As part of clinical learning, residents and trainees are sometimes allowed to make supervised mistakes when patient safety is not at risk. In this study, pediatric hospitalists describe potential benefits and risks of allowing failure, the process of allowing or interrupting failure, and how they decide to allow failure to happen. Consistent with previous research, patient, trainee, team, and institutional factors were identified. Additionally, caregiver/parent factors were noted.

Learning to recover after a medical error is an important component of medical training. This qualitative study, which included postgraduate trainees from Europe and Canada, concluded that failure represents a valuable learning opportunity, but noted the importance of perceived intentions if trainees judge that their supervisors have allowed them to fail.

Previous research has found that error permission (allowing errors to arise naturally and not preventing them) is a common strategy used in clinical training. This qualitative study with supervising physicians found that decisions to allow residents to fail are often made in the moment and are influenced by the patient, supervisor, trainee, and environmental factors.

This qualitative study explored physicians experience allowing for failure for education purposes in clinical training. This study found that error permission (allowing errors to arise naturally and not preventing them) was a common strategy, particularly in procedures, medication dosing, communication, and patient management. Allowing supervised failure was perceived to be an important element of trainee development and was not considered to be a threat to patient safety.

Learning from failure is more appropriate in some contexts than others. This review examined the use of learning from failures in postgraduate medicine and found further research is needed to understand how this strategy affects patient safety and learner resilience.

This observation and interview study examined instances of surgical trainees hesitating in the operating room. Both trainees and attending physicians interpreted hesitation as incompetence. The authors suggest that this interpretation of hesitation does not support progressive autonomy for trainees and must be addressed in order to promote surgical safety.

… JAMA … JAMA … The sharing of stories is a key method to provide context to drive change. The authors …

Checklists have been heralded as an important tool to improve health care safety. This review examined whether the science supports that recognition. Numerous studies have been published, but the literature base hasn't been developed to fully understand the complexities of surgical checklist implementation programs.

This randomized controlled trial of different resident shift lengths (12, 16, and 24 hours) sought to examine how duty hours affect patient safety, housestaff well-being, and handoffs. The authors found no effects on patient safety outcomes, including adverse events and mortality. This study adds to literature suggesting that decreasing duty hours does not improve safety for hospitalized patients.

This study identified four systems-related factors that contribute to operating room team conflict. Broadly, these triggers include team characteristics, procedural training, equipment management, and administrative leadership.

Although interrupting learners' admission case presentations may provide valuable opportunities for teaching, this study found that it may also hinder comprehensive information sharing.

Detection and prevention of near misses depend on a balance between individual accountability and collective vigilance, according to interviews with clinicians of different disciplines at an academic medical center.

This study identified three different scenarios associated with organizational responses to near misses.

This study revealed that nurses perceived their role in team-based error disclosure as secondary to balancing professional boundaries.

Implementation of a checklist-guided perioperative team briefing was associated with a significant improvement in the timely administration of perioperative antibiotics.

This qualitative study explored the cognitive behavior of surgeons and the continuum that exists around how much attention is reinvested into monitoring activities in the operative setting. The authors suggest that remaining purposefully attentive may benefit patient safety.

Use of structured communication tools in the operating room was associated with improved perception of safety culture, especially among nurses.

… J Adv Nurs … Communication failures are a known problem in operating rooms, with past studies … as potential solutions. Interprofessional conflict can be a mediating factor in such failures, and this ethnographic … to describe what the authors refer to as “silences” as a root cause of such conflict. Based on observations of …

This review provides insight into the application of social science research concepts to gain understanding of how teams can work safely together.

… preoperative checklist briefing and discovered a significant three-fold reduction in communication … and applauds the authors' efforts to rigorously evaluate a communication tool. …