Medical error, incident investigation and the second victim: doing better but feeling worse?

[...]incident investigation has become a routine part of the hospital's response to an adverse event. 1 In the USA, the Joint Commission's Sentinel event policy and the Veterans Affairs hospitals' adoption of root cause analysis have made root cause analysis standard operating procedure. 2 Armed with the results of these investigations, research and quality improvement efforts are now taking on system improvements required to create a safer healthcare environment. In a few studies, up to half of healthcare workers surveyed reported an incident in which they feel that they were a second victim. 18-20 Trainees may be particularly vulnerable to sustaining damage to their clinical confidence and self-esteem. 21 In this issue, two papers describe the profound and enduring effects of adverse events on physicians in training. 22 23 In their study of residents in the USA, Kronman and colleagues identified the need for training programs to provide structured, meaningful ways for house officers to discuss their errors, to help them cope, and to forestall negative emotional consequences.