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Release: June 18, 2002

UI Physician To Study Impact Of Beliefs On Self-Reporting Of Errors

When faced with a dilemma or decision that could have serious or even negative consequences for ourselves, we often do some "soul searching" for guidance in our actions.

It's a generally accepted practice in our personal lives, but how do our foundational beliefs – personal, philosophical and religious – shape our professional lives? Moreover, how do these basic beliefs influence our values and conduct in the workplace?

These questions form the basis of a research study developed by Lauris Kaldjian, M.D., University of Iowa assistant professor of internal medicine, and biomedical ethics and medical humanities. Specifically, he will examine the impact of foundational beliefs on the self-reporting of medical errors by medical students, medical residents and physicians.

Kaldjian will conduct the study with the aid of a $300,000 grant from the Robert Wood Johnson Foundation's Generalist Physician Faculty Scholars Program. The program awards four-year career-development grants to outstanding junior faculty at U.S. medical schools in family practice, general internal medicine and general pediatrics. Kaldjian was one of 15 investigators nationwide selected to receive the prestigious award.

"A lot of discussion in the medical profession about increasing patient safety and reducing or eliminating medical errors has been geared toward improving systems or protocol," Kaldjian said. "But you also need people who are willing to report errors. Physician experiences with medical error may involve fear, guilt, professional isolation and the need for forgiveness. My view has been that you need to have a sturdy set of deep beliefs to motivate you to do something that, for most physicians, is threatening to their self-image as a health care providers."

Kaldjian's study has two parts. First, he will develop a taxonomy (set of terms or principles) of foundational beliefs and ethical values that are likely to influence the self-reporting of medical errors by physicians. Kaldjian will accomplish this by reviewing previous work published in medical ethics literature and by conducting a series of small focus groups involving medical students, residents and attending physicians.

"The goal will be to merge the conceptual understanding from medical ethics literature and the terms people actually use in their own discussions about this topic," he said.

Second, Kaldjian will develop a questionnaire to learn more about attitudes toward medical errors. The survey, involving approximately 540 second-year medical students, 430 first-year residents and 140 attending physicians at the UI and at Yale University, will include questions about the participants' foundational beliefs and questions related to a series of case vignettes. Respondents will be asked how they would respond to hypothetical situations involving medical errors. Each of the groups will be surveyed again after two years to see if time spent in the medical teaching and training environment actually promotes or hinders attitudes toward disclosure of medical errors.

"We're following the faculty somewhat as a control group," Kaldjian said. "They're not being exposed to a new training experience per se, but I'm interested in whether any attitude changes that may be found among faculty are due to changes system-wide or perhaps a cultural shift nationwide in the profession toward self-reporting medical errors."

Kaldjian noted that the survey will gather demographic information on the study participants, including their religious background, to see what role religious practice or beliefs plays in reporting medical errors.

Results from the study could lead to initiatives by medical schools and teaching hospitals that take into consideration the foundational beliefs of students, residents and attending physicians, Kaldjian added. Such efforts would complement the "systems approach" in facilitating a culture of disclosure that increases overall patient safety.

Kaldjian's interest in the project stems from his own personal and academic background. He teaches medical ethics in addition to his research and patient care activities in general internal medicine. He also is completing a Ph.D. in ethics through Yale's Department of Religious Studies.

"Our deepest beliefs are inseparable from who we are and what we do," Kaldjian said. "What's remarkable is that this point is so frequently neglected. My religious ethics background lends itself to asking what really drives our motivations and practices. As a medical clinician and educator, I'm interested in how these core beliefs can shape, and ultimately improve, our profession."

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