Study: New Doctors Make Large Number of Medical Mistakes

The Archives of Internal Medicine has just published a new study funded by the Department of Health and Human Services' Agency for Healthcare Research and Quality (AHRQ). The report, "Medical Errors Involving Trainees: A Study of Closed Malpractice Claims from 5 Insurers" shows many instances of medical malpractice can be traced back to a lack of teamwork between new doctors that are training and those attending physicians that are supervising treatment.

In an AHRQ press release, Director Carolyn M. Clancy, M.D. said, "This study reminds us that we have a lot to do to ensure that hospitals are providing appropriate supervision to trainees and implementing team-training programs, both in the inpatient and outpatient setting."

The study looked at nearly 900 cases of malpractice from between 2002 and 2004. The 889 cases were chosen based on two factors: Errors involving medical trainees and errors that resulted in injury. This particular study also chose only four categories of malpractice claims to include in the study. The categories were those that involved obstetrics, surgery, medications, and delayed or incorrect diagnoses. These four categories accounted for 80 percent of all medical malpractice claims in the US during the years studied.

Of the cases examined, 27 percent involved trainees in which their involvement was considered "at least moderately important." Medical residents were to blame in 87 percent of those, with interns and fellows making up the rest. The majority of the injuries that resulted from the errors were serious, and one-third resulted in death. A third of the significant injuries took place in outpatient facilties.

The researchers from the medical schools at Harvard, the University of Texas, and Baylor as well as from the Michael E. Debakey Veterans Affairs Medical Center also studied the causes of the errors. 72 percent were due to "errors in judgement", and more than half of all cases involved the trainee lacking adequate technical knowledge. "Failure of vigilance or memory" was also a factor in more than half of all cases.

When it comes to the trainees having adequate supervision and oversight from experienced doctors on staff, 106 cases showed evidence that attending doctors failed to oversee the work of residents and interns. That is 82 percent of the 129 malpractice claims that involved a lack of supervision leading to injury.

The study also found that communication errors between trainees and attending physicians contributed to the errors. A similar number of communication breakdowns happened between trainee and trainee. When these cases were further examined, a fifth of the cases showed that more than two parties were involved, and another fifth involved support staff, such as nurses and laboratory technicians.

The study also points out that many graduate medical programs are not addressing teamwork or communication training. The study's lead author, Hardeep Singh, added this to the AHRQ release, " Our study confirms the relationship of poor teamwork to preventable errors and quality of care." He hopes the study will help residency programs address the lack of training in these areas.

Source: US Department of Health and Human Services' Agency for Healthcare Research and Quality