Female residents experiencing medical errors in general internal medicine: a qualitative study

Abstract

BackgroundDoctors, especially doctors-in-training such as residents, make errors. They have to face the consequences even though today’s approach to errors emphasizes systemic factors. Doctors’ individual characteristics play a role in how medical errors are experienced and dealt with. The role of gender has previously been examined in a few quantitative studies that have yielded conflicting results. In the present study, we sought to qualitatively explore the experience of female residents with respect to medical errors. In particular, we explored the coping mechanisms displayed after an error. This study took place in the internal medicine department of a Swiss university hospital.MethodsWithin a phenomenological framework, semi-structured interviews were conducted with eight female residents in general internal medicine. All interviews were audiotaped, fully transcribed, and thereafter analyzed.ResultsSeven main themes emerged from the interviews: (1) A perception that there is an insufficient culture of safety and error; (2) The perceived main causes of errors, which included fatigue, work overload, inadequate level of competences in relation to assigned tasks, and dysfunctional communication; (3) Negative feelings in response to errors, which included different forms of psychological distress; (4) Variable attitudes of the hierarchy toward residents involved in an error; (5) Talking about the error, as the core coping mechanism; (6) Defensive and constructive attitudes toward one’s own errors; and (7) Gender-specific experiences in relation to errors. Such experiences consisted in (a) perceptions that male residents were more confident and therefore less affected by errors than their female counterparts and (b) perceptions that sexist attitudes among male supervisors can occur and worsen an already painful experience.ConclusionsThis study offers an in-depth account of how female residents specifically experience and cope with medical errors. Our interviews with female residents convey the sense that gender possibly influences the experience with errors, including the kind of coping mechanisms displayed. However, we acknowledge that the lack of a direct comparison between female and male participants represents a limitation while aiming to explore the role of gender.

Psychological responses, coping and supporting needs of healthcare professionals as second victims

“…In line with this, a qualitative study reported mitigation of responsibility, normalizing the incident, and blaming the system as defensive attitudes (Mankaka et al. ). To cope with the ordeal, rationalizing was also used (Pinto et al.…”

“…Three studies agreed that female healthcare workers experienced greater intensity of emotions than male healthcare workers (Mankaka et al. ; McLennan et al. ; Mira et al.…”

“…Of the three, the qualitative study only interviewed female residents, limiting the reliability of this claim as a direct comparison between genders is not permitted (Mankaka et al. ).…”

“…AEs provoke insecurity, thus, a sense of guilt is presented in response to unfavourable patient outcomes and ruminations about possibly having prevented the AE (Bowers et al 2006;Engel et al 2006). Several qualitative studies identified guilt as one of the most common emotional responses (Engel et al 2006;Mankaka et al 2014;Schelbred & Nord 2007;Ullstr€ om et al 2014). This appeared consistent across quantitative studies which recorded 10.1-58.8% prevalence of guilt (Hobgood et al 2005;Karga et al 2011;Mira et al 2015;O'Beirne et al 2012).…”

“…Several studies identified that second victims experienced feelings of frustration or anger or both directed at patient, themselves, or the work environment (Engel et al 2006;Hobgood et al 2005;Karga et al 2011;Mankaka et al 2014;O'Beirne et al 2012;Ullstr€ om et al 2014). Hobgood et al (2005) explained that these negative emotions were related to job-related dissatisfaction for instance unsupportive institution, inadequate training and educational factors.…”