“Overcoming these biases is akin to suppressing a reflex. It requires self-awareness, practice, and most importantly, education and training,” Vapiwala said.

Looking at other fields that have high-stake consequences when an error occurs, such as the airline industry, the authors offer several strategies to overcome these patterns of thought, utilizing elements of social psychology to transform the current culture of error disclosure. Recommendations include incorporating standardized patients (SPs), actors who simulate patients, not only to “practice” difficult patient encounters, but also to help model interactions with family members, peers, and administrators in order to teach various behavior and coping mechanisms. SPs have been proven to effectively mimic the psychosocial elements of error disclosure, including profound guilt, feelings of ineptitude, and fear of repercussions.


Virtual reality (VR) is another tool that can offer immersive and realistic technology to supplement traditional curricula, while also offering tremendous scalability at a lower cost than SPs. The authors cite an example of a recent VR exercise which allowed viewers to experience the perspective of a 12-year Syrian refugee to incite more compassion and understanding. While VR medical content doesn’t currently exist, it is on the horizon for many medical trainees and professions.

However, both SP and VR do have limitations, as the users ultimately know that the scenario is simulated.

“Standardized patients and other simulated scenarios provide an excellent foundation, but until you are put into a real-world situation and forced to confront your mistake and its potential consequences, you can’t truly understand the psychosocial challenges,” Han said.

Finally, the authors recommend implementing a professional standard for trainees, including a formal evaluation of the skills needed to disclose and cope with medical errors. This standard would further normalize error disclosure and make it a common practice among physicians and trainees.

The authors conclude that the primary change will need to be cultural, not just among trainees, but at every level of medical practice, in order to successfully pivot away from the current stigma related to error disclosure.

“Administrators must make a shift from asking ‘who is at fault’ to asking ‘why’ and ‘how’ did a situation occur, creating a culture that embraces error disclosure and seeks to solve the many systematic factors that lead to an error in the first place. This approach will not only normalize error disclosures but also help us better understand why they happen so we can prevent more of them in the future,” Vapiwala said.

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