Available online 2 May 2023

Author links open overlay panel, , OBJECTIVE

This qualitative descriptive study aims to explore trainees’ experiences of error disclosure (ED) during their surgical postgraduate training and the factors influencing the intention-behavior gap for ED.

DESIGN

This study employs an interpretivist methodology and a qualitative descriptive research strategy. Data were collected using focus group interviews. Data coding was performed by the principal investigator using Braun and Clarke's reflexive thematic analysis. Themes were developed from the data in a deductive manner. Analysis was carried out using NVivo 12.6.1.

SETTING

All participants were at various stages of an 8-year specialist program under the auspices of the Royal College of Surgeons in Ireland. The training program involves clinical work in a teaching hospital under the supervision of senior doctors in their specialist field. Trainees attend mandatory communication skills training days throughout the program.

PARTICIPANTS

Study participants were recruited using purposive sampling from a sampling frame of 25 urology trainees on a national training scheme. Eleven trainees participated in the study.

RESULTS

Participants’ stage of training ranged from first to final year. Seven key themes emerged from the data relating to the trainees’ experiences of error disclosure and the intention-behavior gap for ED. These themes include observed positive and negative practice in the workplace, impact of stage of training, importance of interpersonal interactions, perceived blame/responsibility for multifactorial error or recognized complication, lack of formal training in ED, cultural aspects of the training environment and medicolegal issues around ED.

CONCLUSIONS

While trainees recognize the importance of ED, personal psychological factors, negative environmental culture, and medicolegal concerns are significant barriers to the practice of ED. A training environment that focuses on role-modelling and experiential learning with adequate time for reflection and debriefing is paramount. Areas for further research include broadening the scope of this study of ED across different medical and surgical subspecialties.

Section snippetsINTRODUCTION

Medical error, defined as “an act of omission or commission in planning or execution that contributes or could contribute to an unintended result,”1,p 42 is a common problem in clinical practice. 8% to 10% of inpatients experience a medical error during their hospital stay.2 Notwithstanding efforts to mitigate against adverse events in clinical practice, error disclosure (ED) is fundamental to patient-centered care and shared decision making.3 both important facets of professional practice.

Study Context

All participants were at various stages of an 8-year specialist program under the auspices of the Royal College of Surgeons in Ireland. The training program involves clinical work in a teaching hospital under the supervision of senior doctors in their specialist field. The first 2 years focus on general surgical training, before proceeding to 6 years of sub-specialty training. Biannual assessments occur throughout the program, focusing on the main learning outcomes within the domains of

RESULTS

Eleven participants were included in the study. Participants’ stage of training ranged from first to final year. Three focus groups were conducted between March-May 2021. The focus groups each included 3 to 4 participants and lasted 43 to 64 minutes.

Seven key themes emerged from the data and they are outlined in Table 1.

DISCUSSION

This qualitative descriptive study shows that while surgical doctors in training understand ED and how it can be managed effectively, issues around the personal, professional, and medicolegal implications of ED are ongoing barriers to its routine use in clinical practice. Trainees’ insights into ED are largely informed by their experiences in the workplace rather than by formal teaching, and these experiences are influenced by their stage of training.

Much of the educational literature on ED

CONCLUSION

ED is a complex process, and how trainees experience it is equally complex. While trainees recognize the importance of ED, personal psychological factors, negative environmental culture, and medicolegal concerns are significant barriers to the practice of ED. A holistic view of the training pathway that is tailored for each stage of training and includes multiple learning sources is necessary. A focus on role-modelling and experiential learning with adequate time for reflection and debriefing

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