I Made a Mistake: Error, Disclosure, and the Second Victim — IM Bootcamp

Why this session

This is the heaviest session in the bootcamp, and it runs on facilitator honesty: the faculty leader opens with their own error story — real, specific, with the emotional truth left in — before any intern is asked to speak. That is the price of admission for the room’s candor, and it is also the curriculum: the story the facilitator tells in minute three is the story every intern in the room will someday tell their own interns.

Co-facilitate if the roster allows — one runs the case while one watches the room, because someone present may have already lived a version of it. Have the wellness and support resources physically in your pocket, and know your follow-up path before the session starts.

What interns leave able to do

Execute the first-hour sequence after recognizing an error: patient → senior → attending → disclosure → report.
Participate in a disclosure conversation — what happened, what we’re doing, a genuine apology, what changes — without speculation or blame.
File an event report, and explain why near-misses matter as much as harms.
Recognize the second-victim trajectory¹ and apply its antidotes.
Hold accountability and systems thinking at the same time, because they are not opposites.

The case

Part 1 — 6:12 a.m.

A 72-year-old man, day 4 of a pneumonia admission, improving. Last evening you wrote his orders: nothing by mouth after midnight for a bronchoscopy. You continued his home long-acting insulin at full dose — “basal is never held,” a rule you half-remembered — and added the standing sliding scale. Nobody caught it. The bronchoscopy was delayed to the afternoon; he has now been NPO for eighteen hours.

6:12 a.m.: the nurse calls. Morning glucose is 42. He is sweaty, shaky, answering slowly. She has tried juice; he could not swallow it safely. She is asking for IV dextrose.

You are staring at your own order on the screen, and your stomach is on the floor.

What do you do in the next sixty minutes — in order, including what you say, and to whom?

Part 2 — The conversation

Dextrose given; glucose 94; he is back to baseline, joking weakly about the juice. The procedure is cancelled. The insulin regimen is rewritten with your senior. No lasting harm — this time.

Your attending arrives, hears the whole story, and says: “Good catch by the nurse, right call on the dextrose. Now we need to tell him and his wife what happened. I’ll lead it — but you’re coming in with me, and I’d like you to say part of it.”

What gets said in that room — and what does not get said?

Part 3 — 2 a.m., the stairwell

That night you cannot sleep. You keep running the math: if he had been more frail, if the nurse had checked an hour later, if the glucose had been 28. You replay the order screen. You think about who you almost were today. A co-intern texts “you good?” and you type “yeah just tired” — because what else is there to say?

What is actually happening to you — and what are the moves, tonight, this week, this year?

Running the room

Minutes	Block
0–8	Frame + the facilitator’s own error story, told first
8–30	Part 1 — the first-hour sequence
30–50	Part 2 — disclosure mechanics, with an optional role-play round
50–68	Part 3 — the second victim, the reporting system, the long arc
68–75	Debrief + pocket card

Part 1 — the first-hour sequence

Patient first. Dextrose, glucose rechecks, cancel the NPO and the procedure, hold the insulin, stay with the clinical problem until he is stable. Nothing else exists until he is safe.
Tell your senior immediately — not at sign-out, not “when I have the full picture.” The script: “I made an error. I kept full-dose basal insulin on an NPO patient; his glucose hit 42; we’ve treated it and he’s back to baseline. I need your help with what happens next.” Plain ownership, patient status, a request for help. In any decent program the answer is “okay — is he safe? Good. Here’s what we do.” If the answer is fury, that is the program’s failure, not yours — and the chiefs want to know about it.
The attending next, the same day, before anyone else tells them. An attending must never learn about an error from the chart, the nurse, or the family.
Disclose — Part 2.
Report — the event-reporting system, that day; Part 3 explains why.
Document clinically, not confessionally. The facts of care — the glucose, the treatment, the response, the monitoring plan — go in the note. The sentence “I made an error” belongs in the disclosure conversation and the event report, not the medical record. And never, in any direction, alter or sanitize earlier documentation: the cover-up is the career-ender; the error is not.

The pull to name out loud

“No harm done — why blow it up?” Two answers. He was harmed: a dangerous hypoglycemia, a cancelled procedure, a frightening morning — “no lasting harm” is luck, not absolution. And the system that produced this — a half-remembered rule, no safeguard linking NPO status to insulin dosing, an intern alone with an endocrine decision at 6 p.m. — is still loaded for the next patient. Reporting is how it gets unloaded.

