Creating Learning Cultures Around Mistakes for Residents

描述（来自申请人）：奥尔巴尼大学，学院 公共卫生部与奥尔巴尼医学院合作， 纵向，定性的案例研究，旨在探讨居民是如何 围绕错误问题以及最佳实践如何与 “学习型氛围”在教师中表现出来， 在两个不同的训练环境中。这些最佳实践 指的是这两者之间的思维、互动和行为的特定方式。 这些团体通常会导致更高的系统思维和更大的 倾向于围绕患者安全、发展和晋升进行团队合作 对错误的定义和处理有共同的看法， 和个人的方法来处理和减少错误，这是自我- 反思、移情和学习导向。研究的具体目标 五个方面：（a）描述和比较居民如何社会化周围 当代医师培训中的医疗差错问题 （B）确定培训文化中的现有要点， 已经包含了“学习型组织”的要素， 错误是由个人定义和处理的;（c）在两个 临床专业和住院医师培训的两个领导组合 纳入具体活动的机会和障碍 与学习处理错误的文化有关;（d） 探索潜在的性别和种族/民族差异， 对错误和未遂情况作出反应并从中吸取教训;以及（e）开始 起草一个可以在其他居住地验证的“文化模板”模型 设置的目的是由居住计划在全国使用， 评估和改善他们的居住社会化环境 围绕错误。数据收集将集中在两个临床专业，即， 外科和内科。它将包括扩展的实地考察，包括 观察住院医师和主治医师之间的互动， 在他们的日常临床工作中，检查实际错误是如何发生的， 在居住环境中，以及一对一的采访和焦点 与这些相同的人。实现这些目标， 了解住院医师培训环境如何使年轻人 医生思考和行动周围的错误，在某种程度上符合什么 医学研究所的报告和其他人呼吁在讨论的需要， “学习型氛围。"

DESCRIPTION (TAKEN FROM APPLICANT): The University at Albany, School of Public Health, in cooperation with Albany Medical College proposes a longitudinal, qualitative case study intended to explore how residents are socialized around the issues of mistakes and how the best practices associated with a "learning-type atmosphere" manifest themselves among faculty and residents within two separate training environments. These best practices refer to specific ways of thinking, interacting, and behaving among these two groups that result generally in heightened systems thinking and a greater propensity towards teamwork around patient safety, development and promotion of a shared vision with respect to the definition and processing of mistakes, and a personal approach to coping with and reducing mistakes that is self- reflective, empathetic, and learning-oriented. The specific aims of the study are five-fold: (a) describe and compare how residents are socialized around the issue of medical mistakes within a contemporary physician-training environment; (b) identify existing points within the training culture that already contain elements of a "learning organization" in relation to how mistakes are defined and processed by individuals; (c) compare across two clinical specialties and two leadership dyads of the residency training hierarchy opportunities and barriers for incorporating specific activities associated with learning cultures around the treatment of mistakes; (d) explore potential gender and race/ethnicity differences in how residents respond to and learn from mistakes and near miss situations; and (e) begin drafting a model "cultural template" that can be validated in other residency settings for the purpose of being used by residency programs nationally to assess and enhance their environments with respect to residency socialization around mistakes. Data collection will focus on two clinical specialties, i.e., surgery and medicine. It will consist of extended fieldwork including observation of interactions between residents and attending faculty in the course of their daily clinical work, examining how actual mistakes play out within the residency environment, as well as one-on-one interviews and focus groups with these same individuals. Meeting these aims inform our understanding of how residency training environments can socialize young physicians to think and act around mistakes in a way consistent with what the Institute of Medicine Report and others call for in discussing the need for "learning-type atmospheres."