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Open Access Research article

Female residents experiencing medical errors in general internal medicine: a qualitative study

Cindy Ottiger Mankaka1, Gérard Waeber2 and David Gachoud23*

Author Affiliations

1 Medical School, Faculty of Biology and Medicine, University of Lausanne, 1011 Lausanne, Switzerland

2 Service of Internal Medicine, University Hospital of Lausanne (CHUV), 1011 Lausanne, Switzerland

3 Educational Unit, Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 21, BU21/05-246, 1011 Lausanne, Switzerland

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BMC Medical Education 2014, 14:140  doi:10.1186/1472-6920-14-140

Published: 10 July 2014

Abstract

Background

Doctors, especially doctors-in-training such as residents, make errors. They have to face the consequences even though today’s approach to errors emphasizes systemic factors. Doctors’ individual characteristics play a role in how medical errors are experienced and dealt with. The role of gender has previously been examined in a few quantitative studies that have yielded conflicting results. In the present study, we sought to qualitatively explore the experience of female residents with respect to medical errors. In particular, we explored the coping mechanisms displayed after an error. This study took place in the internal medicine department of a Swiss university hospital.

Methods

Within a phenomenological framework, semi-structured interviews were conducted with eight female residents in general internal medicine. All interviews were audiotaped, fully transcribed, and thereafter analyzed.

Results

Seven main themes emerged from the interviews: (1) A perception that there is an insufficient culture of safety and error; (2) The perceived main causes of errors, which included fatigue, work overload, inadequate level of competences in relation to assigned tasks, and dysfunctional communication; (3) Negative feelings in response to errors, which included different forms of psychological distress; (4) Variable attitudes of the hierarchy toward residents involved in an error; (5) Talking about the error, as the core coping mechanism; (6) Defensive and constructive attitudes toward one’s own errors; and (7) Gender-specific experiences in relation to errors. Such experiences consisted in (a) perceptions that male residents were more confident and therefore less affected by errors than their female counterparts and (b) perceptions that sexist attitudes among male supervisors can occur and worsen an already painful experience.

Conclusions

This study offers an in-depth account of how female residents specifically experience and cope with medical errors. Our interviews with female residents convey the sense that gender possibly influences the experience with errors, including the kind of coping mechanisms displayed. However, we acknowledge that the lack of a direct comparison between female and male participants represents a limitation while aiming to explore the role of gender.

Keywords:
Medical errors; Patient safety; Medical education; Internal medicine; Gender; Qualitative research