A New Look at Medical Errors in Residency Training




It’s a phenomenon that medical educators have long suspected but haven’t been able to prove: a rise in medical errors when newly-hatched physicians begin their residency training programs in July. This suspected occurrence has been studied several times, but until recently, no conclusive evidence existed that it actually was true. For the first time, a study based in Australia has been able to demonstrate that this really does happen, but perhaps not for the reasons you’d suspect.

The study, published in the British Medical Journal (BMJ), looked at close to twenty thousand patients who received anesthesia-related procedures while under the care of trainees starting work for the first time at a specific Australian hospital over a five year period.

What they found was a noticeable spike in medical errors in July, but not just for the rookies. Even seasoned anesthesia residents made significantly more errors in July, at a rate similar to the newbies.

The reason for the errors, the authors postulate, may not just be related to lack of technical expertise. Given that the error rate was similar across all levels of training, it may have had more to do with the unfamiliarity of the environment and the pitfalls associated with it. The facility may have used materials that were different than the ones trainees had used in the past, policies related to a given procedure may have been different, even the staff would have been different, which may have affected how comfortable a trainee would feel asking for help.

So while lack of technical expertise may contribute to medical errors in residents, there are clearly other factors at play. Perhaps the next focus of our efforts to reduce medical errors among physician trainees should be to better familiarize our residents with their environment, materials, and staff well before their work is to commence.

Reference

Haller, G., Myles, P., Taffe, P., Perneger, T., & Wu, C. (2009). Rate of undesirable events at beginning of academic year: retrospective cohort study BMJ, 339 (oct13 1) DOI: 10.1136/bmj.b3974

  • I find that new residents make diagnostic errors because they have been taught to respond quickly with the “right answer” and haven’t been taught to do a proper differential. Illness scripts can force them to develop differential skills.

    We’ve also started teaching students about cognitive errors in order to give them a vocabulary to describe this type of mistake.

  • This is very interesting. I would also postulate that trained medical professionals also make more errors during this time because they are more conscious of what they are doing since they are trying to teach students. To draw an analogy: have you ever tried paying attention to the way you walk? Of course walking is second nature to us, but when we focus our awareness on the actual mechanics of it then it feels “weird,” “off,” and “unnatural.” The same could be true for doctors. Just a psychology majors two cents…

  • GR

    This is very informative. Your blog is full of innovative and informative posts.. Keep us the good blogging..

  • Angry Father

    I’ll keep this brief as possible:
    In 1993 – 16 years ago when my daughter was in Hospital (she was about two years old at the time)- waiting to be flown to Starship hospital Auckland for surgery following “mistakes- accidents” caused by Doctors in ChristChurch
    At that stage while we were in hospital, we the parents were doing ALL here cares for her gastronomy tube – (trust was gone)

    we had an appointment at ChCh Womens hospital (partner was pregnant), we mistakenly thought it’ld be safe to leave our in the hospital ward – while we went to the appointment
    – lucky for my child the appointment finished early

    when we came back to ChCh public Hospital (a few days before my two year old child had been put in a room by herself, -not the the big ward rooms with other patients or witness)
    as we entered her room there was a ‘bureau nurse’ a nurse i’ld never seen before (not one of the regular nurses from the ward) she had a kettle of hot boiled water in one hand in her other hand was my childs open gastronomy tube(plastic tube that leads straight into the stomach) just about to pour it down

    I immediately asked her ‘what the fuck are you doing?’
    she replied she was just going to clean her gastronomy tube,
    i said are you a idiot thats boiling hot water
    she left the room, walked down the corridor – and never returned – she did not stay on the ward to complete a shift

    my first thoughts were how could she be so stupid – after she left – never to return it occurred to me what had actually happened, what we had just witnessed
    the boiling water would of in all likelihood of have killed her, the implications were huge, we the parents would have got the blame, (framed, imprisoned for a crime we never committed) as we were doing ALL her gastronomy cares, and to rub salt in the wound my unborn son would have been taken from us as well –
    what we wittnessed was not in the catorgory of a medical mishap but that THE STATE WILL MURDER INNOCENT CHILDREN TO COVER MEDICAL MISHAPS
    since that very day, we have come up against brick walls and EXTREME discrimination from Government Depts eg: 9 months to get a disability allowance processed, review after review after review(this is ALL on Govt record – they keep documents, I have copies as well, this is just the tip of the ice berg) we seem to be the only New Zealander’s in this entire country of 4 million people who cannot receive entitlements that by law – ALL other citizens take for granted and can access with ease

    i’ve had to live with this discrimination and the fear of myself and families well being for the last 16 years, dead people don’t talk, for a long time i’ve kept quiet out of fear for myself and family, but the discrimination still happens, today, which indicates they’re not prepared to forget or leave us alone either, i believe having told others and keeping files of my child Hospital records of their mistakes with others is the reason i and my family are still here
    my only crime i can see for deserving this Govt discrimination was walking in and preventing my child from being killed – and yes i’ld do again in bat of an eyelid
    People Need To Know
    we’re lucky my is childs alive -but what has been the fate of others?????????

T. A. McNamee, MD

T. A. McNamee, MD, is an associate professor and internal medicine residency program director at Sanford School of Medicine of the University of South Dakota.
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