Reflection on medical errors: A thematic analysis.

BACKGROUND: As there is a need to prepare doctors to minimize errors, we wanted to determine how doctors go about reflecting upon their medical errors. METHODS: We conducted a thematic analysis of the published reflection reports of 12 Dutch doctors about the errors they had made. Three questions guided our analysis: What triggers doctors to become aware of their errors? What topics do they reflect upon to explain what happened? What lessons do doctors learn after reflecting on their error? RESULTS: We found that the triggers which made doctors aware of their errors were mostly death and/or a complication. This suggests that the trigger to recognize that something might be wrong came too late. The 12 doctors cited 20 topics' themes that explained the error and 16 lessons-learnt themes. The majority of the topics and lessons learnt were related more to the doctors' inner worlds (personal features) than to the outer world (environment). CONCLUSION: To minimize errors, doctors should be trained to become earlier and in time aware of distracting and misleading features that might interfere with their clinical reasoning. This training should focus on reflection in action and on discovering more about doctors' personal inner world to identify vulnerabilities.

The availability of diseases for medical students in a university hospital.

The Dutch national objectives for the education of medical doctors (in terms of diseases), expressed in the form of a student compiled logbook, must be attained at the time of graduation. The diseases that are required are divided into the categories 'essential' and 'compulsory choice'. The aim of this study is to investigate whether the inpatient department of internal nedicine offers medical students sufficient diseases during two four-week periods in the clerkship, such that the required diseases related to Internal Medicine as described in our logbook can be met. At five subdivisions, medical doctors recorded the diseases available for students. Of the 37 'essential' diseases students may be expected to encounter during one four-week stay in the department: 57% in internal medicine-I; 55% in internal medicine-II; 47% in nephrology; 41% in respiratory medicine; 13% in oncology. Of the 65 'compulsory choice' diseases the number of diseases encountered is respectively: 78%; 57%; 41%; 34%; 33%. We conclude that a considerable number of the diseases required by the Blueprint and therefore by the government is available in two four-week periods in the inpatient clerkship, when this comprises a stay at a general subdivision and a specialist-oriented subdivision. To be more precise about the fulfilment of the logbook requirements, further research is necessary.