.	423 medical students and house staff Hospital	Quantitative Cross-sectional Questionnaire	Self-report Immediate impact	All medical errors
Newman	1996	USA (Philadelphia)	None explicitly stated. Based on editorial comments describing physician's anguish caused by making error.	To explore the emotional impact of family physician's most memorable mistake	30 physicians Hospital	Qualitative Cross-sectional Semistructured interviews	Self-report Immediate impact	Most memorable medical mistake
Scott et al	2009	USA (Missouri)	Exploratory work not theoretically driven. Based on investigations through The Office of Clinical Effectiveness (OCE) raising awareness of professional's suffering as a result of a patient event.	To explore the experiences and recovery trajectory of second victims with regard to the impact of a clinical event	31 health professionals 10 physicians, 11 registered nurses, 10 other health professionals	Qualitative Cross-sectional Semistructured interview	Self-report Immediate, ongoing and future impact	All types of clinical events that impacted the health professional
Schelbred and Nord	2007	Europe (Norway)	None explicitly stated. Based on prior literature describing the negative impact of medication errors on nurses.	To describe the experiences of nurses after making a serious medication error	10 Nurses Various specialities	Qualitative interview Cross-sectional Semistructured interviews	Self-report Immediate impact	Serious medication errors
Waterman et al	2007	Canada	None explicitly stated. Based on prior literature demonstrating the potential for involvement in medical error to compound job-related stress and the need for larger samples to be evaluated.	To understand how practising physicians are personally affected by errors	3171 physicians Various specialities	Quantitative Cross-sectional Questionnaire	Self-report Immediate impact	All medical errors
West et al	2006	USA	None explicitly stated. Based on prior literature describing distress in association with making medical errors and the need to identify the magnitude and direction of these links.	To identify the frequency of self-perceived errors and links with quality of life, burnout, depression and empathy	184 internal medicine residents Hospital	Prospective 3-year longitudinal Questionnaire (QoL scales, Maslach Burnout Inventory, depression screening, Interpersonal Reactivity Scale)	Self-report Immediate and longer-term impact	Self-perceived medical errors
Wolf et al	2000	USA	Hughes (1950) ‘mistakes at work’ theory that mistakes are common in all occupations and committed by the most and least proficient individuals.12	To examine responses and concerns of health professionals about making medication errors and estimated patient harm as a result	402 health professionals—208 nurses, 112 pharmacists and 82 physicians Various specialities	Mixed methods Cross-sectional Questionnaire	Self-report Immediate impact	All medication errors
Wu et al	2003	USA	None explicitly stated. Based on evidence to show that making an error be a powerful experience and the need to identify the impact on learning.	To learn how making medical mistakes results in subsequent changes in practice	114 house officers Hospital	Quantitative Cross-sectional Questionnaire (inc. Folkman and Lazarus ‘Ways of Coping’ scale)	Self-report Immediate impact	Most significant medical mistake