From Healer to Harmer: Preparing Senior Medical Students for Patient Harm Events in a Transition-to-Residency Course

Abstract

Introduction: A physician's first patient harm event oftentimes occurs during the intern year. Residents encounter and are responsible for medical errors, yet little training is offered in how to properly cope with these events. Earlier and more in-depth education about how to process patient harm events is needed.

Methods: We developed a 110-minute workshop focused on coping strategies for patient harm events and delivered it to a cohort of fourth-year medical students during a transition-to-residency course just before graduation. The workshop emphasized interns' increasing exposure to medical errors, how to personally process them, and how to debrief near-peers in processing them.

Results: A total of 190 students participated in the workshop. Our survey response rate was 88%. Students' confidence in defining second casualty after the workshop grew from eight responding very or extremely confident (7%) to 95 responses (87%). Comfort utilizing positive coping mechanisms improved from 14 very or extremely confident responses (12%) to 73 responses (67%). Confidence utilizing first responder structure grew from three very or extremely confident responses (3%) to 61 responses (56%). Comfort helping colleagues cope with patient harm events grew from 16 very or extremely confident responses (14%) to 78 responses (72%).

Discussion: This workshop fills an important gap in UME by preparing senior-level students to resolve emotional conflict related to patient harm events. Our findings illustrate that a short-term intervention on this topic can impact students' confidence. We believe discussion around how patient harm events emotionally impact trainees should be expanded.

Keywords: Complications; Coping Skills; Patient Harm; Transition to Residency.

Figure 1.. Students’ confidence in defining the second casualty phenomenon before and after the workshop.

Figure 2.. Students’ confidence in utilizing positive coping mechanisms before and after the workshop.

Figure 3.. Students’ confidence in using the first responder structure for discussing patient harm events before and after the workshop.

Figure 4.. Students' confidence in helping colleagues cope with patient harm events before and after the workshop.