Table 2 Methods, support programs and interventions to address the emotional experience (second victim) of being involved in or witnessing a mistake causing harm to a patient during their clerkships or training
From: Unveiling the hidden struggle of healthcare students as second victims through a systematic review
First author, year | Methods to address the SV phenomenon | Outcome measure results (if applicable) | Use of second victim term |
|---|---|---|---|
Breslin A, 2019 [28] | 2.5-h seminars consisting of: 1. a large group session to introduce the psychology of shame and guilt responses to medical error 2. current residents shared personal narratives of shame experiences encountered during medical training 3. students met in small groups to discuss their reactions to the large-group content | Significant increasement (p < 0.001) in confidence in identifying shame, in ability to differentiate shame from guilt, to identify shame reactions, and reported increased willingness to ask for help from others | No |
Davis M, 2020 [29] | A 3-h interactive lecture/discussion session which consists of 6 HRO modules adapted from the World Health Organization Patient Safety Curriculum. Each module opened with an anecdote (video or narrative format), which depicted an actual episode of patient care error relevant to that module's topic | After the educational intervention, participants improved pretest to posttest scores about their knowledge, application skills, and critical thinking by 74%. They evaluated the learning experience positively | Yes |
Gillies RA, 2011 [41] | Multi-faceted apologies intervention using Miller’s clinical competence pyramid as a model (ie, learners move from knowledge to competence, performance, and action). These tasks included online reading and interactive apology tasks to small-group and standardized patient interactions | Perceived utility of the course and module: 66% considered useful or extremely useful Perceived utility of apology evaluations: 74% considered useful or extremely useful Perceived utility of standardized patient interview: 62% considered useful or extremely useful Increased confidence in providing effective apologies Increased their comfort in disclosing errors to a faculty member or patient Increased perceived importance of apology skills | No |
Hanson J, 2020 [35] | Preparatory framework for ‘speaking up for safety’ To use the rehearsal and practice of a graded assertiveness technique using the P.A.C.E and C.U.S·S frameworks in a preparation for their practice course | Reaching assertiveness skills and establishing a preparatory framework for ‘speaking up for safety’ early in a nursing students tertiary education can have important psychosocial implications for their confidence, empowerment and success | No |
Huang H, 2020 [38] | Discussing the patient safety incident with professionals or peers Support and understanding of patients | Not applicable | Yes |
Kim CW, 2017 [33] | Education program that included practice of error disclosure using a standardized patient scenario, debriefing session with clinical vignettes describing medical error. feedback, and short didactic sessions | Participants’ abilities to disclose medical error: 65% of participants said that they had become more confident in coping with medical errors, and most participants (79.7%) were satisfied with the education program | No |
Krogh T, 2023 [37] | Current coping strategies: Individual and social processing, either using more formal offers of support (voluntary or mandatory) or their informal network | Not applicable | Yes |
Lane AS,2021 [36] | 4-h education session (simulation activity) based on open disclosure after medication error | Not applicable | |
Le H, 2022 [30] | Educational intervention including: 1. a brief lecture on medical errors, 2. participation in a standardized patient encounter in which the students were required to disclose a medical error to the spouse of a critically ill patient 3. group debriefing focused on the challenges of disclosing medical errors and the impact of error on professional identity | 94% agreed that medical error is an important topic 92% felt more comfortable discussing medical errors | No |
Mohsin SU, 2019 [44] | 4-h workshop including: 1. overview of patient safety and medical errors 2. episode of a TV show about a patient safety incident 3. overview on error analysis and tools 4. discussions about conditions contributing to errors, types of errors, error prevention, interventions/actions and strength of actions to prevent errors 5. discussions about the importance of reporting: students were required to submit a simulated error report about an error they personally observed | Increased clinical error reporting frequency | No |
Mousinho Tavares AP, 2022 [42] | Support from classmates and professors of the practical courses provided support The students showed no knowledge of organizational support or protocols available to students who become second victims of patient safety incidents | Not applicable | Yes |
Musunur S, 2020 [31] | An hour-long interactive session, delivered by local faculty, which aims to show likelihood of being involved in a medical error, the professional and personal impact of medical errors through small group discussion and storytelling, and enabling students to identify both informational resources and individual personnel available at the local level if they or their colleagues faced with a medical error | Increased awareness of available resources in coping with medical errors Increased self-reported confidence in detecting and coping with medical error Pre-existing attitudes and knowledge regarding medical error stayed consistent | Yes |
Noland CM, 2015 [32] | -To report mistakes and tell someone -Formal training in-class modules showing how to report a mistake -Informal education by the sharing of stories while in their clinicals (e.g. advice from a nurse) -Training about how to behave (remain calm) and to talk about the error with the patient and the supervisor -Training in Situation–Background–Assessment–Recommendation (SBAR) communication, as “a strategy to optimally prepare student nurses to communicate effectively within the clinical setting” | Not applicable | No |
Rinaldi C, 2022 [39] | To talk to someone about the patient safety incident mainly with their colleagues, friends, clinical tutors, nurses, their partners, patients or patient’s relatives Formal support sources: the University Counseling Service and the General Practitioner Clinic | Not applicable | Yes |
Roh H, 2014 [34] | Three-day patient safety course based on the World Health Organization (WHO) patient-safety guide for medical schools and previous research on patient safety education. The training consisted of: 1.basic concepts of patient safety (interactive lecture with video clips) 2. Error causes and quality improvements 3. Self-regulation and clerkship ethics 4. Teamwork and error-reporting 5. Communication with patients and caregivers 6. Frequent issues Using these methods: Interactive lecture with demonstration or videos, discussion with experts, small group practice, role-playing, practice with standardized patient, and debriefing) | Understanding, attitudes, and sense of responsibility regarding patient safety improved after training | No |
Ryder HF, 2019 [19] | Interactive patient safety reporting curriculum (PSRC) to provide students with direct experience identifying, analyzing, and reporting medical errors This consisted of writing a structured written report, analyzing a patient safety incident they experienced The report focused on severity of outcome, root cause(s) analysis, system-based prevention, and personal reflection. The report was bookended by 2 interactive, case-based sessions led by faculty with expertise in patient safety, quality improvement, and medical errors | After the PSRC, students self-reported improved attitudes toward medical error and increased comfort with analyzing and disclosing them. Baseline attitudes remained high and significantly increased relative to historical controls Students receiving the PSRC in the second half of their third year reported higher levels of skill acquisition than students receiving training in the first half of their third year | No |
Thomas I, 2015 [40] | A 30–minute simulated ward round experience with a focus on medical error and distraction | Students though that this simulated experience help them to reflect on positive behavioral changes for safe future practice, built confidence and was deemed to be of high fidelity. All students felt that mandatory curricular integration was important | No |
Zieber MP, 2015 [43] | Support from peers, clinical instructor, family members, | Not applicable | No |