How Soon Should Students Learn to Care For the Caregiver? Part One

A number of core themes ran through our four-year patient safety curriculum. In previous posts, I have shared aspects of informed consent/shared decision-making and disclosure of medical errors as two of the themes with patients at the center. It was also our belief, however, that we couldn’t have a patient safety curriculum for medical students and resident physicians without addressing the impact harm can have on caregivers and care teams as well.

A number of years ago, Albert Wu and others started using the term “second victim” when referring to caregivers who unintentionally harmed a patient during treatment. The term was not received well by patients and family members who felt caregivers should not be considered “victims” on par with patients who were seriously harmed, or died from a medical error. A more common term used today for caregivers involved in a medical error is “second patient,” which many feel is more appropriate because of the growing body of research on the impact of medical errors on caregivers and care teams (see below).

During the third and fourth year of our patient safety medical school curriculum we started conversations with our students around the importance of Care for the Caregiver programs. Like other programs across the country, UIC does have a Care for the Caregiver program in place, as it was one of our Seven Pillars. We shared the tenets of this program with all of our students and residents during their training with us, incorporating articles from the growing body of work focused on the impact a medical error has on the care providers involved. Those articles include:

(1)  Residents’ Responses to Medical Error: Coping, Learning, and Change. Kirsten G. Engel, MD, Marilynn Rosenthal, PhD, and Kathleen M. Sutcliffe, PhD Acad Med. 2006; 81:86–93. Engel et al concluded that:

“Medical mishaps have a profound impact on resident physicians by eliciting intense emotional responses. It is critical that resident training programs recognize the personal and professional significance of these experiences for young physicians. Moreover, resident education must support the development of constructive coping skills by facilitating candid discussion and learning subsequent to these events.”

(2)  The Emotional Impact of Medical Errors on Practicing Physicians in the United States and Canada. Amy D. Waterman, Ph.D. Jane Garbutt, M.B., Ch.B. Erik Hazel, Ph.D. William Claiborne Dunagan, M.D. Wendy Levinson, M.D. Victoria J. Fraser, M.D. Thomas H. Gallagher, M.D. Waterman et al concluded:

“Physicians reported increased anxiety about future errors, loss of confidence, sleeping difficulties, reduced job satisfaction, and harm to their reputation following errors. Physicians’ job-related stress increased when they had been involved with a serious error. However, one third of physicians only involved with near misses also reported increased stress. Physicians were more likely to be distressed after serious errors when they were dissatisfied with error disclosure to patients, perceived a greater risk of being sued, spent greater than 75% time in clinical practice, or were female. Only 10% agreed that health care organizations adequately supported them in coping with error-related stress (emphasis added).

(3)  Association of perceived medical errors with resident distress and empathy: a prospective longitudinal study. West et al. JAMA. 2006 296(6): 1071-8. West et al concluded:

“Self-perceived medical errors are common among internal medicine residents and are associated with substantial personal distress. Personal distress and decreased empathy are associated with increased odds of future errors…reciprocal cycle.”

Additionally, we shared that hospitals were not supposed to treat Care for the Caregiver programs as if they were optional – that the National Quality Forum (NQF) has made these programs a requirement. NQF Safe Practice #8 is Care-for-the-Caregiver, and it states:

“Following serious unintentional harm due to systems failures and/or errors that resulted from human performance failures, the involved caregivers (clinical providers, staff, and administrators) should receive timely and systematic care to include: treatment that is just, respect, compassion, supportive medical care, and the opportunity to fully participate in event investigation and risk identification and mitigation activities that will prevent future events.”

Come back tomorrow for more on Care for the Caregiver programs and why there is such a strong need to make these programs mainstream education in our medical and health science schools…

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2 Comments on “How Soon Should Students Learn to Care For the Caregiver? Part One”

  1. This post couldn’t have come at a better time. We were recently made aware of a resident at an urban teaching hospital who is being put on probation in large part due to an adverse outcome that will likely result in a lawsuit.

    What resources are out there first to the resident physician involved, who is not only distraught about their actions, experiencing some of the same things mentioned in the articles in these posts, but also has been put on the defense and feels as though their career could be jeopardized?

    Second, what resources can we use as an organization to advocate for more honest communication and positive systems changes as opposed to punitive actions?

    On a personal level, it is heart wrenching to see this young physician, who has been lauded as a staunch supporter of patients, to be so emotionally distressed by this experience that they feel as though they cannot even walk in the doors of the hospital and practice because they have made a terrible mistake.

    • Hilary,
      Thanks for sharing this story. This is exactly what we all need to address and do a better job of. The more we share and talk about these issues in an open forum, the sooner we can make things better.


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