Perceptions of Medical School Culture and Incoming Residents’ Intentions to Report Medical Errors

This cross-sectional study examined whether perceptions of specific features of medical school culture were associated with incoming residents' intentions to report medical errors during residency. A total of 741 incoming residents reported their perceptions of psychological safety and a harmful hidden curriculum during medical school, of whom 738 met inclusion criteria. Incoming residents were also asked about their intentions to report self-performed mistakes and witnessed errors across three mistake types (i.e., near-misses, minor, and major) to three reporting targets (i.e., another resident/fellow, a program director, and an attending physician). Psychological safety was associated with intentions to report self-performed medical mistakes across all mistake severity-by-reporting target pathways and intentions to report witnessed medical errors across seven of nine pathways. A harmful hidden curriculum was associated with four of nine pathways for self-performed errors, including intentions to report near-misses and minor errors to attending physicians and program directors, and three of nine pathways for witnessed errors. These findings suggest that, beyond features of the current clinical environment, experiences from prior training environments may help explain error-reporting intentions among incoming residents.