When faced with a patient safety concern, staff need to decide whether to speak up or remain silent. Leaders play a crucial role in addressing contextual factors behind employees’ decisions to remain silent. This article offers support for leaders to create a culture of psychological safety and encourage speaking up behaviors.

Medical errors affect not only the patients and families involved, but the clinicians and organization as well. This commentary focuses on physicians as second victims and how mistakes influence their emotional health, stress levels, and work performance.

Patients are the first victims when medical mistakes occur, and studies have indicated that these incidents can also impact clinicians' emotional well-being. This commentary explores the ways errors can affect physicians, including subsequent feelings of guilt, persistent fear of errors, depression, and high levels of burnout. The authors advocate for organizations to provide counseling for these clinicians and enable discussions about errors to support learning from the experience.

Simulation training has taken hold as a key method for safely teaching procedural proficiency. Prior studies have found simulation to be superior to traditional didactics in improving skills and behaviors. This systematic review focused specifically on whether the skill set obtained from simulation is transferable to the operating room. The study was restricted to randomized controlled trials involving novice surgical trainees. The findings demonstrate a positive impact on operating competence, but the metrics used in studies thus far have been limited. The authors advocate for more robust assessment of operative performance. A recent systematic review, published as part of the AHRQ Making Health Care Safer II report, also found evidence that simulation training improved procedural competence and patient care outcomes. An AHRQ WebM&M perspective by Dr. David Cook reviews the literature on health care simulation training.

This review recommends educating surgical trainees about error disclosure, teamwork, and non-technical skills to augment their ability to cope and learn from medical errors.

Standardized feedback resulted in lower error rates for surgery residents completing simulated laparoscopic surgical procedures.