Medical error:a discussion of the medical construction of error and suggestions for reforms of medical education to decrease error

Introduction: There is a growing public perception that serious medical error is commonplace and largely tolerated by the medical profession. The Government and medical establishment's response to this perceived epidemic of error has included tighter controls over practising doctors and individual stick-and-carrot reforms of medical practice. Discussion: This paper critically reviews the literature on medical error, professional socialization and medical student education, and suggests that common themes such as uncertainty, necessary fallibility, exclusivity of professional judgement and extensive use of medical networks find their genesis, in part, in aspects of medical education and socialization into medicine. The nature and comparative failure of recent reforms of medical practice and the tension between the individualistic nature of the reforms and the collegiate nature of the medical profession are discussed. Conclusion: A more theoretically informed and longitudinal approach to decreasing medical error might be to address the genesis of medical thinking about error through reforms to the aspects of medical education and professional socialization that help to create and perpetuate the existence of avoidable error, and reinforce medical collusion concerning error. Further changes in the curriculum to emphasize team working, communication skills, evidence-based practice and strategies for managing uncertainty are therefore potentially key components in helping tomorrow's doctors to discuss, cope with and commit fewer medical errors.

Evaluating the effectiveness of Bayesian feature selection

A practical Bayesian approach for inference in neural network models has been available for ten years, and yet it is not used frequently in medical applications. In this chapter we show how both regularisation and feature selection can bring significant benefits in diagnostic tasks through two case studies: heart arrhythmia classification based on ECG data and the prognosis of lupus. In the first of these, the number of variables was reduced by two thirds without significantly affecting performance, while in the second, only the Bayesian models had an acceptable accuracy. In both tasks, neural networks outperformed other pattern recognition approaches.

The influence of age and trait attributions on recruitment selection

The role of interpersonal attraction into the recruitment selection is gaining research attention. Early work in the domain of the influence of attraction in organisations suggested that men are given more resources, such as higher salaries and promotions. However, recent research has found women have an automatic in-group bias. It was suggested that female interviewers are more likely to hire another female. In contrast, male interviewers were found to be equally as likely to hire men as women. To resolve these two conflicting findings a behavioural experiment was set up looking at gender, attractiveness and recruitment selection. Forty participants, twenty male and twenty female, of varying ages (18-65) were recruited through age stratified sampling. Participants took on the role of manager of a medium sized company and were shown twenty photographs of faces previously rated for attractiveness. On initial viewing participants were asked to decide whether they would firstly hire the person and secondly give as many reasons for their decision. Findings from this research show that in all age groups male and female participants gave females (especially attractive females) more jobs, except in the case of the 18-21 year old females who gave attractive males more jobs. On examining the reasons behind the participant’s decisions, it was evident that if you appeared confident, friendly, youthful and attractive you were 46% more likely to receive the job. However, if you were perceived to be untrustworthy, lazy, arrogant and unintelligent you were 49% more likely not to receive the job. These findings shed light on the various processes that may underpin human resource decisions in an organisational setting.

Selection & development of short-term project team members:developmental stability as an indicator of interpersonal skills

Short-term project teams do not have the advantage of prior performance or long-term membership to facilitate development of effective team performance. Research suggests interpersonal skills are crucial to success but this is under researched longitudinally. Evolutionary psychology can provide a lens to explain how people develop differing levels of interpersonal skills via the relationship between fluctuating asymmetry and pro-social behaviours. This research aims to investigate the relationship between fluctuating asymmetry and interpersonal skills, the impact of training and to further the evolutionary psychology field by embedding research in a real-world context as opposed to solely in laboratory or student settings.

Evaluating the impact of a web-based resource on student learning

This paper reports on an experiment of using a publisher provided web-based resource to make available a series of optional practice quizzes and other supplementary material to all students taking a first year introductory microeconomics module. The empirical analysis evaluates the impact these supplementary resources had on student learning. First, we investigate which students decided to make use of the resources. Then, we analyse the impact this decision has on their subsequent performance in the examination at the end of the module. The results show that, even after taking into account the possibility of self-selection bias, using the web-based resource had a significant positive effect on student learning.

Medical students' personal experience of high-stakes failure:case studies using interpretative phenomenological analysis

Abstract (provisional): Background Failing a high-stakes assessment at medical school is a major event for those who go through the experience. Students who fail at medical school may be more likely to struggle in professional practice, therefore helping individuals overcome problems and respond appropriately is important. There is little understanding about what factors influence how individuals experience failure or make sense of the failing experience in remediation. The aim of this study was to investigate the complexity surrounding the failure experience from the student’s perspective using interpretative phenomenological analysis (IPA). Methods The accounts of 3 medical students who had failed final re-sit exams, were subjected to in-depth analysis using IPA methodology. IPA was used to analyse each transcript case-by-case allowing the researcher to make sense of the participant’s subjective world. The analysis process allowed the complexity surrounding the failure to be highlighted, alongside a narrative describing how students made sense of the experience. Results The circumstances surrounding students as they approached assessment and experienced failure at finals were a complex interaction between academic problems, personal problems (specifically finance and relationships), strained relationships with friends, family or faculty, and various mental health problems. Each student experienced multi-dimensional issues, each with their own individual combination of problems, but experienced remediation as a one-dimensional intervention with focus only on improving performance in written exams. What these students needed to be included was help with clinical skills, plus social and emotional support. Fear of termination of the their course was a barrier to open communication with staff. Conclusions These students’ experience of failure was complex. The experience of remediation is influenced by the way in which students make sense of failing. Generic remediation programmes may fail to meet the needs of students for whom personal, social and mental health issues are a part of the picture.