Systems errors versus physicians' errors: Finding the balance in medical education

In recent years, identifying the origins of medical errors has been aided b y a growing awareness that such errors are frequently the result of flaws i n the system. In short, they are "accidents waiting to happen." Despite the value of the systems approach in identifying and preventing errors, it cre ates a difficult ethical problem for medical educators. Evidence suggests t hat when physicians ascribe errors to systemic causes, they may be less lik ely to modify their future behaviors and thus will be more likely to repeat past errors. Therefore, academic medical centers (i.e., teaching hospitals ) must achieve a delicate balance that protects patients from the errors th at a systems approach can identify, yet provides optimal education for hous e officers by reaching them to focus also on personal reasons for errors. The authors suggest that this balance can be achieved by having residency p rograms work aggressively to remove the obstacles that house officers predi ctably encounter when they look for the personal causes of error (e.g., bei ng shamed, feeling fear and inadequacy). Programs must also encourage house staff to disclose their errors and make constructive changes in their own behaviors, encouraged and guided by role models, The article concludes with discussion of these and related strategies to achieve the desired balance between the use of a systems approach and a personal-responsibility approac h to managing errors in academic medical centers.