Health & Healthcare
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
4 Comments/Trackbacks
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?????????
Leave a Reply
Tuesday, February 9, 2010
- Religion - A "Natural" Phenomenon?
- Creating an Artificial Brain
- How Culture Shapes Our Mind and Brain
- Sex, Violence and The Male Warrior Hypothesis
- The Secret to Good Health – Listen to the Data
- If Herbal Medicine is Medicine, Shouldn't it be Treated as Such?
- Too Much Information?
- Swine Flu - A Lose-Lose Situation for Public Health Authorities
- Logging On for Psychotherapy
- The Neural Basis of the Self
- Income Inequality and Health Outcomes
- Ginkgo Biloba Ineffective... Again
- The Evolution of Depression
- Post-Partum Psychosis - Rare but Real
- Worried Well on the Web
- Is Your Doctor Happy or Burnt-Out?
- Journal Retracts Autism Research
- How Young is Too Young to Diagnose Depression?
- In Sickness and Mental Health
- Health Insurance for All - A Weighty Issue
- “I Feel Your Pain” – The Neural Basis of Empathy
- Speaking in Tongues – A Neural Snapshot
- Neuro Case 1 – Using Transcranial Doppler for Basilar Artery Occlusion
- Journal Retracts Autism Research
- Crossing the Line from Physician to Journalist
- Ginkgo Biloba Ineffective… Again
- The Smart Ones are Living Longer
- Too Much Information?
- Drugs and Pharmacology, Nineteenth Edition
- Coping with Trauma – Lessons from Resilient Individuals
- Worried Well on the Web
- Neurology, Neurosurgery, and Neuroscience Conferences for 2010
- One Puff Forward, Two Pounds Back
- Income Inequality and Health Outcomes
- Farewell 2009, Welcome 2010
- When the Drugs Don’t Work, or Just Make it Worse
- Is a Slim Santa Claus Coming to Town?
- Stimulants May Offer Protection in ADHD
- Sex, Violence and The Male Warrior Hypothesis
- Is Time on Your Side?
- We all get depressed every now and then. It's part of life. Sometimes you feel g...
- it will take many test to prove whether gingko biloba is effective..but for now ...
- i do not know which Australlia you are talking abiuy. My impression about this c...
- The Institute of Natural Excellence has a new way to look at this and many other...
- My guessI expect that in their childhood...free flowing care free ...
- its the mind game when it comes to good healthy survival. better iq means better...
- the ability of brain to store information, regarding different languages while c...
- 12 children were taken as subjects for a very controversial research , the resu...
- Below is how and why the Swine flu was Genetically Engineered. For full version...
- Having worked with developmentally disabled persons for 17 years, I see many par...
- Great job. I've posted a link to here from the ...
- Yeah... I don't buy it. Know why? Because rotund Santa was around for many gener...
- For those unfamiliar with Dr. John Cannell's Vitamin D Theory of Autism see the...
- It is a pity that very little coverage of this issue names the journalist who is...
- I would like to see some research into what Ginkgo biloba does do instead of wha...
- It is easier for us to ignore the problem than really attack the problem, due to...
- I was going by Alan MacFarlane's description of Hunter Gatherer societies.( les...
- Javaid, where on earth do you get the idea that hunter-gatherers have little or ...
- This is my angle ..Hunter Gatherers have the lightest density footprint and ...
- yes , i really like it. isuggest everyone to be fit and healthy....
Sponsored Links
Diet and Health Supplements, Best vitamins supplements, Brain Fitness DVD, Home Care, Alcohol Rehab, Emergency Lighting, Online Criminal Justice Degrees, Tattoo, Health Insurance, Electronic Accessories , Finance Information , Retractable Banner Stands , Kids Furniture , Biotherapeutic Product Information , Breast Cancer Stages , Buy Deplin Online , Cystic Fibrosis Disease , Pancreas Cancer , Dallas health insurance agency , Hydrocephalus Treatment , Short Term Disability Insurance , Lung Cancer Treatment , immigration attorneys Frisco , Who Gets Lyme Disease? , Edgepark Medical , Hydroxycut, Astrology compatibility.
Neuroscience & Neurology
February 09, 2010 | 1 Comment | By Meghan Meyer, PhD student
“I Feel Your Pain” – The Neural Basis of Empathy
More In Neuroscience & Neurology
- Speaking in Tongues – A Neural Snapshot
- Neuro Case 1 – Using Transcranial Doppler for Basilar Artery Occlusion
- Neurology, Neurosurgery, and Neuroscience Conferences for 2010
- Are Physicians Spending Too Much Time Diagnosing Patients?
- Two Wrongs Make a Right – Abnormal Brain Circuitry May Stop Abnormal Movement
Neuroscience & Neurology
Opinion
February 01, 2010 | 0 Comments | By Jennifer Gibson, PharmD
Crossing the Line from Physician to Journalist
More In Opinion
- Sex, Violence and The Male Warrior Hypothesis
- Bruxism and the Brain
- Religion – A “Natural” Phenomenon?
- Natural Good, Chemical Bad – Right?
- Time for a Change – Gender Reassignment
Opinion
Psychiatry & Psychology
February 03, 2010 | 5 Comments | By Jennifer Gibson, PharmD
Journal Retracts Autism Research
More In Psychiatry & Psychology
- White Bears – The Paradox of Mental Suppression
- Sugar and Spice and Everything Nice?
- The Evolution of Depression
- Why So Serious About The Self?
- New Report on the Use of Antidepressants During Pregnancy


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.