571 - Learning from Mistakes: Pediatric Residents’ Attitudes Toward and Responses to Peer Errors

Poster Number: 571
Publication Number: 571.116

Chloë E. Nunneley, Boston Children's Hospital/Harvard Medical School, Boston, MA, United States; Beth Harper, Boston Children's Hospital, Boston, MA, United States; Elizabeth Pingree, Harvard Medical School and Boston Children's Hospital, Boston, MA, United States; Carolyn Marcus, Boston Children's Hospital, Boston, MA, United States

Background: Physicians tend to feel personally responsible and want to receive feedback on errors. Feedback can result in increased error reporting and individual behavior change. However, errors may be detected by other medical professionals, leaving one unaware of their involvement and vulnerable to repeating the same mistake.

Objective: We aimed to assess pediatric residents’ attitudes toward and responses to errors made by their peers and determine if these are related to characteristics of errors, individuals, or program culture. We also sought to identify the barriers and facilitators to notifying peers of errors.

Design/Methods: We developed an anonymous survey that included hypothetical scenarios in which a resident makes a cognitive error. Respondents were asked to rate the importance of their peer being aware of the error on a 5-point Likert scale, as well as identify actions they would take if they discovered the error. Respondents answered the same questions imagining they had made the error themselves. Errors associated with no (near-miss), minor, or moderate harm to patients were included. Demographic questions and a validated psychological safety scale were included. The survey was distributed to 4 pediatric residency programs of varying size and geographic location.

Results: The survey was completed by 244/350 residents (70%, Table 1). Respondents reported that it was very important for residents to be notified of their errors (mean 4.4/5, SD 0.78), which increased with error severity (p < 0.001, Table 1) and when errors reached patients (p < 0.001). Respondents reported increased efforts to notify peers as error severity increased (p < 0.001, Table 2) and if errors reached patients (p < 0.001). Responses did not differ by PGY, gender, or psychological safety ratings (Tables 2 and 3). Respondents tended to rate the importance of notification higher when they committed an error and wanted their peers to take greater effort to notify them.
 
Facilitators of notification included perceiving an error as a learning opportunity and a resident’s own desire to be notified. Barriers included being unsure an error occurred, resident unavailability, and an error being a near-miss.Conclusion(s): Pediatric residents tend to believe it is very important to be notified of errors, particularly when errors are increasingly severe. As near-misses comprise the majority of errors and are the most psychologically safe mistakes from which to learn, residency programs should consider utilizing near-misses as teaching opportunities and normalizing the discussion of these errors to facilitate individual and system learning.
HMS cv - CENunneley.pdf
Importance of Peer Notification