Teaching and medical errors: primary care preceptors' views.

PURPOSE: To assess primary care preceptors' perceptions of the issues involved in teaching when medical errors occur. In particular, we examined preceptors' responses to trainees involved in medical errors, factors influencing their response, and their perceptions of barriers to teaching from medical errors.
METHODS: A total of 38 primary care preceptors participated in 7 focus groups on teaching and medical errors. Participants were drawn from medical schools throughout the northeastern USA. Content analysis of transcripts identified major themes.
RESULTS: We developed a framework describing how preceptors and learners respond to medical errors, the factors that influence these responses, and the relationships between these. We also identified barriers to teaching from medical errors. Preceptors are especially sensitive to learners' distress as a result of errors. Emotional distress and self-doubt are seen as inimical to learning, possibly causing more attention to be directed to emotional support than to correction and instruction. At the same time, accepting responsibility for errors was seen as prerequisite to learning. For many preceptors, vivid recollections of their own errors during training were influential in determining how they in turn responded as preceptors; none reported having received training in this area.
CONCLUSION: This study describes preceptors' experiences of responding to trainees' medical errors, and identifies barriers to teaching from errors. The intersection of patient safety and medical education is a critical area for future research. We propose a framework that may help guide future research efforts, which should focus on identifying factors that promote faculty development to optimise learning and reduce the likelihood of future errors.