Everyone can relate to the fear of making mistakes, perhaps none more so than the physicians and other front-line providers whose decisions may be life-or-death.
A recent study on the impact of self-perceived medical errors on physician wellbeing has uncovered the significant extent to which distress is experienced – now termed “second victim phenomenon” – as well as the concerning correlation between medical errors during residency, and higher rates of depression, burnout, and fatigue, as well as a lower quality of life and loss of empathy.
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Second-hand victim phenomenon is arguably an inevitable result of surviving the culture of competition and perfectionism rife throughout medical communities. In exploring attitudes and behaviours around disclosing mistakes made, researchers found it was mostly only to other residents of more senior levels, if at all. Of the non-disclosing group, the most common influencer was fear – fear of judgement, of being labelled incompetent, and of facing potentially career-threatening consequences.
Several residents also identified prior experiences of disclosing mistakes that were met with callousness or judgement as reason enough to keep silent thereafter. Shame is a silent epidemic among medical professionals, fuelled further by toxic beliefs such as “doctors are not allowed to make mistakes.”
So where does one begin approaching an issue as complex and sensitive as second victim phenomenon?
Most errors in residency occurred during the first year at 58%, compared to 25% and 12%, occurring in the second and third years, respectively.
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In discussion, the authors identified a ‘great need’ for early career physicians to be better supported through education and access to mental health resources. Suggested strategies included targeted skill training and debriefing sessions in the wake of errors made.
On a related note, medical education is undergoing a transformation worldwide, evolving into proficiency-based courses that incorporate more simulation-based training, rather than traditional time-bound clinical clerkships. Why does this matter?
“Simulation-trained participants showed superiority in surgical performance in comparison with untrained surgeons. The operation time, accuracy, incidence of intraoperative errors, and postoperative complications were statistically better in the simulation-trained group in comparison with the conventional-trained group.” (Spiliotis et al., 2020, p. 2)
Furthermore, as stated by Hamstra and colleagues,
“All forms of simulation offer added learning through the opportunity for debriefing after the event.” (Hamstra et al. 2012)
Simulation-based learning provides a safe and controlled training environment. The ability to practice repeatedly at the students own pace builds self-confidence and allows students to feel more prepared when interacting with real patients. This translates to a better quality of care and positive patient experiences.
“As well as confidence being essential for an individual, demonstrating confidence is important for the patients who have put a lot of trust in health care professionals.4” (Abas & Juma 2016).
Of course, improving student learning experiences and medical accuracy is but one helping hand in the rebuilding of our healthcare structures. While there is no one solution to an issue as multifaceted as second-hand victim phenomenon, the glimmers of hope, and promises of transformative change glow more brightly with each step in the unstoppable march of progress.
“As technology becomes more realistic, there is very little excuse why a real patient should be the first experience any clinician has performing a skill or technique.” – Quote by Russel Metcalfe-Smith, Manager of the Women’s Guild Simulation Center for Advanced Clinical Skills. (2017)
Abas, T., & Juma, F. Z. (2016). Benefits of simulation training in medical education. Advances in medical education and practice, 7, 399–400. https://doi.org/10.2147/AMEP.S110386
Fatima, S., Soria, S. & Esteban- Cruciani, N. Medical errors during training: how do residents cope?: a descriptive study. BMC Med Educ 21, 408 (2021). https://doi.org/10.1186/s12909-021-02850-1
Hamstra, S., & Philibert, I. (2012). Simulation in graduate medical education: understanding uses and maximizing benefits. Journal of graduate medical education, 4(4), 539–540. https://doi.org/10.4300/JGME-D-12-00260.1
Spiliotis, A. E., Spiliotis, P. M., & Palios, I. M. (2020). Transferability of Simulation-Based Training in Laparoscopic Surgeries: A Systematic Review. Minimally invasive surgery, 2020, 5879485. https://doi.org/10.1155/2020/5879485