The association between attendings’ feedback and residents’ reporting of near-misses

OBJECTIVE: Accreditation Council for Graduate Medical Education’s Clinical Learning Environment Review report suggests that residents in clinical learning environments underreport their near-misses, an indicator of patient safety. Furthermore, when the residents report these events, they receive little feedback from their attendings. Although, various studies emphasize the importance of feedback given to the residents, the association between feedback and patient safety has not been explored. This study was conducted in 28 emergency medicine residents in a level 1 trauma center. A recent study in the same cohort found that residents’ stress biomarker levels and patient acuity were positively related to their near-misses reports. The current study hypothesizes that residents that receive constructive feedback on their performance from their attendings would report more near-misses. RESULTS: Linear regression was used to determine whether ratings of attendings’ feedback predicted residents’ reports of near-misses. Feedback was positively related to residents’ near-misses reports even after controlling for patient acuity and stress biomarker levels. This may be due to the residents becoming more aware of what a near miss is or it may also be that constructive feedback encourages them to report more near-misses as they may view this as a learning opportunity.