Part 2 — the disclosure

What happened, in plain language: “While you weren’t able to eat, your insulin dose wasn’t adjusted the way it should have been, and your blood sugar dropped dangerously low this morning.”
What we did and what changes: the treatment, the monitoring, why the procedure moved, the rewritten regimen, the safeguard now in place.
A genuine apology: “This shouldn’t have happened, and I’m sorry.” An apology is not a legal confession — many states protect expressions of sympathy, and your institution’s disclosure policy and risk-management team exist to support exactly this conversation. What patients consistently want is acknowledgment. An apology is owed; give it.
The intern’s part: the attending may ask you to say your piece — “I wrote the insulin order, and I’m sorry. I’m glad you’re okay, and we’ve changed how we’re managing it.” Presence matters in both directions: hiding the intern teaches the family that someone is being hidden, and teaches the intern that errors are unfaceable. Neither is true.
What does not get said: speculation beyond the facts, blame of named individuals, legal predictions — or the cowardly middle path, the vague non-disclosure (“her sugar dipped a little, all good now”) that leaves the family to discover the story in a portal note at midnight. Families forgive errors. They do not forgive cover-ups.
Afterward: document that the conversation occurred — who, when, what was discussed — in factual language; tell the nursing team; loop in risk management per your institution’s policy.

Optional role-play: the facilitator plays the wife — “How could this happen? Isn’t someone checking your work?” — and an intern practices the honest answer that neither grovels nor deflects: “There are checks, and they didn’t catch it — including me. What I can tell you is exactly what happened and exactly what’s changed.”

Part 3 — the second victim

Name what is happening in the stairwell: the second victim experience — the clinician involved in an error who is themselves wounded.¹ (Some safety bodies now prefer “clinician involved in an adverse event,” because the patient and family are always the first victims; the phenomenon, under either name, is real.) Shame, replay loops, the sudden conviction that everyone will discover you are a fraud. It is normal, it is predictable, and it has antidotes:

Tell someone tonight. The “yeah just tired” text is the fork in the road. The real reply: “No — I made an error today and I’m spinning. Can you walk?” Every senior in the program has the story that matches yours. You will not shock them; you will join them.
Systems thinking without self-absolution. The honest analysis has both halves: I wrote the order — and the system had no forcing function, no double-check, no protocol. The event report drives the second half; that is what root-cause analysis actually is — not a blame tribunal, but a “how does this never happen again” exercise. Report the near-misses too: they are free lessons, and a rising near-miss report rate is the signature of a healthy safety culture, not a clumsy cohort. If you are invited to the review, go — it is some of the best systems education in the building.
Structured self-forgiveness. You are allowed to feel terrible and to hold the truth that you are a careful doctor who made an error inside a system where errors are possible. Both, at once. The residents who struggle most are not the ones who feel the error — they are the ones who carry it alone for months, and the rare ones who feel nothing at all.
The long arc: this case, metabolized well, becomes the story you tell your own interns — which is literally what your facilitator did in minute three. That is the entire pipeline of safety culture, demonstrated live.

Common pitfalls to surface

The quiet fix: treating, saying nothing, and letting the night nurse’s note tell the story.
Waiting to tell the senior until you “understand what happened.”
Confessional documentation in the record — or its twin, chart-sanitizing.
The vague non-disclosure that breeds midnight portal surprises.
White-knuckling the shame alone; it compounds.

Key teaching points

The sequence: patient → senior → attending → disclose → report. Same day, every time.
Disclosure = what happened + what we’re doing + a genuine apology + what changes. No speculation, no blame, no vanishing.
Report the near-misses too. The system stays loaded until someone does.
The cover-up is worse than the error — always, in every direction.
The second victim is real: tell someone tonight. Shame shared is shame halved; shame soloed compounds.
Accountability and systems thinking are not opposites. Hold both.

Pocket card

Carry this

Patient first. Then senior. Then attending. Same day.
Disclose: what happened · what we’re doing · “I’m sorry” · what changes.
Report it — and the near-misses. The system stays loaded until you do.
Facts in the chart; ownership in the room; analysis in the report.
The cover-up is the career-ender. The error is not.
Tonight: tell somebody. “I’m spinning — can you walk?”

Variations

The near-miss version: pharmacy catches the order before administration — same structure, lower emotional cost, and worth teaching that the sequence still applies. Useful for a group that is visibly maxed out.
The sound-alike error: swap the mechanism — a medication ordered for the wrong patient, or a sound-alike drug mix-up caught late. Different failure, identical sequence.
The co-intern’s error: for an advanced group — you discover the mistake, and it isn’t yours. Now the peer conversation and “we tell the team together” — a bridge to the struggling-colleague session.

Notes

The case is a fictional composite; no patient or clinician in it is real. The second-victim concept is Albert Wu’s.¹ The evidence for why error response belongs in an intern bootcamp is in the bootcamp introduction.

Sources

Wu, A. W. (2000). Medical error: The second victim. The doctor who makes the mistake needs help too. BMJ, 320(7237), 726–727. https://pubmed.ncbi.nlm.nih.gov/10720336/ ↩₁ ↩₂ ↩₃

This page is a teaching scenario for facilitated small-group education. Every patient in it is fictional. It is not clinical or legal guidance; disclosure practices, apology-law protections, and event-reporting systems vary by institution and state — localize before teaching, and involve your risk-management and quality teams per your policies. Last reviewed July 2026.

I made a mistake:
error, disclosure, and the second victim