How can teaching hospitals give medical residents the opportunity to learn from their mistakes while also maintaining patient safety?

Research by Tal Katz-Navon, PhD, an organizational psychologist at the Interdisciplinary Center in Herzliya, Israel, and his colleagues sought to answer that in September's Journal of Applied Psychology (Vol. 94, No. 5).

“Errors are a natural by-product of active learning,” they said. “There is a dilemma between, on one hand, the residents' need to actively learn and explore, which is at the core of high-quality medicine and, on the other hand, the need to keep patients safe.”

In their study, the researchers identified three factors involved in this balance: freedom to experiment and try new techniques; priority of safety within the department; and managerial style of supervisors. They surveyed 123 resident physicians across a number of disciplines, asking them to what degree those three factors described their departments. The researchers compiled those combinations and three months later asked participating residents' supervisors about any medical errors the residents made.

For residents who reported being free to actively learn, the best combination for reducing medical errors was a moderate safety priority, combined with a high level of supervisor interaction. A high degree of active learning combined with a high priority on safety actually resulted in more medical errors, the researchers said, likely because those two competing priorities stretched resources thin.

To solve that problem, the researchers recommend that medical schools instill a high degree of managerial involvement: more supervision, rewards or punishments for consequences, and better identification and correction of safety problems. That, they say, helps balance the residents' need to be free to make mistakes.

The authors recommend that organizations, instead of directing lots of their resources toward promoting a climate of safety, stress the importance of managers' involvement in identifying and correcting the root causes of errors and hazardous conditions and incorporate that responsibility for reducing medical errors into their professional roles.

—M. Price