Does the perception of severity of medical error differ between varying levels of clinical seniority?

Background and purpose: The Francis Report called for a more "open culture" to empower health care staff to report medical errors. However, there are differing opinions amongst doctors as to what constitutes a medical error, and no previous study has investigated whether the perception of medical errors varies with clinical seniority.

Methods: A prospective study comprising medical students (s), junior doctors (jd), and consultants (c) from one Deanery was conducted, where participants were anonymously assessed on their perceptions of error in eight different hypothetical scenarios using a numerical scale (1-10). Scenarios were reviewed for face validity and pilot tested before implementation. A statistician prospectively determined the number of participants to ensure the study was sufficiently powerful. Scenario ratings were analyzed using non-parametric statistical tests and free-text answers were analyzed by immersion and crystallization.

Results: Two hundred thirteen participants were recruited with near equal distribution in gender (51%:49%, F:M) and clinical seniority (36%:34%:30%, s:jd:c, respectively). Significant difference was shown in three out of the eight scenarios between the students and the consultants, and in one of those three between junior doctors and students. Qualitative analysis found various factors that contribute to participants' decision regarding error severity. Students and junior doctors commented on potential consequences in greater detail, but consultants showed greater awareness of the latent factors contributing to error.

Conclusion: Heterogeneity in answers was seen within each of the cohorts. The most influential factors were scenario outcome and potential consequences. Latent factors, such as error circumstances and participant's empathy, also contributed to response. There were significant differences in the scores between medical students and consultants in some scenarios which may be related to clinical experience. The heterogeneity of answers suggests there is scope for improvement in medical error education.