The association between attendings’ feedback and residents’ reporting of near-misses

Abstract

Objective Accreditation Council for Graduate Medical Education’s Clinical Learning Environment Review report suggests that residents in clinical learning environments underreport their near-misses, an indicator of patient safety. Furthermore, when the residents report these events, they receive little feedback from their attendings. Although, various studies emphasize the importance of feedback given to the residents, the association between feedback and patient safety has not been explored. This study was conducted in 28 emergency medicine residents in a level 1 trauma center. A recent study in the same cohort found that residents’ stress biomarker levels and patient acuity were positively related to their near-misses reports. The current study hypothesizes that residents that receive constructive feedback on their performance from their attendings would report more near-misses. Results Linear regression was used to determine whether ratings of attendings’ feedback predicted residents’ reports of near-misses. Feedback was positively related to residents’ near-misses reports even after controlling for patient acuity and stress biomarker levels. This may be due to the residents becoming more aware of what a near miss is or it may also be that constructive feedback encourages them to report more near-misses as they may view this as a learning opportunity.

The Value of Learning From Near Misses to Improve Patient Safety: A Scoping Review

“…For more than 20 years, there have been calls for health care to focus on learning from near misses to improve patient safety. During this time, efforts have focused on trying to improve near-miss reporting, 9 with beliefs that highlighting the value of reporting will increase reporting 14,15 . However, this assumes that there is value in learning from near misses and that they improve patient safety.…”

“…Near misses do not cause harm 12 and when balanced with the competing demands of health care, 13 it is understandable why they may not be reported. The perception of value is further undermined when staff do not see improvements resulting from their reporting because of limited feedback 14,15 . The research focus on trying to improve near-miss reporting, as described by Feng et al, 9 therefore, seems justified if they will indeed support improvements in patient safety.…”

Learning From Mistakes: Pediatric Residents’ Attitudes Toward and Responses to Peer Errors

“…1,2 Further, feedback can result in increased error reporting as well as individual behavior change. 3,4 However, errors may be intercepted and corrected by other medical professionals, improving patient care but leaving a physician unaware of their involvement and vulnerable to repeating the same mistake.…”