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.


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

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.
See All Posts By The Author