Creating Learning Cultures Around Mistakes for Residents

描述(摘自申请者)：奥尔巴尼大学商学院 公共卫生，与奥尔巴尼医学院合作提出了一项 纵向、定性的案例研究，旨在探索居民是如何 围绕错误问题以及最佳实践如何与 在教职员工和学生中体现出一种“学习型氛围”。 在两个独立的培训环境中的住院医生。这些最佳实践 指两者之间的思维、互动和行为的具体方式 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、发展和促进进行团队合作 关于错误的定义和处理的共同愿景， 以及处理和减少错误的个人方法，这是自我 深思熟虑、同理心强、以学习为导向。这项研究的具体目的 有五个方面：(A)描述和比较居民是如何与周围的人社交的 当代医师培训中的医疗差错问题 环境；(B)确定培训文化中的现有要点 已经包含了与如何创建学习型组织相关的要素 错误是由个人定义和处理的；(C)比较两个 临床专业与住院医师培训的两个领导二元 纳入特定活动的层级、机会和障碍 与围绕处理错误的学习文化联系在一起；(D) 探索潜在的性别和种族/民族差异 对错误和险些发生的情况作出反应并从中吸取教训；和(E)开始 起草一个可在其他派驻工作中验证的模型“文化模板” 为供全国派驻计划使用的设置 评估和改善他们的居住社会化环境 围绕着错误。数据收集将集中在两个临床专科，即， 外科手术和药物治疗。它将包括广泛的实地工作，包括 他们日常临床工作的过程，检查实际错误是如何发生的 在派驻环境中，以及一对一面试和焦点 拥有相同个体的群体。实现这些目标告诉我们 了解住院医师培训环境如何使年轻人社会化 医生对错误的思考和行动要与 医学研究所的报告和其他人呼吁在讨论 “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."