Learning From Mistakes: Honesty, Ownership, Professionalism, and Adaptation in Oncology Pharmacy Training

Introduction

Steve Jobs has reflected that some of the greatest growth comes from the “scar tissue” created through difficult experiences, incorrect decisions, and the responsibility that comes with implementing meaningful work. While this idea is often discussed in leadership and business circles, the emotional weight can feel even heavier in patient care where mistakes carry the possibility of directly affecting another person’s health and well-being. Oncology pharmacists are often at the center of patient care plans, working to ensure oncolytic treatment plans are seamlessly implemented. They provide education, monitor for adherence, and assess tolerability.¹ The therapies used in hematology and oncology are high risk, the patient situations are emotionally complex, and even near misses can feel deeply personal, particularly early in training.

The landmark report To Err Is Human helped shift conversations around medical errors away from individual blame alone and toward the complexity of healthcare systems that contribute to errors.² Residency is an early phase of practice built around structured, supervised clinical experiences. Residency training programs are designed to support growth and the development of clinical judgement which are skills are ultimately further refined through experience, reflection, and adaptation.

During my residency training, I was asked to convert an intensive care unit (ICU) patient's fentanyl patch regimen to an intravenous hydromorphone infusion. After reviewing the patient's opioid requirements, I provided a recommendation to the medical team. Minutes later, while independently rechecking my calculations, I realized I had made a mathematical error resulting in an incorrect dosing recommendation. I still remember the immediate feeling that followed. My first reaction was embarrassment. My second was concern for the patient and the potential consequences of an incorrect recommendation. Immediately, I contacted the resident on service and asked them to meet me on the unit so I could walk them through where my calculation was wrong and what needed to be corrected. We reviewed the recommendation and made the necessary changes before the orders were written.

While I recall very little about the details regarding the specific calculations, the experience left a lasting impression. What I remember most is the emotional response in realizing I was wrong and the professional responsibility that followed. In my time in practice since, I have come to realize the clinical details of mistakes are going vary in each scenario, but the lessons they teach about accountability, reflection, and professionalism are remarkably consistent. Learning how to respond to these moments with honesty, ownership, professionalism, and the ability to adapt to practice is an essential part of developing into a thoughtful and dependable oncology pharmacist.

Honesty Through Accountability

My own experience has taught me that the hardest part was not identifying the error but immediately contacting the team to tell them I made a miscalculation. Accountability in that moment was more than recognizing the mistake; it was owning it and ensuring the correct recommendation was implemented. Appropriate follow up requires clear communication with all involved team members, even if it means publicizing one’s own errors. This approach completes the full process of accepting responsibility for one’s role in a mistake but subsequently allows for correction before potential patient harm.

While reporting errors can be uncomfortable, the ability and opportunity to respond professionally to mistakes and feedback can build greater trust. In my scenario, the team was kind, responsive, and happy to review in detail why the recommendation was wrong and what a correct dose for the patient should be. The focus of the conversation shifted from the mistake itself to more of an understanding of why it occurred and how it can be prevented in the future. Instead of damaging my relationships with the team members, this ultimately built an even deeper trust with the multidisciplinary team. Residents may fear that a mistake may negatively impact how they are viewed by their preceptors and colleagues, but trust in our space is built by consistency and a willingness to grow and accept feedback. Despite oncology pharmacists being a cohort of high performers, many tend to internalize mistakes deeply, as patient relationships and clinical decisions often carry substantial emotional weight. The concept of the “second victim” highlights that clinicians themselves may experience guilt, shame, anxiety, or loss of confidence following errors or near misses.³

Ownership Through Reflection

An interesting aspect of my example is that I did not spend weeks ruminating on the mistake.  This was partly due to the fact that the situation was addressed promptly, and no patient harm occurred. Despite that, years later I still reflect on the case, not so much as a traumatic memory but more so as a learning experience I can share with learners.

Development in residency is not only limited to clinical knowledge and growth, but also trains pharmacists to critically self-evaluate and identify opportunities for improvement. Some of the most productive learning is done in unfamiliar and challenging situations, where outcomes are not guaranteed and mistakes or near misses may occur. With this in mind, it should be expected that not every clinical decision or intervention will be executed perfectly.

The real value of making errors lies not in the mistakes themselves, but from the opportunity to learn from them. Productive self-reflection allows residents to identify what happened, isolate the contributing factors, and then develop opportunities for improvement. This reflection helps avoid rumination, which is described by the American Psychiatric Association as “repetitive dwelling on negative feelings and distress and their causes and consequences.”⁴ It is essential to develop a structured approach to dealing with these situations, but it also must be understood that this rarely occurs independently. In my example, the debrief with the ICU residents and fellows allowed us to review the complexity of the conversion, correct the miscalculation, and refocus on providing optimal patient care. The conversation served as the catalyst to transform the event from a mistake to a learning opportunity. Similar dialogues with trusted colleagues, mentors, and preceptors will provide perspective and transform mistakes into meaningful opportunities for growth.

Professionalism After a Mistake

Professionalism is often most visible during difficult situations and is measured by response, not perfection. Once a mistake has been identified and communicated, the focus shifts from the error itself to how the individual responds. In my opioid conversion example, feelings of embarrassment were unavoidable, however, I still needed to function as the pharmacist as patient care responsibilities did not stop. The recommendation needed correction, the patient required appropriate care, and this had to be conveyed in a manner that was effective and professional. This often requires setting aside personal discomfort and priorities long enough to focus on the needs of the patient and the healthcare team. Accepting feedback with humility and remaining patient-focused in your approach emits professionalism and is generally well received. Difficult conversations are inevitable in practice, and they need to be approached as opportunities for growth rather than punishment.

Adaptation Through Practice Change

Conversations about change are meaningless if they are not accompanied by future implementation of lessons learned. The goal is to create real, purposeful changes to improve future performance. While honesty, ownership, and professionalism are valuable skills, their greatest impact occurs when they combine to positively adapt clinical practice or improve the patient care system. In oncology pharmacy, mistakes and near misses often highlight vulnerabilities in workflows, communication, or individual practice behaviors that may otherwise go unnoticed. These situations should be reported through established institutional processes so that lessons learned can contribute to broader patient safety initiatives. Contrary to the systematic benefits of reporting, meaningful change also occurs at the individual level. These experiences often improve situational awareness, strengthen communication skills, and encourage clinicians to think more critically about the many interconnected processes that influence patient care. Over time, these lessons learned become incorporated into everyday practice, helping pharmacists develop stronger clinical skills.

Conclusion

Mistakes are inevitable when practicing in dynamic, complex patient care systems. Nobody enters this career path intending to intentionally make mistakes, yet these experiences often become the most impactful opportunities for learning throughout a career. Much like the “scar tissue” described by Steve Jobs, the experiences that challenge us often leave a lasting impression.

Looking back, I really remember very little about my opioid conversion miscalculation itself, but I do remember the lessons the experience taught me about how being honest, taking ownership, acting professionally, and continuously adapting can transform a difficult moment into an opportunity for improved patient care.